1 00:00:05,920 --> 00:00:09,200 I'M DR. SHANNON ZENK, DIRECTOR 2 00:00:09,200 --> 00:00:10,840 OF THE NATIONAL INSTITUTE OF 3 00:00:10,840 --> 00:00:12,680 NURSING RESEARCH. 4 00:00:12,680 --> 00:00:15,680 ALSO A CO-CHAIR OF THE IMPROVE 5 00:00:15,680 --> 00:00:17,440 INITIATIVE, ALONG WITH MY 6 00:00:17,440 --> 00:00:20,040 COLLEAGUE, DR. DIANA BIANCHI AND 7 00:00:20,040 --> 00:00:21,160 DR. JANINE CLAYTON. 8 00:00:21,160 --> 00:00:24,400 IT REALLY IS MY PLEASURE TO 9 00:00:24,400 --> 00:00:26,680 WELCOME YOU TO TODAY'S IMPROVE 10 00:00:26,680 --> 00:00:28,120 AWARDEE WORKSHOP WHERE YOU AND 11 00:00:28,120 --> 00:00:31,600 YOUR COLLEAGUES CAN SHARE 12 00:00:31,600 --> 00:00:32,560 LESSONS LEARNED, EXPLORE 13 00:00:32,560 --> 00:00:34,560 COMMONALITIES ACROSS YOUR 14 00:00:34,560 --> 00:00:36,040 PROGRAMS OF RESEARCH, AND THINK 15 00:00:36,040 --> 00:00:41,960 ABOUT NEW LINES OF INQUIRY. 16 00:00:41,960 --> 00:00:44,000 ALLOW ME TO LOOK BACK AT HOW 17 00:00:44,000 --> 00:00:47,400 IMPROVE CAME TO BE. 18 00:00:47,400 --> 00:00:50,560 NEXT SLIDE PLEASE. 19 00:00:50,560 --> 00:00:52,840 IT IS WELL DOCUMENTED THAT THE 20 00:00:52,840 --> 00:00:55,160 MATERNAL MORTALITY RATE IN THE 21 00:00:55,160 --> 00:00:56,920 UNITED STATES CONTINUES TO 22 00:00:56,920 --> 00:01:00,400 EXCEED THAT OF MANY OTHER 23 00:01:00,400 --> 00:01:01,560 INDUSTRIALIZED NATIONS. 24 00:01:01,560 --> 00:01:05,720 THE RATE OF MATERNAL MORTALITY 25 00:01:05,720 --> 00:01:09,280 INCREASE BUYING 29% FROM 2009 TO 26 00:01:09,280 --> 00:01:09,480 2020. 27 00:01:09,480 --> 00:01:13,440 A RECENT CDC REPORT FOUND THAT 28 00:01:13,440 --> 00:01:15,440 AN ALARMING 84% OF 29 00:01:15,440 --> 00:01:16,800 PREGNANCY-RELATED DEATHS THAT 30 00:01:16,800 --> 00:01:21,160 OCCURRED IN THE UNITED STATES 31 00:01:21,160 --> 00:01:25,520 BETWEEN 2017 AND 2019 WERE 32 00:01:25,520 --> 00:01:26,640 DETERMINED TO BE PREVENTIBLE. 33 00:01:26,640 --> 00:01:29,240 EVEN MORE CONCERNING WILL THE 34 00:01:29,240 --> 00:01:31,880 STARK DISPARITIES IN MATERNITY 35 00:01:31,880 --> 00:01:33,280 HEALTH OUTCOMES WHEN VIEWED 36 00:01:33,280 --> 00:01:36,360 THROUGH THE LENS OF RACIAL AND 37 00:01:36,360 --> 00:01:42,960 ETHNIC GAT -- CATEGORIES, BLAC, 38 00:01:42,960 --> 00:01:45,240 AMERICAN INDIAN AND NATIVE 39 00:01:45,240 --> 00:01:47,200 AMERICAN ARE MORE LIKELY TO DIE 40 00:01:47,200 --> 00:01:54,640 FROM PREGNANCY RELATED CAUSES 41 00:01:54,640 --> 00:01:56,600 THAT WHITE WOMEN, DISPARITIES 42 00:01:56,600 --> 00:01:58,400 INCREASE BY AGE, FOUR TO FIVE 43 00:01:58,400 --> 00:02:01,680 TIMES OF THE WHITE COUNTER 44 00:02:01,680 --> 00:02:02,560 PARENTS AND MORALITY RATE FOR 45 00:02:02,560 --> 00:02:05,080 WOMEN WITH AT LEAST A COLLEGE 46 00:02:05,080 --> 00:02:07,800 DEGREE WAS FIVE TIMES AS HIGH AS 47 00:02:07,800 --> 00:02:09,920 WHITE WOMEN WITH SIMILAR 48 00:02:09,920 --> 00:02:10,160 EDUCATION. 49 00:02:10,160 --> 00:02:13,040 IN THE SAME CDC REPORT, 50 00:02:13,040 --> 00:02:14,200 RESEARCHERS SHOWED VAST 51 00:02:14,200 --> 00:02:15,960 VARIATION IN THE MOST FREQUENT 52 00:02:15,960 --> 00:02:18,080 UNDERLYING CAUSES OF DEATH FOR 53 00:02:18,080 --> 00:02:21,920 BIRTHING PEOPLE WHEN COMPARED 54 00:02:21,920 --> 00:02:24,560 ACROSS RACIAL AND ETHNIC GROUPS. 55 00:02:24,560 --> 00:02:25,960 CARDIAC AND CORONARY CONDITIONS 56 00:02:25,960 --> 00:02:26,960 WERE THE MOST FREQUENT 57 00:02:26,960 --> 00:02:29,800 UNDERLYING CAUSE OF DEATH AMONG 58 00:02:29,800 --> 00:02:31,240 NON-HISPANIC BLACK PERSONS. 59 00:02:31,240 --> 00:02:32,200 MENTAL HEALTH CONDITIONS WERE 60 00:02:32,200 --> 00:02:33,920 THE MOST FREQUENT UNDERLYING 61 00:02:33,920 --> 00:02:36,360 CAUSE OF DEATH AMONG HISPANIC 62 00:02:36,360 --> 00:02:38,760 PERSONS, AND HEMORRHAGE WAS THE 63 00:02:38,760 --> 00:02:40,840 MOST FREQUENT UNDERLYING CAUSE 64 00:02:40,840 --> 00:02:43,320 OF DEATH AMONG ASIAN PERSONS. 65 00:02:43,320 --> 00:02:49,240 ONE OF THE MOST DISTURBING 66 00:02:49,240 --> 00:02:54,960 FINDINGS WAS THE DETERMINATION 67 00:02:54,960 --> 00:02:57,120 93% OF PREGNANCY-RELATED DEATHS 68 00:02:57,120 --> 00:02:59,640 IN THE AMERICAN INDIAN AND 69 00:02:59,640 --> 00:03:01,080 ALASKA POPULATIONS WERE 70 00:03:01,080 --> 00:03:02,520 PREVENTIBLE. 71 00:03:02,520 --> 00:03:06,640 IT IS CRUCIAL TO NOTE THE RISING 72 00:03:06,640 --> 00:03:09,520 RATE DOES NOT HAVE TO BE 73 00:03:09,520 --> 00:03:10,400 INEVITABLE. 74 00:03:10,400 --> 00:03:12,280 WE MUST CONTINUE TO ACT TO 75 00:03:12,280 --> 00:03:14,240 REVERSE THIS DEADLY TREND AND 76 00:03:14,240 --> 00:03:17,920 SAVE LIVES OF PREGNANT AND 77 00:03:17,920 --> 00:03:18,600 BIRTHING PEOPLE. 78 00:03:18,600 --> 00:03:19,720 NEXT SLIDE PLEASE. 79 00:03:19,720 --> 00:03:21,120 AS A COUNTERMEASURE TO THE 80 00:03:21,120 --> 00:03:23,120 RISING RATES OF MATERNAL 81 00:03:23,120 --> 00:03:27,160 MORTALITY IN THIS COUNTRY, IN 82 00:03:27,160 --> 00:03:29,200 2019 NIH RESPONDED BY LAUNCHING 83 00:03:29,200 --> 00:03:31,960 IMROFT INITIATIVE TO SUPPORT 84 00:03:31,960 --> 00:03:32,800 RESEARCH TO REDUCE PREVENTABLE 85 00:03:32,800 --> 00:03:35,360 CAUSES OF MATERNAL DEATH AND 86 00:03:35,360 --> 00:03:37,560 IMPROVE HEALTH BEFORE, DURING, 87 00:03:37,560 --> 00:03:39,800 AFTER DELIVERY. 88 00:03:39,800 --> 00:03:41,600 SINCE ITS INCEPTION, THE 89 00:03:41,600 --> 00:03:43,360 "IMPROVE" INITIATIVE HAS RALLIED 90 00:03:43,360 --> 00:03:46,200 THE DISTINCT INSTITUTES, CENTERS 91 00:03:46,200 --> 00:03:48,080 AND OFFICES OF NIH TO SUPPORT 92 00:03:48,080 --> 00:03:52,920 RESEARCH AND IMPROVE'S MISSION 93 00:03:52,920 --> 00:03:57,160 TO REDUCE PREVENTABLE MORTALITY 94 00:03:57,160 --> 00:04:00,120 AND PROMOTE HEALTH EQUITY. 95 00:04:00,120 --> 00:04:00,760 THROUGH THIS CROSS-NIH 96 00:04:00,760 --> 00:04:03,520 INITIATIVE WE PLACE A SPECIAL 97 00:04:03,520 --> 00:04:05,400 EMPHASIS ON HEALTH DISPARITIES. 98 00:04:05,400 --> 00:04:08,000 THE POPULATIONS THAT ARE ARE 99 00:04:08,000 --> 00:04:10,640 DISPROPORTIONATELY AFFECTED BY 100 00:04:10,640 --> 00:04:12,360 HIGH RATES OF PREGNANCY-RELATED 101 00:04:12,360 --> 00:04:12,840 COMPLICATIONS AND DEATH 102 00:04:12,840 --> 00:04:16,760 INCLUDING RACIAL AND ETHNIC 103 00:04:16,760 --> 00:04:17,880 MINORITY POPULATIONS, VERY YOUNG 104 00:04:17,880 --> 00:04:21,320 WOMEN, WOMEN OF ADVANTAGESSED 105 00:04:21,320 --> 00:04:22,440 MATERNAL -- ADVANCED MATERNAL 106 00:04:22,440 --> 00:04:24,400 AGE AND PEOPLE WITH 107 00:04:24,400 --> 00:04:24,800 DISABILITIES. 108 00:04:24,800 --> 00:04:26,360 THE INITIATIVE HAS BEEN DESIGNED 109 00:04:26,360 --> 00:04:30,560 TO RECOGNIZE AND ADDRESS THE 110 00:04:30,560 --> 00:04:31,760 REALITY THAT PREGNANCY-RELATED 111 00:04:31,760 --> 00:04:33,960 COMPLICATION AND DEATHS NOT ONLY 112 00:04:33,960 --> 00:04:38,200 OCCUR DURING BIRTH BUT ALSO 113 00:04:38,200 --> 00:04:40,200 PRENATAL AND POSTPARTUM PERIODS. 114 00:04:40,200 --> 00:04:44,640 NEXT SLIDE PLEASE. 115 00:04:44,640 --> 00:04:45,760 ADDITIONALLY, THE "IMPROVE" 116 00:04:45,760 --> 00:04:47,640 INITIATIVE RECOGNIZES THE 117 00:04:47,640 --> 00:04:48,480 REALITY THAT PREGNANCY-RELATED 118 00:04:48,480 --> 00:04:50,240 COMPLICATION AND DEATH OCCUR NOT 119 00:04:50,240 --> 00:04:52,000 ONLY DURING BIRTH BUT ALSO AGAIN 120 00:04:52,000 --> 00:04:55,160 AS I SAID DURING THE PRENATAL 121 00:04:55,160 --> 00:04:58,000 AND POSTNATAL PERIODS. 122 00:04:58,000 --> 00:05:00,080 NEXT SLIDE PLEASE. 123 00:05:00,080 --> 00:05:03,800 IN FISCAL YEAR 2020, NIH AWARDED 124 00:05:03,800 --> 00:05:06,120 OVER $7 MILLION TO SUPPORT 36 125 00:05:06,120 --> 00:05:07,760 PROJECTS THROUGH IMPROVE, TO 126 00:05:07,760 --> 00:05:09,520 RAPIDLY ENHANCE OUR 127 00:05:09,520 --> 00:05:11,920 UNDERSTANDING OF AND MITIGATION 128 00:05:11,920 --> 00:05:16,080 STRATEGIES FOR LEADING CAUSES OF 129 00:05:16,080 --> 00:05:17,400 PREGNANCY-RELATED MORBIDITY 130 00:05:17,400 --> 00:05:20,760 THROUGH ONE YEAR POSTPARTUM. 131 00:05:20,760 --> 00:05:23,080 THESE PROJECTS FOCUS ON MAJOR 132 00:05:23,080 --> 00:05:25,800 DRIVERS OF MORTALITY, INCLUDING 133 00:05:25,800 --> 00:05:27,360 THOSE RELATED TO CARDIOVASCULAR 134 00:05:27,360 --> 00:05:29,320 AND MENTAL HEALTH CONDITIONS. 135 00:05:29,320 --> 00:05:32,800 THE NEXT YEAR NIH CONTINUED TO 136 00:05:32,800 --> 00:05:33,760 SUPPORT RESEARCHERS AND 137 00:05:33,760 --> 00:05:36,400 CLINICIANS THROUGH IMPROVE BY 138 00:05:36,400 --> 00:05:38,760 AWARDING OVER $13 MILLION, TO 139 00:05:38,760 --> 00:05:41,000 SUPPORT 22 PROJECTS THAT 140 00:05:41,000 --> 00:05:43,280 EXAMINED LEADING CAUSES OF 141 00:05:43,280 --> 00:05:45,160 MATERNAL MORBIDITY AND MORTALITY 142 00:05:45,160 --> 00:05:46,800 INCLUDING IMPACT OF COVID-19 AS 143 00:05:46,800 --> 00:05:51,160 WELL AS IMPACT OF STRUCTURAL 144 00:05:51,160 --> 00:05:53,240 RACISM AND DISCRIMINATION, ON 145 00:05:53,240 --> 00:05:54,800 MATERNAL HEALTH OUTCOME IN 146 00:05:54,800 --> 00:05:56,520 CONTEXT OF COVID-19. 147 00:05:56,520 --> 00:05:57,280 SO DURING TODAY'S WORKSHOP WE'LL 148 00:05:57,280 --> 00:05:59,680 HEAR SOME OF THE KEY FINDINGS 149 00:05:59,680 --> 00:06:02,920 FROM A NUMBER OF THESE PROJECTS, 150 00:06:02,920 --> 00:06:04,200 AS RESEARCHERS REVIEW MAJOR 151 00:06:04,200 --> 00:06:07,800 RESULTS AND LESSONS LEARNED FROM 152 00:06:07,800 --> 00:06:09,120 THEIR IMPROVE-FUNDED PROJECTS. 153 00:06:09,120 --> 00:06:11,960 AND WITH THE RECENT 154 00:06:11,960 --> 00:06:12,720 CONGRESSIONAL APPROPRIATION OF 155 00:06:12,720 --> 00:06:15,520 $30 MILLION IN FISCAL YEAR 22, 156 00:06:15,520 --> 00:06:17,840 TO SUPPORT THE "IMPROVE" 157 00:06:17,840 --> 00:06:19,600 INITIATIVE, WE LOOK FORWARD TO 158 00:06:19,600 --> 00:06:21,680 SHOWCASING SEVERAL MORE STUDIES 159 00:06:21,680 --> 00:06:24,440 AND FUTURE WORKSHOPS. 160 00:06:24,440 --> 00:06:26,040 NEXT SLIDE PLEASE. 161 00:06:26,040 --> 00:06:27,480 SO WHILE SUPPORTING RESEARCH 162 00:06:27,480 --> 00:06:30,000 STUDIES IN THE AREAS OF MATERNAL 163 00:06:30,000 --> 00:06:31,640 MORBIDITY AND MORTALITY IS A 164 00:06:31,640 --> 00:06:33,400 LARGE COMPONENT OF IMPROVE THE 165 00:06:33,400 --> 00:06:36,320 INITIATIVE IS IN FACT DIVIDED 166 00:06:36,320 --> 00:06:38,880 INTO SIX COMPONENTS. 167 00:06:38,880 --> 00:06:39,800 THE DISSEMINATION AND 168 00:06:39,800 --> 00:06:40,920 IMPLEMENTATION RESEARCH NOTICE 169 00:06:40,920 --> 00:06:43,040 OF SPECIAL INTEREST IS THE 170 00:06:43,040 --> 00:06:44,000 PRIMARY FUNDING MECHANISM FOR 171 00:06:44,000 --> 00:06:46,640 THE PROJECT THAT YOU WILL HEAR 172 00:06:46,640 --> 00:06:49,040 ABOUT TODAY. 173 00:06:49,040 --> 00:06:50,680 THE CONNECT-A-THON ENGAGES 174 00:06:50,680 --> 00:06:52,200 STAKEHOLDER COMMUNITIES TO 175 00:06:52,200 --> 00:06:56,040 DEVELOP ELECTRONIC HEALTH RECORD 176 00:06:56,040 --> 00:06:56,840 STANDARDS, ESTABLISH 177 00:06:56,840 --> 00:06:59,440 LONGITUDINAL MATERNAL HEALTH 178 00:06:59,440 --> 00:07:05,800 RECORDS AND ENABLE AUTOMATED TO 179 00:07:05,800 --> 00:07:08,000 LINK MATERNAL-CHILD HEALTH 180 00:07:08,000 --> 00:07:08,840 RECORDS. 181 00:07:08,840 --> 00:07:09,480 RAPID ACCELERATION OF 182 00:07:09,480 --> 00:07:14,920 DIAGNOSTICS AIMS TO ACCELERATE 183 00:07:14,920 --> 00:07:16,240 DEVELOPMENT OF MATERNAL HEALTH 184 00:07:16,240 --> 00:07:18,320 DIAGNOSTIC AND REMOTE SENSING 185 00:07:18,320 --> 00:07:22,920 TECHNOLOGIES TO REDUCE 186 00:07:22,920 --> 00:07:24,560 DISPARITIES AND CARE DESERTS. 187 00:07:24,560 --> 00:07:27,800 THE PROGRAM AIMS TO STUDY USE OF 188 00:07:27,800 --> 00:07:29,680 STRATEGIES TO ADOPT AND 189 00:07:29,680 --> 00:07:32,440 INTEGRATE INTERVENTIONS OF KNOWN 190 00:07:32,440 --> 00:07:34,440 EFFICACY AND EFFECTIVENESS INTO 191 00:07:34,440 --> 00:07:37,280 COMMUNITY SETTINGS, TO IMPROVE 192 00:07:37,280 --> 00:07:39,080 MATERNAL HEALTH OUTCOMES. 193 00:07:39,080 --> 00:07:42,400 THE CONNECTING THE COMMUNITY FOR 194 00:07:42,400 --> 00:07:44,280 MATERNAL HEALTH CHALLENGE 195 00:07:44,280 --> 00:07:45,720 FOCUSES ON BUILDING RESEARCH 196 00:07:45,720 --> 00:07:47,680 INFRASTRUCTURE AND CAPACITY FOR 197 00:07:47,680 --> 00:07:49,520 NON-PROFIT ORGANIZATIONS SEEKING 198 00:07:49,520 --> 00:07:51,960 TO ADVANCE MATERNAL HEALTH 199 00:07:51,960 --> 00:07:52,360 RESEARCH. 200 00:07:52,360 --> 00:07:53,880 AND FINALLY, THE MATERNAL HEALTH 201 00:07:53,880 --> 00:07:55,840 RESEARCH CENTERS OF EXCELLENCE 202 00:07:55,840 --> 00:07:58,160 WILL ULTIMATELY UNIFY EACH OF 203 00:07:58,160 --> 00:08:00,800 THE "IMPROVE" INITIATIVE WORK 204 00:08:00,800 --> 00:08:04,800 STREAMS TO INTEGRATE BIOLOGICAL 205 00:08:04,800 --> 00:08:05,840 AND BIOPSYCHOSOCIAL RESEARCH 206 00:08:05,840 --> 00:08:07,440 WITH PROJECTS THAT INCORPORATE 207 00:08:07,440 --> 00:08:11,600 LOCAL COMMUNITY NEEDS AND 208 00:08:11,600 --> 00:08:11,920 PERSPECTIVES. 209 00:08:11,920 --> 00:08:12,720 NEXT SLIDE PLEASE. 210 00:08:12,720 --> 00:08:16,200 NOW I'D LIKE TO SHARE A LITTLE 211 00:08:16,200 --> 00:08:18,640 BIT ABOUT NIMR AND OUR 212 00:08:18,640 --> 00:08:19,120 ENGAGEMENT. 213 00:08:19,120 --> 00:08:20,840 FOR THOSE WHO MAY NOT BE 214 00:08:20,840 --> 00:08:24,960 FAMILIAR WITH U.S., NINR'S 215 00:08:24,960 --> 00:08:27,360 MISSION TO TO LEAD RESEARCH TO 216 00:08:27,360 --> 00:08:29,280 SOLVE CHALLENGES AND INFORM 217 00:08:29,280 --> 00:08:30,440 PRACTICE AND POLICY, OPTIMIZING 218 00:08:30,440 --> 00:08:32,680 HEALTH AND ADVANCING HEALTH 219 00:08:32,680 --> 00:08:34,520 EQUITY INTO THE FUTURE. 220 00:08:34,520 --> 00:08:37,040 WE SUPPORT NURSING SCIENCE THAT 221 00:08:37,040 --> 00:08:39,240 VIEWS HEALTH AND HEALTH CARE 222 00:08:39,240 --> 00:08:41,400 THROUGH FIVE RESEARCH LENSES, 223 00:08:41,400 --> 00:08:43,480 INCLUDING HEALTH EQUITY, SOCIAL 224 00:08:43,480 --> 00:08:44,680 DETERMINANTS OF HEALTH, 225 00:08:44,680 --> 00:08:46,640 POPULATION AND COMMUNITY HEALTH, 226 00:08:46,640 --> 00:08:48,320 PREVENTION AND HEALTH PROMOTION, 227 00:08:48,320 --> 00:08:49,920 AND SYSTEMS AND MODELS OF CARE. 228 00:08:49,920 --> 00:08:52,760 AND WE ARE VERY PROUD TO BE 229 00:08:52,760 --> 00:08:55,760 HELPING TO LEAD IMPROVE WHICH IS 230 00:08:55,760 --> 00:08:59,480 SUCH AN IMPORTANT INITIATIVE. 231 00:08:59,480 --> 00:09:00,760 NEXT SLIDE PLEASE. 232 00:09:00,760 --> 00:09:01,800 MATERNAL HEALTH AND MORBIDITY 233 00:09:01,800 --> 00:09:05,280 ARE ISSUES THAT CUT ACROSS THE 234 00:09:05,280 --> 00:09:07,160 NINR RESEARCH LENSES AND WE 235 00:09:07,160 --> 00:09:08,840 SUPPORT STUDIES UNDER IMPROVE. 236 00:09:08,840 --> 00:09:11,840 ONE OF THEM WILL FOR THE FIRST 237 00:09:11,840 --> 00:09:13,440 TIME EVALUATE THE IMPLEMENTATION 238 00:09:13,440 --> 00:09:18,640 OF A REMOTE ACCESS ON DEMAND 239 00:09:18,640 --> 00:09:22,120 PERINATAL DEPRESSION PREVENTION 240 00:09:22,120 --> 00:09:23,480 PROGRAM EMBEDDED IN THE PATIENT 241 00:09:23,480 --> 00:09:26,200 PORTAL OF A LARGE SYSTEM. 242 00:09:26,200 --> 00:09:32,360 ANOTHER STUDY EXAMINES HOW 243 00:09:32,360 --> 00:09:36,280 PERSISTENT CARE SHORTAGES IMPACT 244 00:09:36,280 --> 00:09:38,680 MATERNAL MORTALITY AND 245 00:09:38,680 --> 00:09:39,000 MORBIDITY. 246 00:09:39,000 --> 00:09:39,880 MORE SPECIFICALLY INVESTIGATORS 247 00:09:39,880 --> 00:09:43,960 ARE LOOKING AT WHETHER RECENT 248 00:09:43,960 --> 00:09:46,320 INTERVENTIONS AND EXPANSION OF 249 00:09:46,320 --> 00:09:47,640 THE NATIONAL HEALTH SERVICE 250 00:09:47,640 --> 00:09:49,280 CORPS IS HELPING REDUCE 251 00:09:49,280 --> 00:09:51,800 DISPARITIES IN MATERNAL CARE AND 252 00:09:51,800 --> 00:09:54,000 OUTCOMES BETWEEN SHORTAGE AREAS 253 00:09:54,000 --> 00:09:56,720 AND OTHER AREAS. 254 00:09:56,720 --> 00:09:58,920 NEXT SLIDE PLEASE. 255 00:09:58,920 --> 00:10:01,640 A THIRD STUDY BEING SUPPORTED 256 00:10:01,640 --> 00:10:03,760 UNDER IMPROVE IS USING 257 00:10:03,760 --> 00:10:07,240 INNOVATIVE APPROACH TO 258 00:10:07,240 --> 00:10:08,800 UNDERSTAND BIOLOGICAL 259 00:10:08,800 --> 00:10:10,560 SPECIFICALLY IMMUNOLOGICAL AND 260 00:10:10,560 --> 00:10:11,600 SOCIOCULTURAL FACTORS THAT 261 00:10:11,600 --> 00:10:14,360 CONTRIBUTE TO OVERALL MORTALITY 262 00:10:14,360 --> 00:10:16,800 AND SEVERE MATERNAL MORBIDITY. 263 00:10:16,800 --> 00:10:19,320 INVESTIGATORS WILL DETERMINE HOW 264 00:10:19,320 --> 00:10:20,520 MATERNAL STRESS AFFECTED IMMUNE 265 00:10:20,520 --> 00:10:20,920 FUNCTION. 266 00:10:20,920 --> 00:10:23,600 A FOURTH STUDY IS EXAMINING 267 00:10:23,600 --> 00:10:27,320 IMPACT OF THE COVID-19 PANDEMIC 268 00:10:27,320 --> 00:10:30,160 ON PREGNANT AND POSTPARTUM 269 00:10:30,160 --> 00:10:31,920 WOMEN, WITH LOW INCOME MOTHERS 270 00:10:31,920 --> 00:10:33,320 IN LOUISIANA, INVESTIGATORS ARE 271 00:10:33,320 --> 00:10:37,840 LOOKING AT HOW THE PANDEMIC 272 00:10:37,840 --> 00:10:40,160 AFFECTED WEIGHT GAIN, ADVERSE 273 00:10:40,160 --> 00:10:40,960 OUTCOMES, PERINATAL MENTAL 274 00:10:40,960 --> 00:10:41,400 HEALTH. 275 00:10:41,400 --> 00:10:44,280 THE GOAL IS TO USE THE FINDINGS 276 00:10:44,280 --> 00:10:46,880 TO DEVICE STRATEGIES AND 277 00:10:46,880 --> 00:10:49,560 SOLUTIONS THAT IMPROVE PERINATAL 278 00:10:49,560 --> 00:10:51,640 OUTCOMES DURING THIS PANDEMIC 279 00:10:51,640 --> 00:10:55,480 AND FUTURE DISASTERS. 280 00:10:55,480 --> 00:10:56,800 NEXT SLIDE PLEASE. 281 00:10:56,800 --> 00:10:58,320 ANOTHER NINR INITIATIVE I'M 282 00:10:58,320 --> 00:11:01,080 EXCITED TO TELL YOU ABOUT IS ONE 283 00:11:01,080 --> 00:11:04,320 IN WHICH WE SUPPORT MATERNAL 284 00:11:04,320 --> 00:11:05,680 HEALTH, AND CALLED ADVANCING 285 00:11:05,680 --> 00:11:08,120 INTEGRATED MODELS OF CARE TO 286 00:11:08,120 --> 00:11:09,920 IMPROVE MATERNAL HEALTH OUTCOMES 287 00:11:09,920 --> 00:11:12,760 AMONG WOMEN WHO EXPERIENCE 288 00:11:12,760 --> 00:11:15,400 PERSISTENT DISPARITIES, OR AIM. 289 00:11:15,400 --> 00:11:17,920 FOCUS ON IDENTIFYING SOLUTIONS, 290 00:11:17,920 --> 00:11:19,680 THIS INITIATIVE SUPPORTS 291 00:11:19,680 --> 00:11:21,640 INTERVENTION RESEARCH TO 292 00:11:21,640 --> 00:11:23,120 DEVELOP, IMPLEMENT, AND EVALUATE 293 00:11:23,120 --> 00:11:24,840 INTEGRATED MODELS OF SUPPORTIVE 294 00:11:24,840 --> 00:11:27,320 CARE THAT ADDRESS STRUCTURAL AND 295 00:11:27,320 --> 00:11:29,280 SOCIAL INEQUITIES, TO PREVENT 296 00:11:29,280 --> 00:11:31,080 ADVERSE MATERNAL HEALTH OUTCOMES 297 00:11:31,080 --> 00:11:32,120 AND DISPARITIES. 298 00:11:32,120 --> 00:11:34,560 TO DATE WE FUNDED SEVEN PROJECTS 299 00:11:34,560 --> 00:11:36,160 ACROSS THE COUNTRY THROUGH THIS 300 00:11:36,160 --> 00:11:38,280 INITIATIVE AND I'M HAPPY TO 301 00:11:38,280 --> 00:11:40,240 REPORT THAT THIS FUNDING 302 00:11:40,240 --> 00:11:41,480 OPPORTUNITY WAS JUST REISSUED. 303 00:11:41,480 --> 00:11:44,000 WE LOOK FORWARD TO SUPPORTING 304 00:11:44,000 --> 00:11:46,560 EVEN MORE CUTTING-EDGE RESEARCH 305 00:11:46,560 --> 00:11:51,400 THAT WILL HELP ELIMINATE HEALTH 306 00:11:51,400 --> 00:11:51,680 DISPARITIES. 307 00:11:51,680 --> 00:11:54,120 I KNOW THAT EVERYONE HERE TODAY 308 00:11:54,120 --> 00:11:58,040 JOINS NINR IN OUR DEDICATION TO 309 00:11:58,040 --> 00:11:59,440 SOLVING PREGNANCY-RELATED HEALTH 310 00:11:59,440 --> 00:11:59,920 CHALLENGES AND ENDING 311 00:11:59,920 --> 00:12:00,240 DISPARITIES. 312 00:12:00,240 --> 00:12:01,640 I WANT TO THANK YOU FOR YOUR 313 00:12:01,640 --> 00:12:03,840 COMMITMENT TO YOUR RESEARCH AND 314 00:12:03,840 --> 00:12:10,120 TO THE PEOPLE WHO MAY BENEFIT. 315 00:12:10,120 --> 00:12:15,720 I'LL HAND OVER TO THE FIRST 316 00:12:15,720 --> 00:12:17,360 MODERATOR TO BEGIN OUR FIRST 317 00:12:17,360 --> 00:12:20,280 SESSION OF THE DAY. 318 00:12:20,280 --> 00:12:20,520 NAHITA? 319 00:12:20,520 --> 00:12:26,800 >>THANK YOU, DR. ZENK. 320 00:12:26,800 --> 00:12:36,280 I'M AT NICHD, PREGNANCY AND 321 00:12:36,280 --> 00:12:43,520 PERINATOLOGY Y BRANCH. 322 00:12:43,520 --> 00:12:44,720 I'LL INTRODUCE SPEAKERS AND TURN 323 00:12:44,720 --> 00:12:48,560 IT TO THE FIRST SPEAKER FOR HER 324 00:12:48,560 --> 00:12:49,960 PRESENTATION. 325 00:12:49,960 --> 00:12:56,200 FIRST PRESENTER IS DR. THERESA 326 00:12:56,200 --> 00:12:58,760 GENOVIK, A PROFESSOR AT THE 327 00:12:58,760 --> 00:13:00,720 ICAHN SCHOOL OF MEDICINE AT 328 00:13:00,720 --> 00:13:01,520 MOUNT SINAI. 329 00:13:01,520 --> 00:13:05,680 SHE WILL BE FOLLOWED BY DR. 330 00:13:05,680 --> 00:13:06,640 ANDREA ADLOW, SOCIAL PROFESSOR 331 00:13:06,640 --> 00:13:15,200 OF OBSTETRICS AT HARVARD. 332 00:13:15,200 --> 00:13:16,320 DR. HEIDI PRICE, ASSISTANT 333 00:13:16,320 --> 00:13:19,480 PROFESSOR OF RESEARCH DEPARTMENT 334 00:13:19,480 --> 00:13:24,160 OF OBSTETRICS AND REPRODUCTIVE 335 00:13:24,160 --> 00:13:26,360 MEDICINE, RENAISSANCE SCHOOL AT 336 00:13:26,360 --> 00:13:28,880 STONY BROOK AND DR. NATASHA 337 00:13:28,880 --> 00:13:31,920 DEJINA, ASSOCIATE PROFESSOR OF 338 00:13:31,920 --> 00:13:32,720 PSYCHIATRY, EPIDEMIOLOGY, 339 00:13:32,720 --> 00:13:33,800 UNIVERSITY OF PITTSBURGH. 340 00:13:33,800 --> 00:13:38,720 I WILL TURN IT NOW TO DR. TERESA 341 00:13:38,720 --> 00:13:40,560 JANEVIC FOR HER PRESENTATION. 342 00:13:40,560 --> 00:13:42,080 >>THANK YOU FOR THE 343 00:13:42,080 --> 00:13:42,440 INTRODUCTION. 344 00:13:42,440 --> 00:13:43,520 I APPRECIATE THE OPPORTUNITY TO 345 00:13:43,520 --> 00:13:45,760 BE PART OF THIS IMPORTANT 346 00:13:45,760 --> 00:13:46,840 CONVERSATION TODAY. 347 00:13:46,840 --> 00:13:50,880 I'M GOING TO TALK ABOUT OUR 348 00:13:50,880 --> 00:13:53,640 RESEARCH ON GENDERED RACIAL 349 00:13:53,640 --> 00:13:55,800 MICROAGGRESSION IN THE CONTEXT 350 00:13:55,800 --> 00:13:59,080 OF THE PANDEMIC, AND POSTPARTUM 351 00:13:59,080 --> 00:14:00,880 BLOOD PRESSURE. 352 00:14:00,880 --> 00:14:03,200 NEXT SLIDE PLEASE. 353 00:14:03,200 --> 00:14:06,120 THE CORONAVIRUS IMPACT ON BIRTH 354 00:14:06,120 --> 00:14:07,640 EQUITY, THE VIBE STUDY, CAME 355 00:14:07,640 --> 00:14:09,560 ABOUT AT THE ONSET OF THE 356 00:14:09,560 --> 00:14:11,800 PANDEMIC, MOST OF YOU ARE AWARE 357 00:14:11,800 --> 00:14:13,280 THAT HERE IN NEW YORK CITY WE 358 00:14:13,280 --> 00:14:17,320 WERE ONE OF THE FIRST EPICENTERS 359 00:14:17,320 --> 00:14:19,880 IN THE UNITED STATES OF THE 360 00:14:19,880 --> 00:14:20,120 PANDEMIC. 361 00:14:20,120 --> 00:14:22,200 AT ICAHN SCHOOL OF MEDICINE WE 362 00:14:22,200 --> 00:14:24,560 LAUNCHED A POSTPARTUM SURVEY TO 363 00:14:24,560 --> 00:14:27,720 UNDERSTAND BECAUSE WE WERE 364 00:14:27,720 --> 00:14:30,760 GRAVELY CONCERNED ABOUT BIRTHING 365 00:14:30,760 --> 00:14:32,800 PEOPLE'S EXPERIENCES DURING THE 366 00:14:32,800 --> 00:14:33,080 PANDEMIC. 367 00:14:33,080 --> 00:14:36,120 AND WE FOUND THAT WOMEN OF COLOR 368 00:14:36,120 --> 00:14:38,000 WERE MORE LIKELY TO REPORT 369 00:14:38,000 --> 00:14:38,960 EVERYDAY EXPERIENCES OF 370 00:14:38,960 --> 00:14:40,720 DISCRIMINATION DURING THE 371 00:14:40,720 --> 00:14:42,880 PANDEMIC THAN WHITE PATIENTS, 372 00:14:42,880 --> 00:14:44,400 AND IMPORTANTLY HIGHER INCIDENCE 373 00:14:44,400 --> 00:14:46,480 OF RACIAL HEALTH CARE 374 00:14:46,480 --> 00:14:48,440 DISCRIMINATION DURING DELIVERY 375 00:14:48,440 --> 00:14:51,000 AS WELL AS GREATER SYMPTOMS OF 376 00:14:51,000 --> 00:14:52,760 ANXIETY AND DEPRESSION. 377 00:14:52,760 --> 00:14:53,960 NEXT SLIDE PLEASE. 378 00:14:53,960 --> 00:14:57,240 THIS LED US TO APPLY TO THE 379 00:14:57,240 --> 00:14:59,880 "IMPROVE" INITIATIVE TO DIG OF 380 00:14:59,880 --> 00:15:00,320 DEEPER. 381 00:15:00,320 --> 00:15:03,160 SO THE OVERALL GOAL OF THE VIBE 382 00:15:03,160 --> 00:15:06,960 STUDY IS TO EXAMINE INFLUENCE OF 383 00:15:06,960 --> 00:15:09,280 STRUCTURAL INTERPERSONAL AND 384 00:15:09,280 --> 00:15:13,560 INTERNALIZED RACISM AS WELL AS 385 00:15:13,560 --> 00:15:16,960 COVID-19 EXPOSURES ON POSTPARTUM 386 00:15:16,960 --> 00:15:17,560 MATERNAL HEALTH, DRAWING FROM 387 00:15:17,560 --> 00:15:18,680 DR. JONES'S SUPER INFLUENTIAL 388 00:15:18,680 --> 00:15:22,000 FRAMEWORK OF LEVELS OF RACISM. 389 00:15:22,000 --> 00:15:24,400 TODAY'S FOCUS IS GOING TO BE ON 390 00:15:24,400 --> 00:15:27,120 A VERY IMPORTANT OUTCOME FOR 391 00:15:27,120 --> 00:15:28,560 MATERNAL MORTALITY, WHICH IS 392 00:15:28,560 --> 00:15:29,400 POSTPARTUM BLOOD PRESSURE. 393 00:15:29,400 --> 00:15:33,320 AND I'M GOING TO SHOW SOME 394 00:15:33,320 --> 00:15:37,400 FINDINGS REGARDING THE QUESTION 395 00:15:37,400 --> 00:15:38,600 ARE GENDERED RACIAL MICRO 396 00:15:38,600 --> 00:15:39,800 AGGRESSION ASSOCIATED WITH 397 00:15:39,800 --> 00:15:42,000 DIFFERENCE IN POSTPARTUM BLOOD 398 00:15:42,000 --> 00:15:45,720 PRESSURE IN NON-WHITE WOMEN, AND 399 00:15:45,720 --> 00:15:46,480 DOES EXPERIENCING 400 00:15:46,480 --> 00:15:48,120 COVID-19-RELATED ECONOMIC STRESS 401 00:15:48,120 --> 00:15:50,960 MAGNIFY THESE ASSOCIATIONS. 402 00:15:50,960 --> 00:15:53,240 NEXT SLIDE PLEASE. 403 00:15:53,240 --> 00:15:54,720 THE STUDY TOOK PLACE IN 404 00:15:54,720 --> 00:15:58,200 PHILADELPHIA AND NEW YORK CITY, 405 00:15:58,200 --> 00:16:01,680 FOUR HOSPITALS, AND WE ENROLLED 406 00:16:01,680 --> 00:16:03,240 WOMEN IN POSTPARTUM UNITS AT 407 00:16:03,240 --> 00:16:06,320 DELIVERY FROM APRIL TO OCTOBER 408 00:16:06,320 --> 00:16:08,920 IN 2022 AND FOLLOWED THEM FOR 409 00:16:08,920 --> 00:16:11,760 THREE MONTHS POSTPARTUM. 