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Maglaque D, Master M, von Esenwein S, Gazmararian J, Clark CJ, Blake SC. Addressing the Community Resource and Social Service Needs of Families During the COVID-19 Pandemic: Perspectives of Home Visiting Staff and Clients in Georgia. Matern Child Health J 2024; 28:804-811. [PMID: 38261275 DOI: 10.1007/s10995-023-03866-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Home visiting programs provide support services to families and their children to promote positive health outcomes. This study sought to describe strategies employed by home visiting programs during the early phase of the COVID-19 pandemic to address the community resource and social service needs of home visiting clients in Georgia. METHODS We conducted a mixed methods study between December 2020 and April 2021 using online surveys and key informant interviews of home visiting staff and clients from 21 program sites. Structured content analysis was conducted of the triangulated data to elicit thematic findings. RESULTS Due to the pandemic-induced economic conditions, clients expressed increased demand for housing, employment, and childcare support services. Staff experienced challenges with client referrals to these services because of interruptions in social service availability and transitions to virtual services. In response to these challenges, home visiting programs strengthened existing community partnerships and created new collaborations with local agencies to fill any gaps in services. DISCUSSION Home visiting programs in Georgia provided critical linkages to community resources for families during the early phase of the pandemic. Preserving this essential home visiting service in future national emergencies will require improved coordination of community resources and social services.
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Affiliation(s)
- Dianne Maglaque
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA.
| | - Margaret Master
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Silke von Esenwein
- Center for Public Partnerships and Research, University of Kansas, 1617 St. Andrews Drive, Lawrence, KS, 66047, USA
| | - Julie Gazmararian
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Cari Jo Clark
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Sarah C Blake
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
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Yu X, Meghea CI, Raffo JE, Meng R, Vander Meulen P, Lloyd CS, Roman LA. Community Health Workers: Improving Home Visiting Engagement of High-Risk Birthing People in Segregated Neighborhoods. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:E124-E134. [PMID: 38320306 DOI: 10.1097/phh.0000000000001861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
CONTEXT Racial and ethnic disparities in perinatal health remain a public health crisis. Despite improved outcomes from home visiting (HV) participation during pregnancy, most eligible individuals of color do not engage. Neighborhood segregation, a manifestation of structural racism, may impose constraints on engaging eligible individuals in HV. OBJECTIVE To examine whether race, ethnicity, and/or language-concordant community health workers (CHWs) increased HV engagement for birthing people in segregated neighborhoods. DESIGN Program evaluation using administrative linked data from birth records, Medicaid claims, and HV program participation. Strong Beginnings (SB), a program with HV provided by CHWs working with nurses and social workers, was compared with the Maternal Infant Health Program (MIHP), a state Medicaid-sponsored HV program without CHW involvement. Data were analyzed using χ 2 tests and Poisson regressions. PARTICIPANTS A total of 4560 individuals with a Medicaid-eligible birth between 2016 and 2019, including 1172 from SB and 3388 from the MIHP. MAIN OUTCOME MEASURES Penetration (percentage of participants in HV among all Medicaid-eligible individuals across quintiles of neighborhood segregation) and dosage (the total number of home visits from both CHWs and nurses/social workers, and then restricted to those from nurses/social workers). RESULTS SB penetrated more segregated neighborhoods than the MIHP (58.4% vs 48.3%; P < .001). SB participants received a higher dosage of home visits (mean [SD]: 11.9 [6.1]) than MIHP participants (mean [SD]: 4.4 [2.8], P < .001). Importantly, CHWs did not replace but moderately increased home visits from nurses and social workers (51.1% vs 35.2% with ≥5 intervention visits, P < .001), especially in more segregated neighborhoods. POLICY IMPLICATION Community-informed HV models intentionally designed for people facing disparities may help facilitate program outreach to segregated neighborhoods with concentrated deprivation and reduce racial and ethnic disparities. CONCLUSIONS An HV program provided by CHWs working with nurses and social workers was associated with an increase in penetration and dosage in segregated neighborhoods, compared with HV without CHW involvement. This underscores the value of CHWs partnering with licensed professional workers in improving HV engagement in disadvantaged communities.
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Affiliation(s)
- Xiao Yu
- Author Affiliations: Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids and East Lansing, Michigan (Drs Yu, Meghea, and Roman and Mss Raffo and Meng); and Corewell Health, Healthier Communities Department, Strong Beginnings, Grand Rapids, Michigan (Mss Vander Meulen and Lloyd)
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Akinyemi O, Ogundare T, Fasokun M, Nwokolo V, Weldeslase T, McDonald V, Colon-Santos L, Luo G. Impact of Medicaid expansion on pregnancy outcomes among women with gestational diabetes. Int J Gynaecol Obstet 2024; 165:519-525. [PMID: 38445784 DOI: 10.1002/ijgo.15439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/07/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION The Affordable Care Act (ACA) aims to broaden health care access and significantly impacts obstetric practices. Yet, its effect on maternal and neonatal outcomes among women with gestational diabetes across diverse demographics is underexplored. OBJECTIVE This study examines the impact of the implementation of the ACA on maternal and neonatal health in Maryland with ACA implementation and Georgia without ACA implementation. METHODOLOGY We used data from the Maryland State Inpatient Database and US Vital Statistics System to assess the ACA's influence on maternal and neonatal outcomes in Maryland, with Georgia serving as a nonexpansion control state. Outcomes compared include cesarean section (CS) rates, low Apgar scores, neonatal intensive care unit (NICU) admissions, and assisted ventilation 7 h postdelivery. We adjusted for factors including women's age, race, insurance type, preexisting conditions, prior CS, prepregnancy obesity, weight gain during pregnancy, birth weight, labor events, and antenatal practices. RESULTS The study included 52 479 women: 55.8% from Georgia and 44.2% from Maryland. Post-ACA, CS rates were 45.1% in Maryland versus 48.2% in Georgia (P = 0.000). Maryland demonstrated better outcomes, including lower rates of low Agar scores (odds ratio [OR], 0.74 [95% confidence interval (CI), 0.63-0.86]), assisted ventilation (OR, 0.79 [95% CI, 0.71-0.82]), and NICU admissions (OR, 0.76 [95% CI, 0.71-0.82]), but no significant change in CS rates (OR, 0.96 [95% CI, 0.92-1.01]). CONCLUSION After ACA implementation, Maryland showed improved maternal and neonatal outcomes compared with Georgia, a nonexpansion state.
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Affiliation(s)
- Oluwasegun Akinyemi
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, District of Columbia, USA
- Department of Health Policy, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Temitope Ogundare
- Department of Psychiatry, Boston School of Medicine, Boston, Massachusetts, USA
| | - Mojisola Fasokun
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Vania Nwokolo
- Department of Obstetrics and Gynecology, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Terhas Weldeslase
- Department of Surgery, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Vanesa McDonald
- Department of Obstetrics and Gynecology, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Lyanne Colon-Santos
- Department of Obstetrics and Gynecology, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Guoyang Luo
- Department of Obstetrics and Gynecology, Howard University College of Medicine, Washington, District of Columbia, USA
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Mallinson DC, Gillespie KH. Racial and Geographic Variation of Prenatal Care Coordination Receipt in the State of Wisconsin, 2010-2019. J Community Health 2024:10.1007/s10900-024-01338-5. [PMID: 38407757 DOI: 10.1007/s10900-024-01338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 02/27/2024]
Abstract
Medicaid-funded obstetric care coordination programs supplement prenatal care with tailored services to improve birth outcomes. It is uncertain whether these programs reach populations with elevated risks of adverse birth outcomes-namely non-white, highly rural, and highly urban populations. This study evaluates racial and geographic variation in the receipt of Wisconsin Medicaid's Prenatal Care Coordination (PNCC) program during 2010-2019. We sample 250,596 Medicaid-paid deliveries from a cohort of linked Wisconsin birth records and Medicaid claims. We measure PNCC receipt during pregnancy dichotomously (none; any) and categorically (none; assessment/care plan only; service receipt), and we stratify the sample on three maternal characteristics: race/ethnicity, urbanicity of residence county; and region of residence county. We examine annual trends in PNCC uptake and conduct logistic regressions to identify factors associated with assessment or service receipt. Statewide PNCC outreach decreased from 25% in 2010 to 14% in 2019, largely due to the decline in beneficiaries who only receive assessments/care plans. PNCC service receipt was greatest and persistent in Black and Hispanic populations and in urban areas. In contrast, PNCC service receipt was relatively low and shrinking in American Indian/Alaska Native, Asian/Pacific Islander, and white populations and in more rural areas. Additionally, being foreign-born was associated with an increased likelihood of getting a PNCC assessment in Asian/Pacific Islander and Hispanic populations, but we observed the opposite association in Black and white populations. Estimates signal a gap in PNCC receipt among some at-risk populations in Wisconsin, and findings may inform policy to enhance PNCC outreach.
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Affiliation(s)
- David C Mallinson
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, 610 N. Whitney Way, STE 200, Madison, WI, 53705, USA.
| | - Kate H Gillespie
- School of Nursing, University of Wisconsin-Madison, 701 Highland Avenue, Madison, WI, 53705, USA
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Zaidi M, Fantasia HC, Penders R, Koren A, Enah C. Increasing U.S. Maternal Health Equity Among Immigrant Populations Through Community Engagement. Nurs Womens Health 2024; 28:11-22. [PMID: 38072010 DOI: 10.1016/j.nwh.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 01/09/2024]
Abstract
Immigrant women in the United States are at an elevated risk of poor maternal health outcomes due to cultural, linguistic, or socioeconomic barriers that may lead to critical delays in obtaining adequate health care. Ensuring access to high-quality, culturally appropriate perinatal health care is crucial to improve the health and well-being of immigrant mothers and their children. Various aspects of perinatal health care for immigrant women can be improved through community engagement strategies. Barriers can be addressed by involving community members in designing and delivering culturally appropriate maternal health services. Some strategies discussed in this commentary include working with community health workers, encouraging telehealth through community health workers, providing breastfeeding and mental health support within cultural norms, and involving community-based doulas and midwives.
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Venkatesh KK, Yee LM, Johnson J, Wu J, McNeil B, Mercer B, Simhan H, Reddy UM, Silver RM, Parry S, Saade G, Chung J, Wapner R, Lynch CD, Grobman WA. Neighborhood Socioeconomic Disadvantage and Abnormal Birth Weight. Obstet Gynecol 2023; 142:1199-1207. [PMID: 37769319 DOI: 10.1097/aog.0000000000005384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/29/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE To examine whether exposure to community or neighborhood socioeconomic disadvantage as measured by the ADI (Area Deprivation Index) is associated with risk of abnormal birth weight among nulliparous individuals with singleton gestations. METHODS This was a secondary analysis from the prospective cohort NuMoM2b study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be). Participant addresses at cohort enrollment between 6 and 13 weeks of gestation were geocoded at the Census tract level and linked to the 2015 ADI. The ADI, which incorporates the domains of income, education, employment, and housing quality into a composite national ranking of neighborhood socioeconomic disadvantage, was categorized by quartiles (quartile 1, least disadvantaged, reference; quartile 4, most disadvantaged). Outcomes were large for gestational age (LGA; birth weight at or above the 90th percentile) and small for gestational age (SGA; birth weight below the 10th percentile) compared with appropriate for gestational age (AGA; birth weight 10th-90th percentile) as determined with the 2017 U.S. natality reference data, standardized for fetal sex. Multinomial logistic regression models were adjusted for potential confounding variables. RESULTS Of 8,983 assessed deliveries in the analytic population, 12.7% (n=1,143) were SGA, 8.2% (n=738) were LGA, and 79.1% (n=7,102) were AGA. Pregnant individuals living in the highest ADI quartile (quartile 4, 17.8%) had an increased odds of delivering an SGA neonate compared with those in the lowest referent quartile (quartile 1, 12.4%) (adjusted odds ratio [aOR] 1.32, 95% CI 1.09-1.55). Pregnant individuals living in higher ADI quartiles (quartile 2, 10.3%; quartile 3, 10.7%; quartile 4, 9.2%) had an increased odds of delivering an LGA neonate compared with those in the lowest referent quartile (quartile 1, 8.2%) (aOR: quartile 2, 1.40, 95% CI 1.19-1.61; quartile 3, 1.35, 95% CI 1.09-1.61; quartile 4, 1.47, 95% CI 1.20-1.74). CONCLUSION Neonates of nulliparous pregnant individuals living in U.S. neighborhoods with higher area deprivation were more likely to have abnormal birth weights at both extremes.
