Kathleen O'Rourke

Unintended pregnancy rates among a US military population

Unintended pregnancy among military women influences their lives and has implications for troop readiness and deployment. The purpose of this study was to identify the prevalence of unintended pregnancy in the US Army and assess the variables associated with unintended pregnancy. Using a cross-sectional design, 212 female soldiers who delivered viable infants at Darnall Army Community Hospital, Fort Hood, Texas from 1 June 1998 to 6 October 1998 completed a self-administered survey on pregnancy intention and sociodemographic factors. Approximately 35% of the infants were intended, 51% were unintended and 14% were ambivalent, resulting in 65% not intended, a rate consistent with the upper level of civilian communities. Factors associated univariably with unintended pregnancy included being unmarried, being in the lower enlisted rank, having less than a college degree, and living in the barracks. This study shows the importance of developing programmes and policies that address pregnancy among military personnel.

The association of drinking water quality and sewage disposal with Helicobacter pylori incidence in infants: the potential role of water-borne transmission

The mode of transmission of Helicobacter pylori, a bacterium causing gastric cancer and peptic ulcer disease, is unknown although waterborne transmission is a likely pathway. This study investigated the hypothesis that access to treated water and a sanitary sewerage system reduces the H. pylori incidence rate, using data from 472 participants in a cohort study that followed children in Juarez, Mexico, and El Paso, Texas, from April 1998, with caretaker interviews and the urea breath test for detecting H. pylori infection at target intervals of six months from birth through 24 months of age. The unadjusted hazard ratio comparing bottled/vending machine water to a municipal water supply was 0.71 (95% confidence interval (CI): 0.50, 1.01) and comparing a municipal sewer connection to a septic tank or cesspool, 0.85 (95% CI: 0.60, 1.20). After adjustment for maternal education and country, the hazard ratios decreased slightly to 0.70 (95% confidence interval: 0.49, 1.00) and 0.77 (95% confidence interval: 0.50, 1.21), respectively. These results provide moderate support for potential waterborne transmission of H. pylori.

Sunlight Exposure and Cutaneous Human Papillomavirus Seroreactivity in Basal Cell and Squamous Cell Carcinomas of the Skin

BACKGROUND Ultraviolet radiation exposure may interact synergistically with cutaneous human papillomavirus (HPV) infection in the development of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin. METHODS To investigate differences in the risk of sunlight-associated BCC and SCC by cutaneous genus-specific HPV serostatus, a case-control study was conducted among 204 BCC and 156 SCC cases who were recruited from a university dermatology clinic and 297 controls who had no history of cancer and screened negative for current skin cancer. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between measures of sunlight exposure and BCC/SCC, stratified by genus-specific HPV serostatus, with adjustment for age and sex. RESULTS Sunburn due to cutaneous sensitivity to sunlight exposure (P = .006) and poor tanning ability (P = .003) were associated with a higher seroprevalence for genus beta HPV types. Poor or no tanning ability was more strongly associated with SCC among individuals who were seropositive for antibodies to cutaneous HPV types in genera alpha (OR, 15.60; 95% CI, 5.40-45.1; P = .01 for interaction) and beta (OR, 6.86; 95% CI, 3.68-12.80; P = .001 for interaction), compared with individuals who were seronegative for these HPV types. CONCLUSIONS Seropositivity for HPV types in genera alpha or beta increased the risk of SCC associated with poor tanning ability.

Efficacy of a secondary adolescent pregnancy prevention program: an ecological study before, during and after implementation of the Second Chance Club.

Teen mothers are at increased risk of subsequent adolescent births. Interventions to reduce secondary teen pregnancies are expensive and difficult to evaluate. An ecological evaluation compared change in the repeat teen birth rate in an intervention community in Charleston, South Carolina over time to state birth certificate data to determine the efficacy of a school-based pregnancy prevention program. Evaluation included comparison of birth rates for multigravida teens in the programs school catchment area (intervention zip codes) to selected state and community data before, during and after program implementation. The intervention community demonstrated a decrease in repeat teen births during the intervention period of the program with a rebound after it was discontinued. This trend differed from a 50% linear decrease across these time periods in the state. This low cost evaluation method may be useful for evaluation of teen pregnancy prevention programs with limited resources for program evaluation.

