Risk Factors and Birth Outcomes of a High-Risk Cohort of Women Served by a Community-Based Prenatal Home Visiting Program.

Our study explored risk factors and birth outcomes of a community maternal and child outreach program for high poverty mothers in East and Central Harlem. We conducted a retrospective chart review of 75 mother-infant dyads, with singleton pregnancies, receiving antepartum and postpartum home visits. Inexperienced parenting was associated with increased odds of giving birth to an infant weighing <2,700 g compared to experienced parenting after adjustment for race/ethnicity and preeclampsia diagnosis (odds ratio (OR) 4.9, p = 0.04). Mothers had comparatively lower depression risk in the postpartum period compared to antepartum (p = 0.006).

Awareness of High Blood Pressure by Nativity Among Black Men: Implications for Interpreting the Immigrant Health Paradox.

INTRODUCTION: Differences in the social determinants of health and cardiovascular health outcomes by nativity have implications for understanding the immigrant health paradox among black immigrants. We aimed to understand whether blood pressure awareness, a precursor to achieving blood pressure control among hypertensive patients, varied by nativity among a sample of black men. METHODS: Data were collected from 2010 through 2014. In 2016, we conducted logistic regression models using data from a large sample of urban-dwelling middle-aged and older black men. All men in the study had measured high blood pressure at the time of enrollment and were also asked whether they were aware of having high blood pressure. Independent variables included demographics, socioeconomic status, access to care, and health-related behaviors. RESULTS: Foreign-born participants were significantly less likely than US-born participants to report awareness of having high blood pressure (P < .001). We observed a significant positive relationship between proportion of life spent in the US and being aware of having hypertension (ß = 0.863; 95% CI, 0.412-1.314; P < .001). This relationship remained after adjusting the model for salient independent variables (ß = 0.337; 95% CI, 0.041-0.634; P = .03). CONCLUSIONS: Difference in hypertension awareness by nativity may skew surveillance estimates used to track health disparities by large heterogeneous racial categories. Our results also indicate that prior health care experience and circumstances should be considered when studying the immigrant health paradox.

Perceptions of Job Hazards and Requests for Accommodation Among Pregnant Women in a Large Urban Hospital System.

BACKGROUND: Many pregnant women remain uninformed about job accommodation options or have not been empowered to ask their employers. METHODS: A cross-sectional survey of a sample base of pregnant women from late first through third trimester was conducted. Associations between job perception variables, work characteristics, race/ethnicity, and income were assessed using binary logistic regression. RESULTS: Workers in service/support occupations were twice as likely as those in management to perceive need for job duty change and to request job accommodation. Perception of needed job change was higher when jobs had high physical demands and low substantive complexity. CONCLUSIONS: We found positive relationships between highly physical work, perception of harm, and need for job change in pregnancy. Further research could explore worker/employer characteristics explaining why these perceptions did not translate into requesting and receiving job accommodation during pregnancy.

Differences in disease prevalence among homeless and non-homeless veterans at an urban VA hospital.

OBJECTIVES: Approximately 10% of homeless adults in the US are veterans and that number is increasing. Veterans who experience homelessness tend to do so for longer periods compared to non-veterans; and homelessness is associated with more chronic disease complications. We compared the prevalence of five chronic, ambulatory-care sensitive conditions in homeless and domiciled individuals who received primary care at an urban VA hospital. METHODS: Data were obtained from the Veteran's Hospital Administration clinical data warehouse. Differences in disease prevalence were compared between the two groups using chi-square analyses and then adjusted for age, gender, race/ethnicity, BMI, and other risk factors where appropriate, using logistic regression. All analyses were conducted using SAS version 9.4. RESULTS: Homeless individuals were 46% more likely to have asthma (OR 1.46, 95% CI 1.16-1.84) and 40% more likely to have COPD (OR 1.40, 95% CI 1.14-1.73) after adjustment for age, gender, race/ethnicity, BMI, and tobacco use status. After adjustment for covariates, there was no difference between homeless and domiciled veterans in the prevalence of diabetes, hypertension, or congestive heart failure. DISCUSSION: Future quality improvement projects should identify social-environmental risk factors like employment characteristics, and housing quality that can impact chronic respiratory illness prevalence and associated complications.

Cardiovascular Health Risk Behaviors by Occupation in the NYC Labor Force.

OBJECTIVE: We explored associations between occupation and cardiovascular disease (CVD) risk behaviors including: attempted weight loss, physical activity, smoking, and restaurant meal and sugary beverage consumption. METHODS: We used NYC Health and Nutrition Examination Survey 2013 to 2014 data, and coded free-text, occupational question responses using 2010 US Census Bureau Classification. CVD risk behaviors were compared across occupational categories, using regression to adjust for demographics. RESULTS: There were health behavior differences across occupational categories. Construction/transportation/maintenance workers smoked more and were less likely than management to attempt weight loss, service workers were less likely to eat restaurant-prepared meals, sales/office workers were less likely to be physically active (all P < 0.05). Adjusting for demographics, differences in health behaviors were reduced, but remained present. CONCLUSIONS: Knowledge of occupational disparities may aid chronic disease prevention by identifying populations for targeted interventions.

