Publications by authors named "Katherine E Heck"

9 Publications

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The Affordable Care Act and Changes in Women's Health Insurance Coverage Before, During, and After Pregnancy in California.

Public Health Rep 2021 Jan/Feb;136(1):70-78. Epub 2020 Oct 27.

8785 Center for Health Equity, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA.

Objectives: Having health insurance is associated with improvements in health care access and use, health behaviors, and outcomes. We examined changes in health insurance coverage for California women before, during, and after pregnancy after implementation of the Affordable Care Act (ACA).

Methods: We used data from the 2011-2017 California Maternal and Infant Health Assessment, an annual representative survey of women sampled from birth certificates (n = 47 487). We examined health insurance coverage at baseline before ACA implementation (2011-2013) and in each survey year from 2014 to 2017 for 3 periods (before, during, and after pregnancy). We calculated prevalence ratios to evaluate changes in health insurance coverage, adjusting for changes in demographic characteristics. Few women were uninsured during pregnancy before implementation of the ACA; therefore, analyses focused on health insurance before pregnancy and postpartum.

Results: Before ACA implementation, 24.4% of women reported being uninsured before pregnancy, which decreased to 10.1% in 2017. About 17% of women reported being uninsured postpartum before ACA implementation, and this percentage decreased to 7.5% in 2017. ACA implementation resulted in a >50% adjusted decline in the likelihood of being uninsured before pregnancy or postpartum, primarily because of substantial increases in Medicaid coverage.

Conclusions: ACA implementation resulted in a dramatic reduction in mothers in California who were uninsured before and after pregnancy. Medicaid expansion played a major role in this improvement.
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October 2020

Passenger distractions among adolescent drivers.

J Safety Res 2008 8;39(4):437-43. Epub 2008 Aug 8.

Department of Human and Community Development, 4-H Center for Youth Development, University of California, Davis, 1 Shields Ave., Davis, CA 95616, USA.

Problem: Adolescents who drive with peers are known to have a higher risk of crashes. While passengers may distract drivers, little is known about the circumstances of these distractions among teen drivers.

Method: This study used survey data on driving among 2,144 California high school seniors to examine distractions caused by passengers.

Results: Overall, 38.4% of youths who drove reported having been distracted by a passenger. Distractions were more commonly reported among girls and students attending moderate- to high-income schools. Talking or yelling was the most commonly reported type of distraction. About 7.5% of distractions reported were deliberate, such as hitting or tickling the driver or attempting to use the vehicle's controls. Driving after alcohol use and having had a crash as a driver were both significant predictors of reporting passenger-related distraction.

Conclusion: Adolescents often experience distractions related to passengers, and in some cases these distractions are intentional.

Impact On Industry: These results provide information about teenage drivers who are distracted by passenger behaviors. In some cases, passengers attempted to use vehicle controls; however, it seems unlikely that this behavior is common enough to warrant redesign of controls to make them less accessible to passengers.
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November 2008

Socioeconomic status and breastfeeding initiation among California mothers.

Public Health Rep 2006 Jan-Feb;121(1):51-9

National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA.

Unlabelled: Objectives. To examine multiple dimensions of socioeconomic status and breastfeeding among a large, random sample of ethnically diverse women.

Methods: This study used logistic regression analysis to examine the influence of a range of socioeconomic factors on the chances of ever breastfeeding among a stratified random sample of 10,519 women delivering live births in California for 1999 through 2001. Measures of socioeconomic status included family income as a percentage of the federal poverty level, maternal education, paternal education, maternal occupation, and paternal occupation.

Results: Consistent with previous research, there was a marked socioeconomic gradient in breastfeeding. Women with higher family incomes, those who had or whose partners had higher education levels, and women who had or whose partners had professional or executive occupations were more likely than their counterparts to breastfeed. After adjustment for many potential confounders, maternal and paternal education remained positively associated with breastfeeding, while income and occupation were no longer significant. Compared with other racial or ethnic groups, foreign-born Latina women were the most likely to breastfeed.

Conclusions: The significant association of maternal and paternal education with breastfeeding, even after adjustment for income, occupation, and many other factors, suggests that social policies affecting educational attainment may be important factors in breastfeeding. Breastfeeding rates may be influenced by health education specifically or by more general levels of schooling among mothers and their partners. The continuing importance of racial/ethnic differences after adjustment for socioeconomic factors could reflect unmeasured socioeconomic effects, cultural differences, and/or policies in Latin American countries.
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February 2006

Bridging between two standards for collecting information on race and ethnicity: an application to Census 2000 and vital rates.

Public Health Rep 2004 Mar-Apr;119(2):192-205

Office of Analysis, Epidemiology, and Health Promotion, National Center for Health Statistics, 3311 Toledo Rd., Rm. 6415, Hyattsville, MD 20782, USA.

