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PURPOSE: With an estimated 3.1 million unintended pregnancies in the United States each year, patterns of contraceptive use have significant public health importance. Little literature has focused on these patterns in women over age 35. METHODS: Using data from the 2004 Behavioral Risk Factor Surveillance System, we conducted a population-based analysis of 22,890 women between the ages of 35-44 years who completed information on family planning. Lifestyle, demographic, and medical history covariates were assessed and multinomial logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Female sterilization was the most popular contraceptive method among women aged 35-44 years (28.5%). Relative to non-Hispanic white women, Hispanic and non-Hispanic black women were less likely to use effective methods of contraception such as male sterilization (OR = 0.33, 95% CI: 0.23, 0.46; and OR = 0.10, 95% CI: 0.06, 0.16, respectively) and oral contraceptives (OR = 0.55, 95% CI: 0.41, 0.73; and OR = 0.42, 95% CI: 0.31, 0.57, respectively) after adjustment for demographic, lifestyle, and medical factors. CONCLUSIONS: Although fecundity is reduced in women of this age group, increased rates of maternal and fetal complications make unintended pregnancies riskier. This study demonstrates opportunities for targeted counseling and increased awareness of the diversity of contraceptive choices for older women. [ABSTRACT FROM AUTHOR]

PURPOSE: Studies have suggested that obesity is associated with an increased risk for oral contraceptive (OC) failure. We conducted a case-cohort study in South Carolina to examine the association between body mass index (BMI) and OC failure by using population-based data sources. METHODS: Our cohort sample from the source population consists of 205 women who reported using OCs to prevent pregnancy on the 1999 Behavioral Risk Factor Surveillance System survey. The 153 women who reported using OCs at the time of conception on the 2000 Pregnancy Risk Assessment Monitoring System survey represent the case sample that arose from the source population. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: In unadjusted models with normal BMI (20 to 24.9 kg/m(2)) as the comparison, greater BMI was associated significantly with OC failure (overweight [25 to 29.9 kg/m(2)], OR = 2.54; 95% CI, 1.18-5.50; and obese [>/=30 kg/m(2)], OR = 2.82; 95% CI, 1.05-7.58). After adjustment for education, income, and race/ethnicity, associations were attenuated and no longer statistically significant. CONCLUSIONS: In this heterogeneous population, we found a suggestion that overweight and obese women may be at increased risk for OC failure. However, long-term prospective studies are needed to study this association in diverse populations. [ABSTRACT FROM AUTHOR]

Miscarriage is a pervasive and socioemotionally complex pregnancy complication. Evidence suggests that poor clinical management can worsen these experiences. Yet, assessments of healthcare communication during a miscarriage are limited and a systematic review of the literature is needed. This review identified and synthesized original research on miscarriage and healthcare communication in the United States from the past 20 years to identify existing knowledge gaps for future miscarriage research. The following databases were searched: PubMed, PsychINFO, and ERIC Database. Data were charted according to Arksey and O'Malley's Scoping Review Framework. Eleven articles were included in the review and three primary themes emerged: (a) patients overwhelmingly prefer patient-centered care; (b) miscarriage is often overmedicalized, which leads to poor communication; and (c) informed decision-making related to one's miscarriage can improve patient experiences. Several gaps were also identified, including studies seeking physician perspectives on miscarriage communication, evaluation of standard care guidelines, and studies evaluating diverse patients' perspectives. This review highlights the need for patient-centered care that utilizes compassionate and accessible language and promotes informed decision-making. Future research should use quantitative methodologies and longitudinal designs to build upon these findings and improve patient experiences of miscarriage.

Objective: The Exercise is Medicine® On Campus (EIM-OC) international campaign leverages university resources (e.g., health centers, recreation, and kinesiology departments) to encourage students, faculty, and staff to integrate physical activity into campus culture. This involves evaluating student physical activity levels during health visits and establishing referral systems for exercise prescriptions. EIM-OC allows universities to earn tiered recognition (Gold, Silver, or Bronze) based on their on-campus physical activity promotion and integration. For Gold recognition, schools must incorporate routine physical activity assessments into their health system, ultimately connecting healthcare providers with health/fitness professionals (HFPs, e.g., campus recreation professionals, kinesiology professors). This research worked to uncover pivotal factors driving EIM-OC on-campus collaborations through HFPs' perspectives., Methods: HFPs ( n  = 11) working full-time at a Gold-level institution ( n  = 10 in United States) participated. Semi-structured, Zoom-recorded interviews with a generic qualitative research design were completed between June and September 2022., Results: Major thematic findings included the importance of tangible support (e.g., personnel), encounters with both trust and tension cross-campus, positive student development opportunities, and variations in outcome reporting and program evaluation. Faculty and staff emphasized the need for methods to obtain and sustain program funding. Participants also expressed the importance of interdisciplinary collaboration to increase the collective impact of EIM-OC on student health and overall collegiate success., Conclusion: HFPs expanded on their EIM-OC experiences and program sustainment or growth requirements. With increased interdisciplinary collaboration, rigor in outcome reporting, and tangible resources, the collective impact of EIM-OC on student health outcomes and overall collegiate success could be greatly perpetuated., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Inc.)