A Multidisciplinary Home Visiting Program for Children With Medical Complexity.

OBJECTIVES: Given the high needs and costs associated with the care of children with medical complexity (CMC), innovative models of care are needed. Home-visiting care models are effective in subpopulations of pediatrics and medically complex adults, but there is no literature on this model for CMC. We describe the development and outcomes of a multidisciplinary program that provides comprehensive home-based primary care for CMC. METHODS: Medical records from our institution were reviewed for patients enrolled in our program from July 2013 through March 2019. Demographics, clinical characteristics, and health care use were collected. We compared the differences in pre- and postprogram enrollment health care use using Wilcoxon signed rank test. We applied Cox proportional hazard models to examine the association between the time-dependent postenrollment health care use and numbers of home visits. We collected total claims data for a subset of our patients to examine total costs of care. RESULTS: We reviewed data collected from 121 patients. With our findings, we demonstrate that enrollment in our program is associated with reductions in average length of stay. More home visits were associated with decreased emergency department visits and hospitalizations. We also observed in patients with available cost data that total costs of care decreased after enrollment into the program. CONCLUSIONS: Our model has the potential to improve health outcomes and be financially sustainable by providing home-based primary care to CMC.

An Assessment of E-health Resources and Readiness in the Republic of the Marshall Islands: Implications for Non-communicable Disease Intervention Development.

The prevalence of non-communicable diseases (NCDs) is rapidly increasing in low and middle income countries (LMIC). The Republic of the Marshall Islands is an island country in the Pacific located near the equator and has the third highest prevalence of diabetes in the world, high rates of complications, and early mortality with limited or no resources for tertiary care of these complications. Given the limited resources of the country, there is a need for strategies which emphasize NCD prevention. E-health interventions are becoming more popular in LMICs. A rapid qualitative assessment, involving focus groups, site visits, and key informant interviews, was performed to ascertain community perceptions about the causes of NCDs including diabetes and potential solutions. An assessment of the technology infrastructure was conducted to assess capacity for potential e-health interventions. Thirty local participants were interviewed. Participants identified diabetes as the highest priority NCD with dietary shifts toward imported, processed foods and decrease in physical activity as the major causes. Text messaging and Facebook were found to be widely utilized for personal and public communication. Given the low-tech, low-cost communication mechanisms and widespread use of Facebook, a social media intervention could help support local NCD prevention communications initiatives.

A Rapid Assessment Procedure to Develop A Non-Communicable Disease Prevention Pilot Health Communications Project Using E- and M-Health Communications in Pohnpei State, Federated States of Micronesia.

Pohnpei State of the Federated States of Micronesia, located in the Northwestern Pacific Ocean, has limited health research infrastructure; chronic non-communicable diseases (NCD) such as diabetes, heart disease, and cancer are a concern. Over 73% of Pohnpei's population is overweight or obese. E- and m- (mobile) health interventions are becoming more popular in low and middle income countries. A Rapid Assessment Procedure was conducted for formative research to identify the enabling factors and challenges related to health communication and technology in Pohnpei to address NCD prevention. Thirty-seven local stakeholders were identified through snowball sampling for interviews and group discussions about e-health readiness and NCD priorities, held in local settings. Interviews were audio recorded, with field notes taken. Data were iteratively coded using DEDOOSE. Diabetes emerged as the most serious NCD issue because both the health system and local community are having to deal with the complications and consequences. Stakeholders recommended that prevention should be integrated with diabetes treatment. Local health workers' teaching evidence-based diabetes prevention and other health promotion education were through handheld (mobile devices) was identified. The ability to readily access evidence-based health education materials and modules is compatible with community approaches providing tailored, individual and small group education and social support. This approach may serve as a key component of local NCD prevention communications initiatives integral to prevent diabetes and its complications as remote Small Island Nations face burgeoning NCD epidemics and dramatic shifts in diet and activity.

Improving Physical Activity among Residents of Affordable Housing: Is Active Design Enough?

