Janice F. Bell

This study examines associations between parents’ report of their children’s oral health and receipt of a dental visit for preventive care. We conducted a cross-sectional analysis of oral health status and receipt of a preventive dental visit among US children and youth, ages 1–17 years, using data from the 2007 National Survey of Children’s Health (n = 86,764). Survey-weighted logistic regression was used to estimate associations between perceived oral health status and receipt of a preventive dental health visit in the prior 12 months. Overall, 78 % of children and youth received at least one preventive dental health visit in the prior year. Among the youngest children, lower oral health status was associated with higher odds of receiving a preventive dental visit; among older children, lower oral health status was associated with lower odds of receiving a dental visit for preventive care. Use of preventive dental health care is below national target goals. Younger children in worse oral health are more likely, and older youth less likely, to receive preventive dental care. Public health efforts to educate parents to seek early and ongoing preventive oral health care, rather than services in response to problems, may yield oral health benefits later in childhood and over the life course.

Age‐ and sex‐specific annual health‐care expenditures (total, in‐patient, ambulatory care, and outpatient prescription drug) were estimated within established weight classifications in a nationally representative sample of children and adults aged 6–85 years (n = 80,516) in the Medical Expenditures Panel Survey (MEPS). The expenditures were estimated with two‐part regression models and standard errors accounted for the complex survey design. Compared to their normal‐weight counterparts, total expenditures were higher for overweight females between age 22 ($85; 95% CI: $1, $166) and age 77 ($623; 95% CI: $14, $1,259); overweight males between age 48 ($168; 95% CI: $9, $312) and age 67 ($612; 95%: $31, $1,139); obese females between age 21 ($88; 95% CI: $12, $207) and age 82 ($1,497; 95% CI: $212, $2,592); and obese males between age 25 ($88; 95% CI: $9, $158) and age 83 ($3,236; 95% CI: $378, $6,637). Differences were primarily due to higher ambulatory care and prescription drug expenditures and, for women only, higher in‐patient expenditures. Overweight‐ and obesity‐associated health‐care expenditures are substantial and emerge at younger ages for women than for men. Expenditures associated with obesity exceed those associated with overweight. Further research is required to elucidate factors underlying the differences by sex.

Objective: To examine the general pediatric health care quality experiences of children and youth with mental health impairment. Methods: We conducted a cross-sectional analysis of 2006 Medical Expenditures Panel Survey data for children and youth aged 5 to 17 years (n = 7263). Mental health impairment was defined using the recommended cut-point (score ≥16) on the parent version of the Columbia Impairment Scale. Health care quality was measured with the Consumer Assessment of Healthcare Providers and Systems including parent ratings in 3 domains: provider communication, getting needed care, and getting care quickly. Logistic regression was used to test associations between mental health impairment and dichotomized Consumer Assessment of Healthcare Providers and Systems measures (poor vs good quality) adjusted for demographic characteristics, health insurance, and socioeconomic status. Analysis was conducted with Stata, Version 10.1 SE, and all estimates accounted for the Medical Expenditures Panel Survey complex sampling design. Results: In multivariable analysis, health care experiences of children with mental health impairment (versus those without) were consistently rated less favorably by parents, with greater odds of inferior quality of care ratings in all domains: getting needed care (odds ratio [OR] = 2.35), getting care quickly (OR = 1.41), physician communication (OR = 1.72), and overall health care quality (OR = 1.63). Conclusions: Further research is needed to identify specific aspects of care that families find problematic in relation to the organization and delivery of care within each quality domain. Interventions are needed to improve service systems for children and youth with mental health impairment, especially to support access to needed care.

