For over 10 years, the Wisconsin-based Providers and Teens Communicating for Health (PATCH) Program has worked alongside youth ages 14–19 to enhance adolescent health programs, policies, and practices. This evaluation explores the lasting effects on those who participated in the PATCH program as an adolescent. All former Wisconsin PATCH participants were invited to complete a retrospective pre-post survey that asked them to reflect on their attitudes, actions, and knowledge before and after participating in PATCH. The survey used 5-point Likert scales and open-ended questions to comprehensively assess themes such as job exploration and readiness, relationships and connectedness, advocacy, self-worth, stigma, and health- and healthcare-related knowledge, confidence, and behaviors. A total of 104 past participants completed the survey. All 11 scales showed significant changes (p < .001), and qualitative analysis yielded 6 key themes, including the program’s impact on sense of community and interpersonal relationships, advocacy, and workforce development. These findings contribute to the understanding of the long-term benefits of youth engagement in health programs and provide valuable insights for practitioners aiming to develop and enhance similar initiatives. Furthermore, they underscore the critical role of sustained, structured youth involvement in achieving meaningful and lasting improvements in adolescent health. Youth engagement is an important component of Maternal and Child Health efforts. Evaluations of different types of youth engagement programs demonstrate a wide array of short-term positive impacts. Less is known about the long-term impact of participation. This article builds on existing literature and explores the longer-term impacts of participation in a health-focused youth engagement program. This evaluation explores the wide-reaching impact of youth participation in this program on their personal and social development, workforce and professional development, and overall health and well-being.
Maternal psychological distress during COVID-19 has been linked to reduced neonatal brain volume. This study aimed to determine whether mandatory COVID-19 lockdown exposure was associated with reduced fetal head growth and to identify maternal, behavioral, and obstetric factors associated with this relationship. A retrospective cohort study compared pregnancies during mandatory COVID-19 lockdown (March–December 2020) with the corresponding 2019 period. Women with SARS-CoV-2 infection, multiple gestations, and congenital anomalies or infections were excluded. The primary outcome was third-trimester fetal head circumference (HC) z-score. Covariates included maternal demographic, obstetric, and clinical factors, including prenatal smoking (consistent reporting at every prenatal visit). Linear mixed-effects models with interaction terms were used. A total of 1,116 pregnancies (545 exposed, 571 unexposed) were included. Lockdown exposure was associated with greater weight gain (11 vs. 10 kg, p < 0.01), higher prenatal smoking (6.1
Childhood immunization coverage remains low in Afghanistan, but evidence is limited regarding completion of the broader national immunization schedule beyond the first year of life. This study estimated full-schedule immunization coverage and examined factors associated with its completion among Afghan children aged 24–35 months. We analysed nationally representative data from the Afghanistan Multiple Indicator Cluster Survey (MICS) 2022–23, including 6342 children aged 24–35 months. Full immunization was defined according to the MICS TC.11b indicator for completion of all vaccinations included in the national childhood immunization schedule. Survey-weighted analyses estimated vaccine-specific coverage, within-series dropout and provincial variation. A prespecified survey-weighted multivariable logistic regression model was used to identify factors associated with full-schedule completion. Only 16.2
Growing CAPITOL 4 Life is a place-based public health initiative focused on the first 1000 days (F1D), from conception to a child’s second birthday. It sought to strengthen community capacity for early-childhood health by leveraging local knowledge, assets and partnerships, while moving beyond one-way information provision towards sustained learning, empowerment and collective action. This study retrospectively examined the co-design process through the lens of the Double Diamond. Parents, educators, service providers and community stakeholders across Burnie, Circular Head and Devonport, Tasmania, participated in co-design workshops. Engagement spanned government, local government, Aboriginal organizations, libraries and community services. The process was facilitated by a place-based systems-change organization and supported by the University of Tasmania. Community members contributed lived experience alongside professional and academic knowledge, with decision-making remaining largely community-led and guided by the principle of “for the community, by the community.” Across the four phases, communities moved from sharing experiences and identifying strengths and challenges (Discover), to refining priorities (Define), developing locally relevant resources and learning approaches (Develop), and shaping