Background: Racially and ethnically marginalized US women experience unintended pregnancy at twice the rate of White women. Understanding contraceptive attitudes can help identify women at increased risk of contraceptive non-use and unintended pregnancy. We assessed the contraceptive attitudes of US-born and foreign-born Black women and examined differences by nativity., Methods: We used an electronic survey, implemented by Lucid LLC, a consumer research firm, to collect cross-sectional data from 657 reproductive-aged women. Analysis was limited to 414 Black women aged 18-44 years. The exposure variable was nativity (US-born or foreign-born), and the outcome variable was cumulative score on the 32-item Contraceptive Attitude Scale (CAS). Analysis included multivariable linear regression, adjusted for confounders. We also estimated separate models, stratified by nativity to identify predictors of contraceptive attitude among US-born Black women and foreign-born Black women, respectively., Results: Three in four participants were US-born (76.6%). The average cumulative CAS score was 118.4 ±20.4 out of 160 indicating favorable contraceptive attitudes. In pooled analysis, foreign-born Black women had significantly lower contraceptive attitude scores compared to US-born women (adjusted regression coefficient (β)= -6.48, p=0.036). In nativity-stratified analysis, income, education, and perceived control over pregnancy timing were significant predictors of contraceptive attitudes for both US-born and foreign-born women. Other significant predictors of contraceptive attitude among US-born women were older maternal age, multi-parity, and perceived pregnancy risk; whereas, for foreign-born women, other significant predictors included marital status (married/cohabiting), language spoken predominantly at home (French), and perceived ability to have a baby and still achieve life goals (agree, neither agree nor disagree)., Conclusion: In addressing the contraceptive needs of Black women, it is important to recognize the differences in attitudes towards contraception by nativity and provide culturally sensitive information and education., (© 2023. W. Montague Cobb-NMA Health Institute.)

Background: Nearly 40% of pregnant women in 2016 were enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Prior studies have investigated nutritional behaviors among WIC participants and access to WIC breastfeeding counseling services. However, there are no (few?) nationally representative, large-scale analyses of WIC users and pregnancy behaviors. Thus, the present study aims to examine associations between WIC use and select pregnancy outcomes among Medicaid enrollees., Methods: We examined pregnancy-related behaviors and outcomes using 2018 U.S. Birth Certificates for Medicaid patients aged 18-45 years (N = 1 159 263). Outcomes included prenatal care (PNC) adequacy, breastfeeding initiation, cigarette use, and gestational weight gain. Standard binary and multinomial logistic regressions were used to estimate odds ratios (OR) and 95% confidence intervals (CIs)., Results: After adjustment, WIC users had statistically significant increased odds of adequate PNC (adjusted OR [AOR] = 1.31 [95% CI 1.30, 1.32]), cigarette use (quit smoking during pregnancy 1.09 [1.07, 1.11]; smoked throughout pregnancy 1.16 [1.14, 1.18], and exceeding recommendations of weight gain 1.07 [1.06, 1.08]) compared with non-WIC users. WIC enrollees also experienced decreased odds of breastfeeding initiation (0.85 [0.85, 0.86]) compared with non-WIC users., Conclusions: The study underscores the value of the WIC program in improving access to PNC. Yet, low-income women remain at risk for smoking during pregnancy and exceeding the recommended amount of weight gain. Breastfeeding initiation is lower than anticipated among WIC participants. Additional studies are needed to investigate WIC program efficacy., (© 2022 Wiley Periodicals LLC.)

Introduction: Although previous studies have found a relationship between having a preterm birth and maternal depression, methodologic issues may have limited the generalizability of results. Thus, the purpose of this study was to evaluate the relationship between having a preterm birth and postpartum depressive symptoms using a large, population-based sample of U.S. women., Methods: This secondary data analysis used 2012-2014 U.S. Pregnancy Risk Assessment Monitoring System data (N = 89,366). Data on the exposure, preterm birth, were obtained from birth certificates. Infants born at 32 to less than 37 weeks' gestation were considered moderate to late preterm, infants born at 28 to less than 32 full weeks' gestation were considered very preterm, and infant born at less than 28 full weeks' gestation were considered extremely preterm. To assess the outcome, two Pregnancy Risk Assessment Monitoring System questions measuring postpartum depressive symptoms were used. Logistic regression was used to calculate unadjusted and adjusted odds ratios (ORs) and 95% confidence interval (CIs)., Results: After adjustment for confounders, the relationship between having a preterm birth and maternal hopelessness was statistically significant for those who had very preterm and extremely preterm births (moderate to late preterm OR, 1.19; 95% CI, 1.00-1.42; very preterm OR, 1.28; 95% CI, 1.04-1.58; extremely preterm OR, 1.81; 95% CI, 1.31-2.49). In addition, after adjustment, findings indicated no association between preterm birth and maternal loss of interest (extremely preterm OR, 0.85 95% CI, 0.60-1.19; very preterm OR, 1.04; 95% CI, 0.86-1.26; preterm OR, 0.95; 95% CI, 0.82-1.10)., Conclusions: Given the statistically significant increased association between having a preterm birth and postpartum depressive symptoms, health professionals may consider implementing comprehensive screening for depression and other mental illnesses among women who give birth prematurely. Findings may also inform future interventions to emphasize the importance of postpartum care among women who have experienced preterm birth., (Copyright © 2020 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)

Antenatal care (ANC) can improve maternal health. We examined associations of individual and community socioeconomic status (SES) with the quality of ANC in West and Central Africa. Data were from the 2009-2011 UNICEF Multiple Indicator Cluster Surveys for women in seven countries (n = 24,718). Individual SES variables included women's education and wealth; community SES was defined as low or high poverty index. ANC quality was defined as receiving six services: blood pressure monitoring, blood tests, urine tests, malaria prophylaxis, tetanus vaccine, and HIV screening, and coded low or high. We used multilevel logistic regression to estimate fixed and random effects of individual and community SES on ANC quality. Less than one-fourth of women received high-quality ANC. Only small percentages of women had malaria prophylaxis and were counseled and tested for HIV. In adjusted country-stratified results, living in a poor community was associated with reduced odds of receiving high-quality ANC in six countries (Central African Republic: odds ratio, OR = 0.76; 95% confidence interval, CI:0.58-0.98; Chad: OR = 0.48; CI:0.32-0.74; Ghana: OR = 0.86; CI:0.61-0.97; Nigeria: OR = 0.74; CI:0.61-0.92; Sierra Leone: OR = 0.71; CI:0.57-0.91; and Togo: OR = 0.80; CI:0.47-0.91). The health system may be missing important opportunities to provide high-quality ANC and, thereby, improve pregnancy outcomes in these settings.

