Oregon Department of Human Services, Public Health Division, Office of Family Health, Portland, Oregon, USA.
J Rural Health. 2009 Spring;25(2):150-7. doi: 10.1111/j.1748-0361.2009.00211.x.
Identifying how maternal residential location affects late initiation of prenatal care is important for policy planning and allocation of resources for intervention.
To determine how rural residence and other social and demographic characteristics affect late initiation of prenatal care, and how residence status is associated with self-reported barriers to accessing early prenatal care.
This observational study used data from the 2003 Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) (N = 1,508), with late initiation of prenatal care (after the first trimester) as the primary outcome. We used Rural-Urban Commuting Area (RUCA) codes to categorize maternal residence as urban, large rural, or small/isolated rural. Multivariate logistic regression was used to evaluate whether category of residence was associated with late initiation of prenatal care after adjusting for other maternal factors. Association between categories of barriers to prenatal care and maternal category of residence were determined using the Cochran-Mantel-Haenszel test of association.
We found no significant association between residence category and late initiation of prenatal care, or residence category and barriers to prenatal care initiation. Urban women tended to be over age 34 or nonwhite. Women from large rural areas were more likely to be younger than 18 years, unmarried, and have an unintended pregnancy. Women from small rural areas were more likely to use tobacco during pregnancy.
Maternal residence category is not associated with late initiation of prenatal care or with barriers to initiation of prenatal care. Differences in maternal risk profiles by location suggest possible new foci for programs, such as tobacco education in small rural areas.
确定产妇居住地如何影响产前护理的延迟开始，对于政策规划和资源分配干预措施非常重要。
确定农村居住和其他社会人口特征如何影响产前护理的延迟开始，以及居住状况如何与自我报告的早期产前护理障碍有关。
本观察性研究使用了 2003 年俄勒冈州妊娠风险评估监测系统（PRAMS）的数据（N=1508），将产前护理的延迟开始（在第一孕期之后）作为主要结果。我们使用农村-城市通勤区（RUCA）代码将产妇居住地分类为城市、大农村或小/偏远农村。多变量逻辑回归用于评估在调整其他产妇因素后，居住地类别是否与产前护理的延迟开始有关。使用 Cochran-Mantel-Haenszel 关联检验来确定产前护理障碍的类别与产妇居住地类别的关联。
我们没有发现居住地类别与产前护理的延迟开始之间存在显著关联，也没有发现居住地类别与产前护理开始障碍之间存在显著关联。城市女性往往年龄在 34 岁以上或非白人。来自大农村地区的女性更年轻，不到 18 岁，未婚，意外怀孕。来自小农村地区的女性在怀孕期间更可能吸烟。
产妇居住地类别与产前护理的延迟开始或产前护理开始障碍无关。按地点划分的产妇风险特征差异表明，在小农村地区可能有新的烟草教育等项目的新焦点。
