Early Parturition: Is Young Maternal Age at First Birth Associated with Obesity?

STUDY OBJECTIVE: Examine the association of age at first birth with body mass index (BMI), and explore the role of young maternal age and subsequent obesity. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS: This study analyzed data from the Panel Study of Income Dynamics, a nationally representative longitudinal study of US families. Analyses were conducted using a mixed effects longitudinal linear regression with a random intercept to examine the effect of aging, age at first birth, and minority status using nested data. Study criteria yielded a final sample of 146 women with 707 observations. MAIN OUTCOME MEASURES: BMI. RESULTS: Age at first birth exhibited a significant association with BMI. The association of age at first birth with BMI was greatest for women age 21 and younger. Overall, women who experienced their first birth at age 21 or younger had a BMI 5 units greater than women who delayed childbearing until at least age 30 (point estimate, 5.02; P = .02; 95% confidence interval, 0.65-9.40). CONCLUSION: Young maternal age at first birth might be associated with increased BMI. Minority women also experience their first birth at younger ages compared with white women, suggesting possible linkages between the timing of reproductive events and obesity disparities.

Differences in Obesity Rates Among Minority and White Women: The Latent Role of Maternal Stress.

White and minority women experience different rates of obesity in the United States. Yet our understanding of the dynamics that give rise to this gap remains limited. This article presents a conceptual framework that considers pathways leading to these different rates. It draws upon the life-course perspective, allostatic load, and the weathering hypothesis to identify pathways linking childbearing, stress, and obesity. This conceptual framework extends prior work by identifying age at first birth as an important parameter that influences these pathways. Empirical evidence to test these pathways is needed.

National Needs of Family Planning Among US Men Aged 15 to 44 Years.

OBJECTIVES: To estimate national need for family planning services among men in the United States according to background characteristics, access to care, receipt of services, and contraception use. METHODS: We used weighted data from the 2006-2010 National Survey of Family Growth to estimate the percentage of men aged 15 to 44 years (n = 10 395) in need of family planning, based on sexual behavior, fecundity, and not trying to get pregnant with his partner. RESULTS: Overall, 60% of men were in need of family planning, defined as those who ever had vaginal sex, were fecund, and had fecund partner(s) who were not trying to get pregnant with partner or partner(s) were not currently pregnant. The greatest need was among young and unmarried men. Most men in need of family planning had access to care, but few reported receiving family planning services (< 19%), consistently using condoms (26%), or having partners consistently using contraception (41%). CONCLUSIONS: The need for engaging men aged 15 to 44 years in family planning education and care is substantial and largely unmet despite national public health priorities to include men in reducing unintended pregnancies.

Family Planning and Preconception Health Among Men in Their Mid-30s: Developing Indicators and Describing Need.

The Centers for Disease Control and Prevention and Healthy People 2020 call for improvements in meeting men's reproductive health needs but little is known about the proportion of men in need. This study describes men aged 35 to 39 in need of family planning and preconception care, demographic correlates of these needs, and contraception use among men in need of family planning. Using data from Wave 4 (2008-2010) of the National Survey of Adolescent Males, men were classified in need of family planning and preconception care if they reported sex with a female in the last year and believed that they and their partner were fecund; the former included men who were neither intentionally pregnant nor intending future children and the latter included men intending future children. Men were classified as being in need of both if they reported multiple sex partners in the past year. About 40% of men aged 35 to 39 were in need of family planning and about 33% in need of preconception care with 12% in need of both. Current partner's age, current union type, and sexually transmitted infection health risk differentiated men in need of family planning and preconception care (all ps < .01) and participants' race/ethnicity further differentiated men in need of preconception care (p < .01). More than half of men in need of family planning reported none of the time current partner hormonal use (55%) or condom use (52%) during the past year. This study identified that many men in their mid-30s are in need of family planning or preconception care.

Men Aged 15-44 in Need of Preconception Care.