410 00:16:11,760 --> 00:16:14,000 ELIGIBLE PEOPLE IDENTIFIED AS 411 00:16:14,000 --> 00:16:16,160 BLACK HISPANIC OR ASIAN SPOKE 412 00:16:16,160 --> 00:16:18,160 ENGLISH OR SPANISH, HAD A 413 00:16:18,160 --> 00:16:19,360 WORKING CELL PHONE. 414 00:16:19,360 --> 00:16:23,080 YOU CAN SEE OUR STUDY KIT ON THE 415 00:16:23,080 --> 00:16:25,440 RIGHT. 416 00:16:25,440 --> 00:16:29,520 NEXT SLIDE PLEASE. 417 00:16:29,520 --> 00:16:32,600 THE LEFT YOU'LL SEE THE 418 00:16:32,600 --> 00:16:34,040 DEMOGRAPHIC RACIAL/ETHNIC 419 00:16:34,040 --> 00:16:37,080 BACKGROUND FOR THE NEW YORK CITY 420 00:16:37,080 --> 00:16:37,320 HOSPITALS. 421 00:16:37,320 --> 00:16:38,240 THEY WERE TWO PUBLIC HOSPITALS 422 00:16:38,240 --> 00:16:40,520 IN NEW YORK CITY THAT ARE 423 00:16:40,520 --> 00:16:41,400 AFFILIATES OF MOUNT SINAI AS 424 00:16:41,400 --> 00:16:44,720 WELL AS TWO OF THE UNIVERSITY OF 425 00:16:44,720 --> 00:16:46,040 PENNSYLVANIA HOSPITALS. 426 00:16:46,040 --> 00:16:50,560 HERE IN OUR NEW YORK HOSPITALS, 427 00:16:50,560 --> 00:16:52,560 THE POPULATION WAS MAJORITY 428 00:16:52,560 --> 00:16:55,720 REPRESENTED BY HISPANIC AND IN 429 00:16:55,720 --> 00:17:00,520 PENNSYLVANIA MAJORITY BLACK. 430 00:17:00,520 --> 00:17:02,680 NEXT SLIDE PLEASE. 431 00:17:02,680 --> 00:17:06,000 AT BASELINE IN THE HOSPITAL WE 432 00:17:06,000 --> 00:17:08,280 HAD PEOPLE CREATE AN ONLINE -- 433 00:17:08,280 --> 00:17:11,240 EXCUSE ME COMPLETE AND ONLINE 434 00:17:11,240 --> 00:17:13,680 SURVEY AND PARTICIPATED IN A 435 00:17:13,680 --> 00:17:17,200 HOME TEXT-BASED BLOOD PRESSURE 436 00:17:17,200 --> 00:17:19,600 MONITORING SYSTEM, CALLED WAY TO 437 00:17:19,600 --> 00:17:21,480 HEALTH, AND THIS TEXT MESSAGING 438 00:17:21,480 --> 00:17:23,200 SYSTEM PROMPTED THEM TO TAKE 439 00:17:23,200 --> 00:17:25,120 THEIR BLOOD PRESSURE IN THE 440 00:17:25,120 --> 00:17:30,000 FIRST WEEK DAILY TWO TIMES, AND 441 00:17:30,000 --> 00:17:31,280 UP THROUGH THREE MONTHS, TWICE 442 00:17:31,280 --> 00:17:34,040 WEEKLY AND EXIT SURVEY AT THREE 443 00:17:34,040 --> 00:17:34,440 MONTHS. 444 00:17:34,440 --> 00:17:39,720 NEXT SLIDE PLEASE. 445 00:17:39,720 --> 00:17:41,680 THIS TO OUR KNOWLEDGE IS THE 446 00:17:41,680 --> 00:17:49,120 FIRST STUDY TO USE THE GENDERED 447 00:17:49,120 --> 00:17:50,760 RACIAL MICRO AGGRESSION SCALE IN 448 00:17:50,760 --> 00:17:52,080 THIS CONTEXT WORKING WITH A 449 00:17:52,080 --> 00:17:53,960 COMMUNITY EXPERT PANEL TO THINK 450 00:17:53,960 --> 00:17:56,360 ABOUT WHICH QUESTIONS WERE 451 00:17:56,360 --> 00:17:57,880 RELEVANT FOR THIS CONTEXT, AND 452 00:17:57,880 --> 00:17:59,960 WHAT WOULD BE RELEVANT FOR 453 00:17:59,960 --> 00:18:01,720 OBSTETRIC CARE. 454 00:18:01,720 --> 00:18:03,800 SO IN SHORT, THE SCALE ASKED 455 00:18:03,800 --> 00:18:05,320 PARTICIPANTS HOW FREQUENTLY THEY 456 00:18:05,320 --> 00:18:07,760 EXPERIENCED MICRO AGGRESSION 457 00:18:07,760 --> 00:18:09,400 SUCH AS FEELING UNHEARD, BEING 458 00:18:09,400 --> 00:18:10,800 IGNORED, BEING PUT IN THEIR 459 00:18:10,800 --> 00:18:12,680 PLACE, ET CETERA. 460 00:18:12,680 --> 00:18:14,520 AND WE DID CONDUCT PSYCHOMETRIC 461 00:18:14,520 --> 00:18:16,720 ANALYSES WHICH I WON'T PRESENT 462 00:18:16,720 --> 00:18:18,920 TODAY BUT WE FOUND THAT THE 463 00:18:18,920 --> 00:18:21,200 SCALE PERFORMED SIMILARLY IN OUR 464 00:18:21,200 --> 00:18:25,240 BLACK AND HISPANIC SUBGROUPS. 465 00:18:25,240 --> 00:18:27,440 NEXT SLIDE PLEASE. 466 00:18:27,440 --> 00:18:30,400 FOR COVID-19 ECONOMIC STRESS WE 467 00:18:30,400 --> 00:18:33,440 DREW FROM THREE QUESTIONS, TWO 468 00:18:33,440 --> 00:18:36,040 ASKED ABOUT HOUSING AND FOOD 469 00:18:36,040 --> 00:18:39,040 INSECURITY, AND THE THIRD ASKED 470 00:18:39,040 --> 00:18:40,560 ABOUT OVERALL DISTRESS DUE TO 471 00:18:40,560 --> 00:18:46,880 FINANCIAL EMPLOYMENT IMPACTS OF 472 00:18:46,880 --> 00:18:47,160 COVID-19. 473 00:18:47,160 --> 00:18:47,920 GROUPS TOGETHER HIGHLY EXPOSED 474 00:18:47,920 --> 00:18:49,760 THOSE WHO ANSWERED IN THE HIGH 475 00:18:49,760 --> 00:18:55,440 END ANY OF THESE QUESTIONS. 476 00:18:55,440 --> 00:18:57,840 NEXT SLIDE PLEASE. 477 00:18:57,840 --> 00:19:00,280 WE FOLLOWED CONCEPTUAL FRAMEWORK 478 00:19:00,280 --> 00:19:05,160 IN WHICH WE PLACED BOTH GENDERED 479 00:19:05,160 --> 00:19:07,800 RACIAL MICROAGGRESSION DURING 480 00:19:07,800 --> 00:19:09,680 OBSTETRIC CARE AND CONTEXT OF 481 00:19:09,680 --> 00:19:11,840 ECONOMIC STRESS AS PART OF THE 482 00:19:11,840 --> 00:19:15,680 FRAMEWORK OF STRUCTURAL RACISM 483 00:19:15,680 --> 00:19:19,080 DURING THE PANDEMIC, OVERLAID ON 484 00:19:19,080 --> 00:19:21,160 EXISTING STRUCTURES OF RACIAL, 485 00:19:21,160 --> 00:19:23,320 GENDER, ECONOMIC INEQUALITY, AND 486 00:19:23,320 --> 00:19:27,600 THEN WE PROPOSED THAT THROUGH 487 00:19:27,600 --> 00:19:29,280 EMBODIMENT AND DIFFERENT 488 00:19:29,280 --> 00:19:31,680 DISRUPTION OF PHYSIOLOGIC 489 00:19:31,680 --> 00:19:36,040 SYSTEMS THIS WOULD AFFECT 490 00:19:36,040 --> 00:19:36,640 POSTPARTUM SYSTOLIC AND 491 00:19:36,640 --> 00:19:38,320 DIASTOLIC BLOOD PRESSURE. 492 00:19:38,320 --> 00:19:40,200 NEXT SLIDE PLEASE. 493 00:19:40,200 --> 00:19:42,040 LINEAR MIXED MODELS USED 494 00:19:42,040 --> 00:19:43,040 REPEATED MEASURES OF BLOOD 495 00:19:43,040 --> 00:19:45,240 PRESSURE, TO LOOK AT 496 00:19:45,240 --> 00:19:48,000 ASSOCIATIONS BETWEEN GENDERED 497 00:19:48,000 --> 00:19:50,520 RACIAL MICROAGGRESSION AND THE 498 00:19:50,520 --> 00:19:51,480 COVID ECONOMIC STRESS WITH 499 00:19:51,480 --> 00:19:52,800 POSTPARTUM BLOOD PRESSURE. 500 00:19:52,800 --> 00:19:56,280 AND THEN IMPORTANTLY WE LOOKED 501 00:19:56,280 --> 00:19:59,600 AT IF THE ASSOCIATION BETWEEN 502 00:19:59,600 --> 00:20:02,320 THE MICROAGGRESSIONS AND BLOOD 503 00:20:02,320 --> 00:20:05,520 PRESSURE WAS INTENSIFIED BY 504 00:20:05,520 --> 00:20:06,840 COVID-19 STRESS. 505 00:20:06,840 --> 00:20:09,080 ALSO IF IT WAS WORSE IN WOMEN 506 00:20:09,080 --> 00:20:12,840 WHO WERE HIGH RISK DUE TO 507 00:20:12,840 --> 00:20:15,360 HYPERTENSIVE DISORDERS OF 508 00:20:15,360 --> 00:20:16,840 PREGNANCY. 509 00:20:16,840 --> 00:20:17,840 NEXT SLIDE PLEASE. 510 00:20:17,840 --> 00:20:20,920 ABOUT A THIRD OF PARTICIPANTS 511 00:20:20,920 --> 00:20:23,080 OVERALL REPORTED EXPERIENCING AT 512 00:20:23,080 --> 00:20:24,880 LEAST ONE GENDERED RACIAL 513 00:20:24,880 --> 00:20:26,320 MICROAGGRESSION DURING PREGNANCY 514 00:20:26,320 --> 00:20:28,280 OR DELIVERY CARE, THE MOST 515 00:20:28,280 --> 00:20:30,240 COMMON ITEM ALTHOUGH ALL HAD 516 00:20:30,240 --> 00:20:33,600 SOME FREQUENCY WERE FEELING 517 00:20:33,600 --> 00:20:34,280 UNHEARD, COMMENTING IGNORED, 518 00:20:34,280 --> 00:20:35,680 TOLD TO CALM DOWN. 519 00:20:35,680 --> 00:20:38,320 OVER A QUARTER OF SAMPLE 520 00:20:38,320 --> 00:20:39,160 REPORTED HIGH ECONOMIC STRESS, 521 00:20:39,160 --> 00:20:41,240 AND ABOUT A QUARTER FELL INTO 522 00:20:41,240 --> 00:20:43,800 THAT HIGH RISK CATEGORY OF 523 00:20:43,800 --> 00:20:47,200 HAVING EITHER PRE-PREGNANCY 524 00:20:47,200 --> 00:20:49,240 GESTATIONAL HYPERTENSION OR 525 00:20:49,240 --> 00:20:51,440 PREECLAMPSIA. 526 00:20:51,440 --> 00:20:53,840 NEXT SLIDE PLEASE. 527 00:20:53,840 --> 00:20:56,040 IN BOLD YOU'LL SEE THE RESULTS 528 00:20:56,040 --> 00:21:04,120 SO WOMEN WHO DID EXPERIENCE 529 00:21:04,120 --> 00:21:05,800 GENDERED RACIAL MICROAGGRESSION 530 00:21:05,800 --> 00:21:07,120 ADJUSTED FOR FACTORS TWO 531 00:21:07,120 --> 00:21:08,520 MILLIMETERS OF MERCURY HIGHER 532 00:21:08,520 --> 00:21:12,920 BLOOD PRESSURE THAN THOSE WHO 533 00:21:12,920 --> 00:21:13,680 DIDN'T. 534 00:21:13,680 --> 00:21:16,960 THIS WAS SIGNIFICANT FOR BOTH 535 00:21:16,960 --> 00:21:18,040 SYSTOLIC AND DIASTOLIC BLOOD 536 00:21:18,040 --> 00:21:18,400 PRESSURE. 537 00:21:18,400 --> 00:21:20,440 COVID ECONOMIC STRESS HOWEVER 538 00:21:20,440 --> 00:21:21,440 WAS NOT ASSOCIATED WITH BLOOD 539 00:21:21,440 --> 00:21:28,360 PRESSURE AND WE DID NOT FIND 540 00:21:28,360 --> 00:21:29,640 THAT INTENSIFIED GENDERED RACIAL 541 00:21:29,640 --> 00:21:30,040 MICROAGGRESSIONS. 542 00:21:30,040 --> 00:21:30,440 NEXT SLIDE PLEASE. 543 00:21:30,440 --> 00:21:32,480 THIS SHOWED WE DID FIND 544 00:21:32,480 --> 00:21:33,800 INTERACTION SUCH THAT YOU CAN 545 00:21:33,800 --> 00:21:37,600 SEE ON THE RIGHT WOMEN WHO HAD 546 00:21:37,600 --> 00:21:40,920 HYPERTENSIVE DISORDERS HAD A 547 00:21:40,920 --> 00:21:42,760 BIGGER EFFECT OF THE 548 00:21:42,760 --> 00:21:43,560 MICROAGGRESSIONS THAN THOSE WHO 549 00:21:43,560 --> 00:21:44,760 DID NOT. 550 00:21:44,760 --> 00:21:46,280 THERE WAS AN EFFECT, A SMALL 551 00:21:46,280 --> 00:21:48,560 EFFECT PRESENT EVEN IN LOW RISK 552 00:21:48,560 --> 00:21:52,280 WOMEN, HIGH RISK IT WAS 553 00:21:52,280 --> 00:21:54,040 INTENSIFIED. 554 00:21:54,040 --> 00:21:56,360 NEXT SLIDE PLEASE. 555 00:21:56,360 --> 00:21:57,440 CONCLUSION, GENDERED RACIAL 556 00:21:57,440 --> 00:21:58,640 MICROAGGRESSION DURING OBSTETRIC 557 00:21:58,640 --> 00:22:00,040 CARE IS COMMON AMONG NON-WHITE 558 00:22:00,040 --> 00:22:03,040 WOMEN AND IS ASSOCIATED WITH 559 00:22:03,040 --> 00:22:04,560 HIGHER POSTPARTUM SYSTOLIC AND 560 00:22:04,560 --> 00:22:05,960 DIASTOLIC BLOOD PRESSURE THROUGH 561 00:22:05,960 --> 00:22:08,680 90 DAYS, THIS ASSOCIATION WAS 562 00:22:08,680 --> 00:22:10,920 STRONGEST IN HIGH RISK PATIENTS. 563 00:22:10,920 --> 00:22:12,440 COVID ECONOMIC STRESS WASN'T 564 00:22:12,440 --> 00:22:13,920 ASSOCIATED WITH BLOOD PRESSURE 565 00:22:13,920 --> 00:22:15,560 MEASURES BUT DEFINITELY MIGHT BE 566 00:22:15,560 --> 00:22:17,480 RELEVANT TO OTHER POSTPARTUM 567 00:22:17,480 --> 00:22:21,400 HEALTH OUTCOMES TO BE EXPLORED. 568 00:22:21,400 --> 00:22:23,240 NEXT SLIDE PLEASE. 569 00:22:23,240 --> 00:22:26,080 IMPLICATIONS ARE INTERVENTIONS 570 00:22:26,080 --> 00:22:35,600 ARE NEEDED TO ELIMINATE 571 00:22:35,600 --> 00:22:41,880 MICROAAGGRESSION, THESE INCREASS 572 00:22:41,880 --> 00:22:42,840 WE SEE POSTPARTUM IN BLOOD 573 00:22:42,840 --> 00:22:44,600 PRESSURE EVEN THOUGH SOME MAY BE 574 00:22:44,600 --> 00:22:47,800 IN THE NORMAL RANGE, COULD 575 00:22:47,800 --> 00:22:48,960 POTENTIALLY INCREASE RISK OF 576 00:22:48,960 --> 00:22:51,280 CARDIOVASCULAR DISEASE ACROSS 577 00:22:51,280 --> 00:22:53,560 THE LIFE COURSE. 578 00:22:53,560 --> 00:22:54,680 NEXT SLIDE PLEASE. 579 00:22:54,680 --> 00:22:57,320 I'D LIKE TO ACKNOWLEDGE THE 580 00:22:57,320 --> 00:22:58,080 PRINCIPLE INVESTIGATOR ELIZABETH 581 00:22:58,080 --> 00:23:01,400 HOWELL AS WELL AS OUR WONDERFUL 582 00:23:01,400 --> 00:23:04,640 STUDY TEAM. 583 00:23:04,640 --> 00:23:05,960 >>THANK YOU. 584 00:23:05,960 --> 00:23:11,640 IT'S MY PLEASURE TO BE HERE TO 585 00:23:11,640 --> 00:23:15,360 SPEAK WITH YOU ABOUT A NOVEL 586 00:23:15,360 --> 00:23:16,880 COMMUNITY INITIATIVE TO IMPROVE 587 00:23:16,880 --> 00:23:17,880 PERINATAL MENTAL HEALTH IN HIGH 588 00:23:17,880 --> 00:23:18,240 RISK POPULATION. 589 00:23:18,240 --> 00:23:20,080 THESE ARE THE MEMBERS OF OUR 590 00:23:20,080 --> 00:23:22,720 STUDY TEAM. 591 00:23:22,720 --> 00:23:26,200 TO GIVE BACKGROUND, HUGS/ABRAZOS 592 00:23:26,200 --> 00:23:27,600 WAS CREATED TO ADDRESS 593 00:23:27,600 --> 00:23:30,000 SIGNIFICANT SOCIAL AND 594 00:23:30,000 --> 00:23:32,760 BEHAVIORAL HEALTH NEEDS 595 00:23:32,760 --> 00:23:35,400 EXACERBATED BY THE COVID-19 596 00:23:35,400 --> 00:23:36,840 PANDEMIC AMONG PREGNANT 597 00:23:36,840 --> 00:23:37,440 INDIVIDUALS AND FAMILIES WITH 598 00:23:37,440 --> 00:23:38,480 CHILDREN UNDER 6 LIVING IN THESE 599 00:23:38,480 --> 00:23:39,720 COMMUNITIES SERVED BY 600 00:23:39,720 --> 00:23:41,120 MASSACHUSETTS GENERAL HOSPITAL. 601 00:23:41,120 --> 00:23:44,200 THE MAP OF LOCATIONS AT THE 602 00:23:44,200 --> 00:23:47,240 UPPER LEFT SHOWS COMMUNITIES IN 603 00:23:47,240 --> 00:23:48,040 MASSACHUSETTS DIAGNOSING MORE 604 00:23:48,040 --> 00:23:49,840 THAN 25 CASES OF COVID-19 DAILY, 605 00:23:49,840 --> 00:23:52,640 JUST THE PERIOD FROM OCTOBER 606 00:23:52,640 --> 00:23:54,560 2020 TO FEBRUARY OF 2021, BUT 607 00:23:54,560 --> 00:23:56,320 THE MAP WAS RED FOR THESE 608 00:23:56,320 --> 00:23:58,200 COMMUNITIES FOR MORE THAN A YEAR 609 00:23:58,200 --> 00:24:00,200 OF THE COVID PANDEMIC. 610 00:24:00,200 --> 00:24:02,720 SO THIS SHOWS THESE LOCATIONS 611 00:24:02,720 --> 00:24:05,560 SERVED BY YOUR HEALTH CENTERS 612 00:24:05,560 --> 00:24:06,720 WERE HARD HIT BY COVID-19. 613 00:24:06,720 --> 00:24:08,960 THE HEAT MAP ON THE BOTTOM LEFT 614 00:24:08,960 --> 00:24:11,040 SHOWS PATIENTS FROM THESE 615 00:24:11,040 --> 00:24:12,800 COMMUNITIES COMPRISED MAJORITY 616 00:24:12,800 --> 00:24:14,000 OF PREGNANT INDIVIDUALS 617 00:24:14,000 --> 00:24:16,320 DIAGNOSED WITH SARS-COV-2 IN 618 00:24:16,320 --> 00:24:17,840 PREGNANCY AT MASSACHUSETTS 619 00:24:17,840 --> 00:24:19,160 GENERAL HOSPITAL. 620 00:24:19,160 --> 00:24:20,880 AND WE HAD A PUBLICATION 621 00:24:20,880 --> 00:24:23,840 ADDRESSING THESE DISPARITIES NOT 622 00:24:23,840 --> 00:24:24,960 ONLY IN DIAGNOSIS OF SARS-COV-2 623 00:24:24,960 --> 00:24:26,920 BUT ALSO IN DISEASE SEVERITY IN 624 00:24:26,920 --> 00:24:29,760 THE GREEN JOURNAL AND REAL 625 00:24:29,760 --> 00:24:30,960 EPICENTER OF THE PANDEMIC FOR 626 00:24:30,960 --> 00:24:33,800 LONG PERIOD OF TIME WITH THE 627 00:24:33,800 --> 00:24:35,240 CHELSEA COMMUNITY HERE SHOWN IN 628 00:24:35,240 --> 00:24:36,880 RED ON THE BOTTOM LEFT. 629 00:24:36,880 --> 00:24:38,600 THE BAR GRAPH ON THE RIGHT FROM 630 00:24:38,600 --> 00:24:40,560 THE GREATER BOSTON FOOD BANK 631 00:24:40,560 --> 00:24:41,920 SHOWS SIGNIFICANT INCREASE IN 632 00:24:41,920 --> 00:24:43,880 FOOD INSECURITY THAT OCCURRED IN 633 00:24:43,880 --> 00:24:45,200 GREATER BOSTON AREA DURING THE 634 00:24:45,200 --> 00:24:47,200 COVID-19 PANDEMIC, AND THESE 635 00:24:47,200 --> 00:24:51,080 EFFECTS WERE AMPLIFIED IN 636 00:24:51,080 --> 00:24:53,280 CHELSEA, REVERE, EVERETT. 637 00:24:53,280 --> 00:24:54,840 CHELSEA, NEARLY 16% OF FAMILIES 638 00:24:54,840 --> 00:24:56,120 LIVED BELOW THE FEDERAL POVERTY 639 00:24:56,120 --> 00:24:58,000 LEVEL, MORE THAN TWICE THE RATE 640 00:24:58,000 --> 00:25:01,280 IN MASSACHUSETTS AS A WHOLE. 641 00:25:01,280 --> 00:25:05,680 67% OF HOUSEHOLDS IN CHELSEA 642 00:25:05,680 --> 00:25:10,120 SELF-IDENTIFY AS LATINX OR 643 00:25:10,120 --> 00:25:10,560 HISPANIC. 644 00:25:10,560 --> 00:25:11,120 PARTICIPANTS FROM THESE 645 00:25:11,120 --> 00:25:13,640 COMMUNITIES ARE AT HIGH RISK FOR 646 00:25:13,640 --> 00:25:14,760 ADVERSE LIFE EXPERIENCES 647 00:25:14,760 --> 00:25:16,360 INCLUDING TOXIC LEVELS OF 648 00:25:16,360 --> 00:25:17,600 STRESS, DEPRESSION, ANXIETY AND 649 00:25:17,600 --> 00:25:23,320 HAVE A HIGH BURDEN OF SOCIAL 650 00:25:23,320 --> 00:25:24,440 RISK FACTORS. 651 00:25:24,440 --> 00:25:27,360 WE SOUGHT TO EVALUATE IMPACT OF 652 00:25:27,360 --> 00:25:27,920 NOVEL COMMUNITY-BASED 653 00:25:27,920 --> 00:25:32,840 INTERVENTION HELPING US GROW 654 00:25:32,840 --> 00:25:34,880 STRONGER, HUGS, OR ABRAZOS IN 655 00:25:34,880 --> 00:25:36,560 SPANISH, IN A DIVERSE POPULATION 656 00:25:36,560 --> 00:25:45,440 IN THE COVID-19 PANDEMIC. 657 00:25:45,440 --> 00:25:54,400 AND HUGS/ABRAZOS WAS DEVELOPED 658 00:25:54,400 --> 00:25:55,920 BY, ASSESSING HOW POSTPARTUM 659 00:25:55,920 --> 00:26:02,160 INDIVIDUALS EXPERIENCED THE 660 00:26:02,160 --> 00:26:03,800 PROGRAM BY MOLLY SIEGLE. 661 00:26:03,800 --> 00:26:06,320 THIS IS A STUDY OF INDIVIDUALS 662 00:26:06,320 --> 00:26:07,280 REFERRED TO HUGS, INDIVIDUALS 663 00:26:07,280 --> 00:26:09,600 WERE OFFERED UP TO FOUR VIRTUAL 664 00:26:09,600 --> 00:26:11,800 BEHAVIORAL HEALTH SESSIONS FROM 665 00:26:11,800 --> 00:26:13,680 A COGNITIVE BEHAVIORAL THERAPY 666 00:26:13,680 --> 00:26:15,120 TRAINED AND TRAUMA INFORMED CARE 667 00:26:15,120 --> 00:26:17,080 TRAINED SOCIAL WORKER AND UP TO 668 00:26:17,080 --> 00:26:18,360 FOUR RESOURCE NAVIGATION VISITS 669 00:26:18,360 --> 00:26:20,360 WITH A COMMUNITY HEALTH WORKER 670 00:26:20,360 --> 00:26:24,720 TO SERVE NEEDS SUCH AS REFERRAL 671 00:26:24,720 --> 00:26:27,240 TO SNAP, WIC, FOOD BANK, NEED 672 00:26:27,240 --> 00:26:29,200 FOR DIAPERS, CLOTHING, LEGAL 673 00:26:29,200 --> 00:26:30,200 ASSISTANCE, HOUSING NEEDS. 674 00:26:30,200 --> 00:26:31,520 INDIVIDUALS ALSO RECEIVED A CARE 675 00:26:31,520 --> 00:26:34,520 PACKAGE WHICH I'LL SHOW ON THE 676 00:26:34,520 --> 00:26:36,240 NEXT PAGE. 677 00:26:36,240 --> 00:26:38,680 THIS IS THE SCHEMATIC OF THE 678 00:26:38,680 --> 00:26:40,280 PROGRAM, PATIENTS WHO WERE 679 00:26:40,280 --> 00:26:45,320 ELIGIBLE ARE IN THE TOP BAR, 680 00:26:45,320 --> 00:26:47,160 UNMET SOCIAL DETERMINANT OF 681 00:26:47,160 --> 00:26:48,360 HEALTH NEEDS, ESTABLISHED CARE 682 00:26:48,360 --> 00:26:50,000 IN OUR SYSTEM. 683 00:26:50,000 --> 00:26:51,360 IF THEY HAD PATIENT NAVIGATION 684 00:26:51,360 --> 00:26:53,720 NEEDS THERE WAS A NOVEL RESOURCE 685 00:26:53,720 --> 00:26:55,560 TOOL USED TO OPTIMIZE PATIENT 686 00:26:55,560 --> 00:26:57,440 NAVIGATION AND PATIENTS HAD A 687 00:26:57,440 --> 00:26:58,640 DEDICATED COMMUNITY HEALTH 688 00:26:58,640 --> 00:26:59,160 WORKER. 689 00:26:59,160 --> 00:27:00,400 THOSE PATIENTS IDENTIFIED AS 690 00:27:00,400 --> 00:27:01,200 HAVING BEHAVIORAL HEALTH SUPPORT 691 00:27:01,200 --> 00:27:04,360 NEEDS MET WITH SOCIAL WORKER AS 692 00:27:04,360 --> 00:27:05,800 DESCRIBED AND THEN INDIVIDUALS 693 00:27:05,800 --> 00:27:07,760 RECEIVED SOME DIRECT RELIEF FROM 694 00:27:07,760 --> 00:27:10,160 CARE PACKAGES THAT INCLUDED $50 695 00:27:10,160 --> 00:27:14,000 GROCERY GIFT CARD, MASKS, HAND 696 00:27:14,000 --> 00:27:14,760 SANITIZER, LANGUAGE CONCORDANT 697 00:27:14,760 --> 00:27:16,080 BOOKS AND ACTIVITIES FOR 698 00:27:16,080 --> 00:27:20,120 CHILDREN AS INFORMATION ABOUT 699 00:27:20,120 --> 00:27:22,400 HEALTHY EATING. 700 00:27:22,400 --> 00:27:25,160 PARTICIPANTS COMPLETED THE 701 00:27:25,160 --> 00:27:27,480 VALIDATED SURVEY INSTRUMENTS, WE 702 00:27:27,480 --> 00:27:29,320 SELECTED INSTRUMENTS THAT 703 00:27:29,320 --> 00:27:31,600 ASSESSED MOOD, ANXIETY, STRESS, 704 00:27:31,600 --> 00:27:34,000 FOOD INSECURITY, EXPERIENCES OF 705 00:27:34,000 --> 00:27:36,000 DISCRIMINATION, AND ALSO HAD 706 00:27:36,000 --> 00:27:46,480 NON-VALIDATED QUESTIONS ABOUT 707 00:27:46,480 --> 00:27:48,560 PROGRAM SATISFACTION. 708 00:27:48,560 --> 00:27:53,840 SO HERE IS A SCHEMATIC 709 00:27:53,840 --> 00:27:55,200 DEMONSTRATING HOW MANY PATIENTS 710 00:27:55,200 --> 00:27:57,000 WERE APPROACHED FOR THE PROGRAM, 711 00:27:57,000 --> 00:27:58,800 OF THESE 45 INDIVIDUALS HAD 712 00:27:58,800 --> 00:27:59,840 ALREADY BEGUN THE PROGRAM AND SO 713 00:27:59,840 --> 00:28:03,760 WE WERE ABLE TO CONSENT THEM AND 714 00:28:03,760 --> 00:28:04,880 ADMINISTERED VALIDATED SURVEY 715 00:28:04,880 --> 00:28:05,880 INSTRUMENTS AFTER THEY COMPLETED 716 00:28:05,880 --> 00:28:11,440 THE PROGRAM OF THE OF THE 717 00:28:11,440 --> 00:28:13,960 REMAINING 188 ELIGIBLE 718 00:28:13,960 --> 00:28:14,720 PARTICIPANTS, 45 DECLINED 719 00:28:14,720 --> 00:28:16,640 ALTOGETHER. 720 00:28:16,640 --> 00:28:18,000 OF THOSE THAT COMPLETED, 10 721 00:28:18,000 --> 00:28:20,280 DECLINED PARTICIPATION IN THE 722 00:28:20,280 --> 00:28:22,200 SURVEY STUDY, REMAINING 133 723 00:28:22,200 --> 00:28:23,720 COMPLETED SURVEY PRE AND POST 724 00:28:23,720 --> 00:28:25,360 HUGS PROGRAM AND SUBSET WERE 725 00:28:25,360 --> 00:28:28,760 ALSO ENROLLED IN OUR COVID-19 726 00:28:28,760 --> 00:28:30,320 PREGNANCY BIOREPOSITORY AND WE 727 00:28:30,320 --> 00:28:32,040 HAD CYTOKINES FROM THEIR BLOOD 728 00:28:32,040 --> 00:28:33,560 DRAWS TAKEN DURING ACUTE COVID 729 00:28:33,560 --> 00:28:35,480 INFECTION BECAUSE WE ALSO WANTED 730 00:28:35,480 --> 00:28:39,600 TO INVESTIGATE HOW THE DEGREE OF 731 00:28:39,600 --> 00:28:41,600 INFLAMMATION MIGHT IMPACT HOW 732 00:28:41,600 --> 00:28:45,440 THE PATIENTS RECEIVED THE STUDY 733 00:28:45,440 --> 00:28:46,440 AND BASELINE STRESS ANXIETY 734 00:28:46,440 --> 00:28:48,720 SCORES HOW THOSE MIGHT CORRELATE 735 00:28:48,720 --> 00:28:50,040 WITH INFLATION. 736 00:28:50,040 --> 00:28:55,080 TURNING TO RESULTS, THESE ARE 737 00:28:55,080 --> 00:28:55,960 DEMOGRAPHICS, OVERALL 738 00:28:55,960 --> 00:28:57,480 PARTICIPANTS WERE RELATIVELY 739 00:28:57,480 --> 00:28:59,600 YOUNG, MAJORITY IDENTIFIED AS 740 00:28:59,600 --> 00:29:02,680 HISPANIC OR LATINX, OVER 30% 741 00:29:02,680 --> 00:29:05,080 WERE SPANISH SPEAKING, OVER 80% 742 00:29:05,080 --> 00:29:07,480 PUBLICLY INSURED, AND WE FOUND 743 00:29:07,480 --> 00:29:09,120 VERY HIGH RATES OF INDIVIDUALS 744 00:29:09,120 --> 00:29:11,640 IN THE STUDY WHO WERE DIAGNOSED 745 00:29:11,640 --> 00:29:14,040 WITH SARS-COV-2 INFECTION IN 746 00:29:14,040 --> 00:29:15,400 PREGNANCY, WHO REPORTED 747 00:29:15,400 --> 00:29:18,360 EXPERIENCING DISCRIMINATION OR 748 00:29:18,360 --> 00:29:19,640 FOOD INSECURITY IN THE LATTER 749 00:29:19,640 --> 00:29:20,160 MONTHS. 750 00:29:20,160 --> 00:29:23,160 HIGH RATES OF FOOD INSECURITY 751 00:29:23,160 --> 00:29:24,840 WERE PARTICULARLY SURPRISING AND 752 00:29:24,840 --> 00:29:26,880 NOTABLE TO US PARTICULARLY GIVEN 753 00:29:26,880 --> 00:29:30,400 THAT PRIOR TO THE PANDEMIC FOOD 754 00:29:30,400 --> 00:29:32,360 INSECURITY REPORTED IN A 755 00:29:32,360 --> 00:29:33,480 DIFFERENT PATIENT POPULATION AT 756 00:29:33,480 --> 00:29:35,320 MASS GENERAL HOSPITAL WITH 5%, 757 00:29:35,320 --> 00:29:37,640 SO AMONG THIS COMMUNITY HEALTH 758 00:29:37,640 --> 00:29:39,960 CLINIC POPULATION DURING THE 759 00:29:39,960 --> 00:29:42,200 PANDEMIC, 63% OF PATIENTS ARE 760 00:29:42,200 --> 00:29:45,200 REPORTING FOOD INSECURITY, 68% 761 00:29:45,200 --> 00:29:47,600 REPORTED EXPERIENCES OF 762 00:29:47,600 --> 00:29:48,880 DISCRIMINATION, AND 62% WERE 763 00:29:48,880 --> 00:29:52,280 INFECTED WITH SARS-COV-2 IN THE 764 00:29:52,280 --> 00:29:52,720 LAST YEAR. 765 00:29:52,720 --> 00:29:54,440 OUR PATIENTS ALSO REPORTED HIGH 766 00:29:54,440 --> 00:29:56,440 PROGRAM SATISFACTION, SO THE 767 00:29:56,440 --> 00:29:58,520 VAST MAJORITY WERE VERY OR 768 00:29:58,520 --> 00:29:59,120 EXTREMELY LIKELY TO RECOMMEND 769 00:29:59,120 --> 00:30:00,920 THE PROGRAM TO A FRIEND OR 770 00:30:00,920 --> 00:30:01,840 FAMILY MEMBER. 771 00:30:01,840 --> 00:30:03,800 THEY FELT THE PROGRAM MET THEIR 772 00:30:03,800 --> 00:30:05,520 NEEDS WELL OR EXTREMELY WELL AND 773 00:30:05,520 --> 00:30:07,520 FELT THE PROGRAM WAS HELPFUL OR 774 00:30:07,520 --> 00:30:10,560 VERY HELPFUL IN CONNECTING THEM 775 00:30:10,560 --> 00:30:11,440 TO SERVICES. 776 00:30:11,440 --> 00:30:12,760 SCORES ON THE VALIDATED 777 00:30:12,760 --> 00:30:15,040 INSTRUMENTS, WHEN WE TOOK THE 778 00:30:15,040 --> 00:30:16,560 PARTICIPANTS ALL TOGETHER WE 779 00:30:16,560 --> 00:30:20,560 FOUND THAT COMPLETING THE 780 00:30:20,560 --> 00:30:22,800 HUGS/ABRAZOS PROGRAM WAS 781 00:30:22,800 --> 00:30:23,800 ASSOCIATED WITH IMPROVED 782 00:30:23,800 --> 00:30:25,800 IMPROVEMENT IN SCORES AND SCREEN 783 00:30:25,800 --> 00:30:27,840 POSITIVE THRESHOLD FOR THIS IS 784 00:30:27,840 --> 00:30:30,040 8, SO WE SAW SIGNIFICANT 785 00:30:30,040 --> 00:30:32,880 REDUCTION THERE. 786 00:30:32,880 --> 00:30:34,000 WE SAW SIGNIFICANT DIFFERENCES 787 00:30:34,000 --> 00:30:36,600 PRE AND POST PROGRAM COMPLETION 788 00:30:36,600 --> 00:30:38,480 IN PERCEIVED STRESS SCALE SCORES 789 00:30:38,480 --> 00:30:40,440 AS WELL AS SIGNIFICANT 790 00:30:40,440 --> 00:30:41,120 IMPROVEMENT IN PREGNANCY ANXIETY 791 00:30:41,120 --> 00:30:42,400 SCALE SCORES. 792 00:30:42,400 --> 00:30:44,400 WE DID NOT SEE SIGNIFICANT 793 00:30:44,400 --> 00:30:45,480 DIFFERENCES PRE AND POST PROGRAM 794 00:30:45,480 --> 00:30:49,120 COMPLETION IN THE PROMISE SCALE, 795 00:30:49,120 --> 00:30:49,880 HOWEVER. 796 00:30:49,880 --> 00:30:51,320 WE WERE INTERESTED IN 797 00:30:51,320 --> 00:30:53,240 UNDERSTANDING MORE ABOUT HOW 798 00:30:53,240 --> 00:30:53,840 THOSE INDIVIDUALS AT HIGHEST 799 00:30:53,840 --> 00:30:56,680 RISK, WHETHER DUE TO FOOD 800 00:30:56,680 --> 00:31:01,400 INSECURITY, HAVING COVID-19 IN 801 00:31:01,400 --> 00:31:02,520 PREGNANCY OR EXPERIENCES OF 802 00:31:02,520 --> 00:31:03,400 DISCRIMINATION MIGHT RECEIVE THE 803 00:31:03,400 --> 00:31:05,080 PROGRAM AND HOW THE PROGRAM 804 00:31:05,080 --> 00:31:06,840 MIGHT MODIFY THEIR SCORES ON 805 00:31:06,840 --> 00:31:08,840 THESE VALIDATED INSTRUMENTS. 