1
|
Luis Damaso Ê, Bettiol H, Cardoso VC, de Nadai MN, Moisés ECD, Vieira CS, Cavalli RC. Sociodemographic and reproductive risk factors associated with metabolic syndrome in a population of Brazilian women from the city of Ribeirão Preto: a cross-sectional study. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo8. [PMID: 38765525 PMCID: PMC11075418 DOI: 10.61622/rbgo/2024ao08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/28/2023] [Indexed: 05/22/2024] Open
Abstract
Objective To identify sociodemographic and reproductive risk factors associated with MetS in women in their fourth decade of life. Methods Cohort study conducted on women born from June 1978 to May 1979 in Ribeirão Preto, Brazil. Sociodemographic, clinical, and obstetric data were collected by interview and clinical evaluation. Univariable and multivariable binomial logistic regression models were constructed to identify the risk factors of metabolic syndrome and the adjusted relative risk (RR) was calculated. Results The cohort included 916 women, and 286 (31.2%) of them have metabolic syndrome. MetS was associated with lack of paid work (RR 1.49; 95% CI 1.14-1.95), marital status of without a partner (RR 1.33; 95% CI 1.03-1.72), low educational level (less than 8 years of schooling [RR 1.72; 95% CI 1.23-2.41], 8 to 12 years of schooling [RR 1.37; 95% CI 1.06-1.76], when compared with more than 12 years of schooling), and teenage pregnancy (RR 2.00; 95% CI 1.45-2.77). There was no association between MetS, and the other covariates studied. Conclusion Metabolic syndrome in a population of women in the fourth decade of life was associated with lack of employment, lack of a partner, low educational level, and teenage pregnancy.
Collapse
Affiliation(s)
- Ênio Luis Damaso
- Universidade de São PauloBauru Dental SchoolDepartment of Pediatric Dentistry, Orthodontics and Public HealthBauruSPBrazilDepartment of Pediatric Dentistry, Orthodontics and Public Health, Bauru Dental School, Universidade de São Paulo, Bauru, SP, Brazil.
| | - Heloisa Bettiol
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoRibeirão PretoSPBrazilFaculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Viviane Cunha Cardoso
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoRibeirão PretoSPBrazilFaculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Mariane Nunes de Nadai
- Universidade de São PauloBauru Dental SchoolDepartment of Pediatric Dentistry, Orthodontics and Public HealthBauruSPBrazilDepartment of Pediatric Dentistry, Orthodontics and Public Health, Bauru Dental School, Universidade de São Paulo, Bauru, SP, Brazil.
| | - Elaine Christine Dantas Moisés
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoRibeirão PretoSPBrazilFaculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Carolina Sales Vieira
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoRibeirão PretoSPBrazilFaculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Ricardo Carvalho Cavalli
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoRibeirão PretoSPBrazilFaculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| |
Collapse
|
2
|
Damaso ÊL, Bettiol H, Cardoso VC, Vieira CS, Moisés ECD, Cavalli RC. Sociodemographic and reproductive risk factors associated with obesity in a population of brazilian women from the city of Ribeirão Preto: a cross-sectional study. BMC Public Health 2023; 23:1222. [PMID: 37353820 PMCID: PMC10288772 DOI: 10.1186/s12889-023-16056-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 06/05/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Obesity is a highly prevalent chronic disease that is associated with the development of other metabolic comorbidities. Its etiology is complex and multiple risk factors have been reported. In women, weight gain during pregnancy and the effect of pregnancy on subsequent weight gain are important events in women's history. Both pregnancy and postpartum are critical periods for the development of obesity. OBJECTIVES To identify sociodemographic and reproductive risk factors associated with obesity in women in their fourth decade of life. METHODS Cohort study conducted on women born from June 1978 to May 1979 in Ribeirão Preto, Brazil. Sociodemographic, clinical, and obstetric data were collected by interview and clinical evaluation. Univariable and multivariable binomial logistic regression models were constructed to identify the risk factors of obesity and the adjusted relative risk (RR) was calculated. RESULTS The cohort included 916 women and 309 (33.7%) of them were obese. Obesity was associated with low educational level (RR 1.77, 95%CI 1.33-2.35) and teenage pregnancy (RR 1.46, 95%CI 1.10-1.93). There was no association of obesity with the other covariates studied. CONCLUSION Obesity is associated with years of schooling and teenage pregnancy.
