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

7. Study Group at Screening (N=1044) N Risk Behaviors % Cumulativ e % 140.440.2 237.077.4 317.094.4 45.6100.0

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 Parameter s CategoryP-ValueOdds Ratio 95% CI for OR Women resolved at least one risk vs. women resolved no risks at postpartum Care Group I vs. UC0.0031.651.19-2.28 Illicit Drugs Y vs. N0.010.540.33-0.86 ETSEY vs. N0.00013.792.48-5.78 Depressio n Y vs. N0.00013.432.47-4.76 IPVY vs. N0.00014.072.95-5.60

10. Does the Intervention Affect Medical Outcomes?

11. Pregnancy Outcomes (Smoking) InterventionUsual CareP-value Miscarriage 1.4%4.8%0.04 Preterm <37 wk 12.2%13.3%0.73 V. Preterm <33 wk 1.0%4.6%0.03 E. Preterm <28 wk 0%2.1%0.04 LBW <2500 gm 13.3%10.8%0.45 VLBW <1500 gm 0.5%2.7%0.08