Establishing the infrastructure to conduct comparative effectiveness research toward the elimination of disparities: a community-based participatory research framework

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.

The association between HIV/AIDS during pregnancy and fetal growth parameters in Florida: a population based study

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.

The association between female genital mutilation and intimate partner violence

OBJECTIVE

To determine whether female genital mutilation (FGM) is a risk factor for intimate partner violence (IPV) and its subtypes (physical, sexual and emotional).

DESIGN

Population-based cross-sectional study.

SETTING

The study used the 2006 Demographic and Health Survey (DHS) conducted in Mali.

POPULATION

A total of 7875 women aged 15-49 years who responded to the domestic violence and female circumcision modules in the 2006 administration of the DHS in Mali.

METHODS

Multivariable logistic regression was used to compute adjusted odds ratios (aOR) and 95% confidence intervals (CI) to measure risk for IPV.

MAIN OUTCOME MEASURES

The outcomes of interest were IPV and its subtypes.

RESULTS

Women with FGM were at heightened odds of IPV (aOR 2.71, 95% CI 2.17-3.38) and IPV subtypes: physical (aOR 2.85, 95% CI 2.22-3.66), sexual (aOR 3.24, 95% CI 1.80-5.82), and emotional (aOR 2.28, 95% CI 1.68-3.11). The odds of IPV increased with ascending FGM severity (P for trend <0.0001). The most elevated odds were observed among women with severe FGM, who were nearly nine times as likely to experience more than one IPV subtype (aOR 8.81, 95% CI 5.87-13.24).

CONCLUSIONS

Study findings underscore the need for multi-tiered strategies, incorporating policy and education, to reduce FGM and IPV, potentially improving the holistic health and wellbeing of Malian women.

Does maternal obesity cause preeclampsia? A systematic review of the evidence

AIM

The aim of this paper was to assess whether maternal obesity causes preeclampsia.

METHODS

A systematic literature review of the previous two decades (1992-2011) was conducted. The exposure was maternal obesity while the outcome of interest was preeclampsia.

RESULTS

Our review revealed consistent findings showing strong association between obesity and preeclampsia. Multiple biomarkers that potentially explain the mechanistic pathway in this relationship were identified, including leptin and adiponectin, matrix metalloproteinase (MMP), C-reactive protein (CRP), and sex hormone-binding globulin (SHBG). A causative biologic linkage remains, however, elusive.

CONCLUSION

Epidemiologic evidence exists linking maternal obesity and preeclampsia. However, the exact causal pathway remains poorly defined. Given the minimal understanding of the nature of this relationship, research studies that utilize prospective designs and expand on the previous examination of biomarkers are recommended to determine potential causative pathways.

Understanding the psychosocial issues of African American couples surviving prostate cancer

African Americans are disproportionately affected by prostate cancer, yet less is known about the most salient psychosocial dimensions of quality of life. The purpose of this study was to explore the perceptions of African American prostate cancer survivors and their spouses of psychosocial issues related to quality of life. Twelve African American 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 study was theoretically based on Ferrell's Quality of Life Conceptual Model. Common themes emerged regarding the psychosocial needs of African American couples. These themes were categorized into behavioral, social, psychological, and spiritual domains. Divergent perspectives were identified between male prostate cancer survivors and their female spouses. This study delineated unmet needs and areas for future in-depth investigations into psychosocial issues. The differing perspectives between patients and their spouses highlight the need for couple-centered interventions.

The effect of paternal age on fetal birth outcomes

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). We examined these outcomes among infants across seven paternal age-groups (<20, 20-24, 25-29, 30-34, 35-39, 40-45, and >45 years) using the generalized estimating equation framework. Compared with infants born to younger fathers (25-29 years), infants born to fathers aged 40 to 45 years had a 24% increased risk of stillbirth but a reduced risk of SGA. A 48% increased risk of late stillbirth was observed in infants born to advanced paternal age (>45 years). Moreover, advanced paternal age (>45 years) was observed to result in a 19%, 13%, and 29% greater risk for LBW, PTB, and VPTB (very preterm birth) infants, respectively. Infants born to fathers aged 30 to 39 years had a lower risk of LBW, PTB, and SGA, whereas those born to fathers aged 24 years or younger had an elevated likelihood of experiencing these same adverse outcomes. These findings demonstrate that paternal age influences birth outcomes and warrants further investigation.