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Affiliation(s)
- Kartik K Venkatesh
- Departments of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, Northwestern University, Chicago, Illinois, Indiana University, Indianapolis, Indiana, Case Western Reserve University, Cleveland, Ohio, University of Pittsburgh, Pittsburgh, Pennsylvania, Columbia University, New York, New York, University of Utah, Salt Lake City, Utah, University of Pennsylvania, Philadelphia, Pennsylvania, University of Texas Medical Branch, Galveston, Texas, and University of California, Irvine, School of Medicine, Orange, California; and RTI International, Durham, North Carolina
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Lugo-Candelas C, Talati A, Glickman C, Hernandez M, Scorza P, Monk C, Kubo A, Wei C, Sourander A, Duarte CS. Maternal Mental Health and Offspring Brain Development: An Umbrella Review of Prenatal Interventions. Biol Psychiatry 2023; 93:934-941. [PMID: 36754341 PMCID: PMC10512172 DOI: 10.1016/j.biopsych.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/20/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023]
Abstract
The idea that risk for psychiatric disorders may be transmitted intergenerationally via prenatal programming places interest in the prenatal period as a critical moment during which intervention efforts may have a strong impact, yet studies testing whether prenatal interventions also protect offspring are limited. The present umbrella review of systematic reviews and meta-analyses (SRMAs) of randomized controlled trials aimed to synthesize the available evidence and highlight promising avenues for intervention. Overall, the literature provides mixed and limited evidence in support of prenatal interventions. Thirty SRMAs were included. Of the 23 SRMAs that reported on prenatal depression interventions, 16 found a significant effect (average standard mean difference = -0.45, SD = 0.25). Similarly, 13 of the 20 SRMAs that reported on anxiety outcomes documented significant reductions (average standard mean difference = -0.76, SD = 0.95 or -0.53/0.53 excluding one outlier). Only 4 SRMAs reported child outcomes, and only 2 (of 10) analyses showed significant effects of prenatal interventions (massage and telephone support on neonatal resuscitation [relative risk = 0.43] and neonatal intensive care unit admissions [relative risk = 0.91]). Notably missing, perhaps due to our strict inclusion criteria (inclusion of randomized controlled trials only), were interventions focusing on key facets of prenatal health (e.g., whole diet, sleep). Structural interventions (housing, access to health care, economic security) were not included, although initial success has been documented in non-SRMAs. Most notably, none of the SRMAs focused on offspring mental health or neurodevelopmental outcomes. Given the possibility that interventions deployed in this period will positively impact the next generation, randomized trials that focus on offspring outcomes are urgently needed.
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Affiliation(s)
- Claudia Lugo-Candelas
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Ardesheer Talati
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Caila Glickman
- New York State Psychiatric Institute, New York, New York
| | - Mariely Hernandez
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Pamela Scorza
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Catherine Monk
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Ai Kubo
- Division of Research, Kaiser Permanente, Oakland, California
| | - Chiaying Wei
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Andre Sourander
- Department of Child Psychiatry, Turku University Hospital, Turku University, Turku, Finland
| | - Cristiane S Duarte
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.
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Lewis KN, Tilford JM, Goudie A, Beavers J, Casey PH, McKelvey LM. Cost-benefit analysis of home visiting to reduce infant mortality among preterm infants. J Pediatr Nurs 2023:S0882-5963(23)00111-2. [PMID: 37183165 DOI: 10.1016/j.pedn.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE The Following Baby Back Home (FBBH) visiting program, which is provided by nurse and social worker teams, supports families of low-birthweight preterm infants after discharge from a neonatal intensive care unit. Enrollment in the FBBH program has been documented to reduce the likelihood of infant death. In this study, we conducted a cost-benefit analysis of the FBBH program. DESIGN AND METHODS Infants enrolled in the FBBH program (N = 416) were identified through administrative records. Infants in the FBBH program were propensity score matched with comparison infants to estimate the difference in healthcare costs in the first year of life. RESULTS Infants enrolled in the FBBH program incurred similar medical care costs compared to a comparison group. Avoided deaths, program costs, healthcare costs resulted in net economic benefits of the FBBH program to avoid infant death estimate at $83,020, cost per life saved at $3080, and benefit-to-cost ratio at 27.95. CONCLUSIONS The FBBH program's net economic benefits from avoided deaths suggest a substantial return on investment of resources, yielding benefits in excess of program and healthcare costs. PRACTICE IMPLICATIONS It is economically beneficial to provide home visiting services to families of low-birthweight babies by a team comprised of a registered nurse and social worker.
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Affiliation(s)
- Kanna N Lewis
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
| | - J Mick Tilford
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Anthony Goudie
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Arkansas Center for Health Improvement, Little Rock, AR, United States of America
| | - Jared Beavers
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Patrick H Casey
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Lorraine M McKelvey
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
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Mallinson DC, Elwert F, Ehrenthal DB. Spillover Effects of Prenatal Care Coordination on Older Siblings Beyond the Mother-Infant Dyad. Med Care 2023; 61:206-215. [PMID: 36893405 PMCID: PMC10009763 DOI: 10.1097/mlr.0000000000001822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND Pregnancy care coordination increases preventive care receipt for mothers and infants. Whether such services affect other family members' health care is unknown. OBJECTIVE To estimate the spillover effect of maternal exposure to Wisconsin Medicaid's Prenatal Care Coordination (PNCC) program during pregnancy with a younger sibling on the preventive care receipt for an older child. RESEARCH DESIGN Gain-score regressions-a sibling fixed effects strategy-estimated spillover effects while controlling for unobserved family-level confounders. SUBJECTS Data came from a longitudinal cohort of linked Wisconsin birth records and Medicaid claims. We sampled 21,332 sibling pairs (one older; one younger) who were born during 2008-2015, who were <4 years apart in age, and whose births were Medicaid-covered. In all, 4773 (22.4%) mothers received PNCC during pregnancy with the younger sibling. MEASURES The exposure was maternal PNCC receipt during pregnancy with the younger sibling (none; any). The outcome was the older sibling's number of preventive care visits or preventive care services in the younger sibling's first year of life. RESULTS Overall, maternal exposure to PNCC during pregnancy with the younger sibling did not affect older siblings' preventive care. However, among siblings who were 3 to <4 years apart in age, there was a positive spillover on the older sibling's receipt of care by 0.26 visits (95% CI: 0.11, 0.40 visits) and by 0.34 services (95% CI: 0.12, 0.55 services). CONCLUSION PNCC may only have spillover effects on siblings' preventive care in selected subpopulations but not in the broader population of Wisconsin families.
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Affiliation(s)
- David C. Mallinson
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, United States
| | - Felix Elwert
- Department of Sociology, College of Letters and Sciences, University of Wisconsin-Madison, United States
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, United States
- Center for Demography and Ecology, University of Wisconsin-Madison, United States
| | - Deborah B. Ehrenthal
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania, United States
- Social Science Research Institute, Pennsylvania State University, University Park, Pennsylvania, United States
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Chambers BD, Fontenot J, McKenzie-Sampson S, Blebu BE, Edwards BN, Hutchings N, Karasek D, Coleman-Phox K, Curry VC, Kuppermann M. "It was just one moment that I felt like I was being judged": Pregnant and postpartum black Women's experiences of personal and group-based racism during the COVID-19 pandemic. Soc Sci Med 2023; 322:115813. [PMID: 36881972 PMCID: PMC9968447 DOI: 10.1016/j.socscimed.2023.115813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 02/06/2023] [Accepted: 02/24/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Racial inequities in maternal and child health outcomes persist: Black women and birthing people experience higher rates of adverse outcomes than their white counterparts. Similar inequities are seen in coronavirus disease (COVID-19) mortality rates. In response, we sought to explore the intersections of racism and the COVID-19 pandemic impact on the daily lives and perinatal care experiences of Black birthing people. METHODS We used an intrinsic case study approach grounded in an intersectional lens to collect stories from Black pregnant and postpartum people residing in Fresno County (July-September 2020). All interviews were conducted on Zoom without video and were audio recorded and transcribed. Thematic analysis was used to group codes into larger themes. RESULTS Of the 34 participants included in this analysis, 76.5% identified as Black only, and 23.5% identified as multiracial including Black. Their mean age was 27.2 years [SD, 5.8]. Nearly half (47%) reported being married or living with their partner; all were eligible for Medi-Cal insurance. Interview times ranged from 23 to 96 min. Five themes emerged: (1) Tensions about Heightened Exposure of Black Lives Matter Movement during the pandemic; (2) Fear for Black Son's Safety; (3) Lack of Communication from Health Care Professionals; (4) Disrespect from Health Care Professionals; and (5) Misunderstood or Judged by Health Care Professionals. Participants stressed that the Black Lives Matter Movement is necessary and highlighted that society views their Black sons as a threat. They also reported experiencing unfair treatment and harassment while seeking perinatal care. CONCLUSIONS Black women and birthing people shared that exposure to racism has heightened during the COVID-19 pandemic, increasing their levels of stress and anxiety. Understanding how racism impacts Black birthing people's lives and care experiences is critical to reforming the police force and revising enhanced prenatal care models to better address their needs.
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Affiliation(s)
- Brittany D Chambers
- Department of Human Ecology, College of Agricultural and Environmental Sciences, University of California, Davis, Davis, CA, USA; California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Jazmin Fontenot
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Safyer McKenzie-Sampson
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Bridgette E Blebu
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Brittany N Edwards
- Central Valley Health Policy Institute, College of Health and Human Services, California State University, Fresno. Fresno, CA, USA
| | | | - Deborah Karasek
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kimberly Coleman-Phox
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Venise C Curry
- Central Valley Health Policy Institute, College of Health and Human Services, California State University, Fresno. Fresno, CA, USA
| | - Miriam Kuppermann
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Noroña-Zhou A, Coccia M, Sullivan A, O’Connor TG, Collett BR, Derefinko K, Renner LM, Loftus CT, Roubinov D, Carroll KN, Nguyen RHN, Karr CJ, Sathyanarayana S, Barrett ES, Mason WA, LeWinn KZ, Bush NR. A Multi-Cohort Examination of the Independent Contributions of Maternal Childhood Adversity and Pregnancy Stressors to the Prediction of Children's Anxiety and Depression. Res Child Adolesc Psychopathol 2023; 51:497-512. [PMID: 36462137 PMCID: PMC10017630 DOI: 10.1007/s10802-022-01002-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/05/2022]
Abstract
Women's social experiences can have long-term implications for their offspring's health, but little is known about the potential independent contributions of multiple periods of stress exposures over time. This study examined associations of maternal exposure to adversity in childhood and pregnancy with children's anxiety and depression symptoms in a large, sociodemographically diverse sample. Participants were 1389 mother-child dyads (child age M = 8.83 years; SD = 0.66; 42% Black, 42% White; 6% Hispanic) in the ECHO-PATHWAYS Consortium's three U.S. pregnancy cohorts. Women reported their exposure to childhood traumatic events (CTE) and pregnancy stressful life events (PSLE). Children self-reported on their symptoms of anxiety and depression at age 8-9 years. Regression analyses estimated associations between maternal stressors and children's internalizing problems, adjusting for confounders, and examined child sex as a modifier. Exploratory interaction analyses examined whether geospatially-linked postnatal neighborhood quality buffered effects. In adjusted models, PSLE counts positively predicted levels of children's anxiety and depression symptoms ([ßAnxiety=0.08, 95%CI [0.02, 0.13]; ßDepression=0.09, 95%CI [0.03, 0.14]); no significant associations were observed with CTE. Each additional PSLE increased odds of clinically significant anxiety symptoms by 9% (95%CI [0.02, 0.17]). Neither sex nor neighborhood quality moderated relations. Maternal stressors during pregnancy appear to have associations with middle childhood anxiety and depression across diverse sociodemographic contexts, whereas maternal history of childhood adversity may not. Effects appear comparable for boys and girls. Policies and programs addressing prevention of childhood internalizing symptoms may benefit from considering prenatal origins and the potential two-generation impact of pregnancy stress prevention and intervention.
