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ABSTRACT: PURPOSE: To prospectively determine whether individual, family, and community assets help youth to delay initiation of sexual intercourse (ISI); and for youth who do initiate intercourse, to use birth control and avoid pregnancy. The potential influence of neighborhood conditions was also investigated. METHODS: The Youth Asset Study was a 4-year longitudinal study involving 1,089 youth (mean age = 14.2 years, standard deviation = 1.6; 53% female; 40% white, 28% Hispanic, 23% African American, 9% other race) and their parents. Participants were living in randomly selected census tracts. We accomplished recruitment via door-to-door canvassing. We interviewed one youth and one parent from each household annually. We assessed 17 youth assets (e.g., responsible choices, family communication) believed to influence behavior at multiple levels via in-person interviews methodology. Trained raters who conducted annual windshield tours assessed neighborhood conditions. RESULTS: Cox proportional hazard or marginal logistic regression modeling indicated that 11 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for ISI; seven assets (e.g., educational aspirations for the future, responsible choices) were significantly associated with increased use of birth control at last sex; and 10 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for pregnancy. Total asset score was significantly associated with all three outcomes. Positive neighborhood conditions were significantly associated with increased birth control use, but not with ISI or pregnancy. CONCLUSIONS: Programming to strengthen youth assets may be a promising strategy for reducing youth sexual risk behaviors.
Journal of Adolescent Health 02/2013; · 3.33 Impact Factor
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ABSTRACT: Assess whether the 55% increase in Florida's Hispanic infant mortality rate (HIMR) during 2004-2007 was real or artifactual. Using linked data from Florida resident live births and infant deaths for 2004-2007, we calculated traditional (infant Hispanic ethnicity from death certificates and maternal Hispanic ethnicity from birth certificates) and nontraditional (infant and maternal Hispanic ethnicity from birth certificate maternal ethnicity) HIMRs. We assessed trends in HIMRs (per 1,000 live births) using Chi-square statistics. We tested agreement in Hispanic ethnicity after implementation of a revised 2005 death certificate by using kappa statistics and used logistic regression to test the associations of infant mortality risk factors. Hispanic was defined as being of Mexican, Puerto Rican, Cuban, Central/South American, or other/unknown Hispanic origin. During 2004-2007 traditional HIMR increased 55%, from 4.0 to 6.2 (Chi-square, P < 0.001) and nontraditional HIMR increased 20%, from 4.5 to 5.4 (Chi-square, P = 0.03). During 2004-2005, agreement in Hispanic ethnicity did not change with use of the revised certificate (kappa = 0.70 in 2004; kappa = 0.76 in 2005). Birth weight was the most significant risk factor for trends in Hispanic infant mortality (OR = 1.33, 95% CI = 1.10-1.61). Differences in Hispanic reporting on revised death certificates likely accounted for the majority of traditional HIMR increase, indicating a primarily artifactual increase. Reasons for the 20% increase in nontraditional HIMR during 2004-2007 should be further explored through other individual and community factors. Use of nontraditional HIMRs, which use a consistent source of Hispanic classification, should be considered.
Maternal and Child Health Journal 10/2011; 16(6):1188-96. · 2.24 Impact Factor
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Deborah L Dee, Diana M Bensyl,
Jacqueline Gindler,
Benedict I Truman,
Barbara G Allen,
Tiffany D'Mello,
Alejandro Pérez,
Laurie Kamimoto,
Matthew Biggerstaff,
Lenee Blanton,
Ashley Fowlkes,
Maleeka J Glover,
David L Swerdlow,
Lyn Finelli
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ABSTRACT: Concerns have been raised regarding possible racial-ethnic disparities in 2009 pandemic influenza A (H1N1) (pH1N1) illness severity and health consequences for U.S. minority populations.
Using data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, Emerging Infections Program Influenza-Associated Hospitalization Surveillance, and Influenza-Associated Pediatric Mortality Surveillance, we calculated race-ethnicity-specific, age-adjusted rates of self-reported influenza-like illness (ILI) and pH1N1-associated hospitalizations. We used χ(2) tests to evaluate racial-ethnic disparities in ILI-associated health care-seeking behavior and pH1N1 hospitalization. To evaluate pediatric deaths, we compared racial-ethnic proportions of deaths against U.S. population distributions.
Prevalence of self-reported ILI was lower among Hispanics (6.5%), higher among American Indians/Alaska Natives (16.2%), and similar among non-Hispanic blacks (7.7%) compared with non-Hispanic whites (8.5%). No racial-ethnic differences were identified in ILI-associated health care-seeking behavior. Age-adjusted pH1N1-associated Emerging Infections Program hospitalization rates were higher among all minority populations (range: 8.1-10.9/100,000 population) compared with non-Hispanic whites (3.0/100,000). The proportion of pH1N1-associated pediatric deaths was higher than expected among Hispanics (31%) and lower than expected among non-Hispanic whites (45%) given the proportions of the U.S. population they comprise (22% and 58%, respectively).
