1. Central Pennsylvania Center of Excellence to Improve Pregnancy Outcome Botti JJ, Weisman CS, Hillemeier MA, Baker SA The Central Pennsylvania Center of Excellence for Research on Pregnancy Outcomes (COE) is funded by a Pennsylvania Department of Health non-formula tobacco settlement grant awarded in June 2004. The COE is a partnership of Pennsylvania State University’s main and medical campuses, Franklin & Marshall College, Lock Haven University of Pennsylvania, and the Family Health Council of Central Pennsylvania to address health disparities in women who may become pregnant in this region. The primary research project conducted in the COE is the Central PA Women’s Health Study (CePAWHS). The purpose of CePAWHS is to assess and improve the health of reproductive age women in a 28 county predominantly rural region of Central PA (see map, Fig. 1). The research focuses on reducing disparities in preterm birth and low birthweight, which are persistent public health problems in the nation and in Pennsylvania. More than 40 years of scientific study on the prevention of preterm birth and low birthweight have improved our understanding of some of the mechanisms that lead to preterm birth and low birthweight, but multiple therapeutic interventions have not substantially reduced the rates of prematurity and low birthweight, nor have they eliminated racial/ethnic disparities in these pregnancy outcomes. Prematurity is disproportionately greater among women of color and families in poverty in Central PA, as in other regions. This program uses a preconception, multiple- determinants, life-stage model (Misra, 2003) of perinatal health to identify environmental, psychosocial, biological, and health care risk factors that may account for disparities in birth outcomes and that are amenable to population- based interventions to improve women’s health before they become pregnant. (Fig. 2) The COE will research the risks for preterm birth and low birthweight (LBW) in diverse populations in the region; provide a structure for testing innovative population-based interventions in partnership with the communities; and provide education to collegiate undergraduate, physician assistant and medical students, and new investigators through coursework and mentored research to improve pregnancy outcomes through research and practice. Continuing education will also be designed for health professionals working in the geographical study areas. CePAWHS is an unique, two-phase research project designed to reduce the incidence of preterm birth (birth occurring before 37 weeks of gestation) and low birthweight babies (babies that weigh less than 5 1/2 pounds at birth) by improving the health of high-risk women before they become pregnant. The first phase, CePAWHS-1, is a survey of 2,300 women ages 18-45 who reside in the 28-county study region in Central Pennsylvania and of 300 16-17-year-olds seeking services in family planning clinics. The purpose of the survey is to gather information on the health status, health habits, pregnancy history, and patterns of health care use of women in our target population and to identify the key risk factors for preterm birth and low birthweight in the population. This is the first comprehensive survey ever conducted on the health of reproductive-age, Central Pennsylvania women. The survey is being conducted by telephone, household interviews, and clinic-based interviews. Baseline survey analysis will be completed in 2005. The information obtained in the survey will help the investigators design a program that will be tested in phase 2 of the research. The second phase, CePAWHS-2, is a special program designed to help women who are considering a future pregnancy to improve their health status and health habits. Using the findings about key risk factors from phase 1, the researchers will develop a program to improve women's health literacy, teach behavior change skills, and provide selected health services. The program will be tested in a randomized trial that includes baseline and follow-up risk assessments. Fig 1. CePaWHS study area DISTAL DETERMINANTS Community size (rural  urban) Sociodemographics (age, race/ethnicity, SES, etc.) Family context (marital status, household composition) Environmental/occupational exposures Genetic factors OUTCOMES Preterm birth Low birthweight Predisposition to lifetime complications HEALTH CARE (MODIFIERS) Use patterns Health information sources/ health literacy Access barriers PROXIMAL DETERMINANTS Psychosocial stress and stress- related behavior: Acute/chronic stressors; depression/anxiety; tobacco use; alcohol/drug use; poor nutrition; physical inactivity Chronic Conditions: Hypertension; diabetes; asthma; obesity Infections: Bacterial vaginosis; vaginal douching; sexually transmitted infections Pregnancy History: Previous preterm birth; maternal complications (pre-eclampsia, gestational diabetes); inter-pregnancy interval; contraceptive use; infertility issues Fig. 2. Conceptual Framework: Determinants of Preterm Birth and LBW (adapted from Misra et al. 2003) Improved understanding of the bio-behavioral mechanisms associated with preterm birth and low birthweight in the CePAWHS target population of reproductive-age women should lead to innovative pre-pregnancy approaches to diagnoses and therapeutic interventions to improve pregnancy outcomes. DefinitionPA Rate 2002 Healthy People 2010 Goal Preterm Birth < 37 weeks gestation 9.9%7.6% LBW<2,500 grams8.2%5.0% Fig. 3. Pennsylvania preterm birth and low birth weight rates, 2002. www.womenshealthcoe.psu.edu CePAWHS (Central Pennsylvania Women’s Health Study)