Abstract Identifying Data Needs to Support the Public Health Program of First Care Background: First Care (FC) is a Georgia (GA) public health (PH) program funded by Title V Block Grant, whose main purpose is to provide collaborative skilled PH services for infants with LBW and VLBW (low and very low birth weight) as well as those considered at high risk for illness and disabilities. Purpose: 1. Describe current health outcomes of GA infants less than one years of age. * Current baselines of IMR (infant mortality rate), preterm, very low birth weight (VLBW) and low birth weight (LBW) births 2. Use data to inform FC program in order to improve overall health outcomes in LBW, VLBW and preterm infants less than 1 years of age in GA as well as IMR. * Identifying common diagnoses and reasons for the hospitalization of infants less than one. Methods: Several online secondary data sources containing GA birth outcomes were evaluated. These sources were used to produce most current or 2008, GA and national profiles on health outcomes such as IMR, preterm, LBW and VLBW births. SAS was used to evaluate OHIP (Office of Health Information and Policy) hospital discharges in 2008 to determine common diagnosis affecting GA children under 1 years of age. Results: National comparisons of health outcomes revealed that GA consistently ranks below the national average for IMR, preterm, VLBW, and LBW births. GA’s poor health outcomes are also seen when compared to Healthy People 2010 objectives. A comparison of GA public health districts (PHD) health outcomes demonstrates lagging indicators mainly in the southern and midsection (central section) of GA. This study also revealed racial disparities indicating Blacks falling behind in all health outcomes when compared to Whites and Hispanics. Statistical analysis of hospital discharges showed that the top 25 discharges reflect common conditions that affect high-risk infants such as preterm, VLBW and LBW infants. Higher rates of morbidity were found in the southern and central PHDs of GA. Conclusion: The purpose for FC is to provide current data baselines on health outcomes of GA infants less than one year of age, as well as information regarding current hospitalizations. Current results are only preliminary findings underscoring the need for continued research. By emphasizing their need for monitoring will allow FC to focus on this critical role that will only grow with an expanding population in GA.

Physical activity guidelines encouraging activity among healthy pregnant women have been issued by the Centers for Disease Control and Prevention, yet Latina women remain more sedentary than non-Latina white women. Latina women are also at higher risk for gestational diabetes mellitus and, among Latina women, Puerto Rican women have the highest rates of low birth weight and preterm-related infant death. This dissertation utilized data from the Latina GDM study, a prospective cohort study of 1,231 Latina women recruited early in pregnancy and followed through delivery. Participants were interviewed in early and mid pregnancy for assessment of sociodemographics, acculturation, medical, and behavioral factors, in addition to administration of the Kaiser Physical Activity Survey for assessment of physical activity and sedentary behaviors. Birth outcomes were abstracted from medical records following delivery. In the first chapter, we assessed the prevalence of three health behaviors (meeting physical activity guidelines, meeting fruit/vegetable consumption guidelines, and cigarette smoking) in early and mid pregnancy and identified multiple factors associated with meeting health behavior guidelines in pregnancy. In the second chapter, we examined participation in sedentary behaviors, such as time spent TV watching, sitting at work, and low levels of sports and exercise, in pre, early and mid pregnancy in relation to maternal glucose intolerance and gestational diabetes mellitus. In the final chapter, we analyzed four types of physical activity (sports/exercise, household/caregiving, occupational, and active transportation) as well as total activity in relation to risk of preterm birth and small-for-gestational age. Findings represent the first study of physical activity and maternal/fetal outcomes conducted exclusively among Latina women, a group largely understudied in epidemiologic research. Results will guide culturally specific intervention programs in this high risk population.

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Poor birth outcomes are associated with illicit drug use during pregnancy. While prenatal cigarette exposure has similar effects, cessation of illicit drug use during pregnancy is often prioritized over cessation of smoking. The study goal was to examine the impact of pregnancy tobacco use, relative to use of illicit drugs, on birth outcomes. Women were recruited at entry to prenatal care, with background and substance use information collected during pregnancy. Urine drug screens were performed during pregnancy, and the final sample (n = 265) was restricted to infants who also had biologic drug testing at delivery. Participants were classified by pregnancy drug use: no drugs/no cigarettes, no drugs/cigarette use, illicit drugs/no cigarettes, and illicit drugs/cigarette use. Groups differed significantly on infant birthweight, but not gestational age at delivery after control for confounders including background and medical factors. Among women who smoked, the adjusted mean birthweight gain was 163 g for those not using hard illicit drugs, while marijuana use had no effect on birth weight beyond the effect of smoking cigarettes. Women who used hard illicit drugs and did not smoke had an adjusted mean birthweight gain of 317 g over smokers. Finally, women who refrained from hard illicit drugs and smoking had a birthweight gain of 352 g. Among substance using pregnant women, smoking cessation may have a greater impact on birthweight than eliminating illicit drug use. Intervention efforts should stress that smoking cessation is at least as important to improving pregnancy outcomes as abstaining from illicit drug use.

No description available.

