Shanna Cox

Tobacco Product Use Among Adults — United States, 2013–2014

While significant declines in cigarette smoking have occurred among U.S. adults during the past 5 decades, the use of emerging tobacco products* has increased in recent years (1-3). To estimate tobacco use among U.S. adults aged ≥18 years, CDC and the Food and Drug Administration (FDA) analyzed data from the 2013-2014 National Adult Tobacco Survey (NATS). During 2013-2014, 21.3% of U.S. adults used a tobacco product every day or some days, and 25.5% of U.S. adults used a tobacco product every day, some days, or rarely. Despite progress in reducing cigarette smoking, during 2013-2014, cigarettes remained the most commonly used tobacco product among adults. Young adults aged 18-24 years reported the highest prevalence of use of emerging tobacco products, including water pipes/hookahs and electronic cigarettes (e-cigarettes). Furthermore, racial/ethnic and sociodemographic differences in the use of any tobacco product were observed, with higher use reported among males; non-Hispanic whites, non-Hispanic blacks, and non-Hispanics of other races(†); persons aged <45 years; persons living in the Midwest or South; persons with a General Educational Development (GED) certificate; persons who were single/never married/not living with a partner or divorced/separated/widowed; persons with annual household income <

Hospitalizations With Respiratory Illness Among Pregnant Women During Influenza Season

20,000; and persons who were lesbian, gay, or bisexual (LGB). Population-level interventions that focus on all forms of tobacco product use, including tobacco price increases, high-impact anti-tobacco mass media campaigns, comprehensive smoke-free laws, and enhanced access to help quitting tobacco use, in conjunction with FDA regulation of tobacco products, are critical to reducing tobacco-related diseases and deaths in the United States.(§).

Elective oophorectomy in the United States: Trends and in-hospital complications, 1998-2006

OBJECTIVE: To examine hospitalizations with respiratory illness among pregnant women in the United States during periods of influenza activity. METHODS: Data were obtained from the Healthcare Cost and Utilization Project National Inpatient Sample (NIS), the largest publicly available all-payer hospital discharge database. Hospitalizations for respiratory illness and pregnancy were classified with International Classification of Diseases, 9th Revision, Clinical Modification codes. Analyses were stratified by delivery status. Discharge characteristics, length of stay, and complications of delivery among hospitalized pregnant women with and those without respiratory illness were compared. RESULTS: During the 1998–2002 influenza seasons, 3.4 per 1,000 hospitalizations of pregnant women included diagnoses of respiratory illness. Characteristics of pregnancy hospitalizations associated with higher odds of respiratory illness were presence of a high-risk condition for which influenza vaccination is recommended (adjusted odds ratio [OR] 3.2, 95% confidence interval [CI] 3.0–3.5 and OR 6.0, 95% CI 5.2–6.9 for nondelivery and delivery, respectively), Medicaid/Medicare as primary expected payer of care (OR 1.2, 95% CI 1.1–1.3 and OR 1.9, 95% CI 1.7–2.2 for nondelivery and delivery, respectively), and hospitalization in a rural area (OR 1.2, 95% CI 1.1–1.4 for nondelivery). During influenza season, hospitalized pregnant women with respiratory illness had significantly longer lengths of stay and higher odds of delivery complications than hospitalized pregnant women without respiratory illness. CONCLUSION: Hospitalizations with respiratory illness among pregnant women during influenza season are associated with increased burden for patients and the health care system. Intervention efforts to decrease influenza-related respiratory morbidity among pregnant women should be encouraged. LEVEL OF EVIDENCE: III

