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Background: Home visits prior to inpatient rehabilitation facility (IRF) discharge allow occupational therapists to observe functional abilities among patients with stroke and address barriers that impact daily activities at home. However, home visits prior to IRF discharge are not standard practice due to barriers of time and cost constraints. We explored whether an access visit (visiting the home without the patient) could serve as an alternative to a home visit (with the patient) to anticipate functional abilities at home. Methods: We used baseline data from a randomized controlled trial that occurred before and during the COVID-19 pandemic, which caused predischarge home visits to be modified to access visits without the participant. Participants had suffered a stroke and were treated in an IRF, aged ≥ 50, with plans to discharge home. International Classification of Functioning, Disability, and Health (ICF) qualifier scores were compared between participants' home/access visits and IRF discharge. ICF scores were compared between predischarge home visits and IRF discharge and between access visits and IRF discharge using Wilcoxon signed-rank tests. Differences in ICF scores between home/access and IRF discharge were compared between home and access visits using linear regression models. Results: Among 99 participants (58% men, average 67 years old, 60% Black), 57 received a home visit and 42 received an access visit. Both groups had significantly worse ICF scores at the home/access visit compared to IRF discharge for most activities. Differences in scores between home visit and IRF were significantly greater than between access and IRF for bathing, upper and lower body dressing, bed/chair transfer, walking, and navigating stairs. The largest differences between home and access visits were for walking (β = 1.05 95% CI 0.46 to 1.64) and going up and down stairs (β = 0.87 95% CI 0.25 to 1.49). Conclusions: Participants with stroke had greater difficulty performing daily activities in both home and access visits than at the IRF, but observed differences were greater for home visits than access visits. While access visits may be beneficial to anticipate functional abilities in the home when home visits cannot occur, visiting the home to directly observe patients' performance is ideal. Trial registration: Registered on 3/26/2018 at clinicaltrials.gov, NCT03485820. [ABSTRACT FROM AUTHOR]

Introduction: People ageing with long-term physical disabilities face unique challenges to maintaining independence. We developed a novel, evidence-based intervention – Removing Environmental Barriers to Independent Living – to support participation and reduce falls. Methods: To examine Removing environmental barriers to independent living's feasibility and estimate its magnitude of efficacy, we conducted a single-blinded randomised controlled trial. Fifty participants who were aged 45–65 years with a physical disability for at least 5 years were randomised to intervention (n = 24) or control (n = 26). Activity performance, environmental barriers to performance, community participation, environmental fall hazards and fall prevention behaviours were assessed at baseline and at 6-month follow-up. Dose, adherence, fidelity and cost were examined. Linear mixed-effects models for repeated measures were used to assess the effects of time, group and group by time interaction on the continuous outcomes. Results: Removing environmental barriers to independent living had high fidelity and adherence and a low implementation cost. There were trends for greater improvements in activity limitations and activity performance among intervention versus control participants. Conclusion: Removing environmental barriers to independent living is a feasible intervention with high fidelity and adherence. Findings trended towards greater improvements in activity performance for intervention participants. Results could inform future planning for a larger pragmatic trial. [ABSTRACT FROM AUTHOR]

It is evident that father engagement in parenting contributes to child well-being, and fatherhood programs effectively enhance father engagement and employment outcomes. However, program effectiveness can be compromised if participating fathers drop out. This study investigates factors associated with program engagement (i.e., initiating treatment) and completion (i.e., attending 75% or more sessions) with a sample of primarily African American fathers recruited from a community-based organization in the United States (n = 691). The analysis showed that nearly one-third (31%) of enrolled fathers did not attend any program session, and just over half (55%) of those who attended at least one session completed the program. Being older was associated with program engagement, while having a high school diploma and being ordered by the court to pay child support were associated with program completion. Fathers expressed several barriers to program participation, including programmatic and institutional issues (Rules and Staff, Fit Misaligned with Needs), as well as scheduling and external factors (Job-Related Conflict, Logistic Issues, Challenging Life Events). These findings highlight the importance of identifying participant motivation, addressing life challenges, and implementing strengths-based practices in fatherhood programs to make fathers feel seen, welcomed, and supported. [ABSTRACT FROM AUTHOR]