Objective: The purpose of this study was to evaluate factors associated with postpartum contraceptive use among women with short and moderate-to-long birth intervals using population-based data from the Pregnancy Risk Assessment and Monitoring System., Methods: Because only Mississippi and Tennessee include a question about birth interval length on their Pregnancy Risk Assessment and Monitoring System survey, this analysis was limited to women from those states who reported information on this variable (N = 2198). Demographic, lifestyle, and reproductive data, including information on postpartum contraceptive use, were obtained from surveys and birth certificates. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs)., Results: Nearly 90% of women reported currently using a form of contraception during the postpartum period. In the unadjusted model, among women with short birth intervals, there was no association between alcohol consumption during pregnancy and postpartum contraceptive use (OR 1.03, 95% CI 0.15-7.31); however, smoking during pregnancy was associated with a decreased odds of postpartum contraceptive use (OR 0.70, 95% CI 0.25-1.96). Among women with moderate-to-long birth intervals, alcohol use during pregnancy was associated with a decreased odds (OR 0.71, 95% CI 0.28-1.80) and smoking during pregnancy was associated with an increased odds (OR 1.18, 95% CI 0.60-2.30) of postpartum contraceptive use. Regardless of birth interval length, women with no health insurance had a decreased odds of postpartum contraceptive use when compared with women with health insurance (short birth interval: OR 0.89, 95% CI 0.32-2.49 and moderate-to-long birth interval: OR 0.85, 95% CI 0.52-1.39). Among women with short birth intervals, non-Hispanic black women had a decreased odds of postpartum contraceptive use (OR 0.14, 95% CI 0.03-0.64) and women who were unmarried or had a history of preterm delivery had an increased odds of postpartum contraceptive use (unmarried: OR 5.81, 95% CI 1.26-26.69 and preterm delivery: OR 4.19, 95% CI 1.42-12.37, respectively) after adjustment for confounders. Among women with moderate-to-long birth intervals, individuals who identified as Hispanic/mixed race/other had a statistically significant decreased odds of postpartum contraceptive use after adjustment (OR 0.43, 95% CI 0.18-0.99)., Conclusions: Findings underscore the importance of postpartum medical visits for all women, regardless of birth interval length. Certain groups of women may need additional counseling regarding the importance of using contraceptives to prevent another closely spaced or unintended pregnancy.

Although developing countries may find it difficult to provide adequate prenatal care, it is likely that they can provide at least some. We examined associations of prenatal care with infant mortality in West Africa. We used data from the Demographic and Health Surveys (n = 57,322) and proportional hazards regression models to estimate the risk of infant mortality. Having any prenatal care was associated with lower infant mortality risk in all but the poorest wealth quintile, with 56% lower risk in the wealthiest quintile (95% confidence interval [CI] 0.28-0.69). Even limited prenatal care may significantly reduce infant mortality in developing countries.

Introduction: Most studies evaluating the effect of group prenatal care on maternal and neonatal health outcomes assess the CenteringPregnancy model, which follows a set structure and educational curriculum. Group prenatal visits (GPVs) bring together pregnant patients for visits that include education and a health evaluation. GPVs represent a more flexible method of delivering group prenatal care, compared with CenteringPregnancy. Our study sought to determine whether GPV participation affects maternal and neonatal health outcomes., Methods: The Myers Park Obstetrics and Gynecology Clinic is located in Charlotte, North Carolina, and serves a racially, ethnically, and socioeconomically diverse population. GPVs were offered at the clinic between July 2014 and July 2015. Retrospective data were collected for women who obtained prenatal care, either GPV or individual care, during that period. Demographic, birth, and postpartum data were extracted from the electronic health record. GPV participants were categorized by the percent of prenatal visits that were GPVs (limited GPV: <30% of visits as GPV; moderate GPV: ≥30% of visits as GPV). Logistic regression models were created to assess the effect of GPV participation on low birth weight, preterm birth, cesarean birth, and postpartum visit attendance., Results: There were 355 study participants (GPV n = 78, individual care n = 277). Among GPV participants, 52.6% were classified as limited GPV, and 47.4% were classified as moderate GPV. The adjusted analysis showed limited-GPV patients had lower odds of postpartum visit attendance, compared with individual-care patients (odds ratio, 0.48; 95% CI, 0.24-0.94). Neither the unadjusted nor adjusted models demonstrated a statistically significant association between GPV participation and low birth weight, preterm birth, or cesarean birth., Discussion: GPVs for prenatal care can be implemented without negative effects on maternal or neonatal health. However, fidelity to a more comprehensive model of group prenatal care may be necessary to achieve health outcome improvements., (© 2018 by the American College of Nurse-Midwives.)

