Martha Wingate - Academia.edu (original) (raw)
Papers by Martha Wingate
Maternal and Child Health Journal, 2013
The purpose of this article is to describe the initial assessment for the development of a home v... more The purpose of this article is to describe the initial assessment for the development of a home visiting (HV) system in a state with no existing system. We outline a mixed methods process where the quantitative component was used to identify the communities that possess "at-risk" profiles, and the qualitative component explored the resources and gaps in existing HV services. We employed a mixed methods approach, using six categories of indicators from quantitative secondary data sources to identify "at-risk" profiles for Alabama's 67 counties. A weighted score for each indicator was calculated and counties were ranked. Surveys and focus groups were conducted to further define resources and gaps of existing HV programs. The composite indicator scores identified 13 counties as having the highest level of risk. Five of these 13 communities had no HV home visitation services. Areas of focus for future HV system development include trust, communication, availability, cost, and timeliness. In this assessment related to the Alabama HV system, we used quantitative data to apply criteria to the indicators being measured and qualitative data to supplement the quantitative findings. We examined resources, gaps, program quality, and capacity of the existing HV programs in order to assist in the future development of the HV system and early childhood system. The methods presented in this paper have potential applications beyond HV programs and systems, including broader examinations of complex systems for service provision to the maternal and child health populations.
Journal of public health management and practice : JPHMP, Jan 13, 2014
The purpose of this article was to describe a methodology to identify continuous quality improvem... more The purpose of this article was to describe a methodology to identify continuous quality improvement (CQI) priorities for one state's Maternal, Infant, and Early Childhood Home Visiting program from among the 40 required constructs associated with 6 program benchmarks. The authors discuss how the methodology provided consensus on system CQI quality measure priorities and describe variation among the 3 service delivery models used within the state. Q-sort methodology was used by home visiting (HV) service delivery providers (home visitors) to prioritize HV quality measures for the overall state HV system as well as their service delivery model. There was general consensus overall and among the service delivery models on CQI quality measure priorities, although some variation was observed. Measures associated with Maternal, Infant, and Early Childhood Home Visiting benchmark 1, Improved Maternal and Newborn Health, and benchmark 3, Improvement in School Readiness and Achievement, ...
Http Dx Doi Org 10 2105 Ajph 2012 300790, Jun 14, 2012
We examined how changes in risk factors over time influence fetal, first day, and combined fetal-... more We examined how changes in risk factors over time influence fetal, first day, and combined fetal-first day mortality and subsequent racial/ethnic disparities. We selected deliveries to US resident non-Hispanic White and Black mothers from the linked live birth-infant death cohort and fetal deaths files (1995-1996; 2001-2002) and calculated changes over time of mortality rates, odds, and relative odds ratios (RORs) overall and among mothers with modifiable risk factors (smoking, diabetes, or hypertensive disorders). Adjusted odds ratios (AORs) for fetal mortality overall (AOR=0.99; 95% confidence interval [CI]=0.96, 1.01) and among Blacks (AOR=0.98; 95% CI=0.93, 1.03) indicated no change over time. Among women with modifiable risk factors, the RORs indicated no change in disparities. The ROR was not significant for fetal mortality (ROR=0.96; 95% CI=0.83, 1.01) among smokers, but there was evidence of some decline. There was evidence of increase in RORs in fetal death among mothers with diabetes and hypertensive disorders, but differences were not significant. Disparities in fetal, first day, and combined fetal-first day mortality have persisted and reflect discrepancies in care provision or other factors more challenging to measure.
