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The objectives are to report the estimated prevalence of pregnancy complications and adverse pregnancy outcomes in a defined population of Alaska Native women and also examine factors contributing to an intensive and successful collaboration between a tribal health center and the Centers for Disease Control and Prevention. Investigators abstracted medical record data from a random sample of singleton deliveries to residents of the study region occurring between 1997 and 2005. We used descriptive statistics to estimate the prevalence and 95% confidence intervals of selected pregnancy complications and adverse pregnancy outcomes. Records were examined for 505 pregnancies ending in a singleton delivery to 469 women. Pregnancy complication rates were 5.9% (95% CI 4.0, 8.4) for gestational diabetes mellitus, 6.1% (95% CI 4.2, 8.6%) for maternal chronic hypertension and 11.5% (95% CI 8.8, 14.6) for pregnancy associated hypertension, and 22.9% (95% CI 19.2-26.5%) for anemia. The cesarean section rate was 5.5% (95% CI 3.5, 7.5) and 3.8% (95% CI 2.3, 5.8) of newborns weighed > 4,500 g. Few previous studies reported pregnancy outcomes among Alaska Native women in a specific geographic region of Alaska and regarding the health needs in this population. We highlight components of our collaboration that contributed to the success of the study. Studies focusing on special populations such as Alaska Native women are feasible and can provide important information on health indicators at the local level. Keywords Alaska Native * Pregnancy * Collaboration, Background Although women of childbearing age and infants comprise approximately 46% of Alaska's native population [1], few population-based studies of the health status of Alaska Native women and infants have [...]

Objectives. We sought to estimate the effect of universal implementation of a clinic-based, psychosocial smoking cessation intervention for pregnant women. Methods. We used data from US birth certificates (2005) and the Pregnancy Risk Assessment Monitoring System (2004) to estimate the number of women smoking at conception. To calculate the number of women eligible to receive the cessation intervention, we used estimates from the literature of the percentage of women who quit spontaneously (23%), entered prenatal care before the third trimester (96.5%), and disclosed smoking to their provider (75%). We used the pooled relative risk (RR) for continued smoking from the 2004 Cochrane Review as our measure of the intervention's effectiveness (RR=0.94). Results. We estimated that 944240 women smoked at conception. Of these, 23.0% quit spontaneously, 6.3% quit with usual care, and an additional 3.3% quit because of the intervention, leaving 67.4% smoking throughout pregnancy. The calculated smoking prevalence in late pregnancy decreased from 16.4% to 15.6% because of the intervention. Conclusions. Universal implementation of a best-practice, clinic-based intervention would increase the total number of quitters but would not substantially reduce smoking prevalence among pregnant women. doi:10.2105/AJPH.2008.144485)

Objectives. Increasing rates of cesarean deliveries have received widespread attention in recent years, as concern in the United States about unnecessary surgical procedures has increased. However, little information has been published on the national trends of other operative obstetric procedures occurring during deliveries. Methods. We analyzed data from the National Hospital Discharge Survey to examine trends in the use of forceps, vacuum extraction, and cesarean section from 1980 through 1987. Results. The rate of cesarean sections increased by 48%, while the rate of forceps procedures declined by 43%. Although the risk of cesarean section was significantly increased for older women, the risk of forceps and vacuum extraction procedures did not vary by age. Women with private insurance were significantly more likely to receive a cesarean section (rate ratio [RR] = 1.2), forceps procedure (RR = 1.7), and vacuum extraction procedure (RR = 1.8) than were women without private insurance. Conclusions. As pressure mounts to decrease the national cesarean section rate from 24% to 15% by the year 2000, attention should also be given to surveillance of other operative delivery procedures. (Am J Public Health. 1992;82:1340-1344)

A report is presented concerning the use of alcohol by pregnant and nonpregnant women during the years 1985 through 1988 in 20 states and the District of Columbia. These states participated in the Behavioral Risk Factor Surveillance System (BRFSS), a collaborative study between state health departments and the Centers for Disease Control. Data for the BRFSS were collected in telephone surveys of a carefully selected sample of women; at the end of the interview, respondents were asked if they were pregnant. Items were included in the questionnaire concerning respondents' ages, alcohol use during the past month, marital status, use of tobacco, and other items. Those who used alcohol were classified as current drinkers (had drunk alcohol in the past month); binge drinkers (had five or more drinks consumed on at least one occasion in the past month); or heavier drinkers (averaged two or more drinks per day). Results showed that pregnant women were less than half as likely as nonpregnant women to say they had consumed an alcoholic beverage in the past month (25 percent versus 55 percent). They were also less likely to have indulged in binge drinking (3 percent versus 12 percent) or heavier drinking (0.6 percent versus 2.5 percent). Women who were pregnant and smoked, were unmarried, college graduates, or aged between 35 and 45, were more likely to consume alcohol than pregnant women who lacked these characteristics. A smaller proportion of pregnant women used alcohol in 1988 (20 percent) than 1985 (32 percent); the proportion of nonpregnant women who used alcohol decreased only slightly (from 57 percent to 53 percent) during those same years. Pregnant women who had used alcohol in the past month had consumed an average of 4.2 drinks in the month; for nonpregnant women, the value was 8.7 drinks. Overall, the prevalence of alcohol use among pregnant women declined by 38 percent in the time studied, but this was not true among unmarried women, smokers, or the least educated or youngest women. In addition, when women did drink during pregnancy, their average number of drinks had not lessened in more recent years. (Consumer Summary produced by Reliance Medical Information, Inc.)

