American Births Research Articles

African American’s Awareness of Disparities in Infant Mortality Rates and Sudden Infant Death Syndrome Risks

African American infant mortality rates (IMR) in San Francisco have remained 2.5 to three times those of Whites for over 20 years. A 69-item telephone survey of African American residents in four neighborhoods with the most African American births assessed awareness of IMR disparities, associated risks, and social capital. Of the 804 respondents, 57% were not aware of the IMR disparity. Higher levels of awareness occurred in those volunteering (OR 1.5, CI 1.1-2.0), participating in efforts to benefit the African American community (OR 1.8, CI 1.3-2.4), sensing that they belonged in their neighborhood (OR 1.7, CI 1.2-2.3), and being aware of a local African American-led initiative to improve infant health (OR 2.3, CI 1.7-3.9). Lack of awareness can be a barrier to a population's engagement in improving its overall health. Lack of awareness of IMR disparities and risk factors exists in the San Francisco African American population and is related to less social capital. Improving awareness is a prerequisite for implementing community level interventions.

Costs and length of stay for patients with and without sickle cell disease after hysterectomy, appendectomy, or knee replacement

Costs and length of stay for patients with and without sickle cell disease after hysterectomy, appendectomy, or knee replacement

Mortality risk of small infants varies with their mother's birthweight and race

We analysed a transgenerational linked birth file to investigate the relationship between maternal birthweight and infant birthweight-specific mortality risk for white and African American infants. Birth records of 267,303 infants born between 1989 and 1991 were linked to records of their mothers, born between 1956 and 1976, and to their own death certificates for those dying in the first year. The means, standard deviations and z-scores were calculated for each race- and generation-specific birthweight distribution. Investigators then analysed the mortality of very small infants (birthweight at least two standard deviations below their mean) for three maternal birthweight categories. Over half of the infant deaths involved births with weights more than two standard deviations below the relevant population mean birthweight (comprising 4.2% of white and 6.9% of African American births respectively). African American infants experienced higher mortality rates at all levels of standardised birthweight, from z-scores of -3 to +3. The relative risk of mortality associated with very small infant size was less for infants delivered to smaller birthweight mothers when compared with those whose mothers were average sized or large at birth. This differential effect was confined to neonatal deaths and was more prominent in the white subpopulation.

State-Specific Trends in Preterm Delivery: Are Rates Really Declining Among Non-Hispanic African Americans Across the United States?

This study sought to examine state-specific trends in preterm delivery rates among non-Hispanic African Americans and to assess whether these rates are influenced by misclassification of gestational age. The sample population consisted of singleton non-Hispanic White and non-Hispanic African-American infants born in 1991 and 2001 to U.S. resident mothers. For both time periods, state-specific and national preterm delivery rates were calculated for all infants, stratified by infant race/ethnicity. Next, birth-weight distributions within strata of gestational age were studied to explore possible misclassifications of gestational age. Lastly, state-specific and national preterm delivery rates among infants who weighed less than 2,500 g were separately computed. National analyses showed that the frequency of preterm delivery increased by 15.8% among non-Hispanic Whites but declined by 10.3% among non-Hispanic African Americans over the same period. For both subgroups, a bimodal distribution of birth weights was apparent among preterm births at 28-31 weeks of gestation. The second peak with its cluster of normal-weight infants was more prominent among non-Hispanic African Americans in 1991 than in 2001. After excluding preterm infants who weighed 2,500 g or more, the national trends persisted. State-specific analyses showed that preterm delivery rates increased for both subgroups in 13 states during this period. Of these 13, 6 states had a number of non-Hispanic African-American births classified as preterm that were apparently term births mistakenly assigned short gestational ages. Such misclassification was more frequent in 1991 than in 2001 and inflated 1991 rates. There is heterogeneity in state-specific preterm delivery rates. Such differences are often overlooked when aggregate results are presented.

Use of inhaled steroids by pregnant asthmatic women does not reduce intrauterine growth

Background Inhaled steroids are recommended for the treatment of persistent asthma during pregnancy, but their potential effects on intrauterine growth have been inadequately evaluated. Objective The purpose of this study was to evaluate the association between maternal use of specific inhaled steroids and inhaled steroid dose during pregnancy and the incidence of infants who are small for gestational age (SGA) and mean birth weight. Methods Pregnant asthmatic women being treated with inhaled steroids were enrolled in the study before delivery by their managing allergists. Information regarding the specific inhaled steroid and daily dose used, requirement for oral steroids, occurrence of acute asthmatic episodes, maternal race, birth weight, gestational age, and congenital malformations was obtained for each patient. SGA was defined through use of a published normative sample of American births. Results A total of 474 women were enrolled in the study; of the 451 enrolled participants whose pregnancy ended in a singleton live birth, 396 (88%) completed the study. The incidence of infants with low birth weight, preterm births, and congenital malformations in this cohort was not greater than expected in the general population. The incidence of SGA was 7.1% (95% CI, 5.0% to 10.1%). No significant relationships between specific inhaled steroid or dose of inhaled steroid used and either SGA or mean birth weight were observed. Conclusion These data suggest that the use of inhaled steroids by pregnant asthmatic women does not reduce intrauterine growth and supports the recommendation that inhaled steroids should be used in the management of persistent asthma during pregnancy.

