Session
Multi Determinants of MCH across the Lifecourse
APHA 2022 Annual Meeting and Expo
Abstract
Disparities in postpartum appointment attendance and content meeting ACOG clinical guidelines
APHA 2022 Annual Meeting and Expo
Background. Postpartum visits historically lack standardization, and attendance is often poor. This study describes the association of patient-level factors with postpartum appointment attendance and completion of appointment components as described by American College of Obstetricians and Gynecologists (ACOG) guidelines.
Methods. This analysis used Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System (PRAMS) survey data regarding postpartum appointment attendance and content among US women with a recent live birth. A postpartum appointment that covered six recommended topic areas including healthy eating and weight loss, pregnancy spacing, birth control, tobacco use, mental health, and diabetes screening was considered to meet ACOG guidelines. Multivariable logistic regression models were used to assess associations.
Results. PRAMS data from 68,870 women giving birth in 2018 and 2019 was available for analysis. Mothers who were non-white, less educated, of lower income strata, or with non-marketplace insurance had higher odds of non-attendance compared to their counterparts (all p<0.05). Thirty percent of women attended an appointment that met ACOG guidelines. Odds of attending an appointment that met ACOG guidelines were higher among non-white women, lower income women (<$32k per year) and women with government insurance compared to referent groups (all p<0.05).
Conclusions. Patient-level factors are significantly associated with appointment non-attendance, as well as completion of recommended visit topics. However, the observed disparities in attendance were not associated with quality of care received. These findings emphasize the importance of interventions targeting access to postpartum care, as well as standardization of visit components.
Abstract
A Framework for Faith-Based Maternal and Child Health Promotion
APHA 2022 Annual Meeting and Expo
Background: There is growing recognition that families must have resources accessible to them within their built environment to address social determinants affecting birth outcomes. We developed a process framework to guide our partnerships with faith-based organizations (FBO) to grow their capacity to address pregnancy and infant health.
Methods: The spiritual care/chaplaincy department of a statewide health system facilitated connections with local FBOs within neighborhoods with poor birth outcomes. Partnering FBO leadership developed a congregation/community team to lead their faith-based maternal and child health (MCH) initiative. Our five pillars of service framework guided the congregation/community team’s MCH efforts. These pillars are: positive MCH communication strategies, lifespan MCH programming, developing lay MCH leaders, honoring local data and stories, and connecting with local MCH resources. Project staff supported development, implementation and evaluation of each pillar’s action.
Results: Three FBO partnered with us including: an African American protestant church, a Methodist church, and a mosque serving predominantly immigrants/refugees from Western or Northern Africa. Two FBOs developed lay MCH leaders. Communication strategies included informing congregant/community members about MCH resources and data through social media and preaching; community baby showers, health fairs and women/pregnancy peer support groups were created to serve congregation and community members.
Conclusions: Our faith-based MCH framework grew the MCH capacity of a diverse array of FBOs to serve constituents. As continuing research examines religion as a social determinant of public health, we hope our framework will inspire further study and partnership with FBOs to promote positive MCH outcomes in communities.
Abstract
Maternal and Child Health in Rural Areas-Authored book
APHA 2022 Annual Meeting and Expo
The health of women and children is a vital part of the right to health, incorporating reproductive and maternal health (prenatal and postnatal), and child health care. The CDC’s
Division of Reproductive Health provides leadership in the promotion of women’s and infants’ health before, during, and after pregnancy. The major task of this division is to reduce disease and death among mothers and babies, with special attention to reducing racial and ethnic differences in health in these populations. Women living in rural areas are among the most vulnerable populations due to lack of access to health care as well as disparity issues.
In this chapter, we present the most important concepts under the umbrella of maternal-child health, with a focus on rural health. First, we will provide a description of the foundational lens through which maternal and child health has been largely conceptualized in the past two decades—the life course approach. In this section, we will discuss the five guiding principles of the life course approach as well as three temporal concepts related to one’s development
over the life course. Second, we describe the epidemiology of maternal health.
