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京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第19636号 / 社医博第69号 / 新制||社医||9(附属図書館) / 32672 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 佐藤 俊哉, 教授 今中 雄一, 教授 小西 郁生 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

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Thesis advisor: Corrine Y. Jurgens / Background: Reproductive coercion (RC) is a form of intimate partner violence (IPV) involving a partner’s control of a woman’s reproductive health decisions regarding pregnancy and childbearing. RC is associated with numerous negative health consequences; however, the impact on a pregnancy and developing fetus and association with adverse birth outcomes is not known.Design: Secondary analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) data, 2012 – 2015, from five states. Purpose: To examine whether RC before pregnancy is associated with an increased likelihood of experiencing preterm birth (< 37 weeks gestational age), neonatal intensive care (NICU) after birth, and infant death. Method: Data on women ages 17 years and older who gave birth to a live infant (N = 18,728) were analyzed. Logistic regression procedures were used to determine the odds of preterm birth, infant death, and need for NICU care among women experiencing RC while controlling for known risk factors (age, race, ethnicity, education, marital status, depression, drinking, and smoking). The moderation effect of IPV on the relationship of RC and birth outcomes was tested by including an interaction term (product of RC and IPV) in the model. Results: No significant association between RC and preterm birth, need for NICU care, or infant death was detected. Additionally, exposure to IPV did not have a moderating effect on either the direction or magnitude of the relationship between RC and birth outcomes. Conclusions: Despite these findings, RC remains a significant concern for nurses caring for pregnant women and women of reproductive age. This study highlights a current gap in knowledge about the ways RC can affect a pregnancy and birth outcomes. Replication studies using more robust measures of RC and data collection approaches that can most accurately identify RC experiences are needed to increase understanding. / Thesis (PhD) — Boston College, 2022. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Wildfires pose a significant and growing threat to human health. Current trends in climate change predict that wildfire occurrence and severity will increase in the near future, and therefore the adverse health effects associated with wildfire and its air quality effects are becoming increasingly relevant. Even with current efforts to stem future rises in temperature, wildfire activity will continue to increase due to lags in the climate system itself. Thus, in addition to the known increase in mortality, respiratory, and cardiovascular risks, there is a growing need to investigate other health outcomes associated with wildfire smoke exposure, especially their effect on pregnancy and birth outcomes. In order to provide a broad overview of the state of wildfire research on the topic of pregnancy and birth outcomes, this narrative review will summarize the existing literature on pregnancy and birth outcomes associated with wildfire smoke exposure, with consideration for the ambient air pollution literature that informs wildfire research. As research in this specific topic is still developing, a pattern of limitations to study designs is beginning to emerge, which will guide future research needs. Finally, practical considerations for implementing research findings into land management and public health policies that reduce wildfire exposure in order to mitigate the health risks associated with it will be explained.

Maternal residency in Central Appalachian coalfields has been associated with low birth weight at the county-level. To refine the relationship between proximity and adverse birth outcomes, this study employs finer spatial scales of exposure. Spatiotemporal characterizations of surface mining boundaries in Central Appalachia between 1986-2015 were developed using Landsat data. The maternal address field on births records from VA, WV, KY, and TN were geocoded and assigned amount of surface mining within a 5km radius of residence (street-level). Births were also assigned exposures based on the amount of surface mining within residential ZIP code tabulation area (ZCTA) (ZIP code-level). Using linear and logistic regression, associations between surface mining activities during gestation and birth weight, preterm birth, low birth weight, and term low birth weight were determined, adjusting for available demographic factors. An increase in surface mining activities was negatively associated with birth weight at the street-level (β = −8.93g; (95% CI = -12.69 -5.7, P= <0.001) and ZIP code-level (β = −4.41g ; 95% CI = -6.30, -2.52, P= <0.001). Small, statistically significant associations were also found between preterm birth and mining within 5km of residence (OR = 1.003; 95% CI = 1.001, 1.005, P= 0.003) and within maternal ZCTA (OR = 1.002; 95% CI = 1.001, 1.003, P=0.001). Relationships were also found between amount of mining within 5km of residence and low birth weight and term low birth weight outcomes. This study found subtle, but significant associations between proximity to active surface mining during gestation and adverse birth outcomes. / M.S. / Central Appalachian surface mining produces air, water, and noise pollution, all of which have been associated with increased risk of adverse birth outcomes. Previous studies examining associations between surface mining and adverse birth outcomes rely upon relatively coarse county-level data. This research compares outcomes from hundreds of thousands of individual birth records and proximity of maternal home address to surface mines for a fine-scale, epidemiological study. Surface mining boundaries between 1986-2015 were developed using satellite imagery. Birth records from VA, WV, KY, and TN were geocoded and assigned the amount of surface mining within a 5km radius of residence. Births were also assigned exposures based on the amount of surface mining within residential ZIP code since geocoding led to a considerable loss of records. Associations between proximity to surface mining during gestation and birth weight, preterm birth (PTB), low birth weight (LBW), and term low birth weight (tLBW) were determined by linear and logistic regression, adjusting for available demographic factors. Results demonstrate significantly decreased birth weights were found near active mining operations. Mothers living near active surface mining also saw a slight increase in the odds of their birth being PTB, LBW or tLBW. These results suggest there is a subtle, but significant relationship between proximity to surface mining and adverse birth outcomes.