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Affiliation(s)
- Amanda Noroña-Zhou
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA USA
- Department of Pediatrics, UCSF, San Francisco, CA USA
- Center for Health and Community, UCSF, San Francisco, CA USA
| | - Michael Coccia
- Center for Health and Community, UCSF, San Francisco, CA USA
| | - Alexis Sullivan
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA USA
| | - Thomas G. O’Connor
- Departments of Psychiatry, Psychology, Neuroscience, Department of Obstetrics & Gynecology, University of Rochester, Rochester, NY USA
| | - Brent R. Collett
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle Children’s Research Institute, Seattle, WA USA
| | - Karen Derefinko
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN USA
| | | | - Christine T. Loftus
- Department of Occupational and Environmental Health Sciences, University of Washington, Seattle, WA USA
| | - Danielle Roubinov
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA USA
| | - Kecia N. Carroll
- Departments of Environmental Medicine and Public Health and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Ruby H. N. Nguyen
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN USA
| | - Catherine J. Karr
- Department of Occupational and Environmental Health Sciences, Department of Pediatrics, University of Washington, Seattle, WA USA
| | - Sheela Sathyanarayana
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle Children’s Research Institute, Seattle, WA USA
| | - Emily S. Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Environmental and Occupational Health Sciences Institute, Rutgers University, New Brunswick, NJ USA
| | - W. Alex Mason
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN USA
| | - Kaja Z. LeWinn
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA USA
| | - Nicole R. Bush
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA USA
- Department of Pediatrics, UCSF, San Francisco, CA USA
- Center for Health and Community, UCSF, San Francisco, CA USA
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12
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Anderson G, Meiselbach MK. Why Are Some Value-Based Programs Successful? JAMA Netw Open 2023; 6:e234412. [PMID: 36912841 DOI: 10.1001/jamanetworkopen.2023.4412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Affiliation(s)
- Gerard Anderson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mark K Meiselbach
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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13
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Sullivan M, Lange S, Young A, Gass M, Mackeen AD, Paglia MJ. Pregnancy Outcomes in Patients Enrolled in the Healthy Beginnings Plus Program. Nurs Womens Health 2023; 27:103-109. [PMID: 36773628 DOI: 10.1016/j.nwh.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/15/2022] [Accepted: 01/15/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of enrollment in the Healthy Beginnings Plus Program (HB) on pregnancy outcomes. DESIGN Retrospective cohort study of 12,299 singleton pregnancies birthed between January 2007 and December 2018. SETTING/LOCAL PROBLEM Individuals of low socioeconomic status are at increased risk for adverse pregnancy outcomes, such as preterm birth (PTB) and low-birth-weight (LBW) neonates. Pennsylvania offers HB to pregnant individuals with Medical Assistance insurance to provide additional psychosocial and obstetric resources to routine prenatal care to minimize risk. PARTICIPANTS Individuals with Medical Assistance insurance enrolled in HB (n = 4,645), individuals with Medical Assistance insurance not enrolled in HB (n = 2,874), and individuals with private insurance (n = 4,780). MEASUREMENTS Primary outcomes were rates of PTB and LBW neonates. Secondary outcomes included rates of gestational diabetes, gestational hypertension, small-for-gestational-age neonates, and admission to the NICU. RESULTS There were no differences in PTB (adjusted OR [aOR] = 0.93, 95% confidence interval [CI] [0.76, 1.13]) or LBW neonates (aOR = 1.06, 95% CI [0.86, 1.31]) between individuals with Medical Assistance enrolled in HB versus those with Medical Assistance insurance not enrolled in HB. Individuals with Medical Assistance enrolled in HB were less likely to develop gestational hypertension compared to individuals with Medical Assistance insurance not enrolled in HB (aOR = 1.41, 95% CI [1.25, 1.59]) and individuals with private insurance (aOR = 0.85, 95% CI [0.76, 0.96]). They also attended more prenatal visits than individuals with Medical Assistance insurance not enrolled in HB (12.0 vs. 14.0, p < .01). CONCLUSION Although there was no significant difference between groups for the primary outcomes studied, individuals with Medical Assistance insurance enrolled in HB attended more prenatal visits than those who did not enroll in HB. Similar programs should evaluate outcomes and consider whether changes are needed.
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Koay JM, Spat-Lemus J, Cornwell MA, Sacks-Zimmerman A, Mandelbaum S, Kohn A, McLean E, Meli G, Bender HA. The Evolving Need for Neuropsychology in Neurosurgical Settings: Challenges Facing Transformative Care. World Neurosurg 2023; 170:277-285. [PMID: 36782426 DOI: 10.1016/j.wneu.2022.09.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 02/10/2023]
Abstract
Clinical neuropsychology has been a valuable asset to neurologic surgery, contributing to lateralization and localization of pathologic brain tissue, identification of eloquent cortex, and evaluation of postoperative neuropsychological functioning. Moreover, neuropsychologists provide empirically driven interventions aimed at supporting preparation and/or recovery of neurosurgery patients. Nonetheless, several challenges may limit the reliability, validity, and generalizability of the assessment data obtained and reduce the usefulness of other neuropsychological services provided. Specifically, linguistic, cultural, educational, and other biases associated with demographic characteristics can lead to a narrowed view of an individual's life experiences, which must be confronted to fulfill the mission of ensuring that all patients have access to care that is appropriate to their needs. Instead of perceiving these challenges as insurmountable barriers, such issues can be viewed as opportunities to catalyze change and foster innovation for the future of neuropsychological care in neurosurgical settings. In addition to reviewing the possible mechanisms of these obstacles, the current article offers tangible solutions at both a macro level (e.g., discipline-wide transformations) and micro level (e.g., individualized patient-centric approaches). Outlined are practical techniques to potentially improve consensus and standardization of methods, advance and globalize research, expand representativeness of measures and practices to serve diverse individuals, and increase treatment adherence through engagement of patients and their families.
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Affiliation(s)
- Jun Min Koay
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA; Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Jessica Spat-Lemus
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Melinda A Cornwell
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Sarah Mandelbaum
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Clinical Psychology with Health Emphasis, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Aviva Kohn
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Clinical Psychology with Health Emphasis, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Erin McLean
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Gabrielle Meli
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - H Allison Bender
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.
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McCue K, Sabo S, Wightman P, Butler M, Pilling V, Jiménez D, Annorbah R, Rumann S. Impact of a Community Health Worker (CHW) Home Visiting Intervention on Any and Adequate Prenatal Care Among Ethno-Racially Diverse Pregnant Women of the US Southwest. Matern Child Health J 2022; 26:2485-2495. [PMID: 36269498 DOI: 10.1007/s10995-022-03506-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/27/2022] [Accepted: 09/06/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Social and structural barriers drive disparities in prenatal care utilization among minoritized women in the United States. This study examined the impact of Arizona's Health Start Program, a community health worker (CHW) home visiting intervention, on prenatal care utilization among an ethno-racially and geographically diverse cohort of women. METHODS We used Health Start administrative and state birth certificate data to identify women enrolled in the program during 2006-2016 (n = 7,117). Propensity score matching was used to generate a statistically-similar comparison group (n = 53,213) of women who did not participate in the program. Odds ratios were used to compare rates of prenatal care utilization. The process was repeated for select subgroups, with post-match regression adjustments applied where necessary. RESULTS Health Start participants were more likely to report any (OR 1.24, 95%CI 1.02-1.50) and adequate (OR 1.08, 95%CI 1.01-1.16) prenatal care, compared to controls. Additional specific subgroups were significantly more likely to receive any prenatal care: American Indian women (OR 2.22, 95%CI 1.07-4.60), primipara women (OR 1.64, 95%CI 1.13-2.38), teens (OR 1.58, 95%CI 1.02-2.45), women in rural border counties (OR 1.45, 95%CI 1.05-1.98); and adequate prenatal care: teens (OR 1.31, 95%CI 1.11-1.55), women in rural border counties (OR 1.18, 95%CI 1.05-1.33), primipara women (OR 1.18, 95%CI 1.05-1.32), women with less than high school education (OR 1.13, 95%CI 1.00-1.27). CONCLUSIONS FOR PRACTICE A CHW-led perinatal home visiting intervention operated through a state health department can improve prenatal care utilization among demographically and socioeconomically disadvantaged women and reduce maternal and child health inequity.
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Affiliation(s)
- Kelly McCue
- Northern Arizona University Center for Health Equity Research, PO Box 4065, 86001, Flagstaff, AZ, USA.
| | - Samantha Sabo
- Northern Arizona University Center for Health Equity Research, PO Box 4065, 86001, Flagstaff, AZ, USA
| | - Patrick Wightman
- University of Arizona Center for Population Science and Discovery, P.O. Box 245024, 85724, Tucson, AZ, USA
| | - Matthew Butler
- Department of Economics, Brigham Young University, 435 Crabtree Technology Building, 84602, Provo, UT, USA
| | - Vern Pilling
- University of Arizona Center for Biomedical Informatics and Biostatistics, PO Box 210242, 85721, Tucson, AZ, USA
| | - Dulce Jiménez
- Northern Arizona University Center for Health Equity Research, PO Box 4065, 86001, Flagstaff, AZ, USA
| | - Rebecca Annorbah
- Northern Arizona University Center for Health Equity Research, PO Box 4065, 86001, Flagstaff, AZ, USA
| | - Sara Rumann
- Arizona Department of Health Services, Bureau of Women's and Children's Health, 150 North 18th Avenue, Suite 320, 85007, Phoenix, AZ, USA
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16
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Wightman P, McCue K, Sabo S, Annorbah R, Jiménez D, Pilling V, Butler M, Celaya MF, Rumann S. Community health worker intervention improves early childhood vaccination rates: results from a propensity-score matching evaluation. BMC Public Health 2022; 22:1854. [PMID: 36195944 PMCID: PMC9531224 DOI: 10.1186/s12889-022-14239-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Arizona's Health Start Program is a statewide community health worker (CHW) maternal and child health home visiting intervention. The objective of this study was to test if participation in Health Start during 2006-2016 improved early childhood vaccination completion rates. METHODS This retrospective study used 11 years of administrative, birth certificate, and immunization records. Propensity score matching was used to identify control groups, based on demographic, socioeconomic, and geographic characteristics. Results are reported by historically disadvantaged subgroups and/or with a history of low vaccine uptake, including Hispanic/Latinx and American Indian children, and children of low socioeconomic status and from rural areas, children with teen mothers and first-born children. The average treatment-on-the-treated (ATT) effect estimated the impact of Health Start on timely completion of seven early childhood vaccine series: diphtheria/tetanus toxoids and acellular/whole-cell pertussis (DTaP/DTP), Haemophilus influenzae type b (Hib), hepatitis B (Hep. B), measles-mumps-rubella (MMR), pneumococcal conjugate vaccine (PCV13), poliovirus, and varicella. RESULTS Vaccination completion rates (by age five) were 5.0% points higher for Health Start children as a group, and on average 5.0% points higher for several subgroups of mothers: women from rural border counties (ATT 5.8), Hispanic/Latinx women (ATT 4.8), American Indian women (ATT 4.8), women with less than high school education (ATT 5.0), teen mothers (ATT 6.1), and primipara women (ATT 4.5), compared to matched control groups (p-value ≤ 0.05). Time-to-event analyses show Health Start children complete vaccination sooner, with a hazard rate for full vaccination 13% higher than their matches. CONCLUSION A state-operated home visiting intervention with CHWs as the primary interventionist can effectively promote early childhood vaccine completion, which may reduce the incidence of preventable diseases and subsequently improve children's health. Effects of CHW interventions on vaccination uptake is particularly relevant given the rise in vaccine-preventable diseases in the US and globally. TRIAL REGISTRATION Approved by the University of Arizona Research Institutional Review Board (Protocol 1701128802), 25 January 2017.
