Adverse Childhood Experiences and Complex Post-traumatic Stress in Pregnant Teens: A Pilot Study.

INTRODUCTION: Pregnant teens are seen as a group at risk, yet one area that remains understudied is the impact of trauma on their mental health, maternal fetal attachment and pregnancy-related health behavior. METHODS: A pilot study of urban pregnant teens receiving home visiting services examined trauma exposure, complex traumatic stress, maternal fetal attachment, and health behaviors of pregnancy. The sample (n = 36) was recruited over a period of 20 months from Nurse-Family Partnership of New York City (NFP-NYC) service sites. The teens interviewed completed scales measuring adverse childhood experiences (ACEs), symptoms of complex posttraumatic stress (TSCC), prenatal attachment (MAAS), and pregnancy health behaviors (HPQ-II). FINDINGS: Over one third of participants reported 4 or more ACEs (36%), and scores on the Trauma Symptom Checklist subscales ranged from a low of 11% for anger to 25% for depression, anxiety and post-traumatic stress. Maternal-fetal attachment was strong and pregnancy health behaviors were positive. The number of ACEs was related to traumatic stress symptoms but not to maternal fetal attachment or health behaviors in pregnancy. CONCLUSIONS: Pregnant teens with trauma histories could benefit from access to trauma-informed mental health services integrated into the obstetrical or home-visiting services they receive.

Evaluation of non-response bias in a cohort study of World Trade Center terrorist attack survivors.

BACKGROUND: Few longitudinal studies of disaster cohorts have assessed both non-response bias in prevalence estimates of health outcomes and in the estimates of associations between health outcomes and disaster exposures. We examined the factors associated with non-response and the possible non-response bias in prevalence estimates and association estimates in a longitudinal study of World Trade Center (WTC) terrorist attack survivors. METHODS: In 2003-04, 71,434 enrollees completed the WTC Health Registry wave 1 health survey. This study is limited to 67,670 adults who were eligible for both wave 2 and wave 3 surveys in 2006-07 and 2011-12. We first compared the characteristics between wave 3 participants (wave 3 drop-ins and three-wave participants) and non-participants (wave 3 drop-outs and wave 1 only participants). We then examined potential non-response bias in prevalence estimates and in exposure-outcome association estimates by comparing one-time non-participants (wave 3 drop-ins and drop-outs) at the two follow-up surveys with three-wave participants. RESULTS: Compared to wave 3 participants, non-participants were younger, more likely to be male, non-White, non-self enrolled, non-rescue or recovery worker, have lower household income, and less than post-graduate education. Enrollees' wave 1 health status had little association with their wave 3 participation. None of the disaster exposure measures measured at wave 1 was associated with wave 3 non-participation. Wave 3 drop-outs and drop-ins (those who participated in only one of the two follow-up surveys) reported somewhat poorer health outcomes than the three-wave participants. For example, compared to three-wave participants, wave 3 drop-outs had a 1.4 times higher odds of reporting poor or fair health at wave 2 (95% CI 1.3-1.4). However, the associations between disaster exposures and health outcomes were not different significantly among wave 3 drop-outs/drop-ins as compared to three-wave participants. CONCLUSION: Our results show that, despite a downward bias in prevalence estimates of health outcomes, attrition from the WTC Health Registry follow-up studies does not lead to serious bias in associations between 9/11 disaster exposures and key health outcomes. These findings provide insight into the impact of non-response on associations between disaster exposures and health outcomes reported in longitudinal studies.

Unmet mental health care need 10-11 years after the 9/11 terrorist attacks: 2011-2012 results from the World Trade Center Health Registry.

