Samantha S. Goldfarb

Family structure and risk behaviors: the role of the family meal in assessing likelihood of adolescent risk behaviors.

Background Previous literature has asserted that family meals are a key protective factor for certain adolescent risk behaviors. It is suggested that the frequency of eating with the family is associated with better psychological well-being and a lower risk of substance use and delinquency. However, it is unclear whether there is evidence of causal links between family meals and adolescent health-risk behaviors. Purpose The purpose of this article is to review the empirical literature on family meals and adolescent health behaviors and outcomes in the US. Data sources A search was conducted in four academic databases: Social Sciences Full Text, Sociological Abstracts, PsycINFO®, and PubMed/MEDLINE. Study selection We included studies that quantitatively estimated the relationship between family meals and health-risk behaviors. Data extraction Data were extracted on study sample, study design, family meal measurement, outcomes, empirical methods, findings, and major issues. Data synthesis Fourteen studies met the inclusion criteria for the review that measured the relationship between frequent family meals and various risk-behavior outcomes. The outcomes considered by most studies were alcohol use (n=10), tobacco use (n=9), and marijuana use (n=6). Other outcomes included sexual activity (n=2); depression, suicidal ideation, and suicide attempts (n=4); violence and delinquency (n=4); school-related issues (n=2); and well-being (n=5). The associations between family meals and the outcomes of interest were most likely to be statistically significant in unadjusted models or models controlling for basic family characteristics. Associations were less likely to be statistically significant when other measures of family connectedness were included. Relatively few analyses used sophisticated empirical techniques available to control for confounders in secondary data. Conclusion More research is required to establish whether or not the relationship between family dinners and risky adolescent behaviors is an artifact of underlying confounders. We recommend that researchers make more frequent use of sophisticated methods to reduce the problem of confounders in secondary data, and that the scope of adolescent problem behaviors also be further widened.

A systematic review of the association between family meals and adolescent risk outcomes.

OBJECTIVE To conduct a systematic review of the literature examining the relationship between family meals and adolescent health risk outcomes. METHODS We performed a systematic search of original empirical studies published between January 1990 and September 2013. Based on data from selected studies, we conducted logistic regression models to examine the correlates of reporting a protective association between frequent family meals and adolescent outcomes. RESULTS Of the 254 analyses from 26 selected studies, most reported a significant association between family meals and the adolescent risk outcome-of-interest. However, model analyses which controlled for family connectedness variables, or used advanced empirical methods to account for family-level confounders, were less likely than unadjusted models to report significant relationships. CONCLUSIONS The type of analysis conducted was significantly associated with the likelihood of finding a protective relationship between family meals and the adolescent outcome-of-interest, yet very few studies are using such methods in the literature.

State-Level Progress in Reducing the Black–White Infant Mortality Gap, United States, 1999–2013

Objectives To assess state-level progress on eliminating racial disparities in infant mortality. Methods Using linked infant birth-death files from 1999 to 2013, we calculated state-level 3-year rolling average infant mortality rates (IMRs) and Black-White IMR ratios. We also calculated percentage improvement and a projected year for achieving equality if current trend lines are sustained. Results We found substantial state-level variation in Black IMRs (range = 6.6-13.8) and Black-White rate ratios (1.5-2.7), and also in percentage relative improvement in IMR (range = 2.7% to 36.5% improvement) and in Black-White rate ratios (from 11.7% relative worsening to 24.0% improvement). Thirteen states achieved statistically significant reductions in Black-White IMR disparities. Eliminating the Black-White IMR gap would have saved 64 876 babies during these 15 years. Eighteen states would achieve IMR racial equality by the year 2050 if current trends are sustained. Conclusions States are achieving varying levels of progress in reducing Black infant mortality and Black-White IMR disparities. Public Health Implications Racial equality in infant survival is achievable, but will require shifting our focus to determinants of progress and strategies for success.

Correlates of wellness among youth with functional disabilities.

BACKGROUND The literature is more informative on the impediments to wellness among youth with functional limitations and less instructive on the state of wellness for this population. OBJECTIVE To explore overall wellness, and each sub-dimension of wellness, in a national sample of youth with functional limitations and to determine how demographic characteristics are associated with wellness. METHODS Using a previously validated screening instrument, we identify youth with functional limitations aged 12 to 17 represented in the 2011/12 National Survey of Childrens Health. Survey items were coded to operationalize an overall wellness score comprised of four sub-dimensions of wellness (i.e., physical, intellectual, emotional, and social). RESULTS The mean overall wellness score was 26.7 (out of 40) and had an approximate normal distribution. Mean raw scores for each sub-dimension were as follows: social = 2.79 (out of 4; 69.7%); emotional = 4.09 (out of 6; 68.2%); intellectual = 3.79 (out of 8; 47.4%); and physical = 6.30 (out of 8; 78.7%). Lower wellness scores were associated with older age among youth, increasing number of chronic health conditions, lower income, single mother homes, and youth whose mother reported fair or poor mental health status (all p < 0.05). Higher wellness scores were positively associated with mothers education (p < 0.001). CONCLUSIONS Program planners should consider interventions that target youth with functional limitations shown to be at particular risk for lower overall wellness and promote family involvement and comprehensive supports, including maternal educational attainment, mental health screening, and referral.