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Affiliation(s)
- Patrick Wightman
- Center for Population Health Sciences, University of Arizona, Tucson, AZ, USA
| | - Kelly McCue
- Center for Health Equity Research, Northern Arizona University, PO Box 4065, 86011, Flagstaff, AZ, USA.
| | - Samantha Sabo
- Center for Health Equity Research, Northern Arizona University, PO Box 4065, 86011, Flagstaff, AZ, USA
| | - Rebecca Annorbah
- Center for Health Equity Research, Northern Arizona University, PO Box 4065, 86011, Flagstaff, AZ, USA
| | - Dulce Jiménez
- Center for Health Equity Research, Northern Arizona University, PO Box 4065, 86011, Flagstaff, AZ, USA
| | - Vern Pilling
- Center for Biomedical Informatics and Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Matthew Butler
- Department of Economics, Brigham Young University, Provo, UT, USA
| | - Martín F Celaya
- Arizona Department of Health Services, Bureau of Women's and Children's Health, Phoenix, AZ, USA
| | - Sara Rumann
- Arizona Department of Health Services, Bureau of Women's and Children's Health, Phoenix, AZ, USA
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17
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Garite TJ, Manuck TA. Should case management be considered a component of obstetrical interventions for pregnancies at risk of preterm birth? Am J Obstet Gynecol 2022; 228:430-437. [PMID: 36130634 PMCID: PMC10024643 DOI: 10.1016/j.ajog.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/11/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022]
Abstract
Preterm birth remains the leading cause of morbidity and mortality among nonanomalous neonates in the United States. Unfortunately, preterm birth rates remain high despite current medical interventions such as progestogen supplementation and cerclage placement. Case management, which encompasses coordinated care aimed at providing a more comprehensive and supportive environment, is a key component in improving health and reducing costs in other areas of medicine. However, it has not made its way into the general lexicon and practice of obstetrical care. Case management intended for decreasing prematurity or ameliorating its consequences may include specialty clinics, social services, coordination of specialty services such as nutrition counseling, home visits or frequent phone calls by specially trained personnel, and other elements described herein. It is not currently included in nor is it advocated for as a recommended prematurity prevention approach in the American College of Obstetricians and Gynecologists or Society for Maternal-Fetal Medicine guidelines for medically indicated or spontaneous preterm birth prevention. Our review of existing evidence finds consistent reductions or trends toward reductions in preterm birth with case management, particularly among individuals with high a priori risk of preterm birth across systematic reviews, metaanalyses, and randomized controlled studies. These findings suggest that case management has substantial potential to improve the environmental, behavioral, social, and psychological factors with patients at risk of preterm birth.
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Affiliation(s)
- Thomas J Garite
- Sera Prognostics, Salt Lake City, UT; University of California Irvine, Irvine, CA.
| | - Tracy A Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Institute for Environmental Health Solutions, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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18
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Strutz KL, Luo Z, Raffo JE, Meghea CI, Vander Meulen P, Roman LA. Determining County-Level Counterfactuals for Evaluation of Population Health Interventions: A Novel Application of K-Means Cluster Analysis. Public Health Rep 2022; 137:849-859. [PMID: 34323147 PMCID: PMC9379838 DOI: 10.1177/00333549211030507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Evaluating population health initiatives at the community level necessitates valid counterfactual communities, which includes having similar population composition, health care access, and health determinants. Estimating appropriate county counterfactuals is challenging in states with large intercounty variation. We describe an application of K-means cluster analysis for determining county-level counterfactuals in an evaluation of an intervention, a county perinatal system of care for Medicaid-insured pregnant women. METHODS We described counties by using indicators from the American Community Survey, Area Health Resources Files, University of Wisconsin Population Health Institute County Health Rankings, and vital records for Michigan Medicaid-insured births for 2009, the year the intervention began (or the closest available year). We ran analyses of 1000 iterations with random starting cluster values for each of a range of number of clusters from 3 to 10 with commonly used variability and reliability measures to identify the optimal number of clusters. RESULTS The use of unstandardized features resulted in the grouping of 1 county with the intervention county in all solutions for all iterations and the frequent grouping of 2 additional counties with the intervention county. Standardized features led to no solution, and other distance measures gave mixed results. However, no county was ideal for all subpopulation analyses. PRACTICE IMPLICATIONS Although the K-means method was successful at identifying comparison counties, differences between the intervention county and comparison counties remained. This limitation may be specific to the intervention county and the constraints of a within-state study. This method could be more useful when applied to other counties in and outside Michigan.
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Affiliation(s)
- Kelly L. Strutz
- Department of Obstetrics, Gynecology and Reproductive Biology,
Michigan State University College of Human Medicine, East Lansing and Grand Rapids,
MI, USA
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, Michigan State
University College of Human Medicine, East Lansing, MI, USA
| | - Jennifer E. Raffo
- Department of Obstetrics, Gynecology and Reproductive Biology,
Michigan State University College of Human Medicine, East Lansing and Grand Rapids,
MI, USA
| | - Cristian I. Meghea
- Department of Obstetrics, Gynecology and Reproductive Biology,
Michigan State University College of Human Medicine, East Lansing and Grand Rapids,
MI, USA
| | - Peggy Vander Meulen
- Strong Beginnings Federal Healthy Start Program, Grand Rapids, MI,
USA
- Healthier Communities, Spectrum Health, Grand Rapids, MI,
USA
| | - Lee Anne Roman
- Department of Obstetrics, Gynecology and Reproductive Biology,
Michigan State University College of Human Medicine, East Lansing and Grand Rapids,
MI, USA
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Johnson JE, Roman L, Key KD, Meulen MV, Raffo JE, Luo Z, Margerison CE, Olomu A, Johnson-Lawrence V, White JM, Meghea C. Study protocol: The Maternal Health Multilevel Intervention for Racial Equity (Maternal Health MIRACLE) Project. Contemp Clin Trials 2022; 120:106894. [PMID: 36028193 PMCID: PMC9809987 DOI: 10.1016/j.cct.2022.106894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/09/2022] [Accepted: 08/20/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To test the effectiveness and cost-effectiveness of a multilevel intervention for population-level African American (AA) severe maternal morbidity and mortality. BACKGROUND Severe maternal morbidity and mortality in the U.S. disproportionately affect AA women. Inequities occur at many levels, including community, provider, and health system levels. DESIGN Intervention. Throughout the two intervention counties, we will expand access to enhanced prenatal care services using telehealth and flexible scheduling (community level), provide actionable maternal health-focused anti-racism training (provider level), and implement equity-focused community care maternal safety bundles (health system level). Partnership. Interventions were developed/co-developed by intervention county partners, including AA women, enhanced prenatal care staff, and health providers. For equity, 46% of project direct cost dollars go to our partners. Most study investigators are female (75%) and/or AA (38%). Partners are overwhelmingly AA women. Sample, measures, analyses. We use a quasi-experimental difference-in-differences with propensity scores approach to compare pre (2016-2019) to post (2022-2025) changes in outcomes for Medicaid-insured women in intervention counties to similar women in the other Michigan, USA, counties. The sample includes all Medicaid-insured deliveries in Michigan during these years (n ~ 540,000), with women observed during pregnancy, at birth, and up to 1 year postpartum. Measures are taken from a linked dataset that includes Medicaid claims and vital records. CONCLUSION This study is among the first to examine effects of any multilevel intervention on AA severe maternal morbidity and mortality. It features a rigorous quasi-experimental design, multilevel multi-partner county-wide interventions developed by community partners, and assessment of intervention effects using population-level data.
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Affiliation(s)
- Jennifer E Johnson
- Division of Public Health, Michigan State University College of Human Medicine, 200 East 1(st) St Room 366, Flint, MI 48502, United States of America.
| | - LeeAnne Roman
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University College of Human Medicine, 965 Wilson Rd, Room, Room A629B, East Lansing, MI 48823, United States of America.
| | - Kent D Key
- Division of Public Health, Michigan State University College of Human Medicine, 200 East 1(st) St Room 367, Flint, MI 48502, United States of America.
| | - Margaret Vander Meulen
- Strong Beginnings - Healthy Start, 751 Lafayette NE, Grand Rapids, MI 49503, United States of America.
| | - Jennifer E Raffo
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University College of Human Medicine, MSU Secchia Center, 15 Michigan St. NE, Grand Rapids, MI 49503, United States of America.
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, B627 West Fee Hall, 909 Wilson Road, East Lansing, MI 48823, United States of America.
| | - Claire E Margerison
- Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, 909 Wilson Rd. Rm 601B, East Lansing, MI 48823, United States of America.
| | - Adesuwa Olomu
- Department of Medicine, Michigan State University College of Human Medicine, B323 Clinical Center, East Lansing, MI 48824, United States of America.
| | - Vicki Johnson-Lawrence
- Department of Family Medicine, Michigan State University College of Human Medicine, B106 Clinical Center, 788 Service Road, East Lansing, MI 48824., United States of America.
| | - Jonne McCoy White
- Division of Public Health, Michigan State University College of Human Medicine, 200 East 1(st) St Room 371, Flint, MI 48502, United States of America.
| | - Cristian Meghea
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University College of Human Medicine, 965 Wilson Rd, Room A627, East Lansing, MI 48823, USA.
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Bonnevie E, Barth C, May J, Carey T, Knell SB, Wartella E, Smyser J. Growing and Glowing: A Digital Media Campaign to Increase Access to Pregnancy-Related Health Information for Black Women During the COVID-19 Pandemic. Health Promot Pract 2022; 24:444-454. [PMID: 35392694 PMCID: PMC10159794 DOI: 10.1177/15248399221083844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Low birthweight is a health issue disproportionately experienced by Black women. In Hillsborough County, Florida, Black women experience higher rates of low birthweight compared to the rest of Florida. This study examines the feasibility of a second attempt to use a digital low birthweight campaign to increase knowledge about low birthweight and pregnancy among Black women in Hillsborough. METHODS Content for the Growing and Glowing campaign was delivered on social media through a web series with local prenatal care providers and educational images. Two cross-sectional surveys examined changes in pregnancy-related knowledge, attitudes, and behaviors among Black women in Hillsborough. Digital metrics showed campaign reach and engagement. RESULTS Growing and Glowing attained 1,234 followers, 805,437 impressions, and a reach of 19,875. Web series videos were viewed almost 27,000 times, with 89% average viewer retention. The website attracted 2,634 unique page views. Evaluation surveys showed significant improvements in positive pregnancy-related intentions. Women aware of the campaign showed significantly higher awareness of the importance of prenatal care, and higher awareness of local resources. CONCLUSION Results from the second study of this campaign approach suggest that using a highly targeted digital intervention can be a well-received and potentially effective way to deliver pregnancy-related health information to Black women, even during a global pandemic. This approach has numerous benefits in reaching women who may fall outside traditional health marketing approaches.
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Affiliation(s)
| | | | | | - Toni Carey
- The Public Good Projects, Washington, DC, USA
| | | | | | - Joe Smyser
- The Public Good Projects, New York, NY, USA
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Meghea CI. Successful Strategies to Increase Cessation Rates Among Low-Income Maternal Smokers. Am J Public Health 2022; 112:351-353. [PMID: 35196062 PMCID: PMC8887156 DOI: 10.2105/ajph.2021.306655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Cristian I Meghea
- Cristian I. Meghea is with the Department of Obstetrics, Gynecology, and Reproductive Biology, in the College of Human Medicine, Michigan State University, East Lansing, and with the Department of Public Health, College of Political, Administrative, and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
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22
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Roman LA, Raffo JE, Strutz KL, Luo Z, Johnson ME, Meulen PV, Henning S, Baker D, Titcombe C, Meghea CI. The Impact of a Population-Based System of Care Intervention on Enhanced Prenatal Care and Service Utilization Among Medicaid-Insured Pregnant Women. Am J Prev Med 2022; 62:e117-e127. [PMID: 34702604 DOI: 10.1016/j.amepre.2021.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/09/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Enhanced prenatal/postnatal care home visiting programs for Medicaid-insured women have significant positive impacts on care and health outcomes. However, enhanced prenatal care participation rates are typically low, enrolling <30% of eligible women. This study investigates the impacts of a population-based systems approach on timely enhanced prenatal care participation and other healthcare utilization. METHODS This quasi-experimental, population-based, difference-in-differences study used linked birth certificates, Medicaid claims, and enhanced prenatal care data from complete statewide Medicaid birth cohorts (2009 to 2015), and was analyzed in 2019-2020. The population-based system intervention included cross-agency leadership and work groups, delivery system redesign with clinical-community linkages, increased enhanced prenatal care-Community Health Worker care, and patient empowerment. Outcomes included enhanced prenatal care participation and early participation, prenatal care adequacy, emergency department contact, and postpartum care. RESULTS Enhanced prenatal care (7.4 percentage points, 95% CI=6.3, 8.5) and first trimester enhanced prenatal care (12.4 percentage points, 95% CI=10.2, 14.5) increased among women served by practices with established clincial-community linkages, relative to that among the comparator group. First trimester enhanced prenatal care improved in the county (17.9, 95% CI=15.7, 20.0), emergency department contact decreased in the practices (-11.1, 95% CI= -12.3, -9.9), and postpartum care improved in the county (7.1, 95% CI=6.0, 8.2). Enhanced prenatal care participation for Black women served by the practices improved (4.4, 95% CI=2.2, 6.6) as well as early enhanced prenatal care (12.3, 95% CI=9.0, 15.6) and use of postpartum care (10.4, 95% CI=8.3, 12.4). CONCLUSIONS A population systems approach improved selected enhanced prenatal care participation and service utilization for Medicaid-insured women in a county population, those in practices with established clinical-community linkages, and Black women.
