- Dr. Euna M. August is a public health professional with 25 years of experience.edit
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The number of new HIV diagnoses is highest in the South. Many persons who might benefit from pre-exposure prophylaxis (PrEP) are not engaged in the HIV PrEP continuum of care. We analyzed National HIV Behavioral Surveillance data to... more
The number of new HIV diagnoses is highest in the South. Many persons who might benefit from pre-exposure prophylaxis (PrEP) are not engaged in the HIV PrEP continuum of care. We analyzed National HIV Behavioral Surveillance data to assess engagement in the PrEP continuum of care among persons with increased HIV risk. We compared PrEP awareness, discussion with a clinical provider, and use among persons living in the South to those living elsewhere in the United States. PrEP awareness was lowest among heterosexual persons (7%), highest among men who have sex with men (85%), and 26% among persons who inject drugs. PrEP use was low among each population (≤ 35% for all cycles). There was limited evidence of differences in PrEP use between persons in southern and non-southern U.S. Efforts are needed to increase use of PrEP among each of the groups with increased HIV risk.
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The Zika Contraception Access Network (Z-CAN) was established during the 2016-2017 Zika virus outbreak in Puerto Rico as a short-term emergency response program providing client-centered contraceptive counseling and same-day access to the... more
The Zika Contraception Access Network (Z-CAN) was established during the 2016-2017 Zika virus outbreak in Puerto Rico as a short-term emergency response program providing client-centered contraceptive counseling and same-day access to the full range of reversible contraceptive methods at no cost to women wishing to delay pregnancy. An evidence-based communication campaign, Ante La Duda, Pregunta (ALDP), was launched to encourage utilization of Z-CAN services. We assessed the effectiveness of campaign tactics in increasing awareness of Z-CAN among women in Puerto Rico. Data on campaign exposure and awareness were obtained through a self-administered online survey approximately two weeks after an initial Z-CAN visit, while the number of searches for participating clinics were obtained from monitoring the campaign website. Findings demonstrated that the most common ways survey respondents learned about Z-CAN were through friends or family (38.3%), social media (23.9%), a clinical encou...
The number of new HIV diagnoses is highest in the South. Many persons who might benefit from pre-exposure prophylaxis (PrEP) are not engaged in the HIV PrEP continuum of care. We analyzed National HIV Behavioral Surveillance data to... more
The number of new HIV diagnoses is highest in the South. Many persons who might benefit from pre-exposure prophylaxis (PrEP) are not engaged in the HIV PrEP continuum of care. We analyzed National HIV Behavioral Surveillance data to assess engagement in the PrEP continuum of care among persons with increased HIV risk. We compared PrEP awareness, discussion with a clinical provider, and use among persons living in the South to those living elsewhere in the United States. PrEP awareness was lowest among heterosexual persons (7%), highest among men who have sex with men (85%), and 26% among persons who inject drugs. PrEP use was low among each population (≤ 35% for all cycles). There was limited evidence of differences in PrEP use between persons in southern and non-southern U.S. Efforts are needed to increase use of PrEP among each of the groups with increased HIV risk.
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Abstract Objective To evaluate changes in Ebola-related knowledge, attitudes and prevention practices during the Sierra Leone outbreak between 2014 and 2015. Methods Four cluster surveys were conducted: two before the outbreak peak (3499... more
Abstract Objective To evaluate changes in Ebola-related knowledge, attitudes and prevention practices during the Sierra Leone outbreak between 2014 and 2015. Methods Four cluster surveys were conducted: two before the outbreak peak (3499 participants) and two after (7104 participants). We assessed the effect of temporal and geographical factors on 16 knowledge, attitude and practice outcomes. Findings Fourteen of 16 knowledge, attitude and prevention practice outcomes improved across all regions from before to after the outbreak peak. The proportion of respondents willing to: (i) welcome Ebola survivors back into the community increased from 60.0% to 89.4% (adjusted odds ratio, aOR: 6.0; 95% confidence interval, CI: 3.9–9.1); and (ii) wait for a burial team following a relative’s death increased from 86.0% to 95.9% (aOR: 4.4; 95% CI: 3.2–6.0). The proportion avoiding unsafe traditional burials increased from 27.3% to 48.2% (aOR: 3.1; 95% CI: 2.4–4.2) and the proportion believing spiritual healers can treat Ebola decreased from 15.9% to 5.0% (aOR: 0.2; 95% CI: 0.1–0.3). The likelihood respondents would wait for burial teams increased more in high-transmission (aOR: 6.2; 95% CI: 4.2–9.1) than low-transmission (aOR: 2.3; 95% CI: 1.4–3.8) regions. Self-reported avoidance of physical contact with corpses increased in high but not low-transmission regions, aOR: 1.9 (95% CI: 1.4–2.5) and aOR: 0.8 (95% CI: 0.6–1.2), respectively. Conclusion Ebola knowledge, attitudes and prevention practices improved during the Sierra Leone outbreak, especially in high-transmission regions. Behaviourally-targeted community engagement should be prioritized early during outbreaks.