Maternal and Child Health Journal, 2008
The two-fold purpose of this analysis is first to contrast the maternal risk factors and birth ou... more The two-fold purpose of this analysis is first to contrast the maternal risk factors and birth outcomes of American Indians (AIs) with other race/ethnic groups and to compare the maternal risk factors and birth outcomes of AIs by region to assess whether there are geographic variations in the adverse outcomes that might suggest intervention strategies. This study used the National Center for Health Statistics live birth infant death cohort files from 1995-2001. Singleton live births to U.S. resident mothers were selected. The analyses were limited to non-Hispanic American Indians, including Aleuts and Eskimos (n = 239,494), Non-Hispanic White (n = 15,488,133), and Hispanic births (n = 5,284,978). This comparison of birth characteristics and outcomes by ethnic group revealed that AIs have more adverse maternal risk factors (e.g., unmarried and <18 years of age) than Whites and Hispanics. After adjustment for these factors, AIs have higher risks of low birth weight and preterm birth and elevated risks of postneonatal and infant mortality. Their cause-specific rates for perinatal, SIDS, injury and infection are also higher. The regional analysis indicated the South/Northeast have more low birth weight and preterm problems, but the Mid-West has the highest risks of infant mortality among LBW infants gestational age-specific mortality rates, and mortality from SIDS. These data show that AIs are not a homogenous group as evinced by distinct regional differences. SIDS is mainly a problem in the Mid-West, suggesting the involvement of environmental factors in that region. Further investigation is needed to examine the current AI perinatal health concerns.
The Journal of reproductive medicine
To update the trends in initiation of childbirth by age of the mother, describing the characteris... more To update the trends in initiation of childbirth by age of the mother, describing the characteristics of women having their first child at age 30 or above, and to determine the risk for adverse pregnancy outcomes for this group of women. This was a cross-sectional study using National Center for Health Statistics linked live birth and infant death cohort files from 1995 to 2000, and Natality file from 1980 to 2002. Analysis was limited to index pregnancies only. Logistic regression analysis was used to determine the risk of poor outcomes. There is a decreasing trend of first-time births to women 20-29 years old, while births to women 30 and older are showing a continued rise. As compared to 20-29-year-olds, women who start childbearing at age 30 or older are at increased risk of maternal complications in general. However, 30-34-year-olds have a reduced risk for pregnancy-induced hypertension and pre-existing hypertension. Infants born to women aged 30 and above are at increased risk for prematurity and low birth weight in addition to fetal and infant mortality. Because of the increasing trend of women starting childbearing in their 30s and the increased risk for poor outcomes in older women, health providers need to pay extra attention to this group of women as they plan and deliver services for them.
Background: Adequate PNCU is especially important among women with chronic conditions due to thei... more Background: Adequate PNCU is especially important among women with chronic conditions due to their increased risk for poor outcomes. Research on the relationship between nativity and prevalence of chronic conditions is limited and findings are inconsistent. The aim of this study was to determine if foreign-born women with chronic conditions had similar patterns of PNCU to U.S.-born women with chronic conditions. Methods: We used the 2001 to 2002 NCHS natality files for complete information for the PNCU index and nativity. The dependent variable was PNCU based on the R-GINDEX. Maternal nativity and the presence of a chronic condition (diabetes or hypertensive disorder) were independent variables. We calculated odds ratios for each PNCU group and by chronic condition, using U.S.-born mothers as the reference group. Results: The proportion of diabetes is higher overall in foreign-born population compared to U.S.-born; for hypertensive disorder, the proportion is higher in U.S.-born. Th...
Background: Rates of cesarean section (c/s) deliveries have increased 53% from 20.7% in 1996 to 3... more Background: Rates of cesarean section (c/s) deliveries have increased 53% from 20.7% in 1996 to 32% in 2007 with variations by race and ethnicity. Simultaneously prevalence in chronic diseases has risen and racial and ethnic disparities persist. The purpose of this study was to determine if whether racial and ethnic disparities in c/s exist among women with chronic conditions. Methods: Using 2007-2009 U.S. Natality files, we selected singleton live births to primiparous U.S. resident mothers; we focused our analyses to women with primary c/s deliveries. We calculated primary cesarean delivery rates by race and ethnicity as well as unadjusted and adjusted odds ratios of c/s delivery among women with hypertensive disorders and diabetes. Non-Hispanic white (white) was used as the reference group, controlling for sociodemographic and other perinatal or maternal risk factors. Results: The proportions of c/s delivery among all women with hypertensive disorders and diabetes was higher (47....
