Does Age Affect the Association between Race/Ethnicity and HPV Screening: A Retrospective Cohort Study of United States Women

Many studies have demonstrated disparities in awareness of and knowledge about human papillomavirus (HPV) among young, immigrant, and minority populations. Yet, there is a lack of existing research that has investigated the role of race/ethnicity and HPV screening, and how it varies by age. The purpose of this study was to evaluate this association using 2016 Behavioral Risk Factor Surveillance System (BRFSS) data. This study included 120,646 women who self-reported information on race/ethnicity, HPV screening, and age. Logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (CIs). A stratified analysis was conducted to determine if age modified the race/ethnicity and HPV screening association. After adjustment, non-Hispanic Black and Multiracial women had statistically significant increased odds of receiving HPV screening as compared to non-Hispanic white women (OR 1.20; 95% CI 1.11, 1.29 and OR 1.58; 95% CI 1.33, 1.88, respectively). There was no association between Hispanic race/ethnicity and HPV screening (OR 1.02; 95% CI 0.95, 1.09). The findings of this study provide evidence that age modifies the association between race/ethnicity and HPV screening. Among the oldest categories of women, non-Hispanic Black, Multiracial, and Hispanic women had increased odds of HPV screening. Conversely, among the youngest categories of women, non-Hispanic Other and Hispanic had decreased odds of HPV screening. Public health interventions and health care providers may need to focus on specific minority subgroups to increase HPV screening in certain sub age categories

Association of type of birth attendant and place of delivery on infant mortality in sub-Saharan Africa

Objective: To examine the association between type of birth attendant and place of delivery, and infant mortality (IM).Methods: This cross-sectional study used self-reported data from the Demographic Health Surveys for women in Ghana, Kenya, and Sierra Leone. Logistic regression estimated odds ratios (ORs) and95% confidence intervals.Results: In Ghana and Sierra Leone, odds of IM were higher for women who delivered at a health facility versus women who delivered at a household residence (OR=3.18, 95% confidence interval, CI: 1.29-7.83, p=0.01 and OR=1.62, 95% CI: 1.15-2.28, p=0.01, respectively). Compared to the use of health professionals, the use of birth attendants for assistance with delivery was not significantly associated with IM for women in Ghana or Sierra Leone (OR=2.17, 95% CI: 0.83-5.69, p=0.12 and OR=1.25, 95% CI: 0.92-1.70, p=0.15, respectively). In Kenya, odds of IM, though nonsignificant, were lower for women who used birth attendants than those who used health professionals to assist with delivery (OR=0.85, 95% CI: 0.51-1.41, p=0.46), and higher with delivery at a health facility versus a household residence (OR=1.29, 95% CI: 0.81-2.03, p=0.28).Conclusions: Women in Ghana and Sierra Leone who delivered at a health facility had statistically significant increased odds of IM. Birth attendant type-IM associations were not statistically significant.Future research should consider culturally-sensitive interventions to improve maternal health and help reduce IM.Keywords: birth attendant, infant mortality, sub-Saharan Afric

Interbirth Intervals of Immigrant and Refugee Women in the United States: A Cross-Sectional Study

Background and Objective: Despite guidelines recommending an interval of at least 18–24 months between a live birth and the conception of the next pregnancy, nearly one-third of pregnancies in the United States are conceived within 18 months of a previous live birth.The purpose of this study was to examine the associations between multiple immigration-related variables and interbirth intervals among reproductive-aged immigrant and refugee women living in the United States. Methods: This was a cross-sectional, quantitative study on the sexual and reproductive health (SRH) of reproductive-aged immigrant and refugee women in the United States. The data were collected via an online survey administered by Lucid LLC. We included data on women who had complete information on nativity and birth history in the descriptive analysis (n = 653). The exposure variables were immigration pathway, length of time since immigration, and country/region of birth. The outcome variable was interbirth interval (≤18, 19–35, or ≥36 months).We used multivariable ordinal logistic regression, adjusted for confounders, to determine the factors associated with having a longer interbirth interval among women with second- or higher-order births (n = 245). Results: Approximately 37.4% of study participants had a short interbirth interval.Women who immigrated to the United States for educational (aOR = 4.57; 95% CI, 1.57–9.58) or employment opportunities (aOR = 2.27; 95% CI, 1.07–5.31) had higher odds of reporting a longer interbirth interval (19–35 or ≥36 months) than women born in the United States. Women born in an African country had 0.79 times the odds (aOR = 0.79; 95% CI, 0.02–0.98) of being in a higher category of interbirth interval. Conclusion and Global Health Implications: Although all birthing women should be counseled on optimal birth spacing through the use of postpartum contraception, immigrant and refugee women would benefit from further research and policy and program interventions to help them in achieving optimal birth spacing. SRH research in African immigrant and refugee communities is especially important for identifying ameliorable factors for improving birth spacing.   Copyright © 2023 Olorunsaiye et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0