806 00:31:08,840 --> 00:31:11,040 WE DID A STRATIFIED ANALYSIS AND 807 00:31:11,040 --> 00:31:13,120 THE PATTERN THROUGHOUT WAS THAT 808 00:31:13,120 --> 00:31:15,520 THOSE INDIVIDUALS AT HIGHEST 809 00:31:15,520 --> 00:31:17,000 RISK DUE TO FOOD INSECURITY, 810 00:31:17,000 --> 00:31:20,560 COVID INFECTION IN 811 00:31:20,560 --> 00:31:23,080 PREGNANCY-RELATED FREQUENCY HAD 812 00:31:23,080 --> 00:31:27,360 THE GREATEST REDUCTION IN 813 00:31:27,360 --> 00:31:30,600 DEPRESSION, STRESS, ANXIETY 814 00:31:30,600 --> 00:31:31,520 SCORES BETWEEN STARTING AND 815 00:31:31,520 --> 00:31:32,920 COMPLETING THE PROGRAM SO THE 816 00:31:32,920 --> 00:31:34,240 PROGRAM BENEFITED THOSE 817 00:31:34,240 --> 00:31:38,480 INDIVIDUALS AT HIGHEST RISK 818 00:31:38,480 --> 00:31:39,560 POTENTIALLY MORE. 819 00:31:39,560 --> 00:31:40,560 WHAT CONCLUSIONS CAN WE DRAW 820 00:31:40,560 --> 00:31:42,080 FROM THIS WORK? 821 00:31:42,080 --> 00:31:44,640 IN THIS URBAN HEALTH CENTER 822 00:31:44,640 --> 00:31:45,840 OBSTETRIC POPULATION NOTED HIGH 823 00:31:45,840 --> 00:31:47,800 RATES OF FOOD INSECURITY, 824 00:31:47,800 --> 00:31:50,680 EXPERIENCES OF DISCRIMINATION, 825 00:31:50,680 --> 00:31:53,400 AND COVID-19 INFECTION, AND THIS 826 00:31:53,400 --> 00:31:55,480 INTERVENTION LED TO IMPROVEMENT 827 00:31:55,480 --> 00:31:56,760 IN DEPRESSION, PERCEIVED STRESS 828 00:31:56,760 --> 00:31:58,120 AND ANXIETY WITH GREATEST IMPACT 829 00:31:58,120 --> 00:32:07,440 IN THOSE WITH FOOD SECURED AND 830 00:32:07,440 --> 00:32:10,640 COVID-19 INFECTION, A PIPELINE 831 00:32:10,640 --> 00:32:12,800 CAN ENSURE TIMELY ACCESS TO 832 00:32:12,800 --> 00:32:13,760 BEHAVIORAL HEALTH SERVICES AS 833 00:32:13,760 --> 00:32:17,160 WELL AS COMMUNITY HEALTH WORKER 834 00:32:17,160 --> 00:32:18,400 NAVIGATION CAN INFLUENCE HEALTH 835 00:32:18,400 --> 00:32:24,280 OF THE MOTHER-INFANT DYADS WITH 836 00:32:24,280 --> 00:32:26,720 POTENTIAL TO HAVE LONG LASTING 837 00:32:26,720 --> 00:32:29,400 ON MATERNAL AND ALSO CHILD 838 00:32:29,400 --> 00:32:29,640 HEALTH. 839 00:32:29,640 --> 00:32:31,600 WITH THAT, I WANT TO THANK ALL 840 00:32:31,600 --> 00:32:33,640 OF OUR COLLABORATORS IN THIS 841 00:32:33,640 --> 00:32:36,840 WORK AND OTHER WORK AROUND 842 00:32:36,840 --> 00:32:38,280 COVID-19, ESPECIALLY THANKS TO 843 00:32:38,280 --> 00:32:39,720 IMPROVE INITIATIVE FOR FUNDING 844 00:32:39,720 --> 00:32:41,440 THIS PROJECT AND ANOTHER PROJECT 845 00:32:41,440 --> 00:32:43,960 THAT WE DID IN THE LAB AND 846 00:32:43,960 --> 00:32:45,080 EVERYONE IN MY LAB WHO HAS DONE 847 00:32:45,080 --> 00:32:47,600 SO MUCH WORK ON THIS AND OTHER 848 00:32:47,600 --> 00:32:49,240 PROJECTS, ESPECIALLY 849 00:32:49,240 --> 00:32:52,920 HIGHLIGHTING MOLLY SEGAL WHO 850 00:32:52,920 --> 00:32:53,520 SPEARHEADED THIS PROJECT. 851 00:32:53,520 --> 00:32:56,640 >>THANK YOU SO MUCH, ANDREA. 852 00:32:56,640 --> 00:33:02,280 NOW WE TURN TO DR. HEIDI PRICE. 853 00:33:02,280 --> 00:33:03,680 >>GOOD AFTERNOON. 854 00:33:03,680 --> 00:33:05,640 VERY EXCITED TO BE HERE. 855 00:33:05,640 --> 00:33:16,040 CAN YOU SEE MY SLIDES? 856 00:33:18,320 --> 00:33:18,640 >>YES. 857 00:33:18,640 --> 00:33:19,000 >>GREAT. 858 00:33:19,000 --> 00:33:23,680 >>THE SLIDES OR WORD DOCUMENT, 859 00:33:23,680 --> 00:33:24,480 WHICH ARE YOU SEEING? 860 00:33:24,480 --> 00:33:26,280 >>WORD DOCUMENT. 861 00:33:26,280 --> 00:33:28,400 >>I'M SHARING THE WRONG SCREEN. 862 00:33:28,400 --> 00:33:30,000 THIS SHOULD BE IT. 863 00:33:30,000 --> 00:33:30,240 >>YES. 864 00:33:30,240 --> 00:33:31,000 >>ALL RIGHT. 865 00:33:31,000 --> 00:33:32,000 SORRY ABOUT THAT. 866 00:33:32,000 --> 00:33:35,280 I'M GOING TO TALK ABOUT 867 00:33:35,280 --> 00:33:36,920 PERINATAL ANXIETY, DURING THE 868 00:33:36,920 --> 00:33:38,920 COVID-19 PANDEMIC AND GROWTH 869 00:33:38,920 --> 00:33:39,640 TRAJECTORIES AND THEIR 870 00:33:39,640 --> 00:33:43,240 CONTRIBUTORS IN THE FIRST YEAR 871 00:33:43,240 --> 00:33:43,560 POSTPARTUM. 872 00:33:43,560 --> 00:33:46,120 SMALL DISCLOSURE I'M GOING TO BE 873 00:33:46,120 --> 00:33:47,760 USING THE TERM WOMEN AND 874 00:33:47,760 --> 00:33:49,520 MATERNAL, I RECOGNIZE NOT ALL 875 00:33:49,520 --> 00:33:51,480 INDIVIDUALS THAT ARE CAPABLE OF 876 00:33:51,480 --> 00:33:53,680 PREGNANCY AND BIRTH IDENTIFY 877 00:33:53,680 --> 00:33:55,840 WITH THOSE TERMS. 878 00:33:55,840 --> 00:33:58,480 AND ANOTHER DISCLOSURE, THIS 879 00:33:58,480 --> 00:34:00,760 WORK WAS FUNDED BY STONY BROOK 880 00:34:00,760 --> 00:34:03,520 UNIVERSITY, OF COURSE BY THE 881 00:34:03,520 --> 00:34:04,080 "IMPROVE" INITIATIVE. 882 00:34:04,080 --> 00:34:05,840 SO, SOME BACKGROUND ABOUT 883 00:34:05,840 --> 00:34:08,000 ANXIETY IN THE PERIPARTUM PERIOD 884 00:34:08,000 --> 00:34:08,480 AND PERINATAL PERIOD. 885 00:34:08,480 --> 00:34:12,520 IT IS ONE OF THE MOST COMMON 886 00:34:12,520 --> 00:34:15,680 MORBIDITIES WITH UP TO 1 IN 5 887 00:34:15,680 --> 00:34:19,720 WOMEN AFFECTED BY ANXIETY, AS WE 888 00:34:19,720 --> 00:34:23,640 ALSO HEARD THIS IS ALSO 889 00:34:23,640 --> 00:34:24,600 POTENTIALLY RELATED TO MORBIDITY 890 00:34:24,600 --> 00:34:27,480 AND MORTALITY IN THE FIRST YEAR 891 00:34:27,480 --> 00:34:27,880 POSTPARTUM. 892 00:34:27,880 --> 00:34:31,120 IT IS ASSOCIATED WITH INCREASED 893 00:34:31,120 --> 00:34:32,720 RISK FOR MATERNAL AND CHILD 894 00:34:32,720 --> 00:34:34,840 HEALTH, IN TERMS OF THE 895 00:34:34,840 --> 00:34:38,560 PREGNANCY RELATED TO HIGHER 896 00:34:38,560 --> 00:34:42,520 RATES OF ADVERSE OUTCOMES LIKE 897 00:34:42,520 --> 00:34:44,600 GESTATIONAL DIABETES OR PRE-TERM 898 00:34:44,600 --> 00:34:45,160 BIRTH. 899 00:34:45,160 --> 00:34:47,120 IT'S RELATED TO POSTPARTUM 900 00:34:47,120 --> 00:34:48,880 ANXIETY AND DEPRESSION. 901 00:34:48,880 --> 00:34:52,800 AND ALSO HAS NEGATIVE POTENTIAL 902 00:34:52,800 --> 00:34:54,640 EFFECT ON INFANTS. 903 00:34:54,640 --> 00:35:02,120 THE RISK FACTORS INCLUDE ADVERSE 904 00:35:02,120 --> 00:35:04,640 CHILDHOOD EXPERIENCES, DIFFERENT 905 00:35:04,640 --> 00:35:06,080 SOCIOECONOMIC DEPRIVATIONS, AND 906 00:35:06,080 --> 00:35:09,920 ALSO STRESS AND HISTORY OF 907 00:35:09,920 --> 00:35:11,200 MENTAL HEALTH DISORDERS. 908 00:35:11,200 --> 00:35:13,840 NOW, WHAT HAPPENED WITH 909 00:35:13,840 --> 00:35:17,560 PERIPARTUM ANXIETY DURING THE 910 00:35:17,560 --> 00:35:17,880 PANDEMIC? 911 00:35:17,880 --> 00:35:19,080 AS EXPECTED, YOU KNOW, DURING 912 00:35:19,080 --> 00:35:23,000 THE PANDEMIC WE SAW ELEVATED 913 00:35:23,000 --> 00:35:25,560 LEVELS OF ANXIETY REPORTED 914 00:35:25,560 --> 00:35:27,080 WORLDWIDE, PARTICULARLY AMONG 915 00:35:27,080 --> 00:35:27,520 WOMEN. 916 00:35:27,520 --> 00:35:31,120 AND WOMEN THAT WERE PREGNANT 917 00:35:31,120 --> 00:35:32,440 FACED ADDITIONAL UNIQUE 918 00:35:32,440 --> 00:35:35,640 STRESSORS DURING THE PANDEMIC 919 00:35:35,640 --> 00:35:37,360 LIKE UNCERTAINTY ABOUT EFFECT OF 920 00:35:37,360 --> 00:35:44,360 THE INFECTION ON PREGNANCY OR 921 00:35:44,360 --> 00:35:49,280 FETUS, IMPACT TO PRENATAL CARE, 922 00:35:49,280 --> 00:35:56,320 TO SUPPORT, AND THESE INCREASED 923 00:35:56,320 --> 00:36:00,360 THEIR ANXIETY LEVELS, AND WE -- 924 00:36:00,360 --> 00:36:02,760 THIS RESULTED IN SIGNIFICANT 925 00:36:02,760 --> 00:36:04,280 INCREASES IN PERINATAL ANXIETY 926 00:36:04,280 --> 00:36:07,680 THAT WERE REPORTED IN MULTIPLE 927 00:36:07,680 --> 00:36:08,120 STUDIES. 928 00:36:08,120 --> 00:36:10,080 HOWEVER, LITTLE IS KNOWN ABOUT 929 00:36:10,080 --> 00:36:11,520 THE TRAJECTORIES OF ANXIETY 930 00:36:11,520 --> 00:36:13,280 THROUGHOUT PREGNANCY AND INTO 931 00:36:13,280 --> 00:36:16,680 THE FIRST YEAR POSTPARTUM, AS 932 00:36:16,680 --> 00:36:18,040 THE PANDEMIC CONDITIONS CHANGED. 933 00:36:18,040 --> 00:36:20,720 WHICH BRINGS US TO THE AIMS OF 934 00:36:20,720 --> 00:36:23,560 THE CURRENT PROJECT THAT I'M 935 00:36:23,560 --> 00:36:28,600 PRESENTING TODAY, WHICH WAS TO 936 00:36:28,600 --> 00:36:29,200 IDENTIFY LONGITUDINAL ANXIETY 937 00:36:29,200 --> 00:36:32,160 TRAJECTORIES FROM THE PRENATAL 938 00:36:32,160 --> 00:36:34,000 CARE INTO THE FIRST YEAR 939 00:36:34,000 --> 00:36:34,760 POSTPARTUM. 940 00:36:34,760 --> 00:36:37,520 ANOTHER WAS NOT JUST TO IDENTIFY 941 00:36:37,520 --> 00:36:39,160 TRAJECTORIES BUT ALSO IDENTIFY 942 00:36:39,160 --> 00:36:42,680 THE INDIVIDUAL AND COMMUNAL RISK 943 00:36:42,680 --> 00:36:44,200 AND RESILIENCE FACTORS RELATED 944 00:36:44,200 --> 00:36:48,040 TO THESE TRAJECTORIES OF ANXIETY 945 00:36:48,040 --> 00:36:48,680 SYMPTOMS. 946 00:36:48,680 --> 00:36:51,480 SO, THE REPORT TODAY IS PART OF 947 00:36:51,480 --> 00:36:54,600 THE SB-COPE STUDY, STONY BROOK 948 00:36:54,600 --> 00:36:56,000 COVID PREGNANCY EXPERIENCES 949 00:36:56,000 --> 00:36:56,320 STUDY. 950 00:36:56,320 --> 00:37:01,320 AND IN THIS STUDY WE HAD TWO 951 00:37:01,320 --> 00:37:04,080 RECRUITMENT PHASES, WAVE 1 952 00:37:04,080 --> 00:37:06,200 RECRUITED OVER 4,000 WOMEN AT 953 00:37:06,200 --> 00:37:07,480 THE PANDEMIC ONSET, PREGNANT 954 00:37:07,480 --> 00:37:10,120 DURING RECRUITMENT. 955 00:37:10,120 --> 00:37:12,120 AND THE WAVE 2 PARTICIPANTS, 956 00:37:12,120 --> 00:37:14,520 CLOSE TO 3,000 PARTICIPANTS THAT 957 00:37:14,520 --> 00:37:17,360 WERE RECRUITED DURING THE SECOND 958 00:37:17,360 --> 00:37:21,720 U.S. COVID SURGE IN DECEMBER 959 00:37:21,720 --> 00:37:23,280 2020. 960 00:37:23,280 --> 00:37:24,640 BASELINE DATA THAT WE COLLECTED 961 00:37:24,640 --> 00:37:26,200 INCLUDES SOCIAL DETERMINANTS OF 962 00:37:26,200 --> 00:37:27,840 HEALTH, MEDICAL FACTORS, 963 00:37:27,840 --> 00:37:29,640 DIFFERENT TYPES OF PERCEIVED 964 00:37:29,640 --> 00:37:31,920 STRESS MEASURES, PANDEMIC AND 965 00:37:31,920 --> 00:37:35,080 NON-PANDEMIC RELATED. 966 00:37:35,080 --> 00:37:35,480 STRESSFUL EVENTS, 967 00:37:35,480 --> 00:37:36,280 PANDEMIC-RELATED CONDITIONS, 968 00:37:36,280 --> 00:37:37,400 MENTAL HEALTH MEASURES, 969 00:37:37,400 --> 00:37:38,480 PARTICULARLY RELEVANT TO WHAT 970 00:37:38,480 --> 00:37:41,000 I'M PRESENTING TODAY IS THE USE 971 00:37:41,000 --> 00:37:43,320 OF THE GENERALIZED ANXIETY 972 00:37:43,320 --> 00:37:46,560 DISORDER 7, OR THE GAD7 SCALE. 973 00:37:46,560 --> 00:37:52,040 WE ALSO HAD INFORMATION ABOUT 974 00:37:52,040 --> 00:37:55,320 COUNTY LEVEL OR COMMUNITY LEVEL 975 00:37:55,320 --> 00:37:57,320 FACTORS LIKE COVID INFECTION 976 00:37:57,320 --> 00:38:02,440 RATES, COVID DEATH RATES, AND 977 00:38:02,440 --> 00:38:06,600 ALSO DEPRIVATION INDICES THAT WE 978 00:38:06,600 --> 00:38:08,440 GOT INFORMATION ON. 979 00:38:08,440 --> 00:38:11,440 PARTICIPANTS IN THE STUDY HAVE 980 00:38:11,440 --> 00:38:13,160 BEEN FOLLOWED UP EVERY FOUR TO 981 00:38:13,160 --> 00:38:15,440 SIX MONTHS INCLUDING REPEATED 982 00:38:15,440 --> 00:38:17,880 MEASURES OF MENTAL HEALTH AND 983 00:38:17,880 --> 00:38:21,080 THE CURRENT REPORT FOCUSES ON 984 00:38:21,080 --> 00:38:23,360 ANXIETY SYMPTOMS OF WAVE 2 985 00:38:23,360 --> 00:38:25,640 PARTICIPANTS THAT COMPLETED ALL 986 00:38:25,640 --> 00:38:27,640 FOUR TIME POINTS THAT WE HAVE 987 00:38:27,640 --> 00:38:33,080 FULL DATA ON THEIR MENTAL 988 00:38:33,080 --> 00:38:33,320 HEALTH. 989 00:38:33,320 --> 00:38:34,080 OUR STATISTICAL APPROACH 990 00:38:34,080 --> 00:38:37,360 INCLUDED IDENTIFYING BEST 991 00:38:37,360 --> 00:38:41,080 FITTING NUMBER OF LATENT GROWTH 992 00:38:41,080 --> 00:38:41,680 CLASSES. 993 00:38:41,680 --> 00:38:45,680 AND THEN WE VISUALIZED AND 994 00:38:45,680 --> 00:38:47,320 CHARACTERIZED THE BEST-FITTING 995 00:38:47,320 --> 00:38:48,480 CLASSES. 996 00:38:48,480 --> 00:38:52,680 WE THEN CONDUCTED UNIVARIATE 997 00:38:52,680 --> 00:38:55,640 ANALYSIS TO EXAMINE ASSOCIATION 998 00:38:55,640 --> 00:38:58,080 BETWEEN 36 PREDICTORS AND CLASS 999 00:38:58,080 --> 00:38:58,560 MEMBERSHIP. 1000 00:38:58,560 --> 00:39:00,920 AND THEN FOR THOSE FACTORS THAT 1001 00:39:00,920 --> 00:39:06,280 WERE SIGNIFICANT IN THE 1002 00:39:06,280 --> 00:39:09,560 UNIVARIATE ANALYSIS, WHEN THE 1003 00:39:09,560 --> 00:39:12,000 P-VALUE OF LESS THAN 0.001 1004 00:39:12,000 --> 00:39:15,480 INCLUDED THOSE IN AS PREDICTORS 1005 00:39:15,480 --> 00:39:16,680 IN THE STEP-WISE LOGISTIC 1006 00:39:16,680 --> 00:39:18,800 REGRESSION TO REALLY NARROW DOWN 1007 00:39:18,800 --> 00:39:21,240 AND IDENTIFY UNIQUE PREDICTORS 1008 00:39:21,240 --> 00:39:25,120 OF CLASS MEMBERSHIP. 1009 00:39:25,120 --> 00:39:26,440 WE IDENTIFIED THREE TRAJECTORIES 1010 00:39:26,440 --> 00:39:26,720 OF ANXIETY. 1011 00:39:26,720 --> 00:39:30,040 I DON'T KNOW WHY I WROTE STRESS 1012 00:39:30,040 --> 00:39:33,520 UP THERE. 1013 00:39:33,520 --> 00:39:36,360 THE FIRST CLASS INCLUDED 68 -- 1014 00:39:36,360 --> 00:39:41,640 CLOSE TO 68% OF PARTICIPANTS, 1015 00:39:41,640 --> 00:39:45,880 CHARACTERIZED BY LOW LEVELS OF 1016 00:39:45,880 --> 00:39:47,840 ANXIETY, MILD, THAT DECREASED TO 1017 00:39:47,840 --> 00:39:49,720 MINIMAL THROUGHOUT THE FIRST 1018 00:39:49,720 --> 00:39:50,720 YEAR POSTPARTUM. 1019 00:39:50,720 --> 00:39:52,440 THE SECOND CLASS INCLUDED A 1020 00:39:52,440 --> 00:39:55,840 QUARTER OF THE PARTICIPANTS THAT 1021 00:39:55,840 --> 00:39:59,160 HAD INITIAL MODERATE LEVELS OF 1022 00:39:59,160 --> 00:40:02,040 ANXIETY, WHICH REMAINED STABLE 1023 00:40:02,040 --> 00:40:04,080 THROUGHOUT THE POSTPARTUM YEAR. 1024 00:40:04,080 --> 00:40:06,480 THE THIRD CLASS THAT HAD CLOSE 1025 00:40:06,480 --> 00:40:09,920 TO 7% OF THE PARTICIPANTS 1026 00:40:09,920 --> 00:40:13,800 STARTED OFF WITH MODERATE LEVELS 1027 00:40:13,800 --> 00:40:16,440 OF ANXIETY THAT DECREASED, 1028 00:40:16,440 --> 00:40:18,000 EXCUSE ME, THAT INCREASED OVER 1029 00:40:18,000 --> 00:40:20,040 THE FIRST YEAR POSTPARTUM TO 1030 00:40:20,040 --> 00:40:24,400 SEVERE LEVELS, AND ON AVERAGE WE 1031 00:40:24,400 --> 00:40:27,160 SAW AN INCREASE OF 5 POINTS IN 1032 00:40:27,160 --> 00:40:34,840 THE GA D SCALE WHICH SIGNIFIES 1033 00:40:34,840 --> 00:40:35,680 CLINICALLY SIGNIFICANT WORSENING 1034 00:40:35,680 --> 00:40:36,280 OF SYMPTOMS. 1035 00:40:36,280 --> 00:40:39,080 NEXT WAS TO IDENTIFY 1036 00:40:39,080 --> 00:40:39,960 CONTRIBUTORS TO CLASS 1037 00:40:39,960 --> 00:40:41,040 MEMBERSHIPS. 1038 00:40:41,040 --> 00:40:49,080 AND 23 OF THE 36 PREDICTORS WERE 1039 00:40:49,080 --> 00:40:50,160 RELATED SIGNIFICANTLY LESS THAN 1040 00:40:50,160 --> 00:40:52,200 0.001 TO THE CLASS MEMBERSHIP. 1041 00:40:52,200 --> 00:40:54,840 HOWEVER, NONE OF THE COMMUNITY 1042 00:40:54,840 --> 00:40:55,760 LEVEL FACTORS WERE SIGNIFICANTLY 1043 00:40:55,760 --> 00:40:58,680 RELATED, SO THEY WERE NOT 1044 00:40:58,680 --> 00:41:02,040 INCLUDED IN FURTHER ANALYSIS. 1045 00:41:02,040 --> 00:41:08,080 WE TOOK THESE ARE 23 PREDICTORS, 1046 00:41:08,080 --> 00:41:10,200 AND CONDUCTED STEP-WISE LOGISTIC 1047 00:41:10,200 --> 00:41:12,920 REGRESSION WHICH IDENTIFIED 11 1048 00:41:12,920 --> 00:41:13,800 UNIQUE PREDICTORS THAT ARE 1049 00:41:13,800 --> 00:41:15,640 RELATED TO BELONGING TO CLASS 2 1050 00:41:15,640 --> 00:41:21,720 OR CLASS 3 AS COMPARED TO CLASS 1051 00:41:21,720 --> 00:41:22,120 1. 1052 00:41:22,120 --> 00:41:25,040 AND THESE INCLUDED VARIETY OF 1053 00:41:25,040 --> 00:41:25,960 INDIVIDUAL LEVEL STRESSORS, SOME 1054 00:41:25,960 --> 00:41:27,160 SOCIAL DETERMINANTS OF HEALTH, 1055 00:41:27,160 --> 00:41:33,040 AND SOME HAVE TO DO WITH STRESS 1056 00:41:33,040 --> 00:41:35,040 PANDEMIC AND NON-PANDEMIC 1057 00:41:35,040 --> 00:41:35,320 RELATED. 1058 00:41:35,320 --> 00:41:38,200 AND WHAT WAS INTERESTING IS THAT 1059 00:41:38,200 --> 00:41:40,680 SOME OF THESE CONTRIBUTORS WERE 1060 00:41:40,680 --> 00:41:43,960 RELATED TO HIGHER RISK OF 1061 00:41:43,960 --> 00:41:47,480 BELONGING TO BOTH CLASS 2 AND 1062 00:41:47,480 --> 00:41:49,040 CLASS 3, AND SOME CONTRIBUTORS 1063 00:41:49,040 --> 00:41:52,640 WERE RELATED TO ONE OF THESE 1064 00:41:52,640 --> 00:41:53,840 RISK GROUPS. 1065 00:41:53,840 --> 00:41:56,440 SO THINGS LIKE MAJOR STRESSFUL 1066 00:41:56,440 --> 00:41:58,400 LIFE EVENTS THAT OCCURRED PRIOR 1067 00:41:58,400 --> 00:42:01,600 TO THE THIRD TIME POINT, HISTORY 1068 00:42:01,600 --> 00:42:06,080 OF MENTAL HEALTH DIAGNOSIS, HIGH 1069 00:42:06,080 --> 00:42:07,280 LEVELS OF NON-PANDEMIC RELATED 1070 00:42:07,280 --> 00:42:08,720 STRESS WERE RELATED TO HIGHER 1071 00:42:08,720 --> 00:42:12,240 RISK OF BELONGING TO CLASS 2 OR 1072 00:42:12,240 --> 00:42:16,280 CLASS 3, AND PARTNER SUPPORT 1073 00:42:16,280 --> 00:42:17,360 THROUGHOUT, CONTINUED SUPPORT 1074 00:42:17,360 --> 00:42:20,000 THROUGHOUT THE PERINATAL PERIOD 1075 00:42:20,000 --> 00:42:23,800 WAS A PROTECTIVE FACTOR. 1076 00:42:23,800 --> 00:42:25,560 OF SEVERAL FACTORS RELATED, ONLY 1077 00:42:25,560 --> 00:42:27,960 TO INCREASED RISK OF BEING IN 1078 00:42:27,960 --> 00:42:31,040 CLASS 2 THAT MODERATE AND STABLE 1079 00:42:31,040 --> 00:42:34,640 ANXIETY, SO THINGS LIKE LOWER 1080 00:42:34,640 --> 00:42:37,480 EDUCATION, HISTORY OF 1081 00:42:37,480 --> 00:42:39,680 INTERPERSONAL VIOLENCE, AND 1082 00:42:39,680 --> 00:42:40,520 PANDEMIC-RELATED PREGNANCY 1083 00:42:40,520 --> 00:42:43,520 STRESS WERE RELATED TO CLASS 2 1084 00:42:43,520 --> 00:42:43,960 MEMBERSHIP. 1085 00:42:43,960 --> 00:42:45,920 FOR CLASS 3 MEMBERSHIP THAT 1086 00:42:45,920 --> 00:42:47,560 MODERATE TO SEVERE CLASS THERE 1087 00:42:47,560 --> 00:42:50,080 WAS ONLY ONE FACTOR THAT WAS 1088 00:42:50,080 --> 00:42:53,800 UNIQUELY RELATED JUST TO THAT, 1089 00:42:53,800 --> 00:42:57,120 THAT WAS FINANCIAL INSECURITY. 1090 00:42:57,120 --> 00:42:59,360 IN CONCLUSION WE FOUND THREE 1091 00:42:59,360 --> 00:43:01,360 GROUPS THAT DIFFERED IN THEIR 1092 00:43:01,360 --> 00:43:02,760 INITIAL ANXIETY LEVELS IN 1093 00:43:02,760 --> 00:43:04,320 TRAJECTORIES OF CHANGE OVER 1094 00:43:04,320 --> 00:43:08,920 TIME, AND IN THEIR PSYCHOSOCIAL 1095 00:43:08,920 --> 00:43:09,440 CHARACTERISTICS. 1096 00:43:09,440 --> 00:43:13,400 AND THE CONTRIBUTORS WE FOUND 1097 00:43:13,400 --> 00:43:14,840 REALLY CORROBORATE KNOWN 1098 00:43:14,840 --> 00:43:17,840 LITERATURE ON ELEVATED ANXIETY. 1099 00:43:17,840 --> 00:43:23,120 HOWEVER WE SAW CLASS 2, WHICH IS 1100 00:43:23,120 --> 00:43:24,960 THAT STABLE MODERATE ANXIETY, 1101 00:43:24,960 --> 00:43:27,520 THEY WERE CHARACTERIZED BY 1102 00:43:27,520 --> 00:43:29,480 SOCIODEMOGRAPHIC RISK FACTORINGS 1103 00:43:29,480 --> 00:43:32,320 THAT COULD EXPLAIN WHY ANXIETY 1104 00:43:32,320 --> 00:43:36,000 REMAINED STABLE THROUGHOUT THE 1105 00:43:36,000 --> 00:43:38,400 POSTPARTUM PERIOD, BUT CLASS 3 1106 00:43:38,400 --> 00:43:40,840 SEEMED TO HAVE SITUATIONAL 1107 00:43:40,840 --> 00:43:41,800 FINANCIAL INSECURITY THAT COULD 1108 00:43:41,800 --> 00:43:43,960 HAVE MADE THEM VULNERABLE TO 1109 00:43:43,960 --> 00:43:46,440 DETERIORATING MENTAL HEALTH IN 1110 00:43:46,440 --> 00:43:48,680 THE POSTPARTUM PERIOD, AND THERE 1111 00:43:48,680 --> 00:43:50,360 IS SOME -- THERE ARE SOME 1112 00:43:50,360 --> 00:43:51,360 REPORTS THAT TALK ABOUT HOW 1113 00:43:51,360 --> 00:43:55,080 DURING THE PANDEMIC THOSE THAT 1114 00:43:55,080 --> 00:43:58,720 HAD LESS MATERIAL RESOURCES 1115 00:43:58,720 --> 00:43:59,520 EXPERIENCED WORSENING MENTAL 1116 00:43:59,520 --> 00:43:59,880 HEALTH. 1117 00:43:59,880 --> 00:44:03,280 WE ALSO SAW THAT CLASS 2 AND 1118 00:44:03,280 --> 00:44:04,680 CLASS 3 WOMEN WERE TWICE AS 1119 00:44:04,680 --> 00:44:07,960 LIKELY TO HAVE HAD PRE-TERM 1120 00:44:07,960 --> 00:44:09,360 BIRTH AND POSSIBLE RECIPROCAL 1121 00:44:09,360 --> 00:44:11,800 EFFECT WHERE HIGH ANXIETY LIKELY 1122 00:44:11,800 --> 00:44:13,320 INCREASED RISK OF PRE-TERM BIRTH 1123 00:44:13,320 --> 00:44:16,800 AND THEN IN TURN PRE-TERM BIRTH 1124 00:44:16,800 --> 00:44:20,360 LIKELY MAINTAINED OR INCREASED 1125 00:44:20,360 --> 00:44:22,640 THEIR ELEVATED ANXIETY LEVELS. 1126 00:44:22,640 --> 00:44:24,720 AND THERE ARE SEVERAL PRACTICE 1127 00:44:24,720 --> 00:44:26,680 AND POLICY IMPLICATIONS TO THESE 1128 00:44:26,680 --> 00:44:27,080 FINDINGS. 1129 00:44:27,080 --> 00:44:30,960 ONE IS THAT SCREENING FOR THESE 1130 00:44:30,960 --> 00:44:33,560 RISK FACTORS FOR PSYCHOSOCIAL 1131 00:44:33,560 --> 00:44:34,120 CONTRIBUTORS BOTH SOCIAL 1132 00:44:34,120 --> 00:44:36,880 DETERMINANTS OF HEALTH AND ALSO 1133 00:44:36,880 --> 00:44:38,640 STRESSORS, IS IMPERATIVE TO 1134 00:44:38,640 --> 00:44:40,160 ENABLE PREVENTION AND 1135 00:44:40,160 --> 00:44:41,360 INTERVENTIONS WHICH WILL REDUCE 1136 00:44:41,360 --> 00:44:44,320 MORBIDITY IN TERMS OF ANXIETY 1137 00:44:44,320 --> 00:44:45,200 AND ALSO ITS SEQUEL. 1138 00:44:45,200 --> 00:44:47,000 AND SPECIAL ATTENTION SHOULD BE 1139 00:44:47,000 --> 00:44:49,600 GIVEN TO THOSE WITH LESS 1140 00:44:49,600 --> 00:44:51,120 FINANCIAL OR SOCIAL CAPITAL, 1141 00:44:51,120 --> 00:44:56,280 WHICH ARE AT GREATEST RISK FOR 1142 00:44:56,280 --> 00:45:03,400 WORSENING ANXIETY SYMPTOMS. 1143 00:45:03,400 --> 00:45:03,680 THANK YOU. 1144 00:45:03,680 --> 00:45:04,600 >>THANK YOU. 1145 00:45:04,600 --> 00:45:11,520 AS WE LOAD THE SLIDES, I'D LIKE 1146 00:45:11,520 --> 00:45:14,600 TO REMIND EVERYBODY THAT YOU CAN 1147 00:45:14,600 --> 00:45:16,520 SUBMIT YOUR QUESTIONS TO THE 1148 00:45:16,520 --> 00:45:19,800 PRESENTERS THROUGH THE VIDEOCAST 1149 00:45:19,800 --> 00:45:22,000 LIVE FEEDBACK SO WE CAN ANSWER 1150 00:45:22,000 --> 00:45:24,200 YOUR QUESTIONS DURING THE Q&A 1151 00:45:24,200 --> 00:45:24,640 DISCUSSION. 1152 00:45:24,640 --> 00:45:27,920 THANK YOU. 1153 00:45:27,920 --> 00:45:29,920 >>THANK YOU, I'M AT THE 1154 00:45:29,920 --> 00:45:31,120 UNIVERSITY OF PITTSBURGH, AND 1155 00:45:31,120 --> 00:45:32,240 I'M JUST AMAZED BY THE 1156 00:45:32,240 --> 00:45:33,440 TREMENDOUS WORK THAT'S BEEN DONE 1157 00:45:33,440 --> 00:45:35,800 IN THE PAST COUPLE YEARS AROUND 1158 00:45:35,800 --> 00:45:36,120 THIS SUBJECT. 1159 00:45:36,120 --> 00:45:38,040 AND THE TITLE OF MY TALK IS 1160 00:45:38,040 --> 00:45:39,520 YOUNG BLACK WOMEN'S DESIRED 1161 00:45:39,520 --> 00:45:41,320 PREGNANCY AND BIRTHING SUPPORT 1162 00:45:41,320 --> 00:45:43,400 DURING THE COVID-19 PANDEMIC. 1163 00:45:43,400 --> 00:45:44,480 AND ALTHOUGH IT FITS WELL WITH 1164 00:45:44,480 --> 00:45:46,920 THE GROUP OF TALKS TODAY IT 1165 00:45:46,920 --> 00:45:48,560 DIFFERS IN A COUPLE IMPORTANT 1166 00:45:48,560 --> 00:45:48,880 WAYS. 1167 00:45:48,880 --> 00:45:49,960 THIS FOCUSES ON VERY YOUNG 1168 00:45:49,960 --> 00:45:51,920 PEOPLE, THE PEOPLE IN THIS STUDY 1169 00:45:51,920 --> 00:45:54,000 WERE 23 YEARS AND YOUNGER, AND 1170 00:45:54,000 --> 00:45:55,320 IT'S INTERESTING BECAUSE PEOPLE 1171 00:45:55,320 --> 00:45:56,080 THINK THAT BECAUSE YOU'RE 1172 00:45:56,080 --> 00:45:57,960 YOUNGER YOU'RE GOING TO 1173 00:45:57,960 --> 00:45:59,840 NATURALLY HAVE A HEALTHIER 1174 00:45:59,840 --> 00:46:01,440 PREGNANCY THAN GIVING BIRTH AT 1175 00:46:01,440 --> 00:46:03,520 NORMATIVE OR OLDER AGE. 1176 00:46:03,520 --> 00:46:04,640 THAT'S NOT THE CASE. 1177 00:46:04,640 --> 00:46:06,280 A PAPER JUST CAME OUT LAST YEAR 1178 00:46:06,280 --> 00:46:08,320 THAT SHOWED PEOPLE UNDER THE AGE 1179 00:46:08,320 --> 00:46:10,640 OF 20 ARE NOT ONLY MORE LIKELY 1180 00:46:10,640 --> 00:46:13,520 TO DIE DURING CHILD BIRTH AND 1181 00:46:13,520 --> 00:46:14,280 EXPERIENCE MATERNAL MORBIDITY 1182 00:46:14,280 --> 00:46:18,200 BUT IN THE PAST DECADE, THEY 1183 00:46:18,200 --> 00:46:20,280 ACTUALLY HAD INCREASED RISK FOR 1184 00:46:20,280 --> 00:46:21,240 SEVERE MATERNAL MORBIDITY. 1185 00:46:21,240 --> 00:46:23,360 SO IT'S WITHIN THE CONTEXT OF 1186 00:46:23,360 --> 00:46:25,640 THAT THAT WE FOCUS ON YOUNGER 1187 00:46:25,640 --> 00:46:26,640 PEOPLE. 1188 00:46:26,640 --> 00:46:28,800 THE SECOND BIG DIFFERENCE 1189 00:46:28,800 --> 00:46:31,440 BETWEEN TALKS IS WITH THIS 1190 00:46:31,440 --> 00:46:35,160 STUDY, IT BRINGS EQUAL IT 1191 00:46:35,160 --> 00:46:39,880 THAT -- QUALITATIVE DATA IN 1192 00:46:39,880 --> 00:46:41,680 TERMS OF DISCRIMINATION SOME 1193 00:46:41,680 --> 00:46:44,360 PEOPLE EXPERIENCED DURING THE 1194 00:46:44,360 --> 00:46:44,640 PANDEMIC. 1195 00:46:44,640 --> 00:46:46,120 SO, BEFORE WE MOVE TO THE NEXT 1196 00:46:46,120 --> 00:46:47,960 SLIDE I'D LIKE TO ACKNOWLEDGE 1197 00:46:47,960 --> 00:46:54,120 FUNDING BY NIDA AND OFFICE OF 1198 00:46:54,120 --> 00:46:55,760 WOMEN'S HEALTH AND THE IMPROPER 1199 00:46:55,760 --> 00:46:56,360 INITIATIVE. 1200 00:46:56,360 --> 00:46:59,680 I WANT TO THANK MY MENTEE AND 1201 00:46:59,680 --> 00:47:01,000 JUNIOR COLLEAGUE ASHLEY HILL, 1202 00:47:01,000 --> 00:47:03,000 DR. HILL WAS INSTRUMENTAL IN 1203 00:47:03,000 --> 00:47:05,160 ENCOURAGING ME TO SEEK OUT EXTRA 1204 00:47:05,160 --> 00:47:06,480 FUNDING BECAUSE SHE EVEN THOUGH 1205 00:47:06,480 --> 00:47:07,920 WE WERE DOING QUALITATIVE WORK 1206 00:47:07,920 --> 00:47:09,120 IN THE PROJECT SHE KNEW THERE 1207 00:47:09,120 --> 00:47:11,320 WAS MORE THAT PEOPLE HAD TO SAY 1208 00:47:11,320 --> 00:47:12,080 ABOUT THEIR EXPERIENCES 1209 00:47:12,080 --> 00:47:14,800 PARTICULARLY DURING THE PANDEMIC 1210 00:47:14,800 --> 00:47:17,240 WHEN THOSE HEALTH DISPARITIES 1211 00:47:17,240 --> 00:47:20,520 BECAME EVEN MORE PRONOUNCED. 1212 00:47:20,520 --> 00:47:21,720 NEXT SLIDE. 1213 00:47:21,720 --> 00:47:24,440 THE PARENT STUDY IS YOUNGMOMS 1214 00:47:24,440 --> 00:47:26,320 PROJECT, FUNDED BY NIDA TO LOOK 1215 00:47:26,320 --> 00:47:28,160 AT PRENATAL TOBACCO AND CANNABIS 1216 00:47:28,160 --> 00:47:30,560 USE, IN THE YOUNGEST PREGNANT 1217 00:47:30,560 --> 00:47:33,120 AND BIRTHING PEOPLE. 