Lorraine Halinka Malcoe

Residential Mobility during Pregnancy for Mothers of Infants with or without Congenital Cardiac Anomalies: A Reprint

Maternal residence at time of delivery is sometimes used as a proxy for residence during early pregnancy to estimate environmental exposures. Residential addresses during time of conception through...Maternal residence at time of delivery is sometimes used as a proxy for residence during early pregnancy to estimate environmental exposures. Residential addresses during time of conception through the first trimester were obtained from mothers of 152 infants with congenital cardiac anomalies and 175 controls, and they were compared with the addresses at delivery abstracted from birth certificates. An estimated 24.8% (95% CI = 20.3, 29.9) of women moved between the time of conception and delivery, and the percentage of cases and controls who moved was similar. Use of address at time of delivery may reduce the likelihood of finding an association between a congenital malformation and a maternal environmental exposure.

Severe intimate partner violence and alcohol use among female trauma patients

BACKGROUND The lifetime prevalence of intimate partner violence (IPV) among women in the United States is reported to be between 18 and 50%. One-third of female homicide victims are killed by an intimate partner and alcohol is often involved. Despite these figures, 77% of women have never been screened for IPV. Substance abuse in male partners is known to place women at risk. We examined the role of female alcohol use on rates of severe IPV. Our hypotheses were: (1) the prevalence of IPV among women seen in trauma centers is greater than that found in national surveys; (2) alcohol problems among abused women and their partners are greater than those among non-abused women; (3) females and their partners alcohol problems are each independently associated with IPV; and (4) female trauma center patients support domestic violence screening. METHODS An in-person survey was administered to 95 consecutive adult female trauma patients admitted to a Level I Trauma Center. The survey included questions about past-year and lifetime severe IPV, female and male partner alcohol use, and willingness to participate in IPV screening and referral. The multivariate associations of female and partner alcohol use with past-year severe IPV were assessed with logistic regression. RESULTS Nearly one-half (46.3%) of women reported a lifetime history of severe IPV, with 26% experiencing severe IPV in the past year. Past-year IPV was identified in 59.1% of women screening positive for drinking problems, but in only 12.7% of those screening negative for drinking problems (p = 0.001). Similarly, past-year IPV prevalence was 55.2% when the partner was a problem drinker versus 8.3% when he was not (p = 0.001). Multivariate analysis showed that female problem drinking (odds ratio [OR] = 5.8) and partner problem drinking (OR=8.9) were independent predictors of past-year severe IPV. The majority of women (90.5%) felt that it was appropriate for health care professionals to screen for IPV; 90% of women with a history of IPV thought screening was important and 71% wished a previous healthcare provider had asked them about it. CONCLUSIONS Female trauma patients demonstrate a higher prevalence of severe IPV than the general population. IPV rates appear to be related to both female and partner alcohol misuse. Female trauma patients endorsed IPV screening and thus should be screened for alcohol use and IPV in a way that minimizes future violence risk. Further research is needed to elucidate whether intervention for alcohol misuse has an impact on rates of IPV in this population.

Socioeconomic disparities in intimate partner violence against Native American women: a cross-sectional study

BackgroundIntimate partner violence (IPV) against women is a global public health problem, yet data on IPV against Native American women are extremely limited. We conducted a cross-sectional study of Native American women to determine prevalence of lifetime and past-year IPV and partner injury; examine IPV in relation to pregnancy; and assess demographic and socioeconomic correlates of past-year IPV.MethodsParticipants were recruited from a tribally-operated clinic serving low-income pregnant and childbearing women in southwest Oklahoma. A self-administered survey was completed by 312 Native American women (96% response rate) attending the clinic from June through August 1997. Lifetime and past-year IPV were measured using modified 18-item Conflict Tactics Scales. A socioeconomic index was created based on partners education, public assistance receipt, and poverty level.ResultsMore than half (58.7%) of participants reported lifetime physical and/or sexual IPV; 39.1% experienced severe physical IPV; 12.2% reported partner-forced sexual activity; and 40.1% reported lifetime partner-perpetrated injuries. A total of 273 women had a spouse or boyfriend during the previous 12 months (although all participants were Native American, 59.0% of partners were non-Native). Among these women, past-year prevalence was 30.1% for physical and/or sexual IPV; 15.8% for severe physical IPV; 3.3% for forced partner-perpetrated sexual activity; and 16.4% for intimate partner injury. Reported IPV prevalence during pregnancy was 9.3%. Pregnancy was not associated with past-year IPV (odds ratio = 0.9). Past-year IPV prevalence was 42.8% among women scoring low on the socioeconomic index, compared with 10.1% among the reference group. After adjusting for age, relationship status, and household size, low socioeconomic index remained strongly associated with past-year IPV (odds ratio = 5.0; 95% confidence interval: 2.4, 10.7).ConclusionsNative American women in our sample experienced exceptionally high rates of lifetime and past-year IPV. Additionally, within this low-income sample, there was strong evidence of socioeconomic variability in IPV. Further research should determine prevalence of IPV against Native American women from diverse tribes and regions, and examine pathways through which socioeconomic disadvantage may increase their IPV risk.