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In response to the Zika virus outbreak in Puerto Rico (2015-2016), the Zika Contraception Access Network (Z-CAN) was established to provide same-day access to the full range of reversible contraception at no cost to women. Formative... more
In response to the Zika virus outbreak in Puerto Rico (2015-2016), the Zika Contraception Access Network (Z-CAN) was established to provide same-day access to the full range of reversible contraception at no cost to women. Formative research was conducted to inform the development of a communication campaign about Z-CAN. Ten focus groups with women and men, aged 18 to 49 years, in Puerto Rico were conducted to collect data on contraception awareness, use, and decision making during the Zika outbreak, as well as culturally appropriate messaging and outreach strategies. Thematic analysis was conducted using the constant comparative method. Data showed that there was community awareness regarding Zika in Puerto Rico. However, it was not a motivating factor in contraception decision making; instead, economic factors were the major drivers. Most participants preferred to receive information on contraception, potential side effects, and where to access contraceptive services via Internet-...
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BACKGROUND Between January and October 2016, 575 symptomatic confirmed cases of Zika virus infection were reported in the U.S. Virgin Islands (USVI). Zika virus infection during pregnancy can cause serious birth defects. Preventing... more
BACKGROUND Between January and October 2016, 575 symptomatic confirmed cases of Zika virus infection were reported in the U.S. Virgin Islands (USVI). Zika virus infection during pregnancy can cause serious birth defects. Preventing unintended pregnancy among women who choose to delay or avoid pregnancy is a primary strategy to reduce these adverse outcomes. METHODS A rapid assessment, using one men's and five women's focus groups (N = 43), was conducted to inform communication efforts to increase awareness of contraception as a means for preventing unintended pregnancy in the context of a Zika outbreak in the USVI. RESULTS Findings showed that people of reproductive age were aware of the relationship between Zika virus infection during pregnancy and adverse birth outcomes. However, when discussing methods for prevention, participants did not include preventing unintended pregnancy as a strategy to reduce these adverse outcomes. When asked about family planning in the USVI, participants discussed that, for some, planning pregnancies is not common. Participants wanted communications about contraception to include available methods, side effects, costs, and safety. Optimal communication channels included social media and local spokespersons. Participants identified health care providers as a trusted information source. CONCLUSIONS Findings from this assessment informed the design of a culturally appropriate communication strategy to raise awareness of the prevention of unintended pregnancy as a primary strategy to reduce Zika-related adverse birth outcomes in the USVI.
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Stigmatizing attitudes toward people living with HIV (PLWH) cause psychological distress for PLWH and hinder HIV prevention efforts. We estimated the prevalence of stigmatizing attitudes among 6809 adults and 885 adolescents who responded... more
Stigmatizing attitudes toward people living with HIV (PLWH) cause psychological distress for PLWH and hinder HIV prevention efforts. We estimated the prevalence of stigmatizing attitudes among 6809 adults and 885 adolescents who responded to online surveys in 2015. Fear of casual contact with PLWH was reported by 17.5% [95% confidence interval (CI) 16.3-18.6%] of adults and 31.6% (CI 27.8-35.4%) of adolescents. Among adults, 12.5% (CI 11.6-13.5%) endorsed a measure of moral judgment toward PLWH. Stigmatizing attitudes toward PLWH persist in the United States. Continued monitoring of these attitudes and efforts to reduce associated stigma are warranted.
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Identifying patients at-risk for HIV infection, such as men who have sex with men (MSM), is an important step in providing HIV testing and prevention interventions. It is unknown how primary care providers (PCPs) assess MSM status and... more
Identifying patients at-risk for HIV infection, such as men who have sex with men (MSM), is an important step in providing HIV testing and prevention interventions. It is unknown how primary care providers (PCPs) assess MSM status and related HIV-risk factors. We analyzed data from a panel-derived web-based survey for healthcare providers conducted in 2014 to describe how PCPs in the U.S. determined their patients' MSM status. We calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) to describe PCP characteristics associated with systematically determining MSM status (i.e., PCP used "a patient-completed questionnaire" or "routine verbal review of sex history"). Among the 1008 PCPs, 56% determined MSM status by routine verbal review of sexual history; 41% by patient disclosure; 39% by questions driven by symptoms/history; 23% by using a patient-completed questionnaire, and 9% didn't determine MSM status. PCPs who systematically dete...
