Journal of Maternal-Fetal and Neonatal Medicine, 2009
We hypothesised that the gross placental measures would be positively associated with childhood g... more We hypothesised that the gross placental measures would be positively associated with childhood growth. We analysed data on 23,967 mother-infant pairs enrolled in the Collaborative Perinatal Project. In race-stratified regression models, the main outcomes were birthweight and z-score body-mass index (BMI) at ages 4 and 7. Some placental measures were significantly associated with z-score BMI at age 7: in Blacks, placental weight (beta = 0.0004/g; 95%CI: 0.0001, 0.0008), chorionic plate area (beta = 0.0007; 95%CI: 0.0001, 0.0012) and largest diameter (beta = 0.013; 95%CI: 0.004, 0.026); and in Whites placental weight (beta = 0.0004/g; 95%CI: 0.0001, 0.0003) and largest diameter (Model 3: beta = 0.020; 95%CI: 0.007, 0.032). Tested as group, placental measures significantly predicted z-score BMI at age 7 (all p values < 0.005). Placental structure independently predicts birthweight and childhood growth. Strategies to improve placental structure might favourably influence birthweight and childhood development.
Intimate partner violence has been linked to poor child health. A continuous relationship with a ... more Intimate partner violence has been linked to poor child health. A continuous relationship with a primary care pediatric provider can help to detect intimate partner violence and connect families with needed services. The objectives of this study were to determine the relationship between intimate partner violence and (1) maternal report of a regular site for well-child care, (2) maternal report of a primary pediatric provider, (3) well-child visits in the first year of life, (4) up-to-date immunizations at 2 years of age, (5) maternal report of medical neglect, and (6) maternal report of the pediatric provider-caregiver relationship. This retrospective cohort study evaluated data from 209 at-risk families participating in the evaluation of the Healthy Families Alaska program. Research staff interviewed mothers near the time of an index child's birth and again at the child's second birthday. Medical charts were abstracted for information on well-child visits and immunizations. Mothers who disclosed intimate partner violence at the initial interview (n = 62) were significantly less likely to report a regular site for well-child care or a primary pediatric provider. In multivariable models, children of mothers who disclosed intimate partner violence tended to be less likely to have the recommended 5 well-child visits within the first year of life and were significantly less likely to be fully immunized at 2 years of age. Differences in medical neglect were not statistically significant. Of mothers who reported a specific primary pediatric provider, those with intimate partner violence histories trusted this provider less and tended to rate less favorably pediatric provider-caregiver communication and the overall quality of the pediatric provider-caregiver relationship. Future research should explore effective ways to link intimate partner violence-exposed children with a medical home and a primary pediatric provider and to improve relationships between pediatric providers and caregivers who face violence at home.
Journal of the American Academy of Child & Adolescent Psychiatry, 1999
Given that highly sensitive urine-based nucleic acid amplification tests may eliminate the need f... more Given that highly sensitive urine-based nucleic acid amplification tests may eliminate the need for speculum exam to diagnose gonorrhea and chlamydia cervicitis, we sought to determine if vaginal infections could be diagnosed without using a speculum. Matched pairs of vaginal specimens were collected from participants before and during speculum exam for diagnosis of trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis. Females age 12 to 22 years presenting to the Johns Hopkins adolescent primary care clinics who required a pelvic examination were eligible to participate. A convenience sample of 686 patients was recruited between July 1995 and August 1996. Paired vaginal specimens were evaluated with blinded microscopic evaluation. Analysis consisted of: 1) comparison of collection method sensitivities; and 2) assessment of proportions of infections detected by one method that were also detected by the other method. Sensitivities of speculum and nonspeculum collection methods were 75% and 77% (difference = -2%; 95% confidence interval, -11%, 7%) for trichomoniasis, 64% and 68% (difference = -4% [-10%, 3%]) for bacterial vaginosis, and 85% and 80% (difference = 5% [-12%, 22%]) for vulvovaginal candidiasis. The speculum method identified 88% (trichomoniasis), 90% (bacterial vaginosis), and 81% (vulvovaginal candidiasis) of infections detected by the nonspeculum method. The nonspeculum method identified 91% (trichomoniasis), 95% (bacterial vaginosis), and 76% (vulvovaginal candidiasis) of infections detected by the speculum method. Vaginal infections can be adequately diagnosed without a speculum. Once urine-based diagnosis of gonorrhea and chlamydia becomes well established, it may be possible to perform evaluations for uncomplicated genitourinary complaints without using a speculum.
