AJPH December 2015 highlights

Date: Dec 21 2015

AJPH Research: Health outcomes of group prenatal care, adverse childhood experiences of LGB individuals, reducing prescription opioid overdose deaths

CONTACT: For copies of articles or full table of contents of an issue, call Mandi Yohn at 202-777-2509 or email her at amanda.yohn@apha.org.

American Journal of Public Health highlights:

1. Group prenatal care results in healthier moms and babies

LGB individuals have higher prevalence of adverse childhood experiences, excess risk of poor adult health outcomes

Florida regulation of “pill mills” reduces deaths from prescription opioid overdose

Group prenatal care results in healthier moms and babies

Young mothers receiving group prenatal care had better health outcomes than those who received standard individual prenatal care, according to a new study in the American Journal of Public Health.

Researchers from the Yale School of Public Health, supported by the National Institutes of Health, performed a multisite cluster randomized controlled trial in 14 New York City health centers from 2008-2012. The goal of the trial was to assess the effectiveness of group prenatal care – where women meet collectively, coupled with education and skills building – compared to individual care. Using medical records and surveys, researchers analyzed the health outcomes of 1,148 pregnant women 14-21 years old who were at or less than 24 weeks of gestation when they joined the study.

Results from the study showed that young mothers who received group prenatal care were significantly less likely to deliver a baby small for gestational age than those who received individual care. Additionally, women who attended a greater number of group prenatal care visits had babies who spent fewer days in the neonatal intensive care unit. These women also had better reproductive health outcomes, including being less likely to have rapid repeat pregnancy, more likely to use condoms and have fewer acts of unprotected sexual intercourse.

“Adverse birth outcomes remain leading causes of U.S. infant morbidity and mortality and are concentrated among disadvantaged groups. Pregnant adolescents also have higher rates of sexually transmitted infections,” the authors explain. “This study demonstrates the effectiveness of group prenatal care bundled with a reproductive health promotion intervention in real-world clinical settings for decreasing the risk of delivering small-for-gestational-age infants.”

[“Cluster Randomized Controlled Trial of Group Prenatal Care: Perinatal Outcomes Among Adolescents in New York City Health Centers.” Contact: Jeanette Ickovics, PhD, Yale School of Public Health, New Haven, Connecticut.]

LGB individuals have higher prevalence of adverse childhood experiences, excess risk of poor adult health outcomes

According to new research in the American Journal of Public Health, adverse childhood experiences – or ACEs – are related to poor adult health outcomes for lesbian, gay and bisexual – or LGB – individuals.

Researchers with the North Carolina Department of Health and Human Services examined data from the 2012 North Carolina, 2011 Washington and 2011-2012 Wisconsin Behavioral Risk Factor Surveillance System surveys. Administered by the Centers for Disease Control and Prevention, these random-digit-dial telephone surveys captured data on health risks, perceived poor health and chronic conditions by sexual orientation, as well as eight categories of ACEs, including sexual, physical and emotional abuse, and five categories of household dysfunction.

Results showed that LGB individuals reported a higher prevalence of ACEs than heterosexuals. LGB individuals were more likely to report all eight ACE categories than heterosexuals, with the largest differences found for sexual abuse, adult mental illness in the household and an incarcerated household member. Before accounting for prevalence of ACEs, sexual orientation was significantly associated with health risks, perceived poor health and chronic conditions. After accounting for prevalence of ACEs, sexual orientation was no longer significantly associated with smoking, binge drinking or poor physical health. Significant – yet reduced – associations with poor mental health, activity limitation, HIV risk behaviors, asthma, depression and disability remained.

“Particular attention should be directed toward ACEs among the LGB population, given the prevalence of such experiences among this population and the potential contribution of ACEs to health disparities by sexual orientation,” the authors explained. “Research into factors that promote resiliency and mitigate poor health outcomes among LGB individuals who have experienced childhood abuse and trauma may identify individual-, family- and community-level strategies to improve well-being in this population.”

[“Adverse Childhood Experiences Related to Poor Adult Health Among Lesbian, Gay and Bisexual Individuals.” Anna Austin, MPH, North Carolina Department of Health and Human Services, Chapel Hill, North Carolina.]

Florida regulation of “pill mills” reduces deaths from prescription opioid overdose

Florida’s actions to target “pill mills” – a term for health care providers that dispense large quantities of prescription drugs outside the scope of standard medical practice – are associated with significant declines in prescription opioid overdose deaths, according to a new study in the American Journal of Public Health.