feasible delivery models (Deliver). The process centered on the F1D domains of Connection, Nutrition, Caring and Moving and resulted in community-informed Evidence Briefs, workshops and playgroup-based learning. Importantly, the Double Diamond was reflected not as a prescribed sequence, but as a recurring pattern of opening outward to explore and narrowing inward to make sense, prioritize and act. Discussions moved organically between what was working, what was missing, what an ideal future might look like and how communities could move towards it. The findings suggest that the value of the Double Diamond in public health lies less in adherence to predefined stages than in providing sufficient structure for purposeful exploration while preserving community agency. This flexible approach may support locally relevant, acceptable and trusted solutions, particularly in complex regional settings where effective public health responses must emerge from, rather than be imposed upon, communities. F1D, spanning from conception to a child’s second birthday, represents a critical developmental window with lasting implications for health and well-being. Public health initiatives increasingly emphasize this period to prevent disease, promote healthy growth, and optimize potential. This case study demonstrates that the Double Diamond co-design method can be effectively applied in small regional communities. It highlights the value of community-led decision-making, shared care principles, and context-specific implementation to enhance program acceptability, sustainability, and impact.
Stillbirth is a traumatic event with potentially lifelong effects on maternal mental health, but there are few clinical guidelines or resources for supporting families. Additionally, the effects of parental autopsy decision-making and knowledge of cause of death effect on maternal mental health is unclear. We evaluated associations between autopsy decision, cause of death determination, and maternal mental health in data from the multi-center, five region Stillbirth Collaborative Research Network (2006-2008). Secondarily, we examined psychosocial risk factors associated with adverse MMH outcomes. Maternal mental health was assessed at single time point within 6–36 months after stillbirth delivery. Exposures included autopsy decision (none, partial, full) and knowledge of cause of death (known, unknown). Adverse maternal mental health was defined as abnormal scores on one or more validated instruments assessing depression, grief, distress, post-traumatic growth, and change in substance use. Psychosocial risk factors included childhood trauma and perceptions of support or blame. Logistic regression identified associations with maternal mental health outcomes. Among 272 participants (44
Childhood malnutrition remains a major public health challenge with significant implications for child survival and development. Understanding the differential determinants of stunting, wasting, and underweight is essential for designing targeted interventions. To identify and analyze factors associated with stunting, wasting, and underweight among children under five years in Rajasthan, India, using data from the National Family Health Survey (NFHS-5, 2019–21). A cross-sectional study was conducted using data on 12,549 children aged 0–59 months. Nutritional outcomes were defined using the WHO Child Growth Standards. Multivariate logistic regression analyses were performed separately for stunting, wasting, and underweight to assess their associations with socio-demographic and maternal factors. The prevalence of stunting, wasting, and underweight was 32.14
The prevalence of chronic conditions continues to increase in the United States, disproportionately affecting low-income women and Medicaid beneficiaries. This study examined whether an accountable care approach implemented in Oregon Medicaid, known as Coordinated Care Organizations (CCOs), which integrates the delivery of physical and mental health services, may improve high-value healthcare utilization during pregnancy among female Oregon Medicaid beneficiaries with chronic mental-physical comorbidities (MPCs). We performed a retrospective analysis of Oregon Medicaid data from 2008 to 2016, linked with birth certificates and hospital discharge records. Measures of high-value utilization included timely and adequate prenatal care visits, preventable hospitalizations, and preventable emergency department (ED) visits. We utilized a quasi-experimental difference-in-differences approach, comparing the pre-post changes in the outcomes between CCO enrollees and other Medicaid beneficiaries. CCO enrollment was associated with greater odds of having the first prenatal care visit in the first trimester of pregnancy (OR 1.51, CI 1.21, 1.88) and the adequacy of prenatal care (OR 1.40, CI 1.10, 1.78) among women with MPCs. However, no statistically discernible associations were found for preventable hospitalization and ED visits. CCOs are effective in improving timely and adequate utilization of prenatal care among women with MPCs. Further research is needed to understand whether and how CCOs may reduce preventable costly healthcare utilization among women with MPCs during and beyond pregnancy. The rising prevalence of multiple chronic physical