Abstract
Reproduction, environment, and equity: Public health responds to the evidence
Sheela Sathyanarayana, MD, MPH1, Katie Huffling, MS, RN, CNM2, Marya Zlatnik, MD, MMS3, Gary Loy, MD, MPH4 and Susan N. Buchanan, MD, MPH5
(1)University of Washington /Seattle Children's Research Institute, Seattle, WA, (2)Alliance of Nurses for Healthy Environments, Mount Rainier, MD, (3)University of California, San Francisco, San Francisco, CA, (4)Rush University, Chicago, IL, (5)University of Illinois at Chicago, Chicago, IL
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Too often, environmental hazards are overlooked when they matter the most. Preconception and prenatal exposures affect everyone. Low income and minority populations are more often exposed to environmental conditions of which their health professionals should be aware and should account for. In this session, we build on the 2017 Special Joint Maternal and Child Health-Environmental Health Session, and focus more on the tools and experiences that highlight the developmental basis for children's vulnerability to diverse toxins under a wide range of circumstances. Speakers will address: (1) what kinds of environmental risks patients and health professionals seek expert information about; (2) specific threats to preconception and prenatal health that result from a changing climate and how minority populations are affected; and (3) tools and resources for increasing literacy and the quality of care for environmental health from preconception through adulthood.
Environmental health sciences Implementation of health education strategies, interventions and programs Occupational health and safety Other professions or practice related to public health Public health or related education Public health or related nursing
Abstract
Design opportunities to improve the perinatal care experience for vulnerable women
Jennifer Liao, BS1, Lara Chehab, MPH2, Amanda Sammann, MD, MPH3, Devika Patel, MS2 and Malini Nijagal, MD, MPH2
(1)George Washington University, Washington, DC, DC, (2)University of California, San Francisco, San Francisco, CA, (3)University of California at San Francisco, San Francisco, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Issue: Pre-term birth is the leading cause of infant morbidity and mortality in the United States and it disproportionately affects women of color, publicly-insured women, and women living in moderate-to-high poverty neighborhoods. Description: This study used human-centered design to understand the challenges faced by publicly-insured pregnant women living in San Francisco. We conducted 21 in-depth, ethnographic interviews with patients, family members, providers, community workers, social workers, nurses, midwives and doulas. We also performed observations at outpatient clinics, inpatient wards and community organizations. Lessons Learned: We identified seven design opportunities to improve perinatal care for this vulnerable cohort of women. 1) Don’t stress the stressful; pregnancy creates significant life stress that shouldn’t be compounded at medical touchpoints. 2) Shift the focus from ‘natal’ to whole woman care; women need support for all aspects of their complex lives. 3) Address implicit and explicit racism; women cannot benefit from care they don’t trust. 4) Stop treating pregnancy like it is a disease; medical visits must be more celebratory and less judgmental and clinical. 5) Leverage pregnancy to course-correct an at-risk life; capitalize on the fact that women are willing to make life changes on behalf of their baby. 6) Respect women’s autonomy and honor their wishes; ensure women are being heard; let them tell, not yell their plan. 7) Be their proverbial baby shower; women need a community and want to feel worthy of ‘new’. Recommendations: These principles identify opportunities to design innovative solutions to improving the care experience for vulnerable pregnant women.
Diversity and culture Public health or related research Social and behavioral sciences
Abstract
Prenatal hepatitis C virus test estimates among Wisconsin Medicaid recipients, 2011-2015
Theresa Watts, RN, MPH, CPH1, Lauren Stockman, MPH2, Sheila Guilfoyle3, James Vergeront, M.D.3 and Susan Zahner, DrPH, RN, FAAN1
(1)University of Wisconsin-Madison, Madison, WI, (2)California Department of Public Health, Richmond, CA, (3)Wisconsin Division of Public Health, Madison, WI
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: The national Opioid Epidemic, associated injection drug use, transmission of Hepatitis C Virus (HCV), and number of HCV-infected pregnant women are related and simultaneously increasing across the United States. Consequently, vertical transmission of HCV, which occurs in about 6% of infants born to HCV-infected women has also increased. Current guidelines for HCV testing during pregnancy are risk-based and may not be accurately identifying pregnant women who are infected with HCV.