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Affiliation(s)
- Lee Anne Roman
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan.
| | - Jennifer E Raffo
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Kelly L Strutz
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | | | - Peggy Vander Meulen
- Strong Beginnings, Healthier Communities, Spectrum Health, Grand Rapids, Michigan
| | - Susan Henning
- Strong Beginnings, Healthier Communities, Spectrum Health, Grand Rapids, Michigan
| | - Dianna Baker
- Kent County Health Department, Grand Rapids, Michigan
| | | | - Cristian I Meghea
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan; Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania
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Kim KW, Nho JH, Kim S, Park B, Park S, Kang B, Kim SH. Comparison of infant mortality and associated factors between Korean and immigrant women in Korea: an 11-year longitudinal study. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2021; 27:286-296. [DOI: 10.4069/kjwhn.2021.12.12.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/02/2021] [Accepted: 12/12/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose: This study compared infant mortality and the factors associated with infant mortality between Korean and immigrant women using vital statistics gathered by Statistics Korea.Methods: Birth and death statistics from the period between 2009 and 2019 were extracted from the census of population dynamics data of the Microdata Integrated Service, Korea. Statistical data were derived from a complete survey and infant mortality was analyzed from mortality statistics data. Descriptive statistics were used for comparison. Results: The average infant mortality rate (IMR) of Korean women was 2.7, which did not change significantly between 2009 and 2019; however, the IMR of immigrant women increased significantly in 2018 to 4.2 and subsequently decreased to 2.6 in 2019. Moreover, the age of Korean and immigrant women at the time of infant death gradually increased from 31.1 years and 25.9 years in 2009 to 32.8 years and 30.9 years in 2019, respectively. The gestational age was lower for deceased infants born to immigrant women (mean, 31.0 weeks; standard deviation [SD], 6.4; median, 30.0) compared to those born to Korean women (mean, 31.7 weeks; SD, 6.5; median, 32.0). Immigrant women (91.7%) received slightly fewer antenatal care (ANC) visits compared to Korean women (93.1%). Meanwhile, the birth weights of infants born to Korean and immigrant women showed a tendency toward gradual decline from 2009 through 2019. Conclusion: It is vital to devise a plan to lower the IMR of immigrant women in Korea. Moreover, it is necessary to explore the factors related to infant mortality among immigrant women within the context of Korean societal situation, culture, and home environment.
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Raffo JE, Titcombe C, Henning S, Meghea CI, Strutz KL, Roman LA. Clinical-Community Linkages: The Impact of Standard Care Processes that Engage Medicaid-Eligible Pregnant Women in Home Visiting. Womens Health Issues 2021; 31:532-539. [PMID: 34301450 DOI: 10.1016/j.whi.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 06/14/2021] [Accepted: 06/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND To better address physical, emotional, and social needs of Medicaid-insured pregnant women, a Federally Qualified Health Center and a hospital-based obstetrics and gynecology residency practice collaborated with their agency-based state Medicaid-sponsored home visiting program, the Maternal Infant Health Program (MIHP). In partnership, both practice sites created patient standards of care to identify and engage eligible pregnant women into underutilized home visiting services for enhanced prenatal care coordination. The purpose of this study was to describe how each practice operationalized clinical-community linkage strategies that best suited their setting and to determine if efforts resulted in improved MIHP participation and other service use. METHODS Using linked administrative data, a quasi-experimental pre-post difference-in-difference design was used to examine changes in MIHP participation, adequate prenatal care, emergency department use, and postpartum care among patients in each practice compared with the same birth cohorts between 2010 and 2015 in the rest of the state. RESULTS When compared with similar women from the rest of the state, the Federally Qualified Health Center observed a 9.1 absolute percentage points (APP; 95% confidence interval [CI], 8.1-10.1) increase in MIHP participation and 12.5 APP (95% CI, 10.4-14.6) increase in early first trimester enrollment. The obstetrics and gynecology residency practice experienced increases of 4.4 APP (95% CI, 3.3-5.6) in overall MIHP participation and 12.5 APP (95% CI, 10.3-14.7) in first trimester enrollment. Significant improvements in adequate prenatal care, emergency department use, and postpartum visit completion were also observed. CONCLUSIONS Clinical-community linkages can significantly improve participation of Medicaid-insured women in an evidence-based home visiting program and other prenatal services. This work is important because health providers are looking for ways to create clinical-community linkages.
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Affiliation(s)
- Jennifer E Raffo
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, Michigan.
| | | | - Susan Henning
- Spectrum Health, Healthier Communities, Grand Rapids, Michigan
| | - Cristian I Meghea
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan
| | - Kelly L Strutz
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, Michigan
| | - Lee Anne Roman
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan
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25
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Sabo S, Wightman P, McCue K, Butler M, Pilling V, Jimenez DJ, Celaya M, Rumann S. Addressing maternal and child health equity through a community health worker home visiting intervention to reduce low birth weight: retrospective quasi-experimental study of the Arizona Health Start Programme. BMJ Open 2021; 11:e045014. [PMID: 34135037 PMCID: PMC8211081 DOI: 10.1136/bmjopen-2020-045014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To test if participation in the Health Start Programme, an Arizona statewide Community Health Worker (CHW) maternal and child health (MCH) home visiting programme, reduced rates of low birth weight (LBW), very LBW (VLBW), extremely LBW (ELBW) and preterm birth (PTB). DESIGN Quasi-experimental retrospective study using propensity score matching of Health Start Programme enrolment data to state birth certificate records for years 2006-2016. SETTING Arizona is uniquely racially and ethnically diverse with comparatively higher proportions of Latino and American Indian residents and a smaller proportion of African Americans. PARTICIPANTS 7212 Health Start Programme mothers matched to non-participants based on demographic, socioeconomic and geographic characteristics, health conditions and previous birth experiences. INTERVENTION A statewide CHW MCH home visiting programme. PRIMARY AND SECONDARY OUTCOME MEASURES LBW, VLBW, ELBW and PTB. RESULTS Using Health Start Programme's administrative data and birth certificate data from 2006 to 2016, we identified 7212 Health Start Programme participants and 53 948 matches. Programme participation is associated with decreases in adverse birth outcomes for most subgroups. Health Start participation is associated with statistically significant lower rates of LBW among American Indian women (38%; average treatment-on-the-treated effect (ATT): 2.30; 95% CI -4.07 to -0.53) and mothers with a pre-existing health risk (25%; ATT: -3.06; 95% CI -5.82 to -0.30). Among Latina mothers, Health Start Programme participation is associated with statistically significant lower rates of VLBW (36%; ATT: 0.35; 95% CI -0.69 to -0.01) and ELBW (62%; ATT: 0.31; 95% CI (-0.52 to -0.10)). Finally, Health Start Programme participation is associated with a statistically significant lower rate of PTB for teen mothers (30%; ATT: 2.81; 95% CI -4.71 to -0.91). Other results were not statistically significant. CONCLUSION A state health department-operated MCH home visiting intervention that employs CHWs as the primary interventionist may contribute to the reduction of LBW, VLBW, ELBW and PTB and could improve birth outcomes statewide, especially among women and children at increased risk for MCH inequity.
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Affiliation(s)
- Samantha Sabo
- Center for Health Equity Research, College of Health and Human Services, Northern Arizona University, Flagstaff, Arizona, USA
| | - Patrick Wightman
- Center for Population Science and Discovery, University of Arizona Health Sciences, Tucson, Arizona, USA
| | - Kelly McCue
- Center for Health Equity Research, College of Health and Human Services, Northern Arizona University, Flagstaff, Arizona, USA
| | - Matthew Butler
- Department of Economics, Brigham Young University, Provo, Utah, USA
| | - Vern Pilling
- Center for Biomedical Informatics and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Dulce J Jimenez
- Center for Health Equity Research, College of Health and Human Services, Northern Arizona University, Flagstaff, Arizona, USA
| | - Martín Celaya
- Arizona Department of Health Services, Bureau of Women's and Children's Health, Phoenix, Arizona, USA
| | - Sara Rumann
- Arizona Department of Health Services, Bureau of Women's and Children's Health, Phoenix, Arizona, USA
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Anthony ER, Cho Y, Fischer RL, Matthews L. Examining the Causal Impact of Prenatal Home Visiting on Birth Outcomes: A Propensity Score Analysis. Matern Child Health J 2021; 25:947-955. [PMID: 33616819 DOI: 10.1007/s10995-020-03054-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In Ohio, African American babies die at 2.5-3 times the rate of White babies. Preterm birth and low birth weight are the leading causes of infant mortality. Home visiting is an evidence-based strategy for serving low-income pregnant women; however, there are relatively few rigorous studies examining its effect on birth outcomes. METHODS This study uses a propensity score technique to estimate the causal effect of participation in home visiting on prematurity and low birth weight among a low-income, predominantly African American sample (N = 26,814). RESULTS We found that participation in home visiting significantly reduced the odds of experiencing both adverse birth events, with a larger program effect for the low birth weight outcome. CONCLUSIONS FOR PRACTICE Results suggest that selective prevention strategies must be accompanied by universal attempts to improve the health and life circumstances of low income and minority women.
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Affiliation(s)
- Elizabeth R Anthony
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 11235 Bellflower Road, Cleveland, OH, 44106-7164, USA
| | - Youngmin Cho
- Department of Social Welfare, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea.
| | - Robert L Fischer
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 11235 Bellflower Road, Cleveland, OH, 44106-7164, USA
| | - Lisa Matthews
- MomsFirst, Cleveland Department of Public Health, 75 Bethel Ct, Cleveland, OH, 44114, USA
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Testa A, Jackson DB. Barriers to Prenatal Care Among Food-Insufficient Women: Findings from the Pregnancy Risk Assessment Monitoring System. J Womens Health (Larchmt) 2021; 30:1268-1277. [PMID: 33416423 DOI: 10.1089/jwh.2020.8712] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This study examines the relationship among food insufficiency, adequacy of prenatal care, and barriers to prenatal care. Materials and Methods: Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS), 2009-2016, negative binomial and logistic regression models were used to assess the association among food insufficiency during pregnancy, late onset of prenatal care, the number of prental care visits, as well as barriers to prenatal care. Results: Findings indicate that food insufficiency is associated with not initiating prenatal care during the first trimester and having fewer overall visits. In addition, food insufficiency is associated with more overall barriers to prenatal care, and this association operates through several specific barriers, including not having enough money, lacking transportation to get to the clinic or doctor's office, not being able to get time off work, not having a Medicaid card, having too many other things going on, and having no one to take care of children. Conclusion: Considering the adverse consequences of both food insufficiency and a lack of sufficient prenatal care for maternal and child health, study findings suggest a need to develop targeted interventions that expand access and remove barriers to prenatal care among food-insufficient women.