Pediatric paradox: heterogeneity in the birth cohort.

Comparisons of birth-weight-specific infant mortality indicate that low-birth-weight African American infants have lower mortality than low-birth-weight European American infants despite higher infant mortality overall-the "pediatric paradox." One explanation is heterogeneity in birth weight. Analyses of African American and European American births suggest that birth cohorts consist of two heterogeneous subpopulations. One appears to account for normal births, whereas the other may consist of compromised births. Estimates of infant mortality indicate that the compromised subpopulation has higher overall mortality but lower birth-weight-specific mortality. We attribute lower birth-weight-specific infant mortality in the compromised subpopulation to higher rates of fetal loss. Compared to European American birth cohorts, African American birth cohorts have (1) higher birth-weight-specific mortality in the normal subpopulation, (2) larger compromised subpopulations, and (3) lower birth-weight-specific mortality in the compromised subpopulation. Consequently, the pediatric paradox is attributable to greater rates of compromised pregnancies and higher fetal losses among African Americans.

Classification of births by birth weight and gestational age: an application of multivariate mixture models

Background: Classifications such as low birth weight, premature, and small for gestational age, i.e. compromised births, have been criticized because they depend upon arbitrary standards that may not be appropriate for all populations. Aim: This study applies multivariate Gaussian mixture models with covariates to characterize birth weight by gestational age distributions. Subjects and methods: The data consist of Asian, African, Hispanic and European American births in New York State in 1988. The analysis employs maximum likelihood methods. Results: Birth cohorts appear heterogeneous and composed of at least two sub-populations. One sub-population accounts for the majority of births, has a higher mean birth weight and gestational age but small variances. The other sub-population has a lower mean birth weight and gestational age but very large variances. As a result of the large variances this sub-population accounts for compromised births. The model also suggests that a number of compromised births occur within the normal birth weight and gestational age range. Among normal births, birth weight increases and gestational age declines with maternal age. The effects on compromised births vary among populations. Conclusions: Multivariate Gaussian mixture models provide a method of identifying compromised births that is not dependent upon arbitrary standards.

Vocational Rehabilitation Counseling for Adolescents and Adults with Cystic Fibrosis

Affecting approximately 30,000 people in the US in 1990, Cystic Fibrosis (CF) is the most common, fatal, autosomal recessive disease among Caucasians, affecting one in 2,500 Caucasian and one in 17,000 African American live births. Although medical advances have resulted in an improved survival rate for individuals with CF, there continues to be a lag in vocational rehabilitation services to this population. This paper proposes that rehabilitation counselors can play an important role in the lives of individuals with CF. Recommendations are offered to assist rehabilitation counselors in working with clients with CF.

RAUH ET AL. RESPOND

Racial/ethnic differences in the distribution of births across the childbearing years are indeed dramatic and likely reflect powerful economic and sociocultural influences on the timing of births—influences determining who is selected into the pool of women giving birth at older ages. We know that fewer births occur among African American women than among White women after 30 years of age.1,2 We also know that postponement of first birth may be intentional or unintentional, and in the latter case postponement may be due to a medically complicated history. Since intentional postponement is associated with higher income and African Americans have lower average incomes than Whites, we might expect a smaller proportion of first births to older African American women to result from intentional postponement. By default, a higher proportion would result from medical problems. That the effect of maternal age on birthweight is slightly attenuated among second births to African Americans is consistent with this reasoning, since the pool of women having a second birth is reduced by the number of women who experienced the most serious medical problems in relation to first birth. However, multivariate analyses show that the effect of maternal aging on African American births is independent of parity, which would argue against a selection hypothesis, and is exacerbated for the poorest women. As suggested by Geronimus, poverty and the stresses that accompany poverty may work to erode overall health among African American women, with serious consequences for birthweight regardless of birth order.3 The appropriateness of the term “weathering” to name this process is debatable, and the underlying mechanisms deserve further study, but some combination of increased exposure and heightened susceptibility over time is operating. Recent work points to the role of chronic stressors in preterm birth,4,5 possibly mediated by infection,6,7 and both conditions are more prevalent among African American and low-income women.8,9 With respect to childbearing in the United States, social selection is anything but “natural” in the Darwinian sense. Rather, selection forces are socially produced—a consequence of limited choices, diminished resources, and structural constraints. The focus on maternal age–related patterns of risk merely highlights the cumulative nature of the problem. The challenge for public health is to identify the fundamental sources of risk, explore mechanisms that translate social risk into biological adversity, and design policies and interventions to ameliorate this risk among African American women of all ages.10

Family therapy with unmarried African American mothers and their adolescents.

