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Short interbirth interval (IBI) has serious adverse health consequences, yet has an estimated prevalence of 35% in the United States. Similarly, intimate partner violence (IPV) around time of pregnancy, experienced by approximately 5% of women, is associated with increased risk of poor pregnancy outcomes. IPV might compromise women's decision-making, contributing to unintended pregnancy and short IBI. This study examines the relationship between pre-pregnancy IPV and short IBI, and whether insurance status moderates this relationship among multiparous women who responded to the 2009–2011 Pregnancy Risk Assessment Monitoring System survey (N = 13,675). Pre-pregnancy IPV (yes; no), insurance status (Private insurance; Medicaid/public insurance; no insurance), and short IBI (yes; no) were examined. Insurance status was identified as an effect modifier (p =.03), and maternal age, maternal and paternal education, marital status, and drinking alcohol were identified as potential confounders. Multiple logistic regression analysis stratified by insurance status provided adjusted odds ratios (aOR) with corresponding 95% confidence intervals (CI). Overall, 4.6% of women reported IPV before pregnancy, and 48% had a short IBI. When stratified by insurance status, the odds of short IBI was about 3 times higher among women with no insurance and women on Medicaid/public insurance who reported IPV compared to women who did not report IPV (aOR = 3.36, 95% CI = [1.02, 8.02], and aOR = 2.50, 95% CI = [1.04, 5.92], respectively). There was no observed significant difference in the likelihood of short IBI by experience of IPV among privately insured women. Findings from this study strengthen the evidence that women who experience IPV before pregnancy are significantly more likely to have short IBI compared to women who do not experience pre-pregnancy IPV. Furthermore, the odds of short IBI is highest among women experiencing pre-pregnancy IPV who are uninsured or on Medicaid/public insurance. [ABSTRACT FROM AUTHOR]

More than half of all pregnancies in the U.S. are unintended which may lead to poor health outcomes. Racial and ethnic differences underlying the association between IPV and unintended pregnancy are inconsistent. This study examines the association between IPV and unintended pregnancy across racial/ethnic and marital strata among U.S. women. Data from the national 2009/11 Pregnancy Risk Assessment Monitoring System consisting of women who recently delivered a live birth baby were analyzed (n=108,220). A dichotomous variable was created to indicate whether women experienced IPV in the 12 months leading to their most recent pregnancy (yes; no). The outcome, pregnancy intention, was dichotomized as intended or unintended. Subpopulation analysis was conducted stratified by race/ethnicity and marital status. Adjusted odds ratios and 95% confidence intervals were generated using multiple logistic regression models. The odds of unintended pregnancy were increased for married non-Hispanic White women who reported IPV compared to their non-abused counterparts even after controlling for sociodemographic factors, health care access, and reproductive history. Among unmarried non-Hispanic other women, abused women were significantly less likely to report unintended pregnancy than the non-abused. No significant differences were observed for Hispanic or non-Hispanic Black women. There are significant racial and ethnic differences in the association between IPV and unintended pregnancy. Additionally, the association differed by marital status. Public health professionals and health care providers should be aware of these differences. [ABSTRACT FROM AUTHOR]

Immigrant women face unique barriers to prenatal care access and patient-provider communication. Yet, few prior studies have examined U.S.-born/immigrant differences in the content of care. The purpose of this study was to investigate the roles of immigrant status, English proficiency and race/ethnicity on the receipt of self-reported prenatal counseling using nationally representative data. We used data from the Early Childhood Longitudinal Study-Birth Cohort (N ≈ 8100). We investigated differences in self-reported prenatal counseling by immigrant status, English proficiency, and race/ethnicity using logistic regression. Counseling topics included diet, smoking, drinking, medication use, breastfeeding, baby development and early labor. In additional analyses, we separately examined these relationships among Hispanic, Mexican and Non-Hispanic (NH) Asian women. Neither immigrant status nor self-reported English proficiency was associated with prenatal counseling. However, we found that being interviewed in a language other than English language by ECLS-B surveyors was positively associated with counseling on smoking (OR, 2.599; 95% CI, 1.229-5.495) and fetal development (OR, 2.408; 95% CI, 1.052-5.507) among Asian women. Race/ethnicity was positively associated with counseling, particularly among NH black and Hispanic women. There is little evidence of systematic overall differences in self-reported prenatal counseling between U.S.-born and immigrant mothers. Future research should investigate disparities in pregnancy-related knowledge among racial/ethnic subgroups. [ABSTRACT FROM AUTHOR]

