D J Petersen

University of Alabama at Birmingham, Birmingham, Alabama, United States

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Publications (12)27.92 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: In 1995, the Association of Teachers of Maternal and Child Health (ATMCH) decided that information about the employment status of program graduates was essential to attempts to improve MCH curricula. ATMCH requested information from 13 MCH programs in schools of public health funded by the federal Maternal and Child Health Bureau and 12 provided information about their master's degree graduates in the 1990-1994 period, including the year of graduation, degree, Bureau traineeship support, position held, and employing agency. The total number of graduates was 742. Four programs averaged less than 8 graduates per year (small); six, 10-16 (midsize); and two more than 22 (large). More than 90% of graduates received a M.P.H. In the 10 programs that provided data on Bureau support, 46% received traineeship support from the Bureau. Midsize programs had the largest percentage of graduates receiving traineeship support. Overall, 45% of graduates were in administrative positions, 32% were involved in patient care, 20% were in policy-analytic positions, and 3% in other positions. Forty-seven percent of program graduates entered into or continued in community-based agencies, 18% in government agencies, 17% in academic or research agencies, and 18% in other agencies. Program size was significantly associated with both position and the agency in which the graduate was employed. Bureau traineeship support was associated with employing agency. The study suggests the need for changes in MCH curricula, enhanced education opportunities in specialty skill areas, and an ongoing survey of graduates of MCH programs.
    Maternal and Child Health Journal 07/1997; 1(2):121-7. · 2.24 Impact Factor
  • D J Petersen
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    ABSTRACT: One of the goals of the Maternal and Child Health Journal is to encourage professional development. This letter was written to the Editor in light-hearted spirit to convey the true challenge such a goal poses for the journal and the profession.
    Maternal and Child Health Journal 04/1997; 1(1):65-6. DOI:10.1023/A:1026232604530 · 2.24 Impact Factor
  • G R Alexander, D J Petersen
    Journal of Perinatology 01/1995; 15(6):439-40. · 2.35 Impact Factor
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    ABSTRACT: We conducted an analysis of prenatal care utilization among Minnesota resident mothers for the years 1990 to 1991 to determine why this state ranks poorly in prenatal care use while its infant mortality rate is one of the lowest in the nation. We found that 6% of women began care in the first trimester yet did not receive an adequate number of visits. These women were more likely to deliver preterm, low birthweight infants than women who started care later. Fifteen percent of women had records missing important data, and these women also had higher rates of poor pregnancy outcomes. Our findings have implications for maternal outreach and follow-up efforts and suggest potential benefits from private and public health collaborations. In addition, efforts to improve the quality of data reporting should begin immediately.
    Minnesota medicine 08/1994; 77(7):41-5.
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    ABSTRACT: Recent expansions in eligibility for coverage of prenatal care services by the Medicaid program reflect national initiatives to improve pregnancy outcomes. This study investigates the potential impact that completeness of reporting of prenatal care and gestational age variables and strategies to impute missing data may have on evaluations of the Medicaid expansion. This study, examining 15 years of vital record data from a single state and comparing 1 year of data from four mid-Atlantic states, selected single live births to resident mothers for analyses. The "day 15" and the "preceding case" methods were used to impute missing gestational age data. Considerable temporal and geographic variation was detected in completeness of reporting of variables used to construct prenatal care indices. After imputing values for cases with missing data, the proportion of cases for which adequacy of prenatal care utilization could not be determined ranged from 3% to 24% among the states investigated. For those cases where gestational age data could be imputed, the distribution of prenatal care utilization was not markedly disparate from those cases with complete reporting of gestational age. The results indicate that variations in reporting, decisions regarding the treatment of missing data, and the choice of the denominator can alter prenatal care utilization percentages and have implications for evaluations of the impact of the recent Medicaid expansion on prenatal care utilization.