Does pregnancy/paternity intention predict contraception use? A study among US soldiers who have completed initial entry training

Background and methodology The US Army represents a community of young adults at risk for unintended pregnancy/paternity. Our study evaluated the effect of pregnancy/paternity intention on contraceptive choice amongst new, sexually active and non-pregnant recruits. A total of 592 males and 503 females completed self-administered surveys asking about pregnancy/paternity intention, contraceptive use at last intercourse, and potential confounding factors. A multidimensional measurement of pregnancy intention was developed. Contraceptive efficacy was categorised as a four-level ordinal variable. Multivariate ordinal regression measured the association between pregnancy/paternity intention and the most efficacious birth control method used at last intercourse. Results Only 7% of participants planned a pregnancy in the next 6 months, but almost 33% of them used no birth control at last intercourse. Each unit increase in pregnancy avoidance scale was associated with a 14% increase in efficacy of birth control method used (p<0.0001). Effectiveness of birth control method increased for age (p = 0.0873), post-secondary education (p = 0.0142) and male gender (p = 0.0019.). Binge drinking reduced the likelihood of being in a higher category of birth control use (p = 0.0258). Discussion and conclusions Intention to avoid pregnancy and being male was associated with use of higher-level birth control methods.

Implementing the Florida KidCare open enrollment communications campaign: a framework for mobilizing community partners to reduce the number of uninsured children.

Florida ranks third among states with the lowest childrens insurance coverage, due to constraints such as language barriers, multiple programs, documentation requirements, limited outreach, and short enrollment periods. In November 2004, Florida announced a 30-day childrens health insurance enrollment period for January 2005 following an 18-month closure. This article describes the development, implementation, and evaluation of a communication plan creating coalitions between community partners, government agencies, and child advocacy groups to inform families. Over 96,000 families applied, almost five times any previous monthly enrollment. This campaign serves as a template for implementing strategies and engaging community partners to reduce the number of uninsured children.

Trends, correlates, and survival of infants with congenital diaphragmatic hernia and its subtypes: RAMAKRISHNAN et al.

OBJECTIVE To identify the live-birth prevalence, trends, correlates, and neonatal and 1-year survival rates of congenital diaphragmatic hernia. METHODS Using a population-based, retrospective cohort study design, we examined 1,025 cases of congenital diaphragmatic hernia from the 1998-2012 Florida Birth Defects Registry. We used Poisson and joinpoint regression models to compute prevalence ratios and temporal trends, respectively. Kaplan-Meier survival curves and Cox proportional hazards regression were used to describe neonatal and 1-year survival and estimate hazard ratios representing the predictors of infant survival. RESULTS The birth prevalence of congenital diaphragmatic hernia was 3.19 per 10,000 live births (95% confidence interval [CI]: 3.00-3.39); there was a 4.2% yearly increase among multiple cases only. Among all cases, maternal education less than high school (prevalence ratio: 1.25, 95% CI: 1.02-1.53), high school/associate degree/GED (prevalence ratio: 1.15, 95% CI: 1.01-1.32), multiple birth (prevalence ratio: 1.38, 95% CI: 1.05-1.81), and male sex (prevalence ratio: 1.18, 95% CI: 1.05-1.32) were associated with increased risk for congenital diaphragmatic hernia. The 24-hr, neonatal, and 1-year survival rates were 93.6%, 79.8%, and 71.2%, respectively. The highest hazard ratio of 17.87 (95% CI: 1.49-213.82) was observed for neonatal mortality among cases associated with chromosomal anomalies and born <37 weeks at < 1,500 g. Among isolated cases, multiple birth (hazard ratio: 0.41, 95% CI: 0.20-0.86) was associated with decreased 1-year mortality. CONCLUSION Low maternal education and multiple birth may be linked to congenital diaphragmatic hernia. The trends in prevalence, epidemiologic correlates, and predictors of early survival can differ between congenital diaphragmatic hernia subtypes-isolated, multiple, and chromosomal.© 2018 Wiley Periodicals, Inc.

