Heidi E. Jones

We conducted an age-period-cohort (APC) analysis to distinguish age, period and cohort effects underlying temporal trends in: low birth weight (LBW: < 2500 grams), early term deliveries (ETD: 37-38 weeks), induction and c-section using US birth records from 1994-2019 for all singleton, first, full-term (37-44 weeks gestation) births (n = 8 194 523). Using the APC-interaction method, we estimated age, period and cohort effects as odds ratios with 95% confidence intervals (CI). Age and period effects were observed for all outcomes. Pregnant women/people 40-44 years had increased odds of LBW (OR 1.23, 95%CI 1.19-1.26), ETD (OR 1.24, 95%CI 1.23-1.26), induction (OR 1.05, 95%CI 1.04-1.06) and c-section (OR 2.28, 95%CI 2.26-2.30) compared to the total population. Odds of LBW (OR 1.14, 95%CI 1.13-1.16), ETD (OR 1.11, 95%CI 1.10-1.12) and induction (OR 1.71, 95%CI 1.70-1.72) were higher in 2019 compared to the study period average. Cohort effects not explained by age and period effects were observed for women 40-44 years in 2019 indicated by higher odds of ETD (OR 1.08, 95%CI 1.05-1.10), induction (1.10, 95%CI 1.07-1.12) and c-section (OR 1.09, 95%CI 1.06-1.11). These findings suggest obstetric management of pregnant women ≥ 40 years changed in recent decades in ways not expected based on age and temporal trends alone.

Background: Intrauterine contraceptives (IUCs) are effective, but effects on genital inflammation among women living with HIV (WLHIV) by antiretroviral therapy (ART) use are unclear. We evaluated the longitudinal effects of copper IUC (CLIUC) and the levonorgestrel intrauterine system (LNGLIUS) on cervicovaginal cytokine profiles in a secondary analysis of a randomized trial ( NCT01721798 , 2013–2016). Methods: Cervicovaginal secretions were collected from 100 WLHIV (nonLART usersL=L48; ART usersL=L52) randomized 1:1 to ClZIUC or LNGlZIUS. TwentyLeight cytokines were measured prior to insertion and 3- and 6-months postLinsertion. Cytokine concentrations at each followLup visit were compared with baseline, using participant fixedLeffects models stratified by ART status. Results: At enrollment, nonLART users had higher average concentrations of most cytokines (21/28) than women using ART. Among non-ART users, IUC use was not associated with cytokine increases; only MCPL1 increased significantly at 3 months among CLIUC users (log ₁₀ geometric mean ratio 0.77, 95%CI 0.38–1.17), while none increased with LNG-IUS use. Among ART users, C-IUC insertion resulted in broad and sustained cytokine increases at both 3 (16/28) and 6 months (15/28). At month 3, the largest increases in log ₁₀ geometric mean were observed for IL-6 (1.04, 0.72-1.36), RANTES (0.97, 0.54-1.40), MCP-1 (0.71, 0.46-0.96), MIP-1α (0.66, 0.37-0.94), and G-CSF (0.63, 0.36-0.89), which was maintained until month 6. Cytokine changes following LNGLIUS insertion were minimal (IL-5, month 3). Conclusions: Among ART users, CLIUC is associated with increases in cervicovaginal cytokines, across functional classes. This supports LNGLIUS as a less inflammatory option for WLHIV to minimize genital immune activation.

To examine the joint effects of food insecurity and housing instability on academic attrition among college students. A representative sample of 3,160 matriculated students from the City University of New York (CUNY). A cross-sectional survey was conducted in Fall 2023. Food insecurity was assessed using USDA's Six-Item Food Security Module; Housing instability included inability to pay rent/mortgage or utilities. Academic attrition was defined as college withdrawal or academic probation. Adjusted prevalence ratios (aPRs) were estimated using log-binomial regression. Additive interaction was assessed using relative excess risk due to interaction (RERI). Students experiencing both insecurities had over twice the risk of attrition (aPR 2.16, 95%CI: 1.83-2.20). Housing instability posed a greater risk than food insecurity alone (aPR 1.55 vs. 1.30). RERI indicated a synergistic effect (RERI = 0.31, 95%CI: 0.08-0.54). Addressing both food and housing insecurity may reduce academic attrition and support student success.

