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Maternal postpartum depression has been shown to be one of the main predictors of externalizing and internalizing behaviors in toddlers and adolescents. Research suggests that presence of such behaviors can be observed as early as infancy. The current study uses longitudinal data from 247 mothers to examine the relationship between postpartum depressive symptoms at 8 weeks and the infant's externalizing and internalizing behaviors at 12 months. In unadjusted linear regression models, there were associations between postpartum depressive symptoms and infant externalizing behaviors (β=0.082, SE=0.032, p=0.012) and internalizing behaviors (β=0.111, SE=0.037, p=0.003). After controlling for potential confounding factors, including maternal age, race, education, home ownership, smoking status in the postpartum period, marital status, parenting stress, and happiness from becoming a parent, the associations between postpartum depressive symptoms and infant externalizing (β=0.051, SE=0.034, p=0.138) and internalizing behaviors (β=0.077, SE=0.040, p=0.057) were reduced and became non-significant. Furthermore, in these models the total amount of variance explained was 17.2% (p<0.0001) for externalizing behaviors and 10.5% (p<0.01) for internalizing behaviors; the only significant predictor of externalizing behaviors was maternal age (β=-0.074, SE=0.030, p=0.014), and of internalizing behaviors was white non-Hispanic ethnicity (β=-1.33, SE=0.378, p=0.0005). A combined effect of the confounding factors seems to explain the finding of no significant independent association between postpartum depressive symptoms and infant externalizing and internalizing behaviors.

Maternal postpartum depression has been shown to be one of the main predictors of externalizing and internalizing behaviors in toddlers and adolescents. Research suggests that presence of such behaviors can be observed as early as infancy. The current study uses longitudinal data from 247 mothers to examine the relationship between postpartum depressive symptoms at 8 weeks and the infant's externalizing and internalizing behaviors at 12 months. In unadjusted linear regression models, there were associations between postpartum depressive symptoms and infant externalizing behaviors (β=0.082, SE=0.032, p=0.012) and internalizing behaviors (β=0.111, SE=0.037, p=0.003). After controlling for potential confounding factors, including maternal age, race, education, home ownership, smoking status in the postpartum period, marital status, parenting stress, and happiness from becoming a parent, the associations between postpartum depressive symptoms and infant externalizing (β=0.051, SE=0.034, p=0.138) and internalizing behaviors (β=0.077, SE=0.040, p=0.057) were reduced and became non-significant. Furthermore, in these models the total amount of variance explained was 17.2% (p<0.0001) for externalizing behaviors and 10.5% (p<0.01) for internalizing behaviors; the only significant predictor of externalizing behaviors was maternal age (β=-0.074, SE=0.030, p=0.014), and of internalizing behaviors was white non-Hispanic ethnicity (β=-1.33, SE=0.378, p=0.0005). A combined effect of the confounding factors seems to explain the finding of no significant independent association between postpartum depressive symptoms and infant externalizing and internalizing behaviors.

Increasing number of studies have investigated the impact of maternal exposure to air pollution during pregnancy and adverse birth outcomes, particularly low birth weight (LBW, <2,500 g at birth) and preterm birth (PTB, <37 completed weeks of gestation). We performed a comprehensive review of the peer-reviewed literature and a meta-analysis to quantify the association between maternal exposure to particulate matter with aerodynamic diameter 2.5 and 10 μm (PM 2.5  and PM 10 ) during pregnancy and the risk of LBW and PTB. We identified 20 peer-reviewed articles providing quantitative estimate of exposure and outcome that met our selection criteria. There was significant heterogeneity between studies, particularly for findings related to PM 10  exposure (LBW,  I -squared 54%,  p  = 0.01; PTB,  I -squared = 73%,  p  < 0.01). Results from random-effect meta-analysis suggested a 9% increase in risk of LBW associated with a 10-μg/m 3  increase in PM 2.5  (combined odds ratios (OR), 1.09; 95% confidence interval (CI), 0.90–1.32), but our 95% CI included the null value. We estimated a 15% increase in risk of PTB for each 10-μg/m 3  increase in PM 2.5  (combined OR, 1.15; CI, 1.14–1.16). The magnitude of risk associated with PM 10  exposure was smaller (2% per 10-μg/m 3  increase) and similar in size for both LBW and PTB, neither reaching formal statistical significance. We observed no significant publication bias, with  p  > 0.05 based on both Begg's and Egger's bias tests. Our results suggest that maternal exposure to PM, particularly PM 2.5  may have adverse effect on birth outcomes. Additional mechanistic studies are needed to understand the underlying mechanisms for this association.

