Discordance Between Perinatal Alcohol Use Among Women and Provider Counseling for Alcohol Use: An Assessment of the Pregnancy Risk Assessment Monitoring System

2021 ◽  
pp. 003335492098414
Author(s):  
Erika L. Thompson ◽  
Tracey E. Barnett ◽  
Dana M. Litt ◽  
Erica C. Spears ◽  
Melissa A. Lewis
Keyword(s):  
Black Women ◽  
Alcohol Use ◽  
Universal Screening ◽  
White Women ◽  
Hispanic Women ◽  
Pregnancy Risk ◽  
Health Insurance Status ◽  
Prenatal Alcohol Use ◽  
Prenatal Alcohol ◽  
Alcohol Counseling

Objective In the United States, guidelines indicate all pregnant women should be screened for and counseled on alcohol use to prevent adverse perinatal outcomes due to alcohol consumption. The objective of this study was to describe sociodemographic factors associated with receipt of prenatal alcohol counseling and perinatal alcohol use among US women. Methods State health departments collected data for the Pregnancy Risk Assessment Monitoring System Phase 7 during 2012-2015, and we restricted the sample to a complete case analysis (N = 135 111). The 3 dichotomous outcomes were preconception alcohol use (3 months before pregnancy), prenatal alcohol use (during last 3 months of pregnancy), and prenatal alcohol counseling. Predictor variables were age, race, Hispanic ethnicity, education, marital status, health insurance status, and previous live births. We estimated survey-weighted logistic regression models for each outcome. Results Half (56.0%) of pregnant women reported preconception alcohol use, 70.5% received prenatal alcohol counseling, and 7.7% reported prenatal alcohol use during the last 3 months of pregnancy. Black women were significantly less likely than White women (odds ratio [OR] = 0.49; 95% CI, 0.46-0.52) and Hispanic women were significantly less likely than non-Hispanic women (OR = 0.62; 95% CI, 0.58-0.66) to report preconception alcohol use. We found similar patterns for prenatal alcohol use among Black women. Black women were significantly more likely than White women (OR = 1.66; 95% CI, 1.55-1.77) and Hispanic women were significantly more likely than non-Hispanic women (OR = 1.51; 95% CI, 1.40-1.61) to receive prenatal alcohol counseling. We found similar patterns for age, education, and health insurance status. Conclusion Disparities in alcohol counseling occurred despite the national recommendation for universal screening and counseling prenatally. Continued integration of universal screening for alcohol use during pregnancy is needed.

Racial and Ethnic Disparities in Peripartum Hysterectomy Risk and Outcomes

2021 ◽  
Author(s):  
Margaret H. Bogardus ◽  
Timothy Wen ◽  
Cynthia Gyamfi-Bannerman ◽  
Jason D. Wright ◽  
Dena Goffman ◽  
...  
Keyword(s):  
Black Women ◽  
Race And Ethnicity ◽  
White Women ◽  
Hispanic Women ◽  
Intraoperative Complications ◽  
Ethnic Disparities ◽  
Peripartum Hysterectomy ◽  
Increased Risk ◽  
Surgical Site Complications ◽  
Hispanic White

Objective This study aimed to determine whether race and ethnicity contribute to risks associated with peripartum hysterectomy. Study Design This retrospective cross-sectional study utilized the 2000–2014 Nationwide Inpatient Sample to analyze risk of peripartum hysterectomy and associated severe maternal morbidity, mortality, surgical injury, reoperation, surgical-site complications, and mortality by maternal race and ethnicity. Race and ethnicity were categorized as non-Hispanic white, non-Hispanic black, Hispanic, other, and unknown. Multivariable log-linear regression models including patient, clinical, and hospital risk factors were performed with adjusted risk ratios (aRRs) and 95% confidence intervals (CIs). Results Of 59,854,731 delivery hospitalizations, there were 45,369 peripartum hysterectomies (7.6 per thousand). Of these, 37.8% occurred among non-Hispanic white, 13.9% among non-Hispanic black, and 22.8% among Hispanic women. In adjusted analyses, non-Hispanic black (aRR: 1.21, 95% CI: 1.17–1.29) and Hispanic women (aRR: 1.25, 95% CI: 1.22–1.29) were at increased risk of hysterectomy compared with non-Hispanic white women. Risk for severe morbidity was increased for non-Hispanic black (aRR: 1.25, 95% CI: 1.19–1.33), but not for Hispanic (aRR: 1.02, 95% CI: 0.97–1.07) women. Between these three groups, risk for intraoperative complications was highest among non-Hispanic white women, risk for reoperation was highest among Hispanic women, and risk for surgical-site complications was highest among non-Hispanic black women. Evaluating maternal mortality, non-Hispanic black women (RR: 3.83, 95% CI: 2.65–5.53) and Hispanic women (RR: 2.49, 95% CI: 1.74–3.59) were at higher risk than non-Hispanic white women. Conclusion Peripartum hysterectomy and related complications other than death differed modestly by race. In comparison, mortality differentials were large supporting that differential risk for death in the setting of this high-risk scenario may be an important cause of disparities. Key Points