Researchers from the Bloomberg School of Public Health at Johns Hopkins University collected 2003-2012 mortality data from the Florida Department of Health and North Carolina State Center for Health Statistics – the comparison state – to estimate changes in the rates of death from prescription opioid, heroin or any opioid overdose. They then assessed the overall effect of Florida’s interventions to regulate pill mills during that period, including two new state laws in 2010 and 2011 and law enforcement initiatives in 2010 and 2012.

During the intervention period in Florida, results showed an estimated 1,029 fewer deaths due to prescription opioid overdose. Estimated reductions in deaths grew over the intervention period, and Florida’s mortality rates from heroin and total opioid overdose were also lower than anticipated relative to the comparison state of North Carolina, which had no new interventions targeting pill mills during that period.

“Opioid overdose is a complex problem requiring multifaceted solutions,” the authors explained. “Our findings suggest that actions to reduce prescription opioid misuse may reduce heroin overdose deaths in the long term. Further research should assess whether these trends have continued since the end of our study period and examine the interrelationship between policies targeting prescription opioid misuse and heroin use and overdose.”

[“Opioid Overdose Deaths and Florida’s Crackdown on Pill Mills.” Alene Kennedy-Hendricks, PhD, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.]

Find a full list of research papers to be published online on December 21, 2015, at 4 p.m. EST below:

  • Adverse Childhood Experiences Related to Poor Adult Health Among Lesbian, Gay and Bisexual Individuals
  • Health Literacy, Pedometer, and Self-Reported Walking Among Older Adults
  • Contextual Predictors of Injection Drug Use Among Black Adolescents and Adults in US Metropolitan Areas, 1993–2007
  • Barriers to Cervical Screening Among Sex Workers in Vancouver
  • High Tuberculosis Strain Diversity Among New York City Public Housing Residents
  • Younger and Sicker: Comparing Micronesians to Other Ethnicities in Hawaii
  • Improving Adolescent Parenting: Results From a Randomized Controlled Trial of a Home Visiting Program for Young Families
  • Cascade of Care for Hepatitis C Virus Infection Within the US Veterans Health Administration
  • Projecting the Unmet Need and Costs for Contraception Services After the Affordable Care Act
  • Interest Group Conflict Over Medicaid Expansion: The Surprising Impact of Public Advocates
  • Economic Opportunity, Health Behaviors, and Mortality in the United States
  • Opioid overdose deaths and Florida's crackdown on pill mills
  • Reduction in Needle Sharing Among Seattle-Area Injection Drug Users Across 4 Surveys, 1994–2013
  • Nonmedical Opioid Pain Relievers and All-Cause Mortality: a 27-Year Follow-Up From the Epidemiologic Catchment Area Study
  • Group Prenatal Care: Cluster RCT of Perinatal and Reproductive Health Outcomes among Adolescents in Urban Health Centers
  • Public Health Monitoring of Privilege and Deprivation With the Index of Concentration at the Extremes
  • Physical Activity and Dietary Determinants of Weight Loss Success in the US General Population
  • HIV Diagnoses and Care Among Transgender Persons and Comparison With Men Who Have Sex With Men: New York City, 2006–2011
  • Effect of Gun Carrying on Perceptions of Risk Among Adolescent Offenders
  • Independent and Interactive Effects of Smoking Bans and Tobacco Taxes on a Cohort of US Young Adults
  • Elevated Blood Lead Levels in Children Associated with the Flint Drinking Water Crisis: Application of Spatial Analysis to Determine Risk and Prioritize Public Health Response

The articles above will be published online December 21, 2015, at 4 p.m. EST by the American Journal of Public Health under “First Look.” “First Look” articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. The American Journal of Public Health is published by the American Public Health Association, and is available at www.ajph.org.

Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to Mandi Yohn at APHA, 202-777-2509, or email her. A single print issue of the Journal is available for $35 from the Journal’s Subscriptions department. If you are not a member of the press, a member of APHA or a subscriber, online single issue access is $30 and online single article access is $22 at www.ajph.org or for direct customer service, call 202-777-2516, or email.

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The American Journal of Public Health is the monthly journal of the American Public Health Association. APHA champions the health of all people and all communities by strengthening the profession of public health, sharing the latest research and information, promoting best practices and advocating for public health issues and policies grounded in research. More information is available at www.apha.org.