Community health workers as change agents in improving equity in birth outcomes in Detroit.

We examined whether pairing pregnant women with community health workers improved pregnancy outcomes among 254 Black women with singleton pregnancies participating in the Women-Inspired Neighborhood (WIN) Network: Detroit using a case-control design. A subset (N = 63) of women were recontacted and asked about program satisfaction, opportunities, and health behaviors. Michigan Vital Statistics records were used to ascertain controls (N = 12,030) and pregnancy and infant health outcomes. Logistic and linear regression were used to examine the association between WIN Network participation and pregnancy and infant health outcomes. The WIN Network participants were less likely than controls to be admitted to the neonatal intensive care unit (odds ratio = 0.55, 95% CI 0.33-0.93) and had a longer gestational length (mean difference = 0.42, 95% CI 0.02-0.81). Community health workers also shaped participants' view of opportunities to thrive. This study demonstrates that community health workers can improve pregnancy outcomes for Black women.

Partner support in a cohort of African American families and its influence on pregnancy outcomes and prenatal health behaviors.

BACKGROUND: We examined how two indicators of partner involvement, relationship type and paternal support, influenced the risk of pregnancy outcomes (preterm birth, low birth weight) and health behaviors (prenatal care, drug use, and smoking) among African American women. METHODS: Interview and medical record data were obtained from a study of 713 adult African American women delivering singletons between March 2001 and July 2004. Women were enrolled prenatally if they received care at one of three Johns Hopkins Medical Institution (JHMI) prenatal clinics or post-partum if they delivered at JHMI with late, no or intermittent prenatal care. Relationship type was classified as married, unmarried/cohabitating, or unmarried/non-cohabitating. Partner support was assessed using an 8-item scale and was dichotomized at the median. Differences in partner support by pregnancy outcome and health behaviors were assessed using linear regression. To assess measures of partner support as predictors of adverse pregnancy outcomes and health behaviors, Poisson regression was used to generate crude and adjusted prevalence ratios (PR) and 95% confidence intervals (CI). RESULTS: There were no statistically significant differences in pregnancy outcomes or health behaviors by relationship type or when partner support was examined as a continuous or categorical variable. Modeled as a dichotomous variable, partner support was not associated with the risk of preterm birth (PR = 0.81, 95% CI = 0.56, 1.56), low birth weight (PR = 0.77, 96% CI = 0.48, 1.26), or health behaviors. CONCLUSIONS: Paternal involvement was not associated with pregnancy outcomes or maternal health behaviors. Attention to measurement issues and other factors relevant for African American women are discussed.

Direct and proxy recall of childhood socio-economic position and health.

BACKGROUND: The utility of proxy reporting within the life course framework has not been adequately assessed; therefore we sought to assess the magnitude and type of agreement that exists between index and proxy reports for bodyweight, health, and socio-economic position (SEP) in childhood. METHODS: Participants were enrolled as part of an ongoing study of preterm birth in African American women in Metro Detroit. Post-partum women and their mothers (n = 333 pairs) provided retrospective reports about the woman's childhood bodyweight, health, and SEP. Agreement was assessed using kappa, weighted kappa (κ), and intraclass correlation coefficients (ICC). Log-linear models were used to describe the pattern of agreement for ordinal data. RESULTS: Birthweight and weight at age 18 was reported with a high level of agreement (ICC = 0.86 and 0.71, respectively). Kappa indicated moderate agreement for early and late childhood/adolescent weight. Log-linear models suggested that there was diagonal agreement plus linear by linear association for early childhood weight and linear by linear association in late childhood/adolescence. Reports of childhood medical problems and hospitalisations had only moderate agreement. Agreement for SEP in both early (κ = 0.14) and late childhood/adolescence (κ = 0.20) was poor. Log-linear models suggest a linear by linear association, indicating a positive association between the responses. CONCLUSIONS: Results suggest that proxy reports may be utilised in conjunction with an index report to provide an estimate of the accuracy of report or to more fully capture experiences over the life course. This may be particularly useful when multiple developmental periods are examined.