The Changing Association Between Prenatal Participation in WIC and Birth Outcomes in New York City

We analyze the relationship between prenatal WIC participation and birth outcomes in New York City from 1988-2001. The analysis is unique for several reasons. First, we restrict the analysis to women on Medicaid and or WIC who have no previous live births and who initiate prenatal care within the first four months of pregnancy. Our goal is to lessen heterogeneity between WIC and non-WIC participants by limiting the sample to women who initiate prenatal care early and who have no experience with WIC from a previous pregnancy. Second, we focus on measures of fetal growth distinct from preterm birth, since there is little clinical support for a link between nutritional supplementation and premature delivery. Third, we analyze a large sub-sample of twin deliveries. Multifetal pregnancies increase the risk of anemia and fetal growth retardation and thus, may benefit more than singletons from nutritional supplementation. We find no relationship between prenatal WIC participation and measures of fetal growth except among a sub-sample of US-born Blacks between 1990-1992. A similarly sporadic pattern of association exists among US-born Black twins. Our finding that the modest association between WIC and fetal growth is limited to a specific racial and ethnic group during specific years and even specific ages suggests that the protective effect of prenatal WIC on adverse birth outcomes in New York City has been minimal.

Regulating Abortion: Impact on Patients and Providers in Texas

The state of Texas began enforcement of the Woman’s Right to Know (WRTK) Act on January 1, 2004. The law requires that all abortions at 16 weeks gestation or later be performed in an ambulatory surgical center (ASC). In the month the law went into effect, not one of Texas’s 54 non-hospital abortion providers met the requirements of a surgical center. The effect was immediate and dramatic. The number of abortions performed in Texas at 16 weeks gestation or later dropped 88 %, from 3642 in 2003 to 446 in 2004, while the number of residents who left the state for a late abortion almost quadrupled. By 2006, an ASC had opened in 4 major cities down from 9 in 2003 but the abortion rate 16 weeks or more gestation remained 50 percent below its pre-Act level. Regulations of abortion providers that require new facilities or costly renovations could have profound effects on the market for second trimester abortions.

Misclassification Bias and the Estimated Effect of Parental Involvement Laws on Adolescents' Reproductive Outcomes

Objectives. We evaluated the presence of misclassification bias in the estimated effect of parental involvement laws on minors’ reproductive outcomes when subjection to such laws was measured by age at the time of pregnancy resolution

Programs to Reduce Teen Pregnancy, Sexually Transmitted Infections, and Associated Sexual Risk Behaviors: A Systematic Review

PurposeThis systematic review provides a comprehensive, updated assessment of programs with evidence of effectiveness in reducing teen pregnancy, sexually transmitted infections (STIs), or associated sexual risk behaviors.MethodsThe review was conducted in four steps. First, multiple literature search strategies were used to identify relevant studies released from 1989 through January 2011. Second, identified studies were screened against prespecified eligibility criteria. Third, studies were assessed by teams of two trained reviewers for the quality and execution of their research designs. Fourth, for studies that passed the quality assessment, the review team extracted and analyzed information on the research design, study sample, evaluation setting, and program impacts.ResultsA total of 88 studies met the review criteria for study quality and were included in the data extraction and analysis. The studies examined a range of programs delivered in diverse settings. Most studies had mixed-gender and predominately African-American research samples (70% and 51%, respectively). Randomized controlled trials accounted for the large majority (87%) of included studies. Most studies (76%) included multiple follow-ups, with sample sizes ranging from 62 to 5,244. Analysis of the study impact findings identified 31 programs with evidence of effectiveness.ConclusionsResearch conducted since the late 1980s has identified more than two dozen teen pregnancy and STI prevention programs with evidence of effectiveness. Key strengths of this research are the large number of randomized controlled trials, the common use of multiple follow-up periods, and attention to a broad range of programs delivered in diverse settings. Two main gaps are a lack of replication studies and the need for more research on Latino youth and other high-risk populations. In addressing these gaps, researchers must overcome common limitations in study design, analysis, and reporting that have negatively affected prior research

Staged Implementation of Awakening and Breathing, Coordination, Delirium Monitoring and Management, and Early Mobilization Bundle Improves Patient Outcomes and Reduces Hospital Costs

To measure the impact of staged implementation of full versus partial ABCDE bundle on mechanical ventilation duration, ICU and hospital lengths of stay, and cost. Prospective cohort study. Two medical ICUs within Montefiore Healthcare Center (Bronx, NY). One thousand eight hundred fifty-five mechanically ventilated patients admitted to ICUs between July 2011 and July 2014. At baseline, spontaneous (B)reathing trials (B) were ongoing in both ICUs; in period 1, (A)wakening and (D)elirium (AD) were implemented in both full and partial bundle ICUs; in period 2, (E)arly mobilization and structured bundle (C)oordination (EC) were implemented in the full bundle (B-AD-EC) but not the partial bundle ICU (B-AD). In the full bundle ICU, 95% patient days were spent in bed before EC (period 1). After EC was implemented (period 2), 65% of patients stood, 54% walked at least once during their ICU stay, and ICU-acquired pressure ulcers and physical restraint use decreased (period 1 vs 2: 39% vs 23% of patients; 30% vs 26% patient days, respectively; p < 0.001 for both). After adjustment for patient-level covariates, implementation of the full (B-AD-EC) versus partial (B-AD) bundle was associated with reduced mechanical ventilation duration (-22.3%; 95% CI, -22.5% to -22.0%; p < 0.001), ICU length of stay (-10.3%; 95% CI, -15.6% to -4.7%; p = 0.028), and hospital length of stay (-7.8%; 95% CI, -8.7% to -6.9%; p = 0.006). Total ICU and hospital cost were also reduced by 24.2% (95% CI, -41.4% to -2.0%; p = 0.03) and 30.2% (95% CI, -46.1% to -9.5%; p = 0.007), respectively. In a clinical practice setting, the addition of (E)arly mobilization and structured (C)oordination of ABCDE bundle components to a spontaneous (B)reathing, (A)wakening, and (D) elirium management background led to substantial reductions in the duration of mechanical ventilation, length of stay, and cost