The impact of birth spacing on subsequent feto-infant outcomes among community enrollees of a federal healthy start project

Numerous studies have shown an association between shorter birth intervals, and several adverse fetal outcomes, including low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA). However, there is little evidence on the effectiveness of interconception care on fetal outcomes associated with sub-optimal interpregnancy interval (IPI). The purpose of this study is to examine the influence of the Federal Healthy Start's interconception care services on IPI and fetal growth outcomes. This is a retrospective cohort study used records from the Central Hillsborough Healthy Start program in Tampa, Florida linked to Florida vital statistics data covering the period 2002-2009. Only first and second pregnancies were considered, and interpregnancy interval (IPI), the exposure of interest, was categorized in months as 0-5, 6-17, 18-23, and ≥24. The following feto-infant morbidities were considered as primary outcomes: LBW, PTB, and SGA. A composite variable coding the presence of any of the aforementioned adverse fetal events was also created. Multivariate logistic regression modeling was applied Overall, mothers with the shortest IPI (0-5 months: AOR = 1.39, 95% CI 1.23-1.56) and longest IPI (≥60 months: AOR = 1.13, 95% CI 1.03-1.23) were at a greater risk for adverse fetal growth outcomes, compared to the referent category (18-23 months). Our findings support the need for inter conception care that addresses IPI and delayed childbearing among women.

Important considerations for recruiting women to cancer genetics studies in Puerto Rico

A goal of the Minority Institution/Cancer Center Partnership between the Ponce School of Medicine in Puerto Rico and the H. Lee Moffitt Cancer Center & Research Institute in Florida is to provide cross-cultural training in cancer research. This is achieved through a collaborative summer exchange program, which provides US students with an opportunity to conduct research in Puerto Rico. As part of this program, students recruited participants and collected data for a study to enhance the understanding of sociocultural factors among Puerto Rican women regarding genetic testing for hereditary breast/ovarian cancer. Limited studies have examined cancer genetics issues among Latinos, particularly those specific to the various Latino subgroups, such as Puerto Ricans. As a result of the student training experience, culturally appropriate strategies for the recruitment of women in Puerto Rico have been identified. These recommendations can inform the design of cancer research projects and interventions targeting the Puerto Rican population.

Prevalence and temporal trends of hepatitis B, hepatitis C, and HIV/AIDS co-infection during pregnancy across the decade, 1998-2007

BACKGROUND

Limited data are available on hepatitis rates during pregnancy by socio-demographic characteristics. This study examined temporal trends in hepatitis B virus (HBV) and hepatitis C virus (HCV) mono-infections and HIV/HBV and HIV/HCV co-infections in subpopulations among pregnant women in Florida between 1998 and 2007.

METHODS

We analyzed all Florida live births from 1998 to 2007 using hospital discharge data linked to birth records.

RESULTS

The total sample size was 1,700,734 singleton live births. The prevalance of HBV in pregnancy rose from 65.4 per 100,000 births to 123.5 per 100,000 births (p<0.0001 for trend), and the prevalence of HCV in pregnancy increased from 17.0 per 100,000 births to 125.1 per 100,000 births (p<0.0001 for trend). Compared with white mothers, black mothers were more than twice as likely to have HBV in pregnancy (adjusted rate ratios [ARR]=2.24; 95% CI=1.97-2.53). Black mothers were 69% (ARR=0.31, 95% CI=0.25-0.39) and Hispanic mothers were 51% (ARR=0.49, 95% CI=0.41-0.60) less likely to have HCV compared with white mothers.