Objectives: The 2000 Census, which provides denominators used in calculating vital statistics and other rates, allowed multiple-race responses. Many other data systems that provide numerators used in calculating rates collect only single-race data. Bridging is needed to make the numerators and denominators comparable. This report describes and evaluates the method used by the National Center for Health Statistics to bridge multiple-race responses obtained from Census 2000 to single-race categories, creating single-race population estimates that are available to the public.

Methods: The authors fitted logistic regression models to multiple-race data from the National Health Interview Survey (NHIS) for 1997-2000. These fitted models, and two bridging methods previously suggested by the Office of Management and Budget, were applied to the public-use Census Modified Race Data Summary file to create single-race population estimates for the U.S. The authors also compared death rates for single-race groups calculated using these three approaches.

Results: Parameter estimates differed between the NHIS models for the multiple-race groups. For example, as the percentage of multiple-race respondents in a county increased, the likelihood of stating black as a primary race increased among black/white respondents but decreased among American Indian or Alaska Native/black respondents. The inclusion of county-level contextual variables in the regression models as well as the underlying demographic differences across states led to variation in allocation percentages; for example, the allocation of black/white respondents to single-race white ranged from nearly zero to more than 50% across states. Death rates calculated using bridging via the NHIS models were similar to those calculated using other methods, except for the American Indian/Alaska Native group, which included a large proportion of multiple-race reporters.

Conclusion: Many data systems do not currently allow multiple-race reporting. When such data systems are used with Census counts to produce race-specific rates, bridging methods that incorporate geographic and demographic factors may lead to better rates than methods that do not consider such factors.
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June 2004

Multiple-race mortality data for California, 2000-2001.

Public Health Rep 2004 Mar-Apr;119(2):187-91

Office of Analysis, Epidemiology, and Health Promotion, National Center for Health Statistics, Maternal and Child Health Branch, California Department of Health Services, Sacramento, CA, USA.

Objectives: To examine mortality rates and quality of race reporting for multiple-race individuals in California using the new multiple-race data available on the death certificate.

Methods: Death date were drawn from California vital statistics for 2000 and 2001. Denominator data were drawn from the 2000 census Modified Race Data Summary File. The authors calculated mortality rates and relative standard errors for multiple-race individuals as a whole and by county, and for the three largest reported multiple-race groups (African American and white, American Indian/Alaska Native and white, and Asian and white).

Results: Decedents reported to be of more than one race were disproportionately young, Hispanic, male, and never-married. Age-adjusted mortality rates for multiple-race groups were approximately one-sixth as high as rates for single-race individuals. There was substantial variability in rates for multiple-race decedents according to county of residence.

Conclusions: Mortality rates for multiple-race people were implausibly low, and death certificates for multiple-race individuals were geographically clustered. Race reporting on death certificates will need to be improved before accurate death rates can be calculated for those of multiple races.
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June 2004

Does postpartum length of stay affect breastfeeding duration? A population-based study.

Birth 2003 Sep;30(3):153-9

National Center for Health Statistics, and California Department of Health Services, USA.

Background: Short postpartum hospital stays may leave inadequate time for women to receive assistance with breastfeeding. Women leaving the hospital early may also have household responsibilities that could interfere with breastfeeding. This study examined the relationship between postpartum length of stay and breastfeeding cessation.

Methods: This study used data from 10,519 respondents to the California Maternal and Infant Health Assessment (MIHA) surveys from 1999 to 2001. MIHA is an annual statewide stratified random sample, population-based study of childbearing women in California. Survival analysis was used to examine the relationship between length of stay and length of time breastfeeding. Women were asked about the number of nights their infant stayed in the hospital at birth, whether they breastfed, and if so, the age of the child when they stopped. Hospital stay was defined in three categories: standard (2 nights for a vaginal delivery, 4 nights for a cesarean section), or shorter or longer than the standard stay.

Results: Approximately 88 percent of women initiated breastfeeding. Unadjusted predictors of breastfeeding cessation included short or long postpartum stay; young maternal age; Hispanic, African American, or Asian/Pacific Islander race/ethnicity; being unmarried; low income or education level; primiparity; being born in the 50 United States or the District of Columbia; smoking during pregnancy; and low infant birthweight. After adjustment for potential confounders, women with a short stay remained slightly more likely to terminate breastfeeding than women with a standard stay (relative risk, 1.11, 95% confidence interval 1.01, 1.23).

Conclusion: Women who leave the hospital earlier than the standard recommended stay are at somewhat increased risk of terminating breastfeeding early.
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September 2003

Mind the gap: bridge methods to allocate multiple-race mothers in trend analyses of birth certificate data.