To determine the prevalence of hepatitis C virus (HCV) infection in children with an unknown or n... more To determine the prevalence of hepatitis C virus (HCV) infection in children with an unknown or negative human immunodeficiency virus (HIV) status attending an urban hospital pediatric primary care clinic, and to identify HCV risk factors in their mothers. This was a cross-sectional study of 1034 children tested for HCV antibodies (anti-HCV) after excluding children known to be HIV-positive. We assessed maternal HCV risk factors through structured interviews with a sample of mothers (n=573) and through review of available medical records (n=347) for a subsample of mother-child pairs. Means, proportions, and 95% confidence intervals were used to estimate the prevalence of anti-HCV and maternal risk factors. One child (0.1%; 95% CI, 0.002, 0.5) was anti-HCV positive. History of blood transfusion was reported by 7% of mothers and intravenous drug use (IVDU) by 1.8%. A subsample of mothers significantly underreported IVDU when compared with medical record review (1.5% vs 7.8%, P<.001). Our findings suggest that universal screening of children for HCV in high-risk urban communities is not warranted. However, self-report may not be reliable for identifying mothers with a history of IVDU, for whom HCV testing is recommended.
Previous research suggests that experiencing intimate partner violence (IPV) may negatively affec... more Previous research suggests that experiencing intimate partner violence (IPV) may negatively affect employment outcomes. This study explores the relationship between IPV and employment stability both concurrently and longitudinally among a sample of 512 predominantly Asian American and Pacific Islander young women living in Hawaii. Women in this study were identified as being at risk of child maltreatment. About half of women indicated that their current relationship status was married or living together. More than two-thirds of women had graduated from high school and half had worked in the past year. The study explored the concurrent association of IPV and employment by assessing them simultaneously over a 12 month time period. The study examined the longitudinal impact of IPV by analyzing violence at two time points as predictors of unstable employment 6 to 8 years later. The study also explored the mediating effects of depression. Study results demonstrated both concurrent and longitudinal negative associations of IPV with employment stability. Women who experienced violence were more likely to be experiencing unstable employment concurrently. Women who experienced IPV at one point in time had lower levels of employment stability six years later. This decrease was partially mediated by experiencing depressive symptoms. Women who identified their primary ethnicity as Native Hawaiian or Pacific Islander were much more likely to experience unstable employment than Asian American women. More research is needed to explore the roles of mental health, race and ethnicity, and types of violence in the relationship between IPV and employment.
Father involvement may be an important support for children born to adolescent mothers. This stud... more Father involvement may be an important support for children born to adolescent mothers. This study examines patterns and predictors of father involvement, as reported by adolescent mothers, from their child's infancy through toddlerhood. Data were collected from urban, primarily African American, adolescent mothers (N = 138) in four interviews, over a 24-month period. The percentage of fathers categorized as “highly involved” decreased
This study examined the relationship between a teen mother&am... more This study examined the relationship between a teen mother's perceptions of nurturance from her mother and father and her mental health and parenting attitudes. One-hundred and thirty-eight urban, primarily African American adolescent mothers were interviewed. Multivariate results indicate that teen mothers who felt nurtured by their mothers had greater empathy toward their own children, and those who felt nurtured by
Journal of Developmental & Behavioral Pediatrics, 2005
The aims of this study were fourfold: to document the prevalence of language delays in a sample o... more The aims of this study were fourfold: to document the prevalence of language delays in a sample of at-risk 3 year olds; to assess the effectiveness of a home visiting program in preventing early language delays; to determine how often parents, pediatric providers, and home visitors identified early language delays; and to assess the effectiveness of a home visiting program in improving early identification of language delays. The Preschool Language Scale, Third Edition (PLS-3) was administered to 513 at-risk 3 year olds participating in a randomized trial of home visiting services. Families randomized to home visiting were expected to receive weekly to quarterly visits throughout the 3 years of this study. The content of home visits included teaching parents about child development, role-modeling parenting skills, and linking families to a medical home. Identification of delays was measured using structured parent interviews and review of primary care and home visiting records. At age 3 years, 10% of children had severe language delays, defined as scoring >or=2 SD below the national mean on the PLS-3, whereas 49% scored >or=1 SD below the national mean. No differences in prevalence were seen between children who did and did not receive home visiting. Among children with severe delays, 42% were identified by parents, 33% by pediatric providers, and 24% by home visitors. Among children with any delays, 24% were identified by parents, 25% by pediatric providers, and 17% by home visitors. No differences in rates of identification were seen between children who did and did not receive home visiting. Thus, while language delays were highly prevalent among these at-risk children, rates of identification were low, even among children with severe delays. Home visiting was not effective in either preventing language delays or improving early identification. This suggests that pediatric providers and home visiting programs need to reexamine their approaches to recognizing and intervening with early language delays.