1218 00:47:33,120 --> 00:47:34,880 AND SO ALTHOUGH WE'RE FUNDED AND 1219 00:47:34,880 --> 00:47:37,640 INTERESTED IN LOOKING AT 1220 00:47:37,640 --> 00:47:47,880 CORRELATES OF TOBACCO AND 1221 00:47:47,880 --> 00:47:49,000 CANNABIS DUES ACROSS PREGNANCY 1222 00:47:49,000 --> 00:47:52,520 AND POSTPARTUM WE TOOK ALL 1223 00:47:52,520 --> 00:47:53,920 COMEERS UNDER 22 WHO CAN READ 1224 00:47:53,920 --> 00:47:55,480 AND WRITE ENGLISH TO PROVIDE 1225 00:47:55,480 --> 00:47:56,280 INFORMED CONSENT AND COMPLETE 1226 00:47:56,280 --> 00:47:57,520 MEASURES AND WHO ARE NOT 1227 00:47:57,520 --> 00:47:59,400 CURRENTLY IN TREATMENT FOR 1228 00:47:59,400 --> 00:48:02,920 OPIOID USE DISORDER. 1229 00:48:02,920 --> 00:48:06,200 REALLY NO OTHER EXCLUSIONS. 1230 00:48:06,200 --> 00:48:07,040 NEXT SLIDE PLEASE. 1231 00:48:07,040 --> 00:48:09,000 THE PROJECT I'M GOING TO TALK 1232 00:48:09,000 --> 00:48:13,120 BEER IS QUALITATIVE INTERVIEWS 1233 00:48:13,120 --> 00:48:19,680 WITH PEOPLE FROM THE TALK ABOUT 1234 00:48:19,680 --> 00:48:21,280 IS QUALITATIVE INTERVIEWS, 1235 00:48:21,280 --> 00:48:22,960 SELECTED BECAUSE THEY WERE NOT 1236 00:48:22,960 --> 00:48:24,640 RECRUITED INTO THE LONGITUDINAL 1237 00:48:24,640 --> 00:48:28,560 STUDIES, DID NOT HAVE REPEATED 1238 00:48:28,560 --> 00:48:31,120 ASSESSMENTS, THEY WERE INVITED 1239 00:48:31,120 --> 00:48:34,080 TO JUST PARTICIPATE IN ONE ON 1240 00:48:34,080 --> 00:48:42,480 ONE INTERVIEWS, WITH OUR STAFF 1241 00:48:42,480 --> 00:48:44,400 TOUCHES ON A THESE THREE THEMES. 1242 00:48:44,400 --> 00:48:46,520 TODAY I'M GOING TO TALK ABOUT 1243 00:48:46,520 --> 00:48:50,160 THE TEAMS THAT EMERGED AROUND 1244 00:48:50,160 --> 00:48:57,080 STRUCTURAL RACISM GIVEN THE TIME 1245 00:48:57,080 --> 00:48:57,280 LIMIT. 1246 00:48:57,280 --> 00:48:58,600 WE THOUGHT THESE WOULD BE 1247 00:48:58,600 --> 00:49:00,560 IMPORTANT WITH OUR YOUNGER BLACK 1248 00:49:00,560 --> 00:49:01,960 AND BIRACIAL PARTICIPANTS GIVEN 1249 00:49:01,960 --> 00:49:04,080 RESEARCH THAT HAS SHOWN THEY 1250 00:49:04,080 --> 00:49:07,760 EXPERIENCE AT LEAST IN ADULT 1251 00:49:07,760 --> 00:49:09,520 POPULATIONS, EXPERIENCE GREATER 1252 00:49:09,520 --> 00:49:10,280 STRUCTURAL RACISM AND 1253 00:49:10,280 --> 00:49:11,160 DISCRIMINATION, AS THESE YOUNG 1254 00:49:11,160 --> 00:49:14,600 PEOPLE IN THE STUDY ARE 1255 00:49:14,600 --> 00:49:15,560 EXPERIENCING MULTIPLE 1256 00:49:15,560 --> 00:49:16,120 MARGINALIZED IDENTITIES AND 1257 00:49:16,120 --> 00:49:18,840 EXPERIENCES AS A RESULT OF THOSE 1258 00:49:18,840 --> 00:49:19,440 INTERACTING AND INTERSECTING 1259 00:49:19,440 --> 00:49:20,360 IDENTITIES WE THOUGHT IT MIGHT 1260 00:49:20,360 --> 00:49:22,440 BE VERY IMPORTANT TO TALK TO 1261 00:49:22,440 --> 00:49:29,240 THEM SPECIFICALLY ABOUT THESE 1262 00:49:29,240 --> 00:49:31,440 ISSUES. 1263 00:49:31,440 --> 00:49:33,520 IN OUR INTERVIEWS, WE FOUND FOUR 1264 00:49:33,520 --> 00:49:37,200 THEMES AROUND STRUCTURAL RACISM 1265 00:49:37,200 --> 00:49:38,440 AND DISCRIMINATION I'D LIKE TO 1266 00:49:38,440 --> 00:49:45,240 SHARE USING IN QUOTES THINGS 1267 00:49:45,240 --> 00:49:47,520 THAT ILLUSTRATE SOME THEMES. 1268 00:49:47,520 --> 00:49:50,480 ONE WAS AWARENESS OF HISTORICAL 1269 00:49:50,480 --> 00:49:51,120 RACISM AND DISCRIMINATION IN 1270 00:49:51,120 --> 00:49:54,520 HEALTH CARE AND HOW THAT 1271 00:49:54,520 --> 00:49:55,640 INFLUENCES PRENATAL CARE TODAY. 1272 00:49:55,640 --> 00:49:59,240 THIS PERSON SAID I WAS READING 1273 00:49:59,240 --> 00:50:02,280 AN ARTICLE THAT WOMEN OF COLOR, 1274 00:50:02,280 --> 00:50:03,800 A LOT DIE. 1275 00:50:03,800 --> 00:50:05,240 DON'T MEDICAL PROVIDERS DON'T 1276 00:50:05,240 --> 00:50:06,320 TAKE THEIR PROBLEMS SERIOUS. 1277 00:50:06,320 --> 00:50:08,320 THIS IS A VERY YOUNG PERSON, 1278 00:50:08,320 --> 00:50:10,360 THIS PERSON IS AWARE OF THE 1279 00:50:10,360 --> 00:50:11,800 HEALTH DISPARITIES BETWEEN WOMEN 1280 00:50:11,800 --> 00:50:14,560 OF COLOR AND OTHER WOMEN DURING 1281 00:50:14,560 --> 00:50:15,840 PREGNANCY AND BIRTHING 1282 00:50:15,840 --> 00:50:17,040 EXPERIENCES, AND FELT THAT 1283 00:50:17,040 --> 00:50:18,800 WASN'T TAKEN SERIOUSLY BY THEIR 1284 00:50:18,800 --> 00:50:19,800 HEALTH CARE PROVIDERS. 1285 00:50:19,800 --> 00:50:21,080 IN THE OTHER QUOTE THIS PERSON 1286 00:50:21,080 --> 00:50:23,520 SAID THERE WAS AN IDEA FOR LONG 1287 00:50:23,520 --> 00:50:25,360 TIME THAT BLACK PEOPLE COULD 1288 00:50:25,360 --> 00:50:26,880 TOLERATE PAIN BETTER THAN WHITE 1289 00:50:26,880 --> 00:50:30,240 PEOPLE, AND THIS LEADS INTO THE 1290 00:50:30,240 --> 00:50:32,360 HEALTH CARE SITUATION SITUATION 1291 00:50:32,360 --> 00:50:33,320 NOW, PEOPLE NOT LISTENING WHEN 1292 00:50:33,320 --> 00:50:39,040 THEY SAY THEY ARE IN PAIN. 1293 00:50:39,040 --> 00:50:41,320 ONE MORE QUOTE THAT WAS 1294 00:50:41,320 --> 00:50:42,720 POWERFUL, I WISH THEY WOULD 1295 00:50:42,720 --> 00:50:44,120 REALLY, THEY MEANING HEALTH CARE 1296 00:50:44,120 --> 00:50:45,600 PROVIDERS, WOULD SIT DOWN AND GO 1297 00:50:45,600 --> 00:50:47,240 BACK INTO HISTORY AND LOOK AT 1298 00:50:47,240 --> 00:50:48,680 WHERE BLACK WOMEN CAME FROM. 1299 00:50:48,680 --> 00:50:50,560 WE CAME FROM BEING SLAVES AT ONE 1300 00:50:50,560 --> 00:50:53,240 POINT AND BEING RAPED BY SLAVE 1301 00:50:53,240 --> 00:50:53,760 MASTERS. 1302 00:50:53,760 --> 00:50:56,120 STUFF DID GET BETTER. 1303 00:50:56,120 --> 00:50:57,280 STILL THE SEPARATION BETWEEN, OH 1304 00:50:57,280 --> 00:50:59,280 BECAUSE MY SKIN IS TOO DARK, I'M 1305 00:50:59,280 --> 00:51:02,240 NOT PRETTY ENOUGH OR MY BABY IS 1306 00:51:02,240 --> 00:51:03,520 NOT GOING TO BE TAKEN CARE OF IN 1307 00:51:03,520 --> 00:51:05,200 THE HOSPITAL AS A WHITE WOMAN'S 1308 00:51:05,200 --> 00:51:05,720 WOULD. 1309 00:51:05,720 --> 00:51:08,120 THESE ARE YOUNGER PEOPLE, THEY 1310 00:51:08,120 --> 00:51:11,720 ARE AWARE OF THE HISTORICAL 1311 00:51:11,720 --> 00:51:15,120 CONTEXT OF RACISM AND LEGACY 1312 00:51:15,120 --> 00:51:18,200 THAT HAS CONTRIBUTED TO MORE 1313 00:51:18,200 --> 00:51:21,520 DIFFICULT AND DISTRUST IN 1314 00:51:21,520 --> 00:51:23,000 OBSTETRIC PATIENT/PROVIDER 1315 00:51:23,000 --> 00:51:24,680 COMMUNICATION. 1316 00:51:24,680 --> 00:51:26,200 MY COLLEAGUES IN OBSTETRICS AND 1317 00:51:26,200 --> 00:51:27,520 GYNECOLOGY WITH WONDERFUL PEOPLE 1318 00:51:27,520 --> 00:51:30,000 DEDICATED TO PROVIDING THE BEST 1319 00:51:30,000 --> 00:51:32,120 CARE POSSIBLE SO THIS IS NOT 1320 00:51:32,120 --> 00:51:33,920 INTENTIONAL BUT THIS IS WHAT THE 1321 00:51:33,920 --> 00:51:35,840 EXPERIENCES OF YOUNG BLACK AND 1322 00:51:35,840 --> 00:51:37,680 BIRACIAL PEOPLE IN HOSPITAL 1323 00:51:37,680 --> 00:51:40,760 SYSTEM TODAY IS. 1324 00:51:40,760 --> 00:51:41,120 NEXT. 1325 00:51:41,120 --> 00:51:42,720 ANOTHER THEME THAT PEOPLE VOICED 1326 00:51:42,720 --> 00:51:46,000 THERE WAS A CLINICIAN BIAS IN 1327 00:51:46,000 --> 00:51:48,320 THEIR ASSUMPTIONS ABOUT THEM, 1328 00:51:48,320 --> 00:51:51,040 USING SUBSTANCES, AND ALSO THERE 1329 00:51:51,040 --> 00:51:57,960 WAS CONTRACEPTIVE COERCION FROM 1330 00:51:57,960 --> 00:52:01,200 THEIR PROVIDERS. 1331 00:52:01,200 --> 00:52:02,000 NEXT. 1332 00:52:02,000 --> 00:52:03,280 THIS OCCURRED BEFORE THE 1333 00:52:03,280 --> 00:52:04,600 INTERVIEW WAS CONDUCTED. 1334 00:52:04,600 --> 00:52:07,600 WHEN I WAS 18 I WENT TO GET AN 1335 00:52:07,600 --> 00:52:09,440 IUD BECAUSE I HAD CRAMPS AND 1336 00:52:09,440 --> 00:52:11,040 DIDN'T WANT TO HAVE A BABY AT 1337 00:52:11,040 --> 00:52:16,440 THAT TIME AND ACCIDENTS DO 1338 00:52:16,440 --> 00:52:16,760 HAPPEN. 1339 00:52:16,760 --> 00:52:18,600 THE DOCTOR WAS UNHAPPY THAT I 1340 00:52:18,600 --> 00:52:20,600 WAS 18, EXPRESSING HOW SHE FEELS 1341 00:52:20,600 --> 00:52:22,120 I SHOULD FOCUS ON SCHOOL AND SEX 1342 00:52:22,120 --> 00:52:24,120 SHOULD BE THE LAST THING ON MY 1343 00:52:24,120 --> 00:52:25,960 MIND AND I'M TOO YOUNG AND DID 1344 00:52:25,960 --> 00:52:30,880 NOT DO THE IMPLANT, A YOUNG 1345 00:52:30,880 --> 00:52:33,200 PERSON VOICING NEEDS FOR 1346 00:52:33,200 --> 00:52:35,240 REPRODUCTIVE HEALTH CARE, BEING 1347 00:52:35,240 --> 00:52:38,320 DENIED AND DIMINISHED, EXAMPLE 1348 00:52:38,320 --> 00:52:39,440 OF CONTRACEPTIVE COERCION, AND 1349 00:52:39,440 --> 00:52:49,840 HER NEEDS NOT BEING MET. 1350 00:52:53,080 --> 00:52:53,200 NEXT. 1351 00:52:53,200 --> 00:52:57,800 THE DOCTORS MADE IT SEEM LIKE I 1352 00:52:57,800 --> 00:53:06,800 WAS DOING SUBSTANCE, AND I 1353 00:53:06,800 --> 00:53:07,120 WASN'T. 1354 00:53:07,120 --> 00:53:08,320 THE PATIENT SWITCHED PROVIDERS 1355 00:53:08,320 --> 00:53:09,840 AND HOSPITALS BECAUSE THEY 1356 00:53:09,840 --> 00:53:12,480 DIDN'T FEEL LIKE THEIR VOICE WAS 1357 00:53:12,480 --> 00:53:15,320 BEING HEARD IN THIS HEALTH CARE 1358 00:53:15,320 --> 00:53:15,600 SITUATION. 1359 00:53:15,600 --> 00:53:18,680 SO I THOUGHT THAT WAS A GOOD 1360 00:53:18,680 --> 00:53:20,320 EXAMPLE OF A BIAS REGARDING 1361 00:53:20,320 --> 00:53:27,120 SUBSTANCE USE DURING THE 1362 00:53:27,120 --> 00:53:28,040 PATIENT-PROVIDER INTERACTION. 1363 00:53:28,040 --> 00:53:28,240 NEXT. 1364 00:53:28,240 --> 00:53:30,000 THEY FELT BECAUSE THEY WERE 1365 00:53:30,000 --> 00:53:32,320 BLACK THAT THEIR COMPLAINTS AND 1366 00:53:32,320 --> 00:53:33,480 THEIR CONCERNS WEREN'T BEING 1367 00:53:33,480 --> 00:53:34,720 TAKEN AS SERIOUSLY. 1368 00:53:34,720 --> 00:53:42,440 AGAIN, WE SAW THIS IN DR. 1369 00:53:42,440 --> 00:53:46,760 JANOVIC'S TALK AND FROM 1370 00:53:46,760 --> 00:53:48,480 HUGS/ABRAZOS THESE ARE AN EFFECT 1371 00:53:48,480 --> 00:53:50,040 ON HEALTH. 1372 00:53:50,040 --> 00:53:51,680 I WAS SCARED THROUGH THE 1373 00:53:51,680 --> 00:53:52,520 EXPERIENCE, THIS ONE SAID, AGAIN 1374 00:53:52,520 --> 00:53:55,640 THIS IS IN THE CONTEXT OF GIVING 1375 00:53:55,640 --> 00:54:01,520 BIRTH AND HAVING PRENATAL CARE 1376 00:54:01,520 --> 00:54:03,040 DURING COVID, THEY KNEW I WAS 1377 00:54:03,040 --> 00:54:04,280 SECURED, THEY WERE DOING A LOT 1378 00:54:04,280 --> 00:54:07,320 OF THINGS, TALKING TO 1379 00:54:07,320 --> 00:54:08,120 THEMSELVES, NOT LETTING ME KNOW 1380 00:54:08,120 --> 00:54:11,240 WHAT THEY WERE DOING. 1381 00:54:11,240 --> 00:54:14,880 THIS PARTICIPANTS FELT LIKE AN 1382 00:54:14,880 --> 00:54:18,440 OBJECT, THEY WEREN'T BEING 1383 00:54:18,440 --> 00:54:19,560 CONSULTED ON PROCEDURES AND 1384 00:54:19,560 --> 00:54:20,880 THINGS WERE OCCURRING WITHOUT 1385 00:54:20,880 --> 00:54:22,440 THEIR CONSENT AND AROUND THEM. 1386 00:54:22,440 --> 00:54:25,480 THIS WAS VOICED BY SEVERAL 1387 00:54:25,480 --> 00:54:27,200 PARTICIPANTS, EXPERIENCES LIKE 1388 00:54:27,200 --> 00:54:27,400 THIS. 1389 00:54:27,400 --> 00:54:30,080 AND MAY BE A FUNCTION OF ALSO 1390 00:54:30,080 --> 00:54:33,240 AGE, RACE, GENDER, SO THERE'S 1391 00:54:33,240 --> 00:54:34,320 LIKE MULTIPLE INTERSECTING 1392 00:54:34,320 --> 00:54:39,240 IDENTITIES THAT ARE CONTRIBUTING 1393 00:54:39,240 --> 00:54:41,000 TO THESE EXPERIENCES. 1394 00:54:41,000 --> 00:54:43,840 NEXT. 1395 00:54:43,840 --> 00:54:44,960 AND PEOPLE WITH DARKER SKIN 1396 00:54:44,960 --> 00:54:46,680 COLOR HAVE A HARDER TIME 1397 00:54:46,680 --> 00:54:48,800 EXPRESSING BECAUSE WE COME OFF 1398 00:54:48,800 --> 00:54:50,600 AS GREEDY, WE CAN'T SAY IT 1399 00:54:50,600 --> 00:54:51,200 OUTRIGHT. 1400 00:54:51,200 --> 00:54:52,240 I'VE NEVER BEEN ABLE TO SAY, 1401 00:54:52,240 --> 00:54:54,160 HEY, THIS IS HOW I FEEL, WHAT I 1402 00:54:54,160 --> 00:54:55,560 THINK IS GOING ON. 1403 00:54:55,560 --> 00:54:58,280 NO, I'M QUIET WHEN I GO, I 1404 00:54:58,280 --> 00:55:02,040 QUESTION THEM AND MYSELF. 1405 00:55:02,040 --> 00:55:04,080 THIS PERSON IS ACTUALLY 1406 00:55:04,080 --> 00:55:04,840 SELF-SILENCING THEMSELVES AND 1407 00:55:04,840 --> 00:55:06,320 CHANGING SO THEY FEEL LIKE THIS 1408 00:55:06,320 --> 00:55:10,920 HAS AN IMPACTS NOT ONLY ON THE 1409 00:55:10,920 --> 00:55:11,640 PATIENT-PROVIDER COMMUNICATION 1410 00:55:11,640 --> 00:55:12,440 FROM PROVIDER SIDE BUT 1411 00:55:12,440 --> 00:55:15,360 THEMSELVES AS THE PATIENT. 1412 00:55:15,360 --> 00:55:16,720 NEXT. 1413 00:55:16,720 --> 00:55:18,120 AND THEN ANOTHER EXAMPLE WHERE 1414 00:55:18,120 --> 00:55:20,600 THEY FELT THAT BECAUSE OF 1415 00:55:20,600 --> 00:55:23,240 THEIR -- I'M RUSHING A BIT NOW 1416 00:55:23,240 --> 00:55:24,480 WITH THE POWERFUL QUOTES BUT I 1417 00:55:24,480 --> 00:55:26,240 ONLY HAVE A MINUTE. 1418 00:55:26,240 --> 00:55:27,560 I WANTED TO GIVE ANOTHER EXAMPLE 1419 00:55:27,560 --> 00:55:29,600 HOW THEY FELT IF I WAS A WHITE 1420 00:55:29,600 --> 00:55:31,760 WOMAN THEY WOULD HAVE HEARD ME. 1421 00:55:31,760 --> 00:55:33,320 AGAIN, THE SENSE THEIR VOICES 1422 00:55:33,320 --> 00:55:37,600 ARE NOT BEING HEARD. 1423 00:55:37,600 --> 00:55:37,800 NEXT. 1424 00:55:37,800 --> 00:55:39,800 AND WHEN WE ASKED WHAT THEY 1425 00:55:39,800 --> 00:55:41,440 WOULD LIKE TO SEE, ONE THING 1426 00:55:41,440 --> 00:55:42,800 THAT CAME THROUGH FROM A LOT OF 1427 00:55:42,800 --> 00:55:43,920 PARTICIPANTS I'D LIKE TO SEE 1428 00:55:43,920 --> 00:55:45,240 SOMEONE THAT LOOKS LIKE ME, EVEN 1429 00:55:45,240 --> 00:55:50,840 JUST A PERSON OF COLOR. 1430 00:55:50,840 --> 00:55:51,320 NEXT. 1431 00:55:51,320 --> 00:55:53,240 TO CONCLUDE, WHAT YOUNG PEOPLE 1432 00:55:53,240 --> 00:55:55,640 KNOW IS THAT HISTORICAL RACISM 1433 00:55:55,640 --> 00:55:57,800 AND DISCRIMINATION CONTINUES TO 1434 00:55:57,800 --> 00:55:59,680 IMPACT THEIR OB INTERACTIONS 1435 00:55:59,680 --> 00:56:02,440 TODAY AND THEY ARE VERY AWARE 1436 00:56:02,440 --> 00:56:04,240 AND CLINICIAN BIAS INFLUENCES 1437 00:56:04,240 --> 00:56:06,160 THEIR CARE AND DECISION MAKING, 1438 00:56:06,160 --> 00:56:08,280 AND WE FOUND EXAMPLES FROM 1439 00:56:08,280 --> 00:56:09,960 SUBSTANCE USE AND REPRODUCTIVE 1440 00:56:09,960 --> 00:56:11,600 AUTONOMY, THEY ARE VERY GOOD AND 1441 00:56:11,600 --> 00:56:12,520 ARTICULATE AND CLEAR ABOUT 1442 00:56:12,520 --> 00:56:14,560 SAYING WHAT THEY WANT AND NEED 1443 00:56:14,560 --> 00:56:16,320 TO SEE IN PRENATAL CARE BUT FEEL 1444 00:56:16,320 --> 00:56:20,040 THEY ARE NOT BEING HEARD. 1445 00:56:20,040 --> 00:56:20,240 NEXT. 1446 00:56:20,240 --> 00:56:22,240 I'LL CONCLUDE WITH THIS SLIDE OF 1447 00:56:22,240 --> 00:56:25,160 MY AMAZING COLLABORATORS AND 1448 00:56:25,160 --> 00:56:29,240 STAFF WHO WERE I FEEL ABLE TO -- 1449 00:56:29,240 --> 00:56:31,400 THE THE STAFF ESPECIALLY ABLE TO 1450 00:56:31,400 --> 00:56:32,960 CREATE TRUST WITH THESE VERY 1451 00:56:32,960 --> 00:56:34,920 YOUNG PEOPLE AND SO THEY FELT 1452 00:56:34,920 --> 00:56:35,800 COMFORTABLE SHARING PREGNANCY 1453 00:56:35,800 --> 00:56:37,920 AND BIRTHING STORIES WITH US, 1454 00:56:37,920 --> 00:56:40,960 AND MOST GRATEFUL TO THE YOUNG 1455 00:56:40,960 --> 00:56:41,440 MOMS PARTICIPANTS WHO 1456 00:56:41,440 --> 00:56:42,280 PARTICIPATED AND SHARED 1457 00:56:42,280 --> 00:56:51,920 EXPERIENCES WITH US. 1458 00:56:51,920 --> 00:56:54,080 THANK YOU. 1459 00:56:54,080 --> 00:56:56,360 >>I'LL ASK THE PRESENTERS TO GO 1460 00:56:56,360 --> 00:56:58,760 ON CAMERA FOR THE Q&A PERIOD 1461 00:56:58,760 --> 00:57:00,320 UNTIL 1:10 FOR QUESTIONS ANYBODY 1462 00:57:00,320 --> 00:57:08,640 FROM THE PANEL OR AUDIENCE HAS. 1463 00:57:08,640 --> 00:57:11,360 I CAN START WITH DR. JANEVIC. 1464 00:57:11,360 --> 00:57:14,960 QUICK QUESTION RELATED TO YOUR 1465 00:57:14,960 --> 00:57:16,480 PATIENT POPULATION. 1466 00:57:16,480 --> 00:57:19,920 SO I DIDN'T SEE AND I DIDN'T 1467 00:57:19,920 --> 00:57:23,520 LOOK TO SEE IF YOUR PATIENT 1468 00:57:23,520 --> 00:57:25,640 POPULATION HAD ANY COMORBID 1469 00:57:25,640 --> 00:57:27,960 CONDITIONS OR PRE-DIAGNOSIS SORT 1470 00:57:27,960 --> 00:57:30,160 OF PRE-PREGNANCY THAT THEY HAD 1471 00:57:30,160 --> 00:57:32,040 THE INCREASED RISK OF POSTPARTUM 1472 00:57:32,040 --> 00:57:39,720 ELEVATION IN THEIR BLOOD 1473 00:57:39,720 --> 00:57:46,600 PRESSURES IN ADDITION TO 1474 00:57:46,600 --> 00:57:47,240 INSECURITIES AND COVID. 1475 00:57:47,240 --> 00:57:50,120 >>WE DID CONTROL FOR THAT. 1476 00:57:50,120 --> 00:58:00,640 27% HAD EITHER PREEXISTING OR 1477 00:58:02,360 --> 00:58:03,800 HYPERTENSION IN PREGNANCY. 1478 00:58:03,800 --> 00:58:06,560 >>THE FOOD INSECURITY AND 1479 00:58:06,560 --> 00:58:07,320 FINANCIAL INSECURITY, AMAZING 1480 00:58:07,320 --> 00:58:08,960 THAT PLAYED A PART IN THE 1481 00:58:08,960 --> 00:58:10,720 MAJORITY OF YOUR STUDIES THAT 1482 00:58:10,720 --> 00:58:11,920 YOU IDENTIFIED. 1483 00:58:11,920 --> 00:58:14,200 I'M WONDERING FOR THE FOOD 1484 00:58:14,200 --> 00:58:16,400 INSECURITY, DID THEY NOT HAVE 1485 00:58:16,400 --> 00:58:19,480 ACCESS TO WIC PROGRAMS SO THE 1486 00:58:19,480 --> 00:58:20,760 PARTICIPANTS IN YOUR STUDIES, 1487 00:58:20,760 --> 00:58:24,280 DID NOT HAVE ACCESS TO WIC OR 1488 00:58:24,280 --> 00:58:26,440 WERE SERVICES LIMITED DURING 1489 00:58:26,440 --> 00:58:26,640 COVID? 1490 00:58:26,640 --> 00:58:30,080 >>I THINK IT WAS A COMBINATION 1491 00:58:30,080 --> 00:58:34,440 OF, YOU KNOW, THE PARTICIPANTS 1492 00:58:34,440 --> 00:58:37,040 WEREN'T RECEIVING WIC IN A 1493 00:58:37,040 --> 00:58:38,360 TIMELY FASHION, IT WASN'T REALLY 1494 00:58:38,360 --> 00:58:39,240 NECESSARILY SUFFICIENT TO MEET 1495 00:58:39,240 --> 00:58:40,400 THE NEEDS. 1496 00:58:40,400 --> 00:58:41,800 THE QUESTIONS WERE ABOUT ANYTIME 1497 00:58:41,800 --> 00:58:44,600 IN THE PRIOR 12 MONTHS, SO EVEN 1498 00:58:44,600 --> 00:58:48,640 IF PARTICIPANTS WERE ABLE TO 1499 00:58:48,640 --> 00:58:50,760 ACCESS SUFFICIENT FOOD FOR 1500 00:58:50,760 --> 00:58:51,360 THEMSELVES DURING THE ACTUAL 1501 00:58:51,360 --> 00:58:53,200 PREGNANCY, THEY WERE EVEN IN THE 1502 00:58:53,200 --> 00:58:54,680 12 MONTHS PRIOR TO PREGNANCY 1503 00:58:54,680 --> 00:58:56,480 WHEN THEY DIDN'T HAVE ACCESS TO 1504 00:58:56,480 --> 00:58:58,280 WIC THEY WERE EXPERIENCING FOOD 1505 00:58:58,280 --> 00:58:59,320 INSECURITIES SO OH QUESTIONS 1506 00:58:59,320 --> 00:59:01,520 WERE UNABLE TO TEASE APART WAS 1507 00:59:01,520 --> 00:59:06,560 IT ONLY DURING THE PREGNANCY OR 1508 00:59:06,560 --> 00:59:07,400 JUST IN THE LAST 12 MONTHS, WE 1509 00:59:07,400 --> 00:59:09,160 WERE SHOCKED BY THE HIGH RATES 1510 00:59:09,160 --> 00:59:12,120 OF FOOD INSECURITY AND THAT SORT 1511 00:59:12,120 --> 00:59:14,320 OF SPURRED US TO APPLY FOR OTHER 1512 00:59:14,320 --> 00:59:19,360 FUNDING INCLUDING ONE OF OUR 1513 00:59:19,360 --> 00:59:22,960 PEDIATRICS COLLEAGUES LEADING A 1514 00:59:22,960 --> 00:59:24,960 PCORI APPLICATION, TO DELIVER 1515 00:59:24,960 --> 00:59:26,040 GROCERIES TO PREGNANT AND 1516 00:59:26,040 --> 00:59:28,880 POSTPARTUM INDIVIDUALS IN THOSE 1517 00:59:28,880 --> 00:59:31,840 COMMUNITIES BECAUSE THERE ARE 1518 00:59:31,840 --> 00:59:36,000 NEEDS AROUND PREGNANCY AND LATER 1519 00:59:36,000 --> 00:59:36,520 NOT BEING MET. 1520 00:59:36,520 --> 00:59:37,200 >>ABSOLUTELY. 1521 00:59:37,200 --> 00:59:38,080 THANK YOU. 1522 00:59:38,080 --> 00:59:40,160 ANYONE ELSE FROM THE PANEL? 1523 00:59:40,160 --> 00:59:47,960 I'M LOOKING FOR HANDS RAISED OR 1524 00:59:47,960 --> 00:59:48,600 ANY OTHER QUESTIONS. 1525 00:59:48,600 --> 00:59:51,760 THERE ARE NO QUESTIONS FROM THE 1526 00:59:51,760 --> 00:59:53,640 AUDIENCE SO FAR. 1527 00:59:53,640 --> 00:59:59,520 I WAS ALSO VERY IMPRESSED, DR. 1528 00:59:59,520 --> 01:00:03,560 DE GENNA, ABOUT THE KNOWLEDGE OF 1529 01:00:03,560 --> 01:00:06,440 HISTORICAL RACISM AND HOW THAT 1530 01:00:06,440 --> 01:00:09,400 INFLUENCED YOUNGER AGE WOMEN IN 1531 01:00:09,400 --> 01:00:10,320 THEIR -- YOU KNOW, AROUND 25 1532 01:00:10,320 --> 01:00:11,880 YEARS OF AGE. 1533 01:00:11,880 --> 01:00:14,400 DID ANY OF YOUR 25 EXPERIENCE 1534 01:00:14,400 --> 01:00:16,920 ANY ADVERSE EVENTS THAT YOU 1535 01:00:16,920 --> 01:00:17,160 SAMPLED? 1536 01:00:17,160 --> 01:00:20,360 DO YOU KNOW IF THEY HAD ANY 1537 01:00:20,360 --> 01:00:21,440 PREGNANCY-RELATED ADVERSE EVENTS 1538 01:00:21,440 --> 01:00:25,000 THAT PLAYED ALONG WITH THEIR 1539 01:00:25,000 --> 01:00:25,320 IMPRESSIONS? 1540 01:00:25,320 --> 01:00:26,360 >>NO, OUR INTERVIEW GUIDE 1541 01:00:26,360 --> 01:00:27,640 DIDN'T ASK ABOUT THAT 1542 01:00:27,640 --> 01:00:28,120 SPECIFICALLY. 1543 01:00:28,120 --> 01:00:32,280 MAYBE THAT'S WHY WE DIDN'T 1544 01:00:32,280 --> 01:00:33,360 ELICIT THOSE STORIES. 1545 01:00:33,360 --> 01:00:35,240 I WILL SAY WE'RE ABSTRACTING THE 1546 01:00:35,240 --> 01:00:38,280 MEDICAL CHARTS FROM EVERYBODY 1547 01:00:38,280 --> 01:00:40,720 WHO COMPLETES THE FIRST BASELINE 1548 01:00:40,720 --> 01:00:44,120 SURVEY SO WE'LL BE ABLE TO. 1549 01:00:44,120 --> 01:00:49,160 I KNOW ANECDOTALLY WE'VE SEE 1550 01:00:49,160 --> 01:00:50,320 PREECLAMPSIA, PREGNANCY LOSS, 1551 01:00:50,320 --> 01:00:53,280 PRE-TERM BIRTHS EVEN IN THE 1552 01:00:53,280 --> 01:00:55,480 YOUNG AND SUPPOSEDLY HEALTHY 1553 01:00:55,480 --> 01:00:55,720 SAMPLE. 1554 01:00:55,720 --> 01:00:58,320 BUT WE WILL TRY TO FIND OUT AND 1555 01:00:58,320 --> 01:00:59,920 WE'LL HAVE ABOUT 500 OF THOSE WE 1556 01:00:59,920 --> 01:01:02,040 CAN LOOK AT TO SEE AND IN SOME 1557 01:01:02,040 --> 01:01:04,440 SURVEY DATA WE'RE ASKING ABOUT 1558 01:01:04,440 --> 01:01:06,400 EXPERIENCES OF DISCRIMINATION 1559 01:01:06,400 --> 01:01:08,720 AND THINGS LIKE THAT SO WE'LL BE 1560 01:01:08,720 --> 01:01:12,880 ABLE TO SEE IF WE CAN TIE THOSE 1561 01:01:12,880 --> 01:01:13,520 TO ADVERSE EVENTS. 1562 01:01:13,520 --> 01:01:15,720 >>ANDREA HAS A QUESTION FOR YOU 1563 01:01:15,720 --> 01:01:16,560 AS WELL. 1564 01:01:16,560 --> 01:01:18,920 I'LL TURN IT TO ANDREA. 1565 01:01:18,920 --> 01:01:19,960 >>OH, THANKS. 1566 01:01:19,960 --> 01:01:21,600 I WAS SAYING I THINK THAT THIS 1567 01:01:21,600 --> 01:01:24,160 WORK IS SO POWERFUL AND SOME OF 1568 01:01:24,160 --> 01:01:25,680 THE BEST WAYS WE CAN GET A SENSE 1569 01:01:25,680 --> 01:01:31,880 OF PEOPLE THROUGH STAKEHOLDERS, 1570 01:01:31,880 --> 01:01:38,360 SO WHAT DID YOU VIEW AS YOUR 1571 01:01:38,360 --> 01:01:41,000 STEPS? 1572 01:01:41,000 --> 01:01:43,920 AS HIGH RISK OBSTETRICIAN WE 1573 01:01:43,920 --> 01:01:45,040 KNOW ABOUT THIS BUT WHAT DO YOU 1574 01:01:45,040 --> 01:01:46,800 THINK SHOULD BE DONE TO FOLLOW 1575 01:01:46,800 --> 01:01:47,360 UP ON THIS? 1576 01:01:47,360 --> 01:01:49,520 >>WELL, ONE OF THE FIRST THING 1577 01:01:49,520 --> 01:01:53,560 IS MEET WITH OBSTETRIC PROVIDER 1578 01:01:53,560 --> 01:01:58,040 PARTNERS AND SHARE RESULTS, AND 1579 01:01:58,040 --> 01:01:59,720 ONE OF EXPERTS TRIES TO SEE WHAT 1580 01:01:59,720 --> 01:02:02,120 WE CAN DO TO CHANGE WHAT'S 1581 01:02:02,120 --> 01:02:03,320 HAPPENING, AT LEAST FROM THE 1582 01:02:03,320 --> 01:02:04,800 PROVIDER END OF THINGS. 1583 01:02:04,800 --> 01:02:06,600 I THINK SOME IS JUST STRUCTURAL 1584 01:02:06,600 --> 01:02:10,200 THINGS SO WE CAN'T HAVE 1585 01:02:10,200 --> 01:02:10,920 INDIVIDUAL INTERVENTIONS WORKING 1586 01:02:10,920 --> 01:02:11,720 WITH INDIVIDUAL PATIENTS. 1587 01:02:11,720 --> 01:02:13,600 THAT'S NOT GOING TO CHANGE. 1588 01:02:13,600 --> 01:02:16,080 IT HAS TO HAPPEN ON A BIGGER 1589 01:02:16,080 --> 01:02:16,280 LEVEL. 1590 01:02:16,280 --> 01:02:17,320 ON AN INDIVIDUAL SIDE I'M 1591 01:02:17,320 --> 01:02:18,880 WORKING WITH ANOTHER PERSON WHO 1592 01:02:18,880 --> 01:02:21,800 DOES INTERVENTION WORK TO TRY TO 1593 01:02:21,800 --> 01:02:23,320 DEVELOP A COLLABORATIVE OF BLACK 1594 01:02:23,320 --> 01:02:25,640 PEOPLE WITH EXPERIENCES OF 1595 01:02:25,640 --> 01:02:26,560 PRENATAL SMOKING TO UNDERSTAND 1596 01:02:26,560 --> 01:02:28,280 HOW HOW EXPERIENCES MIGHT RELATE 1597 01:02:28,280 --> 01:02:29,480 TO SMOKING, AND ANOTHER THING WE 1598 01:02:29,480 --> 01:02:32,880 DO IS WE HAVE A SURVEY WE 1599 01:02:32,880 --> 01:02:34,200 DEVELOP WE'RE USING QUALITATIVE 1600 01:02:34,200 --> 01:02:36,000 INTERVIEW DATA TO REVISE AND 1601 01:02:36,000 --> 01:02:38,880 REFINE AND THEN LEARN MORE ABOUT 1602 01:02:38,880 --> 01:02:40,000 FOR EXAMPLE FOOD INSECURITY IS 1603 01:02:40,000 --> 01:02:41,840 NOT IN THE PARENT STUDY AND WE 1604 01:02:41,840 --> 01:02:45,320 WANT TO LEARN BECAUSE WE DIDN'T 1605 01:02:45,320 --> 01:02:46,960 ASK ABOUT THAT. 1606 01:02:46,960 --> 01:02:48,840 A LOT OF NEXT STEPS TO TRY TO 1607 01:02:48,840 --> 01:02:50,920 FIGURE OUT WHAT CAN WE DO TO 1608 01:02:50,920 --> 01:02:57,560 HELP AND IMPROVE THE SITUATION 1609 01:02:57,560 --> 01:03:01,240 NOW THAT THESE VOICES ARE BEING 1610 01:03:01,240 --> 01:03:01,480 HEARD. 1611 01:03:01,480 --> 01:03:02,640 >>I'M THANKFUL YOU'RE HEARING 1612 01:03:02,640 --> 01:03:03,200 THE VOICES. 1613 01:03:03,200 --> 01:03:09,000 THERE'S A QUESTION IN THE CHAT. 1614 01:03:09,000 --> 01:03:10,880 I'LL READ IT. 1615 01:03:10,880 --> 01:03:12,760 IT'S FOR EVERYONE SPEAKING. 