Matern Child Health J 2003 Mar;7(1):65-70

Infant and Child Health Studies Branch, National Center for Health Statistics, Hyattsville, Maryland, USA.

Objectives: To examine the effects of proposed methods of redistributing multiple-race mothers to single-race categories when computing trend data from birth certificates.

Methods: Low birthweight and multiple (twin and higher-order) birth rates for California were calculated for non-Hispanic mothers from birth certificate data for 2000. Births to the 1.9% of mothers identified as multiple-race were reassigned to single-race groups according to 12 "bridging" methods. Bridge methods utilized population-based whole allocation, fractional allocation, and other methods, primarily depending on first race listed.

Results: For large race groups, there was little difference in low birthweight and multiple birth rates regardless of the bridge method employed. For smaller groups such as Native Hawaiians and other Pacific Islanders and American Indians/Alaska Natives, there was substantial variation by bridge method in observed rates.

Conclusions: Tracking trends in birth outcomes across the change in data collection will challenge public health researchers. This paper outlines advantages and disadvantages of various bridge methods.
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March 2003

Family structure, socioeconomic status, and access to health care for children.

Health Serv Res 2002 Feb;37(1):173-86

Infant and Child Health Studies Branch, Office of Analysis, Epidemiology and Health Promotion, National Center for Health Statistics, Sacramento, CA 95814, USA.

Objective: To test the hypothesis that among children of lower socioeconomic status (SES), children of single mothers would have relatively worse access to care than children in two-parent families, but there would be no access difference by family structure among children in higher SES families.

Data Sources: The National Health Interview Surveys of 1993-95, including 63,054 children.

Study Design: Logistic regression was used to examine the relationship between the child's family structure (single-mother or two-parent family) and three measures of health care access and utilization: having no physician visits in the past year, having no usual source of health care, and having unmet health care needs. To examine how these relationships varied at different levels of SES, the models were stratified on maternal education level as the SES variable. The stratified models adjusted for maternal employment, child's health status, race and ethnicity, and child's age. Models were fit to examine the additional effects of health insurance coverage on the relationships between family structure, access to care, and SES.

Principal Findings: Children of single mothers, compared with children living with two parents, were as likely to have had no physician visit in the past year; were slightly more likely to have no usual source of health care; and were more likely to have an unmet health care need. These relationships differed by mother's education. As expected, children of single mothers had similar access to care as children in two-parent families at high levels of maternal education, for the access measures of no physician visits in the past year and no usual source of care. However, at low levels of maternal education, children of single mothers appeared to have better access to care than children in two-parent families. Once health insurance was added to adjusted models, there was no significant socioeconomic variation in the relationships between family structure and physician visits or usual source of care, and there were no significant disparities by family structure at the highest levels of maternal education. There were no family structure differences in unmet needs at low maternal education, whereas children of single mothers had more unmet needs at high levels of maternal education, even after adjustment for insurance coverage.

Conclusions: At high levels of maternal education, family structure did not influence physician visits or having a usual source of care, as expected. However, at low levels of maternal education, single mothers appeared to be better at accessing care for their children. Health insurance coverage explained some of the access differences by family structure. Medicaid is important for children of single mothers, but children in two-parent families whose mothers are less educated do not always have access to that resource. Public health insurance coverage is critical to ensure adequate health care access and utilization among children of less educated mothers, regardless of family structure.
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February 2002

The influence of proximity of prenatal services on small-for-gestational-age birth.

J Community Health 2002 Feb;27(1):15-31

National Center for Health Statistics and the California Department of Health Services, Maternal and Child Health Branch, Sacramento, CA 95814, USA.

Some studies suggest that prenatal services may decrease the risk of poor fetal growth for full-term infants, but have not examined the influence of the availability of community health and social services. The availability of prenatal services may have a stronger effect among women already at high risk of a small-for-gestational-age (SGA) birth. Singleton full-term (> or = 37 weeks gestation) California births for 1997-98 (n = 744,736) were geocoded to maternal Census tract of residence. Women were placed into one of three demographic risk groups utilizing combinations of maternal age, marital status, parity, and education. SGA was defined as birthweight less than the 10th percentile for gestational age. Locations of WIC sites, prenatal care providers, and perinatal outreach programs were geocoded. Multilevel logistic regression was used to model the influence of community health care services on SGA, adjusting for additional maternal and community factors. There was no association between SGA and community services available for either high- or low-risk women, in either unadjusted or adjusted models. The addition of maternal prenatal care utilization to models did not change the results. Maternal residence near prenatal services was not associated with SGA, regardless of demographic risk; other community factors may warrant consideration.
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February 2002