Abstract MP66: Social Determinants And Co-morbid Conditions In Women Of Child-bearing Age With Hypertension From 2001-2018

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Lara C Kovell ◽  
Claire Meyerovitz ◽  
Didem Ayturk ◽  
Stephen P Juraschek ◽  
Tiffany A Moore Simas ◽  
...  
Keyword(s):  
Black Women ◽  
Social Determinants ◽  
White Women ◽  
Hispanic Women ◽  
Private Insurance ◽  
Anthropometric Measures ◽  
Mortality And Morbidity ◽  
Child Bearing ◽  
Race Ethnicity ◽  
Morbid Conditions

Introduction: Hypertension (HTN) is the most important modifiable risk factor of serious maternal mortality and morbidity. Social determinants, including economic stability and access to healthcare, influence HTN outcomes and are critical to understanding and addressing racial and ethnic differences in HTN control. Objective: To assess social determinants and co-morbidities in US women of child-bearing age with HTN by race/ethnicity Methods: We studied women (age 20-50) with HTN in the National Health and Nutrition Examination Surveys 2001-2018. Social determinants and co-morbid conditions were examined in groups categorized by race/ethnicity - Non-Hispanic White (White), Non-Hispanic Black (Black), and Hispanic. Demographics, anthropometric measures, and co-morbid conditions were compared with White women as reference. Results: In all women with HTN, the mean (SE) age was 36.0 (0.3) years and 63% were on BP medication. Compared to white women, Black and Hispanic women had lower food security, poverty income ratio, smoking use, and private insurance (all p<0.0001, Table ). Black women had higher BP medication use, BMI, and BP compared to White women (all p<0.0001). Hispanic women had higher rates of diabetes (p=0.009) and no place to go for healthcare (p=0.005) compared to White women. Food insecurity was present in 34% of Hispanic women. Conclusions: Despite effective diagnostics and therapy, health inequity is common in women of child-bearing age with HTN, with differences by race/ethnicity in social determinants and co-morbid conditions. Each racial/ethnic group with HTN brings social determinants and comorbid conditions important for providers to recognize.

scholarly journals New onset of restless legs syndrome in pregnancy in a prospective multiracial cohort

Neurology ◽  
2020 ◽  
Vol 95 (24) ◽  
pp. e3438-e3447
Author(s):  
Muzi Na ◽  
Jing Wu ◽  
Mengying Li ◽  
Stefanie N. Hinkle ◽  
Cuilin Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Black Women ◽  
Restless Legs Syndrome ◽  
White Women ◽  
Hispanic Women ◽  
Nutritional Factors ◽  
Restless Legs ◽  
Relative Risks ◽  
Race Ethnicity ◽  
In Pregnancy

ObjectiveTo determine whether the incidence and risk factors of restless legs syndrome (RLS) in pregnancy differ by race/ethnicity, we estimated relative risks of demographic, socioeconomic, and nutritional factors in association with risk of any incident RLS in pregnancy in a cohort of 2,704 healthy pregnant women without prior RLS.MethodsUsing data from the multicenter, multiracial National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies–Singletons, we examined the incidence of RLS from early pregnancy to near delivery through up to 6 assessments. Multivariable Poisson models with robust variance were applied to estimate relative risks (RRs).ResultsThe cumulative incidence of RLS in pregnancy was 18.1% for all women, 20.3% for White women, 15.4% for Black women, 17.1% for Hispanic women, and 21.1% for Asian women. Among Hispanic women, older age (RR [reference ≤25 years]: 25–35 years, 1.51; 95% confidence interval [CI] 1.05–2.16; ≥35 years, 1.58; 95% CI 0.93–2.68), anemia (RR [reference no]: yes, 2.47; 95% CI 1.31–4.64), and greater total skinfolds of the subscapular and triceps sites, independent of body mass index (RR [reference quartile 1]: quartile 5, 2.54; 95% CI 1.30–4.97; p trend = 0.01) were associated with higher risk of RLS, while multiparity was associated with a lower risk (RR [reference nulliparity]: 0.69; 95% CI 0.50–0.96). In Black women, greater skinfolds and waist circumference were associated with higher risk of pregnancy RLS, although the trends were less clear.ConclusionsThe incidence of RLS in pregnancy was high and differed by race/ethnicity, which is likely accounted for by differences in other risk factors, such as age, parity, and nutritional factors.