Science of The Total Environment, 2015
Prenatal and perinatal exposures to air pollutants have been shown to adversely affect birth outc... more Prenatal and perinatal exposures to air pollutants have been shown to adversely affect birth outcomes in offspring and may contribute to prevalence of autism spectrum disorder (ASD). For this ecologic study, we evaluated the association between ASD prevalence, at the census tract level, and proximity of tract centroids to the closest industrial facilities releasing arsenic, lead or mercury during the 1990s. We used 2000 to 2008 surveillance data from five sites of the Autism and Developmental Disabilities Monitoring (ADDM) network and 2000 census data to estimate prevalence. Multi-level negative binomial regression models were used to test associations between ASD prevalence and proximity to industrial facilities in existence from 1991 to 1999 according to the US Environmental Protection Agency Toxics Release Inventory (USEPA-TRI). Data for 2489 census tracts showed that after adjustment for demographic and socio-economic area-based characteristics, ASD prevalence was higher in census tracts located in the closest 10th percentile compared of distance to those in the furthest 50th percentile (adjusted RR=1.27, 95% CI: (1.00, 1.61), P=0.049). The findings observed in this study are suggestive of the association between urban residential proximity to industrial facilities emitting air pollutants and higher ASD prevalence.
Background: Previous studies have shown significant positive associations between autism spectrum... more Background: Previous studies have shown significant positive associations between autism spectrum disorder (ASD) prevalence among children in the U.S. and indicators of socioeconomic status (SES), raising the possibility that there is under-ascertainment of ASD in less socioeconomically advantaged children. An analysis of data from 12 Autism and Developmental Disabilities Monitoring (ADDM) Network sites for the combined years of 2002 and 2004, for example, found ASD prevalence to increase in a stepwise manner from 4.8, to 6.5 and 8.1 per 1,000 children in the lowest, middle and highest SES tertiles, respectively. Objectives: To replicate the previous ADDM Network study using comparable data for the year 2006, and evaluate the hypothesis that the SES disparity in ASD prevalence would be reduced in 2006 relative to 2002. Support for this hypothesis would be consistent with the possibility that awareness and identification of ASD among children of low SES have improved over time, and h...
Through a conference on Planning for Special Populations in Emergencies and Disasters sponsored b... more Through a conference on Planning for Special Populations in Emergencies and Disasters sponsored by the Alabama Department of Public Health and the South Central Center for Public Health Preparedness, emergency and disaster planning issues were discussed and priorities were established for special needs populations at the individual, family, and agency levels. For this conference special needs included any individual, group or community whose circumstances create barriers to obtaining or understanding information, or the ability to react as the general population has been requested during all phases of emergency management. Circumstances that may create barriers included, but were not limited to: age, physical, mental, emotional or cognitive status, culture, ethnicity, religion, language, citizenship, geography, or socio-economic status. Workshop topics included: lessons learned for special needs populations from previous disasters; mental health issues; senior citizen issues; adults...
International journal of mass emergencies and disasters
Developmental medicine and child neurology, Jan 23, 2015
To determine whether racial disparities in cerebral palsy (CP) risk among US children persist aft... more To determine whether racial disparities in cerebral palsy (CP) risk among US children persist after controlling for socio-economic status (SES) (here indicated by maternal education) and perinatal risk factors. A population-based birth cohort study was conducted using the Autism and Developmental Disabilities Monitoring Network surveillance and birth data for 8-year-old children residing in multi-county areas in Alabama, Georgia, Missouri, and Wisconsin between 2002 and 2008. The birth cohort comparison group included 458 027 children and the case group included 1570 children with CP, 1202 with available birth records. χ(2) tests were performed to evaluate associations and logistic regression was used to calculate relative risks (RR) and adjusted odds ratios (OR) with 95% confidence intervals (CI). The risk of spastic CP was more than 50% higher for black versus white children (RR 1.52, 95% CI 1.33-1.73), and this greater risk persisted after adjustment for SES (OR 1.35, 95% CI 1.18...