CONCLUSIONS

Although the overall prevalence rate of HBV increased over the past decade, black women still had a noticeably higher rate of infection. Similarly, white women and those with HIV co-infection had noticeably higher rates of HCV infection over the study period. Our findings call for improved and increased HBV/HCV prevention, screening, and immunization programs among minority women of childbearing age.

Maternal hepatitis B and hepatitis C carrier status and perinatal outcomes

BACKGROUND AND AIMS

To examine the association between maternal hepatitis B and C mono- and co-infections with singleton pregnancy outcomes in the state of Florida.

METHODS

We analysed all Florida births from 1998 to 2007 using birth certificate records linked to hospital discharge data. The main outcomes of interest were selected pregnancy outcomes including preterm birth, low birth weight (LBW), small for gestational age (SGA), fetal distress, neonatal jaundice and congenital anomaly.

RESULTS

The study sample consisted of 1,670,369 records. Human immunodeficiency virus co-infection and all forms of substance abuse were more frequent in mothers with hepatitis B and C infection. After using multivariable modelling to adjust for important socio-demographical variables and obstetric complications, women with hepatitis C infection were more likely to have infants born preterm [odds ratio (OR), 1.40; 95% confidence intervals (CI), 1.15-1.72], with LBW (OR, 1.39; 95% CI, 1.11-1.74) and congenital anomaly (OR, 1.55; 95% CI, 1.14-2.11). In addition, women with hepatitis B infection were less likely to have infants born SGA (OR, 0.79; 95% CI, 0.66-0.95).

CONCLUSIONS

Our findings provide further understanding of the association between maternal hepatitis B or C carrier status and perinatal outcomes. Infants born to women with hepatitis C infection appear to be at risk for poor birth outcomes, including preterm birth, LBW and congenital anomaly.

Stillbirth as a risk factor for subsequent infant mortality

BACKGROUND

Infant mortality is an important indicator of the health and wellness of a society. Multiple risk factors for infant mortality have been identified and investigated; however, the influence of prior pregnancy experience on subsequent infant mortality is under-researched.

AIMS

To examine the association between stillbirth in the first pregnancy and risk for infant mortality in the second pregnancy in a large population-based dataset.

STUDY DESIGN

Population-based, retrospective cohort study

SUBJECTS

Missouri maternally linked cohort data files were utilized from 1989 through 2005. Analyses were restricted to women who had two singleton pregnancies during the study period.

OUTCOME MEASURES

The exposure was stillbirth in the first pregnancy, while the primary outcome was infant mortality in the second pregnancy.

RESULTS

Women who experienced stillbirth in their first pregnancy were more likely to be of advanced age, black, and obese and had higher rates of pregnancy-related complications (p<0.01). Previous stillbirth was associated with an elevated risk for subsequent infant mortality (AHR=2.51, 95% CI: 1.73-3.65) and neonatal mortality (AHR=3.04, 95% CI: 1.99-4.65), after adjustment for socio-demographic variables and pregnancy complications. Risk estimates for mortality in the second pregnancy were most profound among black mothers with a history of stillbirth in the first pregnancy [risk for infant mortality: (AHR=2.68, 95% CI: 1.41-5.09) and neonatal death: (AHR=4.25, 95% CI: 2.34-7.60)].

CONCLUSIONS

Women with prior stillbirth bear elevated risks for subsequent infant mortality. Women's previous childbearing experiences could serve as important criteria in determining appropriate interconception strategies to improve subsequent feto-infant health and survival.

Abstract A33: African American men's perceptions of the informed decision-making process for prostate cancer screening: Implications for design and development

Introduction: Although prostate cancer mortality rates are on the decline, rates in African American men remain more than twice as high as those in white men. Men at risk for prostate cancer are encouraged to utilize informed decision making (IDM) to determine the most appropriate strategy for screening and prevention. However, multiple barriers exist in the provision of culturally and linguistically appropriate IDM models on prostate cancer for African American men, including mistrust of the health system, fear of cancer, and concerns about discrimination and racism. Multimedia approaches have been determined to be an effective means for the dissemination of culturally and linguistically appropriate IDM models for African Americans that minimize barriers within the community.