BACKGROUND: There is little current information about the unmet mental health care need (UMHCN) and reasons for it among those exposed to the World Trade Center (WTC) terrorist attacks. The purpose of this study was to assess the level of UMHCN among symptomatic individuals enrolled in the WTC Health Registry (WTCHR) in 2011-2012, and to analyze the relationship between UMHCN due to attitudinal, cost, and access factors and mental health symptom severity, mental health care utilization, health insurance availability, and social support. METHODS: The WTCHR is a prospective cohort study of individuals with reported exposure to the 2001 WTC attacks. This study used data from 9,803 adults who completed the 2003-2004 (Wave 1) and 2011-2012 (Wave 3) surveys and had posttraumatic stress disorder (PTSD) or depression in 2011-2012. We estimated logistic regression models relating perceived attitudinal, cost and access barriers to symptom severity, health care utilization, a lack of health insurance, and social support after adjusting for sociodemographic characteristics. RESULTS: Slightly more than one-third (34.2%) of study participants reported an UMHCN. Symptom severity was a strong predictor of UMHCN due to attitudinal and perceived cost and access reasons. Attitudinal UMHCN was common among those not using mental health services, particularly those with relatively severe mental health symptoms. Cost-related UMHCN was significantly associated with a lack of health insurance but not service usage. Access-related barriers were significantly more common among those who did not use any mental health services. A higher level of social support served as an important buffer against cost and access UMHCN. CONCLUSIONS: A significant proportion of individuals exposed to the WTC attacks with depression or PTSD 10 years later reported an UMHCN, and individuals with more severe and disabling conditions, those who lacked health insurance, and those with low levels of social support were particularly vulnerable.

Continuity and change in premarital sex in Vietnam.

CONTEXT: Premarital sexual activity is thought to be rising in Vietnam. However, there is little evidence documenting such an increase, and it is unknown whether levels of premarital sex differ between northern and southern Vietnam and whether premarital sex occurs primarily with a future spouse. METHODS: Surveys conducted in northern Vietnam (Red River Delta) and southern Vietnam (Ho Chi Minh City and surrounding environs) in 2003-2004 among individuals married during one of three important periods in Vietnamese history (1963-1971, 1977-1985 or 1992-2000) were used to assess trends and regional differences in the prevalence and context of premarital sex. RESULTS: In both regional samples, 31% of men who married in 1992-2000 reported having had premarital sex. The proportion was much lower among women (8% in the South, 12% in the North). The prevalence of premarital sex rose markedly across cohorts in the North but only modestly in the South. Relatively few men had premarital sex with someone other than a future spouse (3-23%). The proportion of the rise in the prevalence of premarital sex that was due to sex exclusively with a future spouse was greater in the North (42%) than in the South (25%). CONCLUSIONS: These results suggest that premarital sex is becoming more common in Vietnam but is still not widespread. Better information about the sexual networks of men in the general population and their contacts with high-risk groups (e.g., commercial sex workers) is needed to ascertain the likelihood that HIV/AIDS will spread to the general population.

Attitudes about sex and marital sexual behavior in Hai Duong Province, Vietnam.

This study examines attitudes concerning sexual relations outside marriage and levels of marital sexual activity using data from married individuals from Hai Duong Province collected in 2001. Among individuals who live in urban areas, have more schooling, and were married after the late 1980s, acceptance is growing concerning intimate behavior without marital commitment and having sex with a future spouse. Schooling, urban residence, and recent marriage have stronger associations with less conservative attitudes among men than among women. Even among younger and better-educated respondents, acceptance of premarital and extramarital sex generally remains below a majority. The reported level of premarital sex is higher among men than among women, and lower than available estimates from other parts of Asia and the developing world. The reported level of sexual activity within marriage in Hai Duong Province is similar to that observed elsewhere, including Thailand and the United States. The incidence of sexual activity declines with age, and at all ages men are more likely than women to report having sex with their spouse. The implications of these gender differences in sexual attitudes and behavior are considered.

Women's autonomy and child survival: a comparison of Muslims and non-Muslims in four Asian countries.

In this article, I evaluate the hypothesis that higher infant and child mortality among Muslim populations is related to the lower autonomy of Muslim women using data from 15 pairs of Muslim and non-Muslim communities in India, Malaysia, the Philippines, and Thailand. Women's autonomy in various spheres is not consistently lower in Muslim than in non-Muslim settings. Both across and within communities, the association between women's autonomy and mortality is weak, and measures of autonomy or socioeconomic status are generally of limited import for understanding the Muslim disadvantage in children's survival.