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Severe maternal morbidity continues to be on the rise in the US. Short birth spacing is a modifiable risk factor associated with maternal morbidity, yet few studies have examined this association, possibly due to few available data sources to examine these rare events. To examine the association between interpregnancy interval (IPI) and severe maternal morbidity using near‐national birth certificate data and account for known under‐reporting using probabilistic bias analysis. We used revised 2014‐2017 birth certificate data, restricting to resident women with a non–first‐born singleton birth. We examined the following: (a) maternal blood transfusion, (b) admission to intensive care unit (ICU), (c) uterine rupture (among women with a prior caesarean delivery) and (d) third‐ or fourth‐degree perineal laceration (among vaginal deliveries) by IPI categories (<6, 6‐11, 12‐17, 18‐23, 24‐59 and 60+ months). Risk ratios and 95% confidence intervals were estimated using log‐binomial regression, adjusting for select maternal characteristics. Probabilistic bias analyses were performed. Compared with IPI 18 to 23 months, adjusted models revealed that the risk of maternal transfusion followed a U‐shaped curve with IPI, while risk of ICU admission and perineal laceration increased with longer IPI. Risk of uterine rupture was highest among IPI <6 months. With the exception of maternal transfusion, these findings persisted regardless of the extent or type of misclassification examined in bias analyses. Associations between IPI and maternal morbidity varied by outcome, even after adjusting for misclassification of SMM. Differences across maternal health outcomes should be considered when counselling and making recommendations regarding optimal birth spacing.

Black sexual and gender minorities (SGM) are at greater risk for HIV compared to their White, cisgender, heterosexual counterparts. Linkage to culturally sensitive health care is, therefore, pivotal for HIV prevention and treatment of Black SGM. Unfortunately, social and structural challenges undermine Black SGM individuals' abilities to obtain adequate health care services, indicating a need to understand Black SGM perceptions of health care. To address this gap, we interviewed Black men who have sex with men and transwomen about their experiences with health care providers. Participants discussed needs and concerns, including provider SGM identity diversity and education; assumptions, judgment, stigma, and discrimination; and ability to establish a personal bond, trust, and familiarity. Black SGM indicated that providers often did not meet their needs in different ways regarding their SGM identities. Findings suggest a need for provider cultural sensitivity education programs that address the needs of Black SGM in health care.

Black sexual and gender minorities (SGM) are at greater risk for HIV compared to their White, cisgender, heterosexual counterparts. Linkage to culturally sensitive health care is, therefore, pivotal for HIV prevention and treatment of Black SGM. Unfortunately, social and structural challenges undermine Black SGM individuals' abilities to obtain adequate health care services, indicating a need to understand Black SGM perceptions of health care. To address this gap, we interviewed Black men who have sex with men and transwomen about their experiences with health care providers. Participants discussed needs and concerns, including provider SGM identity diversity and education; assumptions, judgment, stigma, and discrimination; and ability to establish a personal bond, trust, and familiarity. Black SGM indicated that providers often did not meet their needs in different ways regarding their SGM identities. Findings suggest a need for provider cultural sensitivity education programs that address the needs of Black SGM in health care.

Purpose:  Sexual minorities experience signi fi cant health disparities across a variety of mental, behav ioral, and physical health indicators. Yet, an understanding of the etiology and progression of sexual minority health disparities across the lifespan is limited. Methods:  We used the U.S. National Epidemiologic Survey of Alcohol and Related Conditions III to  evaluate the association between sexual minority status and seven past-year health outcomes (alcohol  use disorder, tobacco use disorder, drug use disorder, major depressive episode, generalized anxiety  disorder, sexually transmitted infection, and cardiovascular conditions). To do this, we used unadjusted  and adjusted logistic regression among our study sample (n ¼ 30,999; aged 18 e 65 years) and time- varying effect models to evaluate how sexual orientation differences in these outcomes vary across  adulthood. Results:  Relative to heterosexuals, sexual minorities had elevated odds of past-year alcohol use disorder  and drug use disorder across all ages (18 e 65 years) although the magnitude of the disparity varies by  age. Sexual minorities were also more likely to experience major depressive episode, generalized anxiety  disorder, tobacco use disorder, sexually transmitted infection, and cardiovascular disease, but only at  speci fi c ages. Conclusions:  Sexual minority health disparities vary appreciably across the adult lifespan, thus eluci dating critical periods for focused prevention efforts.

