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2358: Association of medical and psychosocial risk factors with engagement in prenatal home visiting
- Kelly M. Bower, Deborah Gross, Margaret Ensminger, Jana Goins, Phyllis Sharps
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- Journal:
- Journal of Clinical and Translational Science / Volume 1 / Issue S1 / September 2017
- Published online by Cambridge University Press:
- 10 May 2018, p. 27
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- Article
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- Open access
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OBJECTIVES/SPECIFIC AIMS: The purpose of this study is to understand factors that are associated with identifying which eligible pregnant women in Baltimore City accept a referral for HV services. Taking into account demographic and obstetrical variables, we will examine the extent to which 13 medical and 14 psychosocial risk factors differentiate pregnant women who (1) accepted a HV referral, (2) could not be located, or (3) refused a HV referral. METHODS/STUDY POPULATION: In this observational study, we will use secondary data on 8172 pregnant women collected by Health Care Access Maryland (HCAM) between 2014 and 2016. HCAM is the single point of entry for all pregnant women in Baltimore City into HV. HV eligibility includes being a pregnant woman, residing in Baltimore City, being uninsured or receiving Medicaid, and being identified by a prenatal care provider who completed an assessment profile of the woman’s medical and psychosocial risk (prenatal risk assessment). The outcome variable, HV engagement status (ie, accepted referral, could not be located, refused referral), will be based on HCAM discharge codes. Medical risk factors include BMI, hypertension, anemia, asthma, sickle cell, diabetes, vaginal bleeding, genetic risk, sexually transmitted disease, last dental visit >1 year ago, and taking prescription medications. Psychosocial risk factors include current pregnancy unintended; <1 year since last delivery; late entry to prenatal care (>20 wk gestation); mental, physical, or developmental disability; history of abuse or violence within past 6 months; tobacco use; alcohol use; illegal substance use within the past 6 months; resides in home built before 1978; homelessness; lack of social/emotional support; exposure to long-term stress; lack of transportation; and history of depression or mental illness. All risk factor variables are categorical (yes/no). Control variables will include demographics (eg, age, race, ethnicity, marital status, educational level) and OB history (eg, history of preterm labor, history of fetal or infant death). We will conduct descriptive statistics to characterize the sample and look for interrelatedness among the risk factors. Where there is a high level of inter-relatedness we will consider combining or omitting variables to reduce redundancy. We will use multinomial regression to examine which medical and psychological factors are associated with referral category. RESULTS/ANTICIPATED RESULTS: We hypothesize that (a) women with more medical risk factors will be more likely to accept a referral for HV services, (b) women with more psychosocial risk factors will be more likely to refuse HV or not be located, and (c) certain risk factors, such as depression/mental illness, history of abuse/violence, illegal substance use, homelessness, and exposure to long-term stress will be the strongest predictors of not accepting HV referral and/or not being located. DISCUSSION/SIGNIFICANCE OF IMPACT: The translation of effective randomized control trials (RCTs) to successful implementation in community-based programs can be challenging. Community-based programs serving low-income communities typically lack the same resources available to recruit and retain participants in RCTs. And, exclusion criteria applied in RCTs are often not applied in real world implementation which can open program to participants with more complex social and medical characteristics. Findings from this study will inform the translation of evidence-based HV programs into real world settings through an enhanced understanding of the characteristics of women who are not engaged by HV programs. This will inform development of improved outreach methods that may more effectively engage at-risk women for prenatal HV services.
16 - Racial Discrimination and Violence: A Longitudinal Perspective
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- By Joan McCord, Temple University, Margaret E. Ensminger, Johns Hopkins University
- Edited by Darnell F. Hawkins, University of Illinois, Chicago
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- Book:
- Violent Crime
- Published online:
- 22 August 2009
- Print publication:
- 24 February 2003, pp 319-330
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Summary
A century ago, W. E. B. Du Bois wrote: “Crime is a phenomenon of organized social life, and is the open rebellion of an individual against his social environment” (1899/1996: 235). Explaining crime among blacks in Philadelphia between 1835 and 1895, Du Bois noted their overrepresentation in the courts as well as prisons and was acknowledging the damage to society done by racial discrimination both before and after the Civil War. Enumerations of prison populations in 1904, 1910, and 1923 showed serious overrepresentation of blacks both among resident prisoners and among those committed during the years of enumeration (Reuter, 1927). The fact that rates were higher for population counts than for intakes showed that blacks not only were convicted relatively more frequently but that, also, they were given longer sentences.
High crime rates among blacks are, of course, at least partly a function of the operation of the justice system and the way in which crimes and race are recorded. In many cases, white men have committed violence against blacks with impunity, thus not entering into any counts of violence. Although black recorded rates of violence exceeded the averages among whites, they did not rise to the levels of violence among Irish or Italian immigrants at particular times and places (Lane, 1997). Nevertheless, contemporary records indicate that violence among blacks, particularly among young black males, is an extremely serious phenomenon.
11 - Transition to adulthood among high-risk youth
- Edited by Richard Jessor, University of Colorado, Boulder
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- Book:
- New Perspectives on Adolescent Risk Behavior
- Published online:
- 06 July 2010
- Print publication:
- 13 September 1998, pp 364-390
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Summary
Introduction
A recent report by the National Research Council (1993) on high-risk adolescents concludes that research should focus on those who are most at risk for not making a successful transition to young adulthood, that is, those who grow up in poor communities, attend underfunded schools, and live in families that lack the social and economic resources to support their children's socialization process appropriately. In addition, the panel specifically suggested that research should move beyond the sole emphasis on measuring youth problems (such as drug use, pregnancy, arrest) and accomplishments (graduation, employment) to include assessment of the individual and community attributes (alienation, responsibility, attachment, emotional health) that underlie the “status” outcomes (p. 248).
The conceptual issues and empirical results that we present in this chapter are organized around childhood and adolescent social role performance and psychological well-being, which seem to lead to successful adult role performance among a cohort of inner-city children. As Jessor (1993) states, the field of adolescence has been invigorated by a more comprehensive theory, more attention to development, increased awareness of the importance of biology and genetics on the one hand and the social and cultural contexts on the other, a more inclusive focus on previously ignored populations of adolescents, notably ethnic minorities and those living in poverty, and a broader range of research and statistical methods. We attempt to reflect these trends and to address heir implications for future research and program development.