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Neal Halfon

Publications and source records attributed to Neal Halfon.

28 records · Page 2Linked to original sources
PubMed2003

Racial and ethnic disparities in birth outcomes: a life-course perspective.

BACKGROUND: In the United States, Black infants have significantly worse birth outcomes than do White infants. The cause of these persisting racial disparities remains unexplained. Most extant studies focus on differential exposures to protective and risk factors during pregnancy, such as current socioeconomic status, maternal risky behaviors, prenatal care, psychosocial stress, or perinatal infections. These risk factors during pregnancy, however, do not adequately account for the disparities. METHODS: We conducted a literature review for longitudinal models of health disparities, and presented a synthesis of two leading models, using a life-course perspective. Traditional risk factors during pregnancy are then reexamined within their life-course context. We conclude with a discussion of the limitations and implications of the life-course perspective for future research, practice, and policy development. RESULTS: Two leading longitudinal models of health disparities were identified and discussed. The early programming model posits that exposures in early life could influence future reproductive potential. The cumulative pathways model conceptualizes decline in reproductive health resulting from cumulative wear and tear to the body's allostatic systems. We propose a synthesis of these two models, using the life-course perspective. Disparities in birth outcomes are the consequences of differential developmental trajectories set forth by early life experiences and cumulative allostatic load over the life course. CONCLUSIONS: Future research on racial disparities in birth outcomes needs to examine differential exposures to risk and protective factors not only during pregnancy, but over the life course of women. Eliminating disparities requires interventions and policy development that are more longitudinally and contextually integrated than currently prevail.

Black or African American↗
PubMed2003

Childbirth education classes: sociodemographic disparities in attendance and the association of attendance with breastfeeding initiation.

OBJECTIVES: To examine sociodemographic disparities in attendance at childbirth classes, and to evaluate the association of attendance with breastfeeding initiation. METHODS: Parents of a nationally representative, cross-sectional sample of 2068 children ages 4-35 months were surveyed by telephone. The responses of 1540 mothers were included in the analysis. They were asked whether they had attended a childbirth class before giving birth. Disparities in attendance at childbirth classes and the association between attendance and breastfeeding initiation were examined using bivariate and multivariate logistic regression analyses. RESULTS: Two thirds (66%) of the children's mothers had ever attended a childbirth class. White mothers were twice as likely (OR 2.15, CI 1.39, 3.31) as African American mothers to have ever attended. Attendance also varied by education, household income, and marital status. Attendance at childbirth classes was associated with a 75% increase in the odds that a child will be breastfed (OR 1.75, CI 1.18, 2.60). CONCLUSIONS: Significant sociodemographic disparities exist in attendance at childbirth classes. Further research is needed to determine whether improving utilization of childbirth education classes reduces sociodemographic disparities in breastfeeding initiation.

Adult↗
PubMed2003

Children's use of emergency departments for asthma: persistent barriers or acute need?

Our objective was to explore, in a predominantly Latino inner-city population, why caregivers bring their children with asthma to the ED (emergency department). We conducted bilingual parent surveys and medical chart abstractions of a consecutive ED sample consisting of 234 children with asthma (69% Latino; 54% Spanish-speaking) and their caregivers. Outcome measures included: (1) the acute need for ED services based on objective physiological measures, (2) the extent to which these children experienced barriers to quality primary care for asthma before the ED visit, and (3) the relative importance caregivers assigned to worsening symptoms versus perceived barriers to non-ED care when deciding to bring their child to the ED. Most children had moderate or severe asthma attacks. In the prior month, only 33% went to a primary care provider, 83% had used a bronchodilator, and 63%, an age-appropriate spacer device. Seventy-five percent of caregivers cited perceived acute need, instead of barriers to primary care, as the most important reason for using the ED. This perception of acute need was associated with moderate or severe asthma attacks according to objective physiological measures, after controlling for health and sociodemographic characteristics. Children with asthma who use the ED encounter barriers to primary care, but caregivers' perception of acute need--validated by independent measures of attack severity--dominates caregivers' decision to use the ED. Ensuring continuity of care for children with asthma would involve not only improving various aspects of access to and quality of primary non-ED care--including parent education about early recognition and treatment of asthma attacks--but also providing families with practical low-cost alternatives for 24-hour care and assuring linkages between the ED and sources of primary care.

Acute Disease↗
PubMed2002

Life course health development: an integrated framework for developing health, policy, and research.

The life course health development (LCHD) framework organizes research from several fields into a conceptual approach explaining how individual and population health develops and how developmental trajectories are determined by interactions between biological and environmental factors during the lifetime. This approach thus provides a construct for interpreting how people's experiences in the early years of life influence later health conditions and functional status. By focusing on the relationship between experiences and the biology of development, the LCHD framework offers a better understanding of how diseases occur. By suggesting new strategies for health measurement, service delivery, and research, as well as for improving health outcomes, this framework also supports health care-purchasing strategies to develop health throughout life and to build human health capital.

Guidelines as Topic↗
PubMed2002

The association between reported childhood sexual abuse and breastfeeding initiation.

This study examined the association between self-identified childhood sexual abuse and breastfeeding initiation. A nationally representative sample of 2017 parents with children younger than 3 years was surveyed by telephone about child-rearing needs. Respondents were asked to report childhood sexual abuse and breastfeeding practices. Responses of 1220 biological mothers were analyzed. A possible association between self-reported childhood sexual abuse and breastfeeding initiation was investigated through multivariate logistic regression. Seven percent of the respondents reported experiencing childhood sexual abuse. Women who reported childhood sexual abuse were more than twice (adjusted odds ratio = 2.58; 95% confidence interval = 1.14, 5.85; P = .02) as likely to initiate breastfeeding compared with women who did not report childhood sexual abuse. Parenting attitudes and behaviors were compared to consider whether greater concern with parenting is an explanation for this association. In this nationally representative sample, self-identified childhood sexual abuse is associated with an increased likelihood of breastfeeding initiation.

Adult↗
PubMedDate not supplied

Health and mental health services for children in foster care: the central role of foster parents.

It is well documented that children enter foster care with special health and mental health needs and, while in care, those conditions are often exacerbated. However, less attention has been given to foster parents who have the most contact with these children. Results are presented from a national study on the developmental, health and mental health care needs of children in foster care that included foster parents' perspectives and observations. Their role in improving child well being is explained and recommendations for policy, practice and advocacy also are included.

Administrative Personnel↗