142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

More than Just Bus Fare: Critical Theory and GIS to Deconstruct Prenatal Care Travel among Low-income Urban Mothers

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Sunday, November 16, 2014

Joan Bloch, PhD, CRNP , College of Nursing & Health Professions & School of Public Health, Drexel University, Philadelphia, PA
Sarah Cordivano , Azavea, Philadelphia, PA
Marcia Gardner, Ph.D., R.N., C.P.N.P. , College of Nursing, Seton Hall University, South Orange, NJ
Background: Having had preterm birth is most predictive of having another. Racial disparities in preterm birth (PTB) rates in urban areas overlap in socio-economically disadvantaged neighborhoods. Challenged to meet maternal self-care needs, unintended pregnancies with inadequate spacing often result. This study, guided by critical theory, deconstructs travel to public-funded prenatal care (PNC) using public transit.

 Methods:  GIS ‘ground truthing’ method was used. The first step was to use GIS to identify Philadelphia neighborhoods with the highest PTB rates using 2003-2005 geocoded Philadelphia birth records. Then, expert panel simulated case vignettes for a  plausible residential location. Service locations (WIC, prenatal clinic, antenatal testing center and SNAP) for required components of prenatal were geocoded. Time and money spent traveling with public transit ere modeled using ArcMap’s Network Analyst.

 Results: Among 381 census tracts, 36 had PTB rates between 25 -36.9%. Modeling travel time to for routine PNC took 25 visits to different geographically located facilities, 19 hours, 24 minutes to travel 179.6 miles at the personal cost of $69.60. For medically high-risk mothers, this burden increased to 34 visits, 27 hours, 20 minutes to travel 259.6 miles at the personal cost of $98.60 for bus fare.

 Conclusions and Public Health Implications:  This simulation model of travel does not account for the other related  hassles of getting and waiting for care with frail children in tow. Improving pregnancy outcomes among the most at risk requires innovative approaches in research to translate to new models of MCH services.

Learning Areas:

Provision of health care to the public
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Discuss holistic and life-course meanings of neighborhood-level data on individual-level lives burdened with adverse bio-psychosocial determinants of health. Design innovative models for maternal-child health care services for mothers burdened with socio-economic disadvantage and hassles of travel to various geographical locations for care of self and family.

Keyword(s): Health Disparities/Inequities, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: My translational program of research is focused on the racial and ethnic perinatal health disparities specific to higher preterm birth rates among sociology-economically disadvantaged populations of urban mothers. I have had extensive nursing and social epidemiology research training.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.