Introduction: Although the definition of a short interbirth interval has been inconsistent in the literature, Healthy People 2020 recommends that women wait at least 18 months after a live birth before attempting their next pregnancy. In the United States, approximately 33% of pregnancies are conceived within 18 months of a previous birth. Pregnancies that result from short interbirth intervals can pose serious risks. The objective of this study was to determine the association between interbirth interval and understudied pregnancy complications and outcomes, including small for gestational age (SGA) infants, premature rupture of membranes (PROM), preterm PROM (PPROM), placenta previa, and gestational diabetes, using Pregnancy Risk Assessment and Monitoring System data from Mississippi and Tennessee., Methods: This study collected self-reported information from 2212 women on interbirth interval (≤18 months, ie, short; 19-35 months, ie, intermediate; and ≥36 months, ie, long; referent), PPROM, placenta previa, and gestational diabetes. SGA and PROM data were obtained from birth certificates. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs., Results: After adjustment, there were no strong associations between interbirth interval and PPROM, gestational diabetes, or SGA infants. However, women with shorter intervals had increased odds of PROM (short: OR, 3.54; 95% CI, 1.22-10.23 and intermediate: OR, 4.09; 95% CI, 1.28-13.03) and placenta previa (short: OR, 2.58; 95% CI, 1.10-6.05 and intermediate: OR, 1.69; 95% CI, 0.94-3.05)., Discussion: The study's findings provide further support for encouraging women to space their pregnancies appropriately. Moreover, findings underscore the need to provide women with family planning services so that closely spaced pregnancies and unintended pregnancies can be avoided. Additional studies of the role of interbirth interval on these understudied pregnancy complications and outcomes are warranted., (© 2018 by the American College of Nurse-Midwives.)

Purpose: One-third of all pregnancies in the United States are conceived within 18 months of a prior live birth. Preventing unintended pregnancies may help to decrease the prevalence of pregnancies with these short interpregnancy intervals. However, data on factors associated with pregnancy intention among women who have had short birth intervals are sparse. Pregnancy Risk Assessment Monitoring System data were used to further evaluate these associations., Methods: Because only Mississippi and Tennessee Pregnancy Risk Assessment Monitoring System include a survey question about birth interval length, this analysis was limited to women from those states who recently had a short birth interval (n = 384). Pregnancy intention and demographic, lifestyle, and reproductive data were obtained from surveys and birth certificates. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs)., Results: Nearly 76% of women with short birth intervals reported their pregnancy as unintended. Women who were non-Hispanic black or consumed alcohol during pregnancy had statistically significant increased odds of reporting the pregnancy with a short birth interval as being unintended (OR = 3.98; 95% CI: 1.73-9.16 and OR = 10.56; 95% CI: 1.80-61.83, respectively)., Conclusions: Although all women should be counseled on postpartum contraceptive use, findings suggest that important subpopulations of women may benefit from more targeted counseling during prenatal care visits and the immediate postpartum hospital stay regarding the importance of using contraception to not only better space pregnancies but also prevent unintended pregnancies., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to explore the perceptions of child maltreatment among inpatient pediatric nurses., Design and Methods: A cross-sectional survey was used to obtain responses to an online survey designed to examine perceptions of child maltreatment from inpatient pediatric nurses., Results: Many nurses surveyed (41.25%) indicated that they had not received adequate training or had never received training on child maltreatment identification and many (40%) also indicated they were not familiar with the applicable reporting laws., Conclusions: Due to the serious immediate and long term effects of child maltreatment, it is imperative that pediatric inpatient nurses have adequate training on how to identify potential abuse and neglect cases, as well as legal reporting requirements, since they are in a unique position to identify potential cases of maltreatment., Practice Implications: There is a continuing need for training on child maltreatment identification and reporting laws for inpatient pediatric nurses., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Social and health care context may influence prenatal care use. We studied associations of government health expenditures, supply of health care professionals, and country literacy rates with prenatal care use in ten West African countries, controlling for individual factors. We used data from Demographic and Health Surveys (n = 58,512) and random effect logistic regression models to estimate the likelihood of having any prenatal care and adequate prenatal care. Each percentage increase in the literacy rate was associated with 4% higher odds of having adequate prenatal care (p = .029). Higher literacy rates among women may help to promote adequate prenatal care.

Objective: To examine the association between type of birth attendant and place of delivery, and infant mortality (IM)., Methods: This cross-sectional study used self-reported data from the Demographic Health Surveys for women in Ghana, Kenya, and Sierra Leone. Logistic regression estimated odds ratios (ORs) and95% confidence intervals., Results: In Ghana and Sierra Leone, odds of IM were higher for women who delivered at a health facility versus women who delivered at a household residence (OR=3.18, 95% confidence interval, CI: 1.29-7.83, p=0.01 and OR=1.62, 95% CI: 1.15-2.28, p=0.01, respectively). Compared to the use of health professionals, the use of birth attendants for assistance with delivery was not significantly associated with IM for women in Ghana or Sierra Leone (OR=2.17, 95% CI: 0.83-5.69, p=0.12 and OR=1.25, 95% CI: 0.92-1.70, p=0.15, respectively). In Kenya, odds of IM, though nonsignificant, were lower for women who used birth attendants than those who used health professionals to assist with delivery (OR=0.85, 95% CI: 0.51-1.41, p=0.46), and higher with delivery at a health facility versus a household residence (OR=1.29, 95% CI: 0.81-2.03, p=0.28)., Conclusions: Women in Ghana and Sierra Leone who delivered at a health facility had statistically significant increased odds of IM. Birth attendant type-IM associations were not statistically significant.Future research should consider culturally-sensitive interventions to improve maternal health and help reduce IM.

Introduction: In 2003, Barbados, a developing country with universal health care, launched the Barbados Strategic Plan for Health, a national intervention to promote public health. Teachers, health educators, and clinicians worked to improve children's health, with particular focus on asthma and diabetes. We studied this intervention by using data on preventable hospitalization, an indicator that assesses both the overall effectiveness of public health and access to primary health care. The purpose of this study was to assess the Barbados Strategic Plan for Health by measuring rates of preventable hospitalization among children. Few researchers have studied these hospitalizations for children, and only 1 study has done so in a developing country., Methods: We calculated annual (2003-2008) population-based rates of preventable hospitalizations from birth through age 19, both summary and disease-specific, for the 5 conditions that define the indicator for children: asthma, diabetes, gastroenteritis, urinary tract infection, and perforated appendix., Results: Across the 6 years, the population rates of preventable hospitalizations increased 115.4% for boys and 67.2% for girls (both P < .001). Asthma accounted for much of the increase. Regression analysis indicated that the average annual increase in asthma hospitalization for boys was 0.45 per 1,000, an average annual increase of 20.6% of the baseline rate. These results suggest generally increasing rates of hospitalization for asthma for boys. There was no evidence of a corresponding rate trend for girls., Conclusion: Results suggest an opportunity to improve public health education and access to primary health care. Public health professionals in developing countries can use the approaches of this study to evaluate initiatives to improve child health.