conditions in the United States, particularly among women, is a cause for concern, especially as these conditions often co-occur with mental illnesses. Low-income pregnant women with chronic mental-physical comorbidities (MPCs) face limited access to healthcare and increased healthcare costs. Oregon Medicaid’s implementation of Coordinated Care Organizations (CCOs) in 2012, has demonstrated potential to enhance prenatal care and neonatal outcomes, reducing preventable hospitalizations among female Medicaid enrollees. However, no research has been conducted to investigate the effects of CCOs, which are designed to provide integrated physical and mental healthcare delivery on a high-risk subpopulation of women with MPCs. This study addressed the existing gap in the literature by examining the impact of Oregon’s CCO model on healthcare utilization for low-income childbearing women with chronic MPCs. Given the ongoing healthcare system innovations across the country, it is crucial to determine whether and how the care delivery model may improve the utilization of healthcare services that would benefit both the healthcare system and patients, particularly those low-income individuals with complex needs.
Unmet need for family planning (UNFP) among adolescent girls and young women (AGYW) remains a major public health concern because it contributes to unintended pregnancy and adverse reproductive health outcomes. Although Nepal has expanded family planning programs over the past decade, evidence on trends and factors associated with UNFP among AGYW is limited. This study assessed trends and factors associated with UNFP among currently married AGYW aged 15–24 years using nationally representative data from the 2011, 2016, and 2022 Nepal Demographic and Health Surveys. Data from currently married AGYW aged 15–24 years were analyzed. UNFP was categorized as unmet need for spacing or limiting, defined as non-use of contraception despite intending to delay or stop childbearing. A binary overall UNFP variable (no unmet need vs. total unmet need) and a multinomial UNFP variable (no unmet need, unmet need for spacing and unmet need for limiting) were analyzed. In the first case, modified Poisson regression with robust standard errors was used to estimate Adjusted Prevalence Ratios (aPRs), while, in the second case, multinomial logistic regression was performed to calculate adjusted Relative Risk Ratios (RRR) for UNFP related to spacing and limiting needs, compared to no UNFP. All statistical analyses were performed using R version 4.6.1. Overall UNFP declined from 39.1
Maternal nutrition and lifestyle during pregnancy critically influence health outcomes for mother and child. While many countries developed national dietary and lifestyle guidelines (DGs) for pregnant women, in the Eastern Mediterranean Region (EMR), the availability, quality, and coverage of such guidelines remain largely undocumented and inconsistent. This review assesses national DGs for pregnant women in the EMR, identifying gaps, strengths, and opportunities for enhancement. A scoping review was conducted between October 2024 and January 2025, following the PRISMA-ScR framework. Systematic searches were performed across general search engines (Google Search and Google Scholar) and academic databases (PubMed and Scopus). National DGs were included if they addressed nutrition or lifestyle recommendations for pregnant women in any of the 22 EMR countries. Thematic analysis was used to map and evaluate content and structure. Themes were identified inductively from the EMR guidelines and contextualized against established international guidelines. Eleven EMR countries had DGs targeting pregnant women. Fourteen key themes were identified. Most guidelines covered diet, supplements, and gestational weight gain; meanwhile, hydration, physical activity, food safety, religious fasting, and gestational diabetes (GDM) were partially-addressed or absent. Lebanon and Saudi Arabia had the most comprehensive guidelines, addressing over 11 themes each. Only Lebanon adopted a dietary pattern-based approach. Few guidelines included medical consultation for supplementation or culturally-sensitive messaging. This review revealed that several EMR countries lack national DGs for pregnant women, highlighting the importance of encouraging and supporting their development. Few existing guidelines were comprehensive, with key themes like GDM, hydration, and religious fasting often absent. There is a need for more structured, context-specific, and inclusive guidelines across the region. Maternal nutrition and lifestyle during pregnancy are key to maternal and child health. While some countries have developed national guidelines for pregnant women, the availability and content of such guidelines in the Eastern Mediterranean Region (EMR) have not been systematically reviewed. This study maps existing guidelines and identifies their strengths and gaps. While several guidelines comprehensively covered key dietary and lifestyle recommendations, omission of key themes such as religious fasting, hydration, and gestational diabetes highlights the need for contextualization. This review provides the first regional overview and highlights the need for more culturally sensitive, context-specific guidance in the EMR.