Introduction: Synthetic cannabinoid (SC) use among adolescents in the US is a major public health concern. SCs are considered by many teens to be a safe alternative to cannabis; however, little is known about the association between its use and depressive symptomology (DS). This study aims to examine the association between SC use and DS in US high-school seniors. Methods: Data from the 2011–2014 Monitoring the Future (MTF) survey for high-school seniors was analyzed (N = 9,272). Multinomial logistic regression analysis was used to examine the association between SC use (any use, ≤6 or >6 times in the last 12 months) and DS (low, medium, or high). Results: Approximately 8% of high-school seniors reported SC use in the last 12 months and 24% reported high levels of DS. Multinomial logistic regression analyses showed that in the unadjusted model and the model that controlled for sociodemographic factors, a significant association between SC use and DS was observed. However, upon controlling for other substance use, the association became markedly attenuated and lost its statistical significance. Conclusions: SC use was not associated with DS in high-school seniors. Future longitudinal studies are needed to further examine the relationship. [ABSTRACT FROM PUBLISHER]

CONTEXT Age at sexual debut and age gap between partners at debut are modifiable characteristics that may be related to risky sexual behaviors. Understanding any such relationships is a necessary first step toward strengthening risk interventions. METHODS Age at sexual debut and partner age gap were examined for 3,154 female and 2,713 male respondents to the 2011-2013 National Survey of Family Growth who first had intercourse before age 18. Multivariable logistic regression was used to assess associations between these measures and teenage parenthood and reporting a high lifetime number of partners (i.e., a number above the sample median). RESULTS Females' odds of teenage parenthood were elevated if sexual debut occurred at ages 15-17 and involved a partner age gap of 3-4 years (odds ratio, 1.8) or more (2.0); they were reduced if debut occurred before age 15 and the gap was 3-4 years (0.8). Females' likelihood of reporting a high lifetime number of partners was negatively associated with age gap (0.4-0.7, depending on age at debut and length of age gap). Males' likelihood of reporting a large number of partners was positively associated with age gap if sexual debut was before age 15 and the gap was five or more years (1.7) or if debut was at ages 15-17 and involved a 3-4-year gap (2.0). CONCLUSION Identifying the mechanisms underlying these associations could inform program design and implementation. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Research has shown that early age of sexual debut is associated with physical dating violence ( PDV), but sex-specific associations are sparse. We estimated the prevalence of PDV victimization in high school students who have initiated sexual intercourse and examined sex-specific association between age of sexual debut and PDV victimization. METHODS Data on 8637 students in grades 9 through 12 who had initiated sex was obtained from the 2009-2011 national Youth Risk Behavior Survey. The association was examined using multiple logistic regression, accounting for the complex survey design, and stratified by sex. RESULTS Approximately 15% of sexually active students reported past-year PDV victimization. The odds of PDV victimization among girls who had sexual debut at <12 years was 2.46 (95% CI = 1.50-4.02) and 2.20 (95% CI = 1.42-3.41) for boys, compared to those who initiated sex at 16 years and older. CONCLUSIONS Evidence supports the belief that early sexual debut is associated with higher odds of PDV victimization, particularly for girls. Healthcare providers, school counselors, and educators should be aware of this sex difference in the association between early sexual debut age and PDV victimization while focusing PDV interventions on adolescents with early sexual debut age. [ABSTRACT FROM AUTHOR]