Maternal and child health journal, Jan 7, 2015
To compare fetal and first day outcomes of American Indian and Alaskan Natives (AIAN) with non-AI... more To compare fetal and first day outcomes of American Indian and Alaskan Natives (AIAN) with non-AIAN populations. Singleton deliveries to AIAN and non-AIAN populations were selected from live birth-infant death cohort and fetal deaths files from 1995-1998 and 2005-2008. We examined changes over time in maternal characteristics of deliveries and disparities and changes in risks of fetal, first day (<24 h), and cause-specific deaths. We calculated descriptive statistics, odds ratios and confidence intervals, and ratio of odds ratios (RORs) to indicate changes in disparities. Along with black mothers, AIANs exhibited the highest proportion of risk factors including the highest proportion of diabetes in both time periods (4.6 and 6.5 %). Over time, late fetal death for AIANs decreased 17 % (aOR = 0.83, 95 % CI 0.72-0.97), but we noted a 47 % increased risk over time for Hispanics (aOR = 1.47, 95 % CI 1.40-1.55). Our data indicated no change over time among AIANs for first day death. F...
Journal of public health management and practice : JPHMP, Jan 13, 2014
The purpose of this article was to describe a methodology to identify continuous quality improvem... more The purpose of this article was to describe a methodology to identify continuous quality improvement (CQI) priorities for one state's Maternal, Infant, and Early Childhood Home Visiting program from among the 40 required constructs associated with 6 program benchmarks. The authors discuss how the methodology provided consensus on system CQI quality measure priorities and describe variation among the 3 service delivery models used within the state. Q-sort methodology was used by home visiting (HV) service delivery providers (home visitors) to prioritize HV quality measures for the overall state HV system as well as their service delivery model. There was general consensus overall and among the service delivery models on CQI quality measure priorities, although some variation was observed. Measures associated with Maternal, Infant, and Early Childhood Home Visiting benchmark 1, Improved Maternal and Newborn Health, and benchmark 3, Improvement in School Readiness and Achievement, ...
Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002), Jan 28, 2014
Autism spectrum disorder (ASD). 2010. The Autism and Developmental Disabilities Monitoring (ADDM)... more Autism spectrum disorder (ASD). 2010. The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system in the United States that provides estimates of the prevalence of ASD and other characteristics among children aged 8 years whose parents or guardians live in 11 ADDM sites in the United States. ADDM surveillance is conducted in two phases. The first phase consists of screening and abstracting comprehensive evaluations performed by professional providers in the community. Multiple data sources for these evaluations include general pediatric health clinics and specialized programs for children with developmental disabilities. In addition, most ADDM Network sites also review and abstract records of children receiving special education services in public schools. The second phase involves review of all abstracted evaluations by trained clinicians to determine ASD surveillance case status. A child meets the surveillance case definition for ASD if a c...
The purpose was to compare the two different measures of gestational age currently used on birth ... more The purpose was to compare the two different measures of gestational age currently used on birth certificates (the duration of pregnancy based on the date of last menstrual period [LMP] and the clinical estimate [CE] as related to health status indicators. We contrasted these measures by race/ethnicity. METHODS: NCHS natality files for 2000-2002 were used, selecting cases of single live birth to U.S. resident mothers with both LMP and CE gestational age information. RESULTS: Approximately 75% of the records had valid LMP and CE values and for approximately onehalf of these, the LMP and CE values did not exactly agree. Overall and for each race and ethnic group, the LMP measures resulted in higher proportions of very preterm, preterm, postterm and SGA births. CE value provided preterm rates of 7.9% and for LMP, 9.9%. The odds ratio of preterm birth for African-Americans using the CE measure was 1.78 [95% Cl 1.77-1.79]. The odds ratio using LMP was 1.93 [95% Cl 1.92-1.94]. Whites were the referent population. CONCLUSIONS: Different measures of gestational age result in different overall and race-specific rates of very preterm, preterm, postterm, and SGA births. These findings indicate that substituting or combining these measures may have consequences.