To examine whether pre-pandemic state Medicaid expansions for adults affected children's healthcare access and utilization, child health, and parental health during the COVID-19 pandemic. The sample includes children from households with incomes up to 138
Youth experiencing homelessness (YEH) are 5–8 times more likely than housed peers to become pregnant. A more nuanced examination of YEH pregnancy desire may better inform pregnancy and pregnancy prevention guidance. This study examined pregnancy ambivalence, pregnancy history, condom use, and contraceptive use among sexually active YEH. We utilized baseline data of YEH aged 16–25 from a randomized controlled trial published elsewhere (Santa Maria et al., 2021). Pregnancy desire was categorized as ambivalence (43
Autism spectrum disorder (ASD) is a complex neurodevelopmental condition. Diagnosis is based on developmental history and behavioral observation. Parental age has been identified as a potential risk factor for ASD. This study aimed to assess the association between maternal age, paternal age, parental education level, smoking history, and ASD risk. This case-control study included 154 individuals with ASD and 335 controls. Demographic, clinical, and familial data were collected through structured questionnaires and interviews. Statistical analysis included descriptive statistics and chi-square tests for categorical variables. A total of 489 participants were included (154 ASD cases and 335 controls). The ASD group was predominantly male (77
To examine associations between virtual prenatal care utilization, social determinants of health, and stressful life events. We analyzed cross-sectional pooled survey data (N = 11,966) from phase 8 of the Pregnancy Risk Assessment Monitoring System for women who gave birth in 2020 or 2021 and received prenatal care. A third (35
Although close to 1 in 10 children under age 2 gain excess weight and can remain overweight throughout life, engaging parents in early preventative interventions is challenging because they may not recognize the issue of overweight in infancy. This study aimed to inform knowledge about maternal perceptions of infant obesity, to investigate topics of interest for program content and identify barriers and facilitators to parental engagement. Mothers (N = 240) of 0 to 24-month-old children completed an online cross-sectional survey. The majority of mothers were aware that overweight can affect infants, however most considered that excess weight becomes an issue only after 2 years of age and believed that parents should be more worried about their child being underweight than overweight. Mothers were also open to participating in a parenting program, were mostly interested in program content about promoting babies’ health but not feeding, and preferred advertisements for positive parenting and promoting babies’ health rather than preventing infant obesity. These findings can help to develop effective strategies to enhance parental engagement and optimize parenting interventions in infant obesity prevention research. Excess weight in infancy is associated with an increased risk of obesity across the life course, yet engaging parents in early obesity prevention remains challenging. Parents may not perceive infant overweight as a concern and may be more focused on preventing underweight. This study adds to the literature by examining mothers’ perceptions of infant obesity alongside their preferences for parenting program content and promotional messaging. Findings suggest that framing interventions around positive parenting and promoting babies’ health, rather than explicitly focusing on obesity prevention, may provide a more acceptable approach to engaging parents in early prevention efforts.