Background: In 2013, 1 in every 10 students who dated or went out with someone in the previous 12 months reported some form of dating violence (DV). Only a few studies have evaluated the relationship between DV and disordered eating (DE). This study aims to evaluate gender differences in the association between DV victimization and DE behaviors using a nationally representative sample of high school students in the United States. Materials and Methods: Data came from the 2013 National Youth Risk Behavior Survey. Students who reported dating or going out with anyone in the previous 12 months and responded to DV and DE questions were included (N = 9,677). DV was categorized as physical DV, sexual DV, physical and sexual DV, and none. The outcome, or DE, was determined by questions about unhealthy weight control behaviors. Multiple logistic regression models provided odds ratios (ORs) and 95% confidence intervals. Race/ethnicity was an effect modifier; thus, stratified analyses assessed for gender and racial/ethnic differences. Results: The prevalence of past-year physical DV, sexual DV, both physical and sexual DV, and any DV was 5.4%, 5.4%, 4.7%, and 15.5%, respectively. OR estimates were more robust in males than in females. Victims of physical and sexual DV were significantly more likely to report DE, namely among Hispanic and non- Hispanic White males and all female race/ethnic groups, with the exception of non-Hispanic Black females. Conclusions: Findings strengthen support for routine DV screening. Adolescent violence prevention programs should consider risky behaviors, such as DE. Interventions should account for gender and racial/ethnic differences. [ABSTRACT FROM AUTHOR]

Background In the United States, breastfeeding rates fail to meet national guidelines. Given the rising prevalence of obesity and births to unmarried women, this study explores if the association between prepregnancy body mass index (BMI) and breastfeeding duration differs by marital status. Methods Data from the 2009–2011 Pregnancy Assessment Monitoring System were analyzed. The sample included women who had live singleton births in the United States and who reported information to calculate BMI and breastfeeding duration ( n = 93,106). Breastfeeding duration was categorized as never breastfed, breastfed for 8 weeks or less, and breastfed for more than 8 weeks. BMI was categorized as underweight (<18.5 kg/m 2 ), normal weight (18.5–24.9 kg/m 2 ), overweight (25.0–29.9 (kg/m 2 ), or obese (30.0 + kg/m 2 ). Marital status was categorized as married or not married. There was a significant interaction between marital status and prepregnancy BMI ( p = .028). Data were stratified by marital status and multinomial logistic regression was conducted adjusting for confounding factors. Results Approximately one-half of women were of normal weight before pregnancy (50.4%); 24.1% were overweight, 21.2% were obese, and 4.3% were underweight. Among married women, the odds of never breastfeeding and breastfeeding for 8 weeks or less was greater among overweight (adjusted odds ratio [AOR], 1.23 [95% confidence interval {CI}, 1.10–1.38]; AOR, 1.36 [95% CI, 1.24–1.49]) and obese women (AOR, 1.72 [95% CI, 1.53–1.93]; AOR, 1.95 [95% CI, 1.77–2.15]) compared with normal weight women who breastfed for more than 8 weeks. In contrast, among unmarried women, no association was observed among overweight women and the association was attenuated among obese women (AOR, 1.38 [95% CI, 1.21–1.58]; AOR, 1.43 [95% CI, 1.27–1.62]). Conclusion Providers and public health practitioners should be aware of the influence of marital status in the association between prepregnancy BMI and breastfeeding duration. The role of obesity and marital status should be considered in designing breastfeeding promotion interventions. [ABSTRACT FROM AUTHOR]