Prevalence and Correlates of Mental Disorders Among Native American Women in Primary Care

OBJECTIVES We examined the lifetime and the past-year prevalence and correlates of common mental disorders among American Indian and Alaska Native women who presented for primary care. METHODS We screened 489 consecutively presenting female primary care patients aged 18 through 45 years with the General Health Questionnaire, 12-item version. A subsample (n = 234) completed the Composite International Diagnostic Interview. We examined associations between psychiatric disorders and sociodemographic variables, boarding school attendance, and psychopathology in the family of origin. RESULTS The study participants had high rates of alcohol use disorders, anxiety disorders, and anxiety/depression comorbidity compared with other samples of non-American Indian/Alaska Native women in primary care settings. CONCLUSIONS There is a need for culturally appropriate mental health treatments and preventive services.

Prevalence and predictors of home and automobile smoking bans and child environmental tobacco smoke exposure: a cross-sectional study of U.S.- and Mexico-born Hispanic women with young children

BackgroundDetrimental effects of environmental tobacco smoke (ETS) exposure on child health are well documented. Because young childrens primary exposure to ETS occurs in homes and automobiles, voluntary smoking restrictions can substantially reduce exposure. We assessed the prevalence of home and automobile smoking bans among U.S.- and Mexico-born Hispanics in the southwestern United States, and examined the influence of mothers country of birth and smoking practices on voluntary smoking bans and on child ETS exposure.MethodsU.S.- and Mexico-born Hispanic mothers of children aged 2 through 12 years were systematically sampled from health clinics in Albuquerque, New Mexico. In-person interviews were conducted with 269 mothers (75.4% response rate) to obtain information on main study outcomes (complete versus no/partial home and automobile smoking bans; child room and automobile ETS exposure) and risk factors (mothers country of birth, maternal and household smoking behaviors). Data were analyzed with chi square tests and logistic regression models.ResultsThree-fourths (74–77%) of U.S.-born and 90–95% of Mexico-born mothers reported complete automobile and home smoking bans. In multivariate analyses, mothers U.S nativity, mothers current smoking, and presence of other adult smokers in the home were associated with significantly increased odds of not having a complete home or automobile smoking ban. Mothers smoking was associated with child ETS exposure both indoors (odds ratio [OR] = 3.31) and in automobiles (OR = 2.97). Children of U.S.-born mothers had increased odds of exposure to ETS indoors (OR = 3.24; 95% confidence interval [CI]: 1.37–7.69), but not in automobiles. Having complete smoking bans was associated with substantially reduced odds of child ETS exposure both indoors (OR = 0.10; 95% CI: 0.04–0.27) and in automobiles (OR = 0.14; 95% CI: 0.05–0.36).ConclusionThis study of Hispanic mothers in the southwestern U.S. indicates that there are substantial differences between U.S.- and Mexico-born mothers in the prevalence of home and automobile smoking bans, and resulting child ETS exposure. Tobacco interventions to increase smoke-free environments for U.S. Hispanic children should focus on both home and automobile smoking practices, especially among U.S.-born mothers, and utilize strategies that impact smoking practices of all household members.

Congenital cardiac anomalies relative to selected maternal exposures and conditions during early pregnancy