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Background: The absence of fathers during pregnancy increases the risk of feto-infant morbidities, including low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA). Although previous research has shown that... more
Background: The absence of fathers during pregnancy increases the risk of feto-infant morbidities, including low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA). Although previous research has shown that Central Hillsborough Healthy Start (CHHS) a federally-funded initiative in Tampa, Florida has effectively improved birth outcomes, its effectiveness in ameliorating adverse effects of fathers' absence during pregnancy has not been explored. Methods: This population-based, retrospective cohort study used records from a Federal Healthy Start project (CHHS) linked to vital statistics and hospital discharge data (1998-2007). The study population consisted of women who had a singleton birth with an absent father during pregnancy. Women were categorized based on whether they resided within the CHHS service area. To provide unbiased estimation of treatment-effects, propensity score matching was performed to match cases (CHHS) to controls (rest of Florida). ...
Background: Although prostate cancer rates have improved overall, African Americans experience alarmingly high mortality rates. Community advocates cite pervasive feelings of distrust and fear of the healthcare system, as well as... more
Background: Although prostate cancer rates have improved overall, African Americans experience alarmingly high mortality rates. Community advocates cite pervasive feelings of distrust and fear of the healthcare system, as well as discrimination and racism experienced within it, as critical factors in this disparity. Online media provides an opportunity to circumvent these concerns by providing a technological interface for the delivery of unbiased health information in an accessible manner. The formative evaluative data will be presented during this session. Methods: Individual interviews were conducted with prostate cancer survivors, healthcare providers, and technology experts. The interviews with survivors and providers informed the content of the educational curriculum on prostate cancer for African Americans, whereas technology experts provided information on how the internet can best be used to purvey information. Pretesting and learner verification was performed through addit...
Background: Universities have experienced an increase in non-traditional students, who tend to be older, have children, and be married/divorced. Students who have multiple roles also experience multiple demands that may affect their... more
Background: Universities have experienced an increase in non-traditional students, who tend to be older, have children, and be married/divorced. Students who have multiple roles also experience multiple demands that may affect their wellness and academic achievement. Therefore, understanding this population is important for recruitment and retention. However, minimal research has been conducted. The purpose of this study is to understand the experiences of graduate health student parents in balancing their multiple roles. Methods: This study was based on two theoretical frameworks symbolic interactionism and social support. Twelve semi-structured interviews were conducted with graduate health students who are parents of at least one child seven years old or younger. Results: Participants identified multiple roles (e.g. parent, spouse, student, and role model) and prioritized the parent role. Lack of time, finances, childcare, and school support increased role strain, whereas social ...
Substance use is associated with sexual risk behaviors among youth, but little is known about whether nonmedical prescription drug use, an increasingly common behavior, is associated with sexual risk behaviors. Data from the 2011 and 2013... more
Substance use is associated with sexual risk behaviors among youth, but little is known about whether nonmedical prescription drug use, an increasingly common behavior, is associated with sexual risk behaviors. Data from the 2011 and 2013 national Youth Risk Behavior Surveys, cross-sectional surveys conducted among nationally representative samples of students in grades 9 to 12 were combined (n = 29 008) to examine the association between ever taking prescription drugs without a doctor's prescription and sexual risk behaviors (ever having sexual intercourse, current sexual activity, lifetime number of sexual partners, condom use, and alcohol or drug use before last sexual intercourse). Using logistic regression models (adjusted for sex, race/ethnicity, grade, ever injection drug use, and use of alcohol, marijuana, heroin, cocaine, methamphetamines, ecstasy, and inhalants), we estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Nonmedical use of prescr...
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We estimated the number of women of reproductive age in need who would gain coverage for contraceptive services after implementation of the Affordable Care Act, the extent to which there would remain a need for publicly funded programs... more
We estimated the number of women of reproductive age in need who would gain coverage for contraceptive services after implementation of the Affordable Care Act, the extent to which there would remain a need for publicly funded programs that provide contraceptive services, and how that need would vary on the basis of state Medicaid expansion decisions. We used nationally representative American Community Survey data (2009), to estimate the insurance status for women in Massachusetts and derived the numbers of adult women at or below 250% of the federal poverty level and adolescents in need of confidential services. We extrapolated findings to simulate the impact of the Affordable Care Act nationally and by state, adjusting for current Medicaid expansion and state Medicaid Family Planning Expansion Programs. The number of low-income women at risk for unintended pregnancy is expected to decrease from 5.2 million in 2009 to 2.5 million in 2016, based on states' current Medicaid expa...