OBJECTIVES: Preconception care for men focuses on prevention strategies implemented prior to conception of a first or subsequent pregnancy to improve pregnancy and infant outcomes. Little is known about U.S. men in need of preconception care. This analysis describes the proportion of men in need of preconception care and associations of these needs by background characteristics, related health conditions, access to care and receipt of services. METHODS: Data from men aged 15-44 in the National Survey of Family Growth 2006-2010 were analyzed to describe men in need of preconception care, based on future childbearing intentions and self and partner fecundity status (among sexually experienced only), and associated factors with these needs using weighted bivariate analyses. RESULTS: About 60 % of men are in need of preconception care. Higher prevalence of being in need was observed among men aged 15-29 than older; living in urban than non-urban settings; in school than not in school regardless of working status; not in a coresidential union than married or cohabiting; who were recent immigrants than U.S. born; and reporting never having had a child than ≥1 child(ren). Men in need were overweight/obese (56 %), ever binge drank in the last year (58 %), and have high STI risk (21 %). The majority of men in need reported access to care in the last year (>70 %), but few reported receipt of services including STD/HIV testing (<20 %) or counseling (<11 %). CONCLUSIONS FOR PRACTICE: Findings from this analysis have implications for promoting preconception care among U.S. men.

Pathways of early fatherhood, marriage, and employment: a latent class growth analysis.

In the National Longitudinal Survey of Youth 1979 (NLSY79), young fathers include heterogeneous subgroups with varying early life pathways in terms of fatherhood timing, the timing of first marriage, and holding full-time employment. Using latent class growth analysis with 10 observations between ages 18 and 37, we derived five latent classes with median ages of first fatherhood below the cohort median (26.4), constituting distinct early fatherhood pathways representing 32.4% of NLSY men: (A) Young Married Fathers, (B) Teen Married Fathers, (C) Young Underemployed Married Fathers, (D) Young Underemployed Single Fathers, and (E) Young Later-Marrying Fathers. A sixth latent class of men who become fathers around the cohort median, following full-time employment and marriage (On-Time On-Sequence Fathers), is the comparison group. With sociodemographic background controlled, all early fatherhood pathways show disadvantage in at least some later-life circumstances (earnings, educational attainment, marital status, and incarceration). The extent of disadvantage is greater when early fatherhood occurs at relatively younger ages (before age 20), occurs outside marriage, or occurs outside full-time employment. The relative disadvantage associated with early fatherhood, unlike early motherhood, increases over the life course.

Racial and ethnic disparities in sexual risk behaviors and STDs during young men's transition to adulthood.

CONTEXT: Racial and ethnic health disparities are an important issue in the United States. The extent to which racial and ethnic differences in STDs among youth are related to differences in socioeconomic characteristics and risky sexual behaviors requires investigation. METHODS: Data from three waves of the National Survey of Adolescent Males (1988, 1990-1991 and 1995) were used to examine 1,880 young men's history of STDs and their patterns and trajectories of sexual risk behavior during adolescence and early adulthood. Multinomial and logistic regression analyses were conducted to test whether racial and ethnic differences in STDs are due to the lower socioeconomic status and higher levels of risky sexual behavior among minority groups. RESULTS: Young black men reported the highest rates of sexual risk and STDs at each wave and across waves. Compared with white men, black and Latino men had higher odds of maintaining high sexual risk and increasing sexual risk over time (odds ratios, 1.7-1.9). In multivariate analyses controlling for socioeconomic characteristics, black men were more likely than white men to have a history of STDs (3.2-5.0); disparities persisted in analyses controlling for level of risky sexual behavior. CONCLUSIONS: Race and ethnicity continue to differentiate young black and Latino men from their white peers in terms of STDs. Prevention programs that target different racial and ethnic subgroups of adolescent men and address both individual- and contextual-level factors are needed to curb STD incidence.

A quantitative examination of park characteristics related to park use and physical activity among urban youth.