Increasing the Report of Alcohol Use among Low-Income Pregnant Women

2003 ◽  
Vol 17 (6) ◽  
pp. 369-372 ◽  
Author(s):  
Shannon E. Whaley ◽  
Mary J. O'Connor
Keyword(s):  
Alcohol Consumption ◽  
Alcohol Use ◽  
Low Income ◽  
Repeated Measures ◽  
Screening Tool ◽  
Community Setting ◽  
Alcohol Exposure ◽  
Public Health Issue ◽  
Prenatal Alcohol Use ◽  
Prenatal Alcohol

Purpose. To increase the report of prenatal alcohol use in a community setting. Methods. A self-administered alcohol screening tool was developed and introduced at 12 randomly selected sites that administer the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). A matched sample of 12 WIC sites continued to use the existing verbal standard of care for assessing alcohol use. Results. Rates of reported prenatal alcohol consumption at the 12 WIC intervention sites were compared with rates at 12 control WIC sites using a repeated-measures analysis of variance (ANOVA) and independent-samples t-tests. Within 8 months of study commencement, rates of reported prenatal alcohol consumption were significantly higher at the intervention sites than at the control sites. Discussion. Use of a brief, self-administered screening tool in the WIC setting significantly increased reports of prenatal alcohol use, a key first step in the reduction of prenatal alcohol use. The WIC setting represents an excellent place to address the significant public health issue of prenatal alcohol exposure.

scholarly journals Brief Intervention for Prenatal Alcohol Use: A Randomized Trial

2005 ◽  
Vol 105 (5, Part 1) ◽  
pp. 991-998 ◽  
Author(s):  
Grace Chang ◽  
Tay K. McNamara ◽  
E John Orav ◽  
Danielle Koby ◽  
Alyson Lavigne ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Randomized Trial ◽  
Brief Intervention ◽  
Prenatal Alcohol Use ◽  
Prenatal Alcohol

scholarly journals Maternal and partner prenatal alcohol use and infant cognitive development

2018 ◽  
Vol 185 ◽  
pp. 330-338 ◽  
Author(s):  
Clare McCormack ◽  
Delyse Hutchinson ◽  
Lucy Burns ◽  
George Youssef ◽  
Judy Wilson ◽  
...  
Keyword(s):  
Cognitive Development ◽  
Alcohol Use ◽  
Prenatal Alcohol Use ◽  
Prenatal Alcohol ◽  
Infant Cognitive Development

scholarly journals Medicare D Subsidies and Racial Disparities in Persistence and Adherence With Hormonal Therapy

2016 ◽  
Vol 34 (36) ◽  
pp. 4398-4404 ◽  
Author(s):  
Alana Biggers ◽  
Yushu Shi ◽  
John Charlson ◽  
Elizabeth C. Smith ◽  
Alicia J. Smallwood ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Black Women ◽  
Hormonal Therapy ◽  
Low Income ◽  
White Women ◽  
Hispanic Women ◽  
Ethnic Disparities ◽  
Black Patients ◽  
Hispanic Patients ◽  
White Patients

Purpose To investigate the role of out-of-pocket cost supports through the Medicare Part D Low-Income Subsidy on disparities in breast cancer hormonal therapy persistence and adherence by race or ethnicity. Methods A nationwide cohort of women age ≥ 65 years with a breast cancer operation between 2006 and 2007 and at least one prescription filled for oral breast cancer hormonal therapy was identified from all Medicare D enrollees. The association of race or ethnicity with nonpersistence (90 consecutive days with no claims for a hormonal therapy prescription) and nonadherence (medication possession rate < 80%) was examined. Survival analyses were used to account for potential differences in age, comorbidity, or intensity of other treatments. Results Among the 25,111 women in the study sample, 77% of the Hispanic and 70% of the black women received a subsidy compared with 21% of the white women. By 2 years, 69% of black and 70% of Hispanic patients were persistent compared with 61% of white patients. In adjusted analyses, patients in all three unsubsidized race or ethnicity groups had greater discontinuation than subsidized groups (white patients: hazard ratio [HR], 1.83; 95% CI, 1.70 to 1.95; black patients: HR, 2.09; 95% CI, 1.73 to 2.51; Hispanic patients: HR, 3.00; 95% CI, 2.37 to 3.89). Racial or ethnic persistence disparities that were present for unsubsidized patients were not present or reversed among subsidized patients. All three subsidized race or ethnicity groups also had higher adherence than all three unsubsidized groups, although with the smallest difference occurring in black women. Conclusion Receipt of a prescription subsidy was associated with substantially improved persistence to breast cancer hormonal therapy among white, black, and Hispanic women and lack of racial or ethnic disparities in persistence. Given high subsidy enrollment among black and Hispanic women, policies targeted at low-income patients have the potential to also substantially reduce racial and ethnic disparities.

Sign in / Sign up

Export Citation Format

Share Document