Maternal and Child Health Journal, 2013
The purpose of this article is to describe the initial assessment for the development of a home v... more The purpose of this article is to describe the initial assessment for the development of a home visiting (HV) system in a state with no existing system. We outline a mixed methods process where the quantitative component was used to identify the communities that possess &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;at-risk&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; profiles, and the qualitative component explored the resources and gaps in existing HV services. We employed a mixed methods approach, using six categories of indicators from quantitative secondary data sources to identify &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;at-risk&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; profiles for Alabama&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s 67 counties. A weighted score for each indicator was calculated and counties were ranked. Surveys and focus groups were conducted to further define resources and gaps of existing HV programs. The composite indicator scores identified 13 counties as having the highest level of risk. Five of these 13 communities had no HV home visitation services. Areas of focus for future HV system development include trust, communication, availability, cost, and timeliness. In this assessment related to the Alabama HV system, we used quantitative data to apply criteria to the indicators being measured and qualitative data to supplement the quantitative findings. We examined resources, gaps, program quality, and capacity of the existing HV programs in order to assist in the future development of the HV system and early childhood system. The methods presented in this paper have potential applications beyond HV programs and systems, including broader examinations of complex systems for service provision to the maternal and child health populations.
Journal of public health management and practice : JPHMP, Jan 13, 2014
The purpose of this article was to describe a methodology to identify continuous quality improvem... more The purpose of this article was to describe a methodology to identify continuous quality improvement (CQI) priorities for one state's Maternal, Infant, and Early Childhood Home Visiting program from among the 40 required constructs associated with 6 program benchmarks. The authors discuss how the methodology provided consensus on system CQI quality measure priorities and describe variation among the 3 service delivery models used within the state. Q-sort methodology was used by home visiting (HV) service delivery providers (home visitors) to prioritize HV quality measures for the overall state HV system as well as their service delivery model. There was general consensus overall and among the service delivery models on CQI quality measure priorities, although some variation was observed. Measures associated with Maternal, Infant, and Early Childhood Home Visiting benchmark 1, Improved Maternal and Newborn Health, and benchmark 3, Improvement in School Readiness and Achievement, ...
Http Dx Doi Org 10 2105 Ajph 2012 300790, Jun 14, 2012
We examined how changes in risk factors over time influence fetal, first day, and combined fetal-... more We examined how changes in risk factors over time influence fetal, first day, and combined fetal-first day mortality and subsequent racial/ethnic disparities. We selected deliveries to US resident non-Hispanic White and Black mothers from the linked live birth-infant death cohort and fetal deaths files (1995-1996; 2001-2002) and calculated changes over time of mortality rates, odds, and relative odds ratios (RORs) overall and among mothers with modifiable risk factors (smoking, diabetes, or hypertensive disorders). Adjusted odds ratios (AORs) for fetal mortality overall (AOR=0.99; 95% confidence interval [CI]=0.96, 1.01) and among Blacks (AOR=0.98; 95% CI=0.93, 1.03) indicated no change over time. Among women with modifiable risk factors, the RORs indicated no change in disparities. The ROR was not significant for fetal mortality (ROR=0.96; 95% CI=0.83, 1.01) among smokers, but there was evidence of some decline. There was evidence of increase in RORs in fetal death among mothers with diabetes and hypertensive disorders, but differences were not significant. Disparities in fetal, first day, and combined fetal-first day mortality have persisted and reflect discrepancies in care provision or other factors more challenging to measure.