Background:Understanding the interrelationships between risky health behaviors is critical for health promotion efforts. Conceptual frameworks for understanding substance misuse (e.g. stepping-stone models) have not yet widely incorporated other risky behaviors, including those related to sexual health.Objectives:The goals of this study were to assess the relationship between early sexual debut and cannabis use, examine the role of licit substance use in this association, and evaluate differences by gender and race/ethnicity.Methods:Data came from the National Comorbidity Survey-Replication (NCS-R). Primary analysis was restricted to respondents who reported sexual debut at ≥12 years (n= 5,036). Age at sexual debut was categorized as early (<18 years), average (18 years) and late (>18 years). Logistic regression was used to assess the relationship between age at sexual debut and cannabis use. Interaction terms were used to evaluate effect modification by gender and race/ethnicity.Results:Later age of sexual debut was associated with lower odds of cannabis use relative to the average age of debut (AOR = 0.50, 95% CI = 0.37–0.66). For every year that respondents delayed their sexual debut, the relative odds of lifetime cannabis use declined by 17%. After accounting for alcohol and tobacco use the association between early sexual debut and cannabis was attenuated (AOR = 0.90, 95% CI = 0.68–1.20), while later age of debut remained protective (AOR = 0.57, 95% CI = 0.42–0.78). Results were generally consistent across race/ethnicity and gender.Conclusions:Multifactorial intervention strategies targeting both sexual health and substance use may be warranted. [ABSTRACT FROM PUBLISHER]

Our purpose was to estimate the national prevalence of intimate partner violence (IPV) among delivery-related discharges and to investigate its association with adverse feto-maternal birth outcomes and delivery-related cost. A retrospective cross-sectional analysis of delivery-related hospital discharges from 2002 to 2009 was conducted using the Nationwide Inpatient Sample (NIS). We used ICD-9-CM codes to identify IPV, covariates, and outcomes. Multivariable logistic regression modeling was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between IPV and each outcome. Joinpoint regression was used for trend analysis. During the study period, 3,649 delivery-related discharges were diagnosed with IPV (11.2 per 100,000; 95% CI = [10.0, 12.4]). IPV diagnosis during delivery is associated with stillbirth (AOR = 4.12, 95% CI = [2.75, 6.17]), preterm birth (AOR = 1.97, 95% CI = [1.59, 2.44]), fetal death (AOR = 3.34, 95% CI = [1.99, 5.61]), infant with poor intrauterine growth (AOR = 1.55, 95% CI = [1.01, 2.40]), and increased inpatient hospital care cost (US$5,438.2 vs. US$4,080.1) per each discharge, incurring an additional cost of US$4,955,707 during the study period. IPV occurring during pregnancy has a significant health burden to both the mother and infant. Education about IPV; screening at periodic intervals, including during obstetric visits; and ongoing clinical care could help to reduce or eliminate adverse effects of pregnancy-related IPV. Preventing the lifelong consequences associated with IPV can have a positive effect on the overall health of all women and delivery-related health care cost. [ABSTRACT FROM AUTHOR]

Background: Preterm birth is one of the leading causes of infant morbidity and mortality. Although major strides have been made in identifying risk factors for preterm birth, the complexities between social and individual risk factors are not well understood.Objective: This study examines the association between neighborhood youth violence and preterm birth.Study Design: A 10-year live birth registry data set (2004 through 2013) from Richmond, VA, a mid-sized, racially diverse city, was analyzed (N = 27,519). Data were geocoded and merged with census tract and police report data. Gestational age at birth was classified as <32 weeks, 32-36 weeks, and term ≥37 weeks. Using police report data, youth violence rates were calculated for each census tract area and categorized into quartiles. Hierarchical models were examined fitting multilevel logistic regression models incorporating randomly distributed census tract-specific intercepts assuming a binary distribution and a logit link function.Results: Nearly a fifth of all births occurred in areas with the highest quartiles of violence. After adjusting for maternal age, race/ethnicity, education, paternal presence, parity, adequacy of prenatal care, pregnancy complications, history of preterm birth, insurance, and tobacco, alcohol, and drug use, census tracts with the highest level of violence had 38% higher odds of very preterm births (adjusted odds ratio, 1.38; 95% confidence interval, 1.06-1.80), than census tracts with the lowest level of violence.Conclusion: There is an association between high rate of youth violence and very preterm birth. Findings from this study may help inform future research to develop targeted interventions aimed at reducing community violence and very preterm birth in vulnerable populations. [ABSTRACT FROM AUTHOR]