PURPOSE: Although several studies have identified a positive association between recreational facility availability and physical activity, few have examined facility attributes beyond availability and involved minority adolescents. This study examines how both objective and perceived measures of the facility environment are associated with urban adolescents' use of parks and physical activity. METHODS: Study participants included 329 adolescents from two high schools in Baltimore, Maryland, the majority (69%) of whom was African American. A Web-based survey assessed park use, neighborhood crime, and park availability, quality, and use by friends and family. Geographical Information Systems data were used to develop objective measures of park availability and crime. Physical activity data were obtained from 316 participants using accelerometers. Hypotheses regarding environmental correlates of park use and physical activity were tested using logistic regression models (for park use) and linear regression models (for physical activity). RESULTS: Perceptions of greater park availability, quality, and use by friends were associated with a significantly greater likelihood of an adolescents' park use. Perceptions of more park availability was associated with higher levels of physical activity, although this association was marginally significant. Objective measures of park availability and objective and subjective measures of crime were not associated with either park use or physical activity. CONCLUSIONS: Efforts to promote park use for physical activity among urban youth should increase awareness of park availability, improve perceptions of park quality, and utilize social networks.

What are the consequences of relying upon self-reports of sexually transmitted diseases? Lessons learned about recanting in a longitudinal study.

PURPOSE: Self-reports are the standard measure of STD history used in survey research. We explored to what extent self-reports of ever having an STD are recanted in a follow-up data collection. METHODS: Using the National Survey of Adolescent Males (NSAM), we assessed consistency over time in self-reports of ever having an STD in a sample of young men transitioning from adolescence to young adulthood (aged 15-26 years), a population in which STDs are particularly prevalent. RESULTS: Approximately 7% of all sexually experienced young men rescinded STD self-reports over time. Thus, self-reports at one point in time likely underestimate true STD history, using earlier self-reports as the criterion. Among men who ever report an STD, 94-98% recant their reports in later waves. CONCLUSIONS: Knowledge of the extent of underreporting can potentially be used to adjust cross-sectional estimates of STDs based on survey self-reports. These study findings move us one step closer to estimating just how much underreporting of STDs in self-reports is.

Changes in sexual risk behavior as young men transition to adulthood.

CONTEXT: Understanding how young men's sexual risk behaviors change during the transition from adolescence to early adulthood is important for the design and evaluation of effective strategies to reduce the transmission of HIV and other STDs. METHODS: Data from three waves of the National Survey of Adolescent Males (1988, 1991 and 1995) were used to categorize 1,880 respondents into clusters according to sexual risk behaviors. Univariate and bivariate analyses were conducted to assess associations between clusters and rates of self-reported STD diagnoses and positive chlamydia tests. RESULTS: Two dimensions of sexual risk-taking defined the clusters: partner characteristics and condom use. More than 50% of men remained in low-risk groups over time. In the first two waves, 24-32% of men reported engaging in high-risk behaviors (risky partners, condom nonuse); these behaviors were associated with elevated levels of STD outcomes. Nearly 40% of men who entered a high-risk group in the first two waves transitioned to a lower risk group by the third wave. Nine percent of men either engaged in increasingly risky behaviors or maintained membership in high-risk groups; elevated STD rates characterized both trajectories. Low condom use combined with having multiple partners during adolescence was associated with elevated STD rates in the year preceding the third wave; high condom use coupled with having risky partners was not. CONCLUSIONS: The prominence of low-risk behaviors over time suggests that most young men avoid sexual risk-taking. Effective strategies to reduce HIV and STD risk in young men must simultaneously address multiple dimensions of sexual behavior.

The environment and urban adolescents' use of recreational facilities for physical activity: a qualitative study.