BACKGROUND: Various human and animal studies suggest that peak alcohol exposure during a binge episode, rather than total alcohol exposure, may determine fetal development. Research about the impact of binge drinking on birth outcomes is sparse and inconclusive. Data from the Born in Bradford cohort study were used to explore the impact of binge drinking on birth outcomes. METHODS: Interview-administered questionnaire data about the lifestyle and social characteristics of 10 851 pregnancies were linked to maternity and birth data. The impact of self-reported binge drinking (5 units: 40 g of pure alcohol) on two birth outcomes (small for gestational age (SGA) and preterm birth (<37 weeks)) was assessed using multivariate logistic regression models, while adjusting for confounders. RESULTS: The percentage of women classified as binge drinkers fell from 24.5% before pregnancy to 9% during the first trimester and 3.1% during the second trimester. There was a significant association between SGA birth and binge drinking (all categories combined; OR 1.68, 95% CI 1.15 to 2.47, p=0.01). No association was observed between moderate drinking and either birth outcome, or between binge drinking and preterm birth. CONCLUSIONS: Binge drinking during the second trimester of pregnancy was associated with an increased risk of SGA birth. No association was found between any level of alcohol consumption and premature birth. This work supports previous research showing no association between SGA and low-alcohol exposure but adds to evidence of a dose-response relationship with significant risks observed at binge drinking levels.

Health at birth is considered an important indicator of health outcomes in adulthood. It is also shown to have a strong association with future educational attainment and labor market outcomes. I examine the effects of behavioral and environmental factors on infant health. The factors I focus on include alcohol consumption during pregnancy, extreme weather events associated with climate change, and pollution that may result from unconventional oil and natural gas development. In Chapter II, I examine the effects of point-of-sale alcohol warning signage that alcohol retailers are required to post in some states on alcohol use during pregnancy and on birth outcomes. I find that point-of-sale warning signs discourage alcohol consumption among pregnant women and are associated with a decrease in the odds of newborns having very low birth weight or being very pre-term. The findings of this research inform decision makers about a potentially effective mechanism through which alcohol consumption among pregnant women can be reduced. They also suggest causal evidence for the link between prenatal alcohol exposure and inferior health at birth. Chapter III documents that exposure to heat waves during pregnancy is associated with increased likelihood of the mother experiencing an adverse health condition during pregnancy and the newborn having an abnormal condition at birth. The results provide an assessment of the magnitude and timing of the effects of extreme heat events associated with climate change on infant health which is potentially helpful in enhancing the effectiveness of adaptation efforts. Finally, Chapter IV provides an empirical investigation of the link between unconventional oil and natural gas development and infant health. The results indicate that unconventional drilling activity is associated with a small, but statistically significant, decline in birth outcomes, especially for those living in rural areas. Given that it is estimated that the rapid expansion in unconventional oil and gas extraction will continue for at least a few more decades, the results of this study may contribute to the discussions related to initiation or tightening of regulations and monitoring efforts to control pollution. This dissertation includes previously unpublished co-authored material.

Adverse birth outcomes and adverse childhood experiences (ACE) are concerns in the United States, with potential to impact health indices now and in the future. The purpose of this study was to quantitatively examine the association between maternal exposure to ACE, low birth weight, and county of residence in the Appalachian population using the Life Course Approach as the theoretical framework. A cross-sectional study design and clustering strategy was used to randomly select potential respondents from a data set that was provided by Ohio Department of Health. Self-administered questionnaires were sent to potential respondents to collect information about ACE in the maternal population of Appalachia, Ohio with an overall response rate of 29.5% and 212 total participants. A chi-square analysis was completed and no significant association was found between county of residence and risk of low birth weight. However, statistically significant associations were found between the different types of ACE exposure and low birth weight delivery as well as Appalachian county of residence and exposure to ACE. As the sample of low birth weight deliveries was small, it is recommended that the relationship between ACE exposure and low birth weight be further studied to develop more purposeful health interventions to improve maternal health in Appalachia, Ohio specifically, as well as other rural communities. Reducing rates of adverse birth outcomes and chronic disease burden in Appalachia have potential to reduce health disparities between urban and Appalachian communities, allowing for positive social change for many socioeconomically disadvantaged communities and improving population health.

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