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Partnership for Health (PfH) is an evidence-based, clinician-delivered HIV prevention program conducted in the United States for HIV-positive patients. This intervention strives to reduce risky sexual behaviors through provider-patient... more
Partnership for Health (PfH) is an evidence-based, clinician-delivered HIV prevention program conducted in the United States for HIV-positive patients. This intervention strives to reduce risky sexual behaviors through provider-patient discussions on safer sex and HIV status disclosure. A cross-sectional, mixed-methods design was used to evaluate the dissemination and implementation of PfH, including training evaluations, an online trainee survey, and interviews with national trainers for PfH. Descriptive statistics were calculated with the categorical data, whereas thematic analysis was completed with the qualitative data. Between 2007 and 2013, PfH was disseminated to 776 individuals from 104 different organizations in 21 states/territories. The smallest proportion of trainees was physicians (6.9%). More than three-fourths of survey respondents (78.6%) reported using PfH, but less than one-third (31.8%) used the intervention with every patient. The PfH training supports the implem...
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The objective of this study is to evaluate the levels of emergency obstetrics care (EOC) signal functions in health facilities in a developing setting with high maternal morbidity and mortality indices and to determine if there are... more
The objective of this study is to evaluate the levels of emergency obstetrics care (EOC) signal functions in health facilities in a developing setting with high maternal morbidity and mortality indices and to determine if there are differences between public and private health facilities in terms of availability of these signal functions. A survey of health facilities was carried out in six of the 16 Local Government Areas (LGAs) of Kwara State Nigeria. All health facilities in these LGAs including public and private health facilities offering some services to pregnant women were surveyed using an interviewer- administered, facility-assessment questionnaire adapted from the WHO/UNFPA/UNICEF international guidelines for monitoring the availability and use of obstetric services. Frequency tables, percentages and charts were used for presenting the data. Comparing public and private facilities was done using chi-square tests. A total of 258 health facilities that provide maternal healt...
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ABSTRACT Background: Maternal obesity and educational level have been investigated separately for their influence on feto-infant health. Maternal obesity has been associated with increased risk for infant mortality and adverse fetal... more
ABSTRACT Background: Maternal obesity and educational level have been investigated separately for their influence on feto-infant health. Maternal obesity has been associated with increased risk for infant mortality and adverse fetal growth outcomes, whereas higher maternal educational levels result in declining risk. However, the confluence of these factors in relation to stillbirth remains poorly understood. Methods: We utilized data from the Missouri maternally linked cohort data files for 1989-2005 to examine the risk for stillbirth based on obesity status and educational level (less than high school degree vs. high school degree or more). We used odds ratios to approximate relative risks. Results: Women with higher educational levels were more likely to be white, of advanced age (> 35 years), to be obese, and less likely to smoke during pregnancy (p<0.01). They also had higher rates of pregnancy-related complications, including insulin-dependent diabetes, chronic hypertension, pre-eclampsia, and placenta previa (p<0.01). Obese women of advanced education (AOR=1.30; 95% CI 1.19-1.41) and those who did not complete high school (AOR=1.26; 95% CI 1.08-1.47) were equally at elevated risk for stillbirth, as compared to non-obese women with advanced education. Black women with advanced education were twice as likely to experience stillbirth (AOR=1.98; 95% CI 1.80-2018) compared to their white counterparts. Conclusions: Obese women experience higher risk for stillbirth regardless of educational status. Additionally, a black-white disparity was evident. The interplay of multiple demographic and socio-cultural factors should be considered in the determination of the appropriate interconception strategies for women and their families.
ABSTRACT Background: Spouses play a critical role in the quality of life for prostate cancer survivors. Although some studies have found wives of prostate cancer survivors experience a greater amount of psychological distress compared to... more
ABSTRACT Background: Spouses play a critical role in the quality of life for prostate cancer survivors. Although some studies have found wives of prostate cancer survivors experience a greater amount of psychological distress compared to their husbands, minimal research has examined the psychosocial issues encountered by African American couples surviving prostate cancer. To address this gap in the science, this study qualitatively explored the most salient psychosocial dimensions of quality of life among African American prostate cancer survivors and their spouses. Methods: Twelve African American heterosexual couples were recruited from a National Cancer Institute Comprehensive Cancer Center registry and a state-based non-profit organization to participate in individual interviews. The interview guide was structured according to Ferrell's Quality of Life Conceptual Model, which allowed for cultural domain identification. Interview transcripts were analyzed using a combination of hand coding and Atlas.ti software. Results: Common themes emerged regarding the psychosocial needs of African American couples within the behavioral, social, psychological, and spiritual domains. Experiential discordance and concordance were identified between the prostate cancer survivors and their spouses. To manage the cancer experience, multiple behavioral and lifestyle modifications were reported. Social support and spirituality were determined to be essential coping strategies for participants. Conclusions: Cancer survivorship and quality of life are of growing interest and concern as more families are surviving cancer. The study findings will assist in the development and testing of culturally appropriate community education resources and interventions to minimize the impact of the burden of prostate cancer among African Americans.
