Demographic and relationship predictors of paternity establishment for infants born to adolescent mothers.

STUDY OBJECTIVE: To identify demographic and relationship characteristics associated with paternity establishment for children born to adolescent mothers. PARTICIPANTS, SETTING, AND DESIGN: This prospective cohort study included 300 pregnant adolescents 12-19 years old, presenting for prenatal care between March 2002 and February 2005. Demographic and relationship characteristics were compared based on paternity establishment (father's name on the infant's birth certificate). MAIN OUTCOME MEASURE: Paternity establishment (father's name on the infant's birth certificate). RESULTS: Of the 273 participants with outcome data, 54% established paternity. Paternity establishment differed by maternal race/ethnicity (69% Hispanic vs 36% non-Hispanic Black vs 52% non-Hispanic White, P = .01), maternal age (37% for 12-15 years vs 64% for 18-19 years, P = .01), maternal country of birth (48% U.S. born vs 76% non-U.S. born, P = .01), relationship with father of the infant, and father involvement at the time of delivery. CONCLUSION: Paternity establishment rates for children born to teens were low overall. To increase rates of paternity establishment, policies and programs need to consider the unique characteristics and circumstances of teen parents.

Willingness of gynecologic cancer patients to participate in clinical trials.

OBJECTIVES: Fewer than 5% of cancer patients enroll in clinical trials, delaying their completion and the progress of patient care. Patients who are elderly or members of ethnic minorities participate at even lower rates than the general population. The objective of this study was to identify the factors that motivate or inhibit patient enrollment specifically within the gynecologic oncology population. METHODS: An anonymous, voluntary survey was administered to all new patients presenting in the outpatient gynecologic oncology office for an initial consultation. The questionnaire was developed based on prior surveys in the general oncology literature and included questions about age, demographic information, interest in participation in research, and reasons for declining or desiring participation. Groups were compared with Fisher's Exact Test. RESULTS: There were 98 surveys submitted, of which 79 surveys were completed and included for analysis. The median age of patients was 50 years and the majority (86%) was Caucasian. Only 38% stated they would be unwilling to participate in clinical research, while 20% of the patient population stated they would be willing to participate in clinical trials and 42% were unsure. Factors that reached statistical significance (p=.05) in willingness to participate were age less than 50 years, education level beyond high school, and possession of private insurance. CONCLUSIONS: The percentage of women with gynecologic malignancies willing to participate in clinical trials greatly exceeds the number enrolled. Increasing the use of educational materials, improving patient awareness of clinical trials, and offering enrollment to all patients may increase accrual.

Cognitive functioning in the last year of life as a function of age, gender, and race.

Research has shown that many factors affect cognitive functioning. In this study cognitive functioning was analyzed using proxy reports concerning 17,135 decedents included in the 1993 National Followback Mortality Study conducted for the National Center for Health Statistics. These responses form a representative sample of all U.S. residents over age 15 who died in 1993 (except for those in South Dakota, which did not participate). Decedents had more difficulty understanding where they were than remembering what year it was or in recognizing family members. Logistic regression models found that age, gender, and race were the most important predictors of these basic cognitive functions. Although increasing age was associated with more cognitive difficulties, men had fewer deficits than women and Black Americans tended to have fewer deficits than White Americans. Possible reasons for these findings are discussed as well as some general implications for health service provision.

Dying trajectory in the last year of life: does cancer trajectory fit other diseases?

PURPOSE: To examine differences in the pattern of functional decline among persons dying of cancer and other leading noncancer causes of death. DESIGN: Mortality followback survey of next of kin listed on death certificate. SETTING: Probability sample of all deaths in the United States. PARTICIPANTS: Next of kin for 3,614 decedents that represented 914,335 deaths. MEASUREMENTS: Days of difficulty with activities of daily living and mobility in the last year of life. RESULTS: Relative to other decedents, patients with cancer experienced an increased rate of functional impairment beginning as late as 5 months prior to death. For example, only 13.9% of patients with cancer had difficulty getting out of bed or a chair 1-year prior to death. This increased from 22.2% to 63.0% in the last five months of life. In contrast, decedents from other diseases had higher rates of functional impairment 1 year prior to death (approximately 35% had difficulty getting out of bed or chair) and they manifested a more gradual increase in the level of functional decline (approximately 50% had difficulty getting out of bed). Precipitous functional decline was associated with hospice involvement and dying at home. CONCLUSION: Persons dying of cancer experienced sharp functional decline in the last months of life whereas other decedents' have a more gradual decline. The more precipitous functional decline was associated with hospice involvement and dying at home.