BACKGROUND: Preliminary evidence suggests that sexual minority (e.g. lesbian, gay, bisexual, and same-sex attracted) youth are overrepresented in child welfare services. Yet, no study to date has been able to test this hypothesis with national data. OBJECTIVE: Using a two-study design, we test whether sexual minority youth are overrepresented in child welfare, foster care, and out-of-home placement using nationally representative data from the United States. PARTICIPANTS AND SETTING: Study 1 data are from the National Longitudinal Study of Adolescent to Adult Health (n = 14,154; Mean age = 15.4). Study 2 data are from wave three of the National Survey of Child and Adolescent Well-Being II (n = 1309; Mean age = 15.0). METHODS: For Study 1, we use adjusted logistic regression models to test differences in lifetime foster care involvement between sexual minority and heterosexual youth. In Study 2, we calculate a Disproportionality Representation Index (DRI) - a ratio of sample prevalence relative to the general population - to estimate whether sexual minority youth were overrepresented in child welfare and out-of-home care. RESULTS: Study 1 results indicate that sexual minority youth are nearly 2.5 times as likely as heterosexual youth to experience foster care placement (aOR = 2.43, 95% CI 1.40, 4.21, p = .002). Results from Study 2 show that sexual minority youth were largely overrepresented in child welfare services (DRI = 1.95-2.48) and out-of-home placement (DRI = 3.69-4.68). CONCLUSIONS: Findings are the first to demonstrate sexual minority youth's overrepresentation in child welfare, foster care, and out-of-home placement using nationally representative data and emphasizes the need for focused research on sexual minority youth involved in the child welfare system.

Gay‐Straight Alliances (GSA) and school policies focused on support for lesbian, gay, bisexual, transgender, and queer/questioning youth may reduce bias‐based bullying and enhance social supports in schools. Using multivariate regression, we tested the relationship between youth reports of the presence of GSAs and LGBTQ‐focused policies, independently and mutually, with experiences bullying and perceived support ( n  =   1,061). Youth reported higher classmate support in the presence of GSAs and higher teacher support in the presence of LGBTQ‐focused policies; the presence of both GSAs and LGBTQ‐focused policies was associated with less bullying and higher perceived classmate and teacher support. The findings indicate that GSAs and LGBTQ‐focused policies are distinctly and mutually important for fostering safer and more supportive school climates for youth.

This study investigates the relationship between maternal employment and state-to-state differences in childcare cost and mean school day length. Pairing state-level measures with an individual-level sample of prime working-age mothers from the American Time Use Survey (2005–2014; n = 37,993), we assess the multilevel and time-varying effects of childcare  costs  and  school  day  length  on  maternal  full-time  and  part-time  employment  and  childcare  time.  We  find  mothers’ odds of full-time employment are lower and part-time employment higher in states with expensive childcare and shorter school days. Mothers spend more time caring for children in states where childcare is more expensive and as childcare costs increase. Our results suggest that expensive childcare and short school days are important barriers to maternal employment and, for childcare costs, result in greater investments in childcare time. Politicians engaged in national debates about federal childcare policies should look to existing state childcare structures for policy guidance. DOI: https://doi.org/10.1177/2378023119860277