1616 01:03:12,760 --> 01:03:15,040 SOME OF IT YOU'VE ALREADY 1617 01:03:15,040 --> 01:03:15,840 ADDRESSED, BUT WERE YOU 1618 01:03:15,840 --> 01:03:18,800 SURPRISED BY THE HIGH RATES OF 1619 01:03:18,800 --> 01:03:22,400 STRESS ACROSS STUDIES, WHETHER 1620 01:03:22,400 --> 01:03:24,360 RACISM, FOOD INSECURITY AND LOW 1621 01:03:24,360 --> 01:03:31,560 SCORES OF STRESS AND DEPRESSION, 1622 01:03:31,560 --> 01:03:35,760 TWO QUESTIONS, IN THE STUDY THAT 1623 01:03:35,760 --> 01:03:38,120 EXAMINED PRE-TERM BIRTH, SMOKING 1624 01:03:38,120 --> 01:03:38,880 MEASURED, WOULD HAVE -- SORRY, 1625 01:03:38,880 --> 01:03:42,200 ONE OF THE WAYS THAT 1626 01:03:42,200 --> 01:03:45,000 PARTICIPANTS COPED WITH STRESS. 1627 01:03:45,000 --> 01:03:50,680 1628 01:03:50,680 --> 01:03:52,240 DOES ANYONE WANT TO TAKE THE 1629 01:03:52,240 --> 01:03:54,080 FIRST QUESTION ABOUT SORT OF THE 1630 01:03:54,080 --> 01:03:56,960 ADVERSE EVENTS AND LOW SCORE OF 1631 01:03:56,960 --> 01:03:58,600 STRESS AND DEPRESSION AND 1632 01:03:58,600 --> 01:04:00,760 ANXIETY? 1633 01:04:00,760 --> 01:04:03,080 1634 01:04:03,080 --> 01:04:05,160 >>I MEAN, I CAN TRY TO ANSWER 1635 01:04:05,160 --> 01:04:08,040 BUT I'M NOT SURE THIS IS REALLY 1636 01:04:08,040 --> 01:04:09,880 GEARED TOWARDS ME BECAUSE IN MY 1637 01:04:09,880 --> 01:04:12,760 STUDY WE DID HAVE HIGH STRESS 1638 01:04:12,760 --> 01:04:15,040 AND ALSO HIGH ANXIETY. 1639 01:04:15,040 --> 01:04:18,800 SO I WAS NOT SURPRISED BY THE 1640 01:04:18,800 --> 01:04:20,520 HIGH RATES OF ANXIETY. 1641 01:04:20,520 --> 01:04:24,120 AND I'M NOT SURE THAT THE 1642 01:04:24,120 --> 01:04:25,520 QUESTION ABOUT PRE-TERM BIRTH, 1643 01:04:25,520 --> 01:04:31,240 IS THAT ABOUT MY FINDINGS? 1644 01:04:31,240 --> 01:04:31,440 OKAY. 1645 01:04:31,440 --> 01:04:33,120 >>I BELIEVE SO, RIGHT? 1646 01:04:33,120 --> 01:04:36,560 YOU'RE THE ONLY ONE TWO 1647 01:04:36,560 --> 01:04:37,760 MENTIONED PRE-TERM BIRTH. 1648 01:04:37,760 --> 01:04:40,640 IF YOU WANT TO UNMUTE AND ASK 1649 01:04:40,640 --> 01:04:41,640 YOUR QUESTION. 1650 01:04:41,640 --> 01:04:45,000 >>SURE. 1651 01:04:45,000 --> 01:04:48,000 I FOUND IT SURPRISING, I THINK 1652 01:04:48,000 --> 01:04:49,600 YOU USED A SCORE OF GREATER THAN 1653 01:04:49,600 --> 01:04:54,760 8 SO I KNOW YOU GOT THERE, BUT 1654 01:04:54,760 --> 01:04:56,200 FOR SUCH HIGH PREVALENCE OF 1655 01:04:56,200 --> 01:04:58,440 THESE REALLY KIND OF ENORMOUS 1656 01:04:58,440 --> 01:05:00,840 STRESSORS OF RACISM AND 1657 01:05:00,840 --> 01:05:01,880 FINANCIAL INSECURITY AND, YOU 1658 01:05:01,880 --> 01:05:05,480 KNOW, THE METRICS THAT YOU 1659 01:05:05,480 --> 01:05:08,320 SHOWED OF COVID IN 1660 01:05:08,320 --> 01:05:10,160 MASSACHUSETTS, THAT THE SCORES 1661 01:05:10,160 --> 01:05:12,560 WERE, I THINK, RELATIVELY LOW 1662 01:05:12,560 --> 01:05:15,640 COMPARED TO WHAT I'VE SEEN SO I 1663 01:05:15,640 --> 01:05:16,760 WONDERED IF YOU HAD THOUGHTS 1664 01:05:16,760 --> 01:05:18,560 ABOUT THE STUDIES THAT MEASURED 1665 01:05:18,560 --> 01:05:21,200 IT AND, YES, MY QUESTION WAS FOR 1666 01:05:21,200 --> 01:05:24,400 HEIDI AROUND PRE-TERM BIRTH AS 1667 01:05:24,400 --> 01:05:25,600 DR. DE GENNA MENTIONED ABOUT 1668 01:05:25,600 --> 01:05:28,920 SMOKING AS A WAY TO COPE WITH 1669 01:05:28,920 --> 01:05:34,840 RACISM AND OTHER STRESSORS 1670 01:05:34,840 --> 01:05:35,440 DURING PREGNANCY. 1671 01:05:35,440 --> 01:05:38,720 >>IN TERMS OF PRE-TERM BIRTH, 1672 01:05:38,720 --> 01:05:42,920 WHAT I PRESENTED NOW, WE DID NOT 1673 01:05:42,920 --> 01:05:44,760 LOOK AT PRE-TERM BIRTH AS 1674 01:05:44,760 --> 01:05:46,200 PREDICTORS OF PRE-TERM BIRTH AND 1675 01:05:46,200 --> 01:05:49,360 HOW STRESS IS A PREDICTOR. 1676 01:05:49,360 --> 01:05:50,680 SO CONTROLLING FOR TOBACCO USE 1677 01:05:50,680 --> 01:05:52,120 IS NOT REALLY RELEVANT TO THAT 1678 01:05:52,120 --> 01:05:53,960 QUESTION BECAUSE THE OUTCOME WAS 1679 01:05:53,960 --> 01:05:57,560 NOT PRE-TERM BIRTH. 1680 01:05:57,560 --> 01:05:59,200 RATHER, THE ANXIETY WAS THE 1681 01:05:59,200 --> 01:06:00,960 OUTCOME. 1682 01:06:00,960 --> 01:06:02,440 WE HAVE A DIFFERENT PUBLICATION 1683 01:06:02,440 --> 01:06:05,440 FROM THE WAVE 1 PARTICIPANTS 1684 01:06:05,440 --> 01:06:08,840 THAT WE LOOKED AT PERINATAL 1685 01:06:08,840 --> 01:06:12,000 ADVERSE OUTCOMES, AS OUR OUTCOME 1686 01:06:12,000 --> 01:06:15,200 MEASURES, AND THERE WE DO HAVE 1687 01:06:15,200 --> 01:06:16,160 ANALYSES THAT INCLUDED TOBACCO 1688 01:06:16,160 --> 01:06:18,680 USE AND OTHER THINGS THAT I'M 1689 01:06:18,680 --> 01:06:20,360 JUST GOING TO POP THAT IN THE 1690 01:06:20,360 --> 01:06:20,680 CHAT. 1691 01:06:20,680 --> 01:06:28,240 IF YOU'RE INTERESTED IN LOOKING 1692 01:06:28,240 --> 01:06:28,800 AT THAT PUBLICATION. 1693 01:06:28,800 --> 01:06:30,640 >>AS FAR AS THE SCREENING 1694 01:06:30,640 --> 01:06:32,280 SCORES, I AGREE WITH YOU, MAYBE 1695 01:06:32,280 --> 01:06:35,080 WE WOULD HAVE EXPECTED OUR MEAN 1696 01:06:35,080 --> 01:06:38,000 SCORES TO BE HIGHER, BUT IN THE 1697 01:06:38,000 --> 01:06:39,280 STRATIFIED ANALYSES LOOKING AT 1698 01:06:39,280 --> 01:06:41,680 INDIVIDUALS WITH FOOD INSTITUTER 1699 01:06:41,680 --> 01:06:49,840 AS - FOOD INSECURITY AND 1700 01:06:49,840 --> 01:06:52,120 DISCRIMINATION, 10 TO 12, MORE 1701 01:06:52,120 --> 01:06:54,080 MODERATE RISK OF DEPRESSION ON 1702 01:06:54,080 --> 01:06:55,400 THE SCREENER, EVEN TAKEN 1703 01:06:55,400 --> 01:06:57,160 ALTOGETHER IF THE MEAN STARTING 1704 01:06:57,160 --> 01:06:59,120 SCORE WAS JUST SLIGHTLY ABOVE 8, 1705 01:06:59,120 --> 01:07:01,640 WHICH IS SCREEN POSITIVE BUT NOT 1706 01:07:01,640 --> 01:07:03,480 HIGHEST RISK GROUP FOR HAVING 1707 01:07:03,480 --> 01:07:04,800 DEPRESSION, ARE INDIVIDUALS WHO 1708 01:07:04,800 --> 01:07:06,680 HAD THE GREATER LIFE STRESSORS 1709 01:07:06,680 --> 01:07:08,840 WERE MORE SQUARELY IN THAT 1710 01:07:08,840 --> 01:07:12,240 MODERATE CHANGE AND ANOTHER 1711 01:07:12,240 --> 01:07:15,560 GROUP AT MASS GENERAL WHO 1712 01:07:15,560 --> 01:07:18,160 EXAMINED DEPRESSION SCORES AND 1713 01:07:18,160 --> 01:07:20,480 CHANGES IN COVID PANDEMIC AMONG 1714 01:07:20,480 --> 01:07:22,000 HIGH RISK CLINIC POPULATIONS, 1715 01:07:22,000 --> 01:07:23,200 PATIENTS WITH SUBSTANCE USE 1716 01:07:23,200 --> 01:07:27,960 DISORDER FOUND THE PANDEMIC HAD 1717 01:07:27,960 --> 01:07:29,800 NO IMPACT ON THEIR DEPRESSION 1718 01:07:29,800 --> 01:07:32,640 SCORES AND PART OF THAT THEY 1719 01:07:32,640 --> 01:07:34,840 POSTULATED WAS BECAUSE AN 1720 01:07:34,840 --> 01:07:36,720 INDIVIDUAL WHO HAS SO MANY LIFE 1721 01:07:36,720 --> 01:07:38,240 STRESSORS AND SO MANY THINGS 1722 01:07:38,240 --> 01:07:41,960 GOING ON AT ALL TIMES, THEY 1723 01:07:41,960 --> 01:07:44,480 EITHER MIGHT HAVE DEVELOPED 1724 01:07:44,480 --> 01:07:45,640 DIFFERENT RESILIENCY METRICS 1725 01:07:45,640 --> 01:07:48,880 THAT WOULD BE MEASURED BY EPDS, 1726 01:07:48,880 --> 01:07:50,840 BASELINE SCORES OF HOW THEY 1727 01:07:50,840 --> 01:07:52,480 EXPERIENCE LIFE MIGHT NOT HAVE 1728 01:07:52,480 --> 01:07:53,680 DEPRESSION FIGURING AS 1729 01:07:53,680 --> 01:07:54,880 PROMINENTLY AND HAVING ANXIETY 1730 01:07:54,880 --> 01:07:58,360 AND STRESS AS MORE PROMINENT, SO 1731 01:07:58,360 --> 01:08:00,240 THAT'S THE ONLY OTHER INSIGHT I 1732 01:08:00,240 --> 01:08:03,160 HAVE TO OFFER THERE. 1733 01:08:03,160 --> 01:08:06,240 1734 01:08:06,240 --> 01:08:09,200 >>WE DID ASK ABOUT SMOKING AND 1735 01:08:09,200 --> 01:08:11,640 DRINKING SPECIFICALLY AND HAD 1736 01:08:11,640 --> 01:08:14,480 THAT CHANGED DURING COVID. 1737 01:08:14,480 --> 01:08:15,920 SOME PEOPLE SHARED THEY SMOKED 1738 01:08:15,920 --> 01:08:17,440 BUT DIDN'T COME THROUGH AS A NEW 1739 01:08:17,440 --> 01:08:19,280 WAY OF COPING WITH THE STRESSORS 1740 01:08:19,280 --> 01:08:21,680 OF COVID AND THEN THE UNREST AND 1741 01:08:21,680 --> 01:08:24,680 EVERYTHING GOING ON AROUND THE 1742 01:08:24,680 --> 01:08:26,920 COUNTRY AT THE TIME OF 1743 01:08:26,920 --> 01:08:28,360 INTERVIEWS BUT THERE'S A LOT OF 1744 01:08:28,360 --> 01:08:29,920 PRENATAL SMOKING IN THE PARENT 1745 01:08:29,920 --> 01:08:31,920 STUDY SO I FEEL LIKE THAT WAS 1746 01:08:31,920 --> 01:08:33,080 ALREADY THERE FOR A LOT OF 1747 01:08:33,080 --> 01:08:37,560 REASONS INCLUDING THE FACT THAT 1748 01:08:37,560 --> 01:08:38,240 STRUCTURAL RACISM AND 1749 01:08:38,240 --> 01:08:40,000 DISCRIMINATION HAS BEEN A 1750 01:08:40,000 --> 01:08:42,200 STRESSOR FOR A LONG TIME AND 1751 01:08:42,200 --> 01:08:43,800 ADDING COVID PLAY NOT HAVE 1752 01:08:43,800 --> 01:08:45,360 AMPLIFIED BUT I HAVEN'T LOOKED 1753 01:08:45,360 --> 01:08:48,240 AT -- AND I DON'T HAVE THE 1754 01:08:48,240 --> 01:08:50,600 SAMPLE TO LOOK AT THE INCREASES 1755 01:08:50,600 --> 01:08:53,680 IN LEVELS OF SMOKING OR ANYTHING 1756 01:08:53,680 --> 01:08:57,840 OVER THE COURSE OF THE BEFORE, 1757 01:08:57,840 --> 01:08:58,400 DURING, AFTER THE PANDEMIC. 1758 01:08:58,400 --> 01:08:59,480 >>THANK YOU FOR THAT. 1759 01:08:59,480 --> 01:09:02,720 WE HAVE A QUESTION FROM THE 1760 01:09:02,720 --> 01:09:03,960 AUDIENCE FOR DR. DEGENNA. 1761 01:09:03,960 --> 01:09:05,520 WHAT ARE SOME EXAMPLES OF THE 1762 01:09:05,520 --> 01:09:08,160 TYPES OF QUESTIONS YOU ASKED IN 1763 01:09:08,160 --> 01:09:10,560 YOUR INTERVIEW GUIDE THAT 1764 01:09:10,560 --> 01:09:12,760 ELICITED RESPONSES ABOUT 1765 01:09:12,760 --> 01:09:14,400 EXPERIENCES WITH RACISM, WERE 1766 01:09:14,400 --> 01:09:16,240 THE INTERVIEWERS WOMEN WHO WERE 1767 01:09:16,240 --> 01:09:16,920 BLACK AS WELL? 1768 01:09:16,920 --> 01:09:18,320 >>ONE MAJOR LIMITATION OF THE 1769 01:09:18,320 --> 01:09:20,640 STUDY IS THAT OUR INTERVIEWERS 1770 01:09:20,640 --> 01:09:22,040 WERE NOT BLACK. 1771 01:09:22,040 --> 01:09:23,840 TWO WOMEN OF COLOR WERE NOT 1772 01:09:23,840 --> 01:09:25,760 BLACK, THAT'S SOMETHING THAT 1773 01:09:25,760 --> 01:09:27,200 COULD INFLUENCE OBVIOUSLY THE 1774 01:09:27,200 --> 01:09:27,600 RESPONSES. 1775 01:09:27,600 --> 01:09:29,680 THANK YOU FOR THAT EXCELLENT 1776 01:09:29,680 --> 01:09:29,960 QUESTION. 1777 01:09:29,960 --> 01:09:32,440 CERTAINLY A LIMITATION OF THE 1778 01:09:32,440 --> 01:09:33,720 STUDY. 1779 01:09:33,720 --> 01:09:36,160 AND THE KINDS OF QUESTIONS, WE 1780 01:09:36,160 --> 01:09:38,360 KNOW FROM PREVIOUS STUDIES THAT 1781 01:09:38,360 --> 01:09:39,760 THIS EXISTS FROM STUDIES WITH 1782 01:09:39,760 --> 01:09:41,640 OLDER WOMEN. 1783 01:09:41,640 --> 01:09:44,600 WE WERE INTERESTED -- THE 1784 01:09:44,600 --> 01:09:45,360 QUESTIONS WE'RE INTERESTED IN, 1785 01:09:45,360 --> 01:09:49,320 DO YOU FEEL YOU WERE TREATED 1786 01:09:49,320 --> 01:09:50,320 DIFFERENTLY BY YOUR PROVIDERS, 1787 01:09:50,320 --> 01:09:52,280 BECAUSE OF ANYTHING ABOUT YOUR 1788 01:09:52,280 --> 01:09:53,680 IDENTITY, AND THOSE WERE THE 1789 01:09:53,680 --> 01:09:56,000 KINDS OF QUESTIONS WE ASKED, HOW 1790 01:09:56,000 --> 01:09:57,960 WAS IT LIKE GIVING BIRTH DURING 1791 01:09:57,960 --> 01:10:01,480 COVID IS ANOTHER FOCUS, WAS THE 1792 01:10:01,480 --> 01:10:02,320 PANDEMIC -- WERE THINGS 1793 01:10:02,320 --> 01:10:02,680 DIFFERENT? 1794 01:10:02,680 --> 01:10:04,200 AND WE HAVE A SEPARATE PAPER 1795 01:10:04,200 --> 01:10:06,080 WITH DIFFERENT THEMES AROUND 1796 01:10:06,080 --> 01:10:07,360 SPECIFICALLY THE PANDEMIC, A LOT 1797 01:10:07,360 --> 01:10:08,800 OF QUESTIONS ABOUT WHAT WAS THAT 1798 01:10:08,800 --> 01:10:11,160 LIKE FOR YOU AND YOUR FAMILY, 1799 01:10:11,160 --> 01:10:13,160 AND MANY OF THEM HAD BEEN 1800 01:10:13,160 --> 01:10:14,400 PREGNANT PREVIOUSLY, EVEN THOUGH 1801 01:10:14,400 --> 01:10:16,240 VERY YOUNG, WERE ABLE TO 1802 01:10:16,240 --> 01:10:17,760 CONTRAST THE EXPERIENCE WITH NOT 1803 01:10:17,760 --> 01:10:19,640 HAVING THE SUPPORT PERSON WITH 1804 01:10:19,640 --> 01:10:21,200 THEM, AND ALSO A BIG THING WAS 1805 01:10:21,200 --> 01:10:23,800 LACK OF CHILD CARE AND NOT BEING 1806 01:10:23,800 --> 01:10:25,400 ABLE TO BRING YOUR CHILDREN IN 1807 01:10:25,400 --> 01:10:27,280 WITH THEM TO THEIR VISITS AND I 1808 01:10:27,280 --> 01:10:28,960 THINK WE SEE THAT IN OTHER 1809 01:10:28,960 --> 01:10:31,120 STUDIES IN OLDER PEOPLE AS WELL, 1810 01:10:31,120 --> 01:10:32,640 A BARRIER TO PRENATAL CARE AT 1811 01:10:32,640 --> 01:10:35,280 THE HEIGHT OF THE PANDEMIC, 1812 01:10:35,280 --> 01:10:36,840 ESPECIALLY THE CASE FOR YOUNG 1813 01:10:36,840 --> 01:10:39,920 PEOPLE ARE LESS SOCIAL SUPPORT 1814 01:10:39,920 --> 01:10:41,240 AND ACCESS THAN OLDER PATIENTS. 1815 01:10:41,240 --> 01:10:43,560 I'M NOT SURE IF I ANSWERED 1816 01:10:43,560 --> 01:10:47,120 APPROPRIATELY BUT LET ME 1817 01:10:47,120 --> 01:10:47,360 KNOWMENT 1818 01:10:47,360 --> 01:10:49,160 >>THANK YOU VERY MUCH. 1819 01:10:49,160 --> 01:10:49,960 WE'RE AT TIME. 1820 01:10:49,960 --> 01:10:57,720 I WANT TO THANK ALL OUR 1821 01:10:57,720 --> 01:10:59,120 PRESENTERS AND FOR JOINING US, 1822 01:10:59,120 --> 01:11:00,360 AND HOPEFULLY YOU'LL STAY FOR 1823 01:11:00,360 --> 01:11:04,400 THE REST OF THE SESSION AS WELL. 1824 01:11:04,400 --> 01:11:08,320 WE HAVE A 15-MINUTE BREAK. 1825 01:11:08,320 --> 01:11:10,920 WE WILL RECONVENE AT 1:25. 1826 01:11:10,920 --> 01:11:12,920 >>WELCOME TO THIS SESSION, 1827 01:11:12,920 --> 01:11:14,560 CONSIDERING MENTAL HEALTH AND 1828 01:11:14,560 --> 01:11:18,520 BEHAVIORAL HEALTH IN ADDRESSING 1829 01:11:18,520 --> 01:11:19,240 DISPARITIES. 1830 01:11:19,240 --> 01:11:20,920 I'M DR. QUATTARA MODERATING THIS 1831 01:11:20,920 --> 01:11:21,360 SESSION. 1832 01:11:21,360 --> 01:11:22,760 FOR OUR FIRST PRESENTATION IN 1833 01:11:22,760 --> 01:11:27,280 THIS SESSION, WE WOULD LIKE TO 1834 01:11:27,280 --> 01:11:30,680 WELCOME DR. JENNIFER HERN, 1835 01:11:30,680 --> 01:11:31,440 PROFESSOR OF EPIDEMIOLOGY AT 1836 01:11:31,440 --> 01:11:32,440 UNIVERSITY OF CALIFORNIA 1837 01:11:32,440 --> 01:11:35,160 BERKELEY SCHOOL OF PUBLIC 1838 01:11:35,160 --> 01:11:37,280 HEALTH, PRESENTING ON COMMUNITY 1839 01:11:37,280 --> 01:11:39,280 VIOLENCE AND DISPARITIES IN 1840 01:11:39,280 --> 01:11:42,080 MATERNAL AND INFANT HEALTH 1841 01:11:42,080 --> 01:11:43,200 EFFECT AND MECHANISM. 1842 01:11:43,200 --> 01:11:44,840 DR. AHERN, YOU HAVE THE FLOOR. 1843 01:11:44,840 --> 01:11:46,240 >>THANK YOU SO MUCH. 1844 01:11:46,240 --> 01:11:50,600 THANK YOU FOR THE INVITATION TO 1845 01:11:50,600 --> 01:11:50,960 PRESENT. 1846 01:11:50,960 --> 01:11:57,800 I'M JUST GOING TO PUT MY SLIDES 1847 01:11:57,800 --> 01:11:58,040 UP HERE. 1848 01:11:58,040 --> 01:12:00,040 ALL RIGHT. 1849 01:12:00,040 --> 01:12:01,560 HOPEFULLY THAT LOOKS GOOD. 1850 01:12:01,560 --> 01:12:06,920 ALL RIGHT. 1851 01:12:06,920 --> 01:12:08,080 LET'S GET STARTED. 1852 01:12:08,080 --> 01:12:09,760 AS THE INTRODUCTION JUST SAID MY 1853 01:12:09,760 --> 01:12:11,720 PROJECT IS LOOKING AT COMMUNITY 1854 01:12:11,720 --> 01:12:14,760 VIOLENCE AND DISPARITIES IN 1855 01:12:14,760 --> 01:12:16,520 MATERNAL AND INFANT HEALTH, AND 1856 01:12:16,520 --> 01:12:22,120 WE HAVE A SUPPLEMENT TO THAT 1857 01:12:22,120 --> 01:12:26,040 AWARD THROUGH THE IMPROVE 1858 01:12:26,040 --> 01:12:26,400 FUNDING. 1859 01:12:26,400 --> 01:12:28,800 THE AIMS WERE FIRST TO LOOK AT 1860 01:12:28,800 --> 01:12:31,320 EFFECTS OF COVID-19 PANDEMIC ON 1861 01:12:31,320 --> 01:12:33,520 HEALTH AND HEALTH DISPARITIES 1862 01:12:33,520 --> 01:12:34,720 AMONG MOTHERS AND BIRTH PARENTS 1863 01:12:34,720 --> 01:12:38,360 AND TO BUILD ON THAT, LOOKING AT 1864 01:12:38,360 --> 01:12:40,080 COMMUNITY COVID-19 AS A MODIFIER 1865 01:12:40,080 --> 01:12:42,040 OF EFFECT OF COMMUNITY VIOLENCE 1866 01:12:42,040 --> 01:12:42,960 ON HEALTH. 1867 01:12:42,960 --> 01:12:47,200 TODAY I'LL FOCUS ON THE FIRST 1868 01:12:47,200 --> 01:12:53,480 AIM, OVERALL COVID-19 PANDEMIC 1869 01:12:53,480 --> 01:12:54,680 IMPACTS. 1870 01:12:54,680 --> 01:12:59,560 THERE'S SUBSTANTIAL NEGATIVE 1871 01:12:59,560 --> 01:13:03,960 EFFECTS OF SARS-COV-2 ON 1872 01:13:03,960 --> 01:13:05,480 PERINATAL HEALTH, THESE INCLUDE 1873 01:13:05,480 --> 01:13:10,560 MATERNAL CONDITIONS AS WELL AS 1874 01:13:10,560 --> 01:13:11,360 INFANT OUTCOMES. 1875 01:13:11,360 --> 01:13:14,240 HOWEVER, THERE HAVE BEEN FEWER 1876 01:13:14,240 --> 01:13:15,920 STUDIES LOOKING AT EFFECTS OF 1877 01:13:15,920 --> 01:13:20,320 PANDEMIC PERIOD, IN PARTICULAR 1878 01:13:20,320 --> 01:13:21,840 THAT TRY TO DISENTANGLE FROM 1879 01:13:21,840 --> 01:13:24,360 EFFECTS OF THE PERIOD OF THE 1880 01:13:24,360 --> 01:13:24,840 PANDEMIC. 1881 01:13:24,840 --> 01:13:29,320 IN ADDITION VERY LITTLE WORK HAS 1882 01:13:29,320 --> 01:13:30,040 CONSIDERED RACIAL/ETHNIC 1883 01:13:30,040 --> 01:13:33,880 DISPARITIES IN THE INFECTION OR 1884 01:13:33,880 --> 01:13:34,240 PANDEMIC. 1885 01:13:34,240 --> 01:13:36,760 SO TO FILL IN GAPS WE WANTED TO 1886 01:13:36,760 --> 01:13:39,040 LOOK AT EFFECTS OF INFECTION AS 1887 01:13:39,040 --> 01:13:40,280 DISTINCT FROM THE PANDEMIC 1888 01:13:40,280 --> 01:13:44,200 PERIOD, AND LOOK AT BOTH OF 1889 01:13:44,200 --> 01:13:45,720 THESE IN CONNECTION MATERNAL AND 1890 01:13:45,720 --> 01:13:48,680 BIRTH PARENT AND INFANT HEALTH 1891 01:13:48,680 --> 01:13:52,440 OUTCOMES AND TO LOOK AT RACIAL 1892 01:13:52,440 --> 01:13:54,360 AND ETHNIC DISPARITIES PATTERNS. 1893 01:13:54,360 --> 01:13:58,200 TO DO THIS WE DID LINKAGE OF 1894 01:13:58,200 --> 01:14:00,920 STATEWIDE CALIFORNIA DATA 1895 01:14:00,920 --> 01:14:02,560 INCLUDING INDIVIDUALLY LINKING 1896 01:14:02,560 --> 01:14:04,880 VITAL STATISTICS BIRTH DATA WITH 1897 01:14:04,880 --> 01:14:06,400 THE MATERNAL AND BIRTH PARENTS 1898 01:14:06,400 --> 01:14:10,040 AS WELL AS INFANT HOSPITAL 1899 01:14:10,040 --> 01:14:12,440 DISCHARGE RECORDS, AND WHAT I'LL 1900 01:14:12,440 --> 01:14:14,520 PRESENT IS FOCUSED ON 2019 AND 1901 01:14:14,520 --> 01:14:18,160 2020, DURING THE PERIOD OF 2020 1902 01:14:18,160 --> 01:14:23,640 WHEN THERE WERE ICD CODES 1903 01:14:23,640 --> 01:14:25,480 AVAILABLE TO CODE COVID-19. 1904 01:14:25,480 --> 01:14:29,560 WE'RE LOOKING AT THREE DIFFERENT 1905 01:14:29,560 --> 01:14:34,120 EXPOSURES, ONE IS THE DELIVERIES 1906 01:14:34,120 --> 01:14:34,880 WITH INFECTION DUE TO SARS-COV-2 1907 01:14:34,880 --> 01:14:36,760 AT THE TIME OF DELIVERY. 1908 01:14:36,760 --> 01:14:39,320 NEXT GROUP IS DELIVERY IN 2020 1909 01:14:39,320 --> 01:14:41,440 WITHOUT ANY RECORDED INFECTION. 1910 01:14:41,440 --> 01:14:43,760 AND COMPARISON GROUP IS OUR 1911 01:14:43,760 --> 01:14:44,600 DELIVERIES FROM 2019. 1912 01:14:44,600 --> 01:14:49,800 WE LOOKED AT A RANGE OF MATERNAL 1913 01:14:49,800 --> 01:14:51,080 AND INFANT HEALTH OUTCOMES. 1914 01:14:51,080 --> 01:14:54,600 FOR ANALYSIS WE USED A MATCHING 1915 01:14:54,600 --> 01:14:55,440 APPROACH, SPECIFICALLY FULL 1916 01:14:55,440 --> 01:14:56,000 MATCHING. 1917 01:14:56,000 --> 01:14:57,880 AND TO JUST GIVE A SENSE FOR HOW 1918 01:14:57,880 --> 01:15:00,520 TO THINK ABOUT THIS, THE WAY 1919 01:15:00,520 --> 01:15:01,920 MATCHING APPROACH WORKS, IT 1920 01:15:01,920 --> 01:15:04,040 TAKES EXPOSURE GROUP OF 1921 01:15:04,040 --> 01:15:05,320 INTEREST, LET'S SAY DELIVERIES 1922 01:15:05,320 --> 01:15:08,280 THAT ARE POSITIVE FOR 1923 01:15:08,280 --> 01:15:11,040 SARS-COV-2, AT THE TIME OF 1924 01:15:11,040 --> 01:15:12,360 DELIVERY, AND THEN FOR THAT 1925 01:15:12,360 --> 01:15:15,640 GROUP COLLECTS A GROUP OF 1926 01:15:15,640 --> 01:15:17,000 COMPARISON DELIVERIES THAT HAVE 1927 01:15:17,000 --> 01:15:20,680 IN ALL POSSIBLE WAYS THE SAME 1928 01:15:20,680 --> 01:15:21,560 COVARIATE DISTRIBUTION AS THAT 1929 01:15:21,560 --> 01:15:22,440 EXPOSED GROUP. 1930 01:15:22,440 --> 01:15:24,480 WE MIGHT DRAW A MATCHED GROUP 1931 01:15:24,480 --> 01:15:26,120 FROM AMONG THE 2020 BIRTHS, BUT 1932 01:15:26,120 --> 01:15:29,160 THOSE THAT DID NOT HAVE A 1933 01:15:29,160 --> 01:15:30,440 COVID-19 INFECTION. 1934 01:15:30,440 --> 01:15:32,440 AND THEN ONCE WE DO THIS 1935 01:15:32,440 --> 01:15:34,080 MATCHING WE BALANCE THE 1936 01:15:34,080 --> 01:15:35,480 COVARIATES BETWEEN THE TWO 1937 01:15:35,480 --> 01:15:36,160 GROUPS, MAKING THEM COMPARABLE 1938 01:15:36,160 --> 01:15:38,240 WITH RESPECT TO WHAT THE 1939 01:15:38,240 --> 01:15:39,480 COVARIATES WE'VE MEASURED, AND 1940 01:15:39,480 --> 01:15:41,440 CAN COMPARE THE OUTCOMES BETWEEN 1941 01:15:41,440 --> 01:15:42,640 THESE TWO GROUPS. 1942 01:15:42,640 --> 01:15:45,040 WE DID THESE ANALYSES FOR 1943 01:15:45,040 --> 01:15:47,880 CALIFORNIA OVERALL, AND THEN 1944 01:15:47,880 --> 01:15:52,160 ALSO STRATIFIED BY RACIAL/ETHNIC 1945 01:15:52,160 --> 01:15:54,200 GROUPS, CONTROLLED FOR 1946 01:15:54,200 --> 01:15:54,760 COVARIATES AVAILABLE, 1947 01:15:54,760 --> 01:15:55,760 ADMINISTRATIVE DATA, AS WELL AS 1948 01:15:55,760 --> 01:16:00,160 LARGE SET OF NEIGHBORHOOD OR 1949 01:16:00,160 --> 01:16:03,400 COMMUNITY LEVEL COVARIATES. 1950 01:16:03,400 --> 01:16:06,600 SO HERE ARE SOME FINDINGS, 1951 01:16:06,600 --> 01:16:08,160 YOU'LL SEE LONG THE Y-AXIS 1952 01:16:08,160 --> 01:16:10,520 BURDEN OR PREVALENCE OF EACH OF 1953 01:16:10,520 --> 01:16:12,320 THESE OUTCOMES, ALONG THE X-AXIS 1954 01:16:12,320 --> 01:16:14,600 YOU CAN SEE DIFFERENT OUTCOMES 1955 01:16:14,600 --> 01:16:15,520 THAT WE EXAMINED. 1956 01:16:15,520 --> 01:16:19,960 AND SO THE WAY TO INTERPRET THIS 1957 01:16:19,960 --> 01:16:21,560 PLOT IS THE COLORED-IN CIRCLES 1958 01:16:21,560 --> 01:16:24,200 ARE THE BURDEN OF EACH OUTCOME 1959 01:16:24,200 --> 01:16:27,480 IN THE GROUP THAT WAS SARS-COV-2 1960 01:16:27,480 --> 01:16:30,320 POSITIVE AT DELIVERY, AND OPEN 1961 01:16:30,320 --> 01:16:31,640 CIRCLES ARE MATCHED COMPARISON 1962 01:16:31,640 --> 01:16:33,760 GROUP THAT CORRESPOND TO THAT 1963 01:16:33,760 --> 01:16:36,680 INFECTION GROUP, SO THAT'S AMONG 1964 01:16:36,680 --> 01:16:38,240 DELIVERIES THAT TOOK PLACE IN 1965 01:16:38,240 --> 01:16:40,720 2020 BUT WERE NOT INFECTED. 1966 01:16:40,720 --> 01:16:42,280 DIFFERENCE BETWEEN THESE TWO 1967 01:16:42,280 --> 01:16:45,920 GIVES AN ESTIMATE OF THE EFFECT 1968 01:16:45,920 --> 01:16:48,320 OF SARS-COV-2 INFECTION ON EACH 1969 01:16:48,320 --> 01:16:50,360 OF THESE OUTCOMES. 1970 01:16:50,360 --> 01:16:57,080 FOR EXAMPLE, IF WE PULL OUT THE 1971 01:16:57,080 --> 01:16:57,960 SMM OUTCOME AMONG SARS-COV-2 1972 01:16:57,960 --> 01:16:59,360 POSITIVE MOTHERS OR BIRTH 1973 01:16:59,360 --> 01:17:05,400 PARENTS THERE'S A 5% BURDEN OF 1974 01:17:05,400 --> 01:17:06,480 SMM, MATCHED COMPARISON GROUPED 1975 01:17:06,480 --> 01:17:09,320 WITH NO INFECTION THERE'S ONLY 1976 01:17:09,320 --> 01:17:11,520 2.3% BURDEN OF SMM, THEY GIVES A 1977 01:17:11,520 --> 01:17:15,680 SENSE OF A VERY LARGE DIFFERENCE 1978 01:17:15,680 --> 01:17:16,760 CONNECTED TO INDIVIDUAL 1979 01:17:16,760 --> 01:17:19,520 INFECTION AND WE TAKE THE 1980 01:17:19,520 --> 01:17:23,560 DIFFERENCE TO GET OUR ESTIMATES 1981 01:17:23,560 --> 01:17:25,720 FOR THE EFFECT OF SARS-COV-2 ON 1982 01:17:25,720 --> 01:17:27,160 OUTCOMES. 1983 01:17:27,160 --> 01:17:29,680 YOU CAN SEE THERE'S SUBSTANTIAL 1984 01:17:29,680 --> 01:17:30,760 ASSOCIATIONS BETWEEN SARS-COV-2 1985 01:17:30,760 --> 01:17:33,480 INFECTION AND A RANGE OF BOTH 1986 01:17:33,480 --> 01:17:35,160 MATERNAL AND INFANT OUTCOMES 1987 01:17:35,160 --> 01:17:44,640 THAT ARE CERTAINLY OF CONCERN. 1988 01:17:44,640 --> 01:17:51,400 RACIAL ETHNIC DISPARITIES I'LL 1989 01:17:51,400 --> 01:17:53,520 FOCUS ON SMM, ON THE OUTCOME, 1990 01:17:53,520 --> 01:17:56,560 NOW THE Y-AXIS IS JUST THE 1991 01:17:56,560 --> 01:17:58,880 BURDEN OF PREVALENCE, AND THE 1992 01:17:58,880 --> 01:18:01,040 X-AXIS IS EACH OF RACIAL/ETHNIC 1993 01:18:01,040 --> 01:18:04,560 GROUPS AS BEFORE THE COLORED-IN 1994 01:18:04,560 --> 01:18:06,840 CIRCLES ARE BURDEN AMONG THOSE 1995 01:18:06,840 --> 01:18:09,240 WITH INFECTION AT DELIVERY, OPEN 1996 01:18:09,240 --> 01:18:10,800 CIRCLES ARE THE ESTIMATE IT'S 1997 01:18:10,800 --> 01:18:14,280 BURDEN OF OUTCOME IN ABSENCE OF 1998 01:18:14,280 --> 01:18:16,400 INFECTION, AS COMING FROM 1999 01:18:16,400 --> 01:18:18,840 MATCHED GROUP OF MOTHERS AND 2000 01:18:18,840 --> 01:18:20,760 BIRTH PARENTS WHO DID NOT HAVE 2001 01:18:20,760 --> 01:18:22,280 INFECTION AT DELIVERY BUT WERE 2002 01:18:22,280 --> 01:18:24,280 DELIVERING IN 2020. 2003 01:18:24,280 --> 01:18:28,040 YOU CAN SEE DRAMATICALLY LARGE 2004 01:18:28,040 --> 01:18:31,080 DIFFERENCE HERE BETWEEN MOTHERS 2005 01:18:31,080 --> 01:18:32,800 AND BIRTH PARENTS, SO WE TAKE 2006 01:18:32,800 --> 01:18:35,040 THE DIFFERENCE TO GET OUR 2007 01:18:35,040 --> 01:18:35,960 ESTIMATES, AND CONSISTENT WITH 2008 01:18:35,960 --> 01:18:40,440 THE LAST PLOT YOU CAN SEE 2009 01:18:40,440 --> 01:18:41,800 SUBSTANTIALLY HIGHER ASSOCIATION 2010 01:18:41,800 --> 01:18:43,640 BETWEEN SARS-COV-2 INFECTION AND 2011 01:18:43,640 --> 01:18:51,280 SMM AMONG OUR BLACK MOTHERS AND 2012 01:18:51,280 --> 01:18:51,680 BIRTH PARENTS. 2013 01:18:51,680 --> 01:18:53,400 WE SHIFT TO JUST LOOKING AT 2014 01:18:53,400 --> 01:18:55,600 PANDEMIC PERIOD SEPARATE FROM 2015 01:18:55,600 --> 01:18:56,680 INFECTION. 2016 01:18:56,680 --> 01:18:58,120 THESE ARE DELIVERIES IN 2020 WHO 2017 01:18:58,120 --> 01:19:00,720 DID NOT HAVE A SARS-COV-2 2018 01:19:00,720 --> 01:19:03,120 INFECTION RECORDED AS COMPARED 2019 01:19:03,120 --> 01:19:05,640 TO DELIVERIES IN 2019, THAT TWO 2020 01:19:05,640 --> 01:19:07,840 TYPES OF DOTS DEPICTS THE SAME 2021 01:19:07,840 --> 01:19:08,040 THING. 