Adolescent pregnancy has garnered public interest due to its implications for health, social dynamics, and economic outcomes. Fatherhood contributes to the formation of the identity of young men, particularly during their transition to adulthood. Prenatal care presents a valuable opportunity to involve adolescent fathers in parenting and supporting their pregnant partners. This study aims to investigate how adolescent fathers perceive fatherhood while attending a specialized prenatal clinic. This qualitative study focused on 14 expectant adolescent fathers aged up to 19 years, recruited from a specialized prenatal care clinic at a tertiary hospital in Brazil. Employing a purposive sampling strategy, we utilized in-depth interviews, sociodemographic questionnaires, and field diaries for data collection. Data analysis involved content analysis, contextualized within the framework of Health Psychology. We raised four categories: (1) “Myself, a dad?!”: reactions to a positive pregnancy test and the young men’s concepts of fatherhood; (2) The imagined relationship with the baby and expectations for the future; (3) The new dynamics in the relationship with the female adolescent during pregnancy; and (4) The influence of the social circles on the development of fatherhood: the family of origin and the friends. The findings underscore the importance of integrating adolescent fathers into healthcare initiatives, addressing critical life-course topics such as family planning, bonding with the child, social support networks, and assistance for adolescent women. These insights highlight the potential for prenatal care settings to offer comprehensive support and guidance to young men navigating their parental roles. Adolescent fatherhood can lead to negative socioeconomic consequences for young men, including lower education attainment, higher rates of early marriages, and premature entry into the workforce. In the context of best practices for prenatal care, actively engaging fathers in the pregnancy and childbirth process offers significant clinical and psychological benefits for the fathers themselves, as well as for the women and the infants. Consequently, it is essential to better understand the lived experience of expectant adolescent fathers attending prenatal care appointments. The adolescent males interviewed acknowledged the need for behavioral, idealized their future relationships with their babies, and reported positive shifts in their relationships with their partners. They also highlighted the crucial role of family and friends in fostering a positive outlook on fatherhood. However, perceptions of fatherhood varied based of their circumstances. A clear contrast exists between those who planned the pregnancy, those who did not plan it but anticipated a lasting relationship with their partner, and those who did not plan it and doubted the longevity of the relationship.
To examine the strength of perception of tobacco smoking risk, maternal-fetal attachment, and perceived stress as factors for predicting pregnant women’s smoking status, after controlling for socioeconomic variables. This is a cross-sectional, predictive correlational study with a convenience sample recruited from a private prenatal clinic and a federally funded community health clinic in one central Illinois county. Women 18 years or older, at 24 weeks gestation or greater, were surveyed during their prenatal appointments, utilizing the Maternal Antenatal Attachment Scale, the Perceived Stress Scale, the Modified Perception of Pregnancy Risk Questionnaire (MPPRQ), and obstetric, demographic and socioeconomic questions to determine if maternal-fetal attachment, perceived stress, and perceived risks from smoking tobacco (smoking) predict smoking status during pregnancy. We found higher perceived smoking tobacco risk predicted women were likely to not currently use tobacco [p = .004, Exp(B) = 0.96, 95
This study analyzes how the Massachusetts Paid Family Medical Leave (PFML) program impacts parental leave utilization and breastfeeding duration and exclusivity. Multiple organizations recommend exclusive breastfeeding for the first six months of life to protect against disease and promote cognitive growth. We used data from the Massachusetts Pregnancy Risk Assessment Monitoring Surveillance System to calculate prevalence and duration of parental leave and breastfeeding. The sample included 3,480 Massachusetts residents who gave birth in state between 2016 and 2022, oversampled by race and Hispanic ethnicity. We used survival analysis to identify how parental leave and other factors affect breastfeeding duration and exclusivity. In 2021–2022, an additional 3.7 weeks of leave were taken on average in comparison to prior years (14.4 weeks vs. 10.7 weeks, p < 0.05), and 73.3