Journal of Consulting and Clinical Psychology, 2009
Home visiting programs for at-risk mothers and their infants have proliferated nationally in rece... more Home visiting programs for at-risk mothers and their infants have proliferated nationally in recent years, yet experimental studies of home visiting have yielded mixed findings. One promising strategy for explicating the effects of early home visiting is to examine moderators of program impacts. This study assessed the roles of maternal depression and attachment insecurity as moderators of the impacts of Healthy Families Alaska home visiting services for at-risk mothers and their infants. At-risk families (N = 325) were randomly assigned to home visiting or community services as usual (n = 162 and 163, respectively). Maternal depression and attachment insecurity (attachment anxiety and discomfort with trust/dependence) were measured at baseline. Maternal psychosocial and parenting outcomes were measured when children were 2 years old via maternal self-report, observation, and review of substantiated reports of child maltreatment. Maternal depression and attachment insecurity interacted in their moderation of program impacts. For several outcomes, home visiting impacts were greatest for nondepressed mothers with moderate-to-high discomfort with trust/dependence and for depressed mothers with low discomfort with trust/dependence. Implications for practice and policy are discussed.
To examine and compare access to care, comprehensiveness of care, and birth outcomes for teenager... more To examine and compare access to care, comprehensiveness of care, and birth outcomes for teenagers receiving prenatal care in comprehensive adolescent pregnancy programs (CAPPS) in two different settings: school-based vs. hospital-based. Retrospective sohort study using existing data sources: medical records and birth certificates. Using school rosters and hospital clinic databases, we identified pregnant adolescents < or =18 years old who delivered a baby between July 1, 1995 and August 30, 1997 and who received prenatal care in a school-based CAPP (SB-CAPP) or hospital-based CAPP (HB-CAPP). Process of care measures (prenatal care adequacy and comprehensive care) and outcomes (low birth weight) were examined by site of care. Logistic regression models were computed to predict the odds of low birth weight by site of prenatal care, adjusting for prenatal care adequacy, comprehensive care, and possible confounders including baseline maternal characteristics. Three-hundred-ninety eligible teens were identified. Mean age was 15.9 years, 93% were African-American, 84% in school, 13% had a prior birth, and 11% were cigarette smokers. Teens receiving care in the SB-CAPP were significantly younger and more likely to be in school than those in the HB-CAPP. Overall, the two groups had similar low rates of prenatal care adequacy, but compared with teens in the SB-CAPP, those in the HB-CAPP were 1.5 times less likely to receive comprehensive care. Logistic regression analyses adjusting for baseline maternal differences showed that HB-CAPP teens were more than three times as likely to deliver a low birth weight infant compared with SB-CAPP teens (AOR 3.75; 95% CI 1.05-13.36). The increased odds of low birth weight for HB-CAPP teens attenuated when prenatal care was adequate and comprehensive (AOR-HB-CAPP: 2.31, 95% CI 0.65-8.24). School-based prenatal care was associated with significantly lower odds of low birth weight compared with HB-CAPP care. Although selection bias may be a factor in this observational study, our findings suggest that these improved birth outcomes may be mediated through prenatal care adequacy and provision of comprehensive care.