In 2008, members of the American College of Epidemiology's Education Committee began work on a project to facilitate discussion on identifying domains and core competencies for epidemiologic training at the master and doctoral levels. Two online surveys were created and participants (N = 183; n = 147 [established epidemiologists] and n = 36 [recent graduates]) rated the importance of 19 domains and 66 competencies. A total of 17 competencies were viewed as important or very important for individuals earning various master- or doctoral-level degrees in epidemiology, whereas eight competencies were reported as being unimportant for all individuals earning graduate degrees in epidemiology. Twenty additional competencies were viewed as important or very important only for individuals receiving doctoral training. In addition, recent master-level graduates identified nine domains in which they felt less prepared, and recent doctoral-level graduates identified two such domains. Additional research is warranted to ensure that all epidemiologists receive sufficient training in identified areas., (Copyright © 2015 Elsevier Inc. All rights reserved.)

We evaluated access to primary health care for older women and men in Barbados, a developing country, using a widely accepted access indicator, hospitalization for ambulatory care sensitive conditions. Using 2003-2008 data, we calculated gender-specific total annual population-based rates of these hospitalizations per 1,000 older women and men and individual rates for the six most prevalent conditions. Across the 6 years, these hospitalizations increased 33.6% for women, 30.6% for men (both P < .0001). However, the average rate for diabetes fell 32% for women, 36% for men. Findings suggest an opportunity to improve access to primary health care, particularly for older women.

Purpose: This study aimed to describe the frequency of sexual intercourse and whether body size was associated with weekly sexual intercourse among a diverse group of women using oral contraceptives., Methods: This longitudinal prospective cohort study recruited participants (n = 185) from several clinics in Charlotte, NC. Body mass index (BMI) and waist-to-hip ratio (WHR) were used as measures of body size and sexual intercourse frequency was determined from self-reported information provided on daily diaries. Mean monthly frequencies of sexual intercourse were calculated and linear mixed models were used to assess if means remained constant over time. Generalized estimating equations were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs)., Results: Mean monthly frequency of sexual intercourse was similar for women classified as normal or underweight or obese by BMI during each month of data collection but was highest for women classified as overweight. After adjustment, obesity-sexual intercourse associations were attenuated (BMI ≥30 vs. <25.0: OR = 0.78; 95% CI, 0.43-1.42 and WHR ≥ 0.85 vs. <0.85: OR = 1.11; 95% CI, 0.62-2.01)., Conclusions: This study found no association between BMI or WHR and weekly sexual intercourse. However, more research is warranted given the importance of this possible relationship for future studies of fertility, contraceptive effectiveness, and sexual health., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Two-thirds of reproductive-aged women in the United States are overweight or obese and at risk for numerous associated adverse pregnancy outcomes. This study examined whether the amount of weight gained during pregnancy modifies the prepregnancy body mass index (BMI)-cesarean delivery association., Methods: A total of 2,157 women aged 18-45 who participated in the 2008-2009 North Carolina Pregnancy Risk Assessment Monitoring System had complete information on prepregnancy BMI, maternal weight gain, and mode of delivery on infant birth certificates. Logistic regression was used to obtain odds ratios (ORs) and 95 percent confidence intervals (CIs) to model the association between prepregnancy BMI and cesarean delivery, and a stratified analysis was conducted to determine whether maternal weight gain was an effect modifier of the prepregnancy BMI-cesarean delivery association., Results: Obese women had 1.78 times the odds of cesarean delivery as compared with women with a normal BMI (95% CI: 1.44-2.16). When adjusted for race/ethnicity, live birth order, household income, and education, the association increased in magnitude and remained statistically significant (OR = 2.01, 95% CI: 1.63-2.43). In stratified analyses, the obesity-cesarean delivery association persisted and remained statistically significant among all maternal weight gain categories., Conclusions: Health care practitioners should stress the importance of achieving a healthy prepregnancy weight and gaining an appropriate amount of weight during pregnancy to reduce the risk of cesarean delivery and other adverse pregnancy outcomes., (© 2014, Copyright the Authors Journal compilation © 2014, Wiley Periodicals, Inc.)

