Neighborhood Racialized Economic Polarization, Home Visiting Coverage, and Adverse Birth Outcomes in a Medicaid-eligible Population.

Background: Residential polarization shaped by racial segregation and concentrations of wealth (hereafter neighborhood racialized economic polarization) results in both highly deprived and highly privileged neighborhoods. Numerous studies have found a negative relationship between neighborhood racialized economic polarization and birth outcomes. We investigated whether community-informed home visiting programs achieve high rates of service coverage in highly deprived neighborhoods and can attenuate the deleterious effect of neighborhood polarization on birth outcomes.

Severe Maternal Morbidity Disparities Before and During the COVID Pandemic in a Medicaid Population.

Unlabelled: This study assessed racial and ethnic disparities in severe maternal mortality during delivery through 6 weeks postpartum, before and during the COVID pandemic, in a statewide Medicaid population. This retrospective, population-based, cohort study used Medicaid claims data linked to birth certificates from the Michigan Department of Health and Human Services Health Services Data Warehouse that included all individuals giving birth between January 1, 2017, and October 31, 2021, in Michigan who had Medicaid insurance during the month of childbirth. The SMM rate increased more during the COVID pandemic for Black (1.

Community Health Workers: Improving Home Visiting Engagement of High-Risk Birthing People in Segregated Neighborhoods.

Context: Racial and ethnic disparities in perinatal health remain a public health crisis. Despite improved outcomes from home visiting (HV) participation during pregnancy, most eligible individuals of color do not engage. Neighborhood segregation, a manifestation of structural racism, may impose constraints on engaging eligible individuals in HV.

Neighborhood Deprivation and Severe Maternal Morbidity in a Medicaid Population.

Introduction: Few studies have examined whether neighborhood deprivation is associated with severe maternal morbidity (SMM) in already socioeconomically disadvantaged populations. Little is known about to what extent neighborhood deprivation accounts for Black-White disparities in SMM. This study investigated these questions among a statewide Medicaid-insured population, a low-income population with heightened risk of SMM.

Community Health Worker Home Visiting, Birth Outcomes, Maternal Care, and Disparities Among Birthing Individuals With Medicaid Insurance.

Importance: Home visiting is recommended to address maternal and infant health disparities but is underused with mixed impacts on birth outcomes. Community health workers, working with nurses and social workers in a combined model, may be a strategy to reach high-risk individuals, improve care and outcomes, and address inequities.

Objective: To assess the association of participation in a home visiting program provided by community health workers working with nurses and social workers (Strong Beginnings) with adverse birth outcomes and maternal care vs usual care among birthing individuals with Medicaid.

Breaking Barriers to Rapid Whole Genome Sequencing in Pediatrics: Michigan's Project Baby Deer.

The integration of precision medicine in the care of hospitalized children is ever evolving. However, access to new genomic diagnostics such as rapid whole genome sequencing (rWGS) is hindered by barriers in implementation. Michigan's Project Baby Deer (PBD) is a multi-center collaborative effort that sought to break down barriers to access by offering rWGS to critically ill neonatal and pediatric inpatients in Michigan.

Study protocol: The Maternal Health Multilevel Intervention for Racial Equity (Maternal Health MIRACLE) Project.

Purpose: To test the effectiveness and cost-effectiveness of a multilevel intervention for population-level African American (AA) severe maternal morbidity and mortality.

Background: Severe maternal morbidity and mortality in the U.S.

The Impact of a Population-Based System of Care Intervention on Enhanced Prenatal Care and Service Utilization Among Medicaid-Insured Pregnant Women.

Introduction: Enhanced prenatal/postnatal care home visiting programs for Medicaid-insured women have significant positive impacts on care and health outcomes. However, enhanced prenatal care participation rates are typically low, enrolling <30% of eligible women. This study investigates the impacts of a population-based systems approach on timely enhanced prenatal care participation and other healthcare utilization.

An NIH investment in health equity - the economic impact of the Flint Center for Health Equity Solutions.

Background: Health disparities are pervasive and are linked to economic losses in the United States of up to $135 billion per year. The Flint Center for Health Equity Solutions (FCHES) is a Transdisciplinary Collaborative Center for health disparities research funded by the National Institute of Minority Health and Health Disparities (NIMHD). The purpose of this study was to estimate the economic impact of the 5-year investment in FCHES in Genesee County, Michigan.

Determining County-Level Counterfactuals for Evaluation of Population Health Interventions: A Novel Application of -Means Cluster Analysis.

Objectives: Evaluating population health initiatives at the community level necessitates valid counterfactual communities, which includes having similar population composition, health care access, and health determinants. Estimating appropriate county counterfactuals is challenging in states with large intercounty variation. We describe an application of -means cluster analysis for determining county-level counterfactuals in an evaluation of an intervention, a county perinatal system of care for Medicaid-insured pregnant women.

Clinical-Community Linkages: The Impact of Standard Care Processes that Engage Medicaid-Eligible Pregnant Women in Home Visiting.