Racial-ethnic disparities in pH1N1-associated hospitalizations and pediatric deaths were identified. Vaccination remains the primary intervention for preventing influenza.
Annals of epidemiology 08/2011; 21(8):623-30. · 2.95 Impact Factor
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ABSTRACT: Childhood obesity is a major public health concern and is associated with substantial morbidities. Access to less-healthy foods might facilitate dietary behaviors that contribute to obesity. However, less-healthy foods are usually available in school vending machines. This cross-sectional study examined the prevalence of students buying snacks or beverages from school vending machines instead of buying school lunch and predictors of this behavior. Analyses were based on the 2003 Florida Youth Physical Activity and Nutrition Survey using a representative sample of 4,322 students in grades six through eight in 73 Florida public middle schools. Analyses included χ2 tests and logistic regression. The outcome measure was buying a snack or beverage from vending machines 2 or more days during the previous 5 days instead of buying lunch. The survey response rate was 72%. Eighteen percent of respondents reported purchasing a snack or beverage from a vending machine 2 or more days during the previous 5 school days instead of buying school lunch. Although healthier options were available, the most commonly purchased vending machine items were chips, pretzels/crackers, candy bars, soda, and sport drinks. More students chose snacks or beverages instead of lunch in schools where beverage vending machines were also available than did students in schools where beverage vending machines were unavailable: 19% and 7%, respectively (P≤0.05). The strongest risk factor for buying snacks or beverages from vending machines instead of buying school lunch was availability of beverage vending machines in schools (adjusted odds ratio=3.5; 95% confidence interval, 2.2 to 5.7). Other statistically significant risk factors were smoking, non-Hispanic black race/ethnicity, Hispanic ethnicity, and older age. Although healthier choices were available, the most common choices were the less-healthy foods. Schools should consider developing policies to reduce the availability of less-healthy choices in vending machines and to reduce access to beverage vending machines.
Journal of the American Dietetic Association 10/2010; 110(10):1532-6. · 3.59 Impact Factor
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ABSTRACT: We investigated the association between 2009 IOM recommendations and adverse infant outcomes by maternal prepregnancy body mass index (BMI). Birth outcomes for 570,672 women aged 18-40 years with a singleton full-term live-birth were assessed using 2004-2007 Florida live-birth certificates. Outcomes included large-for-gestational-age (LGA) and small-for-gestational-age (SGA). Associations between gestational weight change and outcomes were assessed for 10 BMI groups by calculating proportions, and logistic regression modeling was used to produce adjusted odds ratios (aORs) to account for the effect of confounders. We created comparison categories below and above recommendations using 2009 IOM recommendations as a reference. Of importance, 41.6% of women began pregnancy as overweight and obese and 51.2% gained weight excessively during pregnancy on the basis of 2009 IOM recommendations. Proportions of LGA were higher among obese women and increased with higher weight gain. Compared with recommended weight gain, aORs for LGA were lower with less than recommended gain (aOR range: 0.27-0.77) and higher with more than recommended gain (aOR range: 1.27-5.99). However, SGA was less prevalent among obese women, and the proportion of SGA by BMI was similar with higher weight gain. Gain less than recommended was associated with increased odds of SGA (aOR range: 1.11-2.97), and gain greater than recommended was associated with decreased odds of SGA (aOR range: 0.38-0.83). Gestational weight gain influenced the risk for LGA and SGA in opposite directions. Minimal weight gain or weight loss lowered risk for LGA among obese women. Compared with 1990 IOM recommendations, 2009 recommendations include weight gain ranges that are associated with lower risk of LGA and higher risk of SGA. Awareness of these tradeoffs may assist with clinical implementation of the 2009 IOM gestational weight gain recommendations. However, our results did not consider other maternal and infant outcomes related to gestational weight gain; therefore, the findings should be interpreted with caution.
Maternal and Child Health Journal 03/2010; 15(3):289-301. · 2.24 Impact Factor
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ABSTRACT: Contraceptive use is an important determinant of unintended pregnancy. In the United States, approximately half of all pregnancies are unintended. Population-based information about contraceptive use patterns is limited at the state level. Information about contraceptive use for states can be used to guide the development of state programs and policies to decrease unintended pregnancy and the spread of sexually transmitted infections. Information about contraceptive use for specific subpopulations can be used to further refine state efforts to improve contraceptive use and subsequently decrease the occurrence of unintended pregnancy.
Data were collected in 2002 for men and women.