Background: While alcohol consumption is pervasive in the country of Georgia, the extent of alcohol consumption among pregnant women is yet to be examined. The goal of this study is to examine prevalence and correlates of alcohol consumption during pregnancy in Georgia. Methods: Using data from the World Health Organization’s Stepwise approach to noncommunicable disease risk factor surveillance in Georgia, this study examined prevalence and sociodemographic correlates of alcohol use among pregnant women in Georgia. The study sample of reproductive age (18-45) women was drawn from the STEPS, which is a large and nationally representative survey of adults with a 95% participation rate. Frequencies, multivariate analyses and related statistics were computed to describe and study associations among the target population and the odds of alcohol consumption during pregnancy. Results: Only 66 individuals in the sample were pregnant. About 13% of pregnant women consumed alcohol in the past 30 days and nearly 70% of them engaged in binge drinking on at least one occasion. Pregnant women who were young, married, homemakers, living in two-member households and in the lowest bracket of monthly income had the highest likelihood of consuming alcohol and binge drinking. The study results were statistically significant (p< .05). Conclusions: This study reveals the magnitude of alcohol consumption and binge drinking among reproductive age women in Georgia. This study also shows prevalence and correlates of alcohol consumption during pregnancy in Georgia. The results identify characteristics of women who are most likely to use alcohol during pregnancy. Given that, alcohol use is a modifiable behavioral risk factor, the findings in this study provide the foundation for evidence-based prevention strategies that target pregnant and reproductive age women.

The quantitative scholarship on domestic labor has documented the existence of a gender gap in its performance in all countries for which data are available. Only recently have researchers begun to analyze economic disparities  among  women in their time spent doing housework, and their studies have been largely limited to the U.S. We extend this line of inquiry using data from two European countries, the former West Germany and Sweden. We estimate the “economic gap” in women’s housework time, which we define as the difference between the time spent by women at the lowest and highest deciles of their own earnings. We expect this gap to be smaller in Sweden given its celebrated success at reducing both gender and income inequality. Though Swedish women do spend less time on domestic labor, however, and though there is indeed less earnings inequality among them, the economic gap in their housework is only a little smaller than among women in the former West Germany. In both places, a significant negative association between women’s individual earnings and their housework time translates into economic gaps of more than 2.5 hours per week. Moreover, in both countries, women at the highest earnings decile experience a gender gap in housework that is smaller by about 4 hours per week compared to their counterparts at the lowest decile.

Objectives To assess risk and protective factors associated with bacterial vaginosis (BV) chronicity ascertained by Nugent score criteria. Methods A longitudinal cohort study included 255 sexually experienced, postmenarcheal women who provided weekly self-collected vaginal swabs for up to 2 years. Vaginal swabs were scored using Nugent criteria and classified as normal (≤3), intermediate (4–6) and Nugent-BV (≥7). Detailed behavioural/health information were assessed every 6 months. A per-woman longitudinal summary measure of BV chronicity was defined as the percentage of each woman’s weekly vaginal assessments scored as Nugent-BV over a 6-month interval. Risk and protective factors associated with BV chronicity were assessed using multiple linear regression with generalised estimating equations. Results Average BV chronicity was 39% across all follow-up periods. After adjustment, factors associated with BV chronicity included baseline Nugent-BV (β=35.3, 95% CI 28.6 to 42.0) compared with normal baseline Nugent scores and use of unprotected water for bathing (ie, rainwater, pond, lake/stream) (β=12.0, 95% CI 3.4 to 20.5) compared with protected water sources (ie, well, tap, borehole). Women had fewer BV occurrences if they were currently pregnant (β=−6.6, 95% CI −12.1 to 1.1), reported consistent condom use (β=−7.7, 95% CI −14.2 to 1.3) or their partner was circumcised (β=−5.8, 95% CI −11.3 to 0.3). Conclusions Factors associated with higher and lower values of BV chronicity were multifactorial. Notably, higher values of BV chronicity were associated with potentially contaminated bathing water. Future studies should examine the role of waterborne microbial agents in the pathogenesis of BV.