Derek A. Chapman

Identification of early risk factors for language impairment.

The current study is a population-based investigation of birth risk factors for school-identified specific language impairment (SLI). The sample consisted of 244,619 students (5,862 SLI) born in Florida between 1989 and 1990 who were in the Florida public school system at ages 6-7. Epidemiological measures of effect were used to investigate both individual- and population-level risk for SLI. Very low birth weight (VLBW), low 5-min Apgar score, late or no prenatal care, high birth order, and low maternal education were associated with highest individual-level risk. Low maternal education and having an unmarried mother was associated with the highest population-level risk. The results not only suggest who needs to be screened for a future developmental disability, but identify a group of children who are at-risk for an SLI placement in school. Early intervention services for these children may be the most effective approach to reducing the incidence of school-identified SLI.

Early risk factors for mental retardation: role of maternal age and maternal education.

The predictive value of maternal age and education in relation to rates of administratively defined mental retardation in a 3-year birth cohort (N = 267,277) was studied. Low maternal education placed individuals at increased risk for both educable mentally handicapped (EMH) and trainable mentally handicapped (TMH) placements. Older maternal age was associated with increased risk of mental retardation, but for individuals with EMH, this age effect was only seen in the lowest education group. In terms of population-level risk, it was younger mothers with 12 years of education or less whose births were associated with the greatest proportion of mental retardation. From a public policy viewpoint, children born to mothers with low levels of education are an important group to target for prevention/early intervention efforts.

Cumulative Risk and Low-Income Children's Language Development

This study utilized an electronic data linkage method to examine the effects of risk factors present at birth on language development in preschool. The Preschool Language Scale-3 (PLS-3) was administered to 853 low-income children, and cumulative risk data were abstracted from linked birth records. At least one risk factor was present in 94% of this sample, while 39% were exposed to three or more risk factors. On average, a girls PLS-3 Total Score decreased by 2.3 points with each risk factor; the average decrease for boys was 1.1 point per risk factor. The accumulation of multiple risk factors thus appears to increase the negative effects of poverty. Researchers are encouraged to use historical administrative data sets to support prevention and early identification efforts.

Public Health Approach to the Study of Mental Retardation.

We applied a public health approach to the study of mental retardation by providing a basic descriptive epidemiological analysis using a large statewide linked birth and public school record database (N = 327,831). Sociodemographic factors played a key role across all levels of mental retardation. Birthweight less than 1000 g was associated with the highest individual-level risk, but the impact varied considerably, depending on maternal educational level. Low maternal education was associated with the largest effects at the population level for mild and moderate/severe mental retardation. Focusing exclusively on specific biomedical causes is of little use in developing public health plans; a broader biosocial perspective reflecting the interactive complexity of the risk factors comprising the various etiological patterns is needed.

Intimate Partner Violence and Posttraumatic Stress Disorder Among High-Risk Women: Does Pregnancy Matter?

Interviews from 655 women participating in the Chicago Women’s Health Risk Study (CWHRS) were used to assess prevalence and factors associated with intimate partner violence (IPV) and posttraumatic stress disorder (PTSD). Black women had the highest rate of IPV overall and among pregnant women, and had decreased odds of PTSD compared to Black nonpregnant women. Hispanic pregnant women, however, had decreased odds of IPV and PTSD compared to Hispanic nonpregnant women. Disparities in IPV by race/ ethnicity and pregnancy status complicate the study of IPV and PTSD and have implications for the public health community.

Etiology of unilateral hearing loss in a national hereditary deafness repository

PURPOSE The aim of this study was to characterize the genetic, audiologic, and epidemiologic characteristics of unilateral hearing loss (HL) in a national hereditary deafness repository. MATERIALS AND METHODS This is a prospective clinical study involving 34 subjects identified in a national hereditary deafness repository. Clinical data and family history of HL were obtained on enrollment. Candidate deafness genes were screened by single-stranded conformation polymorphism, and mutations were confirmed with sequencing. RESULTS Thirty-four subjects (19 males, 15 females) with unilateral HL were identified, ranging in age from 2 months to 36 years. The mean age at diagnosis was 7 years, and the left ear was affected in 62% of the cases. The racial distribution of our sample was 62% white, 23% African American, and 15% Hispanic. Imaging results were available in 47%, and most (69%) were considered normal. Nineteen percent had enlarged vestibular aqueducts, 2 had ipsilateral Mondini dysplasia, and 1 had a common cavity deformity. Twenty subjects (59%) had a family history of HL, with 26% specifically reporting familial unilateral HL. Mutational screening revealed sequence variants in the GJB2 (connexin 26), GJB3 (connexin 31), TECTA, and COCH genes. Two novel mutations were detected in COCH and TECTA. CONCLUSIONS Sequence variants in known deafness genes were detected in more than one-third of our study population, suggesting that gene/gene or gene/environmental interactions may indeed play a role in the etiology of some cases of unilateral deafness. Further prospective studies including congenital cytomegalovirus screening at birth and molecular screening of deafness genes in children with congenital unilateral HL will be required to establish the etiology of unilateral deafness with certainty.