2022 01:19:08,040 --> 01:19:09,160 YOU CAN SEE ACROSS THE BOARD 2023 01:19:09,160 --> 01:19:12,560 MOST OF THESE ARE VERY CLOSE TO 2024 01:19:12,560 --> 01:19:13,400 EACH OTHER INDICATING NOT MUCH 2025 01:19:13,400 --> 01:19:15,200 DIFFERENCE AT THE PANDEMIC 2026 01:19:15,200 --> 01:19:17,200 PERIOD IN CONNECTION WITH 2027 01:19:17,200 --> 01:19:18,800 OUTCOMES WITH EXCEPTION OF 2028 01:19:18,800 --> 01:19:21,080 GESTATIONAL DIABETES WHERE WE DO 2029 01:19:21,080 --> 01:19:23,720 IN FACT SEE AN ELEVATION IN 2030 01:19:23,720 --> 01:19:25,600 GESTATIONAL DIABETES FOR THE 2031 01:19:25,600 --> 01:19:28,880 DELIVERIES THAT ARE IN 2020, AS 2032 01:19:28,880 --> 01:19:32,520 COMPARED TO SIMILAR MATCHED 2033 01:19:32,520 --> 01:19:34,240 COMPARISON DELIVERIES IN 2019. 2034 01:19:34,240 --> 01:19:37,320 SO TO WRAP UP, WE FOUND 2035 01:19:37,320 --> 01:19:39,720 SUBSTANTIAL NEGATIVE EFFECTS OF 2036 01:19:39,720 --> 01:19:40,600 SARS-COV-2 INFECTION AT DELIVERY 2037 01:19:40,600 --> 01:19:43,880 ACROSS WIDE RANGE OF OUTCOMES. 2038 01:19:43,880 --> 01:19:45,520 THESE ARE LARGE ASSOCIATIONS AND 2039 01:19:45,520 --> 01:19:48,040 THEY ARE SUBSTANTIALLY DIFFERENT 2040 01:19:48,040 --> 01:19:57,680 EFFECTS BY RACE/ETHNICITY. 2041 01:19:57,680 --> 01:19:59,520 THE PANDEMIC PERIOD SEEMS TO BE 2042 01:19:59,520 --> 01:20:02,160 ASSOCIATE BE ASSOCIATE WITH 2043 01:20:02,160 --> 01:20:03,360 GESTATIONAL DIABETES. 2044 01:20:03,360 --> 01:20:05,120 WE JUST STARTED LIPPING DATA TO 2045 01:20:05,120 --> 01:20:15,760 ALLOW US TO LOOK O LOOK AT SHIFG 2046 01:20:17,960 --> 01:20:18,720 PANDEMIC CONDITIONS. 2047 01:20:18,720 --> 01:20:19,280 THANKS FOR YOUR ATTENTION. 2048 01:20:19,280 --> 01:20:21,440 >>THANK YOU FOR THE 2049 01:20:21,440 --> 01:20:21,880 PRESENTATION. 2050 01:20:21,880 --> 01:20:32,440 NEXT PRESENTATION WE WOULD LIKE 2051 01:20:35,880 --> 01:20:37,320 TO WELCOME JEANNE ALHUSEN, 2052 01:20:37,320 --> 01:20:38,840 PSYCHOSOCIAL STRESS AND ITS 2053 01:20:38,840 --> 01:20:41,360 RELATION TO MATERNAL AND INFANT 2054 01:20:41,360 --> 01:20:42,520 OUTCOMES AMONG PERSONS WITH 2055 01:20:42,520 --> 01:20:43,120 DISABILITIES. 2056 01:20:43,120 --> 01:20:44,200 YOU HAVE THE FLOOR. 2057 01:20:44,200 --> 01:20:45,160 >>GOOD AFTERNOON. 2058 01:20:45,160 --> 01:20:47,480 I'M DELIGHTED TO BE HERE AND 2059 01:20:47,480 --> 01:20:49,120 HAVE ENJOYED LEARNING FROM MY 2060 01:20:49,120 --> 01:20:49,760 COLLEAGUES. 2061 01:20:49,760 --> 01:20:52,520 THE FOCUS OF MY TALK WILL BE ON 2062 01:20:52,520 --> 01:20:54,040 PSYCHOSOCIAL STRESS AND ITS 2063 01:20:54,040 --> 01:20:56,000 RELATION TO MATERNAL AND INFANT 2064 01:20:56,000 --> 01:21:00,160 OUTCOMES AMONG PERSONS WITH 2065 01:21:00,160 --> 01:21:00,960 DISABILITIES. 2066 01:21:00,960 --> 01:21:03,120 I HAVE NO CONFLICTS TO DISCLOSE, 2067 01:21:03,120 --> 01:21:06,440 I'M GRATEFUL FOR FUNDING FROM 2068 01:21:06,440 --> 01:21:07,440 NIH SPECIFICALLY NICHD, 2069 01:21:07,440 --> 01:21:09,160 THROUGHOUT THIS PRESENTATION I 2070 01:21:09,160 --> 01:21:12,440 DO USE PERSON FIRST AND IDENTITY 2071 01:21:12,440 --> 01:21:13,520 FIRST LANGUAGE RECOGNIZING THAT 2072 01:21:13,520 --> 01:21:16,160 THERE ARE VARIED PREFERENCES IN 2073 01:21:16,160 --> 01:21:17,040 DISABILITY COMMUNITY, AND 2074 01:21:17,040 --> 01:21:18,920 MAJORITY OF RESEARCH IN THIS 2075 01:21:18,920 --> 01:21:20,360 AREA FOCUSES ON PREGNANT WOMEN 2076 01:21:20,360 --> 01:21:24,800 YET WE DO ACKNOWLEDGE THAT NOT 2077 01:21:24,800 --> 01:21:26,040 ALL PREGNANT PERSONS ARE WOMEN. 2078 01:21:26,040 --> 01:21:29,000 I'D LIKE TO ACKNOWLEDGE THE 2079 01:21:29,000 --> 01:21:30,640 SUPPORT OF COLLEAGUES AND 2080 01:21:30,640 --> 01:21:32,240 COMMUNITY ADVISORY BOARD 2081 01:21:32,240 --> 01:21:32,480 MEMBERS. 2082 01:21:32,480 --> 01:21:35,080 SO IN THE UNITED STATES, NEARLY 2083 01:21:35,080 --> 01:21:37,080 12 TO 13% OF PERSONS OF CHILD 2084 01:21:37,080 --> 01:21:40,040 BEARING AGE HAVE SOME TYPE OF 2085 01:21:40,040 --> 01:21:40,320 DISABILITY. 2086 01:21:40,320 --> 01:21:43,760 YET WE KNOW THAT PERSONS WITH 2087 01:21:43,760 --> 01:21:45,600 DISABILITIES OFTEN ENCOUNTER 2088 01:21:45,600 --> 01:21:46,920 SIGNIFICANT BARRIERS WHEN 2089 01:21:46,920 --> 01:21:48,920 ACCESSING SEXUAL AND 2090 01:21:48,920 --> 01:21:50,240 REPRODUCTIVE HEALTH SERVICES. 2091 01:21:50,240 --> 01:21:53,520 OFTEN VIEWED AS ASEXUAL WITH A 2092 01:21:53,520 --> 01:21:54,720 LONG HISTORY OF STERILIZATION, 2093 01:21:54,720 --> 01:21:56,680 UNDER THE NOTION OF PROTECTING 2094 01:21:56,680 --> 01:22:00,080 THEM FROM PREGNANCY OR SEXUAL 2095 01:22:00,080 --> 01:22:00,600 ABUSE. 2096 01:22:00,600 --> 01:22:01,400 WHILE RELATIVELY LIMITED, 2097 01:22:01,400 --> 01:22:02,680 RESEARCH DOES SUGGEST THAT 2098 01:22:02,680 --> 01:22:04,120 PREGNANT AND BIRTHING PERSONS 2099 01:22:04,120 --> 01:22:06,840 ARE AT AN INCREASED RISK FOR 2100 01:22:06,840 --> 01:22:08,920 MORBIDITY AND MORTALITY, FOR A 2101 01:22:08,920 --> 01:22:11,560 NUMBER OF REASONS, INCLUDING 2102 01:22:11,560 --> 01:22:14,480 INEQUITIES AND EDUCATIONAL AND 2103 01:22:14,480 --> 01:22:15,480 SUBSEQUENTLY EMPLOYMENT 2104 01:22:15,480 --> 01:22:16,280 OPPORTUNITIES, ACROSS BOTH 2105 01:22:16,280 --> 01:22:18,320 HEALTH CARE PROVIDER AND SYSTEM 2106 01:22:18,320 --> 01:22:21,520 LEVELS, THEY FACE BARRIERS TO 2107 01:22:21,520 --> 01:22:23,560 CARE, AND FINALLY FOR THE 2108 01:22:23,560 --> 01:22:25,440 AFOREMENTIONED REASONS ARE AT 2109 01:22:25,440 --> 01:22:26,760 ELEVATED RISK OF PSYCHOSOCIAL 2110 01:22:26,760 --> 01:22:29,480 STRESS COMPARED TO THOSE WITHOUT 2111 01:22:29,480 --> 01:22:30,080 DISABILITIES. 2112 01:22:30,080 --> 01:22:31,680 AND PSYCHOSOCIAL STRESS FOR THE 2113 01:22:31,680 --> 01:22:33,880 PURPOSE OF THIS PRESENTATION IS 2114 01:22:33,880 --> 01:22:38,280 FOCUSED ON INTIMATE PARTNER 2115 01:22:38,280 --> 01:22:40,640 VIOLENCE, IPV, AND DEPRESSION. 2116 01:22:40,640 --> 01:22:43,040 BRIEFLY, THIS ONGOING STUDY IS A 2117 01:22:43,040 --> 01:22:44,840 MIXED METHOD EXAMINATION OF 2118 01:22:44,840 --> 01:22:47,120 PSYCHOSOCIAL STRESS AND BIRTH 2119 01:22:47,120 --> 01:22:48,480 OUTCOMES AMONG RESPONDENTS WITH 2120 01:22:48,480 --> 01:22:49,520 A DISABILITY. 2121 01:22:49,520 --> 01:22:53,400 FOR QUANTITATIVE AIMS WE'RE 2122 01:22:53,400 --> 01:22:56,440 USING PRAMS DATA, A 2123 01:22:56,440 --> 01:22:57,560 POPULATION-BASED SURVEILLANCE 2124 01:22:57,560 --> 01:22:59,160 SYSTEM THAT COLLECTS DATA FROM 2125 01:22:59,160 --> 01:23:01,560 THE TIME BOTH BEFORE, DURING, 2126 01:23:01,560 --> 01:23:03,880 AND SHORTLY AFTER PREGNANCY, 2127 01:23:03,880 --> 01:23:07,800 AMONG PERSONS WHO HAD A RECENT 2128 01:23:07,800 --> 01:23:09,800 LIVE BIRTH. 2129 01:23:09,800 --> 01:23:11,440 PRAMS COLLECTS INFORMATION ON 2130 01:23:11,440 --> 01:23:22,040 ACCESS TO TO HEALTH CARE, VARIS 2131 01:23:26,520 --> 01:23:26,920 BEHAVIORS. 2132 01:23:26,920 --> 01:23:30,080 IN 2018 THROUGH COLLABORATION 2133 01:23:30,080 --> 01:23:32,080 WITH NIH AND CDC, QUESTIONS 2134 01:23:32,080 --> 01:23:34,000 SPECIFIC TO DISABILITY WERE 2135 01:23:34,000 --> 01:23:35,960 ADDED AS AN OPTIONAL 2136 01:23:35,960 --> 01:23:37,400 QUESTIONNAIRE THAT STATES COULD 2137 01:23:37,400 --> 01:23:38,600 OPT INTO. 2138 01:23:38,600 --> 01:23:40,600 THERE WAS A RECOGNITION THAT A 2139 01:23:40,600 --> 01:23:43,840 BETTER UNDERSTANDING OF 2140 01:23:43,840 --> 01:23:44,840 PREGNANCY, DELIVERY, AND 2141 01:23:44,840 --> 01:23:46,160 POSTPARTUM EXPERIENCES OF 2142 01:23:46,160 --> 01:23:47,680 DISABLED WOMEN WAS NEEDED, AS 2143 01:23:47,680 --> 01:23:50,640 WELL AS INFORMATION ON HOW THESE 2144 01:23:50,640 --> 01:23:53,600 EXPERIENCES COMPARE TO THOSE OF 2145 01:23:53,600 --> 01:23:56,040 NON-DISABLED WOMEN. 2146 01:23:56,040 --> 01:23:56,880 DISABILITY QUESTIONNAIRE 2147 01:23:56,880 --> 01:23:57,360 SUPPLEMENT CONSISTS OF 2148 01:23:57,360 --> 01:23:59,320 WASHINGTON GROUP SHORT SET OF 2149 01:23:59,320 --> 01:24:00,920 QUESTIONS ON DISABILITY, AND 2150 01:24:00,920 --> 01:24:03,560 THAT'S BEEN USED IN OTHER 2151 01:24:03,560 --> 01:24:06,760 FEDERAL AND FRANKLY GLOBAL 2152 01:24:06,760 --> 01:24:06,960 SURVEYS. 2153 01:24:06,960 --> 01:24:10,360 THESE QUESTIONS ARE BASED ON 2154 01:24:10,360 --> 01:24:11,440 W.H.O.'S INTERNATIONAL 2155 01:24:11,440 --> 01:24:12,520 CLASSIFICATION OF FUNCTIONING 2156 01:24:12,520 --> 01:24:14,280 DISABILITY AND HEALTH. 2157 01:24:14,280 --> 01:24:16,120 AND PROVIDE US WITH STANDARDIZED 2158 01:24:16,120 --> 01:24:19,760 LANGUAGE AS WELL AS A FRAMEWORK 2159 01:24:19,760 --> 01:24:21,480 FOR HOW WE OPERATIONALIZE 2160 01:24:21,480 --> 01:24:22,680 DISABILITY. 2161 01:24:22,680 --> 01:24:24,560 SO THESE QUESTIONS AND THERE'S 2162 01:24:24,560 --> 01:24:26,960 SIX, WERE ASKED IN 24 STATES, 2163 01:24:26,960 --> 01:24:29,360 DURING THIS TIME FRAME OF 2164 01:24:29,360 --> 01:24:31,480 ANALYSIS, SOME STATES ACTUALLY 2165 01:24:31,480 --> 01:24:33,000 DISCONTINUED USING THEM, WHILE A 2166 01:24:33,000 --> 01:24:36,040 FEW OTHER STATES BEGAN USING 2167 01:24:36,040 --> 01:24:37,040 THEM. 2168 01:24:37,040 --> 01:24:39,000 THE MAJORITY OF PARTICIPATING 2169 01:24:39,000 --> 01:24:41,760 STATES DO ASK QUESTIONS SPECIFIC 2170 01:24:41,760 --> 01:24:43,360 TO PHYSICAL VIOLENCE, WITH FAR 2171 01:24:43,360 --> 01:24:45,360 FEWER STATES ASKING ABOUT 2172 01:24:45,360 --> 01:24:46,880 REPRODUCTIVE COERCION. 2173 01:24:46,880 --> 01:24:48,960 AND THE EQUAL INDICATIVE AIM 2174 01:24:48,960 --> 01:24:51,400 INCLUDES INTERVIEWS WITH PERSONS 2175 01:24:51,400 --> 01:24:53,080 WITH DISABILITY EITHER PREGNANT 2176 01:24:53,080 --> 01:24:54,360 OR HAVE GIVEN BIRTH IN THE LAST 2177 01:24:54,360 --> 01:24:56,200 TWO YEARS AND HAVE EXPERIENCED 2178 01:24:56,200 --> 01:24:59,160 VIOLENCE OR MENTAL HEALTH 2179 01:24:59,160 --> 01:24:59,680 CONCERNS. 2180 01:24:59,680 --> 01:25:01,560 SO WE'VE RECENTLY PUBLISHED 2181 01:25:01,560 --> 01:25:03,200 THREE PAPERS STEMMING FROM THIS 2182 01:25:03,200 --> 01:25:07,040 ANALYSIS AROUND ASPECTS OF 2183 01:25:07,040 --> 01:25:08,480 REPRODUCTIVE COERCION, IPV, AND 2184 01:25:08,480 --> 01:25:13,280 DEPRESSION. 2185 01:25:13,280 --> 01:25:15,360 I'LL BRIEFLY WALK THROUGH THOSE 2186 01:25:15,360 --> 01:25:17,440 WITH REGARDS TO VIOLENCE BEFORE 2187 01:25:17,440 --> 01:25:19,000 PREGNANCY, IN THE 12 MONTHS 2188 01:25:19,000 --> 01:25:20,600 BEFORE PREGNANCY OR DURING 2189 01:25:20,600 --> 01:25:26,200 PREGNANCY, WE ANALYZED DATA FROM 2190 01:25:26,200 --> 01:25:30,600 JUST SHY OF 75,000 RESPONDENTS. 2191 01:25:30,600 --> 01:25:33,520 THE QUESTIONS WILL DIFFICULTY IN 2192 01:25:33,520 --> 01:25:35,160 VISION, HEARING, AMBULATION, 2193 01:25:35,160 --> 01:25:36,840 COGNITION, COMMUNICATION, 2194 01:25:36,840 --> 01:25:37,080 SELF-CARE. 2195 01:25:37,080 --> 01:25:40,040 WITH THE OUTCOME BEING PERINATAL 2196 01:25:40,040 --> 01:25:41,200 IPV, DEFINED AS EXPERIENCING 2197 01:25:41,200 --> 01:25:43,280 ABUSE BY A CURRENT OR EX-PARTNER 2198 01:25:43,280 --> 01:25:46,480 IN THE YEAR BEFORE OR DURING 2199 01:25:46,480 --> 01:25:46,880 PREGNANCY. 2200 01:25:46,880 --> 01:25:54,160 SO IN ADJUSTED ADJUSTED MODELS 2201 01:25:54,160 --> 01:25:56,360 RESPONDENTS HAD 2.6 TIMES THE 2202 01:25:56,360 --> 01:25:58,480 ODDS BEFORE PREGNANCY, 2.5 TIMES 2203 01:25:58,480 --> 01:26:01,840 ODDS OF EXPERIENCING IPV DURING 2204 01:26:01,840 --> 01:26:06,120 PREGNANCY AS COMPARED TO THOSE 2205 01:26:06,120 --> 01:26:08,680 WITHOUT DISABILITIES. 2206 01:26:08,680 --> 01:26:10,080 SPECIFIC TO DEPRESSIVE SYMPTOMS 2207 01:26:10,080 --> 01:26:11,920 WE FOUND DEPRESSIVE SYMPTOMS 2208 01:26:11,920 --> 01:26:13,920 WERE SIGNIFICANTLY HIGHER IN 2209 01:26:13,920 --> 01:26:16,320 RESPONDENTS WITH DISABILITY 2210 01:26:16,320 --> 01:26:18,720 COMPARED TO THOSE WITHOUT, WITH 2211 01:26:18,720 --> 01:26:21,120 43% OF RESPONDENTS WITH 2212 01:26:21,120 --> 01:26:22,760 DISABILITY REPORTING SYMPTOMS 2213 01:26:22,760 --> 01:26:26,000 DURING PREGNANCY, AND A THIRD 2214 01:26:26,000 --> 01:26:27,960 REPORTING SYMPTOMS IN THE 2215 01:26:27,960 --> 01:26:29,480 POSTPARTUM PERIOD. 2216 01:26:29,480 --> 01:26:31,440 FULLY ADJUSTED MODELS THOSE 2217 01:26:31,440 --> 01:26:32,840 RESPONDENTS WITH DISABILITY WITH 2218 01:26:32,840 --> 01:26:36,160 NEARLY 2 1/2 TIMES AS LIKELY AS 2219 01:26:36,160 --> 01:26:39,000 THOSE WITHOUT TO REPORT 2220 01:26:39,000 --> 01:26:40,000 DEPRESSIVE SYMPTOMS. 2221 01:26:40,000 --> 01:26:43,520 WE WANTED TO LOOK CLOSER AT 2222 01:26:43,520 --> 01:26:45,360 REPRODUCTIVE COERCION AS OUR 2223 01:26:45,360 --> 01:26:47,000 PREVIOUS WORK SUGGESTS, PREVIOUS 2224 01:26:47,000 --> 01:26:50,080 WORK AND CERTAINLY WORK OF 2225 01:26:50,080 --> 01:26:51,960 OTHERS, SUGGESTS THAT PERSONS 2226 01:26:51,960 --> 01:26:53,800 WITH DISABILITIES EXPERIENCE 2227 01:26:53,800 --> 01:26:55,000 UNIQUE FORMS OF ABUSE IN 2228 01:26:55,000 --> 01:26:58,720 ADDITION TO THE KIND OF MORE 2229 01:26:58,720 --> 01:27:01,000 TRADITIONAL MEASURES IN 2230 01:27:01,000 --> 01:27:01,880 POPULATION-BASED SURVEYS. 2231 01:27:01,880 --> 01:27:04,080 UNFORTUNATELY IN PRAMS ONLY THE 2232 01:27:04,080 --> 01:27:06,480 STATE OF MASSACHUSETTS COLLECT, 2233 01:27:06,480 --> 01:27:09,640 DATA ON BOTH DISABILITY AND 2234 01:27:09,640 --> 01:27:10,680 REPRODUCTIVE COERCION. 2235 01:27:10,680 --> 01:27:13,080 WE REALLY COULDN'T DO FULLY 2236 01:27:13,080 --> 01:27:15,480 ADJUSTED MODELS DUE TO LIMITS IN 2237 01:27:15,480 --> 01:27:20,720 BOTH SAMPLE SIZE AND THUS MODEL 2238 01:27:20,720 --> 01:27:21,040 STABILITY. 2239 01:27:21,040 --> 01:27:25,560 PRELIMINARY LOOKS SUGGEST THAT 2240 01:27:25,560 --> 01:27:26,200 RESPONDENTS WITH DISABILITIES 2241 01:27:26,200 --> 01:27:30,040 ARE FOUR TIMES MORE LIKELY TO 2242 01:27:30,040 --> 01:27:33,680 EXPERIENCE REPRODUCTIVE COERCION 2243 01:27:33,680 --> 01:27:35,200 THAN WITHOUT, SOMETHING WE'RE 2244 01:27:35,200 --> 01:27:37,680 EXPLORING AND CONFIRMING WHAT 2245 01:27:37,680 --> 01:27:39,040 WE'RE SEEING HERE. 2246 01:27:39,040 --> 01:27:41,240 PART OF THE CURRENT SUPPLEMENT 2247 01:27:41,240 --> 01:27:42,840 DELVING DEEPER INTO HOW COVID-19 2248 01:27:42,840 --> 01:27:44,080 MAY BE AFFECTING THE MENTAL 2249 01:27:44,080 --> 01:27:46,160 HEALTH OF PERSONS WITH 2250 01:27:46,160 --> 01:27:49,560 DISABILITIES, AND THUS FAR HAVE 2251 01:27:49,560 --> 01:27:51,720 CONDUCTED 16 IN-DEPTH INTERVIEWS 2252 01:27:51,720 --> 01:27:54,720 WITH ANALYSES CENTERED ON THREE 2253 01:27:54,720 --> 01:27:57,960 THEMES, NAMELY ISOLATION DUE TO 2254 01:27:57,960 --> 01:28:04,320 COVID-19, ANXIETY DUE TO 2255 01:28:04,320 --> 01:28:05,080 COVID-RELATED CHAOS, DIMINISHED 2256 01:28:05,080 --> 01:28:09,280 ACCESS TO CARE DUE TO COVID-19. 2257 01:28:09,280 --> 01:28:12,120 SO WITH REGARDS TO ISOLATION, 2258 01:28:12,120 --> 01:28:14,320 RESPONDENTS TALKED ABOUT HOW 2259 01:28:14,320 --> 01:28:16,480 ISOLATION WAS MAGNIFIED DUE TO 2260 01:28:16,480 --> 01:28:17,240 THE PANDEMIC. 2261 01:28:17,240 --> 01:28:19,480 REALLY IN WAYS THAT WERE UNIQUE 2262 01:28:19,480 --> 01:28:21,880 FOR PERSONS WITH DISABILITIES. 2263 01:28:21,880 --> 01:28:24,520 THAT MANY HAD HEALTH CONCERNS 2264 01:28:24,520 --> 01:28:26,680 THAT PRECLUDED THEM OR THEIR 2265 01:28:26,680 --> 01:28:30,520 INFANTS FROM BEING IN SOCIAL 2266 01:28:30,520 --> 01:28:34,120 SITUATIONS, EVEN IF ADHERING TO 2267 01:28:34,120 --> 01:28:35,880 THE RECOMMENDED PRECAUTIONS. 2268 01:28:35,880 --> 01:28:36,920 ANXIETY WAS HEIGHTENED OBVIOUSLY 2269 01:28:36,920 --> 01:28:40,480 DURING THIS TIME FOR A NUMBER OF 2270 01:28:40,480 --> 01:28:41,360 REASONS. 2271 01:28:41,360 --> 01:28:44,200 FOR SOME, COVID PRECAUTIONS 2272 01:28:44,200 --> 01:28:45,400 INTERFERED WITH BASIC 2273 01:28:45,400 --> 01:28:47,360 ACCOMMODATION NEEDS SUCH AS 2274 01:28:47,360 --> 01:28:48,120 LIPREADING, HAVING AN 2275 01:28:48,120 --> 01:28:49,560 INTERPRETER IN THE ROOM, NOT 2276 01:28:49,560 --> 01:28:51,080 HAVING A SUPPORT PERSON WITH 2277 01:28:51,080 --> 01:28:55,240 THEM WHICH WE HEARD IN A PRIOR 2278 01:28:55,240 --> 01:28:55,560 PRESENTATION. 2279 01:28:55,560 --> 01:28:56,880 AND FOR THESE, YOU KNOW, 2280 01:28:56,880 --> 01:28:58,640 PREGNANT AND BIRTHING PERSONS IT 2281 01:28:58,640 --> 01:29:00,600 WAS MOST OFTEN A PARTNER OR 2282 01:29:00,600 --> 01:29:02,480 SPOUSE WHO THEY NEEDED THERE. 2283 01:29:02,480 --> 01:29:06,600 ONE RESPONDENT TALKED ABOUT 2284 01:29:06,600 --> 01:29:08,280 GIVING BIRTH WITH A NURSE AND 2285 01:29:08,280 --> 01:29:10,560 SHE PASSING A CLIPBOARD TO 2286 01:29:10,560 --> 01:29:12,000 COMMUNICATE DURING THE LABOR 2287 01:29:12,000 --> 01:29:12,680 PROCESS BECAUSE THEY DIDN'T 2288 01:29:12,680 --> 01:29:13,840 ALLOW AN INTERPRETER IN THE 2289 01:29:13,840 --> 01:29:14,200 ROOM. 2290 01:29:14,200 --> 01:29:16,800 IT'S NOT HARD FOR ANY ONE OF US 2291 01:29:16,800 --> 01:29:19,040 TO IMAGINE HOW STRESSFUL THAT 2292 01:29:19,040 --> 01:29:22,160 COULD BE. 2293 01:29:22,160 --> 01:29:22,880 AND RESPONDENTS DISCUSSED 2294 01:29:22,880 --> 01:29:25,320 DIMINISHED ACCESS TO CARE DUE TO 2295 01:29:25,320 --> 01:29:27,520 COVID, INCLUDING LACK OF 2296 01:29:27,520 --> 01:29:30,480 CRITICAL SUPPORTS, WHETHER IT BE 2297 01:29:30,480 --> 01:29:32,320 PHYSICAL THERAPY OR LACTATION 2298 01:29:32,320 --> 01:29:34,720 CONSULTANT OR EVEN REGULAR 2299 01:29:34,720 --> 01:29:36,840 PRENATAL CARE WHERE VIRTUAL 2300 01:29:36,840 --> 01:29:38,560 APPOINTMENTS WERE EITHER NOT 2301 01:29:38,560 --> 01:29:39,760 ACCESSIBLE OR LACKING. 2302 01:29:39,760 --> 01:29:43,240 AND ALL OF THESE BARRIERS 2303 01:29:43,240 --> 01:29:44,800 CONTRIBUTING TO INCREASED MENTAL 2304 01:29:44,800 --> 01:29:47,560 HEALTH CONCERNS AS WELL AS 2305 01:29:47,560 --> 01:29:49,280 DIMINISHED OPPORTUNITIES TO BOTH 2306 01:29:49,280 --> 01:29:51,240 SCREEN AND INTERVENE ON THESE 2307 01:29:51,240 --> 01:29:59,040 RISKS AND THE SECOND EXEMPLAR 2308 01:29:59,040 --> 01:30:03,720 FROM A QUADRIPLEGIC MEMBER 2309 01:30:03,720 --> 01:30:05,200 OFFERED VIRTUAL LACTATION 2310 01:30:05,200 --> 01:30:07,320 SUPPORT, NOT HELPFUL BECAUSE AS 2311 01:30:07,320 --> 01:30:08,440 A QUADRIPLEGIC SHE NEEDED 2312 01:30:08,440 --> 01:30:11,600 SOMEONE WHO COULD BE HANDS-ON 2313 01:30:11,600 --> 01:30:13,920 AND SO DESPITE HER GREAT DESIRE 2314 01:30:13,920 --> 01:30:17,080 TO BREASTFEED THAT WAS NOT 2315 01:30:17,080 --> 01:30:19,040 SOMETHING SHE COULD CONSIDER. 2316 01:30:19,040 --> 01:30:22,120 TAKEN TOGETHER WE KNOW 2317 01:30:22,120 --> 01:30:23,600 PSYCHOSOCIAL STRESS INCREASES 2318 01:30:23,600 --> 01:30:25,200 MATERNAL, FETAL, INFANT RISKS 2319 01:30:25,200 --> 01:30:27,600 FOR ADVERSE OUTCOMES. 2320 01:30:27,600 --> 01:30:30,640 AND WE'VE SHOWN RESPONDENTS WITH 2321 01:30:30,640 --> 01:30:32,080 DISABILITIES ARE AT INCREASED 2322 01:30:32,080 --> 01:30:33,280 RISK, WHILE SCREENING FOR THESE 2323 01:30:33,280 --> 01:30:35,360 RISKS IS AN IMPORTANT FIRST STEP 2324 01:30:35,360 --> 01:30:37,440 WE REALLY NEED TO BETTER 2325 01:30:37,440 --> 01:30:40,400 UNDERSTAND THE UNIQUE RISKS AND 2326 01:30:40,400 --> 01:30:45,760 BARRIERS THAT EXIST FOR OUR 2327 01:30:45,760 --> 01:30:47,280 DISABLED RESPONDENTS AT 2328 01:30:47,280 --> 01:30:48,160 INDIVIDUAL LEVEL, SYSTEM LEVEL, 2329 01:30:48,160 --> 01:30:50,000 HEALTH CARE AND EVEN SOCIETAL 2330 01:30:50,000 --> 01:30:52,320 LEVEL IF WE'RE TRULY COMMITTED 2331 01:30:52,320 --> 01:30:55,680 TO REDUCING INEQUITIES AMONG 2332 01:30:55,680 --> 01:30:57,200 PERSONS WITH DISABILITIES. 2333 01:30:57,200 --> 01:30:58,520 SO THE REFERENCES ARE SHOWN 2334 01:30:58,520 --> 01:31:00,640 HERE, AND I THANK YOU FOR YOUR 2335 01:31:00,640 --> 01:31:02,400 TIME AND THE OPPORTUNITY TO 2336 01:31:02,400 --> 01:31:10,280 SHARE OUR TEAM'S WORK. 2337 01:31:10,280 --> 01:31:12,560 >>THANK YOU FOR YOUR 2338 01:31:12,560 --> 01:31:12,920 PRESENTATION. 2339 01:31:12,920 --> 01:31:17,360 WE WANT TO REMIND THE AUDIENCE 2340 01:31:17,360 --> 01:31:18,000 TO SUBMIT QUESTIONS THROUGH THE 2341 01:31:18,000 --> 01:31:19,920 "SEND LIVE FEEDBACK" ON THE 2342 01:31:19,920 --> 01:31:22,240 VIDEOCAST AND QUESTION WILL BE 2343 01:31:22,240 --> 01:31:24,720 DISCUSSED DURING THE Q&A 2344 01:31:24,720 --> 01:31:24,960 SECTION. 2345 01:31:24,960 --> 01:31:28,760 NOW I WOULD LIKE TO MOVE TO OUR 2346 01:31:28,760 --> 01:31:30,600 LAST PRESENTATION OF THIS 2347 01:31:30,600 --> 01:31:38,400 SESSION, AND WOULD LIKE TO 2348 01:31:38,400 --> 01:31:42,200 WELCOME DR. MICHELLE LEVINE, A 2349 01:31:42,200 --> 01:31:47,000 CLINICAL LICENSED PSYCHOLOGY AND 2350 01:31:47,000 --> 01:31:52,280 PROFESSOR OF PSYCHIATRY AT 2351 01:31:52,280 --> 01:31:53,800 UNIVERSITY OF PITTSBURGH. 2352 01:31:53,800 --> 01:31:57,520 YOU HAVE THE FLOOR. 2353 01:31:57,520 --> 01:32:00,040 >>THANK YOU. 2354 01:32:00,040 --> 01:32:03,000 I'M EXCITED TO JOIN YOU ALL 2355 01:32:03,000 --> 01:32:05,840 TODAY AND GRATEFUL FOR THE 2356 01:32:05,840 --> 01:32:08,120 OPPORTUNITY TO TALK ABOUT OUR 2357 01:32:08,120 --> 01:32:10,080 WORK WHICH IS HOPEFULLY SHOWING 2358 01:32:10,080 --> 01:32:11,880 ON YOUR SCREEN RIGHT NOW. 2359 01:32:11,880 --> 01:32:15,040 I'M GOING TO TALK A BIT ABOUT 2360 01:32:15,040 --> 01:32:17,280 RELATIONSHIP BETWEEN EATING 2361 01:32:17,280 --> 01:32:18,400 BEHAVIORS, PSYCHOLOGICAL 2362 01:32:18,400 --> 01:32:19,840 DISTRESS, FOOD INSECURITY, 2363 01:32:19,840 --> 01:32:21,120 EXPERIENCES OF DISCRIMINATION 2364 01:32:21,120 --> 01:32:24,560 AMONG PREGNANT PEOPLE AT HIGH 2365 01:32:24,560 --> 01:32:26,160 RISK FOR CARDIOVASCULAR DISEASE 2366 01:32:26,160 --> 01:32:27,160 AND ONGOING WORK. 2367 01:32:27,160 --> 01:32:30,560 TO START I WANTED TO START WITH 2368 01:32:30,560 --> 01:32:32,680 A DEFINITION OF EATING BEHAVIOR 2369 01:32:32,680 --> 01:32:35,720 WE FOCUSED ON, LOSS OF CONTROL 2370 01:32:35,720 --> 01:32:37,800 EATING, MOST BASIC SENSE LOSS OF 2371 01:32:37,800 --> 01:32:45,320 CONTROL EATING CAN BE LIKENED TO 2372 01:32:45,320 --> 01:32:46,760 BINGE EATING LIKE BULIMIA, THE 2373 01:32:46,760 --> 01:32:48,400 SENSE OF BEING UNABLE TO CONTROL 2374 01:32:48,400 --> 01:32:53,960 AMOUNT OR QUANTITY OR QUALITY OF 2375 01:32:53,960 --> 01:32:55,520 FOOD EATEN ASSOCIATED WITH 2376 01:32:55,520 --> 01:32:57,560 HIGHER CALORIE INTAKE AND MORE 2377 01:32:57,560 --> 01:32:59,200 FREQUENT EPISODES OF OVEREATING, 2378 01:32:59,200 --> 01:33:01,240 ALSO DEPRESSIVE SYMPTOMS AND 2379 01:33:01,240 --> 01:33:02,080 EXPERIENCE OF PSYCHOLOGICAL 2380 01:33:02,080 --> 01:33:02,600 DISTRESS. 2381 01:33:02,600 --> 01:33:04,400 ONE OF THE REASONS WE'VE BEEN 2382 01:33:04,400 --> 01:33:05,880 INTERESTED IN IT IN PREGNANCY IS 2383 01:33:05,880 --> 01:33:08,000 BECAUSE IT'S THE MOST COMMON 2384 01:33:08,000 --> 01:33:09,200 EATING DISORDERED BEHAVIOR 2385 01:33:09,200 --> 01:33:10,480 OBSERVED IN PREGNANT PEOPLE AND 2386 01:33:10,480 --> 01:33:12,280 DOES NOT IMPROVE OVER THE COURSE 2387 01:33:12,280 --> 01:33:14,680 OF PREGNANCY UNLIKE OTHER EATING 2388 01:33:14,680 --> 01:33:17,200 DISORDERED BEHAVIORS. 2389 01:33:17,200 --> 01:33:18,080 MOST IMPORTANTLY, DURING 2390 01:33:18,080 --> 01:33:20,080 PREGNANCY WE'VE SHOWN THAT THIS 2391 01:33:20,080 --> 01:33:22,160 EATING BEHAVIOR LOSS OF CONTROL 2392 01:33:22,160 --> 01:33:23,120 PREDICTING POOR CARDIOVASCULAR 2393 01:33:23,120 --> 01:33:27,320 HEALTH AND POOR PSYCHOLOGICAL 2394 01:33:27,320 --> 01:33:27,520 HEALTH. 2395 01:33:27,520 --> 01:33:29,480 ANOTHER CONSTRUCT THAT'S 2396 01:33:29,480 --> 01:33:30,760 IMPORTANT TO THIS TOPIC 2397 01:33:30,760 --> 01:33:32,400 MENTIONED OTHER TIMES TODAY IS 2398 01:33:32,400 --> 01:33:36,800 THE CONSTRUCT OF FOOD 2399 01:33:36,800 --> 01:33:39,880 INSECURITY, WHICH YOU KNOW IS 2400 01:33:39,880 --> 01:33:41,280 HAVING LIMITED OR UNCERTAIN 2401 01:33:41,280 --> 01:33:42,800 ACCESS TO SUFFICIENT FOODS FOR A 2402 01:33:42,800 --> 01:33:44,720 HEALTHY AND ACTIVE LIFESTYLE. 2403 01:33:44,720 --> 01:33:46,680 I PUT THE RUBRIC IN THE TOP 2404 01:33:46,680 --> 01:33:47,880 RIGHT CORNER TO REMIND MYSELF 2405 01:33:47,880 --> 01:33:50,720 AND ALL OF US THAT FOOD 2406 01:33:50,720 --> 01:33:52,160 INSECURITY REFLECTS NOT JUST THE 2407 01:33:52,160 --> 01:33:54,320 PROBLEMS WITH ACCESS TO FOODS OF 2408 01:33:54,320 --> 01:33:55,880 HIGH QUALITY OR ENOUGH QUANTITY 2409 01:33:55,880 --> 01:33:59,520 BUT THAT IT ALSO HAS 2410 01:33:59,520 --> 01:34:01,920 PSYCHOLOGICAL AND PSYCHOSOCIAL 2411 01:34:01,920 --> 01:34:04,760 IMPLICATIONS AS WELL. 2412 01:34:04,760 --> 01:34:06,720 RATES OF FOOD SECURITY ARE 2413 01:34:06,720 --> 01:34:08,560 HIGHER IN PREGNANT POPULATIONS 2414 01:34:08,560 --> 01:34:10,080 THAN GENERAL POPULATION, RANGING 2415 01:34:10,080 --> 01:34:15,440 BETWEEN 15 AND AS HIGH AS 37%. 2416 01:34:15,440 --> 01:34:17,200 IN PREGNANT POPULATIONS 2417 01:34:17,200 --> 01:34:18,840 AND ON AVERAGE 12%. 