Racial/ethnic and educational inequities in restrictive abortion policy variation and adverse birth outcomes in the United States

Background To examine racial/ethnic and educational inequities in the relationship between state-level restrictive abortion policies and adverse birth outcomes from 2005 to 2015 in the United States. Methods Using a state-level abortion restrictiveness index comprised of 18 restrictive abortion policies, we conducted a retrospective longitudinal analysis examining whether race/ethnicity and education level moderated the relationship between the restrictiveness index and individual-level probabilities of preterm birth (PTB) and low birthweight (LBW). Data were obtained from the 2005–2015 National Center for Health Statistics Period Linked Live Birth-Infant Death Files and analyzed with linear probability models adjusted for individual- and state-level characteristics and state and year fixed-effects. Results Among 2,250,000 live births, 269,253 (12.0%) were PTBs and 182,960 (8.1%) were LBW. On average, states had approximately seven restrictive abortion policies enacted from 2005 to 2015. Black individuals experienced increased probability of PTB with additional exposure to restrictive abortion policies compared to non-Black individuals. Similarly, those with less than a college degree experienced increased probability of LBW with additional exposure to restrictive abortion policies compared to college graduates. For all analyses, inequities worsened as state environments grew increasingly restrictive. Conclusion Findings demonstrate that Black individuals at all educational levels and those with fewer years of education disproportionately experienced adverse birth outcomes associated with restrictive abortion policies. Restrictive abortion policies may compound existing racial/ethnic, socioeconomic, and intersecting racial/ethnic and socioeconomic perinatal and infant health inequities

Autism Spectrum Disorder Among US Children (2002–2010): Socioeconomic, Racial, and Ethnic Disparities

Objectives. To describe the association between indicators of socioeconomic status (SES) and the prevalence of autism spectrum disorder (ASD) in the United States during the period 2002 to 2010, when overall ASD prevalence among children more than doubled, and to determine whether SES disparities account for ongoing racial and ethnic disparities in ASD prevalence

The healthy migrant theory: Variations in pregnancy outcomes among US-born migrants

Various studies have observed that infants born to foreign-born women have better birth outcomes (lower rates of preterm, low birth weight, and infant mortality) than those delivered to US-born women. While much attention has been given to the "healthy migrant effect" as an explanation for these positive outcomes, this theory has not been examined in an internally migrant population. The purpose of this study is to examine the relationship between maternal mobility history and birth outcomes among infants born to US resident mothers of Mexican origin. The study used 1995-1999 National Center for Health Statistics (NCHS) live birth/infant death cohort files of singleton infants delivered in the US to white women of Mexican origin (n=2,446,253). Maternal mobility history (MMH), which refers to the relationship between the maternal place of birth and the state of residence at delivery, was categorized into the four following groups: (a) foreign-born--place of birth outside the US and delivery in the US; (b) outside-region--place of birth in one US region and delivery in another US region; (c) within-region--place of birth in one US region and delivery in a different state in the same US region; and (d) within-state--place of birth and delivery in the same US state. Consistently, there is evidence to support the healthy migrant effect in an internally migrant population. Unique to this study are the findings that infants born to mothers with outside-region MMH had a lower risk of low birth weight (LBW) and small-for-gestational age (SGA) compared to those who did not move. Overall, this study provides evidence that the healthy migrant effect and its relationship to birth outcomes can be applied to an internally migrant population.USA Residential mobility Healthy migrant Low birth weight Preterm birth Mexican American

Prevalence of Selected Birth Defects by Maternal Nativity Status, United States, 1999–2007

Objectives: We investigated differences in prevalence of major birth defects by maternal nativity within racial/ethnic groups for 27 major birth defects. Methods: Data from 11 population-based birth defects surveillance systems in the United States including almost 13 million live births (approximately a third of U.S. births) during 1999–2007 were pooled. We calculated prevalence estimates for each birth defect for five racial/ethnic groups. Using Poisson regression, crude and adjusted prevalence ratios (aPRs) were also calculated using births to US-born mothers as the referent group in each racial/ethnic group. Results: Approximately 20% of case mothers and 26% of all mothers were foreign-born. Elevated aPRs for infants with foreign-born mothers were found for spina bifida and trisomy 13, 18, and 21, while lower prevalence patterns were found for pyloric stenosis, gastroschisis, and hypospadias. Conclusions: This study demonstrates that birth defects prevalence varies by nativity within race/ethnic groups, with elevated prevalence ratios for some specific conditions and lower prevalence for others. More detailed analyses focusing on a broader range of maternal behaviors and characteristics are required to fully understand the implications of our findings

The Role of Socio-economic Status and Perinatal Factors in Racial Disparities in the Risk of Cerebral Palsy

Aim: 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. Method: 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. χ2 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). Results: 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 1.18–1.55), but not after further adjustment for preterm birth and size for gestational age. The protective effect of maternal education remained after adjustment for race/ethnicity and perinatal factors. Interpretation: Maternal education appears to independently affect CP risk but does not fully explain existing racial disparities in CP prevalence in the US