Purpose: Recently, there has been interest in developing a predictive measure to assess pregnancy readiness/intention in clinical settings. Two such measures have been created but tested primarily in pregnant or postpartum populations. This study examined agreement between the pregnancy readiness measures in a diverse population of nonpregnant women., Methods: Women completed short questionnaires while waiting for clinical appointments. Participants' responses to the pregnancy readiness measures were cross-tabulated to assess the level of agreement between the measures. Logistic regression was used to determine factors related to disagreement between the measures. Complete information was available for 220 women., Results: Almost 55% of women had disagreement between the pregnancy readiness measures. Women with a high school education or less had 2.60 times the odds of disagreement (95% confidence interval 1.23-5.49), and women who did not use contraception had 2.40 times the odds of disagreement (95% confidence interval 1.18-4.87)., Conclusions: Although both pregnancy readiness measures are promising tools that could potentially be adapted for use in public health or clinical settings, there are limitations to these measures. These measures should be further tested and refined through the use of qualitative methods to ensure that a valid measure is created for use in non-pregnant populations., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: Family conflict is related to numerous risky behavioral outcomes during adolescence; however, few studies have examined how family conflict is associated with risky sexual behavior during adolescence., Methods: Data from 1104 adolescents aged 15 to 21 who completed the 2008 National Longitudinal Survey of Youth were analyzed. Information on family conflict (family fighting and family criticizing) and sexual behavior (number of sexual partners in past year and use of contraception at last intercourse) was self-reported. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs)., Results: After adjustment, adolescents whose family members often fought had increased odds of not using contraception at last intercourse and having two or more sexual partners in the past year (OR, 1.40 [95% CI, 1.04-1.88] and OR, 1.62 [95% CI, 1.23-2.14], respectively). Adolescents whose family members often criticized each other also had increased odds of not using contraception at last intercourse and having two or more sexual partners in the past year (OR, 1.46 [95% CI, 1.12-1.90] and OR, 1.22 [95% CI, 0.96-1.55], respectively)., Conclusions: Family conflict was associated with risky sexual behaviors in this racially/ethnically diverse sample of adolescents. If confirmed in other studies, adolescents who experience family conflict may be an important population to target with information regarding safer sex practices., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The objective of this study is to examine the relationship between a vulnerable child's family composition (family size and primary caregiver) and three child well-being indicators (immunization status, access to food, educational security). Using 2006-2009 intake data from a Kenyan non-governmental aid agency, this cross-sectional study evaluated a population of 1,424 children in two urban slum settlements in Nairobi. Logistic regression was used to obtain adjusted odds ratios and 95% confidence intervals to examine the relationship between family composition measures and child well-being. Multivariate results were also stratified by orphan status. Vulnerable children who live in household sizes of 4-6 members and vulnerable children who live with non-relatives had greater odds of inadequate immunization (OR = 1.51, 95% CI: 1.13-2.01, OR = 9.02, 95% CI: 4.62-17.62). Paradoxically, vulnerable children living with non-relative caregivers were at lower risk for inadequate food (OR = 0.19, 95% CI 0.07-0.33). Single orphans with an HIV positive parent were less likely to be fully immunized than single orphans with an HIV negative parent. The results provide information on specific groups which could benefit from increased attention related to childhood immunization education and intervention programs. The findings also underscore the need for policies which support families as a means of supporting vulnerable children. Finally, findings reinforce the wisdom of programs which target vulnerable children based on needs, rather than orphan status. These findings can be useful for informing future program and policy development designed to meet needs of vulnerable children.

Chronic disease management requires the individual to perform varying forms of self-care behaviors. Self-efficacy, a widely used psychosocial concept, is associated with the ability to manage chronic disease. In this study, we examine the association between self-efficacy to manage hypertension and six clinically prescribed hypertension self-care behaviors. We interviewed 190 African Americans with hypertension who resided in the greater metropolitan Charlotte area about their self-efficacy and their hypertension self-care activities. Logistic regression for correlated observations was used to model the relationship between self-efficacy and adherence to hypertension self-care behaviors. Since the hypertension self-care behavior outcomes were not rare occurrences, an odds ratio correction method was used to provide a more reliable measure of the prevalence ratio (PR). Over half (59%) of participants reported having good self-efficacy to manage their hypertension. Good self-efficacy was statistically significantly associated with increased prevalence of adherence to medication (PR = 1.23, 95% CI: 1.08, 1.32), eating a low-salt diet (PR = 1.64, 95% CI: 1.07-2.20), engaging in physical activity (PR = 1.27, 95% CI: 1.08-1.39), not smoking (PR = 1.10, 95% CI: 1.01-1.15), and practicing weight management techniques (PR = 1.63, 95% CI: 1.30-1.87). Hypertension self-efficacy is strongly associated with adherence to five of six prescribed self-care activities among African Americans with hypertension. Ensuring that African Americans feel confident that hypertension is a manageable condition and that they are knowledgeable about appropriate self-care behaviors are important factors in improving hypertension self-care and blood pressure control. Health practitioners should assess individuals' self-care activities and direct them toward practical techniques to help boost their confidence in managing their blood pressure.

This study examined the association between contraceptive method and satisfaction and discontinuation. Few studies have examined these issues in the university setting and how they may potentially impact unintended pregnancy rates. This study examined data from 172 college women aged 18-36 years enrolled in the Study on Contraceptive Knowledge in Students, a cross-sectional study conducted at a large, public university. Logistic regression was used to model the association between current type of contraceptive method used (non-coital dependent vs. coital dependent) and satisfaction as well as previous type of contraceptive method used and discontinuation of that method. Nearly 80% of contracepting women currently used a non-coital dependent method. After adjustment for age, race, and location where contraception was obtained, current non-coital dependent users were significantly more likely to be satisfied with their contraceptive method compared to women using coital dependent methods (OR = 4.73, 95% CI: 1.64, 13.63). After adjustment for age, race, and history of pregnancy, women who used non-coital dependent methods of contraception were 91% less likely to have discontinued their method compared to women who used coital dependent methods (OR = 0.09, 95% CI: 0.04, 0.20). Healthcare workers and public health professionals can counsel women on using contraceptive methods that best suit their needs. By doing so, patient satisfaction and consistent contraceptive use may improve and lead to a decrease in unintended pregnancies.