Recently, several studies have explored possible relations between various exposures to women and congenital cardiac anomalies in their infants (1, 12-17). We also investigated potential relations between a variety of maternal exposures or conditions during pregnancy and congenital cardiac anomalies using data from a study designed to estimate risks between maternal exposure to drinking water and congenital cardiac anomalies (11). Approximately 70,000 children born alive in Santa Clara County, California from January 1981 through December 1983 were eligible. Cases, ascertained by the California Birth Defects Monitoring Program, were children with congenital cardiac disease diagnosed by echocardiogram, catheterization, surgery, or autopsy up to one year of age. Excluded were cases with: chromosomal anomalies, isolated ventricular and atrial septal defects (unless diagnosed by catheterization or surgery or associated with heart failure), isolated patent foramen ovale, patent ductus arteriosus among infants < 38 weeks gestation, isolated pulmonic stenosis, arrhythmia, or functional murmur, unless accompanied by congestive heart failure. Control children were randomly selected from vital statistics files of all livebirths without a cardiac anomaly in the county for the same time period. Of 172 cases that met diagnostic criteria, 141 (82.0%) mothers were interviewed. Of the 210 control infants, 176 mothers (83.80/0) were interviewed. Interviews were conducted with mothers primarily by telephone an average 4.6 (range 2.9 to 6.7 years, cases and controls were the same) years after the birth. The effect of maternal exposures or conditions on the risk of a child being born with a cardiac anomaly was estimated by the odds ratio (OR) and its 95°/0 confidence interval. Analyses were performed with all cases as well as with a subset of cases having defects of the conotruncus (truncus arteriosus communis, including aortopulmonary window; tetralogy of Fallot; dextro-transposition of the great vessels; double outlet fight ventricle; pulmonary atresia with a ventricular septal defect; or interruption of the aortic arch) (3). Approximately two-thirds of the diagnoses for the 141 cases were: ventricular septal defect, atrial septal defect, transposition of the great vessels, coarctation of the aorta, hypoplastic left heart, tetralogy of Fallot, pulmonary valve stenosis, or pulmonary valve atresia. Cases and controls were similar with respect to parental race, maternal age, child sex, and parental education. For all cardiac anomalies as a group, crude ORs greater than 1.5 were observed for epilepsy (OR = 3.8), diabetes (OR = 2.2), arthritis (OR = 1.8), insulin (OR = 5.1), anticonvulsant (OR = 2.5), cigarette use (< 0.5 pack per day) (OR = 1.9), heavy alcohol use (OR = 1.7) (defined as 4 or more drinks per occasion at least once per week, or 2-3 drinks per occasion if drank at least several times a week), and use of oral contraceptives (OR = 2.1) near the time of conception

Results From a Lay Health Advisor Intervention to Prevent Lead Poisoning Among Rural Native American Children

OBJECTIVES We tested the effectiveness of a community-based lay health advisor intervention for primary prevention of lead poisoning among Native American children who lived in a former mining area. METHODS We conducted cross-sectional population-based blood lead assessments of Native American and White children aged 1 to 6 years and in-person caregiver interviews before (n=331) and after (n=387) a 2-year intervention. RESULTS Mean childhood blood lead levels decreased and selected preventive behaviors improved for both Native American and White (comparison) communities. Several short-term outcomes also improved from pre- to postintervention, but only knowledge and hand-washing self-efficacy increased more among Native Americans than among Whites. CONCLUSIONS Our findings provide limited support for the effectiveness of lay health advisor interventions as a primary lead poisoning prevention strategy for Native American communities.

Assessing lay health advisor activity in an intervention to prevent lead poisoning in Native American children.

The purpose of this study is to assess patterns of lay health advisor (LHA) activity in an intervention to reduce lead exposure in Native American children exposed to mine waste. A total of 39 LHAs were recruited and trained to become LHAs from eight tribes in northeastern Oklahoma. LHAs completed activity tracking forms over a 2-year intervention period to document contacts made with community groups and individuals in their social networks. They engaged in an average of 5.4 activities per month, reaching an average of 39 persons. Close members of their social networks were reached in 40.4% of the contacts; persons outside of their networks were reached in 24% of the contacts. This study suggests that 1 to 3 contacts per week may be a reasonable expectation for LHA activity. Findings also suggest that LHA interventions are a promising approach for engaging Native American communities in addressing an environmental health problem.

Maternal water consumption during pregnancy and congenital cardiac anomalies

This case-control study, conducted in a California county that had a local incident of water contamination in 1981, investigated the relation between a mothers reported consumption of tap water during pregnancy and congenital cardiac anomalies in their offspring horn during 1981–1983. Data were obtained from telephone interviews with 145 mothers of children born with a severe cardiac anomaly and 176 mothers of children born without such an anomaly. A positive association between a mothers consumption of home tap water during the first trimester of pregnancy and cardiac anomalies in her infant was unrelated to the incident of water contamination, the mothers race, or her educational level. A negative relation was found between a mothers use of bottled water and cardiac anomalies among the infants. These findings corresponded primarily to births in 1981. These data could not fully distinguish between a potential causal agent in the water and differential reporting of exposure by study subjects.

Exposure Misclassification Due to Residential Mobility during Pregnancy in Epidemiologic Investigations of Congenital Malformations

This study addressed the question of how maternal migration between conception and birth affects estimates of risk in studies of congenital malformations when movement is related to the exposure. For example, in studying the potential association between proximity to a chemical waste site and the occurrence of birth defects, incorrect inferences might be drawn if maternal residence at birth was used as a surrogate for exposure at conception in the case when a significant amount of media attention influenced some women to move away from the site after becoming pregnant. A simple statistical model is proposed that defines the distance to a fixed exposure point measured at birth as a function of the distance to the point measured at conception, the probability of movement, the direction of movement, and the distance moved. Bias is the difference between the expected results when distance is measured at birth versus conception. The amount of bias can be substantial for movement patterns that may be likely to occur. This simplified model was used in an effort to explore and better understand the relationships between maternal migration and risk.