Association Between Prepregnancy Obesity and Health Behaviors, Adverse Conditions, and Birth Outcomes in South Dakota.

INTRODUCTION: Prepregnancy obesity has been shown to be associated with increased risk of adverse birth outcomes but little is known about the associations with health-related behaviors and conditions before, during and after pregnancy. METHODS: This retrospective cohort study used data from the South Dakota Pregnancy Risk Assessment Monitoring System (SD PRAMS) survey, which is an ongoing state-based surveillance system of maternal behaviors, attitudes, and experiences before, during, and shortly after pregnancy. The 2017 and 2018 SD PRAMS sampled a total of 3,805 mothers who were randomly selected from birth certificate records to be representative of all South Dakota women who delivered a live-born infant. Logistic regression was used to determine whether prepregnancy obesity was associated with adverse health conditions after controlling for demographic factors. RESULTS: Women with prepregnancy obesity, compared to those who were non-obese, were more likely to report an unintended pregnancy (45 percent vs. 39 percent), smoking three months before pregnancy (32 percent vs. 22 percent), delayed prenatal care (12 percent vs. 16 percent), hypertension during pregnancy (22 percent vs. 9 percent), gestational diabetes (19 percent vs. 8 percent), depression during pregnancy (21 percent vs. 14 percent), C-section delivery (35 percent vs. 22 percent), high birth weight (15 percent vs. 8 percent), and the infant hospitalized for three or more days (41 percent vs. 30 percent). Of women with prepregnancy obesity, 37 percent had been talked to by health care providers about maintaining a healthy weight the 12 months before pregnancy compared to 13 percent of non-obese women. CONCLUSIONS: Health care workers should be more intentional about stressing the potential risks of prepregnancy obesity to properly educate mothers and women of childbearing age.

Safe Sleep Behaviors Among South Dakota Mothers and the Role of the Healthcare Provider.

INTRODUCTION: The purpose of this report was to determine the prevalence of safe sleep practices among South Dakota mothers, and the impact that education from their healthcare provider had on infant safe sleep practices as defined by the American Academy of Pediatrics (AAP). METHOD: A population-based survey was administered to a random sample of mothers delivering in 2017. Data were weighted to obtain statewide and race-specific (white, non-Hispanic; American Indian; other races) prevalence rates. RESULTS: Weighted response rate was 67 percent, with 9.9 percent of mothers giving birth in 2017 completing a survey. Greater than 85 percent of mothers met recommendations regarding placing their infant on their back, breastfeeding, not consuming alcohol or illicit drugs during pregnancy, and attending 80 percent or more of prenatal visits. Less than 85 percent met recommendations regarding infant always sleeping alone on an approved sleep surface (30.8 percent), room-sharing without bed-sharing (44.3 percent), keeping soft objects and loose bed- ding out of crib (47.7 percent), and avoiding smoke exposure during and after pregnancy (82.1 percent). Only 7.7 percent of mothers met all eight recommendations. Healthcare providers talking to the mother about placing the infant to sleep in a crib and placing the crib in the mother's room were associated with a higher percent of mothers meeting these recommendations. Although the health care provider asking the mother if she was going to breastfeed was not associated with ever breastfeeding (p=0.95), if the mother received information from the doctor about breastfeeding she was slightly more likely to breastfeed than if she did not receive information (90.3 vs. 85 percent, p=0.06). CONCLUSIONS: A low percentage of South Dakota mothers met all eight AAP safe sleep recommendations that could be assessed using these data. Health care providers can influence a mother's compliance with some of the safe sleeping recommendations.

Evaluation of the South Dakota fitCare child care provider training program targeting nutrition and physical activity.

INTRODUCTION: Early childhood obesity is a significant health problem that has serious short- and long-term consequences. Recognizing the influence child care providers have on children, state programs have been created through federal funding initiatives to improve childhood health and reduce obesity rates. In 2011, South Dakota Department of Health received a five-year Centers for Disease Control and Prevention Community Transformation grant to improve healthy eating and active living. Grant funds were used to implement the fitCare Child Care Provider Training Program. METHODS: Child care providers in South Dakota volunteered to participate in fitCare training. Surveys were conducted among fitCare and non-fitCare participants to assess South Dakota child care provider implementation of proper nutrition and physical activities in child care settings. RESULTS: Survey findings showed that 52 percent of all providers surveyed have children, newborn to 2 years old, at their day care for more than 40 hours per week. Non-fitCare providers were more likely to provide additional servings of fruit than fitCare providers. Statistically significant findings showed that fitCare providers were more likely than non-fitCare providers to offer structured physical activity (p = < 0.001). Rural Urban Commuting Area analysis was also performed showing differences between rural and urban areas. CONCLUSIONS: Conclusions suggest that the physical activity components of fitCare training have a stronger impact on providers than the nutrition components. Future research should focus on strengthening the nutrition component of fitCare as well as increasing access to healthy foods. Suggestions are offered for improving the fitCare curriculum and training.

Factors Associated with Breastfeeding Initiation and Continuation at Two Months Postpartum in American Indian Women: An Exploratory Analysis.