Archives of Pediatrics & Adolescent Medicine, 1999
Background Diagnosis of Trichomonas vaginalis infection is traditionally performed by microscopic... more Background Diagnosis of Trichomonas vaginalis infection is traditionally performed by microscopic examination of vaginal fluid. Although this technique is relatively insensitive compared with culture, it is widely used because of its lower cost and immediate results. ...
Archives of Pediatrics & Adolescent Medicine, 2002
Firearms continue to be a major cause of mortality in adolescence. Although the American Academy ... more Firearms continue to be a major cause of mortality in adolescence. Although the American Academy of Pediatrics strongly encourages pediatricians to counsel adolescents and their parents on firearm safety, few residency programs educate their trainees in this area. More in-depth information is needed to design effective educational interventions. To determine the attitudes, beliefs, and practices of pediatric residents regarding firearm safety counseling and to compare their counseling practices for adolescents and parents of adolescents during health maintenance visits. Cross-sectional survey. Pediatric residents from 9 programs in the mid-Atlantic region. Of the 322 respondents (76% response rate), few believed that it is not a pediatrician's responsibility to counsel, that their patients are not at risk for firearm injury, and that children are safer with a gun in the home. However, only 50% reported routine counseling, and more than 20% reported almost never counseling adolescents and their parents on firearm safety. Barriers included inadequate training (38%), insufficient time (26%), and a lack of preceptor expectation (13%). The strongest predictors for counseling adolescents included the belief that gun-related media coverage influences counseling practice, level of training, and personal experience with guns in the home. The strongest predictors for counseling parents of adolescents were the belief in the media's influence on counseling practice, perceived counseling effectiveness, and discomfort with firearm safety counseling. To increase counseling practices, clinical preceptors should aim to strengthen residents' comfort in counseling and to develop specific ways to enhance their perceived effectiveness in counseling parents.
Journal of Maternal-Fetal and Neonatal Medicine, 2009
We hypothesised that the gross placental measures would be positively associated with childhood g... more We hypothesised that the gross placental measures would be positively associated with childhood growth. We analysed data on 23,967 mother-infant pairs enrolled in the Collaborative Perinatal Project. In race-stratified regression models, the main outcomes were birthweight and z-score body-mass index (BMI) at ages 4 and 7. Some placental measures were significantly associated with z-score BMI at age 7: in Blacks, placental weight (beta = 0.0004/g; 95%CI: 0.0001, 0.0008), chorionic plate area (beta = 0.0007; 95%CI: 0.0001, 0.0012) and largest diameter (beta = 0.013; 95%CI: 0.004, 0.026); and in Whites placental weight (beta = 0.0004/g; 95%CI: 0.0001, 0.0003) and largest diameter (Model 3: beta = 0.020; 95%CI: 0.007, 0.032). Tested as group, placental measures significantly predicted z-score BMI at age 7 (all p values < 0.005). Placental structure independently predicts birthweight and childhood growth. Strategies to improve placental structure might favourably influence birthweight and childhood development.
Intimate partner violence has been linked to poor child health. A continuous relationship with a ... more Intimate partner violence has been linked to poor child health. A continuous relationship with a primary care pediatric provider can help to detect intimate partner violence and connect families with needed services. The objectives of this study were to determine the relationship between intimate partner violence and (1) maternal report of a regular site for well-child care, (2) maternal report of a primary pediatric provider, (3) well-child visits in the first year of life, (4) up-to-date immunizations at 2 years of age, (5) maternal report of medical neglect, and (6) maternal report of the pediatric provider-caregiver relationship. This retrospective cohort study evaluated data from 209 at-risk families participating in the evaluation of the Healthy Families Alaska program. Research staff interviewed mothers near the time of an index child's birth and again at the child's second birthday. Medical charts were abstracted for information on well-child visits and immunizations. Mothers who disclosed intimate partner violence at the initial interview (n = 62) were significantly less likely to report a regular site for well-child care or a primary pediatric provider. In multivariable models, children of mothers who disclosed intimate partner violence tended to be less likely to have the recommended 5 well-child visits within the first year of life and were significantly less likely to be fully immunized at 2 years of age. Differences in medical neglect were not statistically significant. Of mothers who reported a specific primary pediatric provider, those with intimate partner violence histories trusted this provider less and tended to rate less favorably pediatric provider-caregiver communication and the overall quality of the pediatric provider-caregiver relationship. Future research should explore effective ways to link intimate partner violence-exposed children with a medical home and a primary pediatric provider and to improve relationships between pediatric providers and caregivers who face violence at home.