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Affiliation(s)
- Alexander Testa
- Department of Criminology and Criminal Justice, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins University, Baltimore, Maryland, USA
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Abstract
Birthweight is a well-known predictor of adult-onset chronic disease. The placenta plays a necessary role in regulating fetal growth and determining birth size. Maternal stressors that affect placental function and prenatal growth include maternal overnutrition and undernutrition, toxic social stress, and exposure to toxic chemicals. These stressors lead to increased vulnerability to disease within any population. This vulnerability arises from placental and fetal exposure to stressors during fetal life. The biological drivers linking various social determinants of health to compromised placental function and fetal development have been little studied.
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Stapleton S, Wright J, Jolles DR. Improving the Experience of Care: Results of the American Association of Birth Centers Strong Start Client Experience of Care Registry Pilot Program, 2015-2016. J Perinat Neonatal Nurs 2020; 34:27-37. [PMID: 31996642 DOI: 10.1097/jpn.0000000000000454] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In 2018, the Center for Medicare and Medicaid Innovation in the United States (US) released report demonstrating birth centers as the appropriate level of care for most Medicaid beneficiaries. A pilot project conducted at 34 American Association of Birth Centers (AABC) Strong Start sites included 553 beneficiaries between 2015 and 2016 to explore client perceptions of high impact components of care. Participants used the AABC client experience of care registry to report knowledge, values, and experiences of care. Data were linked to more than 300 process and outcome measures within the AABC Perinatal Data Registry™. Descriptive statistics, t tests, χ analysis, and analysis of variance were conducted. Participants demonstrated high engagement with care and trust in pregnancy, birth, and parenting. Beneficiaries achieved their preference for vaginal birth (89.9%) and breastfeeding at discharge through 6 weeks postpartum (91.7% and 87.6%). Beneficiaries reported having time for questions, felt listened to, spoken to in a way they understood, being involved in decision making, and treated with respect. There were no variations in experience of care, cesarean birth, or breastfeeding by race. Medicaid beneficiaries receiving prenatal care at AABC Strong Start sites demonstrated high levels of desired engagement and reported receiving respectful, accessible care and high-quality outcomes. More investment and research using client-reported data registries are warranted as the US works to improve the experience of perinatal care nationwide.
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Affiliation(s)
- Susan Stapleton
- American Association of Birth Centers, Perkiomenville, Pennsylvania (Drs Stapleton and Jolles); Commission for the Accreditation of Birth Centers, Kennebunk, Maine (Dr Stapleton); AABC Perinatal Data Registry, Brattleboro, Vermont (Ms Wright); and El Rio Community Health Center, Frontier Nursing University, Tucson, Arizona (Dr Jolles)
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30
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Park YJ, Weinberg S, Cogan LW. The impact of the Medicaid high-risk ob care management program in New York State. Health Serv Res 2019; 55:71-81. [PMID: 31713854 DOI: 10.1111/1475-6773.13236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To examine the effect of high-risk obstetrics (HROB) care management on infant health and Medicaid expenditures. DATA SOURCES/STUDY SETTING Medicaid administrative data and vital statistics from 2011 to 2013. In New York State, all Medicaid managed care plans provide HROB care management to their members. STUDY DESIGN We conducted a retrospective cohort study with a nonequivalent control group. Selection bias was addressed by using probit and OLS models with the Heckman correction and inverse probability weight with regression adjustment. PRINCIPAL FINDINGS While program enrollment was associated with poor infant health outcomes (low birthweight, very low birthweight, preterm delivery, and gestational age), correcting for sample selection substantially improved most of these outcomes. All infant health outcomes significantly improved as the number of weeks in the program increased. We found that a 1-week increase in program duration is associated with a 0.01 percentage point decrease in low birthweight and a 0.03 percentage point decrease in very low birthweight. Further, a 1-week increase in program duration decreases the probability of preterm delivery by 0.01 percentage points and increases gestational age by 0.14 days. Medicaid expenditures for maternity care and newborn delivery were not significantly or materially affected by program enrollment or program duration. CONCLUSIONS High-risk obstetrics care management appears to successfully identify individuals with high-risk pregnancies and improve health without substantially increasing medical expenses.
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Affiliation(s)
- Young Joo Park
- School of Public Administration, University of New Mexico, Albuquerque, New Mexico
| | - Stephen Weinberg
- Rockefeller College of Public Affairs and Policy, University at Albany-State University of New York, Albany, New York
| | - Lindsay W Cogan
- New York State Department of Health, Albany, New York.,School of Public Health, University at Albany-State University of New York, Albany, New York
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31
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Mallinson DC, Larson A, Berger LM, Grodsky E, Ehrenthal DB. Estimating the effect of Prenatal Care Coordination in Wisconsin: A sibling fixed effects analysis. Health Serv Res 2019; 55:82-93. [PMID: 31701531 DOI: 10.1111/1475-6773.13239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To estimate Prenatal Care Coordination's (PNCC) effect on birth outcomes for Wisconsin Medicaid-covered deliveries. DATA SOURCE A longitudinal cohort of linked Wisconsin birth records (2008-2012), Medicaid claims, and state-administered social services. STUDY DESIGN We defined PNCC treatment dichotomously (none vs. any) and by service level (none vs. assessment/care plan only vs. service uptake). Outcomes were birthweight (grams), low birthweight (<2500 g), gestational age (completed weeks), and preterm birth (<37 weeks). We estimated PNCC's effect on birth outcomes, adjusting for maternal characteristics, using inverse-probability of treatment weighted and sibling fixed effects regressions. DATA COLLECTION/EXTRACTION METHODS We identified 136 224 Medicaid-paid deliveries, of which 33 073 (24.3 percent) linked to any PNCC claim and 22 563 (16.6 percent) linked to claims for PNCC service uptake. PRINCIPAL FINDINGS Sibling fixed effects models-which best adjust for unobserved confounding and treatment selection-produced the largest estimates for all outcomes. For example, in these models, PNCC service uptake was associated with a 1.3 percentage point (14 percent) reduction and a 1.8 percentage point (17 percent) reduction in the probabilities of low birthweight and preterm birth, respectively (all P < .05). CONCLUSIONS PNCC's modest but significant improvement of birth outcomes should motivate stronger PNCC outreach and implementation of similar programs elsewhere.
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Affiliation(s)
- David C Mallinson
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Andrea Larson
- Department of Obstetrics and Gynecology, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lawrence M Berger
- School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin
| | - Eric Grodsky
- Department of Sociology, College of Letters & Science, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Educational Policy Studies, School of Education, University of Wisconsin-Madison, Madison, Wisconsin
| | - Deborah B Ehrenthal
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Obstetrics and Gynecology, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Heelan-Fancher L, Shi L, Zhang Y, Cai Y, Nawai A, Leveille S. Impact of continuous electronic fetal monitoring on birth outcomes in low-risk pregnancies. Birth 2019; 46:311-317. [PMID: 30811649 DOI: 10.1111/birt.12422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Continuous electronic fetal monitoring (CEFM) is a standard of hospital care during the intrapartum period. We investigated its use on childbirth outcomes in low-risk pregnancies, and examined whether outcomes differed by gestational age within a term pregnancy. METHODS A retrospective secondary data analysis using birth registry data from two diverse northeastern US states from 1992 to 2014. Chi-square test and the Fisher exact tests were used to examine associations between CEFM and childbirth outcomes. Multivariable Poisson regression models were used to estimate risk ratios of childbirth outcomes related to CEFM use, adjusting for potential confounders. RESULTS Use of CEFM was independently associated with a 10% (State 1) and 40% (State 2) increased risk for primary cesarean delivery and an increased risk for assisted vaginal births (14% and 24%, respectively) after adjustment for confounders. CEFM use was not associated with reduced risk for infant mortality (neonatal mortality, 0-27 days, and post-neonatal mortality, 28-364 days) in term births (37-41 weeks' gestation). After stratifying term pregnancies into early term, full term, and late term, use of CEFM was associated with reduced risk for neonatal mortality in early-term births (37 0/7 weeks' to 38 6/7 weeks' gestation) in State 2 (RR 0.44 [95% CI 0.21-0.92]), but not in State 1. There was no association between CEFM use and infant mortality (neonatal and post-neonatal) in full-term or late-term births. CONCLUSIONS The study results do not support universal use of CEFM in pregnancies that are low-risk and at term.
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Affiliation(s)
- Lisa Heelan-Fancher
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Ling Shi
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Yuqing Zhang
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Yurun Cai
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Ampicha Nawai
- Boromarajonani College of Nursing, Chiang Mai, Thailand
| | - Suzanne Leveille
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts.,Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Characteristics Associated With Delivery of an Infant With Congenital Syphilis and Missed Opportunities for Prevention-California, 2012 to 2014. Sex Transm Dis 2019; 45:435-441. [PMID: 29465666 DOI: 10.1097/olq.0000000000000782] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Congenital syphilis (CS), the transmission of Treponema pallidum from mother to fetus during pregnancy, can cause adverse birth outcomes. In 2012 to 2014, the CS rate in California increased more than 200% from 6.6 to 20.3 cases per 100,000 live births. Our objectives were to identify characteristics associated with delivering an infant with CS and missed opportunities for prevention among syphilis-infected pregnant women in California. METHODS We linked California Department of Public Health syphilis surveillance records from women aged 15 to 45 years-diagnosed from March 13, 2012, to December 31, 2014-to birth records. We compared characteristics among mothers who delivered an infant with CS (CS mothers) with mothers who delivered an infant without CS (non-CS mothers) by using χ or Fisher exact tests. To visualize gaps in prevention among syphilis-infected pregnant women, we constructed a CS prevention cascade, a figure that shows steps to prevent CS. RESULTS During the selected period, 2498 women were diagnosed as having syphilis, and 427 (17%) linked to birth records; 164 (38%) were defined as CS mothers and 263 (62%) as non-CS mothers. Mothers with CS were more likely than non-CS mothers to have their first prenatal care visit in the third trimester. High proportions of mothers in both groups reported high-risk sexual behaviors, methamphetamine use, or incarceration (13%-29%). The CS prevention cascade showed decrements of 5% to 11% in prenatal care receipt, testing, and treatment steps; only 62% of potential CS births were prevented. CONCLUSIONS Multifaceted efforts are needed to address gaps in the CS prevention cascade and reduce CS cases in California.
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34
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Larson A, Berger LM, Mallinson DC, Grodsky E, Ehrenthal DB. Variable Uptake of Medicaid-Covered Prenatal Care Coordination: The Relevance of Treatment Level and Service Context. J Community Health 2019; 44:32-43. [PMID: 30022418 PMCID: PMC6330123 DOI: 10.1007/s10900-018-0550-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Prenatal care coordination programs direct pregnant Medicaid beneficiaries to medical, social, and educational services to improve birth outcomes. Despite the relevance of service context and treatment level to investigations of program implementation and estimates of program effect, prior investigations have not consistently attended to these factors. This study examines the reach and uptake of Wisconsin's Prenatal Care Coordination (PNCC) program among Medicaid-covered, residence occurrence live births between 2008 and 2012. Data come from the Big Data for Little Kids project, which harmonizes birth records with multiple state administrative sources. Logistic regression analyses measured the association between county- and maternal-level factors and the odds of any PNCC use and the odds of PNCC uptake (> 2 PNCC services among those assessed). Among identified Medicaid-covered births (n = 136,057), approximately 24% (n = 33,249) received any PNCC and 17% (n = 22,680) took up PNCC services. Any PNCC receipt and PNCC uptake varied substantially across counties. A higher county assessment rate was associated with a higher odds of individual PNCC assessment but negatively associated with uptake. Mothers reporting clinical risk factors such as chronic hypertension and previous preterm birth were more likely to be assessed for PNCC and, once assessed, more likely to received continued PNCC services. However, most mothers reporting clinical risk factors were not assessed for services. Estimates of care coordination's effects on birth outcomes should account for service context and the treatment level into which participants select.