Reasons for current E-cigarette use among U.S. adults

OBJECTIVES: To examine trends in rates of elective bilateral salpingo-oophorectomy in the United States and to assess the association of perioperative complications with elective bilateral salpingo-oophorectomy. METHODS: This cross-sectional study uses 1998–2006 data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, a nationally representative sample of inpatient hospitalizations. Analyses were limited to women aged 15 years or older at average risk for ovarian cancer who underwent hysterectomy for a benign gynecologic condition. Tests for trends in elective bilateral salpingo-oophorectomy rates were performed using weighted least squares regression for two time periods, 1998 to 2001 and 2002 to 2006. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for risks of complications associated with elective bilateral salpingo-oophorectomy were estimated using logistic regression. RESULTS: During the period from 1998 to 2006, 39% of the 2,250,041 women who underwent hysterectomy for benign gynecologic indications had elective bilateral salpingo-oophorectomy (rate, 8.3 per 10,000). The elective bilateral salpingo-oophorectomy rate increased from 7.8 per 10,000 in 1998 to 9.0 per 10,000 in 2001 (P trend <.05) and decreased from 9.0 per 10,000 in 2002 to 7.4 per 10,000 in 2006 (P trend <.05). The largest decline from 2002 to 2006 (20.3%) occurred among those aged 45 to 49 years. Compared with hysterectomy only, elective bilateral salpingo-oophorectomy was associated with an increased risk of complications when performed vaginally (OR 1.12; 95% CI 1.08–1.17) and a decreased risk of complications when performed abdominally (OR 0.91; 95% CI 0.89–0.94) or laparoscopically (OR 0.89; 95% CI 0.83–0.94). CONCLUSION: Elective bilateral salpingo-oophorectomy rates declined since 2002. However, the risks compared with the benefits of the procedure have not been clearly established. Prospective studies examining elective bilateral salpingo-oophorectomy with and without estrogen therapy are needed to guide practice patterns. LEVEL OF EVIDENCE: III

The clinical content of preconception care: infectious diseases in preconception care.

E-cigarette use has increased rapidly among U.S. adults. However, reasons for use among adults are unclear. We assessed reasons for e-cigarette use among a national sample of U.S. adults. Data were collected via online surveys among U.S. adults aged 18 or older from April through June 2014. Descriptive and multivariate regression analyses were conducted to assess reasons for e-cigarette use among 2448 current e-cigarette users, by sociodemographic characteristics and product type. Assessed reasons included cessation/health, consideration of others, convenience, cost, curiosity, flavoring, and simulation of conventional cigarettes. Among current e-cigarette users, 93% were also current cigarette smokers. The most common reasons for e-cigarette use were cessation/health (84.5%), consideration of others (71.5%), and convenience (56.7%). The prevalence of citing convenience (adjusted prevalence ratio [aPR]=1.49) and curiosity (aPR=1.54) as reasons for e-cigarette use were greater among current cigarette smokers than nonsmokers (P<0.05). The prevalence of citing flavoring as a reason for use was greater among adults aged 18 to 24 (aPR=2.02) than 55 or older (P<0.05). Tank use was associated with greater prevalence of citing every assessed reason except convenience and curiosity. Cessation- and health-related factors are primary reasons cited for e-cigarette use among adults, and flavorings are more commonly cited by younger adults. Efforts are warranted to provide consumers with accurate information on the health effects of e-cigarettes and to ensure that flavoring and other unregulated features do not promote nicotine addiction, particularly among young adults.

Hospitalizations with amphetamine abuse among pregnant women.

A number of infectious diseases should be considered for inclusion as part of clinical preconception care. Those infections strongly recommended for health promotion messages and risk assessment or for the initiation of interventions include Chlamydia infection, syphilis, and HIV. For selected populations, the inclusion of interventions for tuberculosis, gonorrheal infection, and herpes simplex virus are recommended. No clear evidence exists for the specific inclusion in preconception care of hepatitis C, toxoplasmosis, cytomegalovirus, listeriosis, malaria, periodontal disease, and bacterial vaginosis (in those with a previous preterm birth). Some infections that have important consequences during pregnancy, such as bacterial vaginosis (in those with no history of preterm birth), asymptomatic bacteriuria, parvovirus, and group B streptococcus infection, most likely would not be improved through intervention in the preconception time frame.

Who's responsible? Correlates of partner involvement in contraceptive decision making.

OBJECTIVE: To examine trends in pregnancy hospitalizations with a diagnosis of amphetamine or cocaine abuse and the prevalence of associated medical complications. METHODS: Data were obtained from the Nationwide Inpatient Sample. Hospitalization ratios per 100 deliveries for amphetamine or cocaine abuse from 1998 to 2004 were tested for linear trends. Amphetamine-abuse hospitalizations were compared with cocaine-abuse hospitalizations and non–substance-abuse hospitalizations. A &khgr;2 analysis was used to compare hospitalization characteristics. Conditional probabilities estimated by logistic regression were used to calculate adjusted prevalence ratios for each medical diagnosis of interest. RESULTS: From 1998 to 2004, the hospitalization ratio for cocaine abuse decreased 44%, whereas the hospitalization ratio for amphetamine abuse doubled. Pregnancy hospitalizations with a diagnosis of amphetamine abuse were geographically concentrated in the West (82%), and were more likely to be among women younger than 24 years than the cocaine-abuse or non–substance-abuse hospitalizations. Most medical conditions were more prevalent in the amphetamine-abuse group than the non–substance-abuse group. When the substance abuse groups were compared with each other, obstetric diagnoses associated with infant morbidity such as premature delivery and poor fetal growth were more common in the cocaine-abuse group, whereas vasoconstrictive effects such as cardiovascular disorders and hypertension complicating pregnancy were more common in the amphetamine-abuse group. CONCLUSION: As pregnancy hospitalizations with a diagnosis of amphetamine abuse continue to increase, clinicians should familiarize themselves with the adverse consequences of amphetamine abuse during pregnancy and evidence-based guidelines to deal with this high-risk population. LEVEL OF EVIDENCE: III

