Critical care among newborns with and without a COVID-19 diagnosis, May 2020-February 2022.

OBJECTIVE: To assess COVID-19 association with newborn critical care outcomes, including nursery level of care and ventilation, during three time periods: Pre-delta (May 2020-June 2021), Delta (July-November 2021), and Omicron (December 2021-February 2022). STUDY DESIGN: In a retrospective cohort of newborns born May 2020-February 2022 using the Premier Healthcare Database, we classified COVID-19 status and critical care using International Classification of Diseases 10th Revision and Current Procedural Terminology codes, laboratory data, and billing records and assessed for variation during three time periods. RESULTS: Of 1,388,712 newborns, 0.06% had COVID-19 during the birth hospitalization (Pre-delta period: 0.03%; Delta: 0.07%; Omicron: 0.21%). Among newborns with COVID-19, the risks for admission to a higher-level nursery and for invasive or non-invasive ventilation were lower in the Omicron period compared to Pre-delta and Delta periods. CONCLUSION: From May 2020-February 2022, COVID-19 in newborns was rare and cases were less severe during the period of Omicron predominance.

Pregnancy and infant outcomes by trimester of SARS-CoV-2 infection in pregnancy-SET-NET, 22 jurisdictions, January 25, 2020-December 31, 2020.

OBJECTIVES: We describe clinical characteristics, pregnancy, and infant outcomes in pregnant people with laboratory-confirmed SARS-CoV-2 infection by trimester of infection. STUDY DESIGN: We analyzed data from the Surveillance for Emerging Threats to Mothers and Babies Network and included people with infection in 2020, with known timing of infection and pregnancy outcome. Outcomes are described by trimester of infection. Pregnancy outcomes included live birth and pregnancy loss (<20 weeks and ≥20 weeks gestation). Infant outcomes included preterm birth (<37 weeks gestation), small for gestational age, birth defects, and neonatal intensive care unit admission. Adjusted prevalence ratios (aPR) were calculated for pregnancy and selected infant outcomes by trimester of infection, controlling for demographics. RESULTS: Of 35,200 people included in this analysis, 50.8% of pregnant people had infection in the third trimester, 30.8% in the second, and 18.3% in the first. Third trimester infection was associated with a higher frequency of preterm birth compared to first or second trimester infection combined (17.8% vs. 11.8%; aPR 1.44 95% CI: 1.35-1.54). Prevalence of birth defects was 553.4/10,000 live births, with no difference by trimester of infection. CONCLUSIONS: There were no signals for increased birth defects among infants in this population relative to national baseline estimates, regardless of timing of infection. However, the prevalence of preterm birth in people with SARS-CoV-2 infection in pregnancy in our analysis was higher relative to national baseline data (10.0-10.2%), particularly among people with third trimester infection. Consequences of COVID-19 during pregnancy support recommended COVID-19 prevention strategies, including vaccination.

Preterm birth among pregnant persons with severe acute respiratory syndrome Coronavirus 2 infection.

OBJECTIVE: We examined the relationship between trimester of SARS-CoV-2 infection, illness severity, and risk for preterm birth. STUDY DESIGN: We analyzed data for 6336 pregnant persons with SARS-CoV-2 infection in 2020 in the United States. Risk ratios for preterm birth were calculated for illness severity, trimester of infection, and illness severity stratified by trimester of infection adjusted for age, selected underlying medical conditions, and pregnancy complications. RESULT: Pregnant persons with critical COVID-19 or asymptomatic infection, compared to mild COVID-19, in the second or third trimester were at increased risk of preterm birth. Pregnant persons with moderate-to-severe COVID-19 did not show increased risk of preterm birth in any trimester. CONCLUSION: Critical COVID-19 in the second or third trimester was associated with increased risk of preterm birth. This finding can be used to guide prevention strategies, including vaccination, and inform clinical practices for pregnant persons.

Trends in School-Related Victimization of Lesbian, Gay, and Bisexual Youths-Massachusetts, 1995-2015.