Almost two-thirds of African American births are to unmarried mothers, and these single parents are among the most economically vulnerable in the United States. The effects of chronic stressors such as poverty can compromise the ability of these mothers to parent effectively, particularly during the developmental period of adolescence, typically a stressful phase of parenting. This article describes a multidimensional family therapy (MDFT) approach to working with African American adolescents who have drug and/or behavior problems. It is maintained that addressing the intrapersonal functioning of African American single mothers is vital if they are to re-establish the attachment bonds necessary for the maintenance of essential parental influence in the lives of their adolescents. Through systematic attention to the parent as an individual, leading to a balance between self-care and care for others, parental supervision is more easily achieved and relational impasses between parent and adolescent more equitably resolved.

Flat tires and other deflations.

Flat tires and other deflations.

Exposure to Immunization Media Messages among African American Parents

Background. African Americans have low immunization rates, yet little is known about their immunization knowledge, attitudes, and practices or about the effect of outreach to this audience. In Spring 1997, the California Department of Health Services (CDHS) launched a statewide culturally sensitive and ethnically specific media campaign directed toward African Americans. This campaign was preceded by a major Los Angeles County Department of Health Services media campaign.Objectives. The objectives of this study were to (a) estimate exposure to immunization media messages among African Americans; (b) determine sources of immunization information; and (c) assess various immunization attitudes and beliefs in order to refine future outreach efforts.Methods. Following the CDHS media campaign, a random digit dial survey was conducted with 801 African American families with children under age 10. The sample was drawn from the four California regions with the highest African American birth rates. It included all zip codes in these regions with greater than 150 African American births per year. Lower bound response rates ranged from 62.5 to 76.1%. Higher income and education levels were overrepresented. Results were weighted to adjust for this.Results. Over 88% remembered seeing or hearing some form of immunization information. Exposure to television ads was reported by 63% followed by billboards (51%) and radio (42%). Sixty-two percent thought mild disease was possible after shots; 27% feared HIV from needles and 19% thought pain was a barrier. Respondents who cited money as a barrier (26%) were less likely to believe that shots were available for free (P = 0.02).Conclusions. Media advertising is an effective tool for reaching African Americans. Addressing specific concerns (e.g., clarification of the circumstances and likelihood of getting a mild case of the disease following an immunization, availability of free shots, and risk of HIV) may contribute to increased immunization rates for this population.

Psychosocial Considerations in Sickle Cell Disease (SCD): The Transition from Adolescence to Young Adulthood

Sickle cell disease (SCD) occurs in 1 of every 400 to 500 African American births. Despite its prevalence, there has been a relative dearth of attention paid to SCD in the psychological literature. African American SCD adolescents and young adults, individuals at an already vulnerable developmental stage, are at increased risk for psychological distress and psychosocial impairments (e.g., depression and low self-esteem, poor social and academic/vocational functioning). Such difficulties often result in problematic adherence to medical regimens, and thus represent a potentially serious clinical and public health problem that merits the attention of psychologists working in medical settings. This article (1) reviews the psychosocial needs peculiar to SCD patients transitioning from adolescence to young adulthood; (2) applies a culturally informed stress-coping-adjustment framework to assess and address the psychological status, psychosocial functioning, and disease outcomes of these individuals; and (3) describes a culturally and developmentally sensitive, psychoeducational group intervention.

Nader Group Sees CNMs Replacing OBs in 'Majority of American Births'

Nader Group Sees CNMs Replacing OBs in 'Majority of American Births'

Restrictions on Medicaid Funding of Abortion: Effects on Birth Weight and Pregnancy Resolutions

This study uses individual data from the 1980-89 National Longitudinal Survey of Youth (NLSY) and state and county level data on Medicaid funding for abortion and access to abortion services and prenatal care from the Alan Guttmacher Institute. The NLSY sample overrepresents the poor and African-Americans. This study estimates the probability that a pregnancy is carried to term and the effects of restrictions on Medicaid funding of abortion on birth weight and low birth weight. Reduced form models are used in the analysis. The analytical framework is based on models developed by Grossman and Joyce. Four models are used in the analyses. Findings indicate that restrictive laws had no significant effect on birth weight. The number of abortion providers was associated with significantly higher birth weights particularly among African-American women and low income women. The example of the effects among African American births of a 13 ounce gain revealed a decline in low birth weight from 11% to 4%. Other community measures with a statistically significant impact were the number of hospitals with prenatal care services in a county and the percentage of births to unmarried women which reduced birth weight by 14 ounces among low income women. Higher birth weight was associated with higher income the presence of a partner maternal height and maternal educational status. Lower birth weight was associated with being African-American and smoking during pregnancy. Southern African-American women and Southern low income women had higher birth weights. Results confirm that laws restricting Medicaid funding increased the probability that a pregnancy was carried to term particularly among some groups. Restrictive laws had little effect on birth weight or the incidence of low birth weight. Restrictive laws and enjoined laws had the same effect among White and high income women when the number of abortion providers was controlled for. Underreporting due to stigma is attributed to the finding that Medicaid funding had an effect on birth probabilities among high income women.