Methods: Focus groups were conducted with African American men in the Tampa Bay area to determine core elements for the design of a video-based patient decision aid for prostate cancer screening. Lay health advisors from the community recruited African American men to participate in this formative research. The inclusion criteria were: African American men; aged 40 to 70 years; and no diagnosis of prostate cancer or any other type of cancer. The focus groups were transcribed verbatim and analyzed using a combination of content analysis and the constant comparison method with Atlas.ti software.

Results: A total of 18 African American men, ranging in age from 41 to 65 years, were recruited (mean age=48.5 years). Overall, men had limited knowledge regarding prostate cancer, and slightly more than one-third (38.9%) of the men had previously been screened for prostate cancer. Multiple themes emerged through the conduct of focus groups, including the influence of cultural beliefs in screening, the need for more information on risk and protective factors for prostate cancer, the involvement of spouses and family members in decision-making, and the importance of culturally-appropriate educators, advocates, and role models.

Conclusions: Overall, there is a lack of information regarding prostate cancer among African American men. Cultural perceptions and beliefs play a critical role in the determination of screening practices in this community. Patient decision aids on prostate cancer for African American men require the utilization of African American health professionals and peers as purveyors of information. Furthermore, messaging should be tailored for African American men, as well as their spouses and families, to aid in the determination of appropriate prevention and screening strategies. These findings will assist in the design and development of culturally and linguistically appropriate educational resources and interventions on prostate cancer for the African American community.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A33.

Temporal trends in cardiomyopathy in pregnancy and association with feto-infant morbidity outcomes

OBJECTIVE

To examine temporal trends of cardiomyopathy in pregnancy and its association with feto-infant morbidity outcomes.

DESIGN AND METHODS

We performed a population-based retrospective cohort analysis utilizing the Florida hospital discharge data linked to vital statistics for 1998 to 2007 (N = 1 738 860). Prevalence rates and trend statistics of cardiomyopathy were computed. Conditional logistic regression models were used to generate adjusted odds ratios (AOR) and 95% confidence intervals (CI).

RESULTS

The annual prevalence of cardiomyopathy in pregnancy increased from 8.5/100 000 births to 32.7/100 000 (p for trend <0.0001), representing an absolute increase of 24% and a relative increase of 300% over the decade. Infants born to women with cardiomyopathy were at higher risk for feto-infant morbidities, including low birth weight (AOR = 3.49, 95% CI: 2.97-4.11), very low birth weight (AOR = 4.43, 95% CI: 2.98-6.60), preterm birth (AOR = 3.33, 95% CI: 2.88-3.85), very preterm birth (AOR = 5.22, 95% CI: 3.92-6.97) and small for gestational age (AOR = 1.57, 95% CI: 1.26-1.96).

CONCLUSION

The observed increasing prevalence of cardiomyopathy during pregnancy over the decade is of concern, as it is related to elevated risk for feto-infant morbidities. There is a need to delineate risk factors for this condition and to formulate appropriate preconception counseling for women with elevated risk for this diagnosis.

A pilot study of knowledge and interest of genetic counseling and testing for hereditary breast and ovarian cancer syndrome among Puerto Rican women

This study explored baseline levels of knowledge and attitude toward genetic testing (GT) for hereditary breast and ovarian cancer among Puerto Rican women. A secondary aim was to evaluate whether these factors differed between respondents in Puerto Rico and Tampa. Puerto Rican women with a personal or family history of breast or ovarian cancer who live in Puerto Rico (n = 25) and Tampa (n = 20) were interviewed. Both groups were interested in obtaining GT; women living in Puerto Rico were more likely to report they would get GT within 6 months (p = 0.005). The most commonly cited barrier was cost; the most commonly cited facilitator was provider recommendation. There was no difference in overall knowledge between Tampa (M = 5.15, SD = 1.63) and Puerto Rico (M = 5.00, SD = 1.87) participants (p = 0.78). Involving health care providers in recruitment and highlighting that GT may be available at minimal or no cost in the USA and Puerto Rico may facilitate participation.