OBJECTIVES: To compare changes over time in prevalence of school victimization among lesbian, gay, and bisexual (LGB) students compared with heterosexual students. METHODS: We analyzed data from 11 Youth Risk Behavior Surveys conducted among representative samples of students in grades 9 through 12 in Massachusetts during 1995 to 2015. We used multivariable logistic regression models to identify trends over time by sexual identity. RESULTS: During 1995 to 2015, the prevalence of missing school decreased overall (from 5.6% to 4.8%) and among heterosexual (from 4.3% to 3.8%) and LGB (from 25.0% to 13.4%) students. The prevalence of having been threatened decreased overall (from 7.8% to 4.1%) and among heterosexual (from 6.5% to 3.5%) and LGB (from 32.9% to 6.7%) students. CONCLUSIONS: We identified evidence of a significant decrease in victimization among all students regardless of sexual identity and a steep decline among LGB students. Additional actions to improve school climate may help eliminate the disparities and decrease victimization for all youths.

Withdrawal as pregnancy prevention and associated risk factors among US high school students: findings from the 2011 National Youth Risk Behavior Survey.

PURPOSE: Withdrawal is less effective for preventing pregnancy than other contraceptive methods and offers no protection against sexually transmitted infections including HIV. Little is known from a national perspective about adolescents who primarily use withdrawal. This study describes the prevalence of withdrawal as their primary method of pregnancy prevention at last sexual intercourse among sexually active US high school students and associations with sexual risk and substance use. METHODS: Data from the 2011 National Youth Risk Behavior Survey were used to estimate sexually active students' most recent contraceptive method. Logistic regressions examined sexual behaviors and substance use, comparing students who used withdrawal to those who used no method, a condom and a highly effective method. RESULTS: Among 4793 currently sexually active students, 10.2% used withdrawal only, 12.4% used no method, 53.6% used a condom and 23.8% used a more effective method as their primary form of pregnancy prevention during last sexual intercourse. Students who used withdrawal were less likely than those who used no method to have had sexual intercourse before age 13 years (Adjusted Prevalence Ratio (APR) =.56) and currently use cocaine (APR=.36). Among females, students who used withdrawal were more likely to engage in risky behaviors than those who used a condom and those who used a highly effective method of pregnancy prevention in a number of ways (e.g., having multiple sex partners during the past 3 months, current alcohol use, binge drinking, current marijuana use, drank alcohol or used drugs before last sexual intercourse). CONCLUSIONS: Approximately 1 in 10 sexually active students used withdrawal only, about the same percentage as those who used no method. Health care providers and others who serve adolescents may want to discuss its pros and cons with their clients and help ensure that they have information about and access to other contraceptive methods that are more effective at preventing pregnancy and sexually transmitted infections. Health care professionals should not consider young people who use withdrawal similar in risk to those that use no method.

Teen Dating Violence (Physical and Sexual) Among US High School Students: Findings From the 2013 National Youth Risk Behavior Survey.

IMPORTANCE: National estimates of teen dating violence (TDV) reveal high rates of victimization among high school populations. The Centers for Disease Control and Prevention's national Youth Risk Behavior Survey has provided often-cited estimates of physical TDV since 1999. In 2013, revisions were made to the physical TDV question to capture more serious forms of physical TDV and to screen out students who did not date. An additional question was added to assess sexual TDV. OBJECTIVES: To describe the content of new physical and sexual TDV victimization questions first administered in the 2013 national Youth Risk Behavior Survey, to share data on the prevalence and frequency of TDV (including the first-ever published overall "both physical and sexual TDV" and "any TDV" national estimates using these new questions), and to assess associations of TDV experience with health-risk behaviors. DESIGN, SETTING, AND PARTICIPANTS: Secondary data analysis of a cross-sectional survey of 9900 students who dated, from a nationally representative sample of US high school students, using the 2013 national Youth Risk Behavior Survey. MAIN OUTCOMES AND MEASURES: Two survey questions separately assessed physical and sexual TDV; this analysis combined them to create a 4-level TDV measure and a 2-level TDV measure. The 4-level TDV measure includes "physical TDV only," "sexual TDV only," "both physical and sexual TDV," and "none." The 2-level TDV measure includes "any TDV" (either or both physical and sexual TDV) and "none." Sex-stratified bivariate and multivariable analyses assessed associations between TDV and health-risk behaviors. RESULTS: In 2013, among students who dated, 20.9% of female students (95% CI, 19.0%-23.0%) and 10.4% of male students (95% CI, 9.0%-11.7%) experienced some form of TDV during the 12 months before the survey. Female students had a higher prevalence than male students of physical TDV only, sexual TDV only, both physical and sexual TDV, and any TDV. All health-risk behaviors were most prevalent among students who experienced both forms of TDV and were least prevalent among students who experienced none (all P < .001). CONCLUSIONS AND RELEVANCE: The 2013 TDV questions allowed for new prevalence estimates of TDV to be established that represent a more complete measure of TDV and are useful in determining associations with health-risk behaviors among youth exposed to these different forms of TDV.

