Several studies have investigated the short-term effects of ambient air pollutants in the development of high blood pressure and hypertension. However, little information exists regarding the health ...effects of long-term exposure. To investigate the association between residential long-term exposure to air pollution and blood pressure and hypertension, we studied 24 845 Chinese adults in 11 districts of 3 northeastern cities from 2009 to 2010. Three-year average concentration of particles with an aerodynamic diameter ≤10 µm (PM(10)), sulfur dioxide (SO(2)), nitrogen dioxides (NO(2)), and ozone (O(3)) were calculated from monitoring stations in the 11 districts. We used generalized additive models and 2-level logistic regressions models to examine the health effects. The results showed that the odds ratio for hypertension increased by 1.12 (95% confidence interval CI, 1.08-1.16) per 19 μg/m(3) increase in PM(10), 1.11 (95% CI, 1.04-1.18) per 20 μg/m(3) increase in SO(2), and 1.13 (95% CI, 1.06-1.20) per 22 μg/m(3) increase in O(3). The estimated increases in mean systolic and diastolic blood pressure were 0.87 mm Hg (95% CI, 0.48-1.27) and 0.32 mm Hg (95% CI, 0.08-0.56) per 19 μg/m(3) interquartile increase in PM(10), 0.80 mm Hg (95% CI, 0.46-1.14) and 0.31 mm Hg (95% CI, 0.10-0.51) per 20 μg/m(3) interquartile increase in SO(2), and 0.73 mm Hg (95% CI, 0.35-1.11) and 0.37 mm Hg (95% CI, 0.14-0.61) per 22 μg/m(3) interquartile increase in O(3). These associations were only statistically significant in men. In conclusion, long-term exposure to PM(10), SO(2), and O(3) was associated with increased arterial blood pressure and hypertension in the study population.
We used data from the National Longitudinal Survey of Youth (n = 6108; 50.9% males; 16.7% Black, 8.1% Hispanic, 75.2% Non‐Black, Non‐Hispanic) to examine associations between parental emotional ...support trajectories at 0–15 years and overweight or obesity at 15–19 years and explore the effects of timing and cumulative exposure to low parental emotional support on overweight or obesity. Parental emotional support was assessed using the Home Observation Measurement of the Environment and adolescent overweight or obesity was defined using the International Obesity Task Force cut‐offs. Latent Class Analysis was used to identify parental emotional support trajectories and Poisson regression was used to examine associations under study. Low parental emotional support in childhood increased the risk of adolescent overweight or obesity, with gender‐based differences.
Highlights
We examined associations between parental emotional support at 0–15 years and overweight or obesity at 15–19 years
We used Latent Class Analysis to identify parental emotional support trajectories and Poisson regression to examine associations under study
Low parental emotional support in childhood increased the risk of adolescent overweight or obesity, with gender‐based differences
Introduction
The Perinatal Periods of Risk approach (PPOR) is designed for use by communities to assess and address the causes of high fetal-infant mortality rates using vital records data. The ...approach is widely used by local health departments and their community and academic partners to inform and motivate systems changes. PPOR was developed and tested in communities based on data years from 1995 to 2002. Unfortunately, a national reference group has not been published since then, primarily due to fetal death data quality limitations.
Methods
This paper assesses data quality and creates a set of unbiased national reference groups using 2014–2016 national vital records data. Phase 1 and Phase 2 analytic methods were used to divide excess mortality into six components and create percentile plots to summarize the distribution of 100 large US counties for each component.
Results
Eight states with poor fetal death data quality were omitted from the reference groups to reduce bias due to missing maternal demographic information. There are large Black-White disparities among reference groups with the same age and education restrictions, and these vary by component. PPOR results vary by region, maternal demographics, and county. The magnitude of excess mortality components varies widely across US counties.
Discussion
New national reference groups will allow more communities to do PPOR. Percentile plots of 100 large US counties provide an additional benchmark for new communities using PPOR and help emphasize problem areas and potential solutions.
Background
Women who smoke cigarettes while pregnant are at elevated risk of having low birth weight infants (LBW, < 2500 g) which increases risks of infant mortality and morbidity, including chronic ...conditions later in life.