Collapse
Affiliation(s)
- Ênio Luis Damaso
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil.
| | - Heloisa Bettiol
- Department of Pediatrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Viviane Cunha Cardoso
- Department of Pediatrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Carolina Sales Vieira
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Elaine Christine Dantas Moisés
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Ricardo Carvalho Cavalli
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| |
Collapse
|
3
|
Stannard S, Berrington A, Alwan NA. Exploring the associations between number of children, multi-partner fertility and risk of obesity at midlife: Findings from the 1970 British Cohort Study (BCS70). PLoS One 2023; 18:e0282795. [PMID: 37053250 PMCID: PMC10101483 DOI: 10.1371/journal.pone.0282795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/22/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Early parenthood, high parity, and partnership separation are associated with obesity. However, the emergence of non-marital partnerships, serial partnering and childbearing across unions, means that it is important to consider their association to obesity. This paper examined the associations between number of biological children and multi-partner fertility (MPF)-defined as having biological children with more than one partner, with obesity at midlife. METHOD The sample consisted of 2940 fathers and 3369 mothers in the 1970 British Cohort Study. The outcome was obesity (BMI 30 or over) at age 46. Fertility and partnership histories ascertained the number of live biological children and MPF status by age 42. The associations were tested using logistic regression adjusting for confounders at birth, age 10 and age 16. Adult factors recorded at age 42 including age at first birth, smoking status, alcohol dependency, educational attainment and housing tenure were considered as mediators. RESULTS For fathers, obesity odds did not differ according to number of children or MPF. In unadjusted models, mothers with one child (OR 1.24 95%CI 1.01-1.51), mothers who had two children with two partners (OR 1.45 95%CI 1.05-1.99), and mothers who had three or more children with two or more partners (OR 1.51 95%CI 1.18-1.93) had higher odds of obesity. In adjusted models, there remained an association between mothers with one child and odds of obesity (OR 1.30 95%CI 1.05-1.60). All other associations were attenuated when confounders were included. CONCLUSIONS Mothers who had children with multiple partners had higher odds of obesity. However this association was completely attenuated when parental and child confounders were accounted for; suggesting that this association may be explained by confounding. Mothers who had one child only may be at increased odds of obesity, however this could be due to multiple factors including age at first birth.
Collapse
Affiliation(s)
- Sebastian Stannard
- Department of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom
- ESRC Centre for Population Change, University of Southampton, Southampton, United Kingdom
- Faculty of Medicine, School of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Ann Berrington
- Department of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom
- ESRC Centre for Population Change, University of Southampton, Southampton, United Kingdom
| | - Nisreen A. Alwan
- Faculty of Medicine, School of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
| |
Collapse
|
4
|
Câmara SMA, McGurk MD, Gigante D, Lima MDA, Shalaby AK, Sentell T, Pirkle CM, Domingues MR. Intersections between adolescent fertility and obesity-pathways and research gaps focusing on Latin American populations. Ann N Y Acad Sci 2022; 1516:18-27. [PMID: 35781886 PMCID: PMC9588536 DOI: 10.1111/nyas.14854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Latin America has notably elevated rates of adolescent fertility and obesity in women. Although numerous studies document associations between adolescent fertility and obesity across the life course, the pathways explaining their association are insufficiently theorized, especially regarding the factors in Latin America that may underpin both. Additionally, much of the existing research is from high-income countries, where fertility and obesity are trending down. In this paper, we review the various complex pathways linking adolescent fertility and obesity, highlighting research gaps and priorities, with a particular focus on Latin American populations. We carefully consider pregnancy's distinct impact on growth trajectories during the critical period of adolescence, as well as the cumulative effect that adolescent fertility may have over the life course. We also articulate a pathway through obesity as it may contribute to early puberty and thus, to adolescent fertility. If obesity is a cause of adolescent fertility, not a result of it, or if it is a mediator of early-life exposures to adulthood obesity, these are critical distinctions for policy aiming to prevent both obesity and early fertility. Research to better understand these pathways is essential for prevention efforts against obesity and undesired adolescent fertility in Latin America.
Collapse
Affiliation(s)
- Saionara M. A. Câmara
- Postgraduate program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, RN, Brazil
| | - Meghan D. McGurk
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Denise Gigante
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
- Postgraduate Program in Nutrition and Food, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Mateus D. A. Lima
- Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, RN, Brazil
| | - Alena K. Shalaby
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Tetine Sentell
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Catherine M. Pirkle
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawaii at Mānoa, Honolulu, HI, USA
| | | |
Collapse
|
5
|
Tabet M, Xaverius PK. Parental emotional support trajectories and the risk of adolescent overweight or obesity. INFANT AND CHILD DEVELOPMENT 2022. [DOI: 10.1002/icd.2358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Maya Tabet
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice Saint Louis University St. Louis Missouri USA
| | - Pamela K. Xaverius
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice Saint Louis University St. Louis Missouri USA
| |
Collapse
|
6
|
Wambach K, Davis AM, Nelson EL, Romine RS, Romero K, Muzzy R, Murray M, Bakula D. A Health Behavior and Lifestyle Intervention Pilot Trial for Childbearing Adolescents. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221080367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We pilot tested a multiple health behavior change (MHBC) intervention to improve breastfeeding rates, healthy eating/active living, and depression prevention among pregnant and parenting adolescent mothers. We also assessed utility of the MHBC mHealth approach by examining health behavior coaction and intervention acceptability. We used a longitudinal randomized controlled trial to compare the tablet-delivered momHealth to a control condition (usual care). Delivered between 32 weeks of pregnancy and one month postpartum, momHealth included nine multi-media education modules, simultaneous daily educational text messaging, and weekly videoconferences for individual and group support. Main outcomes included “any” and “exclusive” breastfeeding initiation and continuation for 5 weeks and 3 months postpartum; number of fruit and vegetable servings; minutes of moderate/vigorous physical activity per day; and depressive symptoms. Sixty-two adolescents aged 16–19 having their first baby were randomized. Compared to Control, more momHealth participants were still breastfeeding at 5 weeks (chi-square = 3.91, df = 1, P = .048). Mothers who breastfed for 3 months were more likely to eat adequate daily fruits/vegetables. Participants positively rated the intervention. momHealth positively affected early breastfeeding continuation and trended toward positive outcomes in healthy living and depressive symptoms. A fully powered trial is planned to test the intervention more effectively.