Community-academic partnerships to reduce black-white disparities in infant mortality in Florida

PROBLEM

In Florida, data reveal a widening black-white disparity in infant mortality to the disadvantage of black families. Eight Florida counties have a significantly pronounced black-white infant mortality gap: Broward, Duval, Gadsden, Hillsborough, Miami-Dade, Orange, Palm Beach, and Putnam.

PURPOSE

The black Infant Health Community Collaborative (BIHCC) was established to address the rising racial/ethnic disparities in infant mortality. The program used a community-based participatory research (CBPR) approach to enable communities to develop sustainable initiatives to improve community health and reduce infant mortality.

KEY POINTS

Grounded in CBPR principles, a community-academic-state partnership was created to address the upsurge in black-white disparity in infant mortality. Community teams from each participating county underwent a 2-year period of capacity building. The culmination of this process was community-driven action plans to alleviate infant health disparities.

CONCLUSION

The BIHCC provides a replicable model for the development of community-academic-state partnerships to enhance capacity for improving infant health outcomes.

Effectiveness of a Federal Healthy Start program in reducing primary and repeat teen pregnancies: our experience over the decade

STUDY OBJECTIVE

To evaluate the effectiveness of a Federal Healthy Start program in reducing primary and repeat teen pregnancies in a disadvantaged community.

DESIGN

An ecological study that compares trends in teen pregnancy in the catchment area in which the community-based intervention was administered with two ecologic controls: the county (Hillsborough) and the state (Florida).

SETTING

Our catchment area is East Tampa, a socio-economically disadvantaged community in Hillsborough County, Florida.

PARTICIPANTS

Preconception care targeted teenagers between the ages of 10 and 19 years. Interconception care involved young mothers under the age of 20 with a previous birth. The population was comprised primarily of African Americans.

INTERVENTION

Preconception care services for primary teen pregnancy reduction offered sex education, family planning, drug and violence prevention education, and communication and negotiation skills acquisition. Interconception care service offered young women health education through monthly home visitation or monthly peer support group meetings addressing a range of topics using the life course perspective as framework.

MAIN OUTCOME MEASURE

Reduction in primary teen pregnancy and repeat teen pregnancy among adolescents.

RESULTS

The decline in primary teen pregnancy in the catchment area was 60% and 80% greater than the reduction experienced at the county level and at the state level respectively over the period of the study. However, efforts to prevent repeat pregnancy were not successful.

CONCLUSION

The Federal Healthy Start Preconception Care program, in collaboration with community partners, contributed to the prevention of first-time teen pregnancy in a community faced with significant social and economic challenges.

Psychosocial issues related to sexual functioning among African-American prostate cancer survivors and their spouses

OBJECTIVE

Focus on cancer survivorship and quality of life (QOL) is a growing priority. The aim of this study was to identify and describe the most salient psychosocial concerns related to sexual functioning among African-American (AA) prostate cancer survivors and their spouses.

METHODS

Twelve AA prostate cancer survivors and their spouses participated in semi-structured individual interviews. The interviews assessed couples' experiences with psychosocial adjustment and sexual functioning posttreatment for localized prostate cancer. The data were analyzed using the constant comparison method and content analysis.

RESULTS

In this qualitative study of couples surviving prostate cancer, there were divergent views between the male prostate cancer survivors and their female partners, particularly regarding sexual functioning. For the males, QOL issues emerged as the primary area of concern, whereas survival of their husbands was considered most important among the female spouses. The male respondents expressed unease with the sexual side effects of their cancer treatment, such as erectile dysfunction and decreased sexual desire and satisfaction. Female spouses recognized decreased sexual desire in their partners following treatment, but this was not considered a primary concern.

CONCLUSIONS

Patients and their spouses may have differing perceptions regarding QOL and the impact of sexual functioning on survivorship. This study points to the need for further research and intervention development to address these domains with a goal to improve QOL.