Students with chronic health conditions miss more school days than their peers and are at increased risk for performing worse on standardized tests and not completing a high school degree. University-based researchers, state government leaders, and a local county school system collaborated to use existing health and academic data to (1) evaluate the strength of the relationship between health status and school performance (absenteeism, grades) and (2) describe the health status of students who are chronically absent. Analyses included descriptive statistics, chi-square tests, negative binomial regression models, and estimated marginal means. The most common health conditions among the 3,663 kindergarten through Grade 12 students were ADD (attention deficit disorder)/ADHD (attention deficit hyperactivity disorder), asthma, migraine headaches, mental health conditions, and eczema/psoriasis/skin disorders. After controlling for covariates, having asthma or a mental health diagnosis was positively associated with absences; and having an ADD/ADHD or mental health diagnosis was negatively associated with GPA (grade point average). Chronically absent students had significantly lower GPAs, and a higher number of health conditions than other students. The success of this demonstration project encourages strengthening existing collaborations and establishing new multidisciplinary partnerships to analyze existing data sources to learn more about the relationship between student health and academic achievement. Moreover, connecting health status to academic achievement might be a chief tactic for advocating for additional resources to improve the care and management of chronic disease conditions among students.

Purpose: Reproductive autonomy is associated with educational attainment, advanced employment, and wellbeing. While U.S. Latinas use contraception to control their own childbearing and have reported a desire to do so, they often use it inconsistently and have the lowest rates of contraceptive use of any group. Reasons previously cited for why Latinas do not use contraception compared with non-Latino white women include lack of access, lack of knowledge, language barriers, emphasis on large families, machismo, and religiosity. These reasons are often overly simplistic and can lead to widespread generalizations about Latinas. Methods: Using focus groups and semistructured interviews from November 2014 through June 2015, this study describes the family planning perspectives and experiences of 16 Latinas living in Baltimore and recruited from two federally qualified health centers. A social determinant of health framework was used to guide identification of important concepts and explain findings. Results: Results demonstrated that respondents reported contraceptive agency and claimed autonomy over their bodies; described a sense of responsibility and often expressed caution about having families too large to care for; expressed educational and career aspirations; and perceived contraception as critical for the postponement of childbearing to achieve their goals. Conclusion: The patient/provider encounter should include communication that recognizes all patient preferences and lived experiences to support vulnerable and/or marginalized Latinas in their desires to control their own childbearing and life choices.

Black populations in the United States are disproportionately affected by HIV. This disparity may be affected by social and structural barriers to HIV testing, leading to undiagnosed infection and prolonged HIV transmissibility. Using data from a nationally representative sample of 1,727 Black men in the 2015 Behavioral Risk Factor Surveillance System we tested for differences in poverty, depression, and health care barriers between Black men who had been HIV tested in the past year and those who had not. We also tested a syndemic index of these factors. Number of syndemic factors was linearly associated with less HIV testing (aPR=0.79, 95% CI 0.66-0.95). Assumptions of unidimensionality were met. The use of a syndemic index was a superior approach to analyzing these factors individually, both in terms of model fit and associations detected. The accumulation of poverty, depression, and health care barriers has an adverse impact on HIV testing among Black men.

For hospital-based violence intervention programs (HVIPs), gun violence intervention and the treatment of firearm-related injuries for male survivors require a  sui generis  network of team members that includes physicians, caseworkers, mental health care providers, and violence intervention specialists (VIS). The VIS can play a vital part in the success of HVIPs, but there is no published literature about the roles, functions, and best practices of this position. A case study conducted at the Capital Region Violence Intervention Program, an emerging HVIP at the University of Maryland Prince George's Hospital Center, demonstrates the importance of the VIS fostering deep levels of interpersonal connection with survivors of violent injury. The VIS actively seeks to increase the rate of psychosocial services usage. Due to cultural competence, street experience, and a willingness to share lived experiences as a survivor of violent injury, the VIS has credibility when discussing mental health symptomatology and usage of services for young Black male survivors of violence. The relationship between the VIS and male survivors of violent injury markedly enhanced the provision of trauma-informed care, peer support, and mentoring. This case study demonstrates the importance of marshalling the shared lived experiences of the VIS to increase trust and perceived credibility by young Black male survivors of gun violence as a means to decrease trauma recidivism.