Reduced Disparities in Birth Rates Among Teens Aged 15–19 Years — United States, 2006–2007 and 2013–2014

OBJECTIVES Researchers have begun looking at joint responsibility for contraceptive decision making as a mechanism to increase effective contraceptive use. This analysis identifies correlates of partner involvement in contraceptive decision making. METHODS Participants were first-time users of either oral contraceptives or Depo-Provera recruited from 10 family planning clinics in Texas (n = 481). Participants completed a self-administered questionnaire that was available in both English and Spanish. Chi-square statistics were used to compare demographics, relationship characteristics, and condom use before and after initiation of the new hormonal method by who is responsible for birth control use. Characteristics that were significant in bivariate testing were then included in a multivariate logistic regression model. RESULTS Forty-five percent of women reported sole responsibility for contraceptive use and 55% reported joint responsibility with their partners. In multivariate models, consistent condom use before and after the initiation of hormonal contraception and duration of sexual activity with main partner for less than 2 years were associated with increased likelihood of joint responsibility for contraceptive decision making. Women whose partners were classified as high risk had reduced the odds of joint responsibility for contraceptive decision making. CONCLUSION Women at increased risk for sexually transmitted diseases (high-risk partners) and their partners may represent a target population for interventions aimed at increasing joint responsibility for contraception use. Continuous engagement in contraceptive decision making among long-term couples should also be encouraged.

Contraceptive Use Among Nonpregnant and Postpartum Women at Risk for Unintended Pregnancy, and Female High School Students, in the Context of Zika Preparedness — United States, 2011–2013 and 2015

Teen childbearing can have negative health, economic, and social consequences for mothers and their children (1) and costs the United States approximately

Frequency of Tobacco Use Among Middle and High School Students--United States, 2014.

9.4 billion annually (2). During 1991-2014, the birth rate among teens aged 15-19 years in the United States declined 61%, from 61.8 to 24.2 births per 1,000, the lowest rate ever recorded (3). Nonetheless, in 2014, the teen birth rate remained approximately twice as high for Hispanic and non-Hispanic black (black) teens compared with non-Hispanic white (white) teens (3), and geographic and socioeconomic disparities remain (3,4), irrespective of race/ethnicity. Social determinants associated with teen childbearing (e.g., low parental educational attainment and limited opportunities for education and employment) are more common in communities with higher proportions of racial and ethnic minorities (4), contributing to the challenge of further reducing disparities in teen births. To examine trends in births for teens aged 15-19 years by race/ethnicity and geography, CDC analyzed National Vital Statistics System (NVSS) data at the national (2006-2014), state (2006-2007 and 2013-2014), and county (2013-2014) levels. To describe socioeconomic indicators previously associated with teen births, CDC analyzed data from the American Community Survey (ACS) (2010-2014). Nationally, from 2006 to 2014, the teen birth rate declined 41% overall with the largest decline occurring among Hispanics (51%), followed by blacks (44%), and whites (35%). The birth rate ratio for Hispanic teens and black teens compared with white teens declined from 2.9 to 2.2 and from 2.3 to 2.0, respectively. From 2006-2007 to 2013-2014, significant declines in teen birth rates and birth rate ratios were noted nationally and in many states. At the county level, teen birth rates for 2013-2014 ranged from 3.1 to 119.0 per 1,000 females aged 15-19 years; ACS data indicated unemployment was higher, and education attainment and family income were lower in counties with higher teen birth rates. State and county data can be used to understand disparities in teen births and implement community-level interventions that address the social and structural conditions associated with high teen birth rates.