Objective
Smoking cessation during pregnancy can reduce the risk of poor birth outcomes. However, the effect that timing of smoking cessation has on the reduction of poor birth outcomes in term pregnancies is unknown.
Study Design
This retrospective cohort study used birth certificate data from Missouri singleton, full-term, live births from 2010 to 2012 (N = 179,653) to examine the rates and timing of smoking cessation during pregnancy on birthweight. Smoking exposure was categorized as non-smoker, preconception cessation, first trimester cessation, second trimester cessation, and smoker. The outcome was low birth weight (LBW). Covariates included maternal race/ethnicity, age, education level, type of payment for the delivery, marital status, paternal acknowledgement, prenatal sexually transmitted infection (STI), comorbidities, and body mass index. Bivariate and multivariable analyses were used to assess relationships between smoking and LBW status.
Results
Preconception cessation did not have a statistically higher risk for LBW than mothers who never smoked (aOR 1.12; 95% CI 0.98, 1.28). First trimester cessation (aOR 1.26; 95% CI 1.05, 1.52), second trimester cessation (aOR 2.00; 95% CI 1.60, 2.67), and smoker (aOR 2.46; 95% CI 2.28, 2.67) had increasing odds for LBW relative to mothers who did not smoke. All covariates had significant relationships with the smoking exposure.
Conclusion
Preconception cessation yielded LBW rates comparable to non-smokers. The risk for LBW increased as smoking continued throughout pregnancy among full term births, an important new finding in contrast with other studies.
China had the second largest proportion of preterm birth (PTB) internationally. However, only 11% of pregnant women in China meet international guidelines for maternal physical activity, a ...significantly lower proportion than that in Western countries. This study aims to examine the association between outdoor physical exercise during pregnancy and PTB among Chinese women in Wuhan, China.
A case-control study was conducted among 6656 pregnant women (2393 cases and 4263 controls) in Wuhan, China from June 2011 to June 2013. Self-reported measures of maternal physical exercise (frequency per week and per day in minutes) were collected. Adjusted odds ratios were estimated using Bayesian hierarchical logistic regression and a generalized additive mixed model (GAMM).
Compared to women not involved in any physical activity, those who participated in physical exercise 1-2 times, 3-4 times, and over five times per week had 20% (aOR: 0.80, 95% credible interval 95% CI: 0.68-0.92), 30% (aOR: 0.70, 95% CI: 0.60-0.82), and 32% (aOR: 0.68, 95% CI: 0.59-0.78) lower odds of PTB, respectively. The Bayesian GAMM showed that increasing physical exercise per day was associated with lower risk of PTB when exercise was less than 150 min per day; however, this direction of association is reversed when physical exercise was more than 150 min per day.
Maternal physical exercise, at a moderate amount and intensity, is associated with lower PTB risk. More data from pregnant women with high participation in physical exercise are needed to confirm the reported U-shape association between the physical exercise and risk of preterm birth.
Background
Spontaneous abortion is one of the prevalent adverse reproductive outcomes, which seriously threatens maternal health around the world.
Objective
The current study is aimed to evaluate the ...association between maternal age and risk for spontaneous abortion among pregnant women in China.
Methods
This was a case-control study based on the China Birth Cohort, we compared 338 cases ending in spontaneous abortion with 1,352 controls resulting in normal live births. The main exposure indicator and outcome indicator were maternal age and spontaneous abortion, respectively. We used both a generalized additive model and a two-piece-wise linear model to determine the association. We further performed stratified analyses to test the robustness of the association between maternal age and spontaneous abortion in different subgroups.
Results
We observed a J-shaped relationship between maternal age and spontaneous abortion risk, after adjusting for multiple covariates. Further, we found that the optimal threshold age was 29.68 years old. The adjusted odds ratio (95% confidence interval) of spontaneous abortion per 1 year increase in maternal age were 0.97 (0.90–1.06) on the left side of the turning point and 1.25 (1.28–1.31) on the right side. Additionally, none of the covariates studied modified the association between maternal age and spontaneous abortion (
P
> 0.05).
Conclusions
Advanced maternal age (>30 years old) was significantly associated with increased prevalence of spontaneous abortion, supporting a J-shaped association between maternal age and spontaneous abortion.
This article assesses emerging trends in the 21st century, if any, in preconception health indicators among women of reproductive age.