Objective To test associations between daytime and nighttime sleep duration and subsequent obesity in children and adolescents. Design Prospective cohort. Setting Panel Survey of Income Dynamics Child Development Supplements (1997 and 2002) from US children. Participants Subjects aged 0 to 13 years (n = 1930) at baseline (1997). Main Exposures Binary indicators of short daytime and nighttime sleep duration (zscores and trichotomized (normal weight, overweight, obese) using established cut points. Ordered logistic regression was used to model body mass index classification as a function of short daytime and nighttime sleep at baseline and follow-up, and important covariates included socioeconomic status, parents' body mass index, and, for children older than 4 years, body mass index at baseline. Results For younger children (aged 0-4 years at baseline), short duration of nighttime sleep at baseline was strongly associated with increased risk of subsequent overweight or obesity (odds ratio = 1.80; 95% confidence interval, 1.16-2.80). For older children (aged 5-13 years), baseline sleep was not associated with subsequent weight status; however, contemporaneous sleep was inversely associated. Daytime sleep had little effect on subsequent obesity in either group. Conclusions Shortened sleep duration in early life is a modifiable risk factor with important implications for obesity prevention and treatment. Insufficient nighttime sleep among infants and preschool-aged children may be a lasting risk factor for subsequent obesity. Napping does not appear to be a substitute for nighttime sleep in terms of obesity prevention.

Objectives: We tested relations between aspects of maternal work and birth outcomes in a national sample and in subgroups known to experience disparities. Methods: Three indices of work attributes (Status and Recognition, Physical Demands, and Exposure to Conflict) were derived by factor analysis of variables extracted from the Department of Labor’s O*Net database. The indices were linked to the National Longitudinal Survey of Youth using occupation codes for the primary jobs held by women who gave birth between 1979 and 2000 and worked during the quarter prior to birth (n = 3,386 births to n = 2,508 mothers). Multiple regression was used to model birth outcomes as functions of the work attribute indices, controlling for several measures of socioeconomic status and risk factors for adverse birth outcomes. Results: In the full sample, work-related Physical Demands were associated with lower average birthweight and increased odds of preterm birth while Status and Recognition was associated with higher average birthweight and lower odds of fetal growth restriction. In stratified models, Status and Recognition was associated with higher birth weight among women with low (versus high) income and with lower odds of preterm birth among women with low (versus high) education. Physical Demands were associated with higher rates of preterm birth among women with low (versus high) income and education and among African-American mothers (compared to Whites). Conclusions: The work environment is an important predictor of healthy births. Relations between maternal work attributes and birth outcomes differ by race/ethnicity and socioeconomic status and according to the outcome under investigation. Further research with measures of work attributes specific to maternal work experiences is recommended to confirm our findings.

Approximately 10% of African-American women smoke during pregnancy compared to 16% of White women. While relatively low, the prevalence of smoking during pregnancy among African-American women exceeds the Healthy People 2010 goal of 1%. In the current study, we address gaps in extant research by focusing on associations between racial/ethnic residential segregation and smoking during pregnancy among urban African-American women. We linked measures of segregation to birth certificates and data from the 2000 census in a sample of US-born African-American women (n = 403,842) living in 216 large US Metropolitan Statistical Areas (MSAs). Logistic regression models with standard errors adjusted for multiple individual observations within MSAs were used to examine associations between segregation and smoking during pregnancy and to control for important socio-demographic confounders. In all models, a u-shaped relationship was observed. Both low segregation and high segregation were associated with higher odds of smoking during pregnancy when compared to moderate segregation. We speculate that low segregation reflects a contagion process, whereby salutary minority group norms are weakened by exposure to the more harmful behavioral norms of the majority population. High segregation may reflect structural attributes associated with smoking such as less stringent tobacco control policies, exposure to urban stressors, targeted marketing of tobacco products, or limited access to treatment for tobacco dependence. A better understanding of both deleterious and protective contextual influences on smoking during pregnancy could help to inform interventions designed to meet Healthy People 2010 target goals.

This study examined the relationships between jail incarceration during pregnancy and infant birth weight, preterm birth, and fetal growth restriction. We used multivariate regression analyses to compare outcomes for 496 births to women who were in jail for part of pregnancy with 4,960 Medicaid-funded births as matched community controls. After adjusting for potential confounding variables, the relationship between jail incarceration and birth outcomes was modified by maternal age. Relative to controls, women incarcerated during pregnancy had progressively higher odds of low birth weight and preterm birth through age 39 years; conversely, jail detainees older than 39 years were less likely than controls to experience low birth weight or preterm birth. For women in jail at all ages, postrelease maternity case management was associated with decreased odds of low birth weight, whereas prenatal care was associated with decreased odds of preterm birth. Local jails are important sites for public health intervention. Efforts to ensure that all pregnant women released from jail have access to enhanced prenatal health services may improve perinatal outcomes for this group of particularly vulnerable women and infants.