Impact of prenatal alcohol consumption on placenta-associated syndromes

The biology of placental and fetal development suggests that alcohol may play a significant role in increasing the risk of feto-infant morbidity and mortality, but study results are inconsistent and the mechanism remains poorly defined. Previous studies have not examined the risk of placenta-associated syndromes (PASs: defined as the occurrence of either placental abruption, placenta previa, preeclampsia, small for gestational age, preterm, or stillbirth) as a unique entity. Therefore, we sought to examine the relationship between prenatal alcohol use and the risk of PAS among singleton births in the Missouri maternally linked data files covering the period 1989-2005. Logistic regression with adjustment for intracluster correlation was used to generate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Compared with nondrinkers, drinkers were more likely to be smokers, 35 years of age or older, black, and multiparous. Drinkers had an increased risk of PAS (OR=1.26, 95% CI=1.22,1.31) when compared with their nondrinking counterparts. The risk of PAS was progressively amplified with increasing prenatal alcohol consumption (P for trend <.01). Women who reported consuming five or more alcoholic drinks per week had more than twofold increased risk of PASs, whereas women in the lowest drinking category (one to two drinks per week) had only a slight increased risk of PAS (OR=1.09, 95% CI=1.05, 1.14). Enhanced understanding of the mechanism by which prenatal alcohol consumption leads to PAS may aid in the development of more targeted interventions designed to prevent adverse pregnancy outcomes. Screening women for alcohol use may assist providers in protecting developing fetuses from the potential dangers of prenatal alcohol use.

Super-obesity and risk for early and late pre-eclampsia

OBJECTIVE

To examine the association between obesity subtypes and risk of early and late pre-eclampsia.

DESIGN

Population-based retrospective study.

SETTING

State of Missouri maternally linked birth cohort files.

POPULATION

All singleton live births in the state of Missouri from 1989 to 2005.

METHODS

The body mass index (BMI) was used to classify women as normal weight (BMI = 18.5-24.9 kg/m(2)), class I obesity (BMI = 30-34.9 kg/m(2)), class II obesity (BMI = 35-39.9 kg/m(2)), class III obesity (BMI = 40-49.9 kg/m(2)) or super-obesity (BMI > or = 50 kg/m(2)). Adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between obesity and the risk of pre-eclampsia were obtained from logistic regression models with adjustment for intracluster correlation.

RESULTS

The rate of pre-eclampsia increased with increasing BMI, with super-obese women having the highest incidence (13.4%). Compared with normal weight women, obese women (BMI > or = 30 kg/m(2)) had a higher risk for pre-eclampsia (OR = 2.59, 95% CI = 2.87-3.01). This risk remained approximately the same for late-onset pre-eclampsia (pre-eclampsia occurring at 34 weeks or more of gestation) and was slightly reduced for early-onset pre-eclampsia (pre-eclampsia occurring at 34 weeks or less of gestation). Within each BMI category, the risk of pre-eclampsia increased with the rate of weight gain. Compared with normal weight mothers with moderate weight gain, super-obese women with a high rate of weight gain had the greatest risk for pre-eclampsia (OR = 7.52, 95% CI = 2.70-21.0).

CONCLUSION

BMI and rate of weight gain are synergistic risk factors that amplify the burden of pre-eclampsia among super-obese women.

High Risk Community—Men’s Perceptions of Black Infant Mortality: A Qualitative Inquiry

Infant mortality has been identified as a key public health concern in the United States. Although infant mortality rates (IMRs) in the United States have declined during the past 10 years, the rates among Blacks are more than two times higher as compared with other racial and ethnic groups. This study used focus groups to explore Black men’s awareness and perceptions of the rising IMR in their community. Twenty-five men participated in an initial and follow-up focus group, which revealed that men had limited awareness of infant mortality, reduced sense of personal responsibility for pregnancy outcomes, and perceptions that stress, the age of the mother, and the health care system were responsible for poor birth outcomes. The role of the community and possible interventions to involve and educate men were also explored.