This is a secondary analysis of cross-sectional data from the ...Behavioral Risk Factor Surveillance System (BRFSS), 2003-2010. Subjects were a sample of noninstitutionalized, 18-44-year-old, nonpregnant, women in the United States (n=547,177) grouped into two categories, 2003-2006 (n=275,630) and 2007-2010 (n=271,547). Overall crude and adjusted prevalence odds ratios were calculated for preconception indicators before 2006 and after 2006.
Significant improvements were found for any and heavy alcohol use, smoking, social and emotional support, moderate/vigorous physical activity, and having had an influenza shot in the last year. In contrast, binge drinking, having a medical condition (i.e., diabetes, high blood pressure, asthma, or obesity), and self-reported health significantly worsened. No change was found for mental distress, HIV testing, and having a routine checkup.
As the 21st century unfolds, emerging trends suggest that we need to focus on educating women, providers, and public health advocates about improved health before pregnancy, especially for women with chronic conditions and those who binge drink alcohol.
Medical examiners and coroners (ME/Cs) investigate deaths important to public health. This cross‐sectional study evaluated 343,412 death certificates from 2007 to 2012 in Missouri. We examined ...agreement between cause and manner of death by year and ME/C contact as well as 2010–2012 trends in ME/C contact. There was near perfect agreement between cause and manner of death when an ME/C was contacted (kappa=0.97, p < 0.0001) and a significant increase in the proportion of deaths with ME/C contact from 2010 to 2012 (p =< 0.0001). There was a significantly higher proportion of ME/C‐certified deaths using the electronic system in 2010–2012 (aOR = 1.18, 95% CI 1.15, 1.21) compared to the manual system in 2007‐2009. Black, non‐Hispanic (aOR = 1.50, 95% CI 1.43,1.57) and Hispanic (aOR = 1.31, 95% CI 1.13, 1.51) deaths, compared to White, non‐Hispanic deaths, were associated with a significantly greater odds of ME/C certification. Race as an independent predictor of ME/C death certification warrants further research.
Abstract Aim Assess differences in pregnancy planning and behavioral risk factors among women of reproductive age, by diabetes status. Methods A secondary analysis of cross-sectional data from the ...Behavioral Risk Factor Surveillance System (2002 and 2004) was conducted. Subjects were 18–44-year-old, non-pregnant, fertile women, grouped into two categories: non-diabetes ( n = 57,436), and diabetes ( n = 2929). Multivariable logistic regression was used to estimate adjusted prevalence odds ratios and 95% confidence intervals. Results Approximately 93% of women of reproductive age with or without diabetes are not intending a pregnancy, and yet among them, women with diabetes are 22% more likely not to use any birth control at all. Women with diabetes are 3.4 times more likely to be obese, 1.4 times more likely to be overweight, 35% less likely to drink any alcohol, and 27% less likely to binge drink alcohol, than women without diabetes. There were no differences in risk factors between women with diabetes that were and were not intending a pregnancy. Conclusions Birth control nonuse for women with diabetes not intending a pregnancy and lack of behavioral change for women with diabetes intending a pregnancy, combined with an increasing prevalence in diabetes, will likely result in significant economic and social tolls on society.
Background. Centering Pregnancy (CP) is an effective method of delivering prenatal care, yet providers have been slow to adopt the CP model. Our main hypothesis is that a site’s adoption of CP is ...contingent upon knowledge of the CP, characteristics health care personnel, anticipated patient impact, and system readiness. Methods. Using a matched, pretest-posttest, observational design, 223 people completed pretest and posttest surveys. Our analysis included the effect of the seminar on the groups’ knowledge of CP essential elements, barriers to prenatal care, and perceived value of CP to the patients and to the system of care. Results. Before the CP Seminar only 34% of respondents were aware of the model, while knowledge significantly after the Seminar. The three greatest improvements were in understanding that the group is conducted in a circle, the health assessment occurs in the group space, and a facilitative leadership style is used. Child care, transportation, and language issues were the top three barriers. The greatest improvements reported for patients included improvements in timeliness, patient-centeredness and efficiency, although readiness for adoption was influenced by costs, resources, and expertise. Discussion. Readiness to adopt CP will require support for the start-up and sustainability of this model.
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