Collapse
Affiliation(s)
- Karen Wambach
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ann M. Davis
- Department of Pediatrics, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO, USA
| | - Eve-Lynn Nelson
- Department of Pediatrics, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Karman Romero
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rachel Muzzy
- Department of Pediatrics, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Megan Murray
- Department of Pediatrics, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Dana Bakula
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO, USA
- Children’s Mercy Kansas City, Kansas City, MO, USA
| |
Collapse
|
7
|
Gamble A, Beech BM, Blackshear C, Herring SJ, Welsch MA, Moore JB. Changes in Physical Activity and Television Viewing From Pre-pregnancy Through Postpartum Among a Socioeconomically Disadvantaged Perinatal Adolescent Population. J Pediatr Adolesc Gynecol 2021; 34:832-838. [PMID: 34271198 PMCID: PMC8578293 DOI: 10.1016/j.jpag.2021.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/16/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE Adolescent pregnancy contributes to accelerated trajectories of adiposity and cardiometabolic diseases. Two potentially low-cost prevention strategies include promoting physical activity (PA) and limiting television (TV) viewing. Few studies have explored these behavior patterns in perinatal adolescents. This study sought to characterize PA and TV viewing in a socioeconomically disadvantaged perinatal adolescent population. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS A cross-sectional, retrospective, 10-item survey was used to explore behavior patterns in 79 predominantly Black (86%) postpartum adolescents. MAIN OUTCOME MEASURES Outcomes included self-reported changes in PA from pre-pregnancy through pregnancy, and 7-day recall of PA and TV viewing in postpartum. RESULTS The majority of adolescents (66%) reported being active on ≥3 days/week in pre-pregnancy; however, many reported low PA (≤2 days/wk) in their first (59%), second (66%), and third (54%) trimesters. Adolescents who reported being active on ≥5 days/wk in pre-pregnancy (19%) experienced first trimester PA decline, which subsequently plateaued. This group remained the most active throughout pregnancy. In postpartum, over half (54%) of all adolescents reported low PA and irrespective of PA, spent considerable time watching TV (median = 1680.0 minutes, inerquartile range = 2940). CONCLUSION Interventions promoting PA coupled with reducing TV viewing during pregnancy and in postpartum may benefit perinatal adolescents. The findings from this study suggest that PA history is a predictor of gestational PA, and low PA and high TV viewing in postpartum underscore the need for behavioral intervention. Conducting a brief assessment of PA history in early gestation may offer important insight.
Collapse
Affiliation(s)
- A Gamble
- Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, Mississippi; Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi.