Journal of the American Academy of Child & Adolescent Psychiatry, 1999
Given that highly sensitive urine-based nucleic acid amplification tests may eliminate the need f... more Given that highly sensitive urine-based nucleic acid amplification tests may eliminate the need for speculum exam to diagnose gonorrhea and chlamydia cervicitis, we sought to determine if vaginal infections could be diagnosed without using a speculum. Matched pairs of vaginal specimens were collected from participants before and during speculum exam for diagnosis of trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis. Females age 12 to 22 years presenting to the Johns Hopkins adolescent primary care clinics who required a pelvic examination were eligible to participate. A convenience sample of 686 patients was recruited between July 1995 and August 1996. Paired vaginal specimens were evaluated with blinded microscopic evaluation. Analysis consisted of: 1) comparison of collection method sensitivities; and 2) assessment of proportions of infections detected by one method that were also detected by the other method. Sensitivities of speculum and nonspeculum collection methods were 75% and 77% (difference = -2%; 95% confidence interval, -11%, 7%) for trichomoniasis, 64% and 68% (difference = -4% [-10%, 3%]) for bacterial vaginosis, and 85% and 80% (difference = 5% [-12%, 22%]) for vulvovaginal candidiasis. The speculum method identified 88% (trichomoniasis), 90% (bacterial vaginosis), and 81% (vulvovaginal candidiasis) of infections detected by the nonspeculum method. The nonspeculum method identified 91% (trichomoniasis), 95% (bacterial vaginosis), and 76% (vulvovaginal candidiasis) of infections detected by the speculum method. Vaginal infections can be adequately diagnosed without a speculum. Once urine-based diagnosis of gonorrhea and chlamydia becomes well established, it may be possible to perform evaluations for uncomplicated genitourinary complaints without using a speculum.
To determine the prevalence of hepatitis C virus (HCV) infection in children with an unknown or n... more To determine the prevalence of hepatitis C virus (HCV) infection in children with an unknown or negative human immunodeficiency virus (HIV) status attending an urban hospital pediatric primary care clinic, and to identify HCV risk factors in their mothers. This was a cross-sectional study of 1034 children tested for HCV antibodies (anti-HCV) after excluding children known to be HIV-positive. We assessed maternal HCV risk factors through structured interviews with a sample of mothers (n=573) and through review of available medical records (n=347) for a subsample of mother-child pairs. Means, proportions, and 95% confidence intervals were used to estimate the prevalence of anti-HCV and maternal risk factors. One child (0.1%; 95% CI, 0.002, 0.5) was anti-HCV positive. History of blood transfusion was reported by 7% of mothers and intravenous drug use (IVDU) by 1.8%. A subsample of mothers significantly underreported IVDU when compared with medical record review (1.5% vs 7.8%, P<.001). Our findings suggest that universal screening of children for HCV in high-risk urban communities is not warranted. However, self-report may not be reliable for identifying mothers with a history of IVDU, for whom HCV testing is recommended.