Prevalence of Cerebral Palsy Among 8-Year-Old Children in 2010 and Preliminary Evidence of Trends in Its Relationship to Low Birthweight

Background: The public health objective for cerebral palsy (CP) in the United States is to reduce the percentage of children with CP who were born low birthweight (LBW, \u3c2500 g) by 10% between 2006 and 2020. This study reports the prevalence of CP in a constant surveillance area for the years 2006, 2008, and 2010 and describes initial progress towards the CP public health objective. Methods: Data on children with CP at age 8 years were ascertained by the Autism and Developmental Disabilities Monitoring (ADDM) Network, a population-based surveillance system that monitored CP in four areas of the United States. Results: CP prevalence in 2010 was 2.9 per 1000 [95% confidence interval (CI) 2.6, 3.2], down from 3.5 (95% CI 3.2, 3.9) in the same surveillance area in 2006. Among CP cases with no documented postneonatal aetiology, 49.1% (95% CI 42.9, 55.2) were born LBW in 2010 compared with 54.3% (95% CI 48.4, 60.1) in 2006. In 2010, 28.1% (95% CI 22.9, 30.4) were born very low birthweight (VLBW, \u3c1500 g) compared with 35.4% (95% CI 30.0, 41.2) in 2006. The relative risks for associations between CP and both LBW and VLBW also declined, though not Conclusions: Declines in the associations between CP and LBW categories may have contributed to declines during the study period in both the prevalence of CP and the percentage of children with CP who were born LBW or VLBW. Ongoing monitoring of these trends is warranted

Prevalence of Cerebral Palsy, Co-occurring Autism Spectrum Disorders, and Motor Functioning – Autism and Developmental Disabilities Monitoring Network, USA, 2008

Aim: The aim of this study was to report the prevalence and characteristics of children with cerebral palsy (CP). Method: Children with CP (n=451) were ascertained by the Autism and Developmental Disabilities Monitoring (ADDM) Network, a population-based, record-review surveillance system monitoring CP in four areas of the USA. Prevalence was calculated as the number of children with CP among all 8-year-old children residing in these areas in 2008. Motor function was categorized by Gross Motor Function Classification System level and walking ability. Co-occurring autism spectrum disorders (ASD) and epilepsy were ascertained using ADDM Network surveillance methodology. Results: The period prevalence of CP for 2008 was 3.1 per 1000 8-year-old children (95% confidence interval 2.8–3.4). Approximately 58% of children walked independently. Co-occurring ASD frequency was 6.9% and was higher (18.4%) among children with non-spastic CP, particularly hypotonic CP. Co-occurring epilepsy frequency was 41% overall, did not differ by ASD status or CP subtype, and was highest (67%) among children with limited or no walking ability. Interpretation: The prevalence of CP in childhood from US surveillance data has remained relatively constant, in the range of 3.1 to 3.6 per 1000, since 1996. The higher frequency of ASD in non-spastic than in spastic subtypes of CP calls for closer examination

Impact of the Addition of Redox-Active Salts on the Charge Transport Ability of Radical Polymer Thin Films

Radical polymers (i.e., macromolecules composed of a nonconjugated polymer backbone and with stable radical sites present on the side chains of the repeat units) can transport charge in the solid state through oxidation–reduction (redox) reactions that occur between the electronically localized open-shell pendant groups. As such, pristine (i.e., not doped) thin films of these functional macromolecules have electrical conductivity values on the same order of magnitude as some common electronically active conjugated polymers. However, unlike the heavily evaluated regime of conjugated polymer semiconductors, the impact of molecular dopants on the optical, electrochemical, and solid-state electronic properties of radical polymers has not been established. Here, we combine a model radical polymer, poly­(2,2,6,6-tetramethyl­piperidinyl­oxy methacrylate) (PTMA), with a small molecule redox-active salt, 4-acetamido-2,2,6,6-tetramethyl-1-oxo­piperidinium tetrafluoro­borate (TEMPOnium), in order to elucidate the effect of molecular doping on this emerging class of functional macromolecular thin films. Note that the TEMPOnium salt was specifically selected because the cation in the salt has a very similar molecular architecture to that of an oxidized repeat unit of the PTMA polymer. Importantly, we demonstrate that the addition of the TEMPOnium salt simultaneously alters the electrochemical environment of the thin film without quenching the number of open-shell sites present in the PTMA-based composite thin film. This environmental alteration changes the chemical signature of the PTMA thin films in a manner that modifies the electrical conductivity of the radical polymer-based composites. By decoupling the ionic and electronic contributions of the observed current passed through the PTMA-based thin films, we are able to establish how the presence of the redox-active TEMPOnium salts affects both the transient and steady-state transport abilities of doped radical polymer thin films. Additionally, at an optimal loading (i.e., doping density) of the redox-active salt, the electrical conductivity of PTMA increased by a factor of 5 relative to that of pristine PTMA. Therefore, these data establish an underlying mechanism of doping in electronically active radical polymers, and they provide a template by which to guide the design of next-generation radical polymer composites