ABSTRACT
BACKGROUND AND OBJECTIVES: Although mortality rates are highest for infants of teens aged 15 to 19, no studies have examined the long-term trends by race and ethnicity, urbanicity, or maternal age. The objectives of this study were to examine trends and differences in mortality for infants of teens by race and ethnicity and urbanicity from 1996 to 2019 and estimate the contribution of changes in the maternal age distribution and maternal age-specific (infant) mortality rates (ASMRs) to differences in infant deaths in 1996 and 2019. METHODS: We used 1996 to 2019 period-linked birth and infant death data from the United States to assess biennial mortality rates per 1000 live births. Pairwise comparisons of rates were conducted using z test statistics and Joinpoint Regression was used to examine trends. Kitagawa decomposition analysis was used to estimate the proportion of change in infant deaths because of changes in the maternal age distribution and ASMRs. RESULTS: From 1996 to 2019, the mortality rate for infants of teens declined 16.7%, from 10.30 deaths per 1000 live births to 8.58. The decline was significant across racial and ethnic and urbanization subgroups; however, within rural counties, mortality rates did not change significantly for infants of Black or Hispanic teens. Changes in ASMRs accounted for 93.3% of the difference between 1996 and 2019 infant mortality rates, whereas changes in the maternal age distribution accounted for 6.7%. CONCLUSIONS: Additional research into the contextual factors in rural counties that are driving the lack of progress for infants of Black and Hispanic teens may help inform efforts to advance health equity.
Subject(s)
Ethnicity , Health Status Disparities , Infant Mortality , Adolescent , Humans , Infant , Hispanic or Latino , Infant Death , Maternal Age , United States/epidemiology , Adolescent Mothers , Female , Black or African AmericanABSTRACT
When compared with births among women aged 20 and over, teen pregnancies result in higher rates of neonatal and infant mortality, preterm birth, low birthweight, and maternal complications (1,2). Despite the declining birth rate for teenagers aged 15-19 since 1991, differences continue to occur in the mortality of infants born to teenagers by race and ethnicity and cause of death (1,3). This report examines 2017-2018 linked birth/infant death data from the National Vital Statistics System to describe the recent pattern in racial and ethnic differences in mortality and the leading causes of death for infants born to teen mothers aged 15-19.
Subject(s)
Cause of Death/trends , Infant Mortality/ethnology , Infant Mortality/trends , Pregnancy in Adolescence , Adolescent , Ethnicity , Female , Humans , Infant , Pregnancy , Race Factors , United States/epidemiology , United States/ethnology , Vital Statistics , Young AdultABSTRACT
BACKGROUND: African Americans have persistently poor access to living donor kidney transplants (LDKT). We conducted a small randomized trial to provide preliminary evidence of the effect of informational decision support and donor financial assistance interventions on African American hemodialysis patients' pursuit of LDKT. METHODS: Study participants were randomly assigned to receive (1) Usual Care; (2) the Providing Resources to Enhance African American Patients' Readiness to Make Decisions about Kidney Disease (PREPARED); or (3) PREPARED plus a living kidney donor financial assistance program. Our primary outcome was patients' actions to pursue LDKT (discussions with family, friends, or doctor; initiation or completion of the recipient LDKT medical evaluation; or identification of a donor). We also measured participants' attitudes, concerns, and perceptions of interventions' usefulness. RESULTS: Of 329 screened, 92 patients were eligible and randomized to Usual Care (n = 31), PREPARED (n = 30), or PREPARED plus financial assistance (n = 31). Most participants reported interventions helped their decision making about renal replacement treatments (62%). However there were no statistically significant improvements in LDKT actions among groups over 6 months. Further, no participants utilized the living donor financial assistance benefit. CONCLUSIONS: Findings suggest these interventions may need to be paired with personal support or navigation services to overcome key communication, logistical, and financial barriers to LDKT. TRIAL REGISTRATION: ClinicalTrials.gov [ NCT01439516 ] [August 31, 2011].
Subject(s)
Black or African American , Decision Support Techniques , Financial Support , Kidney Transplantation/methods , Living Donors , Renal Dialysis/methods , Adult , Black or African American/psychology , Aged , Decision Making , Female , Health Knowledge, Attitudes, Practice , Humans , Kidney Transplantation/economics , Kidney Transplantation/psychology , Living Donors/psychology , Male , Middle Aged , Patient Participation/economics , Patient Participation/methods , Patient Participation/psychology , Renal Dialysis/economics , Renal Dialysis/psychology , Tissue and Organ Procurement , Treatment OutcomeABSTRACT
PURPOSE: The aim of this study was to determine whether increasing the overall speech level or the individual spectral contrasts of vowel sounds can improve vowel formant discrimination for listeners both with and without normal hearing. METHOD: Thresholds of vowel formant discrimination were examined for the F2 frequencies of 3 American English vowels for listeners with and without normal hearing. Spectral contrasts of the F2 were enhanced by 3, 6, and 9 dB. Vowel stimuli were presented at 70 and 90 dB SPL. RESULTS: The thresholds of listeners with hearing impairment were reduced significantly after spectral enhancement was implemented, especially at 90 dB SPL, whereas normal-hearing listeners did not benefit from spectral enhancement. CONCLUSION: These results indicate that a combination of spectral enhancement of F2 and high speech level is most beneficial to improve vowel formant discrimination for listeners with hearing impairment.