School violence and bullying among sexual minority high school students, 2009-2011.

PURPOSE: School-based victimization has short- and long-term implications for the health and academic lives of sexual minority students. This analysis assessed the prevalence and relative risk of school violence and bullying among sexual minority and heterosexual high school students. METHODS: Youth Risk Behavior Survey data from 10 states and 10 large urban school districts that assessed sexual identity and had weighted data in the 2009 and/or 2011 cycle were combined to create two large population-based data sets, one containing state data and one containing district data. Prevalence of physical fighting, being threatened or injured with a weapon, weapon carrying, and being bullied on school property and not going to school because of safety concerns was calculated. Associations between these behaviors and sexual identity were identified. RESULTS: In the state data, sexual minority male students were at greater risk for being threatened or injured with a weapon, not going to school because of safety concerns and being bullied than heterosexual male students. Sexual minority female students were at greater risk than heterosexual female students for all five behaviors. In the district data, with one exception, sexual minority male and female students were at greater risk for all five behaviors than heterosexual students. CONCLUSIONS: Sexual minority students still routinely experience more school victimization than their heterosexual counterparts. The implementation of comprehensive, evidence-based programs and policies has the ability to reduce school violence and bullying, especially among sexual minority students.

Comparing methods for assessing beverage intake among high school students.

OBJECTIVES: To compare 7 beverage intake survey questions against criterion data from 24-hour dietary recall interviews (24HrDRIs) among adolescents. METHODS: Data were available from 610 US high school students completing a survey and ≥3 24HrDRIs. Analyses compared mean intake (times/day) calculated from the survey to intake (servings/day) from the 24HrDRIs. Proportions of students reporting intake of ≥1 times/day were compared to the 24HrDRI results. RESULTS: Survey data significantly correlated with 24HrDRI data (all corrected r: 0.26-0.49). Survey results differed from 24HrDRI results on reported intake of 5 beverages. CONCLUSION: Intake from these beverage questions should be reported in times/day, which is related to, but not a proxy for, servings/day. These questions are useful for population-level surveillance of beverage intake and monitoring trends over time.

Association of UV index and sunscreen use among White high school students in the United States.

BACKGROUND: When used appropriately, sunscreen decreases the amount of ultraviolet (UV) radiation exposure to the skin and is recommended to prevent skin cancer. This study examined the association between annual average UV index and sunscreen use among White, non-Hispanic youth. METHODS: The 2007 and 2009 national Youth Risk Behavior Survey (YRBS) data were analyzed. The YRBS is a school-based, cross-sectional study that uses a 3-stage cluster sample design to obtain a nationally representative sample of public and private high school students in the United States. Overall response rates were 68% and 72% (N = 14,041 and 16,410, respectively). Logistic regression analyzes, controlling for grade, examined whether annual average (mean) UV index where students attend school, a proxy measure of potential sunlight exposure, was associated with sunscreen use. RESULTS: Among White male students, as the mean UV index increased, the adjusted odds of never wearing sunscreen increased (adjusted odds ratio, AOR = 1.15 [95% CI = 1.04, 1.27], p < .01) and the adjusted odds of most of the time or always wearing sunscreen decreased (AOR = 0.85 [0.78, 0.94], p < .01). There was no association between sunscreen use and mean UV index among White female students. CONCLUSION: These findings suggest a need for renewed public health efforts among school, clinical, and public health professionals to promote sunscreen use as part of a comprehensive approach to prevent skin cancer. School and community approaches that passively protect young people from the sun should be considered as a complement to efforts to increase sunscreen use.