Association of type of birth attendant and place of delivery on infant mortality in sub-Saharan Africa.

Objective: To examine the association between type of birth attendant and place of delivery, and infant mortality (IM). Methods: This cross-sectional study used self-reported data from the Demographic Health Surveys for women in Ghana, Kenya, and Sierra Leone. Logistic regression estimated odds ratios (ORs) and95% confidence intervals. Results: In Ghana and Sierra Leone, odds of IM were higher for women who delivered at a health facility versus women who delivered at a household residence (OR=3.18, 95% confidence interval, CI: 1.29-7.83, p=0.01 and OR=1.62, 95% CI: 1.15-2.28, p=0.01, respectively). Compared to the use of health professionals, the use of birth attendants for assistance with delivery was not significantly associated with IM for women in Ghana or Sierra Leone (OR=2.17, 95% CI: 0.83-5.69, p=0.12 and OR=1.25, 95% CI: 0.92-1.70, p=0.15, respectively). In Kenya, odds of IM, though nonsignificant, were lower for women who used birth attendants than those who used health professionals to assist with delivery (OR=0.85, 95% CI: 0.51-1.41, p=0.46), and higher with delivery at a health facility versus a household residence (OR=1.29, 95% CI: 0.81-2.03, p=0.28). Conclusions: Women in Ghana and Sierra Leone who delivered at a health facility had statistically significant increased odds of IM. Birth attendant type-IM associations were not statistically significant.Future research should consider culturally-sensitive interventions to improve maternal health and help reduce IM

Assessing the Contraceptive Attitudes of US-Born and Foreign-Born Black Women Living in the USA: a Descriptive Cross-Sectional Study

BackgroundRacially and ethnically marginalized US women experience unintended pregnancy at twice the rate of White women. Understanding contraceptive attitudes can help identify women at increased risk of contraceptive non-use and unintended pregnancy. We assessed the contraceptive attitudes of US-born and foreign-born Black women and examined differences by nativity. MethodsWe used an electronic survey, implemented by Lucid LLC, a consumer research firm, to collect cross-sectional data from 657 reproductive-aged women. Analysis was limited to 414 Black women aged 18–44 years. The exposure variable was nativity (US-born or foreign-born), and the outcome variable was cumulative score on the 32-item Contraceptive Attitude Scale (CAS). Analysis included multivariable linear regression, adjusted for confounders. We also estimated separate models, stratified by nativity to identify predictors of contraceptive attitude among US-born Black women and foreign-born Black women, respectively. ResultsThree in four participants were US-born (76.6%). The average cumulative CAS score was 118.4 ±20.4 out of 160 indicating favorable contraceptive attitudes. In pooled analysis, foreign-born Black women had significantly lower contraceptive attitude scores compared to US-born women (adjusted regression coefficient (β)= −6.48, p=0.036). In nativity-stratified analysis, income, education, and perceived control over pregnancy timing were significant predictors of contraceptive attitudes for both US-born and foreign-born women. Other significant predictors of contraceptive attitude among US-born women were older maternal age, multi-parity, and perceived pregnancy risk; whereas, for foreign-born women, other significant predictors included marital status (married/cohabiting), language spoken predominantly at home (French), and perceived ability to have a baby and still achieve life goals (agree, neither agree nor disagree). ConclusionIn addressing the contraceptive needs of Black women, it is important to recognize the differences in attitudes towards contraception by nativity and provide culturally sensitive information and education