Pediatric oral health: community-based participatory research.

BACKGROUND: The most common chronic disease affecting children in Canada is dental caries. The objective of this study was to explore, identify, and address the strengths and barriers related to oral health services with an independent Indigenous community in Saskatchewan. METHODS: Community-based participatory research used interviews with Elders, health care providers, teachers, and parents/guardians of elementary school-aged children. The research focused on the development of genuine partnerships with the community. During data collection, the findings/results were returned to the community to establish direction, build success, and establish next steps. Thematic analysis was undertaken with the community. Descriptive statistics were analyzed using SPSS. RESULTS: The most commonly identified themes included: community resilience; the need for resource development and process to improve oral health literacy and skills; and how access to care barriers dually affected and related to personal and community cost, time, and human resources. CONCLUSIONS: The research process involved the co-creation of tools to identify strengths within the community and drive opportunities for change; subsequently generating solutions to the practical problems and potentially transform the health system accessed by the community.

Targeting Hypertension: Working with Rural Barbershops to Identify Hypertension and Encourage Treatment.

INTRODUCTION: Cardiovascular disease (CVD), accounting for one in every four U.S. deaths, has had a devastating impact on Mississippi's African American population. Seeking innovative mitigation models, this study assesses CVD prevalence and reach via barbershops to rural Mississippi African Americans. METHODS: Data was collected from barbershop clientele who consented to be screened and contacted for referral to clinical care if blood pressure was found to be elevated. RESULTS: Most participants were African American (97.7%, n=2,756) and male (54.4%). Descriptive findings revealed more than one-third of participants (34.2%) had elevated blood pressure at screening. Factoring in those with hypertension in control, we found lower rates of hypertension in the male population (males 51.4% vs. females 57.8%), a sharp contrast to national rates. CONCLUSION: Evaluation findings suggest CVD prevalence in rural Mississippi is comparatively high but that barbershop partners were able to successfully reach and screen the target population.

Assessing knowledge of Sudden Infant Death Syndrome among African American women in two Mississippi communities.

PURPOSE: Sudden Infant Death Syndrome (SIDS) is the third leading cause of Mississippi infant mortality with nonwhite infants dying of SIDS at two to three times the rate of white infants. The purpose of this study was to assess the level of SIDS related knowledge among African American women in two geographical areas of Mississippi and gain insight on improving methods for SIDS education and outreach. DESIGN: An African American faculty was contracted to conduct six focus groups among African American women (n = 57) in two geographical areas of the state. FINDINGS: Themes were common among participants from both the metropolitan and rural Delta communities. Participants in both geographical areas were familiar with [or at least had previously heard] the term SIDS. Unfortunately, there was inconsistency among participants as to the source of information. Given the inconsistencies, it is not surprising that overall knowledge related to SIDS was incomplete and in some cases inaccurate. DISCUSSION/CONCLUSION: Some information regarding SIDS is available in the various communities. Unfortunately, the information is not fully understood and is not consistently distributed resulting in a lack of knowledge among these women and thus, a continued risk for high rates of SIDS events in Mississippi.

Association of maternal medical conditions and unfavorable birth outcomes: findings from the 1996-2003 Mississippi linked birth and death data.

This study aimed to identify factors contributing to high rates of preterm birth (PTB), low birth weight (LBW) and infant mortality in Mississippi while considering both traditional risk factors and maternal medical conditions. The retrospective cohort study used 1996-2003 Mississippi linked birth and infant death files. Multiple logistic regression was used to investigate association between maternal medical conditions and unfavorable birth outcomes. Along with traditional risk factors, hypertension was significantly associated with PTB and LBW. Women with hypertension were about 2.2 and 3.2 times as likely to have PTB and LBW, respectively. Hydramnios/oligohydramnios increased 1.8-4.4 folds of risk for PTB, LBW and infant death and was significantly associated with the unfavorable birth outcomes. Non-Hispanic black women were about 1.5-2.0 times as likely to have an unfavorable birth outcome compared to non-Hispanic white women. Maternal education and prenatal care effect appeared to be modified by maternal race. Certain maternal medical conditions may be contributing to PTB, LBW and infant mortality rates identifying preconception and prenatal healthcare as possible strategies for reducing unfavorable outcomes. Results suggest that different risk profiles for unfavorable outcomes may exist according to maternal race highlighting the need to consider racial groups separately when further exploring the sociodemographic and/or health-related factors that contribute to unfavorable birth outcomes.