2418 01:34:18,840 --> 01:34:20,760 FOOD INSECURITY IS ASSOCIATED 2419 01:34:20,760 --> 01:34:24,240 WITH NUMEROUS ADVERSE PRENATAL 2420 01:34:24,240 --> 01:34:25,240 LET OUTCOMES INCLUDING 2421 01:34:25,240 --> 01:34:29,680 PSYCHOLOGICAL YOU OUTCOMES AS 2422 01:34:29,680 --> 01:34:31,560 WELL AS SIMILAR MEDICAL 2423 01:34:31,560 --> 01:34:31,840 OUTCOMES. 2424 01:34:31,840 --> 01:34:32,960 WE'VE BEEN INTERESTED IN TRYING 2425 01:34:32,960 --> 01:34:34,320 TO PUT THESE THINGS TOGETHER, 2426 01:34:34,320 --> 01:34:37,560 LOSS OF CONTROL OVER EATING, 2427 01:34:37,560 --> 01:34:39,440 FOOD INSECURITY, CONSTRUCT OF 2428 01:34:39,440 --> 01:34:41,520 STRUCTURAL RACISM AND 2429 01:34:41,520 --> 01:34:42,600 DISCRIMINATION FOR OBVIOUS 2430 01:34:42,600 --> 01:34:45,440 REASONS DURING THE PANDEMIC, WE 2431 01:34:45,440 --> 01:34:46,800 WERE INTERESTED IN UNDERSTANDING 2432 01:34:46,800 --> 01:34:48,400 THESE EXPERIENCES BECAUSE AS WE 2433 01:34:48,400 --> 01:34:51,240 KNOW THE PANDEMIC AFFECTED 2434 01:34:51,240 --> 01:34:53,040 WELL-BEING IN PERINATAL 2435 01:34:53,040 --> 01:34:55,200 POPULATIONS AND PARTICULARLY 2436 01:34:55,200 --> 01:34:56,440 THOSE FROM HISTORICALLY 2437 01:34:56,440 --> 01:34:56,960 MARGINALIZED GROUPS. 2438 01:34:56,960 --> 01:34:59,360 WE ALSO IS A THE PANDEMIC 2439 01:34:59,360 --> 01:35:00,560 AFFECTED EATING BEHAVIOR SO 2440 01:35:00,560 --> 01:35:02,520 THERE'S GOOD EVIDENCE THAT RATES 2441 01:35:02,520 --> 01:35:04,160 OF FRANK EATING DISORDERS 2442 01:35:04,160 --> 01:35:07,040 INCREASED DURING THE PANDEMIC, 2443 01:35:07,040 --> 01:35:08,440 LARGELY EVIDENCE COMES FROM 2444 01:35:08,440 --> 01:35:09,880 STUDIES OF YOUNGER PEOPLE 2445 01:35:09,880 --> 01:35:10,720 DIAGNOSED WITH EATING DISORDERS 2446 01:35:10,720 --> 01:35:12,040 AND WE CAN REMEMBER THE PANDEMIC 2447 01:35:12,040 --> 01:35:14,360 WAS ASSOCIATED WITH LOTS OF 2448 01:35:14,360 --> 01:35:16,160 PROBLEMS WITH FOOD ACCESS. 2449 01:35:16,160 --> 01:35:17,760 FOOD INSECURITY ITSELF AND 2450 01:35:17,760 --> 01:35:18,600 EXPERIENCES OF DISCRIMINATION 2451 01:35:18,600 --> 01:35:21,600 HAVE BEEN WELL LINKED TO 2452 01:35:21,600 --> 01:35:22,480 PSYCHOLOGICAL DISTRESS OUTSIDE 2453 01:35:22,480 --> 01:35:24,840 OF PREGNANCY SO WITH THE HELP OF 2454 01:35:24,840 --> 01:35:26,200 THE IMPROVE INITIATIVE WE SOUGHT 2455 01:35:26,200 --> 01:35:27,960 TO ANSWER TWO QUESTIONS. 2456 01:35:27,960 --> 01:35:30,440 ONE WAS DID THE PANDEMIC AFFECT 2457 01:35:30,440 --> 01:35:33,440 PRENATAL LOSS OF CONTROL EATING, 2458 01:35:33,440 --> 01:35:34,880 EATING DISORDER BEHAVIOR RELATED 2459 01:35:34,880 --> 01:35:35,840 TO HEALTH AND PSYCHOLOGICAL 2460 01:35:35,840 --> 01:35:37,600 HEALTH, AND YOU WHO DID IT 2461 01:35:37,600 --> 01:35:39,240 AFFECT PSYCHOLOGICAL HEALTH IN 2462 01:35:39,240 --> 01:35:39,680 GENERAL. 2463 01:35:39,680 --> 01:35:42,320 TWO, HOW WAS FOOD INSECURITY AND 2464 01:35:42,320 --> 01:35:44,320 EXPERIENCES OF DISCRIMINATION 2465 01:35:44,320 --> 01:35:46,800 RELATED TO PRENATAL LOSS OF 2466 01:35:46,800 --> 01:35:47,760 CONTROL AND PSYCHOLOGICAL 2467 01:35:47,760 --> 01:35:48,040 DISTRESS. 2468 01:35:48,040 --> 01:35:53,800 WE DID THAT BY ADDING MEASURES 2469 01:35:53,800 --> 01:35:57,320 TO A RANDOMIZED TRIAL, A RUBRIC 2470 01:35:57,320 --> 01:35:58,280 SHOWN HERE. 2471 01:35:58,280 --> 01:36:01,160 TODAY I'LL TALK ABOUT DATA 2472 01:36:01,160 --> 01:36:02,920 COLLECTED PRIOR TO FIRST 2473 01:36:02,920 --> 01:36:03,640 RANDOMIZATION. 2474 01:36:03,640 --> 01:36:05,560 SO WE'RE IN THE MIDDLE OF 2475 01:36:05,560 --> 01:36:08,920 STUDYING A GROUP OF PREGNANT 2476 01:36:08,920 --> 01:36:10,280 INDIVIDUALS WITH PRE-PREGNANCY 2477 01:36:10,280 --> 01:36:13,320 BMIs ABOVE 25, HIGHER 2478 01:36:13,320 --> 01:36:14,640 LONG-TERM CARDIOVASCULAR HEALTH 2479 01:36:14,640 --> 01:36:16,720 RISK, AND FOCUSING ON PERIOD 2480 01:36:16,720 --> 01:36:18,160 PRIOR TO THE FIRST 2481 01:36:18,160 --> 01:36:20,760 RANDOMIZATION, YOU CAN IGNORE 2482 01:36:20,760 --> 01:36:24,360 THE COMPLICATED MULTIPLE 2483 01:36:24,360 --> 01:36:26,200 RANDOMIZATION SCHEME THAT 2484 01:36:26,200 --> 01:36:26,480 HAPPENED. 2485 01:36:26,480 --> 01:36:29,600 WE ADDED THE TWO MEASURES IN THE 2486 01:36:29,600 --> 01:36:31,160 BOTTOM, USDA HOUSEHOLD FOOD 2487 01:36:31,160 --> 01:36:33,360 INSTITUTER MEASURES AS WELL AS 2488 01:36:33,360 --> 01:36:34,440 MAJOR EXPERIENCES OF 2489 01:36:34,440 --> 01:36:38,480 DISCRIMINATION MEASURE, TO THIS 2490 01:36:38,480 --> 01:36:39,880 ONGOING FILE ALREADY ASSESSING 2491 01:36:39,880 --> 01:36:43,720 LOSS OF CONTROL OF EATING USING 2492 01:36:43,720 --> 01:36:48,320 A QUESTIONNAIRE BASED MEASURE 2493 01:36:48,320 --> 01:36:50,320 AND PERCEIVED STRESS SCALES. 2494 01:36:50,320 --> 01:36:51,360 WE COMPARED PREGNANT PEOPLE 2495 01:36:51,360 --> 01:36:54,440 ASSESS THE BEFORE AND AFTER THE 2496 01:36:54,440 --> 01:36:56,200 PANDEMIC, YOU'LL NOTE WE JUST 2497 01:36:56,200 --> 01:36:58,960 USED THE TIME IN MARCH 2020 AS 2498 01:36:58,960 --> 01:37:01,000 THE ONSET OF THE PANDEMIC FOR 2499 01:37:01,000 --> 01:37:02,400 THESE COMPARISONS AND OBVIOUSLY 2500 01:37:02,400 --> 01:37:04,640 HAD A LARGER SAMPLE PRIOR TO THE 2501 01:37:04,640 --> 01:37:06,480 PANDEMIC THAN AFTER. 2502 01:37:06,480 --> 01:37:08,040 WE EVALUATED THE RELATIONSHIPS 2503 01:37:08,040 --> 01:37:10,520 BETWEEN LOSS OF CONTROL AND OUR 2504 01:37:10,520 --> 01:37:12,080 TWO MEASURES OF PSYCHOLOGICAL 2505 01:37:12,080 --> 01:37:16,280 DISSUPPRESS -- DISTRESS. 2506 01:37:16,280 --> 01:37:18,440 IN THE WHOLE SAMPLE OF 312 YOU 2507 01:37:18,440 --> 01:37:21,080 CAN SEE WE HAD PREGNANT PEOPLE 2508 01:37:21,080 --> 01:37:23,560 AROUND 31 YEARS OF AGE, 2509 01:37:23,560 --> 01:37:24,320 ASSESSING THEM EARLY IN 2510 01:37:24,320 --> 01:37:28,160 PREGNANCY JUST AFTER THE END OF 2511 01:37:28,160 --> 01:37:29,360 THE FIRST TRIMESTER AT 13 1/2 2512 01:37:29,360 --> 01:37:32,880 WEEKS, YOU CAN SEE THE REST OF 2513 01:37:32,880 --> 01:37:33,640 PRENATAL CHARACTERISTICS HERE 2514 01:37:33,640 --> 01:37:37,600 INCLUDING THE FACT IN MOST CASES 2515 01:37:37,600 --> 01:37:38,560 THE PREGNANCY WAS INTENTIONAL, 2516 01:37:38,560 --> 01:37:40,760 THEY HAD MODERATE LEVEL OF 2517 01:37:40,760 --> 01:37:42,280 HOUSEHOLD INCOME ON AVERAGE, AND 2518 01:37:42,280 --> 01:37:43,640 HERE YOU CAN SEE RACIAL AND 2519 01:37:43,640 --> 01:37:47,560 ETHNIC BREAK DOWN OF THE SAMPLE. 2520 01:37:47,560 --> 01:37:49,280 68.5 IDENTIFIED AS WHITE, ABOUT 2521 01:37:49,280 --> 01:37:51,720 A QUARTER AS BLACK OR AFRICAN 2522 01:37:51,720 --> 01:37:56,320 AMERICAN, AND JUST UNDER 5% AS 2523 01:37:56,320 --> 01:37:57,720 HISPANIC OR LATINA. 2524 01:37:57,720 --> 01:37:59,480 WHAT DID WE FIND? 2525 01:37:59,480 --> 01:38:00,560 IN TERMS OF PRE AND POST 2526 01:38:00,560 --> 01:38:03,120 PANDEMIC WE DID SEE A 2527 01:38:03,120 --> 01:38:04,520 RELATIONSHIP BETWEEN THE 2528 01:38:04,520 --> 01:38:05,720 PANDEMIC AND EXPERIENCE OF LOSS 2529 01:38:05,720 --> 01:38:07,800 OF CONTROL OVER EATING, PRIOR TO 2530 01:38:07,800 --> 01:38:10,560 THE PANDEMIC ON THE LEFT PART 2531 01:38:10,560 --> 01:38:12,280 30% OF THE SAMPLE ENDORSED LOSS 2532 01:38:12,280 --> 01:38:15,880 OF CONTROL OVER EATING, AFTER 2533 01:38:15,880 --> 01:38:17,240 THE PANDEMIC IT WAS ABOUT 42.5% 2534 01:38:17,240 --> 01:38:18,760 REPORTED AT LEAST ONE EPISODE OF 2535 01:38:18,760 --> 01:38:20,720 LOSS OF CONTROL OVER EATING IN 2536 01:38:20,720 --> 01:38:21,920 THE PAST MONTH. 2537 01:38:21,920 --> 01:38:23,800 HOWEVER WE DIDN'T SEE WHAT WE 2538 01:38:23,800 --> 01:38:26,920 EXPECTED, WHICH WAS A CHANGE IN 2539 01:38:26,920 --> 01:38:28,800 THE PSYCHOSOCIAL CORRELATES OF 2540 01:38:28,800 --> 01:38:31,120 THE PANDEMIC, RATES OF STRESS 2541 01:38:31,120 --> 01:38:32,880 AND PERCEIVED STRESS AND 2542 01:38:32,880 --> 01:38:37,360 DEPRESSIVE SYMPTOMS DID NOT 2543 01:38:37,360 --> 01:38:39,120 INCREASE PRE-TO POST-PANDEMIC. 2544 01:38:39,120 --> 01:38:41,840 WE FOUND THAT 25% OF OUR 2545 01:38:41,840 --> 01:38:43,600 PARTICIPANTS REPORTED SOME LEVEL 2546 01:38:43,600 --> 01:38:44,720 OF FOOD INSECURITY. 2547 01:38:44,720 --> 01:38:47,120 WE MADE THE DECISION TO CONSIDER 2548 01:38:47,120 --> 01:38:49,640 EVEN A MARGINAL LEVEL OF FOOD 2549 01:38:49,640 --> 01:38:50,920 INSECURITY AS FOOD INSECURITY 2550 01:38:50,920 --> 01:38:54,560 AND COMPARE THEM TO THE 75% 2551 01:38:54,560 --> 01:38:55,680 IDENTIFIED AS FOOD SECURE BASED 2552 01:38:55,680 --> 01:38:57,400 ON SOME DATA THAT SHOW EVEN 2553 01:38:57,400 --> 01:38:59,080 MARGINAL LEVEL OF FOOD 2554 01:38:59,080 --> 01:39:00,280 INSECURITY ASSOCIATED WITH 2555 01:39:00,280 --> 01:39:03,200 SIMILAR OUTCOMES AS THOSE OF 2556 01:39:03,200 --> 01:39:04,640 VERY LOW FOOD INSECURITY 2557 01:39:04,640 --> 01:39:05,080 INDIVIDUALS. 2558 01:39:05,080 --> 01:39:07,600 AND ABOUT HALF OF OUR GROUP 2559 01:39:07,600 --> 01:39:09,040 REPORTED AT LEAST ONE MAJOR 2560 01:39:09,040 --> 01:39:10,360 EXPERIENCE OF DISCRIMINATION IN 2561 01:39:10,360 --> 01:39:11,120 THEIR LIFETIME. 2562 01:39:11,120 --> 01:39:13,960 YOU CAN SEE ON THE RIGHT THE 2563 01:39:13,960 --> 01:39:15,600 HISTOGRAM OF THOSE AND THE 2564 01:39:15,600 --> 01:39:17,120 EXPERIENCES OF DISCRIMINATION 2565 01:39:17,120 --> 01:39:19,080 THAT WERE SPECIFICALLY RELATED 2566 01:39:19,080 --> 01:39:21,680 TO RACIAL REASONS HIGHLIGHTED IN 2567 01:39:21,680 --> 01:39:22,480 BLUE COLOR. 2568 01:39:22,480 --> 01:39:25,960 WE DID NOT AS EXPECTED FIND A 2569 01:39:25,960 --> 01:39:26,880 RELATIONSHIP BETWEEN FOOD 2570 01:39:26,880 --> 01:39:28,840 INSECURITY AND LOSS OF CONTROL. 2571 01:39:28,840 --> 01:39:31,280 AS YOU CAN SEE THOSE WHO 2572 01:39:31,280 --> 01:39:32,440 EXPERIENCED A LOSS OF CONTROL 2573 01:39:32,440 --> 01:39:34,640 AND THOSE WHO DID NOT REPORTED 2574 01:39:34,640 --> 01:39:36,280 SIMILAR LEVELS OF FOOD 2575 01:39:36,280 --> 01:39:37,920 INSECURITY, ABOUT 20% OF THOSE 2576 01:39:37,920 --> 01:39:41,080 WITH LOSS OF CONTROL REPORTED 2577 01:39:41,080 --> 01:39:42,280 FOOD INSECURITY PRENATALLY, AND 2578 01:39:42,280 --> 01:39:44,360 29% WHO DID NOT EXPERIENCE LOSS 2579 01:39:44,360 --> 01:39:46,600 OF CONTROL REPORTED FOOD 2580 01:39:46,600 --> 01:39:47,000 INSECURITY. 2581 01:39:47,000 --> 01:39:50,800 BUT WE DID FIND FOOD INSECURITY 2582 01:39:50,800 --> 01:39:51,840 RELATED TO PSYCHOLOGICAL 2583 01:39:51,840 --> 01:39:53,680 DISTRESS, MOST STRONGLY IN TERMS 2584 01:39:53,680 --> 01:39:56,520 OF DEPRESSIVE SYMPTOMS HIGHER IN 2585 01:39:56,520 --> 01:39:58,040 THE FOOD INSECURITY GROUP THAN 2586 01:39:58,040 --> 01:39:59,120 FOOD SECURE. 2587 01:39:59,120 --> 01:40:01,120 RATES OF PERCEIVED STRESS HIGHER 2588 01:40:01,120 --> 01:40:03,440 IN FOOD INSECURE GROUP, 2589 01:40:03,440 --> 01:40:05,080 DIFFERENCE WAS NOT SIGNIFICANT. 2590 01:40:05,080 --> 01:40:06,920 AND FINALLY WE FOUND 2591 01:40:06,920 --> 01:40:08,240 SURPRISINGLY AND HAPPY TO TALK 2592 01:40:08,240 --> 01:40:09,680 ABOUT IT BECAUSE I DON'T KNOW 2593 01:40:09,680 --> 01:40:11,840 WHAT IT MEANS THE EXPERIENCE OF 2594 01:40:11,840 --> 01:40:12,720 DISCRIMINATION WAS RELATED TO 2595 01:40:12,720 --> 01:40:14,360 LOSS OF CONTROL BUT NOT IN THE 2596 01:40:14,360 --> 01:40:16,480 DIRECTION WE MIGHT HAVE 2597 01:40:16,480 --> 01:40:16,800 HYPOTHESIZED. 2598 01:40:16,800 --> 01:40:19,520 WE FOUND THOSE WHO REPORTED A 2599 01:40:19,520 --> 01:40:21,400 LOSS OF CONTROL EXPERIENCE IN 2600 01:40:21,400 --> 01:40:23,800 THE LAST MONTH HAD FEWER 2601 01:40:23,800 --> 01:40:24,360 LIFETIME EXPERIENCES OF 2602 01:40:24,360 --> 01:40:25,680 DISCRIMINATION THAN DID THOSE 2603 01:40:25,680 --> 01:40:27,840 WHO DID NOT REPORT LOSS OF 2604 01:40:27,840 --> 01:40:28,280 CONTROL. 2605 01:40:28,280 --> 01:40:30,680 WE DID NOT, HOWEVER, SEE 2606 01:40:30,680 --> 01:40:32,120 ASSOCIATION BETWEEN EXPERIENCES 2607 01:40:32,120 --> 01:40:35,280 OF DISCRIMINATION AND OUR TWO 2608 01:40:35,280 --> 01:40:36,160 MEASURES OF PSYCHOLOGICAL 2609 01:40:36,160 --> 01:40:36,560 DISTRESS. 2610 01:40:36,560 --> 01:40:38,120 IN TRYING TO PUT IT TOGETHER WE 2611 01:40:38,120 --> 01:40:40,640 FIRST WANTED TO SEE IF THE 2612 01:40:40,640 --> 01:40:42,520 PANDEMIC AFFECTED LOSS OF 2613 01:40:42,520 --> 01:40:45,280 CONTROL, THIS EATING DISORDER 2614 01:40:45,280 --> 01:40:46,040 BEHAVIOR, AND PSYCHOLOGICAL 2615 01:40:46,040 --> 01:40:46,480 DISTRESS. 2616 01:40:46,480 --> 01:40:52,160 RATES OF LOSS OF CONTROL AMONG 2617 01:40:52,160 --> 01:40:52,680 AMONG 2618 01:40:52,680 --> 01:40:53,960 PREGNANT PEOPLE WERE INCREASED 2619 01:40:53,960 --> 01:40:56,080 AFTER THE ONSET OF THE PANDEMIC, 2620 01:40:56,080 --> 01:40:57,600 BUT RATES OF PSYCHOLOGICAL 2621 01:40:57,600 --> 01:40:58,760 DISTRESS DID NOT INCREASE. 2622 01:40:58,760 --> 01:41:01,320 ONE IDEA ABOUT THAT IS THAT WE 2623 01:41:01,320 --> 01:41:02,240 JUST OPERATIONALIZE THE ONSET OF 2624 01:41:02,240 --> 01:41:05,160 THE PANDEMIC BY THE DATE AND CAN 2625 01:41:05,160 --> 01:41:06,800 ALL REMEMBER THAT THE ACUTE 2626 01:41:06,800 --> 01:41:08,800 MOMENTS OF THE PANDEMIC WERE 2627 01:41:08,800 --> 01:41:10,520 DIFFERENT THAN THE SORT OF 2628 01:41:10,520 --> 01:41:11,520 LINGERING MOMENTS AND SO IT 2629 01:41:11,520 --> 01:41:14,120 MIGHT BE OUR MEASURES OF 2630 01:41:14,120 --> 01:41:15,560 PSYCHOLOGICAL DISTRESS WERE 2631 01:41:15,560 --> 01:41:16,960 DIFFERENT AMONG THE GROUP 2632 01:41:16,960 --> 01:41:18,200 SAMPLED EARLIER ON THAN LATER ON 2633 01:41:18,200 --> 01:41:19,360 IN THE PANDEMIC. 2634 01:41:19,360 --> 01:41:21,280 WE ALSO FOUND CONSISTENT WITH 2635 01:41:21,280 --> 01:41:23,640 PRIOR RESEARCH THAT PREGNANT 2636 01:41:23,640 --> 01:41:27,600 PEOPLE WHO HAD SOME LEVEL OF 2637 01:41:27,600 --> 01:41:29,160 FOOD INSECURITY ENDORSED MORE 2638 01:41:29,160 --> 01:41:31,800 SYMPTOMS IN HIGHER LEVELS OF 2639 01:41:31,800 --> 01:41:32,760 PERCEIVED ALTHOUGH NO 2640 01:41:32,760 --> 01:41:33,640 RELATIONSHIP BETWEEN FOOD 2641 01:41:33,640 --> 01:41:35,160 INSECURITY AND LOSS OF CONTROL 2642 01:41:35,160 --> 01:41:39,320 AND RELATIONSHIP BETWEEN FOOD 2643 01:41:39,320 --> 01:41:41,640 INSECURITY AND PERCEIVED STRESS 2644 01:41:41,640 --> 01:41:43,280 WAS NOT STATISTICALLY 2645 01:41:43,280 --> 01:41:43,560 SIGNIFICANT. 2646 01:41:43,560 --> 01:41:44,120 THERE ARE INTERESTING 2647 01:41:44,120 --> 01:41:45,560 MEASUREMENT ISSUES WITH FOOD 2648 01:41:45,560 --> 01:41:50,800 INSECURITY AND EATING BEHAVIORS 2649 01:41:50,800 --> 01:41:51,760 IN PREGNANCY. 2650 01:41:51,760 --> 01:41:55,280 CHRISTINE CALL IN OUR LAB IS 2651 01:41:55,280 --> 01:41:56,560 PURSUING THESE QUESTIONS. 2652 01:41:56,560 --> 01:41:58,000 LOOK OUT FOR WORK FROM HER IN 2653 01:41:58,000 --> 01:42:00,120 THE FUTURE, TRYING TO UNDERSTAND 2654 01:42:00,120 --> 01:42:01,200 PROXIMAL RELATIONSHIPS BETWEEN 2655 01:42:01,200 --> 01:42:06,040 FOOD INSECURITY AND EATING 2656 01:42:06,040 --> 01:42:08,840 PREGNANCY SINCE WE MEASURE USING 2657 01:42:08,840 --> 01:42:10,240 USDA MEASURE ON THE GROWTH 2658 01:42:10,240 --> 01:42:10,440 LEVEL. 2659 01:42:10,440 --> 01:42:12,360 WE ALSO THINK THERE MIGHT BE 2660 01:42:12,360 --> 01:42:14,440 OTHER EATING BEHAVIORS LIKE A 2661 01:42:14,440 --> 01:42:15,720 MORE RESTRICTIVE STYLE WHERE 2662 01:42:15,720 --> 01:42:17,840 CALORIES ARE FEWER THAT MIGHT BE 2663 01:42:17,840 --> 01:42:20,760 RELATED TO FOOD INSECURITY AND 2664 01:42:20,760 --> 01:42:24,040 PREGNANCY AND DIDN'T LOOK AT 2665 01:42:24,040 --> 01:42:27,000 THAT IN THIS SAMPLE. 2666 01:42:27,000 --> 01:42:28,440 IT'S POSSIBLE SCREENING FOR 2667 01:42:28,440 --> 01:42:29,920 IMPROVING DURING PREGNANCY MAY 2668 01:42:29,920 --> 01:42:33,040 HAVE A RELATIONSHIP TO THE 2669 01:42:33,040 --> 01:42:35,640 EXPERIENCE OF PRENATAL 2670 01:42:35,640 --> 01:42:36,760 DEPRESSION. 2671 01:42:36,760 --> 01:42:41,920 FINALLY EXPERIENCES OF 2672 01:42:41,920 --> 01:42:42,560 DISCRIMINATION WERE RELATED TO 2673 01:42:42,560 --> 01:42:45,440 LOSS OF CONTROL IN THE OPPOSITE 2674 01:42:45,440 --> 01:42:46,920 DIRECTION THAN WE HYPOTHESIZED. 2675 01:42:46,920 --> 01:42:48,600 IT'S POSSIBLE MEASURING 2676 01:42:48,600 --> 01:42:55,120 DISCRIMINATION IN A PROXIMAL 2677 01:42:55,120 --> 01:42:57,240 LEVEL, MORE PROXIMAL EXPERIENCE 2678 01:42:57,240 --> 01:42:58,640 AS OTHER TALKED ABOUT MIGHT HAVE 2679 01:42:58,640 --> 01:43:00,160 A GREATER IMPACT ON PRENATAL 2680 01:43:00,160 --> 01:43:00,960 MENTAL HEALTH. 2681 01:43:00,960 --> 01:43:04,560 I WANTED TO END WITH THANKING 2682 01:43:04,560 --> 01:43:07,000 THE MEMBERS OF OUR LAB AND 2683 01:43:07,000 --> 01:43:08,400 PARTICULARLY CHRISTINE CALL, 2684 01:43:08,400 --> 01:43:13,320 WHOSE WORK I MENTIONED, DR. 2685 01:43:13,320 --> 01:43:23,760 RACHEL CONLON AND CLAUDIA. 2686 01:43:24,040 --> 01:43:28,320 >>THANK YOU FOR YOUR WONDERFUL 2687 01:43:28,320 --> 01:43:29,200 PRESENTATIONS. 2688 01:43:29,200 --> 01:43:38,120 NOW WE'LL START ENTERING THE Q&A 2689 01:43:38,120 --> 01:43:42,000 DISCUSSION 2690 01:43:42,000 --> 01:43:42,800 QUESTIONS. 2691 01:43:42,800 --> 01:43:44,520 ANY QUESTIONS FROM THE AUDIENCE? 2692 01:43:44,520 --> 01:43:48,360 I HAVE A GENERAL QUESTION I 2693 01:43:48,360 --> 01:43:53,480 WANTED TO ASK EVERYBODY ON THE 2694 01:43:53,480 --> 01:43:54,040 PANEL. 2695 01:43:54,040 --> 01:44:00,040 SO RESEARCH INDICATES COVID-19 2696 01:44:00,040 --> 01:44:01,920 PANDEMIC HAS DETRIMENTAL TO 2697 01:44:01,920 --> 01:44:03,920 PERINATAL HEALTH ESPECIALLY FOR 2698 01:44:03,920 --> 01:44:05,200 HISTORICAL DISADVANTAGED GROUPS. 2699 01:44:05,200 --> 01:44:06,400 ARE THERE ANY LESSONS LEARNED 2700 01:44:06,400 --> 01:44:08,280 FROM THE PANDEMIC THAT WE CAN 2701 01:44:08,280 --> 01:44:10,800 USE TO IMPROVE MATERNAL AND 2702 01:44:10,800 --> 01:44:13,040 INFANT OUTCOMES? 2703 01:44:13,040 --> 01:44:14,400 >>I'M HAPPY TO START. 2704 01:44:14,400 --> 01:44:17,440 I DIDN'T PRESENT THE DATA 2705 01:44:17,440 --> 01:44:18,640 SPECIFIC TO DISABLED WOMEN OF 2706 01:44:18,640 --> 01:44:21,480 COLOR, THIS NOTION OF 2707 01:44:21,480 --> 01:44:25,520 INTERSECTIONALITY, AND HOW 2708 01:44:25,520 --> 01:44:27,080 MAGNIFIED THEIR RISK FOR ADVERSE 2709 01:44:27,080 --> 01:44:30,000 OUTCOMES IS. 2710 01:44:30,000 --> 01:44:32,440 A TERM I CONTINUED TO HEAR IN 2711 01:44:32,440 --> 01:44:33,840 INTERVIEWS FOR PREGNANT OR 2712 01:44:33,840 --> 01:44:36,920 BIRTHING MOTHERS OF COLOR 2713 01:44:36,920 --> 01:44:38,120 DISABLED IS DOUBLE JEOPARDY, AT 2714 01:44:38,120 --> 01:44:40,520 LEAST SIX OR SEVEN PARTICIPANTS 2715 01:44:40,520 --> 01:44:43,240 HAVE TALKED ABOUT THIS, AND WHAT 2716 01:44:43,240 --> 01:44:47,720 THEY ARE TALKING ABOUT IS FOR 2717 01:44:47,720 --> 01:44:52,040 INSTANCE JUST LAST WEEK, A WOMAN 2718 01:44:52,040 --> 01:44:53,960 WHO HAD GIVEN BIRTH TAIL END OF 2719 01:44:53,960 --> 01:44:55,240 2020 TALKED ABOUT NOT WANTING TO 2720 01:44:55,240 --> 01:44:57,560 LIFT THE BABY OUT OF THE 2721 01:44:57,560 --> 01:44:58,680 BASSINET IN THE HOSPITAL ROOM 2722 01:44:58,680 --> 01:45:00,240 FOR FEAR OF DROPPING IT. 2723 01:45:00,240 --> 01:45:04,040 THIS IS A WOMAN WITH A PHYSICAL 2724 01:45:04,040 --> 01:45:06,560 DISABILITY AND HAS DIMINISHED 2725 01:45:06,560 --> 01:45:07,880 STRENGTH IN UPPER EXTREMITIES. 2726 01:45:07,880 --> 01:45:09,760 I ASKED MORE ABOUT THAT. 2727 01:45:09,760 --> 01:45:12,600 SHE SAID FIRST YOU'RE JUDGED FOR 2728 01:45:12,600 --> 01:45:14,560 BEING BLACK AND PREGNANT. 2729 01:45:14,560 --> 01:45:17,960 AND I SHOULD SAY THIS WOMAN GAVE 2730 01:45:17,960 --> 01:45:20,440 BIRTH AT A FACILITY NOT FAR FROM 2731 01:45:20,440 --> 01:45:21,680 WHERE I AM IN VIRGINIA. 2732 01:45:21,680 --> 01:45:24,240 SHE SAID THEN YOU ADD THE 2733 01:45:24,240 --> 01:45:29,880 DISABILITY PIECE ON IT, AND 2734 01:45:29,880 --> 01:45:30,760 THAT'S DOUBLE JEOPARDY FOR CPS 2735 01:45:30,760 --> 01:45:33,160 COMING TO TAKE MY CHILD AWAY. 2736 01:45:33,160 --> 01:45:34,880 I THINK INTERVENTION AS I 2737 01:45:34,880 --> 01:45:37,360 BRIEFLY ALLUDED TO NEED TO 2738 01:45:37,360 --> 01:45:39,000 HAPPEN ACROSS ALL LEVELS. 2739 01:45:39,000 --> 01:45:40,760 IT CAN'T JUST BE ONE OTHER 2740 01:45:40,760 --> 01:45:42,080 SPEAKER TALKED ABOUT AT THE 2741 01:45:42,080 --> 01:45:42,840 PROVIDER LEVEL. 2742 01:45:42,840 --> 01:45:45,360 I MEAN IT NEEDS TO BE SYSTEMS, 2743 01:45:45,360 --> 01:45:47,880 NEEDS TO BE POLICIES, NEEDS TO 2744 01:45:47,880 --> 01:45:50,160 BE ACCESS TO QUALITY AND NOT 2745 01:45:50,160 --> 01:45:50,600 JUST QUANTITY FOOD. 2746 01:45:50,600 --> 01:45:52,440 I THINK THERE ARE SO MANY THINGS 2747 01:45:52,440 --> 01:45:55,640 WE NEED TO DO IF WE TRULY ARE 2748 01:45:55,640 --> 01:45:59,040 COMMITTED TO REDUCING INEQUITIES 2749 01:45:59,040 --> 01:45:59,800 AMONG OUR MOST MARGINALIZED 2750 01:45:59,800 --> 01:46:01,960 GROUPS. 2751 01:46:01,960 --> 01:46:03,480 2752 01:46:03,480 --> 01:46:09,120 >>THANK YOU. 2753 01:46:09,120 --> 01:46:14,160 ANY OTHER INTERVENTION? 2754 01:46:14,160 --> 01:46:17,760 >>I CAN SPEAK TO, YOU KNOW, OUR 2755 01:46:17,760 --> 01:46:18,960 SORT OF BIG DATA APPROACH 2756 01:46:18,960 --> 01:46:21,640 DOESN'T ALLOW US TO DIG INTO THE 2757 01:46:21,640 --> 01:46:24,000 NUANCES SO GREAT TO SEE IN THE 2758 01:46:24,000 --> 01:46:25,960 OTHER PRESENTATIONS, BUT I DO 2759 01:46:25,960 --> 01:46:27,680 THINK WE KNOW SOME AT LEAST 2760 01:46:27,680 --> 01:46:33,560 ABOUT WHAT CAN BE DONE TO HELP 2761 01:46:33,560 --> 01:46:34,400 PREVENT RACIAL/ETHNIC 2762 01:46:34,400 --> 01:46:37,640 DISPARITIES IN THINGS LIKE SMM 2763 01:46:37,640 --> 01:46:39,520 WHERE HAVING SUPPORT, FOR 2764 01:46:39,520 --> 01:46:42,840 EXAMPLE, FROM A DOULA WHO CAN BE 2765 01:46:42,840 --> 01:46:44,800 THERE TO HELP SUPPORT THE MOTHER 2766 01:46:44,800 --> 01:46:46,000 AND COMMUNICATE WITH THE 2767 01:46:46,000 --> 01:46:48,400 PROVIDER AND MAKE SURE THE 2768 01:46:48,400 --> 01:46:51,440 MOTHER IS BEING HEARD ARE VERY 2769 01:46:51,440 --> 01:46:52,800 EFFECTIVE AND OBVIOUSLY I DIDN'T 2770 01:46:52,800 --> 01:46:54,640 LOOK AT THIS DIRECTLY IN MY WORK 2771 01:46:54,640 --> 01:46:56,400 BUT WE KNOW DURING THE PANDEMIC 2772 01:46:56,400 --> 01:47:00,160 PEOPLE WERE GIVING BIRTH ALONE 2773 01:47:00,160 --> 01:47:02,560 AND SO IT'S NOT PERHAPS 2774 01:47:02,560 --> 01:47:04,640 SURPRISING TO SEE THE 2775 01:47:04,640 --> 01:47:06,480 DISPARITIES AND DIFFERENTIAL 2776 01:47:06,480 --> 01:47:09,000 IMPACT ON BLACK MOTHERS, BUT TO 2777 01:47:09,000 --> 01:47:14,800 ME IT HIGHLIGHTS THE IMPORTANCE 2778 01:47:14,800 --> 01:47:16,240 OF -- INFECTION WAS ONE ASPECT 2779 01:47:16,240 --> 01:47:19,040 OF RISK BUT THERE ARE OTHER 2780 01:47:19,040 --> 01:47:20,720 ASPECTS, MAYBE GOING FORWARD HOW 2781 01:47:20,720 --> 01:47:25,200 TO BALANCE THAT IN A WAY THAT 2782 01:47:25,200 --> 01:47:26,400 DOESN'T LEAVE PEOPLE DELIVERING 2783 01:47:26,400 --> 01:47:27,920 ON THEIR OWN. 2784 01:47:27,920 --> 01:47:34,720 >>I WAS JUST GOING TO ADD, YOU 2785 01:47:34,720 --> 01:47:36,440 KNOW, SORT OF DATA THE 2786 01:47:36,440 --> 01:47:38,600 IMPORTANCE OF LINING ELEVATING 2787 01:47:38,600 --> 01:47:39,880 PEOPLE'S VOICES, ONE OF THE 2788 01:47:39,880 --> 01:47:41,400 THINGS WE'VE ALL LEARNED IN THIS 2789 01:47:41,400 --> 01:47:43,360 PANDEMIC OR I'VE LEARNED IN THE 2790 01:47:43,360 --> 01:47:47,080 PANDEMIC IS THAT THE WAY WE 2791 01:47:47,080 --> 01:47:48,600 MEASURE THINGS, CONCEPTUALIZE 2792 01:47:48,600 --> 01:47:50,920 THINGS, BASED HISTORICALLY ALSO 2793 01:47:50,920 --> 01:47:52,880 TOO AND THAT HISTORICALLY 2794 01:47:52,880 --> 01:47:54,760 MARGINALIZED GROUPS HAVE BEEN 2795 01:47:54,760 --> 01:47:55,520 UNDERREPRESENTED HISTORICALLY 2796 01:47:55,520 --> 01:47:57,800 AND SO WE NEED SOME SORT OF NEW 2797 01:47:57,800 --> 01:48:00,560 MEASURES AND I FEEL LIKE MY 2798 01:48:00,560 --> 01:48:01,840 UNDERSTANDING OF HOW DEPRESSION 2799 01:48:01,840 --> 01:48:03,480 OR THIS EATING BEHAVIOR THAT 2800 01:48:03,480 --> 01:48:05,640 WE'RE INTERESTED IN MIGHT BE 2801 01:48:05,640 --> 01:48:07,840 BASED ON SAMPLES OR MEASURES 2802 01:48:07,840 --> 01:48:10,720 DEVELOPED ON LARGELY WHITE 2803 01:48:10,720 --> 01:48:12,160 IDENTIFYING SAMPLES, SO THE NEED 2804 01:48:12,160 --> 01:48:15,240 TO TRANSLATE INTO BOTH OUR 2805 01:48:15,240 --> 01:48:16,320 RESEARCH AND OUR INTERVENTIONS. 2806 01:48:16,320 --> 01:48:16,760 >>WONDERFUL. 2807 01:48:16,760 --> 01:48:17,760 THANK YOU ALL. 2808 01:48:17,760 --> 01:48:26,400 WE HAVE A QUESTION FROM THE 2809 01:48:26,400 --> 01:48:33,760 AUDIENCE, ADDRESSING TO DR. 2810 01:48:33,760 --> 01:48:36,720 ALHUSEN, COULD THE MARRIAGE BE A 2811 01:48:36,720 --> 01:48:37,360 PROTECTIVE FACTOR? 2812 01:48:37,360 --> 01:48:39,320 >>I WANT TO MAKE SURE I 2813 01:48:39,320 --> 01:48:40,640 UNDERSTAND THE QUESTION. 2814 01:48:40,640 --> 01:48:43,040 HOW DID SOME MOTHERS WHO ARE 2815 01:48:43,040 --> 01:48:47,560 EXPERIENCING IPV NOT REPORT IT? 2816 01:48:47,560 --> 01:48:52,520 >>YES, DESPITE EXPERIENCE OF 2817 01:48:52,520 --> 01:48:52,880 DISABILITY. 2818 01:48:52,880 --> 01:48:53,360 YES. 2819 01:48:53,360 --> 01:48:57,280 HOW SOME MOTHERS DID NOT REPORT 2820 01:48:57,280 --> 01:48:58,920 IPV DESPITE EXPERIENCE OF 2821 01:48:58,920 --> 01:49:00,560 DISABILITY IN PANDEMIC. 