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Retrospective studies indicate 2 major classes of autism spectrum disorder (ASD) onset: early and later, after a period of relatively healthy development. This prospective, longitudinal study examined social, language, and motor trajectories in 235 children with and without a sibling with autism, ages 6–36 months. Children were grouped as: ASD identified by 14 months, ASD identified after 14 months, and no ASD. Despite groups' initial similar developmental level at 6 months, ASD groups exhibited atypical trajectories thereafter. Impairment from 14 to 24 months was greater in the Early-ASD than the Later-ASD group, but comparable at 36 months. Developmental plateau and regression occurred in some children with ASD, regardless of timing of ASD diagnosis. Findings indicate a preclinical phase of varying duration for ASD.

We investigated racial and ethnic disparities in COVID-19 vaccine uptake, using data from the Centers for Disease Control and Prevention. As of March 29,2022, uptake of the first dose was higher among Hispanic and Asian people than among White and Black people. In contrast, uptake rates of the booster were higher among Asian and White people than among Black and Hispanic people. Black and Hispanic populations in the US have been disproportionately affected by COVID-19, having higher rates of death than the population average documented during the first wave of the pandemic.1 Uptake of the first dose of COVID-19 vaccines was slower and remains lower for Black people than for Asian, Hispanic, or White people.2 Numerous factors affect vaccination uptake. People may choose not to get vaccinated or may be willing to get vaccinated but face barriers including transportation and language, as well as the inability to take time off work.3 Improving vaccine uptake and achieving vaccine equity maybe particularly challenging in the US because it requires coordinating across federal and state public health infrastructures, instead of operating a single centralized vaccine delivery system, as in the UK.4We compared the rates of COVID-19 first dose and first booster vaccinations over time among eligible Asian, Black, Hispanic, and White people in the US (exhibits 1 and 2). All references to boosters include only the first COVID-19 booster dose.Despite efforts at the federal, state, and local levels to dismantle barriers and foster vaccine confidence,3'5'6 vaccination uptake for all groups remains low and is lowest among Black people. Although Hispanic people have the highest uptake for the first dose, their booster uptake is among the lowest. These disparities suggest that additional resources may be needed to mitigate inequities for the Black community and that booster-specific outreach may benefit Hispanic communities.

Despite the rapidly changing policy environment regarding substance use during pregnancy, information is lacking on the association of state policies with neonatal abstinence syndrome (NAS). To determine if punitive or reporting state policies related to substance use during pregnancy are associated with NAS rates. This repeated cross-sectional study used retrospective, difference-in-difference analysis of live births in the State Inpatient Databases from 8 US states in varying years between January 1, 2003, and December 31, 2014. States without punitive or reporting policies were compared with states with policies before and after policy enactment using logistic regression models adjusted for individual and county-level factors and state and year fixed effects. Analyses were conducted from April 10, 2019, to July 30, 2019. Time since enactment of state policies related to substance use in pregnancy, county-level rurality and unemployment, and presence of specialized treatment programs for pregnant and postpartum women in a county. Rates of NAS. Among 4 567 963 live births, 23 377 neonates (0.5%) received a diagnosis of NAS. Among neonates with NAS, 3394 (14.5%) lived in counties without any treatment programs specifically for pregnant and postpartum women, 20 323 (86.9%) lived in metropolitan counties, and 8135 (34.8%) lived in counties in the highest unemployment quartile. In adjusted analyses among neonates in states with punitive policies, odds of NAS were significantly greater during the first full calendar year after enactment (adjusted odds ratio, 1.25; 95% CI, 1.06-1.46; P = .007) and more than 1 full year after enactment (adjusted odds ratio, 1.33; 95% CI, 1.17-1.51; P < .001). After regression adjustment, the annual NAS rate was 46 (95% CI, 43-48) neonates with NAS per 10 000 live births in states without punitive policies; 57 (95% CI, 48-65) neonates with NAS per 10 000 live births in states with punitive policies during the first full year after enactment; and 60 (95% CI, 56-65) neonates with NAS per 10 000 live births in states with punitive policies in effect for more than 1 full year. There was no association between reporting policies and odds of NAS. In this repeated cross-sectional analysis of 8 states, states with punitive policies were associated with greater odds of NAS immediately and in the longer term, but there was no association between NAS and states with reporting policies.