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Affiliation(s)
- Andrea Larson
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Lawrence M Berger
- School of Social Work, University of Wisconsin-Madison, Madison, WI, USA
| | - David C Mallinson
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Eric Grodsky
- Sociology and Educational Policy Studies, University of Wisconsin-Madison, Madison, WI, USA
| | - Deborah B Ehrenthal
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
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Henke RM, Karaca Z, Gibson TB, Cutler E, White C, Head M, Wong HS. Medicaid Accountable Care Organizations and Childbirth Outcomes. Med Care Res Rev 2019; 77:559-573. [PMID: 30614398 DOI: 10.1177/1077558718823132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Some states have adopted Accountable Care Organization (ACO) models to transform their Medicaid programs, but little is known about their impact on health care outcomes and costs. Medicaid ACOs are uniquely positioned to improve childbirth outcomes because of the number of births covered by Medicaid. Using Healthcare Cost and Utilization Project hospital data, we examined the relationship between ACO adoption and (a) neonatal and maternal outcomes, and (b) cost per birth. We compared outcomes in states that have adopted ACO models in their Medicaid programs with adjacent states without ACO models. Implementation of Medicaid ACOs was associated with a moderate reduction in hospital costs per birth and decreased cesarean section rates. Results varied by state. We found no association between Medicaid ACOs and several birth outcomes, including infant inpatient mortality, low birthweight, neonatal intensive care unit utilization, and severe maternal morbidity. Improving these outcomes may require more time or targeted interventions.
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Affiliation(s)
| | - Zeynal Karaca
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | | | | | | | | | - Herb S Wong
- Agency for Healthcare Research and Quality, Rockville, MD, USA
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Complement Activation During Early Pregnancy and Clinical Predictors of Preterm Birth in African American Women. J Perinat Neonatal Nurs 2019; 33:E15-E26. [PMID: 31651632 PMCID: PMC6818745 DOI: 10.1097/jpn.0000000000000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Complement activation is essential for select physiologic processes during pregnancy; however, excess activation has been associated with an increased risk for preterm birth (PTB). African American (AA) women experience disproportionately higher rates of inflammation-associated PTB than other groups of women; thus, the purpose of this study was to explore the relationship between complement activation and perinatal outcomes among AA women. A plasma sample was collected between 8 and 14 weeks' gestation from a cohort of healthy AA women (N = 144) enrolled in a larger PTB cohort study. Medical record review was conducted to collect information on clinical factors (cervical length, health behaviors, gestational age at delivery). Multiple regression analysis was used to explore the relationships between complement marker (C3a/Bb) concentrations and the outcomes of interest after adjusting for baseline characteristics. C3a/Bb concentrations were not significant predictors of the gestational age at delivery, cervical length, or behavioral risk factors for PTB in this sample. Complement markers may not influence pregnancy outcomes among AA women in the same way as in predominantly white populations; however, more studies are needed to define complement dysregulation and the relationship with outcomes among AA women.
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Holland ML, Groth SW, Smith JA, Meng Y, Kitzman H. Low birthweight in second children after nurse home visiting. J Perinatol 2018; 38:1610-1619. [PMID: 30214029 PMCID: PMC6279547 DOI: 10.1038/s41372-018-0222-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 08/10/2018] [Accepted: 08/21/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To examine low birthweight and preterm birth of second children born to home-visited first-time mothers. SUBJECTS Women were previously recruited for a randomized controlled trial of the home visiting model disseminated as Nurse-Family Partnership. 512 of these women had second children within 18 years of the first child's birth, and were included in our sample. RESULTS The intervention was associated with a lower likelihood of low birthweight for second children (odds ratio: 0.51, 95% CI: 0.27, 0.97), an effect apparent only if the first-born had low birthweight and mediated by close birth spacing. These moderation and mediation patterns were similar in the preterm birth outcome. CONCLUSION A home visiting program provided for first-born children reduced low birthweight for second-born children, if the first-born had low birthweight. This finding implies a broader impact than previously documented, because few studies have included these second children.
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Affiliation(s)
- Margaret L. Holland
- Yale School of Nursing, 400 West Campus Drive, Orange, CT 06518, USA, 203-737-4929,
| | - Susan W. Groth
- University of Rochester, School of Nursing, 255 Crittenden Ave, Rochester, NY 14642, USA, 585-275-8895,
| | - Joyce A. Smith
- University of Rochester, School of Nursing, 255 Crittenden Ave, Rochester, NY 14642, USA, 585-275-3405,
| | - Ying Meng
- University of Rochester, School of Nursing, 255 Crittenden Ave, Rochester, NY 14642, USA,
| | - Harriet Kitzman
- University of Rochester, School of Nursing, 255 Crittenden Ave, Rochester, NY 14642, USA, 585-275-8874,
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Improving Rates of Early Entry Prenatal Care in an Underserved Population. Matern Child Health J 2018; 22:1738-1742. [DOI: 10.1007/s10995-018-2569-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kang-Yi CD, Kornfield SL, Epperson CN, Mandell DS. Relationship Between Pregnancy Complications and Psychiatric Disorders: A Population-Based Study With a Matched Control Group. Psychiatr Serv 2018; 69:300-307. [PMID: 29137553 PMCID: PMC5937933 DOI: 10.1176/appi.ps.201700097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to identify whether pregnancy complications differ between women with and without a psychiatric disorder diagnosis prior to pregnancy. METHODS Women who gave birth between 2007 and 2009 in Pennsylvania and were enrolled in Medicaid from one year prior to their pregnancy until their delivery were included (N=9,930); those with psychiatric disorders were compared with a matched control group (N=4,965 for each). Logistic regression analysis estimated the odds of having a pregnancy complication among those with a psychiatric diagnosis prior to pregnancy, adjusting for demographic characteristics and chronic general medical conditions. RESULTS Compared with the control group, women with a psychiatric disorder prior to pregnancy had greater odds of having at least one pregnancy complication (odds ratio=1.48, 95% confidence interval=1.37-1.61). Compared with the control group, their odds of antepartum hemorrhage were 1.50 times higher, their odds of preterm labor were 1.45 times higher, and their odds of preterm birth were 1.61 times higher. CONCLUSIONS Women with psychiatric disorders prior to pregnancy were more likely to experience pregnancy complications, including pregnancy hemorrhage, preterm labor, and preterm birth, after the analysis controlled for age, race-ethnicity, and chronic illness status before and during pregnancy. The finding of an association between psychiatric disorders and a higher complication risk suggests the importance of population-based preconception interventions for women with psychiatric disorders and prenatal monitoring to reduce the risk of pregnancy complications in this group.
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Affiliation(s)
- Christina D Kang-Yi
- The authors are with the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sara L Kornfield
- The authors are with the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - C Neill Epperson
- The authors are with the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - David S Mandell
- The authors are with the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
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A Call to Revisit the Prenatal Period as a Focus for Action Within the Reproductive and Perinatal Care Continuum. Matern Child Health J 2017; 20:2217-2227. [PMID: 27663703 DOI: 10.1007/s10995-016-2187-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives The broad maternal and child health community has witnessed increased attention to the entire continuum of reproductive and perinatal health concerns over the past few years. However, both recent discouraging trends in prenatal care access and utilization and a renewed understanding of prenatal care as a critical anchor of the reproductive/perinatal health continuum for women who do get pregnant demand a new effort to focus on the prenatal period as a gateway for maternal and infant health. Methods This commentary: describes the Medicaid expansions and the momentum for universal access to prenatal care of the 1980-1990s; examines the pivot away from this goal and its aftermath; provides a rationale for why renewed attention to prenatal care and the prenatal period is essential; and, explores the potential focus of an updated prenatal care agenda. Conclusion We conclude that increasing women's access to high quality prenatal care will require substantial effort at the clinical, community, policy, and system levels. Only when attention is paid to all phases of the reproductive/perinatal health continuum with an emphasis on continuity between all periods, and on the social determinants that affect health and well-being, will our nation be able to ensure the health of all women across the life course (whether or not they ever become mothers), while simultaneously fulfilling our nation's promise that all children-no matter their income or race/ethnicity-will have the opportunity to be born well.
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Raffo JE, Lloyd C, Collier M, Slater L, Cunningham B, Penninga K, Henning S, Coil J, Agee B, Quintino-Aranda V, VanderMeulen P, Roman LA. Defining the Role of the Community Health Worker within a Federal Healthy Start Care Coordination Team. Matern Child Health J 2017; 21:93-100. [PMID: 28975453 PMCID: PMC6775630 DOI: 10.1007/s10995-017-2379-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction Federal and state policies often require utilization of evidence-based home visiting programs. Measurement of specified interventions is important for tracking program implementation and achieving program outcomes. Thus, the Strong Beginnings program worked to define community health worker (CHW) interventions, a core service of the program to improve maternal and child health. Methods A workgroup consisting of CHWs, supervisors and other program staff was created in order to develop and define specific CHW interventions within a nurse or social worker care team. Basic interventions were first compared to the nurse or social worker care coordinator home visiting interventions by risk topic. The evaluator then grouped each CHW intervention into categories per risk domain using thematic analysis and assigned a CHW core function or role based on literature review findings. The workgroup confirmed the results. The workgroup then continued discussions to further enhance CHW interventions per risk domain once the general structure was created. Results The workgroup identified seven core functions and 28 maternal and child health risk topics to be addressed by the CHW. The process resulted in a detailed document of program interventions that the CHWs use to guide care. Conclusions The process helped CHWs feel more valued with their role in team care. The specified interventions will help others understand the CHW role within the care team, ensure consistent interventions are delivered across program partners, provide a foundation to better understand how specific CHW contributions are related to health outcomes, and support program sustainability.
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Affiliation(s)
- Jennifer E Raffo
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, 15 Michigan Street NE, Grand Rapids, MI, 49503, USA.
| | - Celeste Lloyd
- Spectrum Health Healthier Communities, 665 Seward Avenue NW, Grand Rapids, MI, 49504, USA
| | - Monica Collier
- Kent County Health Department, 700 Fuller Avenue NE, Grand Rapids, MI, 49503, USA
| | - LaDynah Slater
- Cherry Health, 550 Cherry St. SE, Grand Rapids, MI, 49503, USA
| | - Belinda Cunningham
- Spectrum Health Healthier Communities, 665 Seward Avenue NW, Grand Rapids, MI, 49504, USA
| | | | - Susan Henning
- Spectrum Health Healthier Communities, 665 Seward Avenue NW, Grand Rapids, MI, 49504, USA
| | - Janis Coil
- Kent County Health Department, 700 Fuller Avenue NE, Grand Rapids, MI, 49503, USA
| | - Bonita Agee
- Spectrum Health Healthier Communities, 665 Seward Avenue NW, Grand Rapids, MI, 49504, USA
| | | | - Peggy VanderMeulen
- Spectrum Health Healthier Communities, 665 Seward Avenue NW, Grand Rapids, MI, 49504, USA
| | - Lee Anne Roman
- Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, E Fee Hall, 965 Fee Rd Room A630, East Lansing, MI, 48824, USA
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Margerison-Zilko CE, Talge NM, Holzman C. Preterm delivery trends by maternal race/ethnicity in the United States, 2006–2012. Ann Epidemiol 2017; 27:689-694.e4. [DOI: 10.1016/j.annepidem.2017.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 07/29/2017] [Accepted: 10/02/2017] [Indexed: 11/27/2022]
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Dauber S, John T, Hogue A, Nugent J, Hernandez G. Development and implementation of a screen-and-refer approach to addressing maternal depression, substance use, and intimate partner violence in home visiting clients. CHILDREN AND YOUTH SERVICES REVIEW 2017; 81:157-167. [PMID: 29249846 PMCID: PMC5729752 DOI: 10.1016/j.childyouth.2017.07.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Perinatal maternal depression (MD), substance use (SU), and intimate partner violence (IPV) are critical public health concerns with significant negative impacts on child development. Bolstering the capacity of home visiting (HV) programs to address these significant risk factors has potential to improve child and family outcomes. This study presents a description and mixed-methods feasibility evaluation of the "Home Visitation Enhancing Linkages Project (HELP)," a screen-and-refer approach to addressing MD, SU, and IPV within HV aimed at improving risk identification and linkage to treatment among HV clients. HELP was a three-phase intervention that included three evidence-based interventions: screening, motivational interviewing (MI), and case management (CM). This study presents quantitative fidelity data from 21 home visitors reporting on 116 clients in 4 HV programs, as well as qualitative data from structured interviews with 14 home visitors. Nearly all clients were screened and 22% screened positive on at least one risk domain. Rates of MI and CM implementation were lower than expected, however home visitors implemented general supportive interventions at high rates. Home visitor interviews revealed the following factors that may have impacted HELP implementation: client disclosure of risk, barriers to treatment access, systems integration, home visitor role perception, and integration of HELP into the broader HV curriculum. Implications of study findings for the design of future attempts to address maternal risk within HV are discussed.
