Allen A. Herman

Prenatal Care Reduces the Impact of Illicit Drug use on Perinatal Outcomes

OBJECTIVE: To estimate the extent that prenatal care (PNC) retains its protective influence against prematurity, low birth weight (LBW), and small for gestational age (SGA) status in infants exposed to illicit drug use (IDU) in pregnancy.STUDY DESIGN: This was a prospective cohort analysis including 6673 women residents of the District of Columbia (Washington, DC, USA) delivering at four city hospitals. Women were screened in the immediate postpartum period. Levels of PNC were established according to American College of Obstetrics and Gynecology guidelines and the Kotelchuck index. PNC and IDU were compared between subgroups. Adjusted relative risks for prematurity, LBW and SGA, controlling for maternal and gestational ages, were calculated in different groups according to IDU and level of PNC.RESULTS: IDU was identified in 13% of mothers screened. PNC was classified as none (6%), inadequate (10%), intermediate (20%), and adequate (64%). The highest risk for prematurity, LBW, or SGA occurred in infants born to mothers with no PNC and positive IDU in pregnancy (prematurity OR=12.05, 95% CI: 8.99 to 16.16; LBW OR=14.76, 95% CI: 11.03 to 19.75; SGA OR=9.20, 95% CI: 5.32 to 15.92). As PNC levels increased, significant reductions in risk for prematurity and LBW (not for SGA) in IDU-exposed infants were observed. Risk for SGA in IDU-exposed infants reduced significantly when PNC was introduced.CONCLUSIONS: In infants exposed to IDU, a reduction in risk for prematurity, LBW, and SGA, was consistently demonstrated with improved levels of PNC. In high-risk populations, health care should seek to reach mothers early, especially those identified at risk for IDU, and deliver PNC to them effectively.

Sociodemographic correlates of virginity in seventh-grade black and Latino students

PURPOSE To examine rates of virginity in seventh-grade black and Latino students and assess the extent to which various sociodemographic factors are correlated with virginity. METHODS A total of 523 seventh-grade students from five junior high schools and one middle school in the District of Columbia completed an anonymous self-administered questionnaire. Students responded to questions about age at first intercourse, demographics, grades, educational expectations, and risk behaviors. Multivariate analysis was used to determine the independent strength of the association of these variables with virginity. RESULTS Eighty-one percent of girls and 44% of boys reported never having had sexual intercourse, i.e., being virgins. Black and Latino students were equally as likely to report being virgins. Younger age and absence of other risk behaviors, including smoking and alcohol use, were associated with virginity for males and females. For boys, reporting high academic achievement and living with both parents was significantly correlated with virginity and appeared to be protective. CONCLUSIONS Although prevalent particularly in seventh-grade black and Latino boys, sexual activity was clearly associated with other risk behaviors in both boys and girls. Sociodemographic correlates of virginity were gender-specific. School-based efforts to delay the onset of initiation of sexual activity in high-risk populations should be targeted at boys 12 years and younger with interventions which are gender-specific. This study underscores a need to examine correlates of virginity to generate practical approaches to prevention of early sexual activity.

Very-low-birthweight infants and income incongruity among African American and white parents in Chicago.

OBJECTIVES Illinois vital records for 1982/1983 and US census income data for 1980 were analyzed to ascertain the relationship of income incongruity, race, and very low birthweight. METHODS Positive income incongruity was considered present when study infants resided in wealthier neighborhoods than non-Latino Whites at the same level of parental education attainment and marital status. RESULTS The odds ratios of very low birthweight for African Americans (n = 44,266) and Whites (n = 27,139) who experienced positive income incongruity were 0.7 (95% confidence interval [CI] = 0.5, 0.9) and 0.6 (95% CI = 0.5, 0.9), respectively. CONCLUSIONS Positive income incongruity is associated with lower race-specific rates of very low birthweight.

AN ANALYSIS OF GESTATIONAL AGE, NEONATAL SIZE AND NEONATAL DEATH USING NONPARAMETRIC LOGISTIC REGRESSION

The relationship between gestational age, neonatal size and neonatal death is complex. To date, most authors have used birth weight as a proxy for neonatal size and have neglected to examine head circumference and crown heel length. In addition, they have assumed the size and gestational age were linearly related to neonatal death. In this study we use nonparametric multiple logistic regression to examine the relationship between gestational age, neonatal size and neonatal death. On its own, gestational age was nonlinearly associated with neonatal death. This nonlinearity disappeared with the addition of birth weight, crown heel length and head circumference. Birth weight, head circumference and crown heel length all had significant nonlinear associations with neonatal death in univariate analysis. With all factors in the model, birth weight and head circumference were nonlinearly associated with neonatal death and crown heel length was linearly associated with neonatal death. The complex relations between gestational age, neonatal size and neonatal death were explored with greater ease with nonparametric logistic regression.

Birth weight, gestational age and perinatal mortality: biological heterogeneity and measurement error

At low birth weight the variance of last menstrual period based gestational age is wide and the distribution is positively skewed toward higher values. In this study the variance of gestational age decreases rapidly as birth weight increases, skewness decreases and kurtosis increases in approaching the mean of the birth weight distribution. Some of the wider variance and positive skewness of gestational age at low birth weight appears to reflect heterogeneity of intrauterine growth, in which infants with high values of gestational age are growth retarded. We show by partitioning each birth weight group into two groups of infants with different gestational age distributions, that at low birth weight, infants with low gestational ages have higher neonatal mortality rates but lower fetal mortality rates than infants with a higher gestational age for birth weight. The differences in mortality described between small infants at different gestational ages suggest that infants with a high LMP-based gestational age have experienced a slower rate of intrauterine growth. Some authors interpret the distributional characteristics as indications of systematic error in last menstrual period based assessment of gestational age. It appears from this study that the extent of systematic error in the estimation of LMP based gestational age may have been overstated in the past.

Achieving Success in Poor Urban Minority Community-Based Research: Strategies for Implementing Community-Based Research Within an Urban Minority Population

Various models of community research have been employed to assess community health needs and address community health problems. Infant mortality remains a problem in urban minority communities throughout the United States. This article compares various community research models with a three-tiered community involvement model used in Washington, D.C., an urban, predominantly African American community with one of the worst rates of infant mortality in the nation. The research design incorporated community input throughout the research design process, resulting in a better understanding of issues and problems associated with infant mortality within the community setting. The use of the model improved community participation in the research process, facilitating improved health initiatives.

SYSTOLIC BLOOD PRESSURE DIFFERENCES IN BLACK, COLORED, AND WHITE INFANTS

Systolic blood pressure was measured in a random cluster sample of three-month-old black (n = 532), colored (n = 496), and white (n = 637) infants in Johannesburg, South Africa, by means of a Parks Doppler ultrasound device with a random zero sphygmomanometer. The study was conducted during a nine-month period in 1981. Major predictors of systolic pressure measurements were which fieldworker had taken the measurement and whether the child was quiet or agitated. After adjustment for predictors as necessary, the mean systolic blood pressure of black infants was about 2 mmHg higher than that of coloreds, which was statistically significant, with suggestive evidence that coloreds have a systolic pressure about 1 mmHg higher than that of whites. Findings at age three months may represent ethnic differences in blood pressure distributions of genetic origin.

Lagging Life Expectancy for Black Men: A Public Health Imperative

The authors discuss the lower life expectancy of Black men. They compare the life expectancy of Black men to Black women and White men and discuss social determinants and risk factors contributing to lower life expectancy, the importance of mens health, and the need to include and involve men in family health programs.