Maternal and Child Health Journal, 2008
The two-fold purpose of this analysis is first to contrast the maternal risk factors and birth ou... more The two-fold purpose of this analysis is first to contrast the maternal risk factors and birth outcomes of American Indians (AIs) with other race/ethnic groups and to compare the maternal risk factors and birth outcomes of AIs by region to assess whether there are geographic variations in the adverse outcomes that might suggest intervention strategies. This study used the National Center for Health Statistics live birth infant death cohort files from 1995-2001. Singleton live births to U.S. resident mothers were selected. The analyses were limited to non-Hispanic American Indians, including Aleuts and Eskimos (n = 239,494), Non-Hispanic White (n = 15,488,133), and Hispanic births (n = 5,284,978). This comparison of birth characteristics and outcomes by ethnic group revealed that AIs have more adverse maternal risk factors (e.g., unmarried and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;18 years of age) than Whites and Hispanics. After adjustment for these factors, AIs have higher risks of low birth weight and preterm birth and elevated risks of postneonatal and infant mortality. Their cause-specific rates for perinatal, SIDS, injury and infection are also higher. The regional analysis indicated the South/Northeast have more low birth weight and preterm problems, but the Mid-West has the highest risks of infant mortality among LBW infants gestational age-specific mortality rates, and mortality from SIDS. These data show that AIs are not a homogenous group as evinced by distinct regional differences. SIDS is mainly a problem in the Mid-West, suggesting the involvement of environmental factors in that region. Further investigation is needed to examine the current AI perinatal health concerns.
The Journal of reproductive medicine
To update the trends in initiation of childbirth by age of the mother, describing the characteris... more To update the trends in initiation of childbirth by age of the mother, describing the characteristics of women having their first child at age 30 or above, and to determine the risk for adverse pregnancy outcomes for this group of women. This was a cross-sectional study using National Center for Health Statistics linked live birth and infant death cohort files from 1995 to 2000, and Natality file from 1980 to 2002. Analysis was limited to index pregnancies only. Logistic regression analysis was used to determine the risk of poor outcomes. There is a decreasing trend of first-time births to women 20-29 years old, while births to women 30 and older are showing a continued rise. As compared to 20-29-year-olds, women who start childbearing at age 30 or older are at increased risk of maternal complications in general. However, 30-34-year-olds have a reduced risk for pregnancy-induced hypertension and pre-existing hypertension. Infants born to women aged 30 and above are at increased risk for prematurity and low birth weight in addition to fetal and infant mortality. Because of the increasing trend of women starting childbearing in their 30s and the increased risk for poor outcomes in older women, health providers need to pay extra attention to this group of women as they plan and deliver services for them.
Background: Adequate PNCU is especially important among women with chronic conditions due to thei... more Background: Adequate PNCU is especially important among women with chronic conditions due to their increased risk for poor outcomes. Research on the relationship between nativity and prevalence of chronic conditions is limited and findings are inconsistent. The aim of this study was to determine if foreign-born women with chronic conditions had similar patterns of PNCU to U.S.-born women with chronic conditions. Methods: We used the 2001 to 2002 NCHS natality files for complete information for the PNCU index and nativity. The dependent variable was PNCU based on the R-GINDEX. Maternal nativity and the presence of a chronic condition (diabetes or hypertensive disorder) were independent variables. We calculated odds ratios for each PNCU group and by chronic condition, using U.S.-born mothers as the reference group. Results: The proportion of diabetes is higher overall in foreign-born population compared to U.S.-born; for hypertensive disorder, the proportion is higher in U.S.-born. Th...
Background: Rates of cesarean section (c/s) deliveries have increased 53% from 20.7% in 1996 to 3... more Background: Rates of cesarean section (c/s) deliveries have increased 53% from 20.7% in 1996 to 32% in 2007 with variations by race and ethnicity. Simultaneously prevalence in chronic diseases has risen and racial and ethnic disparities persist. The purpose of this study was to determine if whether racial and ethnic disparities in c/s exist among women with chronic conditions. Methods: Using 2007-2009 U.S. Natality files, we selected singleton live births to primiparous U.S. resident mothers; we focused our analyses to women with primary c/s deliveries. We calculated primary cesarean delivery rates by race and ethnicity as well as unadjusted and adjusted odds ratios of c/s delivery among women with hypertensive disorders and diabetes. Non-Hispanic white (white) was used as the reference group, controlling for sociodemographic and other perinatal or maternal risk factors. Results: The proportions of c/s delivery among all women with hypertensive disorders and diabetes was higher (47....