Previous research suggests that experiencing intimate partner violence (IPV) may negatively affec... more Previous research suggests that experiencing intimate partner violence (IPV) may negatively affect employment outcomes. This study explores the relationship between IPV and employment stability both concurrently and longitudinally among a sample of 512 predominantly Asian American and Pacific Islander young women living in Hawaii. Women in this study were identified as being at risk of child maltreatment. About half of women indicated that their current relationship status was married or living together. More than two-thirds of women had graduated from high school and half had worked in the past year. The study explored the concurrent association of IPV and employment by assessing them simultaneously over a 12 month time period. The study examined the longitudinal impact of IPV by analyzing violence at two time points as predictors of unstable employment 6 to 8 years later. The study also explored the mediating effects of depression. Study results demonstrated both concurrent and longitudinal negative associations of IPV with employment stability. Women who experienced violence were more likely to be experiencing unstable employment concurrently. Women who experienced IPV at one point in time had lower levels of employment stability six years later. This decrease was partially mediated by experiencing depressive symptoms. Women who identified their primary ethnicity as Native Hawaiian or Pacific Islander were much more likely to experience unstable employment than Asian American women. More research is needed to explore the roles of mental health, race and ethnicity, and types of violence in the relationship between IPV and employment.
Father involvement may be an important support for children born to adolescent mothers. This stud... more Father involvement may be an important support for children born to adolescent mothers. This study examines patterns and predictors of father involvement, as reported by adolescent mothers, from their child's infancy through toddlerhood. Data were collected from urban, primarily African American, adolescent mothers (N = 138) in four interviews, over a 24-month period. The percentage of fathers categorized as “highly involved” decreased
This study examined the relationship between a teen mother&am... more This study examined the relationship between a teen mother's perceptions of nurturance from her mother and father and her mental health and parenting attitudes. One-hundred and thirty-eight urban, primarily African American adolescent mothers were interviewed. Multivariate results indicate that teen mothers who felt nurtured by their mothers had greater empathy toward their own children, and those who felt nurtured by
Journal of Developmental & Behavioral Pediatrics, 2005
The aims of this study were fourfold: to document the prevalence of language delays in a sample o... more The aims of this study were fourfold: to document the prevalence of language delays in a sample of at-risk 3 year olds; to assess the effectiveness of a home visiting program in preventing early language delays; to determine how often parents, pediatric providers, and home visitors identified early language delays; and to assess the effectiveness of a home visiting program in improving early identification of language delays. The Preschool Language Scale, Third Edition (PLS-3) was administered to 513 at-risk 3 year olds participating in a randomized trial of home visiting services. Families randomized to home visiting were expected to receive weekly to quarterly visits throughout the 3 years of this study. The content of home visits included teaching parents about child development, role-modeling parenting skills, and linking families to a medical home. Identification of delays was measured using structured parent interviews and review of primary care and home visiting records. At age 3 years, 10% of children had severe language delays, defined as scoring >or=2 SD below the national mean on the PLS-3, whereas 49% scored >or=1 SD below the national mean. No differences in prevalence were seen between children who did and did not receive home visiting. Among children with severe delays, 42% were identified by parents, 33% by pediatric providers, and 24% by home visitors. Among children with any delays, 24% were identified by parents, 25% by pediatric providers, and 17% by home visitors. No differences in rates of identification were seen between children who did and did not receive home visiting. Thus, while language delays were highly prevalent among these at-risk children, rates of identification were low, even among children with severe delays. Home visiting was not effective in either preventing language delays or improving early identification. This suggests that pediatric providers and home visiting programs need to reexamine their approaches to recognizing and intervening with early language delays.
Journal of Consulting and Clinical Psychology, 2009
Home visiting programs for at-risk mothers and their infants have proliferated nationally in rece... more Home visiting programs for at-risk mothers and their infants have proliferated nationally in recent years, yet experimental studies of home visiting have yielded mixed findings. One promising strategy for explicating the effects of early home visiting is to examine moderators of program impacts. This study assessed the roles of maternal depression and attachment insecurity as moderators of the impacts of Healthy Families Alaska home visiting services for at-risk mothers and their infants. At-risk families (N = 325) were randomly assigned to home visiting or community services as usual (n = 162 and 163, respectively). Maternal depression and attachment insecurity (attachment anxiety and discomfort with trust/dependence) were measured at baseline. Maternal psychosocial and parenting outcomes were measured when children were 2 years old via maternal self-report, observation, and review of substantiated reports of child maltreatment. Maternal depression and attachment insecurity interacted in their moderation of program impacts. For several outcomes, home visiting impacts were greatest for nondepressed mothers with moderate-to-high discomfort with trust/dependence and for depressed mothers with low discomfort with trust/dependence. Implications for practice and policy are discussed.