Background: Cardiovascular disease (CVD) is the leading cause of mortality in the United States, with substantial economic and health impacts. While traditional risk factors are well studied, non-traditional factors like telomere length (TL), have garnered interest due to mixed findings on their association with CVD-specific mortality. This study investigates the association between TL and CVD-specific mortality, accounting for non-CVD-specific mortality as a competing risk, using a multistate framework. Methods: We conducted a retrospective cohort study using data from the National Health and Nutrition Examination Survey 1999-2002 and 2019 Linked Mortality Files. This study included 6,516 non-institutionalized adults aged 25 years or older. TL was measured using quantitative PCR and analyzed continuously and categorically. We employed a multistate model to evaluate transitions from an event-free state to CVD-specific and non-CVD-specific mortality, estimating cause-specific hazard ratios (HRs) adjusted for sociodemographic and health risk factors. Results: The cumulative incidence function for CVD-specific mortality was significantly higher in the lowest TL quartile than in the highest quartile (Gray test, p < 0.01). Gray’s test was used to compare CIFs across quartiles without applying a Fine and Gray model. We found that a shorter TL was associated with a higher risk of CVD-specific mortality. In the adjusted model, each unit decrease in TL was associated with a 57% higher rate of CVD-specific mortality (HR: 1.57, 95% CI: 1.24-1.98). Adults in the shortest TL quartile had an 88% higher rate of CVD-specific mortality compared with those in the longest TL quartile (HR: 1.88, 95% CI: 1.29-2.72). Conclusion: Our findings suggest a significant inverse association between TL and CVD-specific mortality, highlighting TL as a potential biomarker for CVD risk. The use of a multistate framework provides a comprehensive understanding of competing risks and enhances the robustness of our results. Further studies are needed to validate these findings and explore the underlying mechanisms.

Background: Medical curricula include advocacy competencies, but how much physicians engage in advocacy and what enables this engagement is not well characterized. The authors assessed facilitators and barriers to advocacy identified by physician alumni of a reproductive health advocacy training program. Methods: The authors present secondary results from a mixed methods program evaluation from 2018 to 2020, using alumni data from a cross-sectional survey (n = 231) and in-depth interviews (IDIs, n = 36). The survey measured engagement in policy, media, professional organization, and medical education advocacy and the value placed on the community fostered by the program (eight questions, Cronbach’s alpha = 0.81). The authors estimated the association of community value score with advocacy engagement using multivariable Poisson regression to estimate prevalence ratios and analyzed IDI data inductively. Results: Over one third of alumni were highly engaged in legislative policy (n = 90, 39%), professional organizations (n = 98, 42%), or medical education (n = 89, 39%), with fewer highly active in media-based advocacy (n = 54, 23%) in the year prior to the survey. Survey and IDI data demonstrated that passion, sense of urgency, confidence in skills, and the program’s emphasis on different forms of advocacy facilitated engagement in advocacy, while insufficient time, safety concerns, and sense of effort redundancies were barriers. The program community was also an important facilitator, especially for “out loud” efforts and for those working in environments perceived as hostile to abortion care (e.g., alumni in hostile environments with high community value scores were 1.8 times [95% CI 1.3, 2.6] as likely to report medium/high levels of media advocacy compared to those with low scores after adjusting for age, gender, and clinical specialty). Conclusion: Physician advocacy training curricula should include both skills- and community-building and identify a full range of forms of advocacy. Community-building is especially important for physician advocacy for reproductive health services such as abortion care.

Global rates of child mortality have significantly declined since 1990 with continued progress made towards the Sustainable Development Goal (SDG) target of less than 25 under-five deaths per 1000 live births by 2030 [1]. Several low- and middle-income countries (LMICs), however, are expected to fall short of this target due to disparities in managing preventable […]