Changes in fertility relative to starting, stopping, and spacing behaviors in a migrating Mennonite community, 1775-1889.

Fertility change over time in a migrating Mennonite church congregation is reconstructed through genealogies developed from church registries of vital events during 1725-1924. The congregation was located in Prussia from 1725-1821, in Russia from 1822-1874, and in Kansas, U.S.A., from 1875-1924. Age-specific marital fertility rates were relatively low and usually peaked for women aged 25-29. Total fertility rates ranged from 1.19 to 5.29. These relatively low figures for a natural fertility population may partly reflect underreporting of births and deaths of infants, but it also reflects the heterogeneity in fertility evident for this population. Some women had many children while others were having either few or none. This pattern changed twice. Fertility was lowest during residence late in Prussia and early in Russia, peaked during residence late in Russia, and has decreased slightly for women born in the United States.

10 Antenatal care in developing countries

The problem of antenatal care in developing countries may be considered from two aspects: (a) areas where antenatal facilities are absent or are inadequate, and (b) areas where antenatal facilities are adequate but for some reasons are not adequately utilized. The solution to the first part of the problem would appear to be simple. The governments concerned should provide the required facilities. This obviously is not an easy task in many areas of the world, especially with the present profound economic depression in many developing countries. The people just have to use the facilities available to their best advantage, or do without the facilities. The second part of the problem presents more difficulties. Where antenatal facilities are available, inadequate utilization has been shown to be due to a number of factors: 1. The facilities are too distant or too expensive. It has been shown how the Nigerian authorities dealt with this problem in the Ibarapa district. However, it is a very expensive solution and few governments will be able to afford this. 2. Illiteracy or ignorance. The obvious solution to this difficulty is to educate the masses and a few governments have already embarked on these commendable programmes. Unfortunately, this procedure is expensive, may take a long time and, as already pointed out, even literate women may not use the antenatal services. 3. Traditional and cultural beliefs and prejudices. It has already been shown that this factor is a very important one in the population in developing countries, even among literate patients. The saying that 'old habits die hard' is probably apt here. Probably, with time, education and closer contact with the developed world, these prejudices will disappear. From the above observations, it would appear that an inexpensive short-term solution to the two parts of the problem mentioned above is for governments to train and use the TBAs who are already 'in our midst' and who already enjoy the confidence of the masses. The authorities, however, have to be very careful in integrating the TBAs into the health system. It has to be done very judiciously and tactfully, otherwise antagonism and unhealthy rivalry will be created between the TBAs and other members of the health team. They must be made to realize that they are a part of the health team.

Seasonality of conception in hutterite colonies of Europe (1758–1881) and North America (1858–1964)

SummaryBirth records of Hutterite colonies were examined for the presence of seasonal variation in conception rate. Month of conception was inferred by counting back 9 months from date of birth. Over 4300 births, occurring between 1758 and 1964 and spanning the years that the colonies inhabited the Ukraine and then migrated to the United States and Canada, were included in the analysis. When combined, the European and North American births showed a seasonal pattern with a general rise in conceptions from December to June followed by a decline in conceptions from July to November. The major peaks in conceptions were in April and June, with a minor peak in December. Separate examination of the European and American records revealed a secular change. The seasonality of North American conceptions was dramatically reduced when compared to the very distinct European seasonal pattern. It is assumed that both biological and cultural factors are responsible for the seasonal variation observed. The influences of light cycle, date of marriage, and work and holiday schedules on conception rates are discussed.

Three patterns of seasonality in American births

Seasonal variation in the numbers of live births in the United States increased in amplitude during the 1940's, remained high throughout the 1950's, and then declined again. This changing pattern of amplitude correlates very significantly with the pattern of over-all fertility, when examined during 1933–1970. This correlation raises the inference that seasonal amplitude is a function of over-all fertility. In an attempt to find out more about seasonal variation in births, it was compared to another form of seasonality, namely, seasonal variation in the sex ratio of live births. Monthly fertility rates and monthly sex ratios were compared for 240 consecutive months and were found to be very significantly correlated when fertility lags behind sex ratio by 2 months. This second correlation points to the possible usefulness of applying to the study of fertility whatever information exists about the sex ratio and vice versa.