| | - B M Beech
- Office of the Provost, University of Houston, Houston, Texas; College of Medicine, University of Houston, Houston, Texas
| | - C Blackshear
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi
| | - S J Herring
- Program for Maternal Health Equity, Center for Urban Bioethics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - M A Welsch
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi
| | - J B Moore
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
8
|
Wambach KA, Davis AM, Nelson EL, Snow K, Yungmeyer A, Muzzy R, Romero K, Murray M. momHealth: A Feasibility Study of a Multibehavioral Health Intervention for Pregnant and Parenting Adolescent Mothers. Kans J Med 2021; 14:176-181. [PMID: 34262638 PMCID: PMC8274814 DOI: 10.17161/kjm.vol1414738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/07/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction In 2016, 209,809 babies were born to mothers 15 - 19 years of age, for a live birth rate of 20.3 per 1,000 in this age group. Many health issues surround adolescent mothers and their infants, many of which can be addressed through behavioral change. The main purpose of this study was to examine the feasibility, acceptability, usability, and relevance of momHealth, an innovative multiple health behavior change (MHBC) education and support mHealth intervention, focused on breastfeeding, healthy eating and active living, and depression prevention among pregnant and parenting adolescents. We also evaluated the proposed online surveys and physical outcome measures for feasibility and acceptability (burden, time, ease of use). Methods A one-group quasi-experimental longitudinal design was used to examine the intervention components and the breastfeeding, diet/activity, and depression outcome measures. Nine iPad-delivered education modules, text messaging, and virtual individual and group support were provided for 12 weeks, beginning at 32 weeks of pregnancy, with follow-up to three months postpartum. Data on the main behaviors and outcomes were collected at three in-home visits, one telephone call soon after birth, and ten postpartum weekly and biweekly online surveys. Results Although recruitment and attrition presented challenges, six participants enrolled in the study during prenatal clinic visits; all were pregnant with their first child, single, and had a mean age of 17.7 years (SD = 1.4). Intervention participation ranged from 59% to 91% for educational module completion, text message reading, and individual virtual support meetings and three virtual peer support groups were held. Intervention acceptability, relevance, and delivery was supported by reports of clear and relevant content, reasonable time burden, iPad ease of use, and acceptable intervention length. Data collection was reported as convenient and non-burdensome, but the diet recall method and activity monitoring challenged some. Conclusions This was the first MHBC research in adolescent pregnant women designed to improve breastfeeding outcomes, healthy eating/active living, and depression prevention. Findings demonstrated strengths and challenges of the interventions and methods, support feasibility and acceptability of momHealth, and informed the recruitment and intervention protocols of our pilot randomized trial.
Collapse
Affiliation(s)
- Karen A Wambach
- School of Nursing, University of Kansas Medical Center, Kansas City, KS
| | - Ann M Davis
- School of Medicine, Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS
| | - Eve Lynn Nelson
- School of Nursing, University of Kansas Medical Center, Kansas City, KS
| | - Kelli Snow
- Children's Mercy Hospital, Kansas City, MO
| | - Annie Yungmeyer
- School of Nursing, University of Kansas Medical Center, Kansas City, KS
| | - Rachel Muzzy
- School of Medicine, Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS
| | - Karman Romero
- School of Nursing, University of Kansas Medical Center, Kansas City, KS
| | - Megan Murray
- School of Medicine, Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS
| |
Collapse
|
9
|
Gamble A, Beech BM, Blackshear C, Cranston KL, Herring SJ, Moore JB, Welsch MA. Recruitment planning for clinical trials with a vulnerable perinatal adolescent population using the Clinical Trials Transformative Initiative framework and principles of partner and community engagement. Contemp Clin Trials 2021; 104:106363. [PMID: 33737198 PMCID: PMC8180492 DOI: 10.1016/j.cct.2021.106363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/03/2021] [Accepted: 03/13/2021] [Indexed: 12/11/2022]
Abstract
Recruitment planning is needed to establish a foundation for obesity prevention research with high risk, disadvantaged perinatal adolescent populations. In the context of developing clinical trial protocols, investigators partnered with Mississippi's Nutrition Program for Women, Infants and Children (WIC) and adopted the Clinical Trials Transformative Initiative (CTTI) framework for recruitment planning to identify and mitigate challenges to recruitment early in the clinical trial development process. The recruitment protocol consisted of 20 passive strategies grounded in principles of partner and community engagement and was flexible, accommodating, altruistic, community-focused, and minimally burdensome to partners and participants. The recruitment goal included 150 adolescent-coparticipant dyads and 145 dyads (96.7%) were successfully recruited. Investigators demonstrated the feasibility of recruiting a disadvantaged and vulnerable perinatal adolescent population that is underrepresented in health research, in one of the most persistently impoverished and poor health regions in the U.S. Four important aspects of recruitment planning using the CTTI framework are discussed including: (1) establishing partnerships with trusted community resources is a paramount investment; (2) dedicating time and resources to know and go to your community is invaluable; (3) fostering trust by offering convenient, continuous and clear communication; and (4) encouraging collaboration and participation through limiting partner and participant burden. Establishing organizational and community partnership requires a substantial amount of invaluable time and fosters recruitment success. Following the CTTI recommendations for recruitment planning led to a robust recruitment protocol that will be used in future intervention trials with an understudied perinatal adolescent population with high risk for poor maternal and fetal health outcomes.
