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Wendy Chavkin

Publications and source records attributed to Wendy Chavkin.

15 recordsLinked to original sources
PubMed2006

Policy efforts to prevent ART-related preterm birth.

At 12.5%, the preterm birth rate is the highest it has ever been in the US. In tandem with the rise in preterm birth is a dramatic increase in multiple birth rates. The recent trend of delayed maternal age at first birth and the associated use of assisted reproductive technologies (ARTs) have led to the increase in multiple gestation and its attendant increased risk for preterm birth. While ARTs are not responsible for the majority of preterm births, the attributable fraction has increased, is iatrogenic- and preventable. Despite widespread recognition of this problem, the rate of associated twin gestation has not decreased. We offer options for policymakers on several levels--from medical to health systems to societal policy--to decrease ART-related preterm births.

Embryo Transfer↗
PubMed2003

Prepregnancy weight and adverse perinatal outcomes in an ethnically diverse population.

OBJECTIVE: To examine the association between excessive prepregnancy weight and adverse outcomes, with a focus on women weighing over 200 lbs (91 kg) before pregnancy. METHODS: Data were from the 1998-1999 New York City births file for 213,208 singletons with information on prepregnancy weight. Five categories of prepregnancy weight were constructed and used to predict gestational diabetes, preeclampsia, cesarean delivery, very low birthweight, macrosomia, and treatment in the neonatal intensive care unit (NICU). Statistical adjustments were made for mother's age, race or ethnicity, marital status, education, parity, social risk (eg, smoking), initiation of prenatal care, health insurance, and infant's sex. RESULTS: Maternal prepregnancy weight was associated with several adverse outcomes. Women in the heaviest group (> 300 lbs or > 136 kg) had the highest adjusted odds ratios (OR) for gestational diabetes (OR 5.2), preeclampsia (OR 5.0), and cesarean delivery (OR 2.7) compared with women weighing 100-149 lbs (45-67 kg). Compared with the reference group, the heaviest women were more likely to have a macrosomic infant and an infant treated in the NICU (OR 4.2 and 1.9, respectively). Even among a subsample of women who did not have any diabetic or hypertensive diseases, excess weight significantly increased the likelihood of macrosomia and NICU treatment. Blacks were disproportionately represented in the two heaviest groups (49.8% of those weighing 200-299 lbs and 63.9% of those weighing over 300 lbs). CONCLUSION: In this population-based study of pregnant women, the adverse outcomes associated with excessive weight underline the urgency of weight loss interventions before pregnancy. The analysis also suggests that research is needed on rapidly growing racial or ethnic subgroups most at risk for obesity.

Adolescent↗
PubMed2002

Changes in use of health insurance and food assistance programs in medically underserved communities in the era of welfare reform: an urban study.

OBJECTIVES: The purpose of this study was to assess changes in health insurance and food assistance enrollment following passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. METHODS: Extant data sources were used to calculate changes in Temporary Assistance for Needy Families (TANF), Medicaid, and Food Stamp program enrollment in medically underserved Manhattan communities after 1996. RESULTS: Dramatic declines in TANF enrollment were accompanied by declines in Food Stamp program enrollment and a deceleration in Medicaid enrollment among several communities. CONCLUSIONS: As the Personal Responsibility and Work Opportunity Reconciliation Act comes up for reauthorization later in 2002, policymakers should revise legislation so that needy families do not lose health insurance or food assistance support.

Aid to Families with Dependent Children↗
PubMed2002

Relationships between welfare status, health insurance status, and health and medical care among children with asthma.

OBJECTIVES: This study evaluated the relationships between health insurance and welfare status and the health and medical care of children with asthma. METHODS: Parents of children with asthma aged 2 to 12 years were interviewed at 6 urban clinical sites and 2 welfare offices. RESULTS: Children whose families had applied for but were denied welfare had more asthma symptoms than did children whose families had had no contact with the welfare system. Poorer mental health in parents was associated with more asthma symptoms and higher rates of health care use in their children. Parents of uninsured and transiently insured children identified more barriers to health care than did parents whose children were insured. CONCLUSIONS: Children whose families have applied for welfare and children who are uninsured are at high risk medically and may require additional services to improve health outcomes.

Adult↗
PubMed2002

Employment barriers among welfare recipients and applicants with chronically ill children.

OBJECTIVES: This study evaluated the association of chronic child illness with parental employment among individuals who have had contact with the welfare system. METHODS: Parents of children with chronic illnesses were interviewed. RESULTS: Current and former welfare recipients and welfare applicants were more likely than those with no contact with the welfare system to report that their children's illnesses adversely affected their employment. Logistic regression analyses showed that current and former receipt of welfare, pending welfare application, and high rates of child health care use were predictors of unemployment. CONCLUSIONS: Welfare recipients and applicants with chronically ill children face substantial barriers to employment, including high child health care use rates and missed work. The welfare reform reauthorization scheduled to occur later in 2002 should address the implications of chronic child illness for parental employment.

Absenteeism↗
PubMed2002

Chronic illness among poor children enrolled in the temporary assistance for needy families program.

OBJECTIVES: This study assessed chronic child illness among recipients of Temporary Assistance for Needy Families (TANF) benefits and poor families not receiving benefits. METHODS: Data from the 1998 National Health Interview Survey were used to examine chronic child illness, enrollment in TANF, health insurance status, and selected access indicators. RESULTS: One quarter of TANF-enrolled children had chronic illnesses. Unenrolled children were 3 times as likely as TANF-enrolled children to be uninsured. Among the chronically ill, 31.7% of unenrolled and 14.3% of enrolled children experienced gaps in insurance coverage that were associated with access barriers. CONCLUSIONS: Welfare policies should consider the effects of chronic illness and gaps in insurance coverage on the health of poor children.

Adolescent↗
PubMed2002

Welfare to work? Impact of maternal health on employment.

OBJECTIVES: This study investigated whether health problems among poor mothers of chronically ill children affect their ability to obtain and maintain employment. METHODS: Mothers of children with chronic illnesses were surveyed at clinical and welfare agency sites in San Antonio, Tex. RESULTS: There were distinct health differences according to mothers' TANF and employment status. Mothers without TANF experience reported better physical and mental health and less domestic violence and substance use than did those who had TANF experience. Those not currently working had higher rates of physical and mental health problems. CONCLUSIONS: Poor maternal health is associated with need for cash assistance and health insurance. Policymakers must recognize that social policies promoting employment will fail if they do not address the health needs of poor women and children.

Adult↗