We report the first national data on smoking before, during, and after pregnancy. Estimates are based on the 1986 Linked Telephone Survey that reinterviewed 1,550 White women 20--44 years of age who were respondents to the 1985 National Health Interview Survey. An estimated 39 percent of White women who had smoked before pregnancy quit smoking while pregnant (27 percent when they found out they were pregnant and 12 percent later during pregnancy). Women with less than 12 years of education were five times as likely to smoke and one-fourth as likely to quit as those with 16 or more years of education. Women who smoked more than one pack of cigarettes per day before pregnancy were one-fifth as likely to quit as those smoking less. Of the women who quit, 70 percent resumed smoking within one year of delivery. Of those who relapsed, 67 percent resumed smoking within three months of delivery and 93 percent within six months. There is little evidence of educational differentials in relapse rates. The fact that relapse remains high suggests that while health of the fetus is a strong influence on women's smoking habits, women may be less aware of the effect of passive smoke on the infant. (Am J Public Health 1990; 80:541-544.), The first national data on smoking by women before, during and after pregnancy are reported. Increased risks of fetal and infant death and injury, and low birth weight have been linked to maternal smoking. Participants in the 1985 National Health Interview Survey (NHIS) were re-interviewed for the 1986 Linked Telephone Survey; the study reports the frequency and timing of relapse among women who quit smoking during their pregnancies. The target population consisted of 2,000 women, who were 18 to 44 years old and who were either pregnant during the 1985 NHIS or whose most recent birth occurred within the five years prior to NHIS. As relatively few black women and white teenagers were included in the sample, the analysis was limited to white women 20 to 44 years of age; 1550 women participated. Pregnant women appear to quit smoking at a greater rate than the general population; 39 percent of the subjects who smoked before pregnancy quit during pregnancy, and most of them stopped smoking when they discovered they were pregnant as opposed to later in pregnancy. The relapse rate for this group is somewhat less than that for quitters in the total population; 70 percent of the sample began smoking again in the first year after the baby was born. The impact on the health of the fetus is a factor governing smoking during pregnancy. The deleterious effects of smoking during pregnancy and passive secondary smoke on infants and children of relapsed smokers should be a major component in prenatal education and intervention programs. While many women are concerned about the negative effects of smoking on the unborn child, the high relapse rate suggests that fewer mothers understand the health risks of passive smoking for the infant. (Consumer Summary produced by Reliance Medical Information, Inc.)

Federal law requires cigarette companies to display conspicuously in advertisements and on cigarette packages one of four health warnings from the Surgeon General regarding the health risks of smoking cigarettes. The ability to read such warnings on two outdoor media, billboards and advertisements on taxicabs, was investigated. On street billboards, 46 percent of the warning captions were readable, while on highway billboards, the readability dropped to 5 percent. However, the brand name and other notable images contained in the advertisement could be recognized more than 95 percent of the time. Observers of 100 taxicab advertisements were unable to read the Surgeon General's health warning in any of them, although brand name and notable imagery were identified in 95 percent of the ads. Factors influencing the inability to read outdoor advertisements included the size of the letters, the length of the health message, and the distance and movement between the ads and the observer. It is concluded that the legally mandated health warning is unreadable in a majority of current forms used in billboard and taxicab advertisements., Outdoor advertising media represent a major vehicle by which cigarette companies promote their products. We investigated the readability of the Surgeon General's warning in cigarette advertisements (ads) in two outdoor media: billboards and taxicab ads. In an experiment in metropolitan Atlanta under typical driving conditions, observes were able to read the entire health warning on 18 (46%) of 39 street billboards but on only two (5%) of 39 highway billboards. In contrast, the content of the ads (ie, brand name, other wording, and notable imagery) could be recognized under the same conditions on more than 95% of the billboards. In a similar study of 100 taxicab cigarette ads in New York City, observes were unable to read the health warning in any of the ads but were able to identify the brand name in all ads and notable imagery in 95% of the ads. Significant differences between the readability of the warning and identification of the advertising content persisted even when partially read warnings were considered to have been read. We conclude that the Surgeon General's warning is not readable in its current form in the vast majority of billboard and taxicab ads. Factors contributing to unreadability include the small size of the letters, the excessive length of the warnings, the distance between the viewers and the ads, and movement between the viewers and the ads.

One of the nation's health goals is to reduce the number of pregnant women who smoke, so that pregnant women are half as likely as nonpregnant women to smoke by 1990. To evaluate the progress toward this goal, the prevalence of smoking reported by 836 pregnant women was compared to that of 18025 nonpregnant women in 1985 and 1986. Pregnant women were 70 percent as likely to smoke cigarettes as nonpregnant women. Comparisons were also made with regard to race and marital status. Differences in smoking prevalence occurred because pregnant women were more likely to have stopped smoking rather than being more likely to have smoked at all. Also, unmarried pregnant white women were 40 percent more likely to smoke than single nonpregnant white women. Based on the findings, the national health goal seems unlikely to be achieved by 1990, and it is recommended that physicians spend more time counseling pregnant women who smoke to quit the habit.