Prenatal care utilization in Mississippi: racial disparities and implications for unfavorable birth outcomes.

The objective of the study is to identify racial disparities in prenatal care (PNC) utilization and to examine the relationship between PNC and preterm birth (PTB), low birth weight (LBW) and infant mortality in Mississippi. Retrospective cohort from 1996 to 2003 linked Mississippi birth and infant death files was used. Analysis was limited to live-born singleton infants born to non-Hispanic white and black women (n = 292,776). PNC was classified by Kotelchuck's Adequacy of Prenatal Care Utilization Index. Factors associated with PTB, LBW and infant death were identified using multiple logistic regression after controlling for maternal age, education, marital status, place of residence, tobacco use and medical risk. About one in five Mississippi women had less than adequate PNC, and racial disparities in PNC utilization were observed. Black women delayed PNC, received too few visits, and were more likely to have either "inadequate PNC" (P < 0.0001) or "no care" (P < 0.0001) compared to white women. Furthermore, among women with medical conditions, black women were twice as likely to receive inadequate PNC compared to white women. Regardless of race, "no care" and "inadequate PNC" were strong risk factors for PTB, LBW and infant death. We provide empirical evidence to support the existence of racial disparities in PNC utilization and infant birth outcomes in Mississippi. Further study is needed to explain racial differences in PNC utilization. However, this study suggests that public health interventions designed to improve PNC utilization among women might reduce unfavorable birth outcomes especially infant mortality.

Evaluating the SIDS diagnosis process utilized by coroners in Mississippi.

To assess the consistency of Mississippi coroners' practices in identifying Sudden Infant Death Syndrome (SIDS) cases, coroners were surveyed about diagnostic protocols. Findings were compared with published Centers for Disease Control guidelines and Mississippi law. One-third of coroners report they sometimes or never perform investigations at the place of infant death. The agency responsible for transferring the infant and the turn-around time for autopsy reports also varies. This study demonstrates inconsistency in SIDS diagnostic protocols among Mississippi coroners.

Association of maternal chronic disease and negative birth outcomes in a non-Hispanic Black-White Mississippi birth cohort.

OBJECTIVE: To investigate the impact of selected maternal chronic medical conditions, race, and age on preterm birth (PTB), low birth weight (LBW), and infant mortality among Mississippi mothers from 1999 to 2003. DESIGN: A retrospective cohort analysis of linked birth and death certificates. SAMPLE: The 1999-2003 Mississippi birth cohort comprising 202,931 singleton infants born to African American and White women. MEASUREMENTS: The relationship between maternal chronic conditions and the dependent variables of PTB, LBW, and infant mortality were investigated using logistic regression analysis. RESULTS: PTB, LBW, and infant mortality were more prevalent among African American women, very young women (< or =15 years), and women with certain chronic medical conditions. Among White mothers, maternal chronic hypertension was significantly associated with PTB and LBW, and maternal diabetes with PTB and infant mortality. Among African American mothers, maternal cardiac disease was significantly associated with PTB and LBW; maternal chronic hypertension was significantly associated with LBW and infant mortality; and maternal diabetes with PTB. CONCLUSIONS: Maternal chronic hypertension and diabetes were significantly associated with negative birth outcomes regardless of maternal race. Maternal cardiac disease was only significantly associated with PTB and LBW among African Americans.

Evaluation of a multistate faith-based program for children affected by natural disaster.

OBJECTIVES: To systematically evaluate Camp Noah, a faith-based intervention for children affected by natural disaster: to assess the extent to which the camps were carried out according to the program design, to describe how the Camp Noah program was implemented, and to explore Camp Noah program effects on children. DESIGN: Qualitative survey. SAMPLE: Twenty-eight local, state, and national stakeholders. MEASUREMENT: Open-ended interviews. RESULTS: Although camps adhered to the curriculum, many implementation weaknesses resulted from a lack of clear program structure and written procedures. Stakeholders observed that children generally were able to process their disaster experiences in the camp, and some children exhibited increased understanding of God's role in their disaster experience. Stakeholders also described parent reports of increased coping skills related to weather among some children. Lastly, stakeholders both observed positive effects of Camp Noah on children's behaviors and symptoms and described changes reported to them by parents. CONCLUSIONS: Every year, thousands of children suffer emotionally as a result of natural disaster in the United States. With public health nursing support and improvements in infrastructure, Camp Noah may be a promising intervention to address this important public health problem.