Future plans and social/recreational activities of youth with special health care needs: The implications of parental help in completing surveys

BACKGROUND A major focus of the literature on youth with special health care needs (YSHCN) is the transition to adult health care. As perceptions of disability are a product of interactions between youth and their environment, it is important to understand youths needs and experiences beyond health care. Few studies have addressed social/recreational activity participation and future plans and none have included parent/caregiver help in survey completion as a potential factor impacting responses. OBJECTIVES We describe activity participation and identification of future plans among YSHCN and examine the impact of receiving parent/caregiver assistance to complete a survey on these responses. Implications for research, policy, and practice affecting programs serving and providing transition assistance for YSHCN are discussed. METHODS Data are from a survey of YSHCN conducted during Alabamas 2010 Title V Maternal and Child Health Needs Assessment. Analyses included descriptive statistics, bivariate analysis, and multivariable logistic regression. RESULTS Youth who received help completing the survey were less likely to report participating in certain social/recreational activities and key future plans, including hobbies, getting married, having children, and working for pay. CONCLUSIONS For YSHCN, parent/caregiver assistance to complete a survey is a critical consideration in analyses and interpretation of results. Whether, how much, and what type of help received may represent a more objective proxy measure of perceptions of condition severity or impact on abilities than do self-reported ratings of these factors. Our results also raise questions about the distinctions between youth and parent/caregiver perceptions of independence, participation, and potential.

Wellness among US adolescents ages 12-17 years.

BACKGROUND Wellness is a multidimensional construct related to an individuals physical, emotional, intellectual and social well-being. We present estimates of wellness among US adolescents aged 12-17 years and explore how demographic characteristics are associated with wellness. METHODS All respondents aged 12 to 17 years (n = 34,601) from the 2011-2012 National Survey of Childrens Health were included in the sample. Survey items were coded to operationalize an overall wellness score, comprised of four subdimensions (physical, intellectual, emotional and social). RESULTS The mean adjusted overall wellness score was 30.2 (out of 40). Mean raw subdimensions scores were: social = 3.14 (out of 4), emotional = 4.79 (out of 6), intellectual = 4.80 (out of 8) and physical = 6.57 (out of 8). Older adolescents, those with special health needs, those in lower income families and those whose mother or father report fair-poor mental health status had lower wellness scores. CONCLUSIONS US adolescents have wellness scores towards the upper or higher end of our scale. Several adolescent and family characteristics were associated with either lower overall wellness and/or lower wellness on multiple subdimensions. Assessing wellness during critical developmental periods of adolescence is a first step towards promoting behaviours that support increased wellness into adulthood.

Disparities in Infant Mortality by Race Among Hispanic and Non-Hispanic Infants

ObjectivesU.S.-born Hispanic infants have a well-documented health advantage relative to other minority groups. However, little published research has examined racial heterogeneity within the Hispanic population, in relation to health outcomes. The current study aims to explore possible implications of racial identification for the health of U.S. born Hispanic compared to non-Hispanic infants. Methods Data were drawn from 2007 to 2008 NCHS Cohort Linked Live Birth—Infant Death Files, restricted to deliveries of Hispanic black, Hispanic white, non-Hispanic black (NHB) and non-Hispanic white mothers (NHW) (n = 7,901,858). Adjusted odds ratios for first week mortality, neonatal, postneonatal, and overall infant mortality were calculated for each group, using NHW as the reference group. Results: A distinct health gradient was observed in which NHB infants (n = 1,250,222) had the highest risk of first week (aOR 2.29, CI 2.21–2.37), neonatal (aOR 2.23, CI 2.17–2.30), postneonatal (aOR 1.74, CI 1.68–1.81), and infant mortality (aOR 2.05, CI 2.00–2.10) compared to NHW infants (n = 4,578,150). Hispanic black infants (n = 84,377) also experienced higher risk of first-week (aOR 1.28 (1.12–1.47), neonatal (aOR .27, CI 1.13–1.44), postneonatal (aOR 1.34, CI 1.15–1.56), and infant mortality (aOR 1.30, CI 1.18–1.43) compared to both NHW and Hispanic white infants (n = 1,989,109). Conclusions for Practice: Risk of infant mortality varies among Hispanic infants by race, with poorer outcomes experienced by Hispanic black infants. Compared to non-Hispanic infants of the same race, Hispanic black infants experience a smaller health disadvantage and Hispanic white infants have better or similar infant health outcomes. Our findings suggest implications of racial heterogeneity on infant health outcomes, and provide insight into the role of race as a social construct.