Purpose: An important, although understudied, area related to contraceptive use is perceptions of contraceptive responsibility. The purpose of this exploratory study was to investigate these perceptions among female college students., Methods: Web-based or mailed questionnaires were completed by 326 students from 2006-2007. Logistic regression was used to obtain odds ratios and 95% confidence intervals (CI) to model the associations between select demographic and lifestyle characteristics and contraceptive responsibility (shared vs. individual responsibility)., Results: Although 89.1% of women felt that contraceptive responsibility should be shared, only 51.8% indicated that responsibility is actually shared in their relationships. After adjustment for age, race/ethnicity, marital status, and year of study, women using "other" methods of contraception (i.e. withdrawal, rhythm, sterilization, etc.) had 3.25 times the odds of stating that contraceptive responsibility is actually shared as compared to hormonal users (95% CI: 1.20, 8.80)., Conclusions: For college women, there is a disconnect between who they feel should be responsible for contraception and who actually is responsible. Insight into perceptions of contraceptive responsibility in the university setting may help guide health educators and clinicians in designing pregnancy and sexually transmitted infection prevention programming., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Despite health warnings about the increased risk of cerebrovascular disease among women who smoke while using oral contraceptives (OCs), prior research suggests that OC use is still prevalent among women who smoke cigarettes. Our objective was to investigate the prevalence of OC use among cigarette smoking women of reproductive age in the United States., Study Design: We extracted data from the 2002 and 2004 Behavioral Risk Factor Surveillance System surveys of 76,544 women between 18 and 44 years of age who reported using some form of contraception. OC use, or self-reported use of "the pill," was examined among those who currently smoke, either everyday or some days. Multivariable logistic regression models were used to compare OC use between smoking and nonsmoking women., Results: One fourth (26.9%) of U.S. women who smoke compared with 34.6% of nonsmoking women reported currently using OCs. After adjusting for age, race/ethnicity, marital status, education level, binge drinking, and health care coverage, women who smoke were 0.6 (95% confidence interval [CI], 0.6-0.7) times as likely to use OCs as nonsmoking women. Among women aged 35 to 44 years, the odds of OC use among smokers was even further reduced (odds ratio [OR], 0.3; 95% CI, 0.3-0.4) compared with nonsmokers., Conclusion: Among U.S. women of reproductive age who use contraception, particularly among women aged 35 to 44 years, those who smoke cigarettes are significantly less likely to use OCs than those who do not., (Published by Elsevier Inc.)

Background: Hypertensive complications during pregnancy occur in nearly 8 percent of pregnancies and account for 15 percent of all maternal mortalities in the United States. The purpose of this study was to investigate further the association between physical activity and hypertensive complications during pregnancy using data from a population-based surveillance system., Methods: This study included 3,348 participants from the 2004 to 2006 North Carolina Pregnancy Risk Assessment Monitoring System. Hypertensive complications during pregnancy were assessed using birth certificate data, and physical activity levels before pregnancy and during pregnancy were self-reported on questionnaires. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) while controlling for confounders., Results: Although no strong association was found between physical activity before pregnancy and hypertensive complications during pregnancy, a dose-response relationship emerged for the physical activity during pregnancy-hypertensive complications association after adjustment for prepregnancy body mass index (physical activity for 1-4 days per week: OR=0.63, 95% CI: 0.45-0.90; physical activity for 5+ days per week: OR=0.46, 95% CI: 0.20-1.02). When levels of physical activity before and during pregnancy were combined, a statistically significant protective effect was seen only for women who indicated that they were physically active both before and during pregnancy (adjusted OR=0.65, 95% CI: 0.44-0.96)., Conclusions: In this population-based study, physical activity, particularly during pregnancy, was associated with a lower risk of hypertensive complications during pregnancy. During a healthy pregnancy, health care practitioners may recommend that women engage in physical activity as one way to potentially prevent the development of this critical condition.

There is growing evidence that environmental tobacco smoke (ETS) exposure may negatively affect birth outcomes, especially birth weight. This study evaluates the effect of residential ETS exposure on the risk of having a low birth weight (LBW) infant and investigates whether there is a dose-response relationship. This retrospective cohort study comprised 2,206 women who participated in the 2004-2005 North Carolina Phase V Pregnancy Risk Assessment Monitoring System. Women self-reported information on ETS exposure and birth weight was obtained from birth certificates. Logistic regression was used to obtain odds ratios and 95% confidence intervals. When adjusted for marital status and income, women exposed to ETS during pregnancy had increased odds of delivering a LBW baby (OR = 1.29, 95% CI: 1.06, 1.57). After adjustment for the same covariates, a weak dose-response relationship between ETS and LBW was found (OR = 1.28, 95% CI: 1.03, 1.60 for women who were exposed to ETS generated by one cigarette smoker; OR = 1.31, 95% CI: 0.96, 1.31 for those who were exposed to ETS generated by two or more cigarette smokers). This study provides evidence of the adverse effect of residential ETS on pregnancy outcomes. The observed relationship emphasizes the health hazard that ETS exposure in the home poses to pregnant women and their unborn babies. Educational anti-tobacco campaigns and quit smoking initiatives should target both mothers and fathers to ensure smoke-free living conditions and a healthy environment for all family members.

Objective: To examine the relationship between physical activity before and during the last trimester of pregnancy and postpartum depressive symptoms., Design: Secondary analysis of data from the 2004 and 2005 Pregnancy Risk Assessment Monitoring System., Settings: Mailed questionnaire or telephone interview of new mothers in North Carolina., Patients/participants: Female residents of North Carolina, ages 18 to 45 (n=2,169), who had given birth to a live infant in the past 2 to 6 months., Methods: Information on physical activity and depressive symptoms was self-reported. Logistic regression was used to examine the physical activity-depressive symptom associations while controlling for confounding variables., Results: After adjustment for confounders, there were no statistically significant associations between being physically active before and/or during pregnancy and feeling depressed or "down." However, participants who were physically active both prepregnancy and during the last trimester had decreased odds of having little interest or pleasure compared with participants who were not physically active, after adjustment for age and marital status (odds ratio =0.66, 95% confidence interval: 0.49, 0.87)., Conclusion: Although regular physical activity is recommended for healthy women during pregnancy, additional studies are needed to investigate the physical activity-depressive symptoms association. If confirmed in other studies, physical activity may be an additional option for women who want to ease postpartum depressive symptoms.