Background: To better address physical, emotional, and social needs of Medicaid-insured pregnant women, a Federally Qualified Health Center and a hospital-based obstetrics and gynecology residency practice collaborated with their agency-based state Medicaid-sponsored home visiting program, the Maternal Infant Health Program (MIHP). In partnership, both practice sites created patient standards of care to identify and engage eligible pregnant women into underutilized home visiting services for enhanced prenatal care coordination. The purpose of this study was to describe how each practice operationalized clinical-community linkage strategies that best suited their setting and to determine if efforts resulted in improved MIHP participation and other service use.

Is a school's neighborhood physical disorder related to its academic outcomes?

Background: Neighborhood environment for student residences has been linked to differences in academic outcomes. However, school neighborhood has not been studied as a potential additional environmental factor in academic outcomes.

Objective: The goal of this study was to explore the association between school neighborhood disorder and academic outcomes.

Perceived safety of smoking a few cigarettes during pregnancy and provider advice in a sample of pregnant smokers from Romania.

Aims: To assess the prevalence of the perceived safety of smoking a few (generally fewer than five per day) cigarettes during pregnancy and identify associated factors in a sample of pregnant smokers in Romania, a middle-income country.

Design And Setting: Cross-sectional design with a convenience sample using a polled data set collected between 2016 and 2019 in the formative and baseline phases of the Quit Together randomized control trial (RCT) in Romania. Data were collected using a structured questionnaire administered by research assistants in clinics in the formative phase and self-administered through the study website at the RCT baseline.

Tobacco cigarette and cannabis use among new mothers.

Background And Aims: In the United States, the prevalence of cannabis use during pregnancy has increased whereas tobacco smoking has decreased. This study aimed to estimate the prevalence of tobacco cigarette smoking and cannabis use among new mothers, stratified by breastfeeding status. Additionally, trend analysis was used to examine changes in tobacco and cannabis use over time.

Using Behavioral Nudges to Engage Pregnant Women in a Smoking Cessation Trial: An Online Field Quasi-Experiment.

Evidence shows that behavioral nudges could be used to enhance enrollment rates in randomized controlled trials (RCTs) by addressing enrollment barriers, but research on this topic is limited. We conducted an online field quasi-experiment with separate pretest (October 2017-January 2018) and posttest (February-May 2018) samples designed to examine the use of behavioral nudges to engage pregnant smokers in a couple-focused smoking cessation RCT relying on online enrollment through paid Facebook ads and a dedicated website, by reporting aggregate Facebook ads and Google Analytics data. The Facebook ads pretest conversion rate of 1.

An mHealth intervention to prevent postnatal smoking relapse: The RESPREMO study protocol.

Up to 70% of women who quit smoking relapse after birth, usually within 3 months postpartum. The wide adoption of mobile technologies, especially smartphones, in recent years in low- and middle-income countries (LMICs) offers the possibility of low-cost, novel, and innovative mobile phone-based interventions for smoking relapse prevention. This study presents the protocol of the RESPREMO clinical trial for postnatal smoking relapse prevention for enrolled women, who recently gave birth and quit tobacco smoking before or during pregnancy, and their life partners.

A Cross-Section Study of Relationship Characteristics and Smoking Cessation During Pregnancy in a Sample of Romanian Pregnant Women.

Introduction: Partner support and relationship characteristics may be important factors in effective couple-based pregnancy smoking cessation programs. Research is needed to investigate the links between couple relationship characteristics and maternal smoking cessation to inform the development of such interventions.

Methods: This paper relies on cross-section data collected during the formative phase in the development of an ongoing couple-focused pregnancy tobacco cessation trial.

Evidence-Based Practices to Promote Tobacco Cessation During Pregnancy in a Sample of Romanian General Practitioners.

Changes in confidence in implementing smoking cessation support for pregnant women was assessed among Romanian General Practitioners (GPs) before and after a training program of evidence-based clinical practices to promote quitting. The total number of physicians participating in the study was 69. Before training, 51% of GPs felt somewhat/very confident asking pregnant women about tobacco use, 39% assisted smokers with a quit plan, 38% arranged follow-up for patients.

A couples-focused intervention for smoking cessation during pregnancy: The study protocol of the Quit Together pilot randomized controlled trial.

Tobacco smoking remains the leading global cause of preventable disease and death. Preconception and pregnancy smoking are high in Central and Eastern Europe. Quit Together is a partnership between a US university and a Romanian university, obstetrics and gynecology clinics in Romania, and other community partners in Romania.

Smoking and quitting smoking during pregnancy: A qualitative exploration of the socio-cultural context for the development of a couple-based smoking cessation intervention in Romania.

Introduction: Smoking during pregnancy has negative effects on the mother and the unborn infant. Barriers to and facilitators of smoking cessation during pregnancy are context-dependent and multifaceted. This qualitative research explored pregnant women's experiences with smoking and cessation in Romania, and informed the development of a couple-focused smoking cessation intervention.

Home- and Car-Based Rules in Foster Care Settings to Reduce Exposure to Secondhand Smoke: Before and after Romanian National Clean Air Legislation.

: To evaluate changes in smoke free rules in the foster care system after the implementation of the Romanian national clean air law. : A repeated cross-sectional, self-administered questionnaire among foster care employees ( = 599) was conducted in 58 foster care homes during 2014 ( = 295) and 51 homes during 2016 ( = 304). We estimated the absolute difference in the proportion of employees who stated that smoke free rules existed before and after national clean air legislation.