Diane J. Abatemarco

Relationships between cigarette smoking and weight control in young women.

While multiple risk factors are associated with smoking, body weight concern is a significant risk factor for smoking among young women, including adolescents. This article explores the relationship between frequency of smoking and weight loss strategies among a nationally representative sample of high school females (n = 7,828). Adjusted odds ratios were generated for smoking, weight goals, and weight loss strategies, controlling for demographics. Daily smokers were two to four times more likely to fast, use pills, and purge to control their weight than nonsmokers. Tobacco control efforts for young women must address the influence of weight concern on smoking in this population.

Buprenorphine for the Treatment of the Neonatal Abstinence Syndrome

BACKGROUND Current pharmacologic treatment of the neonatal abstinence syndrome with morphine is associated with a lengthy duration of therapy and hospitalization. Buprenorphine may be more effective than morphine for this indication. METHODS In this single‐site, double‐blind, double‐dummy clinical trial, we randomly assigned 63 term infants (≥37 weeks of gestation) who had been exposed to opioids in utero and who had signs of the neonatal abstinence syndrome to receive either sublingual buprenorphine or oral morphine. Infants with symptoms that were not controlled with the maximum dose of opioid were treated with adjunctive phenobarbital. The primary end point was the duration of treatment for symptoms of neonatal opioid withdrawal. Secondary clinical end points were the length of hospital stay, the percentage of infants who required supplemental treatment with phenobarbital, and safety. RESULTS The median duration of treatment was significantly shorter with buprenorphine than with morphine (15 days vs. 28 days), as was the median length of hospital stay (21 days vs. 33 days) (P<0.001 for both comparisons). Adjunctive phenobarbital was administered in 5 of 33 infants (15%) in the buprenorphine group and in 7 of 30 infants (23%) in the morphine group (P=0.36). Rates of adverse events were similar in the two groups. CONCLUSIONS Among infants with the neonatal abstinence syndrome, treatment with sublingual buprenorphine resulted in a shorter duration of treatment and shorter length of hospital stay than treatment with oral morphine, with similar rates of adverse events. (Funded by the National Institute on Drug Abuse; BBORN ClinicalTrials.gov number, NCT01452789.)

Defining cigarette smoking status in young adults: a comparison of adolescent vs adult measures.

OBJECTIVE To determine the agreement between 2 measures (adult vs adolescent) of current cigarette smoking among young adults. METHODS We examined data from 1007 young adults from the New Jersey Adult Tobacco Survey. The adult measure incorporates lifetime and present use, whereas the adolescent measure assesses past 30-day use. The kappa coefficient was used to determine agreement between the 2 current cigarette smoking measures. RESULTS Agreement between the measures was high, but not ideal. The percent reporting smoking in the past 30 days but not 100 cigarettes in their lifetime was notably higher, and therefore agreement was lower, for black females, Hispanic males, and college students living on campus. CONCLUSIONS Sole use of the adult or adolescent measure of current cigarette smoking is insufficient to document progression to regular smoking in young adults.

Project Northland in Croatia: Results and Lessons Learned.

As part of an international public health partnership formed in 2001 we assessed the impact of Project Northland in Croatia—an adolescent alcohol school-based prevention intervention implemented in Split—on students. The curriculum was implemented in 13 randomly selected schools with another 13 schools serving as controls. The evaluation included quantitative and qualitative methods, using pre/post-tests to compare intervention and controls and follow-up focus groups with parents and teachers. Quantitative data showed the intervention was more successful in changing attitudes in the first two years, but had less impact on older students. Qualitative data suggest benefits from the program overall. Given the intervention was successful in the earlier grades it should be initiated earlier to have a greater impact. Challenges and lessons learned are offered.

Patterns of gestational weight gain related to fetal growth among women with overweight and obesity

Objective Maternal obesity is associated with increased risk of large-for-gestational-age (LGA) and small-for-gestational-age (SGA) births. Both are related to childhood obesity. We considered that patterns of gestational weight gain (GWG) may help to disentangle these competing risks. Design and methods Patterns of GWG were characterized among a cohort of overweight or obese women (n=651). Polytomous logistic regression models tested for associations between GWG patterns and birthweight outcomes: SGA (<10th) and LGA (>90th percentile). Results Rates of SGA were higher than those for LGA (14.9% vs. 7.8%). Four GWG patterns were identified: consistently high (29%), early adequate/late high (33%), consistently adequate (18%), and consistently low (20%). Risk of LGA was highest in women with consistently high GWG (adjusted odds ratio [OR] 4.62 [1.53, 13.96]), and risk was elevated, but with lower magnitude, among women with early adequate/late high gains (OR 3.07 [1.01, 9.37]). High GWG before 20 weeks, regardless of later gain, was related to LGA. Low gain before 20 weeks accompanied by high gain later may be associated with reduced SGA risk (0.55 [0.29, 1.07]). Conclusions The pattern of weight gain during pregnancy may be an important contributor to or marker of abnormal fetal growth among overweight and obese women.Maternal obesity is associated with increased risk of large‐for‐gestational‐age (LGA) and small‐for‐gestational‐age (SGA) births. Both are related to childhood obesity. This study considers that the patterns of gestational weight gain (GWG) may help to disentangle these competing risks.