Prior research suggests that these characteristics relate to COVID-19 mortality and vaccination rates (3–7); moreover, most are among the factors used to calculate Social Vulnerability Index values and therefore are recognized as relevant to understanding geographic inequities (14). The 8 zip codes with index values below 0.7 are nearly 90% Black and have the lowest median household incomes, although their percentage of residents with health insurance and postsecondary education are higher than zip code groupings with index values near 1 (Table 1). The 6 zip codes with index values below 1 in June 2021 but increases of more than 0.1 were on average about two-thirds Hispanic and had higher percentages of residents without health insurance and without post–high school education than any other group (Table 2). Demographic and Socioeconomic Characteristics of Zip Codesa in Chicago, Grouped by COVID-19 Vaccination Equity Index, July 2022 Demographic/socioeconomic characteristic Vaccination Equity Indexb <0.70 0.70–0.79 0.80–0.99 1.00–1.25 >1.25 No. of ZIP codes 8 7 11 9 17 Population, no. 393,491 368,893 532,752 636,386 744,037 Total population, % 14.7 13.8 19.9 23.8 27.8 Cumulative vaccinated through July 2022, % 11.9 13.0 20.0 25.1 29.9 Cumulative deaths through July 2022, % 22.8 17.4 22.2 23.2 14.4 Race and ethnicity, % Asian 0.3 2.6 5.1 11.4 9.4 Black 89.1 42.0 18.2 16.1 8.7 Hispanic 4.3 35.7 40.0 43.4 17.2 White 4.5 18.0 34.7 26.6 61.1 Average median household income, $ 40,400 43,600 63,711 55,062 93,316 Postsecondary educationc, % 51.6 44.2 48.8

Medicaid claims are an important, but underutilized source of data for neonatal health services research in the United States. However, identifying live births in Medicaid claims data is challenging due to variation in coding practices by state and year. Methods of identifying live births in Medicaid claims data have not been validated, and it is not known which methods are most appropriate for different research questions. The objective of this study is to describe and validate five approaches to identifying births using Medicaid Analytic eXtract (MAX) from 45 states (2006–2014). We calculated total number of MAX births by state-year using five definitions: (1) any claim within 30 days of birth date listed in personal summary (PS) file, (2) any claim within 7 days of PS birth date, (3) live birth ICD-9 in inpatient or other therapies file, (4) live birth ICD-9 code in inpatient file, (5) live birth ICD-9 in inpatient file with matching PS birth date. We then compared the number of MAX births by state and year to expected counts using outside data sources. Definition 1 identified the most births (14,189,870) and was closest to total expected count (98.3%). Each definition produced over- and underestimates compared to expected counts for given state-years. Findings suggest that the broadest definition of live births (Definition 1) was closest to expected counts, but that the most appropriate definition depends on research question and state-years of interest.

Objectives(1) To compare the prevalence of antenatal admissions and mean length of stay among women with opioid-affected and non-opioid-affected deliveries; (2) examine predictors of admission; and (3) describe the most common discharge diagnoses in each group.MethodsUsing data from seven states in the State Inpatient Databases for varying years between 2009 and 2014, delivery hospitalizations among women 18 years of age and older were identified and classified as opioid-affected or non-opioid-affected. Antenatal admissions were linked to deliveries. The antenatal admission ratio and mean length of stay for each group were calculated; the percentage of deliveries in each group with no, any, one, two, or three or more antenatal admissions were compared with t-tests. Logistic regression models estimated odds of any antenatal admission, stratified by opioid-affected and non-opioid-affected deliveries. Frequencies were tabulated for the ten most common discharge diagnoses in each group.ResultsOf 2,684,970 deliveries, 14,765 were opioid-affected. Admissions among women with opioid-affected deliveries were more prevalent (26.4 per 100 deliveries) compared to 6.7 among women with non-opioid-affected deliveries and were associated with a 1.5-day longer mean length of stay. The presence of a behavioral health condition was associated with higher odds of antenatal admission in both groups, with a particularly strong association among women with opioid-affected deliveries. Six of the ten most common diagnoses for admissions prior to opioid-affected deliveries were behavioral health-related.Conclusions for PracticeThese results highlight the importance of addressing the large burden of behavioral health conditions among pregnant women, especially those with opioid dependence and abuse.

IntroductionOnline services increase access to contraception. In February 2022 an innovative pilot offering online access to combined oral contraception (COC), progestogen only contraception (POP) and emergency hormonal contraception (EHC), was launched across Northern Ireland. The service was promoted by not-paid-for posts on NI’s Public Health Agency (PHA) and Health and Social Care (HSC) trust’s social media (SM) profiles.MethodsWe analysed contraception requests in relation to regional (PHA) and local (HSC trust) SM promotion. Reach and engagement with SM posts was reviewed.ResultsBy week seven, 2,342 requests had been made for online contraception - 1,009 POP, 694 COC, 639 EHC.Average daily orders rose from 16, prior to SM promotion, to 32 at the end of week three. Daily orders peaked at 331 immediately following PHA promotion on Twitter, Facebook and Instagram. Subsequent Trust promotions were associated with smaller but substantial activity increases.The PHA post reached 87k people on Facebook (4,928 engagements), and 14k impressions on Twitter, (461 engagements). It was the PHA’s top performing tweet in February.DiscussionOur results demonstrate the value of not-paid-for SM in promoting online contraception services and the role for local and regional health organisations in supporting engagement with service users. The use of different platforms and different agencies is likely to reach more diverse audiences.Organic engagement with the SM posts, and subsequent spikes in activity, also showed a high degree of acceptability for online contraception services in Northern Ireland, and further evaluation of the popular pilot service will help inform future commissioning.Abstract O32 Figure 1

Morbidity and Mortality Weekly Report (MMWR)