Health studies often rely on aggregated instead of individual-level data to protect patient privacy. However, aggregated data are subject to the modifiable areal unit problem (MAUP), meaning results of statistical analyses may differ depending on the data's scale and areal unit. Past studies have suggested MAUP is context-specific and analyzing multiple spatial scales may provide richer understandings of examined phenomena. More research is needed to understand the role of scale and areal unit in health-related analyses. This study examines associations between surface mining and birth outcomes from 1989 to 2015 in Central Appalachia at the individual; postal; county; and county-sized, non-administrative scales. Evidence from previous studies suggests associations exist between health outcomes and county-level measures of mining activity. This is the first study to examine associations between mining and birth outcomes at more spatially refined exposure estimates. We identified surface mines using Landsat imagery and geocoded birth records. Airsheds, used to quantify the influence area of potential airborne pollutants from surface mining activity, were built using HYSPLIT4. The frequency values of each airshed that intersected each geocoded birth record were summed. These cumulative frequency airshed values were then aggregated. Finally, we implemented multiple regression models, each at a different scale, to examine associations between airsheds and birth outcomes. Results suggest MAUP has minimal impacts on the statistical results of examining associations between surface mining and birth outcomes in Central Appalachia. Results also indicate surface mining is significantly associated with preterm birth and reduced birthweight at each scale. / Master of Science / Health studies often rely on data that has been grouped together within political boundaries (e.g. counties) instead of individual-level data to protect patient privacy. However, results from analyses using grouped data may differ depending on the data's scale and areal unit, which describes the modifiable areal unit problem (MAUP). Past studies have suggested MAUP is specific to the situation being analyzed and examining multiple scales may provide richer understandings of the situation. More research is needed to understand the role of scale and areal unit choice in health-related analyses. This study examines associations between surface mining and birth outcomes from 1989 to 2015 in Central Appalachia at the individual; postal; county; and county-sized, non-administrative scales. Evidence from previous studies suggests associations exist between health outcomes and county-level measures of mining activity. This is the first study to examine associations between mining and birth outcomes at finer scales. Surface mines were identified using satellite images, and we identified the locations of birth records using the mother's home address. Airsheds, used to determine the influence area of airborne pollutants from surface mining activity, were created. We then used statistical models, to examine associations between airsheds and birth outcomes at four spatial scales. Results suggest MAUP has minimal impacts on the statistical results of examining associations between surface mining and birth outcomes in Central Appalachia. Results also indicate surface mining is significantly associated with preterm birth and decreased birthweight in grams at each scale.

Objective: The Affordable Care Act (ACA) has influenced increasing interests in population health and population health outcomes. The purpose of this study was to exemplify the importance of using existing vital statistics data for understanding and monitoring health outcomes and consequentially health disparities at the population level. Data from birth records for two geographic regions from 2009-2014 were compared; low birth weight (LBW) and preterm delivery (PD) were used as surrogates for population health outcomes. Methods: A population-based, multi-year, cross-sectional study design using a pooled dataset of birth records from Tennessee (TN) was the framework for the analyses. A sub-population from North East TN (NE TN) was compared to TN. Logistic regression was used to estimate odds ratios. Attributable risks were calculated to translate the findings from conditional associations to population-level associations to help inform public health policy decision-making. Results: Using birth records (vital statistics), we demonstrated that the period prevalence of cigarette smoking before and during pregnancy remained unchanged with approximately one in three women in NE TN (from 37% in 2009 to 32% in 2014) and one in five women in TN (from 23% in 2009 to 20% in 2014) reporting smoking pre-pregnancy. Multivariate analyses demonstrated that mothers who were at each end of the age spectrum, of very low household income level and reported cigarette smoking pre-pregnancy or during pregnancy had increased risk of a LBW or PD infant. During the years of observation, 39 to 50% of the total incidence of LBW in the group of women who smoked cigarettes prior to pregnancy was attributable to smoking cigarettes. Conclusions: Existing data, such as vital statistics data, should be used routinely to identify geographic areas for which programs or policies can be implemented to reach large portions of populations. Reducing prenatal smoking, for example, has the potential to reduce a large fraction of adverse birth outcomes such as LBW and PD. For the geographic area we evaluated, 39 to 50% of LBW could be prevented by devising population-based smoking cessation programs or policies for women of child-bearing age. With recent emphasis on prevention and well-baby care in the ACA, there is potential to increase attention to this problem, implement evidence-based prevention programs and monitor program effectiveness with existing birth record data. Following this model, we can attain population health goals and address health disparities.

Social supports are linked in public health research to improved birth outcomes. This study explored the relationship of social supports, stress and birth outcomes among pregnant Latinas in Pinellas County, Florida. A sample of 411 Healthy Start women at risk of poor birth outcomes participated in this study (99 Latinas, 142 Black, and 158 White). Study methods included ANOVA, Principal Component Analysis, multivariable regression, logistic regression, and structural equation modeling to identify significant associations between social support scores, stress scores, demographics and health risk factors with infant birth weight, preterm and small for gestational age by ethnic group. Study findings indicated there was a direct association between social support and stress across all ethnic groups. However, many confounding variables did not have an effect in the study sample. Latina study participants exhibited significantly lower mean social support scores compared to White and Black participants (p=0.000). Latinas also presented higher stress scores that were significantly different from White and Black participants (p=0.000). The study also found ethnic differences in stress level perceptions using the Perceived Stress Scale. Recommendations for public health included conducting additional studies to assess if the study variables have an impact on a different population, exploring different ethnic interpretations of stress, using repeated measures to assess stress in high risk populations and considering using alternate stress measures such as biological markers and stress life event scales to assess social support, stress and birth outcomes.