This study aimed to determine the prevalence of breastfeeding initiation and continuation at two months postpartum in American Indian (AI) mothers in South Dakota and to identify factors associated with breastfeeding. Using logistic regression, data from the South Dakota Pregnancy Risk Assessment Monitoring System were used to investigate the relationship between binary breastfeeding initiation and continuation outcomes and maternal behaviors and experiences including access to health care, safe sleep practices, ability to handle life events, depression, and sources of breastfeeding information. Higher odds of initiation were seen for factors including access to health care services, ability to handle life events, and sources of breastfeeding information, while lower odds were seen for factors including safe sleep. Higher odds of continuation were seen among mothers who reported not taking long to get over setbacks and among mothers who reported no postpartum depression, while lower odds of continuation were seen among mothers practicing safe sleep. Several modifiable factors were identified as reasons for stopping breastfeeding. This information about factors associated with higher odds of breastfeeding initiation and continuation at two months postpartum can be used to inform interventions, programs, and policies designed to support breastfeeding among AI women and to guide future research in this area.

The obesity epidemic in South Dakota: how big is the problem?

Obesity is an increasing problem both in the United States and South Dakota. Currently, 30.3 percent of South Dakota adults self-report being obese, which is higher than the national prevalence and also increasing at a faster rate than other states. The obesity rate for South Dakota 2- to 5-year-olds from limited-income households is 16.4 percent and above the national prevalence. Obesity prevalence among students Kindergarten through grade 12 was 16.0 percent for the 2009-2010 school year, not higher than national data.

Tobacco use among South Dakotans.

Tobacco use is the leading cause of preventable deaths in the United States and in South Dakota. Reducing tobacco use among South Dakotans is critical to alleviate the heavy burden of preventable deaths, illnesses and excessive health care costs that result from using tobacco products. The South Dakota Department of Health's Tobacco Control Program has collaborated with various agencies and coalitions to discourage people from starting to smoke, to help current smokers quit and to protect all people from exposure to secondhand smoke. The South Dakota Behavioral Risk Factor Surveillance System (BRFSS), the South Dakota Youth Tobacco Survey (YTS), the South Dakota Youth Risk Behavior Survey (YRBS), South Dakota Vital Statistics and the South Dakota Perinatal Health Risk Assessment Survey are the primary instruments used to measure progress toward achieving the goals and objectives of South Dakota's tobacco control effort. Since 2001, the South Dakota Department of Health's Tobacco Control Program has been implementing comprehensive statewide programs to reduce tobacco use and exposure to secondhand smoke. Concurrent with the comprehensive tobacco control program implementation, the prevalence of cigarette smoking declined significantly from its peak of 27.2 percent in 1998 to its current low of 19.8 percent in 2007, which is equal to the national average of 19.8 percent. Use of spit tobacco among adult South Dakotans also has declined from 6.8 percent in 2003 to 5.8 percent in 2007. There also has been a reduction in the number of high school students that are current smokers, i.e., having smoked cigarettes on one or more of the past 30 days, from 33 percent in 2001 to 25 percent in 2007.2 The prevalence of current smokers among middle school-aged South Dakotans has decreased from 8 percent in 2005 to 6 percent in 2007. Important shifts have occurred in the struggle to quit smoking: In South Dakota, 57.2 percent of current smokers are trying to quit. In addition, 80.8 percent of respondents report that smoking is not allowed in any work area. Positive changes have taken place in South Dakotans' attitudes toward exposure to secondhand smoke. There is widespread awareness of the harm of secondhand smoke, with 83 percent of respondents indicating that they believed secondhand smoke causes lung cancer. These positive trends across a multitude of indicators suggest that the comprehensive tobacco control effort in South Dakota is having an effect in reducing the harms of tobacco. The decreases in smoking prevalence among South Dakota adults and youth are some of the most encouraging findings. However, challenges remain. The tobacco industry is well aware of efforts to reduce tobacco use and continues to develop and promote new products. Despite decreasing cigarette use among all adults in South Dakota, 18- to 24-year-olds still have the highest smoking rate, at 29.3 percent. Surveillance will continue to monitor tobacco use trends in South Dakota and assess the impact of tobacco control efforts. Some of the most important findings are summarized in the following report.

Learning About and Using Research Evidence Among Public Health Practitioners.

INTRODUCTION: Funders and accreditation standards increasingly call on state and local public health agencies to use the best available science. Using research evidence is a key process in practicing evidence-based decision making (EBDM). This study explored preferences for and uses of research evidence, and examined correlates regarding frequency of use. METHODS: In 2014, eligible staff from 12 state health departments and their partnering agencies were invited to complete an online self-report questionnaire and achieved an 82% response rate (1,237/1,509). The cross-sectional data analyzed in 2015 were baseline to a study on enhancing EBDM capacity and supports. RESULTS: Webinars/workshops was the most frequently selected method to learn public health findings among those in state and local health departments, whereas academic journals was the top selection by those in universities and healthcare facilities (p<0.001). Several modifiable EBDM practices were associated with more frequent use of research evidence, including direct supervisor expectations for EBDM use and performance evaluation based partially on EBDM use (AOR=2.5, 95% CI=1.9, 3.2 and AOR=2.5, 95% CI=2.1, 2.9, respectively). Increased numbers of EBDM practices were associated with higher odds of frequent research evidence use. Participant characteristics associated with higher research evidence use and adjusted for were job role, education attainment, and gender. CONCLUSIONS: To translate research into public health practice, researchers can tailor evidence on intervention implementation and effectiveness and disease burden to accessible and preferred formats for public health workers and partners. Management practices to support evidence-based disease prevention can be instituted and fostered in public health and partnering agencies.