A focus of research on short interpregnancy intervals (IPI) has been on young disadvantaged women whose births are likely to be unintended. Later initiation of family formation in the United States and other high-income countries points to the need to also consider a woman’s attributes indicative of readiness for purposefully accelerated family formation achieved through short IPIs. We test for whether factors indicating “reproductive readiness”—including being married, being older, and having just had a first birth or a birth later than desired—predict a woman’s non-use of contraception in the postpartum months. We also test for whether this contraceptive non-use results explicitly from wanting to become pregnant again. The data come from the 2012–2015 Pregnancy Risk Assessment Monitoring System, representing women who recently gave birth in any of 35 U.S. states and New York City ( N  = 120,111). We find that these reproductive-readiness factors are highly predictive of women’s postpartum non-use of contraception because of a stated desire to become pregnant and are moderately predictive of contraceptive non-use without an explicit pregnancy intention. We conclude that planning for, or ambivalently risking, a short IPI is a frequent family-formation strategy for women whose family formation has been delayed. This is likely to become increasingly common as family formation in the United States is initiated later in the reproductive life course.

Importance   Millions of low-income children in the United States reside in substandard or unaffordable housing. Relieving these burdens may be associated with changes in asthma outcomes. Objectives   To examine whether participation in the US Department of Housing and Urban Development’s (HUD) rental assistance programs is associated with childhood asthma outcomes and to examine whether associations varied by program type (public housing, multifamily housing, or housing choice vouchers). Design, Setting, and Participants   This survey study used data from the nationally representative National Health Interview Survey linked to administrative housing assistance records from January 1, 1999, to December 31, 2014. A total of 2992 children aged 0 to 17 years who were currently receiving rental assistance or would enter a rental assistance program within 2 years of survey interview were included. Data analysis was performed from January 15, 2018, to August 31, 2019. Exposures   Participation in rental assistance provided by HUD. Main Outcomes and Measures   Ever been diagnosed with asthma, 12-month history of asthma attack, and 12-month history of visiting an emergency department for the treatment of asthma among program participants vs those waiting to enter a program. Overall participation was examined, and participation in public or multifamily housing was compared with participation in housing choice vouchers. Results   This study included 2992 children who were currently participating in a HUD program or would enter a program within 2 years. Among children with an asthma attack in the past year, participation in a rental assistance program was associated with a reduced use of emergency departments for asthma of 18.2 percentage points (95% CI, −29.7 to −6.6 percentage points). Associations were only found after entrance into a program, suggesting that they were not confounded by time-varying factors. Statistically significant results were found for participation in public or multifamily housing (percentage point change, −36.6; 95% CI, −54.8 to −18.4) but not housing choice vouchers (percentage point change, −7.2; 95% CI, −24.6 to 10.3). No statistically significant evidence of changes in asthma attacks was found (percentage point change, −2.7; 95% CI, −12.3 to 7.0 percentage points). Results for asthma diagnosis were smaller and only significant at the 10% level (−4.3; 95% CI, −8.8 to 0.2 percentage points). Conclusions and Relevance   Among children with a recent asthma attack, rental assistance was associated with less emergency department use. These results may have important implications for the well-being of low-income families and health care system costs.

Abstract: Public health and built environment design have a long-intertwined history of promoting a healthy quality of life. They emerged with the common goal of preventing infectious disease outbreaks in urban areas and improving occupants’ living conditions. In recent years, however, the two disciplines have become less engaged and with each developing a distinct focus. To respond to this disconnection, a systematic review was conducted to identify the connection and divergence between public health and built environment design and planning. This paper aims to establish a context for understanding the connections, synergies, and divergence between public health and built environment design disciplines. Further, the four main health factors in the built environment are identified and explained: physical, physiological, biological, and psychological factors. Finally, future trends to reconnect public health with build environment design are then outlined.