To examine and compare access to care, comprehensiveness of care, and birth outcomes for teenager... more To examine and compare access to care, comprehensiveness of care, and birth outcomes for teenagers receiving prenatal care in comprehensive adolescent pregnancy programs (CAPPS) in two different settings: school-based vs. hospital-based. Retrospective sohort study using existing data sources: medical records and birth certificates. Using school rosters and hospital clinic databases, we identified pregnant adolescents < or =18 years old who delivered a baby between July 1, 1995 and August 30, 1997 and who received prenatal care in a school-based CAPP (SB-CAPP) or hospital-based CAPP (HB-CAPP). Process of care measures (prenatal care adequacy and comprehensive care) and outcomes (low birth weight) were examined by site of care. Logistic regression models were computed to predict the odds of low birth weight by site of prenatal care, adjusting for prenatal care adequacy, comprehensive care, and possible confounders including baseline maternal characteristics. Three-hundred-ninety eligible teens were identified. Mean age was 15.9 years, 93% were African-American, 84% in school, 13% had a prior birth, and 11% were cigarette smokers. Teens receiving care in the SB-CAPP were significantly younger and more likely to be in school than those in the HB-CAPP. Overall, the two groups had similar low rates of prenatal care adequacy, but compared with teens in the SB-CAPP, those in the HB-CAPP were 1.5 times less likely to receive comprehensive care. Logistic regression analyses adjusting for baseline maternal differences showed that HB-CAPP teens were more than three times as likely to deliver a low birth weight infant compared with SB-CAPP teens (AOR 3.75; 95% CI 1.05-13.36). The increased odds of low birth weight for HB-CAPP teens attenuated when prenatal care was adequate and comprehensive (AOR-HB-CAPP: 2.31, 95% CI 0.65-8.24). School-based prenatal care was associated with significantly lower odds of low birth weight compared with HB-CAPP care. Although selection bias may be a factor in this observational study, our findings suggest that these improved birth outcomes may be mediated through prenatal care adequacy and provision of comprehensive care.
Archives of Pediatrics & Adolescent Medicine, 1999
Background Diagnosis of Trichomonas vaginalis infection is traditionally performed by microscopic... more Background Diagnosis of Trichomonas vaginalis infection is traditionally performed by microscopic examination of vaginal fluid. Although this technique is relatively insensitive compared with culture, it is widely used because of its lower cost and immediate results. ...
Archives of Pediatrics & Adolescent Medicine, 2002
Firearms continue to be a major cause of mortality in adolescence. Although the American Academy ... more Firearms continue to be a major cause of mortality in adolescence. Although the American Academy of Pediatrics strongly encourages pediatricians to counsel adolescents and their parents on firearm safety, few residency programs educate their trainees in this area. More in-depth information is needed to design effective educational interventions. To determine the attitudes, beliefs, and practices of pediatric residents regarding firearm safety counseling and to compare their counseling practices for adolescents and parents of adolescents during health maintenance visits. Cross-sectional survey. Pediatric residents from 9 programs in the mid-Atlantic region. Of the 322 respondents (76% response rate), few believed that it is not a pediatrician's responsibility to counsel, that their patients are not at risk for firearm injury, and that children are safer with a gun in the home. However, only 50% reported routine counseling, and more than 20% reported almost never counseling adolescents and their parents on firearm safety. Barriers included inadequate training (38%), insufficient time (26%), and a lack of preceptor expectation (13%). The strongest predictors for counseling adolescents included the belief that gun-related media coverage influences counseling practice, level of training, and personal experience with guns in the home. The strongest predictors for counseling parents of adolescents were the belief in the media's influence on counseling practice, perceived counseling effectiveness, and discomfort with firearm safety counseling. To increase counseling practices, clinical preceptors should aim to strengthen residents' comfort in counseling and to develop specific ways to enhance their perceived effectiveness in counseling parents.
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Papers by Anne Duggan