ABSTRACT Background: Numerous studies have identified placenta accreta as a major cause of maternal morbidity. Furthermore, a major risk factor for placenta accreta is cesarean delivery, which increases the likelihood of adverse birth... more
ABSTRACT Background: Numerous studies have identified placenta accreta as a major cause of maternal morbidity. Furthermore, a major risk factor for placenta accreta is cesarean delivery, which increases the likelihood of adverse birth outcomes. However, the relationship between placenta accreta and feto-infant morbidity remains poorly understood. Methods: Using a retrospective cohort design, we analyzed linked hospital discharge and vital statistics data for the state of Florida (1998-2007) to assess the association between placenta accreta and feto-infant morbidity outcomes (i.e., low birth weight [LBW], very low birth weight [VLBW], preterm birth [PTB], very preterm birth [VPTB], and small for gestational age [SGA]) among mothers with singleton births during the study period (N=1,696,827). Propensity score matching was conducted to match cases (mothers with placenta accreta) to controls (mothers without placenta accreta). Conditional logistic regression was employed to generate odds ratios (OR) for the matched observations. Results: Mothers with placenta accreta were more likely to be white, married women of advanced age (>35 years old) who smoked (p<0.01). However, these differences dissolved after propensity score matching. When the mother experienced placenta accreta, infants had elevated risks for all of the considered fetal morbidity outcomes (LBW: OR=2.02, 95% CI=1.80-2.28; VLBW: OR=3.49, 95% CI=2.70-4.50; PTB: OR=1.75, 95% CI=1.57-1.95; VPTB: OR=3.39, 95% CI=2.66-4.32; SGA: OR=1.42; 95% CI=1.27-1.59). Conclusions: These findings indicate that placenta accreta is strongly associated with a heightened risk for feto-infant morbidities. Further research is warranted to expand knowledge and understanding of the impact of placenta accreta on birth outcomes.
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ABSTRACT Background: Infant mortality is an important indicator of the health and wellness of a society. Despite high expenditures in healthcare delivery, the US still performs poorly on the infant mortality index as compared to other... more
ABSTRACT Background: Infant mortality is an important indicator of the health and wellness of a society. Despite high expenditures in healthcare delivery, the US still performs poorly on the infant mortality index as compared to other industrialized nations. Although multiple risk factors for infant mortality have been identified and investigated, the influence of prior pregnancy experience on subsequent infant mortality is under-researched. In this study, we examine the association between stillbirth in the first pregnancy and the risk for infant mortality in the second pregnancy in a large population sample. Methods: This is a retrospective cohort study that utilized information from the Missouri maternally linked cohort data files from 1989 through 2005. The exposure was stillbirth in the first pregnancy, and the primary outcome was infant mortality in the second pregnancy. We generated adjusted estimates from multi-variable logistic regression models, and used odds ratios to approximate relative risks. Results: Women who experienced stillbirth in their first pregnancy were more likely to be of advanced age, black, and obese with no children (p<0.01). They also had higher rates of pregnancy-related complications, such as insulin-dependent diabetes, chronic hypertension, pre-eclampsia, or eclampsia (p<0.01). A history of stillbirth was associated with subsequent infant mortality (AOR=2.25, 95% CI 1.73-3.84) and neonatal mortality (AOR=3.09, 95% CI 1.96-4.90) after adjustment for the afore-mentioned confounders. Conclusions: Women with a history of stillbirth experience higher risks for subsequent infant mortality. Women's previous childbearing experiences could serve as important criteria in determining appropriate interconception strategies to improve feto-infant health and survival.