This presentation describes major health disparities among women living in rural areas, points to the disparity in terms of access to health care, and divides the reasons for such disparities into a “patient factor and a “delivery of care factor. The section ends with a description of various public health programs that are introduced to improve access to services across the United States.
Abstract
Seeking health equity for women with substance use disorders and their infants using a two-generational rural coordination approach
APHA 2022 Annual Meeting and Expo
In 2019, findings from the National Survey on Drug Use and Health (NSDUH)1 revealed that 2 in 5 women (> 18 years) struggled with illicit drugs, 3 in 4 struggled with alcohol use, and 1 in 8 struggled with the combination of drug use. Cumulatively, more than 7.2 million women had a substance use disorder (SUD) in the United States. Substance use during pregnancy is a public health issue, with long-reaching effects. The incidence of Neonatal Abstinence Syndrome (NAS) has been increasing in the US over the past decade particularly in rural areas.2 Pregnant women using substances are vulnerable to high morbidity and mortality rates. As a vulnerable population, they often have trouble seeking, and receiving, services for themselves or their infant over time. Factors commonly associated with service challenges include maternal age, education, source of income, unplanned pregnancy, peer influence, distance to health centers, and quality of care.3 Collectively, this population experiences consistent inequities in their own seeking behaviors and in the response from the health provider community. In rural areas, this process can be particularly complicated with fewer providers, limited coordination, excessive duplication and complication of processes, and stigma. In this study, we review the activities provided in a rural care coordination program called IMPACT WV for women and their infants who had been exposed to substances in utero or were diagnosed with NAS. The purpose of this program was to: 1) increase coordination of services; 2) fill gaps in services where needed; and 3) provide information to families and providers about substance use, NAS, stigma, and related areas. In this proposal, we will also focus on the recruitment and enrollment information identifying where inequities were reported, how we attempted to address them, and what impact these efforts had for this vulnerable group. Finally, we will discuss the potential replicability and technical assistance that this experience might offer to other rural areas with limited providers.
Abstract
College students' reports of changes in mental health during the COVID-19 pandemic
APHA 2022 Annual Meeting and Expo
BACKGROUND: The isolation and uncertainty, as well as the fear of illness, of the COVID-19 pandemic, have been reported anecdotally to have adverse effects on an individual's mental health. However, due to the novelty and continuing evolution of the situation, the correlation between the pandemic and mental health has not been heavily researched.
PURPOSE: This study assesses the associations between personal pandemic behavior and self-reported mental health metrics.
METHODS: 227 SUNY students were recruited via an online participation portal. Participation included answering a 15-20 minute qualtrics survey detailing their mental health scores from Fall 2019 (the pre-pandemic baseline) to Spring 2022. Anxiety scores were measured using the GAD-7, depression scores were measured using the PHQ-9, and perceived stress scores were measured using the PSS. Questions regarding COVID-19 fear and risk behaviors were adapted from the CPAS-11, FCV-19S, and Johnathan Rothwell’s article “Americans’ Social Contacts During the COVID-19 Pandemic .
RESULTS: A paired samples t-test indicated that there here was a significant difference in mental health scores between the Fall 2019 semester (M=4.07, SD=3.39) and Spring 2022 semester (M=5.52, SD=3.24); t(226)=-5.792, p<0.001). Spearman’s rho correlations indicated that higher degrees of social isolation had a significant positive correlation with higher levels of COVID-19 fear for 100% of semesters, higher perceived stress for 55.6% (5/9) of semesters, higher levels of anxiety for 55.6% of semesters, and higher levels of depression symptoms for 77.8% of semesters.
CONCLUSION: Results indicated that the mental health of students worsened with the onset of the COVID-19 pandemic, and has not yet returned to the pre-pandemic rates despite pandemic safety behaviors largely returning to the pre-pandemic “normal. For each semester except for Spring 2020 and Summer 2020, increased risk behavior was significantly correlated with better overall mental health. As a whole, these correlations grew stronger as the semesters progressed.