Home visiting (HV) services promote child and family well-being, with most services targeting families at risk of experiencing health disparities. Yet, services remain underutilized by eligible populations. Moreover, those who do enroll in services often drop out before receiving the full dosage of home visits. The present study utilized the family engagement framework developed by the Cross-Model Collaboration and Data Sharing project (MODS) to examine internal constructs of engagement. Specifically, the primary study aim was to understand internal factors that may influence caregivers’ decision-making when offered evidenced-based home visiting services. Participants included 19 parents ages 21 through 43 years, all identifying as female. Semi-structured qualitative interviews were conducted on Zoom and then transcribed. Thematic analysis was conducted to draw out themes and subthemes using NVivo 14. Parents perceived the in-home service model and HV provision of support as appealing aspects of HV. Most parents were satisfied with their current areas of parenting but expressed interest in learning new parenting strategies. Parents needed more information about HV providers to aid their decision to enroll and simplified enrollment processes. Results suggest enhancing the enrollment process by providing more information about provider qualifications and minimizing administrative burdens, which in turn may increase family engagement with HV. HV promotes child and family well-being, with most services targeting families at risk of experiencing health disparities. However, enrollment among eligible families remains low. Research on HV engagement has focused on later stages of family engagement, such as participation and retention, with limited insight into a family’s decision to enroll. The study fills a critical gap in HV research by investigating the less studied internal states of family engagement, including perceptions, beliefs, and attitudes that may contribute to limited enrollment among eligible families. Results suggest eligible families desire relevant provision of services, easier enrollment processes, and disclosure of provider qualifications.
The COVID-19 pandemic was disruptive to birthing individuals’ peripartum experiences. This study examined associations between interpersonal racism experiences, pandemic worries, and mental health of Asian and Non-Hispanic white birthing individuals receiving prenatal care in a large northeastern healthcare system. The sample (N=122; Age, M = 33.6, SD = 3.73) was n=61 Asian and n=61 white individuals who were propensity matched on age at childbirth, gestational age, relationship status, income, and educational attainment. Participants completed self-report surveys on discrimination experiences, pandemic worries, and general mental health at 10–15 weeks postpartum. Asian individuals reported experiencing significantly more interpersonal racism compared to matched white individuals. Pandemic worries were associated with anxiety and depressive symptoms in the entire sample. Among Asian individuals, the association between pandemic worries and anxiety was stronger among those who reported more interpersonal racism. While postpartum birthing individuals experienced heightened worry during the pandemic, which may have increased risk for anxiety, this association was pronounced among Asian individuals who experienced interpersonal racism. Peripartum individuals had increased rates of mental disorders during the pandemic (Yan et al., 2020). Few studies have examined the pandemic’s negative effects on racially diverse peripartum individuals (Goyal et al., 2023), including Asians who experienced anti-Asian hate. This study investigated the pandemic’s impact on mental health, interpersonal racism, and pandemic worries among Asian postpartum individuals in the U.S.
This study examines the determinants and caste-based disparities of very early pregnancy awareness among Indian women using data from the National Family Health Survey-5 (NFHS-5, 2019–21). Data were obtained from NFHS-5, a nationally representative survey of women aged 15–49 years in India. The analysis included 172,871 women. Very early pregnancy awareness was defined as awareness of pregnancy within the first month of gestation. Survey-weighted logistic regression models accounting for clustering, stratification, and sampling weights were employed to examine associations between very early pregnancy awareness and demographic, socioeconomic, and healthcare access-related factors. Additional caste-stratified analyses were conducted for Scheduled Tribes (ST), Scheduled Castes (SC), and Other caste groups. Supplementary analysis assessed the association between very early pregnancy awareness and timely antenatal care initiation within the first trimester. Higher educational attainment, household wealth, and perceived geographic access to health facilities were significantly associated with greater odds of very early pregnancy awareness. Compared with Scheduled Tribe women, Scheduled Caste women (AOR = 1.277, 95
