Project DCHOPE of The NIHDC Initiative to Reduce Infant Mortality in Minority Populations

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Project DC-HOPE of The 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_at_gwumc.edu [phone]

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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

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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)

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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

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Project DC-HOPE

• Screening Methods
• Audio-Computer Assisted Self Interviewing
• - Mothers were screened for smoking, depression,
  ETSE and IPV

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Behavior/psychosocial Characteristics (N1044)
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.
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Study Group at Screening (N1044)
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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.

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Logistic Regression for at Least One Risk
Resolution
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• Does the Intervention Affect Medical Outcomes?

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Pregnancy Outcomes (Smoking)