Screening for Alcohol Risk in Predominantly Hispanic Youths: Positive Rates and Behavioral Consequences

The present study examined relationships between CAGE alcohol risk scores and predisposing factors for alcohol use, current alcohol use, and behavioral consequences in a large sample of secondary students. Students completed the CAGE, measures of demographics, potential predisposing factors, and consequences of alcohol use. More than 18% of students screened positive for potential alcohol risk using traditional CAGE criteria, and another 23% scored moderate risk using a more liberal criterion. CAGE scores were related to a variety of predisposing factors and were strongly related to current drinking and alcohol-related behavioral consequences. It was recommended that investigators examine multiple options for appropriate alcohol screening instruments.

Abstract 1881: Case-control study of sunlight exposure in basal and squamous cell carcinomas of the skin

Proceedings: AACR 102nd Annual Meeting 2011‐‐ Apr 2‐6, 2011; Orlando, FL Background: Ultraviolet radiation (UVR) exposure is the most important environmental risk factor for non-melanoma skin cancer (NMSC), comprised of basal (BCC) and squamous (SCC) cell carcinomas. However, the precise relationship between UVR exposure and skin cancer may differ by NMSC type. A case-control study was conducted to evaluate the relationship between patterns and timing of sun exposure and BCC/SCC. Methods: Study participants included histologically confirmed BCC (n=218) and SCC (n=169) cases recruited from a university dermatology clinic and control subjects who underwent a skin cancer screening exam and screened negative for and had no history of cancer (n=316). Information on patterns (intermittent vs. continuous) and timing (childhood vs. adulthood) of sun exposure was obtained from self-administered questionnaires. Associations with BCC/SCC were estimated by odds ratios (OR) and 95% confidence intervals (CI) calculated using logistic regression. Backward stepwise elimination was used to obtain the most parsimonious models that best fit the data. Final main effect models were adjusted for the following factors: age, sex, ethnicity, education, eye and hair color, smoking status, skin sensitivity to sun exposure, sun exposure protection behaviors, and history of dysplastic nevi and actinic keratosis. Results: History of blistering sunburn, a marker of intermittent sun exposure, was significantly positively associated with BCC (OR=2.08, 95% CI=1.19-3.64), but no association was observed with SCC (OR-1.37, 95% CI=0.69-2.69). Compared to reporting no moles on ones forearm, reporting ≥ 10 moles, a marker of increased childhood sun exposure, was positively associated with SCC (OR=5.37, 95% CI=1.11-26.0) but not BCC (OR=0.43, 95% CI=0.07-2.59). High levels of continuous sun exposure (5-6 hours versus <1 hour per day spent continuously during the week and on the weekend) was positively associated with SCC in ones teenage years (OR-5.14, 95% CI=0.63-41.8), twenties (OR=11.7, 95% CI=1.21-141.0), thirties (OR=6.17, 95% CI=1.01-37.8), and the ten years prior to study enrollment (OR=5.12, 95% CI=0.64-41.2). For BCC, associations with high levels of continuous sun exposure were observed in ones twenties (OR=4.80, 95% CI=1.10-21.0) and thirties (OR=6.66, 95% CI=1.23-35.4), but similar associations were not observed in ones teenage years (OR=1.29, 95% CI=0.28-5.88) and the past 10 years prior to study enrollment (OR=1.40, 95% CI=0.36-5.49). Conclusions: The associations between UVR and NMSC may differ by patterns and timing of sun exposure. Specifically, intermittent sun exposure appears to be associated with BCC and chronic sun exposure with SCC. Additionally, we observed sunlight exposure in adulthood to be associated with BCC while lifetime sun exposure was associated with SCC, in our study population. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1881. doi:10.1158/1538-7445.AM2011-1881