Pockets of progress amidst persistent racial disparities in low birthweight rates

Racial disparities persist in adverse perinatal outcomes such as preterm birth, low birthweight (LBW), and infant mortality across the U.S. Although pervasive, these disparities are not universal. Some communities have experienced significant improvements in black (or African American) birth outcomes, both in absolute rates and in rate ratios relative to whites. This study assessed county-level progress on trends in black and white LBW rates as an indicator of progress toward more equal birth outcomes for black infants. County-level LBW data were obtained from the 2003 to 2013 U.S. Natality files. Black LBW rates, black-white rate ratios and percent differences over time were calculated. Trend lines were first assessed for significant differences in slope (i.e., converging, diverging, or parallel trend lines). For counties with parallel trend lines, intercepts were tested for statistically significant differences (sustained equality vs. persistent disparities). To assess progress, black LBW rates were compared to white LBW rates, and the trend lines were tested for significant decline. Each county’s progress toward black-white equality was ultimately categorized into five possible trend patterns (n = 408): (1) converging LBW rates with reductions in the black LBW rate (decreasing disparities, n = 4, 1%); (2) converging LBW rates due to worsening white LBW rates (n = 5, 1%); (3) diverging LBW rates (increasing disparities, n = 9, 2%); (4) parallel LBW rates (persistent disparities, n = 373, 91%); and (5) overlapping trend lines (sustained equality, n = 18, 4%). Only four counties demonstrated improvement toward equality with decreasing black LBW rates. There is significant county-level variation in progress toward racial equality in adverse birth outcomes such as low birthweight. Still, some communities are demonstrating that more equitable outcomes are possible. Further research is needed in these positive exemplar communities to identify what works in accelerating progress toward more equal birth outcomes.

The weathering hypothesis and stillbirth: racial disparities across the life span

ABSTRACT Objective: Given that studies have consistently demonstrated increased risk of stillbirth with increasing maternal age as well as race-ethnic disparities in stillbirth, the primary research question is how stillbirth risks within and between race-ethnic groups change with age. Design: Using fetal death (stillbirth) and live birth data from the National Center for Health Statistics 2007–2014. We calculated crude stillbirth rates (per 1,000 deliveries). Using multivariable logistic regression, we calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for stillbirth across age groups to examine disparities in stillbirth among non-Hispanic blacks (blacks) and non-Hispanic whites (whites). Results: Rates and risks of stillbirth increased as maternal age increased; however, the magnitude of risk varies by race-ethnicity. Compared to women less than 20, black women age 40+ had a risk of almost 3.5 times (aOR = 3.47, 95% CI = 3.24–3.70) whereas among white women age 40+, the risk was more than 2.5 times (aOR = 2.68, 95% CI = 2.55–2.82). The risk of stillbirth among blacks compared to whites increased, peaking at ages 30–34 (aOR = 2.64, 95% CI = 2.56–2.73). At age 35 and beyond, the disparity in risks declined. Conclusion: As age increased, the risk of stillbirth increased for both blacks and whites. Because the disparity in risk between blacks and whites did not continue to increase with age, stillbirth does not seem to reflect the weathering hypothesis as other perinatal outcomes do.

Associations between participation in family activities and adolescent school problems

INTRODUCTION Adolescent risk outcomes related to school issues are widespread, with about 20% parents reporting poor school engagement amongst their youth. Previous literature suggests that adolescents who report strong bonds with their parents are often identified as being less likely to engage in risky behaviours, such as substance use. The current study sought to examine the association between the frequencies of selected family activities and school problems amongst adolescents after adjustments for family connectedness and other characteristics. METHODS Data were drawn from the National Longitudinal Survey of Youth, 1997. Of the 8984 youth interviewed, 3855 also had a sibling interviewed who met the selection criteria. School problem outcomes measured were suspension occurrence, poor grades and highest grade completed low for age. Independent variables of interest were self-reported frequency of family dinner, fun and religious activities in a typical week. Multivariable logistic models were estimated for each outcome, and multivariable linear probability models were estimated adjusting for family fixed effects. RESULTS Adjusting for family connectedness, there were significant associations between certain family activities and adolescent school problem measures. However, these results did not remain significant in models with family fixed effects, suggesting that associations could be driven by family-level confounders. DISCUSSION This study did not find strong evidence of a protective relationship between family activities and school problems. Therefore, it suggested that programme and policymakers be cautious in overstating the importance of family activities in preventing adolescent risk outcomes until true causal relationships can be determined.