Validation of a new calculator for predicting success of vaginal birth after cesarean delivery.

Race as a variable in a predictive model for a successful vaginal birth after cesarean delivery has been challenged as contributing to health inequity. In May 2022, the National Institute of Child Health and Development released a modified calculator that removed race as a variable. The aim of this study was to externally validate the revised calculator amongst a cohort at our institution. We reviewed all patients who underwent a trial of labor after cesarean delivery in 2018-2020 at a tertiary academic medical center and calculated the predicted probability of successful vaginal birth after cesarean delivery for each patient using both original and revised classification calculators and compared these to observed birth outcomes. The area under the receiver operating characteristic curve was calculated for each model. From the cohort of 225 patients that fit inclusion criteria, 37% (n=83) identified as African-American or Hispanic. The vaginal birth after cesarean delivery success rate was 75% for the entire population, and 76% among African-American and/or Hispanic patients. The area under the receiver operating characteristic curve of the original calculator was 0.71, compared to 0.74 for the new calculator. For African-American and/or Hispanic patients, the average predicted success rates between the models rose from 60 to 69%. Our review confirmed that African-American and Hispanic patients were calculated to have a lower prediction score for a successful vaginal birth after cesarean delivery based on the original calculator as compared to the revised calculator. Our results also suggest that race/ethnicity did not significantly contribute to classification ability of the calculator in our patient population.

Household Shocks and Adolescent Well-Being in Peru.

This paper explores the linkages between exposure to household shocks across early life and children's educational and well-being outcomes in Peru. We use longitudinal survey data for a sample of 1713 children from five rounds of the Young Lives Survey to investigate how exposure to shocks across early life is linked to test scores and well-being in adolescence and to determine the extent to which critical periods of shock exposure exist. We expand on prior work by assessing the relationship between early childhood shocks and broader metrics of adolescent well-being beyond cognitive outcomes and by evaluating the cumulative impact of shocks over the course of a child's early life. We find that exposure to a greater number of shocks across early life is negatively associated with reading and vocabulary test scores. In addition, shock exposure in adolescence-versus earlier in childhood-has the strongest negative association with testing and well-being outcomes, suggesting that older children's time and household resources may be diverted away from learning and well-being in response to shocks. In light of increasingly frequent and severe weather events associated with climate change, as well as recent large-scale economic and health crises, policies aimed at supporting the most vulnerable children should be considered to alleviate the negative consequences of shocks on children's educational outcomes and well-being. Supplementary Information: The online version contains supplementary material available at 10.1007/s11113-023-09787-x.

Comparing in person and internet methods to recruit low-SES populations for tobacco control policy research.

Tobacco use and the associated consequences are much more prevalent among low-SES populations in the U.S. However, tobacco-based research often does not include these harder-to-reach populations. This paper compares the effectiveness and drawbacks of three methods of recruiting low-SES adult smokers in the Northeast. From a 5-year, [funding blinded] grant about impacts of graphic warning labels on tobacco products, three separate means of recruiting low-SES adult smokers emerged: 1) in person in the field with a mobile lab vehicle, 2) in person in the field with tablet computers, and 3) online via Amazon Mechanical Turk (MTurk). We compared each of these methods in terms of the resulting participant demographics and the "pros" and "cons" of each approach including quality control, logistics, cost, and engagement. Field-based methods (with a mobile lab or in person with a tablet) yielded a greater proportion of disadvantaged participants who could be biochemically verified as current smokers-45% of the field-based sample had an annual income of <$10,000 compared to 16% of the MTurk sample; 40-45% of the field-based sample did not complete high school compared to 2.6% of the MTurk sample. MTurk-based recruitment was substantially less expensive to operate (1/14th the cost of field-based methods) was faster, and involved less logistical coordination, though was unable to provide immediate biochemical verification of current smoking status. Both MTurk and field-based methods provide access to low-SES participants-the difference is the proportion and the degree of disadvantage. For research and interventions where either inclusion considerations or external validity with low-SES populations is critical, especially the most disadvantaged, our research supports the use of field-based methods. It also highlights the importance of adequate funding and time to enable the recruitment and participation of these harder-to-reach populations.

Issues Relevant to Population Health in Political Advertising in the United States, 2011-2012 and 2015-2016.

Policy Points Political advertising can influence which issues are public policy priorities. Population health-relevant issues were frequently referenced in televised political advertising in the 2011-2012 and 2015-2016 US election cycles, with about one-fourth of all ads aired mentioning traditional public health and health policy topics and more than half referencing broader determinants of population health. The volume of population health-relevant issues referenced in political ads varied by geography, political office, political party, and election cycle. Ads referencing broader determinants of population health (such as employment, education, or gender equality) rarely tied these determinants directly to health outcomes. CONTEXT: Political discourse is one way that policymakers and candidates for public office discuss societal problems, propose solutions, and articulate actionable policies that might improve population health. Yet we know little about how politicians define and discuss issues relevant to population health in their major source of electoral communication, campaign advertisements. This study examined the prevalence of references to population health-relevant issues conveyed in campaign advertising for political office at all levels of government in the United States in 2011-2012 and 2015-2016. Understanding advertising as part of the political discourse on topics of relevance to population health yields insights about political agenda-setting and can inform efforts to shape opinion. METHODS: We conducted a content analysis of all English-language, candidate-related campaign advertisements aired on local broadcast, national network, and national cable television in the 2011-2012 and 2015-2016 election cycles (3,980,457 and 3,767,477 airings, respectively). We analyzed the volume of coverage in these ads about issues relevant to population health, including narrowly defined public health issues as well as a broad range of other social, economic, and environmental factors that affect population health. FINDINGS: Across both election cycles and all electoral races, 26% of campaign advertising discussed issues relevant for the narrowly defined conceptualization of public health and 57% discussed issues pertinent to topics within the more expansive population health conceptualization. There was substantial variation in population health-related content in ads across election cycles, by level of political office, political party, and geographic area. Geographic variation indicates that where a person lives affects their potential exposure to political communication about various health-related topics. CONCLUSIONS: Political campaign ads in the United States frequently referenced population health-relevant content at all levels of government, although the ads rarely connected population health-relevant issues to health. Variation in volume and content of these references likely shaped public opinion and the public will to address population health-related policy.

The model standards project: creating inclusive systems for LGBT youth in out-of-home care.

This article describes the Model Standards Project (MSP), a collaboration of Legal Services for Children and the National Center for Lesbian Rights. The MSP developed a set of model professional standards governing the care of lesbian, gay, bisexual and transgender (LGBT) youth in out-of-home care. This article provides an overview of the experiences of LGBT youth in state custody, drawing from existing research, as well as the actual experiences of youth who participated in the project or spoke with project staff. It will describe existing professional standards applicable to child welfare and juvenile justice systems, and the need for standards specifically focused on serving LGBT youth. The article concludes with recommendations for implementation of the standards in local jurisdictions.