Investigating the Role of Race and Stressful Life Events on the Smoking Patterns of Pregnant and Postpartum Women in the United States: A Multistate Pregnancy Risk Assessment Monitoring System Phase 8 (2016-2018) Analysis.

OBJECTIVE: To examine the smoking patterns of women who experienced stressful life events and the impact of racial disparities on the relationship between stressful life events, and prenatal/ postpartum smoking. METHODS: The study analyzed data from the Pregnancy Risk Assessment Monitoring System Phase 8 (2016-2018) survey across five states (CT, LA, MA, MO, WI). Four stressful life event categories were created using thirteen affiliated questions: financial, trauma, partner, and emotional. We assessed: 1) the association between smoking and stressful life events, 2) the impact of race on the relation between smoking and stressful life events, and 3) the long-term effects of smoking on health by assessing the association between smoking and maternal morbidity. Bivariate statistics and multivariate Poisson regression models were conducted. RESULTS: A total of 24,209 women from five states were included. 8.9% of respondents reported smoking during pregnancy, and 12.7% reported smoking postpartum. There was a significant association between all stressful life events and smoking. Trauma stressful life event had the strongest association with smoking during pregnancy (adjusted PR=2.01; CI: 1.79-2.27) and postpartum (adjusted PR= 1.80; CI: 1.64-1.98). Race and stressful life event interaction effects on smoking had varied significant findings, but at least one racial/ ethnic minority group (Black, Hispanic, Asian) had a higher smoking prevalence than non-Hispanic White per stressful life event category. Lastly, the prevalence of maternal morbidity was higher for smoking during pregnancy (adjusted PR= 1.28; CI: 1.19-1.38) and postpartum (adjusted PR= 1.30; CI: 1.22-1.38) compared to no smoking. CONCLUSIONS FOR PRACTICE: Culturally congruent, multi-disciplinary care teams are needed to address both clinical and social needs to reduce stressful life events and smoking. Screenings for stress should be standardized with a referral system in place to provide ongoing support.

Using Collective Impact to Develop a Community-Led Initiative for Improving Black Infant Mortality.

The United States has one of the highest infant mortality rates among developed countries. When stratified by race, disparities are more evident: Black infant mortality rates are 2.5 times higher than non-Hispanic white infants. Structural, systemic racism is a contributing cause for these racial disparities. Multisector collaborations focused on a common agenda, often referred to as collective impact, have been used for infant mortality reduction interventions. In addition, community-based participatory approaches have been applied to incorporate those with lived experience related to adverse pregnancy outcomes. This article critically describes the transition of an infant mortality collective impact initiative from being led by a multisector organizational group to being community led over a 5-year period, 2015-2020. A 34-member community leaders group was developed and determined four priorities and corresponding strategies for the initiative. Findings show that community participatory approaches are a way to address racial equity for public health initiatives.

Community Health Worker Impact on Knowledge, Antenatal Care, And Birth Outcomes: A Systematic Review.

OBJECTIVES: Community health worker (CHW) interventions have been shown to be effective in areas of maternal and child health (MCH), mostly in relation to infant and neonatal mortality. The specific aims of this review were to expand outcomes to include improving knowledge related to pregnancy and infant health and the receipt of antenatal care (ANC), along with birth outcomes. We also summarized the role, characteristics and activities of CHWs in interventions conducted in settings with demonstrated improvements in key MCH outcomes. METHODS: Articles were retrieved from: PubMed, CINAHL, Global Health, Scopus, Web of Science, and the Cochrane Library from January 2008 through 2018. We included evaluation studies that utilized CHWs as all or part of an intervention to improve outcomes, were printed in English, and published in peer-reviewed journals. RESULTS: Initial electronic database search identified 816 studies and 123 studies met inclusion criteria for full text review. The quality assessment resulted in 0 strong-, 19 moderate-, and 25 weak-rated studies. In most interventions, CHWs were a component of a larger intervention. The majority of the studies (n = 10) found that a CHW intervention can have a positive impact on outcomes. CHW interventions showed improvements in knowledge and ANC. When combined with clinical services, the interventions positively impacted birth outcomes. Most conducted home visits and utilized CHW that were members of the community. CONCLUSIONS FOR PRACTICE: CHWs serve an important role as health educators conducting home visits as a member of the community they serve. They should also continue to collaborate with clinical providers to address MCH outcomes.

Role of bilayer characteristics on the structural fate of aß(1-40) and aß(25-40).

The ß-amyloid (Aß) peptide is derived from the transmembrane (TM) helix of the amyloid precursor protein (APP) and has been shown to interact with membrane surfaces. To understand better the role of peptide-membrane interactions in cell death and ultimately in Alzheimer's disease, a better understanding of how membrane characteristics affect the binding, solvation, and secondary structure of Aß is needed. Employing a combination of circular dichroism and deep-UV resonance Raman spectroscopies, Aß(25-40) was found to fold spontaneously upon association with anionic lipid bilayers. The hydrophobic portion of the disease-related Aß(1-40) peptide, Aß(25-40), has often been used as a model for how its legacy TM region may behave structurally in aqueous solvents and during membrane encounters. The structure of the membrane-associated Aß(25-40) peptide was found to depend on both the hydrophobic thickness of the bilayer and the duration of incubation. Similarly, the disease-related Aß(1-40) peptide also spontaneously associates with anionic liposomes, where it initially adopts mixtures of disordered and helical structures. The partially disordered helical structures then convert to ß-sheet structures over longer time frames. ß-Sheet structure is formed prior to helical unwinding, implying a model in which ß-sheet structure, formed initially from disordered regions, prompts the unwinding and destabilization of membrane-stabilized helical structure. A model is proposed to describe the mechanism of escape of Aß(1-40) from the membrane surfaces following its formation by cleavage of APP within the membrane.

Bilayer surface association of the pHLIP peptide promotes extensive backbone desolvation and helically-constrained structures.

Despite their presence in many aspects of biology, the study of membrane proteins lags behind that of their soluble counterparts. Improving structural analysis of membrane proteins is essential. Deep-UV resonance Raman (DUVRR) spectroscopy is an emerging technique in this area and has demonstrated sensitivity to subtle structural transitions and changes in protein environment. The pH low insertion peptide (pHLIP) has three distinct structural states: disordered in an aqueous environment, partially folded and associated with a lipid membrane, and inserted into a lipid bilayer as a transmembrane helix. While the soluble and membrane-inserted forms are well characterized, the partially folded membrane-associated state has not yet been clearly described. The amide I mode, known to be sensitive to protein environment, is the same in spectra of membrane-associated and membrane-inserted pHLIP, indicating comparable levels of backbone dehydration. The amide S mode, sensitive to helical structure, indicates less helical character in the membrane-associated form compared to the membrane-inserted state, consistent with previous findings. However, the structurally sensitive amide III region is very similar in both membrane-associated and membrane-inserted pHLIP, suggesting that the membrane-associated form has a large amount of ordered structure. Where before the membrane-associated state was thought to contain mostly unordered structure and reside in a predominantly aqueous environment, we have shown that it contains a significant amount of ordered structure and rests deeper within the lipid membrane.