Collapse
Affiliation(s)
- Abigail Gamble
- Department of Preventive Medicine, Department of Pediatrics, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, United States of America.
| | - Bettina M Beech
- Strategic Initiatives and Population Health Research, Office of the Provost, College of Medicine, University of Houston, 4302 University Drive, Houston, TX 77204, United States of America.
| | - Chad Blackshear
- Department of Data Science, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, United States of America.
| | - Katherine L Cranston
- Medical Student Research Program, School of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, United States of America.
| | - Sharon J Herring
- Program for Maternal Health Equity, Center for Urban Bioethics, Lewis Katz School of Medicine at Temple University, 3223 N. Broad Street, Philadelphia, PA 19140, United States of America.
| | - Justin B Moore
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, 425 Vine Street, Winston-Salem, NC, 27101, United States of America.
| | - Michael A Welsch
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, United States of America.
| |
Collapse
|
10
|
Rajan S, Jahromi L, Bravo D, Umaña-Taylor A, Updegraff K. Maternal Self-Efficacy Is Protective for Child (but Not Mother) Body Mass Index Among Mexican-Origin Children with Negative Temperament. J Dev Behav Pediatr 2020; 40:633-641. [PMID: 31169655 PMCID: PMC6800616 DOI: 10.1097/dbp.0000000000000696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Childhood obesity persists as a serious public health concern, particularly among Mexican-origin youth. Teen mothers are also at heightened obesity risk. Multiple factors may exacerbate this risk, including stressors associated with parenting. Indeed, difficult child temperaments pose unique parenting challenges, which may also be linked to physical health outcomes in mothers. The purpose of this study was to examine whether the interaction between negative child temperament and parenting self-efficacy is related to the body mass index (BMI) of young children and their adolescent mothers while controlling for important contextual factors. We also examined which pathways differed for girls versus boys. METHODS Data were from a longitudinal study spanning 5 years that included 204 Mexican-origin young mothers and their children (with data collected at birth, age 4 years, and age 5 years). A multigroup structural equation modeling framework was used. RESULTS The rate of early childhood obesity was low in comparison with national averages, whereas the rate of adolescent mother obesity was notably higher than the national average. Negative child temperament was associated with higher child BMI among those adolescent mothers with low parenting self-efficacy. Among the children with a negative temperament, their mothers' high parenting self-efficacy may have served as a protective factor against unhealthy child BMI. This significant interaction held for both boys and girls. CONCLUSION Research evaluating the potential effectiveness of interventions that promote parenting self-efficacy during early childhood as a means to reduce the rate of obesity among children of adolescent mothers should be conducted.
Collapse
Affiliation(s)
- Sonali Rajan
- Department of Health and Behavior Studies, Teachers
College, Columbia University, New York, New York
| | - Laudan Jahromi
- Department of Health and Behavior Studies, Teachers
College, Columbia University, New York, New York
| | - Diamond Bravo
- Graduate School of Education, Harvard University,
Cambridge, MA
| | | | - Kimberly Updegraff
- T. Denny Sanford School of Social and Family Dynamics,
Arizona State University, Tempe, AZ
| |
Collapse
|
11
|
Prevalence and regional variations of coexistence of child stunting and maternal overweight or obesity in Myanmar. Public Health Nutr 2020; 24:2248-2258. [PMID: 32677600 DOI: 10.1017/s136898002000186x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The current study aimed to investigate double burden of malnutrition within households at the national and subnational levels and to identify its association with sociodemographic factors in Myanmar. DESIGN All the variables were extracted from children's file of the Myanmar Demographic and Health Survey 2015-2016. Children under five were identified as stunted based on a height-for-age < -2 sd below the WHO reference median. Maternal overweight/obesity was defined as a BMI ≥ 23 kg/m2. A stunted child with an overweight/obese mother (SCOM) was classified as a double-burden household. SETTING A national household survey in Myanmar. PARTICIPANTS Children under five and their mothers (n 3954 pairs). RESULTS Mean ages of children and mothers were 29 (se 0·14) months and 30·9 (se 0·32) years, respectively. National prevalence of childhood stunting and maternal overweight/obesity was 28·0 % and 39·4 %, respectively, and the prevalence of SCOM was 9·1 %. Significant regional differences were found in SCOM, ranging from 3·6 % in Naypyitaw to 12 % in Kachin and Mon and 14·6 % in Kayah. In the multinomial logistic regression analysis, relative to neither a stunted child nor an overweight/obese mother, child's age, maternal age, maternal experience of a teen birth, short mothers, mothers with primary education and in middle or rich wealth tertiles, and some regions (Kachin, Kayah, Shan, Sagaing, Taninthayi, Ayeyarwaddy, Mon and Yangon) were associated with greater odds of SCOM. CONCLUSIONS The current study showed a relatively high national prevalence of SCOM and significant regional variations. Overarching policies and programmes with culturally sensitive strategies need to be formulated and implemented.