    American Journal of Public Health 09/1991; 81(8):1013-6. DOI:10.2105/AJPH.81.8.1013 · 4.23 Impact Factor
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    ABSTRACT: Utilizing the 1980 Induced Abortion File maintained by the National Center for Health Statistics, we compared gestational age from date of last normal menses and the physician-based estimate of gestational age. An average .51 week difference between the two methods was observed. Beyond seven weeks gestation, the date of last normal menses value was underestimated by the physician-based estimate with a markedly greater divergence after 20 weeks. A relatively greater underestimation of the date of last normal menses interval by the physician estimate was apparent for Whites after 13 weeks. The data of last normal menses value for non-state residents was overestimated across the entire range of the date of last normal menses gestational age distribution until 21 weeks.
    American Journal of Public Health 06/1989; 79(5):603-6. DOI:10.2105/AJPH.79.5.603 · 4.23 Impact Factor
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    ABSTRACT: Utilizing 10,587 cases from the 1980 National Center for Health Statistics Fetal Death Statistics File, we examined the comparability of two methods of determining the gestational age of a fetal death, the calculated interval from date of last normal menses (DLNM) and the physician's estimate. The physician estimated gestational age distribution exhibits even number digit preference and a distinct clustering at the 40-week value. The DLNM distribution appears more smoothly distributed but with a more pronounced post-term tail. An exact agreement between the two methods is observed in only 27.9 per cent of the cases. A 1.7 week mean difference between the methods indicates a systematic underestimation by physician reported gestational age when compared to that calculated from the DLNM, potentially biasing gestational age distributions when the physician estimate is substituted for cases with a missing DLNM. Over 8 per cent of cases 20+ weeks by DLNM are estimated as less than 20 weeks by the physician. This underestimation has important implications for the completeness of reporting of fetal deaths on vital records and the comparability of fetal death rates. Further, it may limit investigations of the completeness of reporting of less than 500 gram live births.
    American Journal of Public Health 06/1989; 79(5):600-2. DOI:10.2105/AJPH.79.5.600 · 4.23 Impact Factor
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    ABSTRACT: Using South Carolina vital record data, we examined current trends in teenage pregnancy and the related pregnancy outcome risks for the period 1977 to 1984. A review of the eight-year trends in the pregnancy outcomes of teenaged mothers (less than 18 years old) indicated a significant decline (P less than .05) in the percentage of total South Carolina live infants born to teenaged mothers. While a significant increase in the teenage abortion ratio was detected, the proportion of total South Carolina pregnancies (estimated by the summation of live births, fetal deaths, and induced abortions) among teenagers significantly decreased. Compared to mothers 18 to 34 years old, teenaged mothers were nearly twice as likely to deliver prematurely, while one half as likely to receive adequate prenatal care. Their offspring were at increased risk of low birth weight and had increased fetal and infant death rates. Thirty percent of pregnancies in teenaged mothers were terminated by induced abortion, and 22% of the teenage pregnancies were to mothers aged 15 or younger, emphasizing the importance of not delaying discussions with teens of the issues of adolescent sexuality and contraception.
    Southern Medical Journal 06/1987; 80(5):581-4, 596. DOI:10.1097/00007611-198705000-00009 · 1.12 Impact Factor
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    ABSTRACT: This study examines the comparability between the last menstrual period-based and clinically estimated gestational age as collected on certificates of live birth. It explores whether sociodemographic or delivery characteristics influence their agreement and contrasts health status and health care utilization indicators, such as preterm, small for gestational age, and adequacy of prenatal care percentages, produced by each gestational age measure. The 1989-91 South Carolina public use live birth files were used for this analysis. A total of 169,082 single births to resident mothers were selected for investigation. The clinically estimated gestational age distribution exhibited a higher mean and a tendency toward even number digit preference. The last menstrual period-based measure produced higher preterm and postterm percentages. More than 60 percent of the last menstrual period-based preterm births were classified as preterm by the clinical estimate. The sensitivity of the clinical estimate was 27 percent for postterm births. The overall concordance (the percentage of cases with the same value for both measures) was 47 percent, but it varied considerably by gestational age. Between 30 and 35 weeks, the clinical estimate exceeded the last menstrual period-based value by 2 weeks or more for more than 40 percent of the cases. Concordance also varied by race of mother, hospital delivery size, trimester prenatal care began, and birth weight. The last menstrual period-based and the clinically estimated gestational age distributions exhibited notable dissimilarities, produced marked differences in health status indicators, and varied in concordance by gestational age and by sociodemographic, prenatal care, and hospital characteristics. These systematic differences suggest that a transition from the traditionally used last menstrual period-based measure to the clinical estimate or a composite measure will not produce uniform results across geo-political areas and at-risk groups but will be appreciably influenced by population and health care characteristics.
