American Journal of Public Health Highlights
- Declines in teen pregnancy tied to abstinence or contraception?
- Moms’ obesity ups risk of preterm birth
- Youth tobacco cessation programs least likely in areas that need them most
- Drug treatment for non-violent offenders may displace others in need
- Children of immigrants face increased risk for mental disorders
Declines in teen pregnancy tied to abstinence or contraception?
The dramatic, recent declines in teen pregnancy rates in the United States are primarily the result of improved use of contraceptives among teenagers.
Teen pregnancy rates in the United States have declined remarkably since 1990, according to a new study from Columbia University and Guttmacher Institute. Columbia and Guttmacher investigators examined sexual behavior and contraceptive use among young women ages 15-19 to determine the contributions of abstinence and contraceptive use to the decline in teen pregnancy. They found that 86 percent of the decline in pregnancy risk was linked to improved use of contraception, with increasing use of birth control pills and condoms and an increased use of two methods at last sex (for example, pills and condoms). Reduced sexual activity explained 14 percent of the decline in teen pregnancy. Using data from the National Survey of Family Growth for 1995 and 2002, the study's authors developed a "Contraceptive Risk Index" that summarized the effectiveness of teen contraceptive use, based on prevalence of non-use and use of each method and published contraceptive failure rates. Researchers also developed an "Overall Pregnancy Risk Index" based upon the contraceptive risk score and the percentage of teens reporting sexual activity. Among younger teens (15-17 years old), 77 percent of pregnancy decline was attributable to improved contraceptive use and 23 percent to reduced sexual activity.
[From: "Explaining Recent Declines in Adolescent Pregnancy in the United States: the Contribution of Abstinence and Improved Contraceptive Use" Contact: John S. Santelli, MD, MPH, Columbia University, New York, N.Y., firstname.lastname@example.org.]
Moms’ obesity ups risk of preterm birth
Obese first-time moms are at an increased risk for preterm birth because they are more likely to have complications, such as high blood pressure, that make their doctor choose to deliver the baby before full term.
Researchers studied 187,290 women in Scotland and analyzed their body mass index (BMI) to determine categories of overweight, obese and morbidly obese mothers. For first-time moms, being morbidly obese, with a BMI of 35 or greater, increased the overall risk of preterm birth. This led to threefold increased risks of a neonatal death and delivering an extremely low birth weight baby (<1000g), a major risk factor for cerebral palsy. Yet once a woman has given birth to a child, obesity doesn't appear to affect preterm birth risk for her other children.
Researchers urged obese women to seek counseling to lose weight before a first pregnancy and to consider the increased risk for preterm birth.
[From: “Maternal Obesity in Early Pregnancy and Risk of Spontaneous and Elective Preterm Delivery: A Retrospective Cohort Study.” Contact: Gordon Smith, MD, PhD, Cambridge University, United Kingdom, email@example.com.]
Youth tobacco cessation programs least likely in areas that need them most
While programs designed to curb or prevent youth smoking are prevalent in the United States, a study of hundreds of such programs found they are the least prevalent in areas that are recording increased youth smoking rates.
The study of 591 youth tobacco cessation programs found that most programs were multi-session, school-based programs serving fewer than 50 adolescents. And although the typical program had a meager annual budget of $2,000, such programs are less prevalent in low-income and rural communities where smoking rates have been on the rise.
“There appears to be an inverse association between the need for cessation programming,
based on trends in smoking prevalence and program availability,” the study’s authors wrote. The authors, however, were encouraged by the findings that most programs used professionally trained adults to deliver treatment with proven protocols and provided follow up.
[From: “A National Survey of Tobacco Cessation Programs for Youth.” Contact: Susan J. Curry, PhD, University of Illinois at Chicago, firstname.lastname@example.org.]
Drug treatment for non-violent offenders may displace others in need
California’s Proposition 36, which offers community-based drug treatment as an alternative to prison time or probation for non-violent drug offenders, has had the unintended result of reducing available drug treatment for those who have not been arrested on drug crimes.
A study that compared drug treatment admissions the year before and two years after the California law was enacted found the number of Proposition 36 offenders admitted to treatment continued to increase in the state (approximately 32,000 in the first year and 48,000 in year two). Voluntary drug treatment clients decreased by 8,000 each year statewide, but the change varied across counties. One-third of treatment providers reported decreased treatment availability for non-Proposition 36 clients in the second year following the law’s enactment. This was despite an expansion in treatment capacity.
[From: “Impact of California’s Proposition 36 on the Drug Treatment System: Treatment Capacity and Displacement.” Contact: Yih-Ing Hser, PhD, University of California Los Angeles, email@example.com.]
Grandchildren of immigrants face increased risk for mental disorders
While some recent studies have shown that immigrants may experience lower rates of mental health problems, such as depression and anxiety, than U.S.-born residents, the children and grandchildren of immigrants may actually be more likely than their parents to suffer such mental health woes. “National Health Surveys Examining Disparities,” a special section in this month’s Journal, examines how different facets of the immigration experience are tied to mental health among nationally representative samples of Asians, blacks and Latinos.
One study looked at the prevalence of depressive, anxiety and substance disorders in relation to ethnicity, nativity, generational status, English proficiency, length of time in the United States and age at migration to the United States for Latinos. The results: the lifetime prevalence estimate for any psychiatric disorders was 28.1 percent for Latino men and 30.2 percent for Latina women. Puerto Ricans had the highest overall prevalence rate among the Latino ethnic groups for any disorder. There were higher rates of psychiatric disorders among the U.S.-born, English proficient and third generation Latinos.
A study of immigration and mental disorders among Asian Americans found that among women, those born in Asian countries had lower rates of mental disorders than U.S.-born Asians. Among men, those who spoke English proficiently had lower rates of mental health problems.
A study of the mental health of black Caribbean immigrants found that when compared to black Americans, immigrant women were less likely to suffer mental health problems and immigrant men were more likely to have mental health problems. Caribbean immigrants had lower rates of psychiatric disorders than their U.S.-born peers, and third generation Caribbean immigrants had markedly elevated rates of disorder.
[From: “Prevalence of Psychiatric Disorders Among Latino Subgroups in the United States.” Contact: Margarita Alegria, PhD, Harvard Medical School and Cambridge Health Alliance, Somerville, Mass., firstname.lastname@example.org. Also from: The Mental Health of Black Caribbean Immigrants: Results from the National Survey of American Life.” Contact: David R. Williams, PhD, MPH, Harvard School of Public Health, Boston, email@example.com. Also from: “Immigration- Related Factors and Mental Disorders Among Asian Americans.” Contact: David T. Takeuchi, PhD, University of Washington, Seattle, firstname.lastname@example.org.]