Background: Falls are the leading cause of injury, disability, premature institutionalization, and injury‐related mortality among older adults. Home hazard removal can effectively reduce falls in this population but is not implemented as standard practice. This study translated an evidence‐based home hazard removal program (HARP) for delivery in low‐income senior apartments to test whether the intervention would work in the "real world." Methods: From May 1, 2019 to December 31, 2020, a stepped‐wedge cluster‐randomized trial was used to implement the evidence‐based HARP among residents with high fall risk in 11 low‐income senior apartment buildings. Five clusters of buildings were randomly assigned an intervention allocation sequence. Three‐level negative‐binomial models (repeated measures nested within individuals, individuals nested within buildings) were used to compare fall rates between treatment and control conditions (excluding a crossover period), controlling for demographic characteristics, fall risk, and time period. Results: Among 656 residents, 548 agreed to screening, 435 were eligible (high fall risk), and 291 agreed to participate and received HARP. Participants were, on average, 72 years, 67% female, and 76% Black. Approximately 95.4% of fall prevention strategies and modifications implemented were still used 3 months later. The fall rate (per 1000 participant‐days) was 4.87 during the control period and 4.31 during the posttreatment period. After adjusting for covariates and secular trend, there was no significant difference in fall rate (incidence rate ratio [IRR] 0.97, 95% CI 0.66–1.42). After excluding data collected during a hiatus in the intervention due to COVID‐19, the reduction in fall rate was not significant (IRR 0.93, 95% CI 0.62–1.40). Conclusions: Although HARP did not significantly reduce the rate of falls, this pragmatic study showed that the program was feasible to deliver in low‐income senior housing and was acceptable among residents. There was effective collaboration between researchers and community agency staff. [ABSTRACT FROM AUTHOR]

We examined substance use onset and associations with pregnancy by age 15 years. Participants were girls ages 15 years or younger (weighted n = 8319) from the 1999-2003 Youth Risk Behavior Surveillance System (YRBS). Multivariable logistic regression examined pregnancy as a function of substance use onset (i.e., age 10 years or younger, 11-12, 13-14, and age 15 years) for alcohol, cigarettes and marijuana, controlling for race/ethnicity and metropolitan location. Of girls pregnant by age 15 years (3% of the sample, weighted n = 243), 16% had smoked marijuana by age 10 years and over 20% had smoked cigarettes and initiated alcohol use by age 10 years. In the multivariable analysis, marijuana use by age 14 years and/or cigarette smoking by age 12 years clearly distinguished girls who became pregnant by age 15 years and is perhaps due to a common underlying risk factor. (Contains 2 tables.)

Author(s): Patricia A. Cavazos-Rehg[sup.1] , Melissa J. Krauss[sup.1] , Edward L. Spitznagel[sup.2] , Kerry Bommarito[sup.3] , Tessa Madden[sup.4] , Margaret A. Olsen[sup.3] [sup.5] , Harini Subramaniam[sup.3] , Jeffrey F. Peipert[sup.4] [...], We utilized an updated nationally representative database to examine associations between maternal age and prevalence of maternal morbidity during complications of labor and delivery. We used hospital inpatient billing data from the 2009 United States Nationwide Inpatient Sample, part of the Healthcare Cost and Utilization Project. To determine whether the likelihood that maternal morbidity during complications of labor and delivery differed among age groups, separate logistic regression models were run for each complication. Age was the main independent variable of interest. In analyses that controlled for demographics and clinical confounders, we found that complications with the highest odds among women, 11-18 years of age, compared to 25-29 year old women, included preterm delivery, chorioamnionitis, endometritis, and mild preeclampsia. Pregnant women who were 15-19 years old had greater odds for severe preeclampsia, eclampsia, postpartum hemorrhage, poor fetal growth, and fetal distress. Pregnant women who were [greater than or equal to]35 years old had greater odds for preterm delivery, hypertension, superimposed preeclampsia, severe preeclampsia, and decreased risk for chorioamnionitis. Older women ([greater than or equal to]40 years old) had increased odds for mild preeclampsia, fetal distress, and poor fetal growth. Our findings underscore the need for pregnant women to be aware of the risks associated with extremes of age so that they can watch for signs and symptoms of such complications.

