Division of Maternal and Child Health, Marion County Public Health Department, Indianapolis, IN, USA.
J Natl Med Assoc. 2012 May-Jun;104(5-6):258-64. doi: 10.1016/s0027-9684(15)30159-0.
To evaluate the impact of prenatal education by case managers on 2 social determinants of health behaviors-breast feeding and smoking cessation-among participants enrolled in Indianapolis Healthy Start (IHS).
Birth and death data up to 1 year for IHS clients were collected from Marion County vital records for births 20 weeks or greater. Case managers provide education on the health benefits for mothers and infants on breast feeding and smoking cessation to all clients. Data were analyzed for differences between the IHS participants and other Marion County births.
Most participants (63%) were non-Hispanic blacks aged less than 25 years (56%), without a high school diploma or general education development (53%), and enrolled in Medicaid (91%). Program participants were more likely to initiate breast feeding than nonparticipants (OR, 1.33; 95% CI, 1.10-1.61), and 22% continued to breast feed for 6 months. Hispanic women were more likely to breast feed for at least 6 months (OR, 4.71; 95% CI, 2.32-9.58). Women with advanced education were more likely to have quit smoking, as were women who were breast feeding at hospital discharge. After controlling for education, IHS clients tended to be less likely to continue to smoke during the third trimester (OR, 0.76, 95% CI, 0.49-1.16), as were those with a first pregnancy (OR, 0.32; 95% CI, 0.10, 0.98) and no other smokers in the home (OR, 0.25; 95% CI, 0.08, 0.74).
Breast feeding and smoking cessation are modifiable risk factors that were impacted by behavioral interventions through case management education.
评估个案管理者对印第安纳波利斯健康开端（IHS）参与者进行产前教育对母乳喂养和戒烟这两个健康行为的社会决定因素的影响。
从马里恩县出生和死亡记录中收集了 IHS 客户的出生和死亡数据，时间范围为 20 周或以上。个案管理者向所有客户提供母乳喂养和戒烟对母婴健康益处的教育。对 IHS 参与者和其他马里恩县出生者的数据进行了分析，以比较差异。
大多数参与者（63%）是非西班牙裔黑人，年龄小于 25 岁（56%），没有高中文凭或普通教育发展证书（53%），并参加了医疗补助计划（91%）。与非参与者相比，参与者更有可能开始母乳喂养（OR，1.33；95%CI，1.10-1.61），并且有 22%的人持续母乳喂养 6 个月。西班牙裔妇女更有可能至少母乳喂养 6 个月（OR，4.71；95%CI，2.32-9.58）。受教育程度较高的妇女、分娩时正在母乳喂养的妇女更有可能戒烟。在控制了教育因素后，IHS 客户在第三个孕期继续吸烟的可能性较低（OR，0.76，95%CI，0.49-1.16），初次怀孕的可能性较低（OR，0.32；95%CI，0.10-0.98），家中没有其他吸烟者的可能性较低（OR，0.25；95%CI，0.08-0.74）。
母乳喂养和戒烟是可改变的风险因素，通过个案管理教育的行为干预对其产生了影响。