Physical inactivity increases risk of chronic disease. Few studies examine how built environment interventions increase physical activity (PA). Active design (AD) utilizes strategies in affordable housing to improve resident health. We assessed how AD housing affects PA among low-income families in Brooklyn, New York. Participants were recruited at lease signings in 2016 from a new AD apartment complex and two recently renovated comparison buildings without AD features. Eligibility included age ≥18 years with no contraindications to exercise. Anthropometric data were collected. PA was self-reported using the Recent and Global Physical Activity Questionnaires. Smartphone users shared their tracked step. Data collection was repeated one year after move-in. All data were analyzed using SPSS. Eighty-eight eligible participants completed the initial questionnaire (36 AD and 52 from 2 comparison buildings) at baseline (T0). There were no differences between AD and comparison cohorts in: stair use, PA, sitting time or, mean waist-to-hip ratio (WHR) at T0. However, the AD cohort had a lower baseline BMI (27.6 vs. 31.0, p = 0.019). At one-year follow-up (T1), 75 participants completed our survey including a 64% retention rate among those who previously completed the T0 questionnaire. Among T0 questionnaire respondents, mean daily steps increased at T1 among AD participants who moved from an elevator building (∆6782, p = 0.051) and in the comparison group (∆2960, p = 0.023). Aggregate moderate work-related activity was higher at T1 in the AD building (746 vs. 401, p = 0.031). AD building women reported more work-related PA overall but AD men engaged in more moderate recreational PA. Living in an AD building can enhance low-income residents' PA. More research with objective measures is needed to identify strategies to sustain higher PA levels and overall health.

Primary Care Group Visits for Childhood Obesity: Clinical Program Evaluation.

We conducted 29 group visits targeting children with elevated body mass index (BMI) and their families. Visit activities focused on social support, mind-body techniques, exercise, and nutrition. Measures included attendance, family satisfaction scores, and per-patient change in BMI percentile. Ninety-six patients attended ≥1 group visit, mean 2.0 (SD ±1.8; range 1-14). Mean patient age was 9.6 years (SD ±2.4; range 4-15 years); 53.1% were female; 44.8% had a BMI 95th to 99th percentile for age/sex; 35.4% had a BMI >99th percentile. Mean attendance per group visit was 6.8 patients (SD ±3.8; range 1-16 patients). Mean family satisfaction scores were 9.8 (SD ±0.8) with 10/10 "would recommend to family or friends." Of 42 patients who attended ≥2 group visits, 5 (11.9%) experienced a ≥5 BMI percentile reduction between first and last visits; 3 (7.1%) maintained this reduction 2 years later. Group visits were associated with high family satisfaction scores, though few patients experienced a reduction in BMI percentile.

Risk Factors for Preeclampsia in a High-Risk Cohort of Women Served by a Nursing-based Home Visiting Program.

This descriptive study aimed to identify the impact of psychosocial risk factors on pregnancy outcomes for high risk women in an urban setting. Women in this category tend to experience adverse pregnancy outcomes, like preeclampsia, at greater rates than low or medium risk women. A retrospective paper chart review of East Harlem women served by LSA Family Health Service (LSA) Maternal Outreach Program (MOP) was conducted. All women who enrolled in the MOP with a singleton pregnancy from January 2015 to December 2017, were eligible for inclusion in our analyses. Data were analyzed using SPSS (version 23). Of 379 total participants, 68.6% (n=203) were Hispanic/Latina women, 44.8% (n=163) were English only speakers, 67.4% (n=226) were identified as overweight/obese, 90.6% (n=328) were mothers over the age of 20 among those for whom data were available. Sixty-two percent (n=235) initiated prenatal care in their first trimester, and 71.5% (n=271) were referred to the MOP by a hospital or other healthcare provider. The percentage of preeclampsia among mothers was 26.9% (n=102). After adjustment for type of LSA services received, and race/ethnicity, there were no associations between psychosocial risk factors and preeclampsia diagnosis in this population. Further research is needed on the relationship between psychosocial risk factors and preeclampsia to identify potential areas of intervention and reduce the burden of disease.

Family Sources of Sexual Health Information, Primary Messages, and Sexual Behavior of At-Risk, Urban Adolescents.

BACKGROUND: Sources of sexual health information exert strong influence on adolescents' sexual behavior. PURPOSE: The current study was undertaken to understand how family serve as sexual information sources, the messages adolescents recall from family, and how family learning experiences affect sexual behavior among at-risk adolescents. METHODS: Individual interviews were conducted with 69 teens, ages 15-18 years, from an alternative high school and a juvenile correctional facility to capture adolescents' early sexual health learning experiences involving family and evaluate their association with teens' recent sexual behavior. Sexual learning narratives were compared among gender and sexual experience groups. RESULTS: Many participants identified family as sexual health information sources. Primary messages recalled: risks of sex, protection, and relationship advice. Many adolescents portrayed learning experiences as negative, cautionary, lacking detail and not always balanced with positive messages. Participants who reported four or more sexual risks were the only group to identify pornography as a sexual health information source. Participants who reported fewer than four sexual risks were most likely to identify family sexual health information sources. DISCUSSION: Participants identified family members as sources of sexual health information, with variations by gender. Negative/cautionary messages require teens to seek additional sexual information elsewhere (primarily friends/media). Males, in particular, appear to often lack familial guidance/education. TRANSLATION TO HEALTH EDUCATION PRACTICE: Sexual health messages should be tailored to adolescents' needs for practical and sex-positive guidance regarding mechanics of sex and formation of healthy relationships, and balanced with cautions regarding negative consequences.