Based on these findings, group-based comprehensive risk reduction was found to be an effective strategy to reduce adolescent pregnancy, HIV, and STIs. No conclusions could be drawn on the effectiveness of group-based abstinence education.

Purpose of review Preterm birth is a significant worldwide health problem of uncertain origins. The extant body of literature examining environmental contaminant exposures in relation to preterm birth is extensive but results remain ambiguous for most organic pollutants, metals and metalloids, and air pollutants. In the present review we examine recent epidemiologic studies investigating these associations, and identify recent advances and the state of the science. Additionally, we highlight biological mechanisms of action in the pathway between chemical exposures and preterm birth, including inflammation, oxidative stress, and endocrine disruption, that deserve more attention in this context. Recent findings Important advances have been made in the study of the environment and preterm birth, particularly in regard to exposure assessment methods, exploration of effect modification by co-morbidities and exposures, and in identification of windows of vulnerability during gestation. There is strong evidence for an association between maternal exposure to some persistent pesticides, lead, and fine particulate matter, but data on other contaminants is sparse and only suggestive trends can be noted with the current data. Summary Beyond replicating current findings, further work must be done to improve understanding of mechanisms underlying the associations observed between environmental chemical exposures and preterm birth. By examining windows of vulnerability, disaggregating preterm birth by phenotypes, and measuring biomarkers of mechanistic pathways in these epidemiologic studies we can improve our ability to detect associations with exposure, provide additional evidence for causality in an observational setting, and identify opportunities for intervention.

Background Fertility counseling and treatment can help women achieve their desired family size, however, disparities exist in the utilization of this care. Methods This study examines the persistence of a racial disparity in visiting a doctor for help getting pregnant by estimating the direct effect of this association using data from the FUCHSIA Women’s Study, a population-based cohort study. This cohort included 1073 reproductive age women (22-45 years) with 28% reporting infertility. We fit log binomial models to quantify the magnitude of the racial difference in reported care seeking after adjustment for hypothesized mediators using inverse probability weighting. Results Compared with white women, black women were less likely to visit a doctor in the total population [adjusted risk ratio (aRR) = 0.57, 95% confidence interval (CI): 0.41, 0.80] and in the subgroup of women with infertility [aRR = 0.75, 95% CI: 0.56, 0.99]. In addition, black women waited twice as long on average before seeking help compared with white women. Conclusions There were notable racial differences in visiting a doctor for help getting pregnant in this study although reports of infertility were similar by race. These differences may be mitigated through improved communication about the range of counseling and treatment options available.

This paper analyses the investment performance of Australian superannuation funds and their managers over the period from January 1973 to June 1981.The analysis indicated that both the funds and the managers performed poorly over the first two and a half years.It was found that the poor performance during these years outweighed the improved performance in sUbsequent years, resulting in an overall poor performance over the total period studied. Only one manager displayed a superior investment ability and this appears to be attributable to his ability to adjust the beta of his portfolio to suit market conditions.

Background Early-life factors can be associated with future health outcomes and are often measured by maternal recall. Methods We used data from the North Carolina Early Pregnancy Study and Follow-up to characterize long-term maternal recall. We used data from the Early Pregnancy Study as the gold standard to evaluate the accuracy of pre-pregnancy weight, early pregnancy behaviors, symptoms and duration of pregnancy, and child’s birthweight reported at follow-up, for 109 women whose study pregnancies had resulted in a live birth. Results Most (81%) participants reported a pre-pregnancy weight at follow-up that correctly classified them by BMI category. Women reported experiencing pregnancy symptoms later at follow-up than what they reported in the Early Pregnancy Study. Accuracy of reporting of early pregnancy behaviors varied based on exposure. Overall, women who had abstained from a behavior were more likely to be classified correctly. Sensitivity of reporting was 0.14 for antibiotics, 0.30 for wine, 0.71 for brewed coffee, and 0.82 for vitamins. Most misclassification at follow-up was due to false-negative reporting. Among women who gave birth to singletons 94% could report their child’s correct birthweight within ½ pound and 86% could report duration of pregnancy within 7 days at follow-up. Conclusions Self-report of pre-pregnancy weight, duration of pregnancy, and child’s birthweight after almost 30 years was good whereas self-reported pregnancy-related exposures resulted in higher levels of reporting error. Social desirability appeared to influence women’s report of their behaviors at follow-up. Self-reported assessment of confidence in the recalled information was unrelated to accuracy.