Science of The Total Environment, 2015
Prenatal and perinatal exposures to air pollutants have been shown to adversely affect birth outc... more Prenatal and perinatal exposures to air pollutants have been shown to adversely affect birth outcomes in offspring and may contribute to prevalence of autism spectrum disorder (ASD). For this ecologic study, we evaluated the association between ASD prevalence, at the census tract level, and proximity of tract centroids to the closest industrial facilities releasing arsenic, lead or mercury during the 1990s. We used 2000 to 2008 surveillance data from five sites of the Autism and Developmental Disabilities Monitoring (ADDM) network and 2000 census data to estimate prevalence. Multi-level negative binomial regression models were used to test associations between ASD prevalence and proximity to industrial facilities in existence from 1991 to 1999 according to the US Environmental Protection Agency Toxics Release Inventory (USEPA-TRI). Data for 2489 census tracts showed that after adjustment for demographic and socio-economic area-based characteristics, ASD prevalence was higher in census tracts located in the closest 10th percentile compared of distance to those in the furthest 50th percentile (adjusted RR=1.27, 95% CI: (1.00, 1.61), P=0.049). The findings observed in this study are suggestive of the association between urban residential proximity to industrial facilities emitting air pollutants and higher ASD prevalence.
Background: Previous studies have shown significant positive associations between autism spectrum... more Background: Previous studies have shown significant positive associations between autism spectrum disorder (ASD) prevalence among children in the U.S. and indicators of socioeconomic status (SES), raising the possibility that there is under-ascertainment of ASD in less socioeconomically advantaged children. An analysis of data from 12 Autism and Developmental Disabilities Monitoring (ADDM) Network sites for the combined years of 2002 and 2004, for example, found ASD prevalence to increase in a stepwise manner from 4.8, to 6.5 and 8.1 per 1,000 children in the lowest, middle and highest SES tertiles, respectively. Objectives: To replicate the previous ADDM Network study using comparable data for the year 2006, and evaluate the hypothesis that the SES disparity in ASD prevalence would be reduced in 2006 relative to 2002. Support for this hypothesis would be consistent with the possibility that awareness and identification of ASD among children of low SES have improved over time, and h...
Through a conference on Planning for Special Populations in Emergencies and Disasters sponsored b... more Through a conference on Planning for Special Populations in Emergencies and Disasters sponsored by the Alabama Department of Public Health and the South Central Center for Public Health Preparedness, emergency and disaster planning issues were discussed and priorities were established for special needs populations at the individual, family, and agency levels. For this conference special needs included any individual, group or community whose circumstances create barriers to obtaining or understanding information, or the ability to react as the general population has been requested during all phases of emergency management. Circumstances that may create barriers included, but were not limited to: age, physical, mental, emotional or cognitive status, culture, ethnicity, religion, language, citizenship, geography, or socio-economic status. Workshop topics included: lessons learned for special needs populations from previous disasters; mental health issues; senior citizen issues; adults...
International journal of mass emergencies and disasters
Developmental medicine and child neurology, Jan 23, 2015
To determine whether racial disparities in cerebral palsy (CP) risk among US children persist aft... more To determine whether racial disparities in cerebral palsy (CP) risk among US children persist after controlling for socio-economic status (SES) (here indicated by maternal education) and perinatal risk factors. A population-based birth cohort study was conducted using the Autism and Developmental Disabilities Monitoring Network surveillance and birth data for 8-year-old children residing in multi-county areas in Alabama, Georgia, Missouri, and Wisconsin between 2002 and 2008. The birth cohort comparison group included 458 027 children and the case group included 1570 children with CP, 1202 with available birth records. χ(2) tests were performed to evaluate associations and logistic regression was used to calculate relative risks (RR) and adjusted odds ratios (OR) with 95% confidence intervals (CI). The risk of spastic CP was more than 50% higher for black versus white children (RR 1.52, 95% CI 1.33-1.73), and this greater risk persisted after adjustment for SES (OR 1.35, 95% CI 1.18...