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Affiliation(s)
- Sarah Dauber
- The National Center on Addiction and Substance Abuse, 633 Third Avenue, New York, NY 10017, United States
| | - Tiffany John
- The National Center on Addiction and Substance Abuse, 633 Third Avenue, New York, NY 10017, United States
| | - Aaron Hogue
- The National Center on Addiction and Substance Abuse, 633 Third Avenue, New York, NY 10017, United States
| | - Jessica Nugent
- Prevent Child Abuse New Jersey, 103 Church Street, New Brunswick, NJ 08901, United States
| | - Gina Hernandez
- Prevent Child Abuse New Jersey, 103 Church Street, New Brunswick, NJ 08901, United States
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Darling R, Atav AS. Measuring birth outcomes in New York State using a multidimensional approach. Nurs Forum 2017; 53:122-128. [PMID: 28662303 DOI: 10.1111/nuf.12224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Poorer birth outcomes in the United States and New York State (NYS) remain a significant public health concern. The objectives of this study were to assess the effect of common and unique demographic, socioeconomic, and health services predictors on low birth weight (LBW), moderately LBW, very low birth weight (VLBW), and extremely low birth weight (ELBW) in NYS counties and to recommend policies that address unique differences at the county level. METHODS Secondary data were collected for each of the 62 counties in NYS. Using a multidimensional approach, common and unique factors for LBW, moderately LBW, VLBW, and ELBW among NYS counties were evaluated. Correlations and multiple regression analyses were conducted for each of the outcome variables. RESULTS Late prenatal care was the only significant predictor across all measures of poorer birth outcomes in NYS counties. Out-of-wedlock births, Medicaid Obstetrical Maternal Service providers, rural location, early prenatal care, advanced maternal age, and teen pregnancy rate were significant predictors, but not for all measures. CONCLUSIONS Findings highlight the need to move beyond the number of providers when analyzing birth outcomes at the county level. Programs that support teens and women of all ages and marital status need to be expanded to curb poorer birth outcomes that take a heavy human and financial toll in NYS.
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Affiliation(s)
- Rosa Darling
- Binghamton University Decker School of Nursing, Binghamton, NY
| | - A Serdar Atav
- Binghamton University Decker School of Nursing, Binghamton, NY
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Home visiting for first-time mothers and subsequent pregnancy spacing. J Perinatol 2017; 37:144-149. [PMID: 27735928 PMCID: PMC5280088 DOI: 10.1038/jp.2016.192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/12/2016] [Accepted: 09/19/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of the study was to determine the association of home visiting with subsequent pregnancy outcomes. STUDY DESIGN Retrospective study of Ohio mothers delivering their first infant from 2007 to 2009. First, we compared mothers enrolled in home visiting with a matched eligible group. Second, we compared outcomes within home visiting based on program participation (low <25% of recommended home visits, moderate 25 to 75%, high 75 to 100% and very high >100%). Time to subsequent pregnancy within 18 months was evaluated using Cox proportional hazards regression; logistic regression tested the likelihood of subsequent preterm birth. RESULTS Of 1516 participants, 1460 were matched 1:1 to a comparison mother (n=2920). After multivariable adjustment, enrollment was associated with no difference in pregnancy spacing or subsequent preterm birth. Among those enrolled, moderate vs low participants had reduced risk of repeat pregnancy over 18 months (hazard ratio 0.68, P=0.003). CONCLUSION Increased pregnancy spacing is observed among women with at least moderate home visiting participation.
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Abstract
OBJECTIVES To evaluate effects of EHR adoption and use during pregnancy on maternal and child health care utilization and health among pregnant mothers and their infants. METHODS The study population was comprised of all Medicaid-insured pregnant women who delivered a singleton birth in Michigan between 1/1/2009 and 12/31/2012 and their infants (N = 226,558). Linked data included birth records, maternal and infant medical claims, and EHR adoption, implementation, upgrading and meaningful use data. Pre-post comparisons with a control group (difference-in-difference) took advantage of a natural experiment of EHR adoption and use among providers in Michigan. Women and infants who received care from providers who adopted and used EHR were compared with those who received care from other providers, in a quasi-experimental framework. RESULTS Over 34 % of all women in the analytic sample received perinatal care from providers who adopted and used EHR. Multivariate regressions indicate that women who received prenatal care mainly from a provider who adopted and used EHR were more likely to have any well-child visits (0.05, p = 0.04), and the appropriate number of well-child visits during the first year of life (0.03, p < 0.01). CONCLUSIONS The findings of this study are consistent with EHR adoption and use supporting improved child health care utilization. The findings have the potential to provide Medicaid and other healthcare program officials with evidence of the potential gains to be derived from EHRs for vulnerable low-income women and infants.
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Velasco-Mondragon E, Jimenez A, Palladino-Davis AG, Davis D, Escamilla-Cejudo JA. Hispanic health in the USA: a scoping review of the literature. Public Health Rev 2016; 37:31. [PMID: 29450072 PMCID: PMC5809877 DOI: 10.1186/s40985-016-0043-2] [Citation(s) in RCA: 262] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 11/16/2016] [Indexed: 12/14/2022] Open
Abstract
Hispanics are the largest minority group in the USA. They contribute to the economy, cultural diversity, and health of the nation. Assessing their health status and health needs is key to inform health policy formulation and program implementation. To this end, we conducted a scoping review of the literature and national statistics on Hispanic health in the USA using a modified social-ecological framework that includes social determinants of health, health disparities, risk factors, and health services, as they shape the leading causes of morbidity and mortality. These social, environmental, and biological forces have modified the epidemiologic profile of Hispanics in the USA, with cancer being the leading cause of mortality, followed by cardiovascular diseases and unintentional injuries. Implementation of the Affordable Care Act has resulted in improved access to health services for Hispanics, but challenges remain due to limited cultural sensitivity, health literacy, and a shortage of Hispanic health care providers. Acculturation barriers and underinsured or uninsured status remain as major obstacles to health care access. Advantageous health outcomes from the "Hispanic Mortality Paradox" and the "Latina Birth Outcomes Paradox" persist, but health gains may be offset in the future by increasing rates of obesity and diabetes. Recommendations focus on the adoption of the Health in All Policies framework, expanding access to health care, developing cultural sensitivity in the health care workforce, and generating and disseminating research findings on Hispanic health.
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Affiliation(s)
- Eduardo Velasco-Mondragon
- College of Osteopathic Medicine, Touro University California, 1310 Johnson Lane; H-82, Rm. 213, Vallejo, CA 94592 USA
| | - Angela Jimenez
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, USA
| | | | - Dawn Davis
- St. Louis University School of Medicine, St. Louis, USA
| | - Jose A. Escamilla-Cejudo
- Regional Advisor on Health Information and Analysis, Pan American Health Organization/World Health Organization, Foggy Bottom, USA
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Kothari CL, Paul R, Dormitorio B, Ospina F, James A, Lenz D, Baker K, Curtis A, Wiley J. The interplay of race, socioeconomic status and neighborhood residence upon birth outcomes in a high black infant mortality community. SSM Popul Health 2016; 2:859-867. [PMID: 29349194 PMCID: PMC5757914 DOI: 10.1016/j.ssmph.2016.09.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 11/23/2022] Open
Abstract
This study examined the interrelationship of race and socioeconomic status (SES) upon infant birthweight at the individual and neighborhood levels within a Midwestern US county marked by high Black infant mortality. The study conducted a multi-level analysis utilizing individual birth records and census tract datasets from 2010, linked through a spatial join with ArcGIS 10.0. The maternal population of 2861 Black and White women delivering infants in 2010, residing in 57 census tracts within the county, constituted the study samples. The main outcome was infant birthweight. The predictors, race and SES were dichotomized into Black and White, low-SES and higher-SES, at both the individual and census tract levels. A two-part Bayesian model demonstrated that individual-level race and SES were more influential birthweight predictors than community-level factors. Specifically, Black women had 1.6 higher odds of delivering a low birthweight (LBW) infant than White women, and low-SES women had 1.7 higher odds of delivering a LBW infant than higher-SES women. Moderate support was found for a three-way interaction between individual-level race, SES and community-level race, such that Black women achieved equity with White women (4.0% Black LBW and 4.1% White LBW) when they each had higher-SES and lived in a racially congruous neighborhood (e.g., Black women lived in disproportionately Black neighborhood and White women lived in disproportionately White neighborhood). In sharp contrast, Black women with higher-SES who lived in a racially incongruous neighborhood (e.g., disproportionately White) had the worst outcomes (14.5% LBW). Demonstrating the layered influence of personal and community circumstances upon health, in a community with substantial racial disparities, personal race and SES independently contribute to birth outcomes, while environmental context, specifically neighborhood racial congruity, is associated with mitigated health risk.
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Affiliation(s)
- Catherine L. Kothari
- Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USA
| | - Rajib Paul
- Department of Statistics, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI 49008, USA
| | - Ben Dormitorio
- PAREXEL International, 1 Federal Street, Billerica, MA 01821, USA
| | - Fernando Ospina
- Eliminating Racism and Claiming/Celebrating Equality, 1213 Blakeslee Street, Kalamazoo, MI 49006, USA
| | - Arthur James
- Department of Obstetrics and Gynecology, Ohio State University, 395 West 12th Avenue, Columbus, OH 43210, USA
| | - Deb Lenz
- Maternal-Child Health Division, Kalamazoo County Health & Community Services, 3299 Gull Road, Kalamazoo, MI 49048, USA
| | - Kathleen Baker
- Department of Geography, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI 49008, USA
| | - Amy Curtis
- Program in Interdisciplinary Health Sciences, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI 49008, USA
| | - James Wiley
- Institute for Health Policy Studies, School of Medicine, University of California San Francisco, 533 Parnassus Avenue, San Francisco, CA 94143, USA
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Goyal NK, Folger AT, Hall ES, Teeters A, Van Ginkel JB, Ammerman RT. Multilevel assessment of prenatal engagement in home visiting. J Epidemiol Community Health 2016; 70:888-94. [PMID: 26912773 PMCID: PMC5672792 DOI: 10.1136/jech-2014-205196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/07/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Low engagement in prenatal home visiting may limit programme effectiveness to improve birth outcomes. Multiple factors may influence engagement. METHODS A retrospective cohort study of first-time mothers enrolled in home visiting prenatally in southwest Ohio from 2007 to 2010. The primary outcome was enrolment by 20weeks' gestation; a secondary outcome included home visit frequency. Two multilevel assessments were conducted using random intercept multilevel modelling; maternal covariates were nested first within the home visiting agency and then within the ZIP code. In the first model, variations attributable to individual agency and agency volume were assessed. In the second model nested within the ZIP code, violence rates by ZIP code and interaction terms between violence rates and maternal factors were evaluated. RESULTS Of 837 women, 25.3% enrolled ≤20 weeks and 7.4% enrolled early and received ≥75% of expected visits. The first model demonstrated a significant variation in early enrolment based on clustering by agency (p<0.001), however, agency volume was not a significant predictor. In the second model, violence rate was not associated with early enrolment (AOR 0.92, p=0.08), but an interaction term with maternal race was significant (p=0.02). The effect of increasing community violence disproportionately affected early enrolment among white women (AOR 0.80, p=0.005) compared with black women (AOR 0.95, p=0.30). In both the random intercept multilevel models, teenagers demonstrated a decreased likelihood of enrolling early (AOR 0.58, p=0.046 and AOR 0.49, p=0.004). CONCLUSIONS Prenatal home visiting engagement is related to maternal, agency and community factors, presenting multiple opportunities to optimise programme implementation.
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Affiliation(s)
- Neera K Goyal
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alonzo T Folger
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Eric S Hall
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Angelique Teeters
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Judith B Van Ginkel
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Robert T Ammerman
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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