ABSTRACT Background: Advanced age and HIV status have been investigated separately for their influence on maternal and infant outcomes. Both have been independently associated with adverse fetal growth outcomes, including low birth weight... more
ABSTRACT Background: Advanced age and HIV status have been investigated separately for their influence on maternal and infant outcomes. Both have been independently associated with adverse fetal growth outcomes, including low birth weight and preterm birth. However, the impact of the co-occurrence of these factors in relation to birth outcomes remains relatively understudied. Methods: We analyzed the Florida hospital discharge linked to vital records for the years 1998-2007. The study population consisted of women of advanced age (>35 years) who had a singleton birth during the study period (N=244,236). The exposure variable was HIV infection status, while the outcomes of interest were low birth weight, very low birth weight, preterm birth, very preterm birth, and small for gestational age. To approximate relative risks, we used multivariable logistic regression to generate adjusted odds ratios (AOR) and 95% confidence intervals (CI). Results: Mothers of advanced age who were HIV-positive were more likely to be black, multiparous, and unmarried with lower levels of education, inadequate prenatal care, and a higher frequency of pregnancy-related complications (p<0.0001). HIV-positive mothers of advanced age had an elevated risk of having infants of low birth weight (AOR=1.51, 95% CI=1.20-1.91) and small for gestational age (AOR=1.43, 95% CI=1.15-1.78). Conclusions: For women of advanced age, HIV-positivity elevates their risk significantly for adverse birth outcomes. The interplay of these multiple biological factors should be considered by healthcare providers when determining appropriate interconception strategies for women and their families.
ABSTRACT Background: Placenta-associated syndromes (PAS) comprise a number of abnormal conditions during pregnancy associated with placental dysfunction, and include pre-eclampsia, eclampsia, gestational hypertension, placental... more
ABSTRACT Background: Placenta-associated syndromes (PAS) comprise a number of abnormal conditions during pregnancy associated with placental dysfunction, and include pre-eclampsia, eclampsia, gestational hypertension, placental infarction, placental abruption, and placenta previa. Although the effects of cocaine on some components of PAS have been examined, the relationship between maternal cocaine abuse and the occurrence of PAS as a single entity has not been previously investigated. Methods: We analyzed all singleton, live births within 20-44 weeks gestation in the state of Florida from 1998-2007 using hospital discharge data linked to birth certificate records. We determined if an association exists between maternal cocaine abuse in pregnancy and PAS using propensity scores matching techniques. Mothers who abused cocaine during pregnancy (n=5,026) were matched to controls (n=5,026) from a sample of 1,693,197 unexposed mothers. Results: Nearly 6% of mothers in the study sample experienced a condition associated with PAS prior to matching. Women who abused cocaine were 58% more likely to have PAS when compared to women who did not (OR=1.58, 95% CI: 1.39, 1.80). Women who abused cocaine were also at elevated odds for placental abruption, placenta previa, preeclampsia, and eclampsia, with the most pronounced odds noted for eclampsia (OR=5.50, 95% CI: 1.22, 24.8). Conclusions: These findings indicate that cocaine abuse during pregnancy is associated with the development of PAS. Further research is warranted to expand knowledge and understanding of PAS. Additionally, adequate screening of women for cocaine abuse during pregnancy is needed to provide support and intervention to improve maternal and infant health outcomes.
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We assessed the impact of Central Hillsborough Healthy Start (CHHS), a federally-funded program dedicated to improving maternal and infant outcomes in a population of high-risk obese mothers in the socio-economically challenged community... more
We assessed the impact of Central Hillsborough Healthy Start (CHHS), a federally-funded program dedicated to improving maternal and infant outcomes in a population of high-risk obese mothers in the socio-economically challenged community of East Tampa in Florida on preterm birth and very preterm birth (VPTB). We utilized hospital discharge records linked to vital statistics data in Florida (2004-2007) to study obese women with a singleton birth, matching mothers in the CHHS catchment area with those from the rest of Florida. We conducted conditional logistic regression with the matched data. Obese mothers in the CHHS service area had a 61 % lower likelihood of having a VPTB infant than obese mothers in the rest of the state (AOR = 0.39, 95 % CI 0.21-0.70). Obese women of reproductive age may benefit from services from federal Healthy Start programs. Study findings underscore the need for further research to explore the impact of such programs.
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To evaluate the relationship between pregnancy weight gain and placental abruption,... more
To evaluate the relationship between pregnancy weight gain and placental abruption, Missouri's population-based, maternally linked, longitudinal dataset (1989-2005, n = 1,146,935) was assessed. Regardless of baseline body mass index, women who gained less than the optimal amount recommended by the Institute of Medicine had a 67% increased likelihood of placental abruption (adjusted odds ratio [AOR] for placental abruption = 1.673; 95%CI = 1.588-1.762) compared with those who gained an optimal amount of weight, while those who gained more than the recommended optimal amount of weight had a 30% reduced AOR for placental abruption (AOR = 0.695, 95%CI = 0.660-0.731). These findings underscore the importance of maternal weight management as part of preconception care to improve pregnancy outcomes.
