Project DC-HOPE of The NIH-DC Initiative to Reduce Infant Mortality in Minority Populations

1. Project DC-HOPEofThe NIH-DC Initiative to Reduce Infant Mortality in Minority Populations Ayman El-Mohandes, MBBCh, MD, MPH Professor and Chairman Department of Prevention and Community Health sphaxe@gwumc.edu (202) 416-0415

2. Background • Elevated infant mortality in African American 13.6 (AA) versus 3/1000 (C) live births in DC 2003 • Medical risks not fully explanatory • Behavioral/psychosocial factors may affect pregnancy outcomes • Little intervention research to date

3. Study Objective To evaluate the efficacy of an integrated counseling/intervention on selected behavioral/psychosocial risks in pregnancy and the postpartum (PP) period. • Smoking • Passive smoking (ETS exposure) • Depression • Intimate partner violence (IPV)

4. Population • Eligible Participants • African-American at least 18 years of age • receiving PNC at one of the 6 participating clinics between 7/9/2001 and 10/31/2003 • Enrolled by 28 weeks gestation • English speaking

5. Project DC-HOPE: Screening Methods • Audio-Computer Assisted Self Interviewing - Mothers were screened for smoking, depression, ETSE and IPV

6. Depression 36% n=59 n=116 n=86 n=297 n=270 n=64 n=32 n=16 n=50 n=44 n=10 IPV 21% Behavior/psychosocial Characteristics (N=1044) Passive Smoking 44%* Active Smoking 48%* * 412 women with both active and passive smoking in the active smoking group. 88 women with active but not passive smoking.

7. Study Group at Screening (N=1044)

8. Conclusions • Psycho-behavioral integrated interventions during pregnancy are effective in modifying risk during pregnancy and in the post-partum period. • Modifying effects are important and unique to various risks and should be addressed in order to maximize benefit.

9. Logistic Regression for at Least One Risk Resolution

10. Does the Intervention Affect Medical Outcomes?

11. Pregnancy Outcomes (Smoking)