Project DC-HOPE of The NIH-DC Initiative to Reduce Infant Mortality in Minority Populations Ayman El-Mohandes, MBBCh, MD, MPH Professor and Chairman Department.

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Presentation transcript:

Project DC-HOPE of The NIH-DC Initiative to Reduce Infant Mortality in Minority Populations Ayman El-Mohandes, MBBCh, MD, MPH Professor and Chairman Department of Prevention and Community Health (202)

Background  Elevated infant mortality in African American 13.6 (AA) versus 3/1000 (C) live births in DC 2003  Medical risks not fully explanatory  Behavioral/psychosocial factors may affect pregnancy outcomes  Little intervention research to date

Study Objective To evaluate the efficacy of an integrated counseling/intervention on selected behavioral/psychosocial risks in pregnancy and the postpartum (PP) period.  Smoking  Passive smoking (ETS exposure)  Depression  Intimate partner violence (IPV)

Population Eligible Participants  African-American at least 18 years of age  receiving PNC at one of the 6 participating clinics between 7/9/2001 and 10/31/2003  Enrolled by 28 weeks gestation  English speaking

Project DC-HOPE: Screening Methods  Audio-Computer Assisted Self Interviewing - Mothers were screened for smoking, depression, ETSE and IPV

Behavior/psychosocial Characteristics (N=1044) Active Smoking 48% * Passive Smoking 44% * * 412 women with both active and passive smoking in the active smoking group. 88 women with active but not passive smoking. n=270 n=297 n=10 n=116 n=64 n=16 n=50 IPV 21% Depression 36% n=86 n=59 n=44 n=32

Study Group at Screening (N=1044) N Risk Behaviors % Cumulativ e %

Conclusions Psycho-behavioral integrated interventions during pregnancy are effective in modifying risk during pregnancy and in the post-partum period. Modifying effects are important and unique to various risks and should be addressed in order to maximize benefit.

Logistic Regression for at Least One Risk Resolution Parameter s CategoryP-ValueOdds Ratio 95% CI for OR Women resolved at least one risk vs. women resolved no risks at postpartum Care Group I vs. UC Illicit Drugs Y vs. N ETSEY vs. N Depressio n Y vs. N IPVY vs. N

Does the Intervention Affect Medical Outcomes?

Pregnancy Outcomes (Smoking) InterventionUsual CareP-value Miscarriage 1.4%4.8%0.04 Preterm <37 wk 12.2%13.3%0.73 V. Preterm <33 wk 1.0%4.6%0.03 E. Preterm <28 wk 0%2.1%0.04 LBW <2500 gm 13.3%10.8%0.45 VLBW <1500 gm 0.5%2.7%0.08