Maternal and child health journal, Jan 7, 2015
To compare fetal and first day outcomes of American Indian and Alaskan Natives (AIAN) with non-AI... more To compare fetal and first day outcomes of American Indian and Alaskan Natives (AIAN) with non-AIAN populations. Singleton deliveries to AIAN and non-AIAN populations were selected from live birth-infant death cohort and fetal deaths files from 1995-1998 and 2005-2008. We examined changes over time in maternal characteristics of deliveries and disparities and changes in risks of fetal, first day (<24 h), and cause-specific deaths. We calculated descriptive statistics, odds ratios and confidence intervals, and ratio of odds ratios (RORs) to indicate changes in disparities. Along with black mothers, AIANs exhibited the highest proportion of risk factors including the highest proportion of diabetes in both time periods (4.6 and 6.5 %). Over time, late fetal death for AIANs decreased 17 % (aOR = 0.83, 95 % CI 0.72-0.97), but we noted a 47 % increased risk over time for Hispanics (aOR = 1.47, 95 % CI 1.40-1.55). Our data indicated no change over time among AIANs for first day death. F...
Journal of public health management and practice : JPHMP, Jan 13, 2014
The purpose of this article was to describe a methodology to identify continuous quality improvem... more The purpose of this article was to describe a methodology to identify continuous quality improvement (CQI) priorities for one state's Maternal, Infant, and Early Childhood Home Visiting program from among the 40 required constructs associated with 6 program benchmarks. The authors discuss how the methodology provided consensus on system CQI quality measure priorities and describe variation among the 3 service delivery models used within the state. Q-sort methodology was used by home visiting (HV) service delivery providers (home visitors) to prioritize HV quality measures for the overall state HV system as well as their service delivery model. There was general consensus overall and among the service delivery models on CQI quality measure priorities, although some variation was observed. Measures associated with Maternal, Infant, and Early Childhood Home Visiting benchmark 1, Improved Maternal and Newborn Health, and benchmark 3, Improvement in School Readiness and Achievement, ...
Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002), Jan 28, 2014
Autism spectrum disorder (ASD). 2010. The Autism and Developmental Disabilities Monitoring (ADDM)... more Autism spectrum disorder (ASD). 2010. The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system in the United States that provides estimates of the prevalence of ASD and other characteristics among children aged 8 years whose parents or guardians live in 11 ADDM sites in the United States. ADDM surveillance is conducted in two phases. The first phase consists of screening and abstracting comprehensive evaluations performed by professional providers in the community. Multiple data sources for these evaluations include general pediatric health clinics and specialized programs for children with developmental disabilities. In addition, most ADDM Network sites also review and abstract records of children receiving special education services in public schools. The second phase involves review of all abstracted evaluations by trained clinicians to determine ASD surveillance case status. A child meets the surveillance case definition for ASD if a c...
The purpose was to compare the two different measures of gestational age currently used on birth ... more The purpose was to compare the two different measures of gestational age currently used on birth certificates (the duration of pregnancy based on the date of last menstrual period [LMP] and the clinical estimate [CE] as related to health status indicators. We contrasted these measures by race/ethnicity. METHODS: NCHS natality files for 2000-2002 were used, selecting cases of single live birth to U.S. resident mothers with both LMP and CE gestational age information. RESULTS: Approximately 75% of the records had valid LMP and CE values and for approximately onehalf of these, the LMP and CE values did not exactly agree. Overall and for each race and ethnic group, the LMP measures resulted in higher proportions of very preterm, preterm, postterm and SGA births. CE value provided preterm rates of 7.9% and for LMP, 9.9%. The odds ratio of preterm birth for African-Americans using the CE measure was 1.78 [95% Cl 1.77-1.79]. The odds ratio using LMP was 1.93 [95% Cl 1.92-1.94]. Whites were the referent population. CONCLUSIONS: Different measures of gestational age result in different overall and race-specific rates of very preterm, preterm, postterm, and SGA births. These findings indicate that substituting or combining these measures may have consequences.