Objective To assess which characteristics are associated with failure to receive fertility counseling among a cohort of young women diagnosed with cancer. Design A population-based cohort study. Setting Not applicable. Patients A total of 1,282 cancer survivors, of whom 1,116 met the inclusion criteria for the analysis. Interventions None. Main Outcome Measure(s) The main outcome in this study was whether or not women reported receiving any information on how cancer treatment might affect their ability to become pregnant at the time of their cancer diagnosis. Results Forty percent of cancer survivors reported that they did not receive fertility counseling at the time of cancer diagnosis. Women were more likely to fail to receive counseling if they had a high school education or less (OR=1.90, 95% CI: 0.97, 3.70) or if they had a prior birth (OR=1.92, 95% CI: 1.31, 2.81). Cancer related variables that were associated with a lack of counseling included not receiving chemotherapy as part of treatment (OR=4.39, 95% CI: 2.96, 6.51) and diagnosis with certain cancer types. Conclusions Counseling about the risk of infertility and available fertility preservation options is important to cancer patients. Additionally, counseling can make women aware other adverse reproductive outcomes such as early menopause and its associated symptoms. Less educated women and parous women are at particular risk of not getting fertility-related information. Programs that focus on training not just the oncologist, but also other healthcare providers involved with cancer care, to provide fertility counseling may help expand access.

In a 1989 paper, Marchbanks et al. (Am J Epidemiol. 1989;130(2):259-267) noted inconsistent definitions of infertility across research and clinical practice and examined differences in prevalence estimates across definitions. Since their study, there have been substantial changes in society, technology, and clinical practice related to female reproductive health. In response, we revisited the original paper using data from a recent study among reproductive-aged women. Internal comparisons across various definitions of infertility were made by assessing how many and which women were classified as infertile, their age at infertility, and the probability of spontaneous pregnancy after infertility. Results were also compared with Marchbanks et al. Black women were more likely to be classified as infertile than white women based on the definition "12 months of unprotected intercourse" (40.1% vs. 33.7%) but less likely by "12 months of attempting pregnancy" (14.3% vs. 21.8%) and "visiting a doctor for help getting pregnant" (8.4% vs. 19.7%). After unprotected intercourse for 12 months, 36.1% of women who were attempting pregnancy spontaneously conceived by 6 months compared with 13.5% of women who were not attempting pregnancy. While our results for most infertility definitions were similar to those of Marchbanks et al., prevalence estimates continued to differ across demographic groups by definition.

Purpose Our goal was to determine if there are differences by place of residence in visiting a doctor for help getting pregnant in a population-based study. Methods Using data from the Furthering Understanding of Cancer, Health, and Survivorship in Adult (FUCHSIA) Women’s Study, a cohort study of fertility outcomes in reproductive-aged women in Georgia, we fit models to estimate the association between geographic type of residence and seeking help for becoming pregnant. Findings The prevalence of visiting a doctor for help getting pregnant ranged from 13%-17% across geographic groups. Women living in suburban counties were most likely to seek medical care for help getting pregnant compared with women living in urbanized counties (adjusted prevalence ratio (aPR) = 1.14, 95% CI: 0.74-1.75); among women who reported infertility this difference was more pronounced (aPR = 1.59, 95% CI: 1.00-2.53). Women living in rural counties were equally likely to seek fertility care compared with women in urbanized counties in the full sample and among women who experienced infertility. Conclusions Women living in urban and rural counties were least likely to seek infertility care, suggesting that factors including but not limited to physical proximity to providers are influencing utilization of this type of care. Increased communication about reproductive goals and infertility care available to meet these goals by providers who women see for regular care may help address these barriers.