Objectives: Although nicotine replacement therapies (NRT) may assist with smoking cessation, little is known about the safety of NRT use during pregnancy. Our purpose was two-fold: to determine characteristics of women prescribed or recommended NRT during pregnancy and to investigate whether NRT prescription/recommendation was associated with adverse pregnancy outcomes using data from the 2004 Pregnancy Risk Assessment Monitoring System., Methods: Smoking and NRT referral was self-reported by 5,716 women. Information on pregnancy outcomes was obtained from birth certificates. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs)., Results: Smokers <35 years of age and of Hispanic, Non-Hispanic Black, and Asian/Pacific Islander race/ethnicity were less likely to be prescribed or recommended NRT during pregnancy. After adjustment for age, marital status, education, and race/ethnicity, women recommended NRT had twice the risk of low birthweight as compared to nonsmokers (OR = 1.95, 95% CI: 1.10, 3.46) while smokers had 1.31 times the risk of low birthweight (95% CI: 0.92, 1.87). Results for preterm birth were similar after adjustment for the same confounding variables (NRT: OR = 2.04, 95% CI: 1.14, 3.63 and smoking: OR = 1.09, 95% CI: 0.74, 1.61)., Conclusions: Risks of low birthweight and preterm birth were highest for women prescribed or recommended NRT. These findings may be related to frequency of maternal smoking. While heavier smokers may be more likely to be recommended NRT, they also may have the most difficulty with cessation. Greater efforts should be made to ensure that these women do successfully cease smoking.

Oral contraceptives are the most popular reversible method of contraception in the United States. Although most women using oral contraceptives are reliably protected against pregnancy, nearly half of the 3 million unintended pregnancies in the United States annually occur among the 90% of women who use contraception. Recent findings suggest that obesity may reduce the biologic effectiveness of oral contraceptives. The purpose of this study was to further investigate the potential obesity-oral contraceptive failure association using 2002 National Survey of Family Growth data. In this retrospective cohort of 1,491 women, body mass index (kg/m2) was derived from self-reported values, and oral contraceptive failure was defined as conceptions that occurred while women used oral contraceptives. Hazard ratios and 95% confidence intervals were obtained from Cox proportional hazards models. Obese women (body mass index > or = 30 vs. 18.5-24.9) had an increased risk of oral contraceptive failure (hazard ratio = 1.59, 95% confidence interval: 0.94, 2.68). Results were largely attenuated after adjustment for age, race/ethnicity, and parity. This population-based study found no association between obesity and oral contraceptive failure. While it is possible that misclassification or uncontrolled confounding obscured a true relation, it may be that there is no association. Large, prospective studies are needed to assess whether obesity plays a biologically relevant role in oral contraceptive effectiveness.

Objectives: Height and weight are key variables in epidemiologic research, including studies of reproductive outcomes. Optimally, this information is collected by trained study personnel. However, direct measurements are not always feasible. The purpose of this study was to investigate the accuracy of self-reported height and weight, as well as the resultant body mass index (BMI) calculated from self-reported height and weight (referred to as self-reported BMI), among a group of women of reproductive age according to select demographic variables., Methods: A total of 381 women provided self-reported height, weight, and demographic information on a questionnaire for a study of contraceptive trends while attending a Family Medicine clinic. Height and weight were also abstracted from medical records for 275 of these study participants. Self-reported and measured values for height, weight, and BMI were compared using paired t-tests. Analysis of variance, chi-square tests, and Fisher's Exact tests were used to examine how differences between self-reported and measured values varied by select demographic factors., Results: Women underestimated weight by 4.6 pounds, overestimated height by 0.1 inches, and underestimated BMI by 0.8 kg/m(2). All women, regardless of age, education, race/ethnicity, or marital status, underestimated their weight. These differences were statistically significant for all groups (p<0.01) with the exception of women with a high school education. Self-reported height and weight measures classified 84% of women into appropriate BMI categories., Conclusions: Overall, self-reported height and weight were found to give an accurate representation of true BMI in this study. There were some demographic differences in the ability to accurately report height and weight, particularly with respect to race/ethnicity. Future studies should investigate these racial/ethnic differences among a larger population.

Objectives: Annually, 3 million pregnancies in the United States are classified as unintended, with many of these unintended pregnancies occurring to women who use some type of contraceptive. Obesity may be affecting the biological effectiveness of contraceptives. We investigated whether there is an association between body weight and unintended pregnancy and whether this association differs by a woman's contraceptive status at the time of conception., Methods: We conducted a case-control study using multistate data from the 1999 Pregnancy Risk Assessment Monitoring System. A total of 18,445 women provided complete information on pregnancy intention, contraceptive use at the time of conception, weight, height, and other covariates. Multivariable logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs)., Results: Among contraceptors, overweight and obese women had nearly twice the odds of having an unintended pregnancy as compared to women with normal body mass indices (OR=1.73 [95% CI: 1.20, 2.36] and OR=1.75 [95% CI: 1.21, 2.52], respectively) after adjustment for age, marital status, education, socioeconomic status, Medicaid, race/ethnicity, and parity. No association was found between heavier weight and unintended pregnancy among noncontraceptors., Conclusions: Though the observed associations could be the result of selection bias or unmeasured confounding, the findings suggest that the effect of obesity on unintended pregnancy is limited to contraceptive failure. Prospective studies designed specifically to examine a body weight-contraceptive failure association are needed to determine if heavier women should be advised to use contraceptive methods other than hormonal contraceptives to prevent unintended pregnancy.