Contraceptive insurance mandates and consistent contraceptive use among privately insured women.

Introduction:Half of the states in the United States mandate that health insurers cover contraceptives. Health care reform includes recommendations to extend these mandates nationally through the essential benefits package. This study evaluates the association of state-level insurance mandates and consistent contraceptive use among privately insured women aged 15–44. Study Design:The National Survey of Family Growth (2006–2008) included 2276 privately insured women at risk for unintended pregnancy. Multilevel logistic regression models provided estimates of the association between state-level insurance coverage mandates and consistent contraceptive use. Results:Among privately insured women, 18% reported a ≥1-month gap in contraceptive use. Compared with women living in states with no mandates, those in states with comprehensive mandates had increased odds of consistent contraceptive use among privately insured women [adjusted odds ratio (aOR), 1.64; 95% confidence interval (CI), 1.08–2.50], but not uninsured women (aOR, 0.77; 95% CI, 0.38–1.55). Partial mandates were not associated with consistent contraceptive use. Discussion:Consistent contraceptive use among women with private insurance is higher in the states with mandates compared with those without mandates.

Residential segregation and gonorrhea rates in US metropolitan statistical areas, 2005-2009.

Background The residential segregation of black populations, often in areas of high-economic disadvantage and low social status, may play a crucial role in the observed racial inequities in sexually transmitted disease rates. Methods An ecological analysis of 2005 to 2009 average gonorrhea rates was performed across 277 US metropolitan statistical areas (MSAs). The black isolation index and Gini index of income inequality were used as proxy measures for racial and economic residential segregation respectively, derived from 2005 to 2009 US Census estimates. We used logistic regression modeling to produce estimates of odds ratios (ORs) and 95% confidence intervals (CIs) for the association between the segregation indices, both independently and in combination, on gonorrhea rates in MSAs. Effect measure modification was assessed by calculating the relative excess risk due to interaction between the 2 indices. Results Compared with MSAs with low levels of racial segregation, MSAs with high levels of racial segregation had increased odds of high gonorrhea rates (adjusted OR, 3.37; 95% CI, 1.23–9.21). Similarly, higher levels of income inequality predicted higher gonorrhea rates, although this association did not persist after adjustment for potential confounders (adjusted OR, 1.54; 95% CI, 0.74–3.24). In combined models, the influence of racial residential segregation on gonorrhea rates was stronger than that of income inequality–based segregation; there was no evidence of additivity or a multiplicative interaction. Conclusions Residential segregation by race or income equality may be a key component in the perpetuation of high rates of gonorrhea and other sexually transmitted diseases among black populations in the United States.

Impacting re-arrest rates among youth sentenced in adult court: An epidemiological examination of the Juvenile Sentencing Advocacy Project.

Examines the impact of a program aimed at reducing re-offending among juveniles transferred to adult court in Miami-Dade County, Florida. Initiated in 1998, the Juvenile Sentencing Advocacy Project (JSAP) worked to increase the degree to which defense lawyers, prosecutors, judges, and police officers considered the developmental status of youth charged with crimes, as well as the contextual basis for their behavior and their potential for rehabilitation. Through such activities, the goal was to increase the use of juvenile sanctions, rather than traditional adult sentences. Based on previous research, it was predicted that increased use of juvenile sanctions would be associated with fewer youth re-offending. This article examines 162 youth who were transferred to and sentenced in adult court during 1999. Re-offense patterns were monitored through June 2001. Analyses using epidemiological measures of effect found that the use of juvenile sanctions significantly increased following implementation of JSAP and that youth receiving adult probation or boot camp were 1.74 to 2.29 times more likely to re-offend than were youth receiving juvenile sanctions. The increased use of juvenile sanctions following implementation of JSAP corresponded to an 11.2% to 15.3% decrease in the number of youth one would have anticipated would re-offend had previous patterns of sentencing continued.

The Impact of Paternity and Marital Status on Low Birth Weight and Preterm Births

In the United States the number of births to unmarried mothers is at a record high. Although being unmarried is a significant risk factor for low birth weight and preterm births, paternal presence may have a protective effect. In addition to marital status, paternity may be a proxy measure for paternal support. Virginia birth registry data were analyzed to investigate the effect of marital and paternity status on low birth weight and preterm births. Findings from this study show that women who reported being unmarried and with no paternity status were 1.6 (odds ratio = 1.57, 95% confidence interval = 1.41–1.75) and 1.4 (odds ratio = 1.39, 95% confidence interval = 1.21–1.61) times more likely to have preterm low birth weight and term low birth weight babies, respectively. Being unmarried and lack of established paternity appear to be significantly correlated with and may be important risk factors for preterm and low birth weight deliveries. Health care professionals should be aware of the potential role of paternal presence and marital status may play with respect to preterm births and low birth weight.