PURPOSE: Investigate environmental factors influencing the use of recreational facilities for physical activity by urban African-American adolescents. DESIGN: Qualitative in-depth interviews and direct observation. SETTING: Two public high schools and 24 public recreational facilities in Baltimore, Maryland. PARTICIPANTS: Forty-eight African-American adolescents aged 14 to 18 years. METHODS: Data from 48 in-depth interviews and 26 observations were coded using NVivo software and analyzed using the constant comparative method. RESULTS: Facility use is influenced by characteristics of the physical, social, organizational, and economic environments. Adolescents are attracted to low-cost, well-maintained facilities that offer preferred activities and that are within close proximity to home. Adolescents with limited access to facilities use alternative play spaces, like the streets or vacant lots, where they risk injury from falling or being hit by a car. They are drawn to facilities where they find active adolescents, and they avoid those where young people are engaged in drug or gang activity. Concerns about facility safety largely determine use, particularly for adolescent girls. CONCLUSION: Previous research points to the importance of increasing facility availability as a means of promoting physical activity, particularly in minority communities in which availability is disproportionately limited. This study shows that, while availability is important, additional facility characteristics should be considered when using environmental change to promote facility use for physical activity.

Adolescents' perceptions of environmental influences on physical activity.

OBJECTIVES: To examine African American adolescents' perceptions of environmental influences on physical activity and identify physical activity promotion strategies. METHODS: Concept mapping with 50 adolescents was used to obtain cluster maps of conceptual domains affecting physical activity. RESULTS: Seven domains were identified, including physical activity settings, social support, negative social influences, parental control, negative environmental influences, transportation and technology issues, and financial issues. Their relative importance to physical activity varied by gender. CONCLUSIONS: This research identified salient environmental characteristics that can be measured in future studies as well as strategies for increasing physical activity in urban youths.

The dynamics of injection drug users' personal networks and HIV risk behaviors.

AIMS: While studies of the social networks of injection drug users (IDUs) have provided insight into how the structures of interpersonal relationships among IDUs affect HIV risk behaviors, the majority of these studies have been cross-sectional. The present study examined the dynamics of IDUs' social networks and HIV risk behaviors over time. DESIGN: Using data from a longitudinal HIV-intervention study conducted in Baltimore, MD, this study assessed changes in the composition of the personal networks of 409 IDUs. We used a multi-nomial logistic regression analysis to assess the association between changes in network composition and simultaneous changes in levels of injection HIV risk behaviors. Using the regression parameters generated by the multi-nomial model, we estimated the predicted probability of being in each of four HIV risk behavior change groups. FINDINGS: Compared to the base case, individuals who reported an entirely new set of drug-using network contacts at follow-up were more than three times as likely to be in the increasing risk group. In contrast, reporting all new non-drug-using contacts at follow-up increased the likelihood of being in the stable low-risk group by almost 50% and decreased the probability of being in the consistently high-risk group by more than 70%. CONCLUSIONS: The findings from this study show that, over and above IDUs' baseline characteristics, changes in their personal networks are associated with changes in individuals' risky injection behaviors. They also suggest that interventions aimed at reducing HIV risk among IDUs might benefit from increasing IDUs' social contacts with individuals who are not drug users.

Racial, ethnic, and gender differences in smoking cessation associated with employment and joblessness through young adulthood in the US.

The dynamics of labor force participation and joblessness during young adulthood influence access to social and material resources and shape exposure to different sources of psychosocial strain. Differences in these dynamics by race, ethnicity, and gender are related to changes in a behavioral determinant of poor health (tobacco use) for young adults aging into midlife. Using discrete-time hazards models, we estimate the relationship between labor force participation in the past year and smoking cessation for US adults (ages 14-21 years in 1979) followed in a population-representative sample until 1998 (i.e. the National Longitudinal Survey of Youth). We assess the unique role of racial, ethnic and gender differences in exposure, vulnerability, and reactivity to employment and joblessness by controlling for social and economic resources obtained through working and by controlling for early life factors that select individuals into certain labor force and smoking trajectories. There are three main findings: (1) joblessness is more strongly associated with persistent daily smoking among women than among men; (2) fewer social and economic resources for women out of the labor force compared to employed women explains their lower cessation rates; and (3) lower cessation among unemployed women compared to employed women can only partially be explained by these resources. These findings illustrate how differential access to work-related social and economic resources is an important mediator of poor health trajectories. Contextual factors such as social norms and psychosocial strains at work and at home may play a unique role among European American men and women in explaining gender differences in smoking.