Correlates of Bidi Use Among Youth.

OBJECTIVES To identify characteristics associated with youth bidi use. METHODS The New Jersey Youth Tobacco Survey is a self-administered school-based survey that uses a 2-stage cluster sample design to obtain a representative statewide sample; 9589 students (grades 7-12) participated. Logistic regression was used to generate an adjusted odds ratio (OR) for current bidi use for each variable, controlling for gender, race, and school grade. RESULTS Higher odds for current bidi use were noted for black and Hispanic students, users of other tobacco products, and students that perceived bidis as safer than cigarettes. CONCLUSIONS These results suggest specific groups that should be targeted for intervention.

Substance use, treatment, and demographic characteristics of pregnant women entering treatment for opioid use disorder differ by United States census region

Opioid use disorder (OUD) among pregnant women increased substantially between 1992 and 2012 across the United States, with the greatest increases occurring in the southern states. We analyzed the 2013 Treatment Episodes Database-Admissions to determine how substances used, characteristics of treatment, and demographics of pregnant women entering treatment for opioid use disorder vary between geographical regions. Analyses were restricted to cases where women reported being pregnant at the time of admission and reported opioids as the primary substance problem leading to the treatment admission. Characteristics were compared between U.S. census regions using Chi-square tests and logistic regression with the South census region as the reference group. Compared to the South, pregnant women admitted for OUD treatment in other regions were 33-79% less likely to use benzodiazepines, twice as likely to be admitted to medication assisted treatment (MAT), 2-3 times more likely to use heroin, and up to 1.5 times more likely to inject drugs. Fewer women in the South reported having medical insurance, education beyond high school, and being married. There is a need in the southern U.S. for policies and treatment programs to target reducing concomitant opioid and benzodiazepine use, increasing access to, and utilization of, MAT, and increasing access to medical insurance.

Using genograms to understand pediatric practices' readiness for change to prevent abuse and neglect.

A novel use of genograms in primary care practice is to identify processes and relationships among physicians and staff prior to implementing practice change. The authors hypothesized that the genogram would inform researchers and practice staff, participating in a child maltreatment prevention study, how practice members function in a practice. They describe the use of genograms and show how the genogram results are associated with intervention uptake. Researchers constructed genograms, collected baseline surveys, and conducted postintervention interviews with physicians. Data were analyzed to determine processes associated with intervention uptake. While survey results supported the relationships and conflicts observed in the genograms, the genogram provided more multilevel information that reflected practices’ abilities to implement change. By providing a snapshot of the relationship and organizational dynamics within a practice, genograms can assess culture for practice change. Genograms describe organizational dynamics and are useful tools to use prior to initiating new programs.

Factors Associated with Zidovudine Receipt and Prenatal Care among HIV-Infected Pregnant Women in New Jersey

Despite reductions in perinatal HIV transmission, cases continue to occur. To determine factors associated with zidovudine (ZDV) receipt among HIV-infected pregnant women we merged three data sets for women in New Jersey in 1995–1997, identifying 395 HIV-infected pregnant women. Half received two arms of ZDV prophylaxis. Attendance at five or more prenatal visits was the strongest independent factor related to ZDV receipt (OR 6.37, 95% CI 3.84, 10.57). Half (49.0%) had limited prenatal care. AIDS diagnosis, race/ethnicity, and drug use were also independently related to ZDV receipt. Post hoc analysis revealed that being unmarried, Black, multiparous, having no insurance, and illegal drug use were associated with limited prenatal care. Although the U.S. has seen reductions in HIV perinatal transmission, our research showed that HIV-infected women who did not get prenatal care were less likely to receive two arms of ZDV prophylaxis. A wide public health net that brings all women into care is necessary to reduce perinatal transmission further.

Impact of Mindfulness-based Parenting on Women in Treatment for Opioid Use Disorder

Objectives: Mothers with opioid use disorder are at high risk for maladaptive parenting. The present observational study aimed to measure the impact of a trauma-informed mindfulness-based parenting (MBP) intervention on quality of parenting behaviors of mothers primarily with opioid use disorders as well as examine associations between exposure to adverse childhood experiences and self-reported mindful parenting. Methods: A pretest posttest design was used with repeated measures. A total of 160 women were recruited from a substance use treatment program into the 12-week-long group-based intervention comprised didactic and experiential mindfulness activities. The Keys to Interactive Parenting Scale (KIPS) measured quality of parenting behavior, the Adverse Childhood Experiences Tool captured history of exposure to childhood trauma, and the Interpersonal Mindfulness in Parenting (IM-P) scale measured the degree of mindful parenting. Analyses were conducted using multilevel modeling. Results: The MBP intervention resulted in clinically significant improvements in KIPS total and all subscale scores and an IM-P total score. Data showed higher baseline Adverse Childhood Experiences and higher program attendance significantly predicted improved overall quality of parenting behaviors at a greater rate over time. Higher IM-P scores were associated with greater rate of improvement in KIPS total and all subscale scores. Conclusions: Study findings suggest a trauma-informed MBP intervention for parenting women with opioid use disorders is associated with significant clinical improvements in quality of parenting behavior. Results of this model show promise in supporting parenting of mothers receiving treatment for opioid use disorders to enhance bonding and parenting.