Purpose: To describe and compare prenatal risk-based HCV test estimates to universal Hepatitis B Virus (HBV) and HIV test estimates among women who were enrolled in Wisconsin Medicaid throughout her pregnancy and who delivered a baby between years 2011 to 2015.
Methods: Standard billing codes were used to explore prenatal tests. A woman was considered tested for HCV, HBV, or HIV if she had a billing code for the viral test at any point during her pregnancy(s). Data for each pregnancy was analyzed to describe the proportion of women who had HCV, HBV, or HIV test at each pregnancy.
Results: Among 78,917 pregnancies occurring among the study population, 6% (n=4,845) had evidence of a HCV test, 73% had evidence of a HBV test, and 67% had evidence of a HIV test. Between 2011-2015, the proportion of pregnancies among women who had prenatal a HCV test increased 54% from 4.64% to 7.16%.
Conclusion: Enhanced prenatal screening of HCV may be needed. If maternal HCV status is unknown, HCV-infected mothers and infants exposed to HCV through vertical transmission may go undiagnosed
Public health or related nursing Public health or related research
Abstract
Designing Technology to Improve Engagement and Retention in a Nurse Home Visiting Model for First-time, Low-income Mothers
Arianna Taboada, MSW, MSPH1, Fred Dillon1, Luke Emerdello, MA2, Madeline Wetta2, Yin-Juei Chang, PhD2, Dawn Dailey, PhD, RN, PHCNS-BC3 and Jana Haritatos, PhD2
(1)Hopelab, San Francisco, CA, (2)Hopelab Foundation, San Francisco, CA, (3)Contra Costa County Health Services - Nurse Family Partnership, Martinez, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
The Nurse-Family Partnership (NFP) pairs a low income, first-time mother with a home-
visiting nurse during pregnancy and through the child’s second birthday. While NFP has more than 35 years of evidence showing improved pregnancy outcomes, reduced child abuse and neglect, and improved life-course outcomes, they have not fully utilized technology to enhance program engagement, retention, and long-term health outcomes.
In 2016, The NFP partnered with Hopelab, a non-profit designing science-based technologies to improve the health and well-being of teens and young adults. Together with moms and nurses, we co-designed Goal Mama, a goal coaching mobile app that moms can use with their home visit nurse to set, track, and reach their goals.
This presentation will share the human-centered design process to build Goal Mama as well as preliminary findings from a six-month efficacy study assessing the causal effect of adding the Goal Mama to existing services delivered by NFP on key goal-related outcomes. Lastly, we will share implementation challenges and opportunities that emerged during the pilot, and the implications for the scaling up of Goal Mama for use in 250+ NFP implementing agencies across the country.
Communication and informatics Conduct evaluation related to programs, research, and other areas of practice Public health or related nursing Public health or related research Social and behavioral sciences
Abstract
Nursing Stigma and Intentions to Provide Safe, Ethical Care to Incarcerated Pregnant Women
Lorie Goshin, PhD, RN
Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York, NY
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: Women are the fastest growing U.S. incarcerated population. An estimated 3-6% of incarcerated women are pregnant. Shackling creates life-threatening safety hazards for incarcerated pregnant women and their babies. Nurses could play a critical role in reducing the use of shackles. Evidence suggests a high level of nursing stigma toward incarcerated people. Attitudes toward incarcerated pregnant women and the relationship between nursing stigma and intentions to provide safe care remain less clear. Framed by the Theory of Planned Behavior, this study tested the hypothesis that intentions to provide safe care to incarcerated pregnant women are associated with lower individual and unit level stigma, and higher feelings of control over care.
Methods: We conducted a web-based survey of 690 nurses experience caring for incarcerated pregnant women in hospitals. Multiple logistic regression was used to predict higher than median care intention scores from individual and unit level stigma, and feelings of control over care when pregnant patients are incarcerated.
Results: As hypothesized, lower individual and unit-level stigma and higher behavioral control scores were associated with high intentions to provide safe care. Individual stigma was the strongest predictor of care intentions, OR=2.7, 95% CI [2.1, 3.4].
Conclusions: To our knowledge, this is the largest study of nursing attitudes toward incarcerated pregnant women, and the first to connect stigma to care intentions. Respondents represented 47 U.S. states and D.C. Results will inform development of trainings to humanize incarcerated pregnant women, decrease nursing stigma, and improve care intentions toward incarcerated pregnant women.
Administration, management, leadership Ethics, professional and legal requirements Public health or related nursing