Research Interests: Pregnancy, Humans, United States, Female, Missouri, and 14 moreIncidence, Body Mass Index, Risk factors, Adult, Odds ratio, Thinness, Body Weight, Risk Factors, Weight Gain, Pregnancy Outcome, Psychology and Cognitive Sciences, Pregnancy complications, Medical and Health Sciences, and Abruptio placentae
The absence of fathers during pregnancy increases the risk of feto-infant morbidities, including low birth weight (LBW), preterm birth (PTB), and small-for-gestational age. Previous research has shown that the Central Hillsborough Healthy... more
The absence of fathers during pregnancy increases the risk of feto-infant morbidities, including low birth weight (LBW), preterm birth (PTB), and small-for-gestational age. Previous research has shown that the Central Hillsborough Healthy Start project (CHHS)-a federally funded initiative in Tampa, Florida-has improved birth outcomes. This study explores the effectiveness of the CHHS project in ameliorating the adverse effects of fathers' absence during pregnancy. This retrospective cohort study used CHHS records linked to vital statistics and hospital discharge data (1998-2007). The study population consisted of women who had a singleton birth with an absent father during pregnancy. Women were categorized based on residence in the CHHS service area. Propensity score matching was used to match cases (CHHS) to controls (rest of Florida). Conditional logistic regression was employed to generate odds ratios (OR) and 95 % confidence intervals (CI) for matched observations. Women residing in the CHHS service area were more likely to be high school graduates, black, younger (<35 years), and to have adequate prenatal care compared to controls (p < 0.01). These differences disappeared after propensity score matching. Mothers with absent fathers in the CHHS service area had a reduced likelihood of LBW (OR 0.76, 95 % CI 0.65-0.89), PTB (OR 0.72, 95 % CI 0.62-0.84), very low birth weight (OR 0.50, 95 % CI 0.35-0.72) and very preterm birth (OR 0.48, 95 % CI 0.34-0.69) compared to their counterparts in the rest of the state. This study demonstrates that a Federal Healthy Start project contributed to a significant reduction in adverse fetal birth outcomes in families with absent fathers.
Research Interests: Program Evaluation, Fathers, Pregnancy, Humans, Female, and 15 moreFlorida, Male, Ethnic Groups, Newborn Infant, Maternal child health, Adult, Maternal Age, Healthy People Programs, Chi Square Distribution, Government Programs, Gestational Age, Prenatal Care, Pregnancy Outcome, Premature Birth, and Medical and Health Sciences
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Research Interests: Sociology and Psychology
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Prior research indicates that infants with absent fathers are vulnerable to unfavorable fetal birth outcomes. HIV is a recognized risk factor for adverse birth outcomes. However, the influence of paternal involvement on fetal morbidity... more
Prior research indicates that infants with absent fathers are vulnerable to unfavorable fetal birth outcomes. HIV is a recognized risk factor for adverse birth outcomes. However, the influence of paternal involvement on fetal morbidity outcomes in women with HIV remains poorly understood. Using linked hospital discharge data and vital statistics records for the state of Florida (1998-2007), the authors assessed the association between paternal involvement and fetal growth outcomes (i.e., low birth weight [LBW], very low birth weight [VLBW], preterm birth [PTB], very preterm birth [VPTB], and small for gestational age [SGA]) among HIV-positive mothers (N=4,719). Propensity score matching was used to match cases (absent fathers) to controls (fathers involved). Conditional logistic regression was employed to generate adjusted odds ratios (OR). Mothers of infants with absent fathers were more likely to be Black, younger (<35 years old), and unmarried with at least a high school education (p<.01). They were also more likely to have a history of drug (p<.01) and alcohol (p=.02) abuse. These differences disappeared after propensity score matching. Infants of HIV-positive mothers with absent paternal involvement during pregnancy had elevated risks for adverse fetal outcomes (LBW: OR=1.30, 95% confidence interval [CI]=1.05-1.60; VLBW: OR=1.72, 95% CI=1.05-2.82; PTB: OR=1.38, 95% CI=1.13-1.69; VPTB: OR=1.81, 95% CI=1.13-2.90). Absence of fathers increases the likelihood of adverse fetal morbidity outcomes in women with HIV infection. These findings underscore the importance of paternal involvement during pregnancy, especially as an important component of programs for prevention of mother-to-child transmission of HIV.