The Behavioral Risk Factor Surveillance System (BRFSS) is a random-digit--dialed, telephone survey of the noninstitutionalized U.S. population aged > or =18 years. All 50 states, the District of Columbia, Guam, the Commonwealth of Puerto Rico, and the U.S. Virgin Islands participated in BRFSS in 2002. These data can be used to track state progress towards the national health objectives for 2010 for responsible sexual behavior. The 2002 BRFSS data represent the first time state data on contraceptive use in all 50 states will be presented and examined by selected sociodemographic characteristics. The 2002 BRFSS also, for the first time, provided an opportunity to examine state-level contraceptive use patterns among men.
Variation across states and territories was observed for the majority of contraceptive methods among the different demographics analyzed and among men and women. The percentage of men and women at risk for pregnancy who said they or their partner was using birth control was high overall and ranged from 67% (Guam) to 88% (Idaho). Oral contraceptives (i.e., the pill), vasectomy, tubal ligation, and condoms were the methods most frequently reported by both male and female respondents who said they or their partner was using birth control. Among female respondents using birth control, the pill was the most common method reported. Among men, vasectomy was the most commonly reported method. The prevalence of use for the four most commonly reported methods (pills, vasectomy, tubal ligation, condoms) varied as much as six-fold among states for vasectomy and three- to four-fold for condoms, pills, and tubal ligation.
The findings in this report document substantial differences among states and sociodemographic groups within states in contraceptive method use.
These data can help states identify populations with an unmet need for birth control, barriers to birth control use, and gaps in the range of birth control methods offered by health-care providers. An analysis of the prevalence of birth control use by state and selected population characteristics can help states target contraceptive programs to best meet the needs of their population.
MMWR. Surveillance summaries: Morbidity and mortality weekly report. Surveillance summaries / CDC 11/2005; 54(6):1-72.
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ABSTRACT: Women with chronic medical conditions are at increased risk for adverse pregnancy outcomes, yet contraceptive use by these women has not been well described. The purpose of this study was to describe contraceptive use by diabetic and overweight/obese women compared with women without these conditions.
Using cross-sectional data from the 11 states participating in the optional Family Planning Module of the Behavioral Risk Factor Surveillance System in 2000, we analyzed contraceptive use among 7,943 sexually active women of reproductive age (18-44) who were not trying to conceive. Using logistic regression techniques, we modeled the effect of diabetes and overweight/obesity on contraceptive nonuse, controlling for age, race/ethnicity, marital status, education, income, and health insurance coverage.
Contraceptive nonuse was reported by 1,500 (18.9%) of the total sample, 31 (25.8%) diabetic women, 371 (20.0%) overweight women, and 385 (23.4%) obese women. In the multivariable model, obesity was significantly associated with contraceptive nonuse (adjusted odds ratio [OR] 1.34, 95% confidence interval [CI] 1.16-1.55), but there were no significant differences in contraceptive nonuse for diabetic women (adjusted OR 1.23, 95% CI 0.80-1.87) or overweight women (adjusted OR 1.14, 95% CI 0.99-1.31). Older, Black, Hispanic, married, less educated, and women without health insurance were more likely to report contraceptive nonuse.
Among women with need for contraception, obese women were more likely to report contraceptive nonuse than normal weight women. Because women with chronic conditions like obesity are at higher risk of pregnancy-related complications and adverse pregnancy outcomes, proper contraceptive use and unintended pregnancy avoidance is a priority.
Women s Health Issues 15(4):167-73. · 1.61 Impact Factor
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ABSTRACT: Evaluate youth assets or potential strengths and sexual intercourse associations by household income.
Data consisted of youth and parent responses from randomly selected households from a cross-sectional study and wave one of a longitudinal extension of that study. Youth assets and sexual intercourse were compared for four income categories.
Midwestern racially diverse, inner-city neighborhoods.
One adolescent (12-19 years) and one parent (2335 pairs).
Adjusted odds ratios (ORs) were calculated using logistic regression. Variables assessed included parent and youth demographics, youth sexual intercourse, and youth assets (adult and peer role models, family communication, use of time [religion or sports], community involvement, future aspirations, responsible choices, and health practices).
Youths' mean age was 14.9 (± 1.8) years, and 52% were female; 44% of respondents were white. Use of time (religion) was significantly associated with never having sex for all but the lowest income youth (OR range=1.79-2.64). The variable peer role models was significant for the lowest income (O =2.01) and two upper income groups (ORs=2.52 and 4.27, respectively). The variable future aspirations was significant for the lowest income youth (OR=1.77).
The youth asset variable future aspirations was critical for the lowest income households. Other asset variables, such as peer role models and use of time (religion) were critical regardless of income.
American journal of health promotion: AJHP 25(5):301-9. · 2.37 Impact Factor