Introduction In 2009, US teenage birth rates hit a record low at 39.1 per 1,000 teenage women ages 15-19 [1]. Yet, enthusiasm over the progress made in declining teenage birthrates [...], To investigate factors associated with favorable pregnancy attitudes among teenage girls. Participants were sexually active teenage girls aged 15-18 years old (n = 965) who took part in the 2002 or 2006-2010 National Survey of Family Growth (NSFG). Multinomial multivariable logistic regression was used to assess the likelihood of being pleased with a teenage pregnancy. Sixteen percent of sexually active teenage girls (n = 164) would be pleased (11 % a little pleased, 5 % very pleased) if they became pregnant. In a multivariable model, participants who had not yet discussed sexual health topics (i.e., how to say no to sexual intercourse or birth control) or had only discussed birth control with a parent were more likely to be very pleased with a teenage pregnancy than participants who had discussed both topics with a parent. Prior pregnancy, racial/ethnic group status, older age, and having parents with a high school education or less also increased the odds of being pleased with a teenage pregnancy. Being pleased with a teenage pregnancy was correlated with a lack of discussion of sexual health topics with parents, prior pregnancy, and sociodemographic factors (having less educated parents, racial/ethnic group status). Pregnancy prevention efforts can be improved by acknowledging the structural and cultural factors that shape teenage pregnancy attitudes. Keywords Teenage pregnancy * Sexual education * Sexual health * Sexual behaviors--adolescent

CHILDREN BORN TO ADOLESCENT MOTHERS are at high risk for premature birth, low birth weight, cognitive deficits, mental health problems, maltreatment, poverty, and death (Fergusson and Woodward, 1999; Overpeck et [...], Objective: The present study examined the associations between initiation and intensity of substance use and with sexual experience with and without a history of teenage pregnancy. Method: Participants were high school females (weighted n = 3,45l) who participated in the 1999-2003 Youth Risk Behavior Surveillance System, a cross-sectional, nationally representative survey. Multinomial multivariable logistic regression was used to assess the likelihood of being sexually experienced (but never pregnant) and teenage pregnancy (reference group: never had sexual intercourse) as a function of age at substance use initiation (i.e., age 12 or younger, 13-14 years of age, and age 15 or older) and intensity of substance use (i.e., nonuser, experimental/ new or nondaily, nonexperimental/daily user) for alcohol, cigarettes, and marijuana, while controlling for race/ethnicity, metropolitan location, symptoms of depression, and illegal drug availability at school. Results: A major finding of our study is that substance use behaviors across each substance (alcohol, cigarettes, and marijuana) independently contributed to an increased risk in sexual intercourse experience with and without a history of teenage pregnancy (vs. nonsexually experienced females). A dose-response relationship was also observed between an increased likelihood of a teenage pregnancy and marijuana behaviors. Furthermore, the risk for teenage pregnancy was compounded for daily cigarette smokers who initiated use at age 12 or younger. Conclusions: Screening substance use behaviors can help to identify girls who may benefit from pregnancy prevention strategies. Targeting cigarette and marijuana behaviors as early as age 12 or younger may provide an added benefit. Prevention strategies should also consider the role of race above and beyond substance use behaviors. (J. Stud. Alcohol Drugs, 72, 194-198, 2011)