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In this population-based retrospective study, we sought to investigate the association between HIV/AIDS during pregnancy and adverse birth outcomes, including low birth weight (LBW), very low birth weight (VLBW), preterm birth (PTB), very... more
In this population-based retrospective study, we sought to investigate the association between HIV/AIDS during pregnancy and adverse birth outcomes, including low birth weight (LBW), very low birth weight (VLBW), preterm birth (PTB), very preterm birth (VPTB), and small for gestational age (SGA), among women in Florida by sociodemographic variables. Using data from Florida's maternally linked birth cohort files, we examined singleton live births in the state during 1998 to 2007 (N = 1,698,107). The study population was categorized based on the maternal HIV/AIDS status. Poisson regression models were used to generate adjusted rate ratios (ARR) to estimate the association between HIV/AIDS status and fetal growth parameters. The main outcome measures were fetal growth parameters, including LBW, VLBW, PTB, VPTB, and SGA. As compared to HIV/AIDS-negative women, mothers with HIV/AIDS had elevated risks for LBW (ARR = 1.40; 95% CI = 1.30-1.50), VLBW (ARR = 1.25; 95% CI = 1.04-1.51), SGA (ARR = 1.26; 95% CI = 1.17-1.35), PTB (ARR = 1.23; 95% CI = 1.03-1.47), and VPTB (ARR = 1.27; 95% CI = 1.20-1.36). Risk estimates for LBW and SGA were highest among Hispanics mothers with HIV/AIDS, while white mothers with HIV/AIDS had the highest risk levels for VLBW and PTB, compared to their HIV/AIDS negative counterparts. Our findings show that women with HIV/AIDS have elevated risks for inhibited fetal growth and shortened gestation with important racial/ethnic variation. This is the first known population-based study that reveals racial/ethnic differences in HIV/AIDS-related fetal growth morbidity outcomes.
Research Interests:
Research Interests:
Research Interests:
To assess the current state of knowledge regarding sleep disorders and their relationship to obstetric outcomes. A systematic literature review of the previous two decades (1991 to 2010) was conducted. The exposure was sleep disorders... more
To assess the current state of knowledge regarding sleep disorders and their relationship to obstetric outcomes. A systematic literature review of the previous two decades (1991 to 2010) was conducted. The exposure was sleep disorders during pregnancy, and the outcomes of interest were feto-infant morbidity and maternal complications. Sleep apnea, snoring, and sleep quantity/duration were identified as the most frequently examined sleep disorders among pregnant women. Although our review found that studies examining the impact of sleep disorders on feto-infant outcomes were lacking, previous research indicates that such disorders may enhance the risk of preterm birth. Additionally, the current body of evidence suggests that sleep disorders adversely impact maternal health, increasing the likelihood of preeclampsia, and gestational diabetes. Existing research points to the potentially harmful effects of sleep disorders on obstetric outcomes. The limited research in this arena highlights the need for further studies regarding the nature and strength of this relationship. Given the multiple dimensions of sleep and pregnancy, multivariate research approaches that incorporate biological and psychosocial factors are warranted.
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Research Interests:
In Tampa, Florida, researchers have partnered with community- and faith-based organizations to create the Comparative Effectiveness Research for Eliminating Disparities (CERED) infrastructure. Grounded in community-based participatory... more
In Tampa, Florida, researchers have partnered with community- and faith-based organizations to create the Comparative Effectiveness Research for Eliminating Disparities (CERED) infrastructure. Grounded in community-based participatory research, CERED acts on multiple levels of society to enhance informed decision making (IDM) of prostate cancer screening among Black men. CERED investigators combined both comparative effectiveness research and community-based participatory research to design a trial examining the effectiveness of community health workers and a digitally enhanced patient decision aid to support IDM in community settings as compared with "usual care" for prostate cancer screening. In addition, CERED researchers synthesized evidence through the development of systematic literature reviews analyzing the effectiveness of community health workers in changing knowledge, attitudes and behaviors of African American adults toward cancer prevention and education. An additional systematic review analyzed chemoprevention agents for prostate cancer as an emerging technique. Both of these reviews, and the comparative effectiveness trial supporting the IDM process, add to CERED's goal of providing evidence to eliminate cancer health disparities.
Research Interests: Decision Making, Health Education, Community Based Participatory Research, Community Health Workers, Humans, and 10 moreFlorida, Male, Interpersonal Relations, African Americans, Aged, Middle Aged, Adult, Public health systems and services research, Curriculum and Pedagogy, and Comparative Effectiveness Research
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Abstract Research investigating the role of paternal age in adverse birth outcomes is limited. This population-based retrospective cohort study used the Missouri maternally linked data set from 1989 to 2005 to assess whether paternal age... more
Abstract Research investigating the role of paternal age in adverse birth outcomes is limited. This population-based retrospective cohort study used the Missouri maternally linked data set from 1989 to 2005 to assess whether paternal age affects fetal birth outcomes: low birth weight (LBW), preterm birth (PTB), stillbirth, and small size for gestational age (SGA).