Collapse
|
12
|
Skeith AE, Stephens CQ, Nielson CM, Caughey AB. History of adolescent birth and diabetes in adulthood: a cross-sectional study of a nationally representative sample of American women. J Matern Fetal Neonatal Med 2019; 34:714-719. [PMID: 31039650 DOI: 10.1080/14767058.2019.1614159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: In the USA, 12-14% have type 2 diabetes mellitus and the incidence is rising. Adolescent birth has been shown to be associated with significant gestational weight gain and obesity in adulthood.Objective: We sought to evaluate the association between the history of adolescent birth and diabetes in adulthood.Study design: We conducted a cross-sectional study of the National Health and Nutrition Examination Survey (NHANES) data, examining 2-year cycles from 2005 to 2014. In a population of adult women who had experienced at least one live birth and who were not currently pregnant, we examined the prevalence of type 2 diabetes mellitus by the history of adolescent birth (live birth prior to 20 years of age). Sample characteristics were compared using survey-weighted chi-square tests. Multivariate logistic regression was used to examine the association between diabetes mellitus and adolescent birth history, with progressive adjustments for birth cohort, race/ethnicity, education level, and body mass index (BMI).Results: In a survey sample of 6507 individuals, we found that 38% of the women had experienced adolescent birth. Significant differences were found between those who had experienced adolescent birth and those who had not by birth cohort, race/ethnicity, federal poverty level, education attainment, parity, and BMI (p < .001 for all). The prevalence of type 2 diabetes was higher in women with a history of adolescent birth in adulthood than in women without a history of adolescent birth (17.2 versus 12.1%, p < .001; BMI-adjusted odds ratio = 1.27; 95% confidence interval, 1.03-1.58, p = .03).Conclusion: American women with a history of adolescent birth are at a significantly higher risk of type 2 diabetes mellitus in adulthood. Greater attention must be paid to preventing metabolic disease in women who experience early parity.
Collapse
Affiliation(s)
- Ashley E Skeith
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
| | - Caroline Q Stephens
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
| | - Carrie M Nielson
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
| |
Collapse
|
13
|
Wall MM, Mason SM, Liu J, Olfson M, Neumark-Sztainer D, Blanco C. Childhood psychosocial challenges and risk for obesity in U.S. men and women. Transl Psychiatry 2019; 9:16. [PMID: 30655501 PMCID: PMC6336849 DOI: 10.1038/s41398-018-0341-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 11/13/2018] [Indexed: 12/31/2022] Open
Abstract
Childhood psychosocial challenges (i.e., adversities, mental and substance use disorders, social challenges) may relate to the onset of obesity and extreme obesity. Identifying the types of psychosocial challenges most strongly associated with obesity could advance etiologic understanding and help target prevention efforts. Using a nationally representative sample of U.S. adults (N = 24,350), the present study evaluates relationships between childhood psychosocial challenges and development of obesity and extreme obesity. After mutually controlling, childhood poverty was a risk in men OR = 1.2 (1.0-1.4) and a significantly stronger one in women OR = 1.6 (1.4-1.8); maltreatment increased odds of obesity in both men and women OR = 1.3, 95% CI (1.1-1.4), and specifically increased odds of extreme obesity in women OR = 1.5 (1.3-1.9). Early childrearing (before age 18) was an independent risk factor in both men OR = 1.4 (1.0-1.9) and women OR = 1.3 (1.1-1.5); not finishing high school was the strongest childhood psychosocial challenge risk factor for extreme obesity in both men (OR = 1.6, 1.1-2.2) and women (OR = 2.0, 1.5-2.5). Psychiatric disorders (MDD, anxiety disorder, PTSD) before age 18 were not independently associated with adult obesity in men nor women, but substance use disorders (alcohol or drug) were inversely associated with adult obesity. Individuals who have experienced childhood adversities and social challenges are at increased risk for obesity. Previous findings also indicate that these individuals respond poorly to traditional weight management strategies. It is critical to identify the reasons for these elevated weight problems, and to develop interventions that are appropriately tailored to mitigate the obesity burden faced by this vulnerable population.
Collapse
Affiliation(s)
- Melanie M. Wall
- 0000000419368729grid.21729.3fDepartment of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032 USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, NY USA
| | - Susan M. Mason
- 0000000419368657grid.17635.36Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN USA
| | - Jun Liu
- 0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, NY USA
| | - Mark Olfson
- 0000000419368729grid.21729.3fDepartment of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032 USA ,0000 0000 8499 1112grid.413734.6New York State Psychiatric Institute, New York, NY USA
| | - Dianne Neumark-Sztainer
- 0000000419368657grid.17635.36Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN USA
| | - Carlos Blanco
- 0000 0004 0533 7147grid.420090.fNational Institute on Drug Abuse, 6001 Executive Blvd., Rockville, MD 20852 USA
| |
Collapse
|
14
|
Hendryx M, Guerra-Reyes L, Holland BD, McGinnis MD, Meanwell E, Middlestadt SE, Yoder KM. A county-level cross-sectional analysis of positive deviance to assess multiple population health outcomes in Indiana. BMJ Open 2017; 7:e017370. [PMID: 29025840 PMCID: PMC5652502 DOI: 10.1136/bmjopen-2017-017370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To test a positive deviance method to identify counties that are performing better than statistical expectations on a set of population health indicators. DESIGN Quantitative, cross-sectional county-level secondary analysis of risk variables and outcomes in Indiana. Data are analysed using multiple linear regression to identify counties performing better or worse than expected given traditional risk indicators, with a focus on 'positive deviants' or counties performing better than expected. PARTICIPANTS Counties in Indiana (n=92) constitute the unit of analysis. MAIN OUTCOME MEASURES Per cent adult obesity, per cent fair/poor health, low birth weight per cent, per cent with diabetes, years of potential life lost, colorectal cancer incidence rate and circulatory disease mortality rate. RESULTS County performance that outperforms expectations is for the most part outcome specific. But there are a few counties that performed particularly well across most measures. CONCLUSIONS The positive deviance approach provides a means for state and local public health departments to identify places that show better health outcomes despite demographic, social, economic or behavioural disadvantage. These places may serve as case studies or models for subsequent investigations to uncover best practices in the face of adversity and generalise effective approaches to other areas.