    Public Health Reports 110(4):395-402. · 1.64 Impact Factor
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    ABSTRACT: The objectives of this study are to examine the influence of paternal and maternal education and marital status on the initiation and adequate use of prenatal care services. Data were obtained from the 1990-1991 Minnesota Live Birth file. Single live births to white resident mothers who were 21 years of age or older were selected for investigation. After these selections 102,798 cases were analyzed. Logistic regression was used to examine the association of parental characteristics on the following three measures of poor prenatal care use: (1) receiving no prenatal care; (2) initiating care later than the first trimester; and (3) given a first trimester start of care, receiving less than the recommended number of prenatal care visits. Within each maternal education stratum, an increased risk of delayed initiation and less efficient use of prenatal care were observed for lower paternal educational attainment. Unmarried women, regardless of educational level, exhibited more than a tenfold risk of receiving no prenatal care, and unmarried women of low educational attainment exhibited the highest risk of delayed care. A persistent positive effect of increasing paternal education on the level of adequacy of prenatal care utilization within all maternal marital status and educational attainment groups poses further challenges to our understanding of the factors that influence prenatal care use.
    Journal of Perinatology 17(4):283-7. · 2.35 Impact Factor
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    ABSTRACT: This study used the 1983-86 U.S. Linked Live Birth-Infant Death Files to examine variations in pregnancy outcomes among 38,551 U.S. resident black and white adolescents ages 10 through 14. The birth rate was 4.29 per 1,000 for blacks, more than 7 times the rate for whites (.59 per 1,000). Black mothers had higher proportions of very low and low birth weight infants than did whites (very low birth weight: 3.7 versus 2.6; low birth weight: 15.0 versus 10.5). Neonatal and infant mortality rates were higher among very low birth weight and low birth weight white infants. Neonatal and infant mortality rates were similar for normal birth weight infants of both races, but were 3.7 to 7.4 times higher among black infants with birth weights more than 4,250 grams. Logistic regression indicated that black mothers were at higher risk for having infants who were low birth weight, very low birth weight, small for gestational age, preterm, and very preterm. There were no differences by race for neonatal, postneonatal, and infant mortality. While the risk for poor pregnancy outcomes is great among young adolescents, young black adolescents appear to be particularly vulnerable. Attempts to reduce unintended pregnancies in this group should receive highest priority.
    Public Health Reports 110(1):53-8. · 1.64 Impact Factor
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    D J Petersen, G R Alexander
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    ABSTRACT: The monthly distribution of conceptions among adolescents and the proportion of adolescent pregnancies that are voluntarily terminated by induced abortion by month of conception are the objects of this study. Additionally, seasonal variations in the timing of initiation of prenatal care services by adolescents are investigated. Vital records files of single live births, fetal deaths, and induced terminations of pregnancy to residents in the State of South Carolina, 1979-86, were aggregated to estimate conceptions. There was a significant difference between adolescents and adults in the monthly distribution of conceptions. The peak month of adolescent conceptions coincided with the end of the school year. Pregnancies of adolescents occurring at this time further demonstrated later access of prenatal care services than conceptions occurring at other times of the year, most notably during the school term. These findings suggest that there is considerable opportunity for improving the availability of reproductive health care services for adolescents. The results specifically suggest the potential benefit of increasing adolescent pregnancy prevention efforts prior to high-risk events and increasing the availability of and access to health care and counseling services to adolescents during the school recess months of the summer.
    Public Health Reports 107(6):701-6. · 1.64 Impact Factor