Collapse
Affiliation(s)
- Michael Hendryx
- Department of Environmental and Occupational Health, Indiana University, Bloomington, Indiana, USA
| | - Lucia Guerra-Reyes
- Department of Applied Health Science, Indiana University, Bloomington, Indiana, USA
| | - Benjamin D Holland
- Department of Environmental and Occupational Health, Indiana University, Bloomington, Indiana, USA
| | - Michael Dean McGinnis
- Department of Political Science, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Emily Meanwell
- Social Science Research Commons, Indiana University Bloomington, Bloomington, Indiana, USA
| | | | - Karen M Yoder
- Office of Civic Engagement, Indiana University School of Dentistry, Indianapolis, Indiana, USA
| |
Collapse
|
15
|
Beaudrot ME, Elchert JA, DeFranco EA. Influence of gestational weight gain and BMI on cesarean delivery risk in adolescent pregnancies. J Perinatol 2016; 36:612-7. [PMID: 27054845 DOI: 10.1038/jp.2016.61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/01/2016] [Accepted: 03/07/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Obesity and excessive gestational weight gain (GWG) increase cesarean delivery (CD) risk; however, their influence on teen pregnancies is less clear. We describe the influence of GWG and pre-pregnancy body mass index (BMI) on primary CD (PCD) risk in adolescent compared with adult pregnancies. STUDY DESIGN Population-based cohort study of Ohio births (2006 to 2012), n=1 034 552. Analyses were limited to 251 398 singleton live births in term (37 to 42 weeks) primiparas. Multivariate logistic regression estimated the association between BMI, GWG and CD risk in teens compared with adults (20 to 34 years), adjusting for maternal race, smoking status and labor induction. RESULTS The primary cesarean rate (PCD) for primiparous women was 25.6%. It was lower for adolescents (17% <15 years, 17% 15 to 17 years, 19% 18 to 19 years) compared with adults (26%, P<0.001). The PCD rate increased with excessive (29%) vs Institute of Medicine (IOM)-recommended GWG (20%). The PCD rate was also increased in mothers who were overweight (29%), and obese (39%) vs those with normal pre-pregnancy BMI (20%, P<0.001). The lowest PCD rate (11.6%) observed in normal weight teens <18 years was with appropriate GWG (adjusted odds ratio (aOR) 0.61; 95% CI 0.54 to 0.69). Compared with adults, teens have 43% lower PCD risk (aOR 0.57; 95% CI 0.55 to 0.60). Excessive GWG increased the risk for PCD in adults by 64% (aOR 1.64; 95% CI 1.59 to 1.68). Excessive GWG increased PCD in the highest risk groups, obese adults (aOR 1.24; 1.17 to 1.32) and obese teens (aOR 1.26; 95% CI 1.08 to 1.46). CONCLUSION Excessive GWG increases the risk of PCD. Young maternal age was protective of this effect. However, excessive GWG increased PCD risk in both teen and adult mothers. To reduce the primary cesarean rate, efforts should target interventions to promote optimal GWG, especially in those at highest risk, obese women of all ages.
Collapse
Affiliation(s)
- M E Beaudrot
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - J A Elchert
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - E A DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
16
|
Lee J, East P, Blanco E, Kang-Sim E, Castillo M, Lozoff B, Gahagan S. Parenthood linked to new onset overweight or obesity among Chilean adolescents. Int J Adolesc Med Health 2016; 28:225-7. [PMID: 26351903 DOI: 10.1515/ijamh-2015-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/06/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine whether early parenthood is associated with the onset of overweight/obesity during adolescence. METHODS Weight status changes between ages 16 and 21 years were measured in 270 Chilean youths. Parenthood by age 21 was assessed by interview. RESULTS Sixty-three youths became overweight/obese between ages 16 and 21 years (23%), and 24% (n=65) of the total sample were parents by age 21. Bearing a child by age 21 was associated with a two-fold risk of becoming newly overweight or obese (OR=2.6, CI: 1.1, 5.9, p<0.05). Earlier internalizing problems were also associated with the development of overweight/obesity in young mothers. CONCLUSION Weight status changes from normal to overweight or obese were more likely to occur among young parents than non-parents. This has implications for adolescents' future health given their likelihood of having subsequent pregnancies and the known risks of increased weight at each pregnancy.
Collapse
|
17
|
Spoer B, Fullilove R. Lessons Learned from the Diffusion of Effective Behavioral Interventions Program for Childhood Obesity Interventions. Public Health Rep 2016; 130:566-9. [PMID: 26556927 DOI: 10.1177/003335491513000604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ben Spoer
- New York University, College of Global Public Health, New York, NY
| | - Robert Fullilove
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, New York, NY
| |
Collapse
|
18
|
Sexual Behavior and Contraceptive Use among 18- to 19-Year-Old Adolescent Women by Weight Status: A Longitudinal Analysis. J Pediatr 2015; 167:586-92. [PMID: 26143383 PMCID: PMC4559226 DOI: 10.1016/j.jpeds.2015.05.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 04/29/2015] [Accepted: 05/20/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe the association between weight status and sexual practices among 18- to 19-year-old women. STUDY DESIGN We analyzed a population-based longitudinal study of 18- to 19-year-old women residing in a Michigan county at cohort inception. Weekly journal surveys measured sexual practices, including contraceptive behaviors. Outcomes included proportion of weeks with a partner, proportion of weeks with sexual intercourse, number of partners, average length of relationships, proportion of weeks with contraception use, and proportion of weeks where contraception was used consistently. We examined 26,545 journal surveys from 900 women over the first study year. Ordinary least squares regression models for each outcome examined differences by weight status, controlling for sociodemographic characteristics. RESULTS The mean proportion of weeks in which adolescents reported sexual intercourse was 52%; there was no difference by weight status. Among weeks in which adolescents reported sexual activity, obese adolescents had a lower proportion of weeks where any contraception was used compared with normal weight adolescents (84% vs 91%, P = .011). Among weeks in which adolescents reported sexual activity and contraceptive use, obese adolescents had a lower proportion of weeks with consistent contraceptive use (68% vs 78%, P = .016) and oral contraceptive pill use (27% vs 45%, P = .001) compared with normal weight adolescents. All other relationships by weight status were not statistically significant. CONCLUSIONS In this longitudinal study, obese adolescent women were less likely to use contraception, and less likely to use it consistently when compared with normal weight peers. Findings suggest obesity may be an important factor associated with adolescent women's sexual behavior.
Collapse
|
19
|
Clarke MA, Haire-Joshu DL, Schwarz CD, Tabak RG, Joshu CE. Influence of home and school environments on specific dietary behaviors among postpartum, high-risk teens, 27 States, 2007-2009. Prev Chronic Dis 2015; 12:E68. [PMID: 25950575 PMCID: PMC4436050 DOI: 10.5888/pcd12.140437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction The objective of this study was to determine whether perceptions of the home and school food environments are related to food and beverage intakes of postpartum teens. Methods Our study was a baseline, cross-sectional analysis of 853 postpartum teens enrolled in a weight-loss intervention study across 27 states from 2007 through 2009. Eight-item scales assessed perceived accessibility and availability of foods and beverages in school and home environments. Associations between environments and intakes were assessed by using χ2 and using logistic regression with generalized estimating equations (GEE), respectively. Results Overall, 52% of teens perceived their school food environment as positive, and 68% of teens perceived their home food environment as positive. A positive school environment was independently associated with fruit consumption and 100% fruit juice consumption. A positive home environment was independently associated with fruit, vegetable, and water consumption and infrequent consumption of soda and chips (χ2P < .05). Having only a positive school environment was associated with fruit consumption (GEE odds ratio [OR], 3.1; 95% confidence interval [CI], 1.5–6.5), and having only a positive home environment was associated with fruit (GEE OR, 2.9; 95% CI, 1.6–5.6), vegetable (GEE OR, 3.1; 95% CI, 1.5–6.2), and water (GEE OR, 2.6; 95% CI, 1.7–4.0) consumption and infrequent consumption of soda (GEE OR, 0.5; 95% CI, 0.3–0.7). Results for positive home and school environments were similar to those for positive home only. Conclusion Home and school environments are related to dietary behaviors among postpartum teens, with a positive home environment more strongly associated with healthful behaviors.
Collapse
Affiliation(s)
- Megan A Clarke
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205.
| | | | | | | | - Corinne E Joshu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
20
|
Brady K. Adolescent Pregnancy: A Webliography. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2014. [DOI: 10.1080/15398285.2014.902277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|