2822 01:49:00,560 --> 01:49:01,800 AND THE QUESTION CONTINUES, 2823 01:49:01,800 --> 01:49:05,320 COULD THE MARRIAGE BE A 2824 01:49:05,320 --> 01:49:05,720 PROTECTIVE FACTOR? 2825 01:49:05,720 --> 01:49:07,880 >>SURE, I DON'T THINK THAT'S 2826 01:49:07,880 --> 01:49:09,200 UNIQUE FOR PERSONS WITH 2827 01:49:09,200 --> 01:49:09,800 DISABILITIES. 2828 01:49:09,800 --> 01:49:12,720 THERE ARE PLENTY OF HEALTHY 2829 01:49:12,720 --> 01:49:15,600 RELATIONSHIPS WITH PARTNERS OR 2830 01:49:15,600 --> 01:49:16,040 SPOUSES. 2831 01:49:16,040 --> 01:49:18,280 WE DO KNOW THAT PERSONS WITH 2832 01:49:18,280 --> 01:49:20,400 DISABILITY MAY BE LESS LIKELY, 2833 01:49:20,400 --> 01:49:22,800 WELL, THE PAPER IS FORTHCOMING, 2834 01:49:22,800 --> 01:49:25,200 BUT TO BE SCREENED FOR VIOLENCE. 2835 01:49:25,200 --> 01:49:26,320 WE'VE JUST FINISHED ANALYZING 2836 01:49:26,320 --> 01:49:30,240 THAT DATA BY HEALTH CARE 2837 01:49:30,240 --> 01:49:34,280 PROVIDERS AND I HEAR TO DR. 2838 01:49:34,280 --> 01:49:36,360 LEVINE'S POINT I HEAR FROM WOMEN 2839 01:49:36,360 --> 01:49:37,440 PROVIDERS WILL SAY THINGS LIKE 2840 01:49:37,440 --> 01:49:39,200 LOOK HOW GREAT HE IS FOR 2841 01:49:39,200 --> 01:49:42,080 STICKING NEXT TO YOU AFTER YOUR 2842 01:49:42,080 --> 01:49:43,920 SPINAL CORD INJURY, THEY JUST 2843 01:49:43,920 --> 01:49:46,440 DON'T EVEN ASK ABOUT VIOLENCE 2844 01:49:46,440 --> 01:49:48,840 BECAUSE IT'S VERY PATERNALISTIC 2845 01:49:48,840 --> 01:49:49,840 VIEW OF DISABILITY. 2846 01:49:49,840 --> 01:49:53,240 BUT JUST SO I'M CLEAR, THE 2847 01:49:53,240 --> 01:49:54,680 DISABILITY IN MY ANALYSES 2848 01:49:54,680 --> 01:49:55,680 PRECEDED VIOLENCE. 2849 01:49:55,680 --> 01:49:58,720 WE CERTAINLY KNOW VIOLENCE CAN 2850 01:49:58,720 --> 01:50:01,120 CAUSE DISABILITY BUT FOR 2851 01:50:01,120 --> 01:50:02,640 ELIGIBILITY THE DISABILITY 2852 01:50:02,640 --> 01:50:03,640 PRECEDED VIOLENCE, SO DISABILITY 2853 01:50:03,640 --> 01:50:06,160 IN AND OF ITSELF IS A RISK 2854 01:50:06,160 --> 01:50:08,120 FACTOR FOR VIOLENCE BUT THAT 2855 01:50:08,120 --> 01:50:10,400 DOESN'T MEAN EVERY DISABLED 2856 01:50:10,400 --> 01:50:11,600 PERSON EXPERIENCES VIOLENCE AND 2857 01:50:11,600 --> 01:50:15,560 I HOPE I ANSWERED THAT QUESTION. 2858 01:50:15,560 --> 01:50:17,600 >>THANK YOU FOR YOUR ANSWER. 2859 01:50:17,600 --> 01:50:21,280 I THINK THIS QUESTION WILL GO TO 2860 01:50:21,280 --> 01:50:22,640 DR. LEVINE. 2861 01:50:22,640 --> 01:50:25,400 IN THE LARGER TRIAL ARE YOU 2862 01:50:25,400 --> 01:50:27,600 EXAMINING LOSS OF CONTROL TO 2863 01:50:27,600 --> 01:50:31,000 FETAL OR INFANT OUTCOMES? 2864 01:50:31,000 --> 01:50:33,280 WHAT TYPE OF INTERVENTION 2865 01:50:33,280 --> 01:50:34,920 ADDRESS LOC IN PREGNANT PERSONS? 2866 01:50:34,920 --> 01:50:38,400 CAN I ANSWER THE SECOND FIRST? 2867 01:50:38,400 --> 01:50:42,240 IT'S MOST EXCITING TO ME AND 2868 01:50:42,240 --> 01:50:44,440 THANK YOU FOR THE QUESTION. 2869 01:50:44,440 --> 01:50:45,840 IT'S MOST EXCITING SINCE THERE 2870 01:50:45,840 --> 01:50:47,360 ARE LOTS OF INTERVENTIONS TO 2871 01:50:47,360 --> 01:50:49,680 ADDRESS LOSS OF CONTROL EATING, 2872 01:50:49,680 --> 01:50:51,560 MOIST COME FROM INDIVIDUALS WITH 2873 01:50:51,560 --> 01:50:53,520 FRANK EATING DISORDERS, WE'RE 2874 01:50:53,520 --> 01:50:56,360 FINDING THIS HIGH RATE IN 2875 01:50:56,360 --> 01:50:57,560 PRENATAL AND PERINATAL 2876 01:50:57,560 --> 01:50:58,240 POPULATIONS THAT AREN'T 2877 01:50:58,240 --> 01:50:59,440 NECESSARILY DIAGNOSED WITH AN 2878 01:50:59,440 --> 01:51:01,160 EATING DISORDER AND SO ONE OF 2879 01:51:01,160 --> 01:51:02,280 THE THINGS WE'RE REALLY HOPING 2880 01:51:02,280 --> 01:51:04,560 TO DO IF YOU COULD SEND GOOD 2881 01:51:04,560 --> 01:51:06,640 JUJU TO ANYBODY ON THE REVIEW 2882 01:51:06,640 --> 01:51:10,160 PANEL IS TO TRY TO DEVELOP 2883 01:51:10,160 --> 01:51:10,800 INTERVENTIONS SPECIFICALLY FOR 2884 01:51:10,800 --> 01:51:13,360 LOSS OF CONTROL OVER EATING IN 2885 01:51:13,360 --> 01:51:15,960 PREGNANCY BECAUSE THE FACT OF 2886 01:51:15,960 --> 01:51:16,840 PREGNANCY CHANGES THE 2887 01:51:16,840 --> 01:51:19,480 RELATIONSHIP TO FOOD, IT'S A 2888 01:51:19,480 --> 01:51:21,680 TIME OF UNEXPECTED WEIGHT GAIN, 2889 01:51:21,680 --> 01:51:25,520 ALSO MAY AFFECT NAUSEA, WHAT YOU 2890 01:51:25,520 --> 01:51:27,560 CAN AND CAN'T EAT. 2891 01:51:27,560 --> 01:51:29,120 WE'RE HOPING TO DO THAT BECAUSE 2892 01:51:29,120 --> 01:51:30,560 NONE EXISTS NOW. 2893 01:51:30,560 --> 01:51:37,080 FETAL AND INFANT OUTCOMES SADLY 2894 01:51:37,080 --> 01:51:37,520 NOT. 2895 01:51:37,520 --> 01:51:41,280 THE HEALTH OF THE MOM OR 2896 01:51:41,280 --> 01:51:43,000 POSTPARTUM PERSON AS THE 2897 01:51:43,000 --> 01:51:46,600 OUTCOME, BUT IT'S A REALLY 2898 01:51:46,600 --> 01:51:48,120 IMPORTANT POINT SO WE SHOULD DO 2899 01:51:48,120 --> 01:51:48,320 THAT. 2900 01:51:48,320 --> 01:51:51,120 >>THANK YOU SO MUCH. 2901 01:51:51,120 --> 01:51:55,320 NEXT QUESTION IS GOING TO DR. 2902 01:51:55,320 --> 01:51:55,720 AHERN. 2903 01:51:55,720 --> 01:52:00,440 YOUR RESULTS ARE DRAMATIC, I 2904 01:52:00,440 --> 01:52:03,520 ASSUME ANALYSIS WAS 2905 01:52:03,520 --> 01:52:06,160 POPULATION-WIDE, APPLYING CAUSAL 2906 01:52:06,160 --> 01:52:07,560 INFERENCE TECHNIQUES, CAN YOU 2907 01:52:07,560 --> 01:52:09,160 ASSIGN A CAUSAL INTERPRETATION 2908 01:52:09,160 --> 01:52:10,960 TO YOUR FINDINGS? 2909 01:52:10,960 --> 01:52:12,840 ARE THERE LIMITATIONS OR 2910 01:52:12,840 --> 01:52:17,040 ASSUMPTIONS NOT SATISFIED AND 2911 01:52:17,040 --> 01:52:18,240 WHICH PROHIBIT CAUSAL 2912 01:52:18,240 --> 01:52:18,600 INTERPRETATION? 2913 01:52:18,600 --> 01:52:21,320 I CAN READ SOME PORTION IF YOU 2914 01:52:21,320 --> 01:52:21,560 WANT TO. 2915 01:52:21,560 --> 01:52:22,160 >>GREAT. 2916 01:52:22,160 --> 01:52:26,360 THANK YOU FOR THAT QUESTION. 2917 01:52:26,360 --> 01:52:30,200 SO IN THIS ANALYSIS WE APPLIED A 2918 01:52:30,200 --> 01:52:33,040 MATCHING METHOD, IT WAS NOT G 2919 01:52:33,040 --> 01:52:36,000 COMPUTATION BUT MATCHING IS 2920 01:52:36,000 --> 01:52:38,280 OFTEN ALSO CONSIDERED, I GUESS A 2921 01:52:38,280 --> 01:52:39,360 CAUSAL INFERENCE TECHNIQUE. 2922 01:52:39,360 --> 01:52:44,640 I DON'T LOVE THAT PHRASE BECAUSE 2923 01:52:44,640 --> 01:52:46,280 IT CONFLATES STATISTICAL METHODS 2924 01:52:46,280 --> 01:52:47,520 WITH INTERPRETATION BEING CAUSAL 2925 01:52:47,520 --> 01:52:49,760 WHICH YOU DON'T GET TO SAY IS A 2926 01:52:49,760 --> 01:52:51,880 CAUSAL EFFECT JUST BECAUSE YOU 2927 01:52:51,880 --> 01:52:54,160 USED A CERTAINLY STATISTICAL 2928 01:52:54,160 --> 01:52:54,360 METHOD. 2929 01:52:54,360 --> 01:52:56,960 AND SO SIMILARLY IN OUR 2930 01:52:56,960 --> 01:52:59,520 SITUATION WE USED THIS METHOD 2931 01:52:59,520 --> 01:53:02,360 BECAUSE IT CREATES A SORT OF 2932 01:53:02,360 --> 01:53:04,080 VERY SUITABLE COMPARISON GROUP 2933 01:53:04,080 --> 01:53:06,720 FOR EACH EXPOSURE GROUP, AND 2934 01:53:06,720 --> 01:53:07,960 MAKES SURE, FOR EXAMPLE, WHEN 2935 01:53:07,960 --> 01:53:08,600 COMPARING MOTHERS AND BIRTH 2936 01:53:08,600 --> 01:53:10,120 PARENTS WHO HAVE A COVID 2937 01:53:10,120 --> 01:53:12,520 INFECTION THAT WE'RE COMPARING 2938 01:53:12,520 --> 01:53:14,960 THEM TO OTHER MOTHERS AND BIRTH 2939 01:53:14,960 --> 01:53:16,480 PARENTS WHO HAVE SIMILAR 2940 01:53:16,480 --> 01:53:19,160 COVARIATES AMONG THOSE WE 2941 01:53:19,160 --> 01:53:20,720 MEASURED, AND THAT WE'RE NOT 2942 01:53:20,720 --> 01:53:21,520 EXTRAPOLATING INTO DIFFERENT 2943 01:53:21,520 --> 01:53:22,880 TINES OF MOTHERS THAT MIGHT NOT 2944 01:53:22,880 --> 01:53:26,560 HAVE HAD AS MUCH INFECTION 2945 01:53:26,560 --> 01:53:28,760 DURING THE EARLY PANDEMIC PERIOD 2946 01:53:28,760 --> 01:53:31,560 BUT OF COURSE WITH ANY ANALYSIS 2947 01:53:31,560 --> 01:53:33,400 WHETHER YOU USE G COMPUTATION 2948 01:53:33,400 --> 01:53:37,160 AND REGRESSION, WHATEVER YOU 2949 01:53:37,160 --> 01:53:39,560 USE, WE WORRY ABOUT POSSIBLE 2950 01:53:39,560 --> 01:53:41,640 BIAS THAT WOULD MEAN WHAT WE 2951 01:53:41,640 --> 01:53:44,600 FIND IS DIFFERENT FROM TRUE 2952 01:53:44,600 --> 01:53:46,800 CAUSAL EFFECT. 2953 01:53:46,800 --> 01:53:48,680 THINGS OF CONCERN MIGHT BE 2954 01:53:48,680 --> 01:53:49,440 CONFOUNDERS WE'RE ABLE TO 2955 01:53:49,440 --> 01:53:52,160 CONTROL ARE LIMITED BY DATA 2956 01:53:52,160 --> 01:53:54,920 SOURCES, WE INCLUDED EVERYTHING 2957 01:53:54,920 --> 01:53:56,640 THAT WE CAN REASONABLY MEASURE 2958 01:53:56,640 --> 01:53:58,120 AND CAPTURE FROM ADMINISTRATIVE 2959 01:53:58,120 --> 01:53:59,400 DATA SOURCES, WE TRIED TO 2960 01:53:59,400 --> 01:54:01,720 ENHANCE THAT BY BRINGING IN A 2961 01:54:01,720 --> 01:54:05,960 LARGE SET OF I THINK 10 2962 01:54:05,960 --> 01:54:06,400 DIFFERENT COMMUNITY 2963 01:54:06,400 --> 01:54:07,440 CHARACTERISTICS, BUT OF COURSE 2964 01:54:07,440 --> 01:54:11,040 THERE COULD BE OTHER DIFFERENCES 2965 01:54:11,040 --> 01:54:12,960 BETWEEN THE MOTHERS FOR EXAMPLE 2966 01:54:12,960 --> 01:54:16,120 WITH INFECTION AND THOSE WITHOUT 2967 01:54:16,120 --> 01:54:17,960 INFECTION BUT DELIVERING IN 2020 2968 01:54:17,960 --> 01:54:23,000 THAT WE'RE NOT ABLE TO CAPTURE. 2969 01:54:23,000 --> 01:54:26,400 USING THESE IS USEFUL, PROVIDES 2970 01:54:26,400 --> 01:54:28,720 NICE INTERPRETABLE RESULTS. 2971 01:54:28,720 --> 01:54:29,720 POPULATION BURDEN TYPE 2972 01:54:29,720 --> 01:54:29,960 ESTIMATES. 2973 01:54:29,960 --> 01:54:31,680 SO, YEAH, I DON'T KNOW IF THAT 2974 01:54:31,680 --> 01:54:34,240 ADDRESSED ALL THE PIECES OF THE 2975 01:54:34,240 --> 01:54:34,520 QUESTION. 2976 01:54:34,520 --> 01:54:37,120 >>THANK YOU SO MUCH, DR. AHERN. 2977 01:54:37,120 --> 01:54:40,040 I WANT TO THANK AGAIN ALL OUR 2978 01:54:40,040 --> 01:54:40,360 PRESENTERS. 2979 01:54:40,360 --> 01:54:43,360 WE'RE AT THE END OF THE Q&A 2980 01:54:43,360 --> 01:54:46,080 DISCUSSION. 2981 01:54:46,080 --> 01:54:49,680 AND WE WILL HAVE 15 MINUTES 2982 01:54:49,680 --> 01:54:51,240 BREAK, WE'LL RECONVENE AT 2:25. 2983 01:54:51,240 --> 01:54:53,520 THANK YOU ALL FOR ATTENDING. 2984 01:54:53,520 --> 01:54:57,280 WE WILL SEE YOU AT THE NEXT 2985 01:54:57,280 --> 01:54:59,880 SESSION. 2986 01:54:59,880 --> 01:55:01,560 >>WELCOME BACK. 2987 01:55:01,560 --> 01:55:03,080 I'M A PROGRAM DIRECTOR IN THE 2988 01:55:03,080 --> 01:55:05,520 OFFICE OF RESEARCH ON WOMEN'S 2989 01:55:05,520 --> 01:55:06,200 HEALTH. 2990 01:55:06,200 --> 01:55:10,480 IT IS MY PLEASURE TO MODERATE 2991 01:55:10,480 --> 01:55:11,320 THIS NEXT SESSION CONSIDERING 2992 01:55:11,320 --> 01:55:13,200 MENTAL HEALTH AND BEHAVIORAL 2993 01:55:13,200 --> 01:55:14,520 HEALTH IN ADDRESSING 2994 01:55:14,520 --> 01:55:15,320 DISPARITIES. 2995 01:55:15,320 --> 01:55:21,400 OUR FIRST PANELIST IS ASSISTANT 2996 01:55:21,400 --> 01:55:22,800 PROFESSOR OF PEDIATRICS AND 2997 01:55:22,800 --> 01:55:23,800 PSYCHIATRY AND ATTENDING 2998 01:55:23,800 --> 01:55:27,160 PHYSICIAN IN THE WELL BABY 2999 01:55:27,160 --> 01:55:29,720 NURSERY, PRESENTATION IS 3000 01:55:29,720 --> 01:55:36,080 STRUCTURAL AND SOCIAL 3001 01:55:36,080 --> 01:55:36,640 DETERMINANTS. 3002 01:55:36,640 --> 01:55:39,120 AFTER THAT ASSOCIATE PROFESSOR 3003 01:55:39,120 --> 01:55:40,240 OF EPIDEMIOLOGY AT TULANE 3004 01:55:40,240 --> 01:55:43,520 UNIVERSITY SCHOOL OF PUBLIC 3005 01:55:43,520 --> 01:55:45,840 HEALTH IN TROPICAL MEDICINE, 3006 01:55:45,840 --> 01:55:48,320 GESTATIONAL WEIGHT GAIN IN 3007 01:55:48,320 --> 01:55:49,440 LOUISIANA DURING THE COVID 3008 01:55:49,440 --> 01:55:54,280 PANDEMIC AND LAST WILL BE DR. 3009 01:55:54,280 --> 01:55:58,400 PATRICIA KISNEH, DEAN OF 3010 01:55:58,400 --> 01:55:58,840 RESEARCH AT VIRGINIA 3011 01:55:58,840 --> 01:56:00,720 COMMONWEALTH UNIVERSITY SCHOOL 3012 01:56:00,720 --> 01:56:03,640 OF NURSING, IMPACT OF RISK AND 3013 01:56:03,640 --> 01:56:05,120 RESILIENCE FACTORS INCLUDING 3014 01:56:05,120 --> 01:56:06,200 STRUCTURAL RACISM AND 3015 01:56:06,200 --> 01:56:07,960 DISCRIMINATION ON MATERNAL 3016 01:56:07,960 --> 01:56:12,920 HEALTH OUTCOMES DURING THE 3017 01:56:12,920 --> 01:56:13,720 COVID-19 PANDEMIC. 3018 01:56:13,720 --> 01:56:16,160 THANK YOU FOR JOINING US TODAY. 3019 01:56:16,160 --> 01:56:18,160 >>THANK YOU FOR HAVING ME. 3020 01:56:18,160 --> 01:56:21,320 IT'S A REAL HONOR TO BE PART OF 3021 01:56:21,320 --> 01:56:22,080 THE GROUP. 3022 01:56:22,080 --> 01:56:23,360 TODAY I'M GOING TO SHARE WITH 3023 01:56:23,360 --> 01:56:25,920 YOU A LITTLE BIT ABOUT OUR 3024 01:56:25,920 --> 01:56:27,160 ONGOING WORK SO UNLIKE MOST OF 3025 01:56:27,160 --> 01:56:28,760 THE PRESENTERS I WON'T REALLY 3026 01:56:28,760 --> 01:56:31,920 HAVE RESULTS BUT RATHER TELL YOU 3027 01:56:31,920 --> 01:56:37,960 ABOUT WHAT WE'RE DOING IN THE 3028 01:56:37,960 --> 01:56:39,800 COMBO INITIATIVE STUDY. 3029 01:56:39,800 --> 01:56:42,240 THIS IS A VERY LARGE STUDY THAT 3030 01:56:42,240 --> 01:56:44,160 WE WERE ABLE TO RAPIDLY MOBILIZE 3031 01:56:44,160 --> 01:56:47,240 AT THE HEIGHT OF THE PANDEMIC, 3032 01:56:47,240 --> 01:56:49,240 IN NEW YORK CITY, SPRING OF 3033 01:56:49,240 --> 01:56:49,440 2020. 3034 01:56:49,440 --> 01:56:52,080 AS YOU KNOW THAT WAS ONE OF THE 3035 01:56:52,080 --> 01:56:53,720 EARLIEST EPICENTERS. 3036 01:56:53,720 --> 01:56:55,560 WE PUT THE STUDY TOGETHER 3037 01:56:55,560 --> 01:57:00,080 INITIALLY WITH THE BACKBONE OF 3038 01:57:00,080 --> 01:57:02,560 SURVEYS, KEPT ADDING SURVEYS AS 3039 01:57:02,560 --> 01:57:04,120 FUNDING WAS AVAILABLE, INFANTS 3040 01:57:04,120 --> 01:57:04,360 MATURED. 3041 01:57:04,360 --> 01:57:07,600 WE'RE ABOUT TO ROLL OUT OUR 3042 01:57:07,600 --> 01:57:09,240 THREE-YEAR SURVEY NOW. 3043 01:57:09,240 --> 01:57:10,480 BUT AS FUNDING BECAME AVAILABLE 3044 01:57:10,480 --> 01:57:15,840 WE WERE ABLE TO ADD ADDITIONAL 3045 01:57:15,840 --> 01:57:18,640 COMPONENTS SUCH AS BIOSPECIMENS, 3046 01:57:18,640 --> 01:57:20,520 VIDEO VISITS, BRAIN MRIs, AND 3047 01:57:20,520 --> 01:57:22,600 OLFACTION TESTING. 3048 01:57:22,600 --> 01:57:24,560 I REALLY WANT TO EMPHASIZE THAT 3049 01:57:24,560 --> 01:57:28,400 THIS IS THE WORK OF A VERY LARGE 3050 01:57:28,400 --> 01:57:30,720 GROUP OF INDIVIDUALS, WE RUN THE 3051 01:57:30,720 --> 01:57:32,480 STUDY AS A CONSORTIUM AND HAVE 3052 01:57:32,480 --> 01:57:34,320 BEEN ABLE TO RAISE SIGNIFICANT 3053 01:57:34,320 --> 01:57:37,760 FUNDS OVER THE PAST FEW YEARS, 3054 01:57:37,760 --> 01:57:39,800 AMONG THE 150 OR SO INDIVIDUALS 3055 01:57:39,800 --> 01:57:40,960 THAT HAVE CONTRIBUTED TO THIS 3056 01:57:40,960 --> 01:57:47,680 WORK AND WE HAVE BEEN ABLE TO 3057 01:57:47,680 --> 01:57:53,480 ENROLL OVER 1300 DYADS EXPANDING 3058 01:57:53,480 --> 01:57:56,560 THROUGH A CDC COLLABORATION. 3059 01:57:56,560 --> 01:57:59,640 THIS STUDY WORKS AS BOTH 3060 01:57:59,640 --> 01:58:00,720 LONGITUDINAL AND CROSS-SECTIONAL 3061 01:58:00,720 --> 01:58:04,240 STUDY, WE HAVE ABOUT FOUR TO 3062 01:58:04,240 --> 01:58:05,960 FIVE HUNDRED ACTIVE PARTICIPANTS 3063 01:58:05,960 --> 01:58:07,520 WHO CONTINUE TO CONTRIBUTE 3064 01:58:07,520 --> 01:58:09,240 LONGITUDINALLY BUT WE ALSO HAVE 3065 01:58:09,240 --> 01:58:10,680 ALLOWED ENTRY INTO THE STUDY AT 3066 01:58:10,680 --> 01:58:12,960 ANY POINT TO BE ABLE TO CAPTURE 3067 01:58:12,960 --> 01:58:16,200 AS MUCH OF THE RICHNESS OF WHAT 3068 01:58:16,200 --> 01:58:20,800 HAS HAPPENED OVER THE LAST FEW 3069 01:58:20,800 --> 01:58:21,920 YEARS, DURING THE PANDEMIC, SO 3070 01:58:21,920 --> 01:58:26,240 YOU SEE SOME OF THE SAMPLE SIZES 3071 01:58:26,240 --> 01:58:34,000 FOR A VARIETY OF SURVEYS, EACH 3072 01:58:34,000 --> 01:58:44,520 IS APPROXIMATELY 45 MINUTES TO 3073 01:58:47,880 --> 01:58:50,080 AN HOUR. 3074 01:58:50,080 --> 01:59:00,280 I WANT TO FOCUS ON LIVED 3075 01:59:00,280 --> 01:59:01,000 EXPERIENCES INTERVIEWS. 3076 01:59:01,000 --> 01:59:05,960 WE HAVE A LARGES NUMBER OF 3077 01:59:05,960 --> 01:59:06,440 OUTCOMES CONTRIBUTING 3078 01:59:06,440 --> 01:59:09,680 INVESTIGATOR FOCUSES ON THE 3079 01:59:09,680 --> 01:59:13,840 PARTICULAR TOPIC, MINE IS 3080 01:59:13,840 --> 01:59:18,760 MOTHER-BABY HEALTH BUT WE COVER 3081 01:59:18,760 --> 01:59:20,000 THE MATERNAL-CHILD SPACE BROADLY 3082 01:59:20,000 --> 01:59:30,440 AS WELL AS FOCUS ON SOCIAL 3083 01:59:39,080 --> 01:59:41,320 DETERMINANTS OF HEALTH. 3084 01:59:41,320 --> 01:59:44,000 THIS SHOWS AN ASSOCIATION WITH 3085 01:59:44,000 --> 01:59:45,680 LOWER NEURODEVELOPMENTAL SCORES 3086 01:59:45,680 --> 01:59:53,120 FOR INFANTS BORN IN THE PANDEMIC 3087 01:59:53,120 --> 01:59:56,600 BUT NOT DUE TO COVID. 3088 01:59:56,600 --> 01:59:58,960 ONE OF THE OTHER THINGS TO 3089 01:59:58,960 --> 02:00:01,240 HIGHLIGHT FOR THIS TOPIC HERE IS 3090 02:00:01,240 --> 02:00:03,040 THE UNIQUE MATCHING STRATEGY 3091 02:00:03,040 --> 02:00:07,680 THAT WE CHOSE IN THE BEGINNING 3092 02:00:07,680 --> 02:00:09,960 WHICH REALLY ENDED UP 3093 02:00:09,960 --> 02:00:12,080 HIGHLIGHTING HEALTH DISPARITIES. 3094 02:00:12,080 --> 02:00:13,600 I'M A PEDIATRICIAN, I'M BABY 3095 02:00:13,600 --> 02:00:15,800 FOCUSED, SO WHEN WE STARTED THIS 3096 02:00:15,800 --> 02:00:23,880 STUDY WE BEGAN CASE MATCHING 3097 02:00:23,880 --> 02:00:26,920 BASED ON INFANT CHARACTERISTICS, 3098 02:00:26,920 --> 02:00:28,920 YOU CAN SEE ^5 00 PARTICIPANTS 3099 02:00:28,920 --> 02:00:31,120 THERE'S NICE MATCHING IN TERMS 3100 02:00:31,120 --> 02:00:32,400 OF CHARACTERISTICS BUT WE BEGAN 3101 02:00:32,400 --> 02:00:40,080 TO SEE EARLY IN THE PANDEMIC WAS 3102 02:00:40,080 --> 02:00:42,080 A DISPARITY IN REAL TIME, SOME 3103 02:00:42,080 --> 02:00:45,000 DATA COME FROM THE SUMMER OF 3104 02:00:45,000 --> 02:00:46,760 2020 WHEN THIS WAS NOVEL, AND 3105 02:00:46,760 --> 02:00:51,120 YOU CAN SEE HERE HOW OUR COVID 3106 02:00:51,120 --> 02:00:51,800 POSITIVE GROUP IS 3107 02:00:51,800 --> 02:00:55,280 OVERREPRESENTED IN TERMS OF 3108 02:00:55,280 --> 02:00:58,560 HISPANICS, SPANISH SPEAKING AND 3109 02:00:58,560 --> 02:01:02,800 LOW SOCIODEMOGRAPHIC GROUPS WHO 3110 02:01:02,800 --> 02:01:03,720 RECEIVED MEDICAID. 3111 02:01:03,720 --> 02:01:06,480 TODAY I'M HERE BECAUSE WE WERE 3112 02:01:06,480 --> 02:01:10,160 FORTUNATE TO RECEIVE FUNDING TO 3113 02:01:10,160 --> 02:01:11,400 STUDY STRUCTURAL AND SOCIAL 3114 02:01:11,400 --> 02:01:13,040 DETERMINANTS OF MATERNAL MENTAL 3115 02:01:13,040 --> 02:01:17,840 HEALTH IN OUR COMBO INITIATIVE 3116 02:01:17,840 --> 02:01:20,560 THROUGH 2021 NOSI AWARD, A 3117 02:01:20,560 --> 02:01:27,240 SUPPLEMENT TO AN ONGOING R01, 3118 02:01:27,240 --> 02:01:27,960 MOTHER-BABY BRAIN AND BEHAVIOR, 3119 02:01:27,960 --> 02:01:30,960 AIMS ARE TO LOOK AT EFFECTS OF 3120 02:01:30,960 --> 02:01:35,800 STRUCTURAL RACISM AND 3121 02:01:35,800 --> 02:01:38,640 DISCRIMINATION ON MATERNAL BRAIN 3122 02:01:38,640 --> 02:01:40,640 AND BEHAVIOR, TO LOOK AT 3123 02:01:40,640 --> 02:01:42,480 TEMPORAL TRENDS IN MATERNAL 3124 02:01:42,480 --> 02:01:44,240 MENTAL HEALTH, USING ELECTRONIC 3125 02:01:44,240 --> 02:01:48,480 HEALTH RECORDS, AND TO LOOK AT 3126 02:01:48,480 --> 02:01:49,120 LIVED EXPERIENCES THROUGH 60 3127 02:01:49,120 --> 02:01:51,800 IN-DEPTH INTERVIEWS, THAT'S WHAT 3128 02:01:51,800 --> 02:01:55,640 I WILL FOCUS ON TODAY. 3129 02:01:55,640 --> 02:01:59,560 WE WERE ACTUALLY ABLE TO 3130 02:01:59,560 --> 02:02:01,640 OVERSHOOT AND HAVE CAPTURED 63 3131 02:02:01,640 --> 02:02:03,360 INTERVIEWS WITH WOMEN, TRYING TO 3132 02:02:03,360 --> 02:02:05,480 CAPTURE AS WIDE OF A RANGE 3133 02:02:05,480 --> 02:02:07,360 WITHIN COMBO AS POSSIBLE, SO YOU 3134 02:02:07,360 --> 02:02:09,320 CAN SEE NICE REPRESENTATION IN 3135 02:02:09,320 --> 02:02:16,640 TERMS OF COVID STATUS, AGE, 3136 02:02:16,640 --> 02:02:21,120 INFANT SEX, AGE AND ETHNICITY 3137 02:02:21,120 --> 02:02:22,440 AND OTHER SOCIODEMOGRAPHIC 3138 02:02:22,440 --> 02:02:22,880 FACTORS. 3139 02:02:22,880 --> 02:02:25,280 THE TOPICS WE COVER IN 3140 02:02:25,280 --> 02:02:26,480 APPROXIMATELY 60 MINUTES AND 3141 02:02:26,480 --> 02:02:31,160 THESE ARE ZOOM INTERVIEWS THAT 3142 02:02:31,160 --> 02:02:34,040 WE ARE CONDUCTING, GROSSLY SPAN 3143 02:02:34,040 --> 02:02:35,560 FOUR DOMAINS, PERINATAL 3144 02:02:35,560 --> 02:02:36,680 EXPERIENCES, PANDEMIC RELATED 3145 02:02:36,680 --> 02:02:38,600 EXPERIENCES, EXPERIENCES OF 3146 02:02:38,600 --> 02:02:41,040 RACISM AND DISCRIMINATION, AND 3147 02:02:41,040 --> 02:02:44,120 PROTECTIVE FACTORS AND STRESS 3148 02:02:44,120 --> 02:02:45,560 BUFFERS AND SOLUTIONS. 3149 02:02:45,560 --> 02:02:46,760 THIS IS ONGOING BUT TODAY I WANT 3150 02:02:46,760 --> 02:02:49,240 TO GIVE YOU A FLAVOR OF WHAT 3151 02:02:49,240 --> 02:02:53,480 WE'RE HEARING FROM OUR NEW YORK 3152 02:02:53,480 --> 02:02:54,400 CITY MOTHERS. 3153 02:02:54,400 --> 02:02:58,120 FOR EXAMPLE NEGATIVE 3154 02:02:58,120 --> 02:03:01,120 INTERACTIONS WITH THE MEDICAL 3155 02:03:01,120 --> 02:03:01,360 COMMUNITY. 3156 02:03:01,360 --> 02:03:03,400 I WENT FOR EARLY SCAN, BOUTIQUE 3157 02:03:03,400 --> 02:03:04,840 PRIVATE PRACTICE IN MANHATTAN. 3158 02:03:04,840 --> 02:03:07,360 I WENT IN AND DID THE SCAN AND 3159 02:03:07,360 --> 02:03:11,800 IT WAS FINE BUT THEN WE SAT DOWN 3160 02:03:11,800 --> 02:03:13,000 AND I HAD QUESTIONS PREPARED. 3161 02:03:13,000 --> 02:03:15,120 I ASKED ABOUT AN UNMEDICATED 3162 02:03:15,120 --> 02:03:17,960 BIRTH, HOW DOES HE FELL ABOUT 3163 02:03:17,960 --> 02:03:18,480 THEM? 3164 02:03:18,480 --> 02:03:19,480 DOES HE SUPPORT THEM? 3165 02:03:19,480 --> 02:03:21,360 JUST TO SEE IF THIS MIGHT BE A 3166 02:03:21,360 --> 02:03:24,840 GOOD FIT. 3167 02:03:24,840 --> 02:03:29,320 HE LAUGHED AN AUDIBLE LAUGH. 3168 02:03:29,320 --> 02:03:31,240 I DID NOT KNOW HOW TO PROCESS. 3169 02:03:31,240 --> 02:03:33,480 IT TOOK ME A MOMENT TO SEE HE 3170 02:03:33,480 --> 02:03:34,040 WAS SERIOUS. 3171 02:03:34,040 --> 02:03:34,920 HE WAS. 3172 02:03:34,920 --> 02:03:36,680 THEN I ASKED A FEW OTHER 3173 02:03:36,680 --> 02:03:37,200 QUESTIONS. 3174 02:03:37,200 --> 02:03:38,160 HE CONTINUED TO BE VERY 3175 02:03:38,160 --> 02:03:41,920 DISMISSIVE OF THE IDEA THAT I 3176 02:03:41,920 --> 02:03:44,680 WOULD ESSENTIALLY HAVE ANY IDEA 3177 02:03:44,680 --> 02:03:45,880 OR CONTROL OR AUTONOMY OR VOICE 3178 02:03:45,880 --> 02:03:48,160 IN THE PROCESS OF HOW I GAVE 3179 02:03:48,160 --> 02:03:49,120 BIRTH. 3180 02:03:49,120 --> 02:03:50,680 THAT WAS PROBABLY MY FIRST TIME 3181 02:03:50,680 --> 02:03:54,040 FEELING REALLY MARGINALIZED BY 3182 02:03:54,040 --> 02:03:55,600 THE MEDICAL COMMUNITY. 3183 02:03:55,600 --> 02:03:57,920 WE ALSO HEAR A LOT ABOUT 3184 02:03:57,920 --> 02:03:59,120 CONCERNS ABOUT THE VIRUS. 3185 02:03:59,120 --> 02:04:00,280 HERE IS AN EXAMPLE. 3186 02:04:00,280 --> 02:04:02,600 I WAS CONCERNED I WAS GOING TO 3187 02:04:02,600 --> 02:04:04,080 CATCH THE VIRUS AND IT WAS GOING 3188 02:04:04,080 --> 02:04:06,080 TO AFFECT THE BABY. 3189 02:04:06,080 --> 02:04:07,400 I WAS CONCERNED ABOUT -- SO I 3190 02:04:07,400 --> 02:04:09,520 THAT THIS OTHER THING I WAS 3191 02:04:09,520 --> 02:04:10,480 MONITORING FOR AND THAT 3192 02:04:10,480 --> 02:04:12,920 SOMETHING WOULD GO WRONG WITH 3193 02:04:12,920 --> 02:04:14,840 HER, THE BILIRUBIN THAT THEY 3194 02:04:14,840 --> 02:04:16,480 WERE MONITORING FOR IN UTERO AND 3195 02:04:16,480 --> 02:04:17,920 WE WOULDN'T CATCH IT IN TIME. 3196 02:04:17,920 --> 02:04:19,440 I WAS CONCERNED SOMEBODY ELSE IN 3197 02:04:19,440 --> 02:04:21,080 MY FAMILY WOULD CATCH IT AND I 3198 02:04:21,080 --> 02:04:22,760 DIDN'T KNOW HOW WE WOULD HANDLE 3199 02:04:22,760 --> 02:04:24,160 ALL OF THAT. 3200 02:04:24,160 --> 02:04:25,920 IF MY HUSBAND GOT SICK, I 3201 02:04:25,920 --> 02:04:27,880 REMEMBER EVEN TALKING TO HIM, I 3202 02:04:27,880 --> 02:04:32,440 GUESS I WOULD CALL AN AMBULANC, 3203 02:04:32,440 --> 02:04:34,120 NOT GOING TO DRIVE YOU TO THE 3204 02:04:34,120 --> 02:04:34,760 HOSPITAL. 3205 02:04:34,760 --> 02:04:35,880 THE REALITY OF THINKING THROUGH 3206 02:04:35,880 --> 02:04:37,920 THAT, THAT I WOULD HAVE TO STAY 3207 02:04:37,920 --> 02:04:39,440 WITH THE KIDS, THAT WAS 3208 02:04:39,440 --> 02:04:39,800 STRESSFUL. 3209 02:04:39,800 --> 02:04:43,960 YEAH, A LOT OF WORRIES. 3210 02:04:43,960 --> 02:04:47,480 WE'RE ALSO HEARING OF INCREASED 3211 02:04:47,480 --> 02:04:48,920 EXPERIENCES WITH DISCRIMINATION. 3212 02:04:48,920 --> 02:04:50,040 I REMEMBER ACTIVELY AVOIDING 3213 02:04:50,040 --> 02:04:51,640 GOING INTO THE CITY WHEN THERE 3214 02:04:51,640 --> 02:04:56,800 WAS A SPIKE IN ASIAN HATE 3215 02:04:56,800 --> 02:04:58,320 CRIMES, ON ELDERLY ESPECIALLY. 3216 02:04:58,320 --> 02:05:02,920 I WAS CONSCIOUS OF NOT HAVING MY 3217 02:05:02,920 --> 02:05:05,000 FAMILY AROUND DURING THAT TIME. 3218 02:05:05,000 --> 02:05:07,800 WE ARE HEARING ABOUT INCREASED 3219 02:05:07,800 --> 02:05:08,280 NEIGHBORHOOD VIOLENCE. 3220 02:05:08,280 --> 02:05:10,680 WE MOVED OUT OF THE CITY LAST 3221 02:05:10,680 --> 02:05:14,880 YEAR TO JERSEY, WHICH I DON'T 3222 02:05:14,880 --> 02:05:15,640 KNOW MY NEIGHBORHOOD CHANGED 3223 02:05:15,640 --> 02:05:16,400 AFTER THE PANDEMIC. 3224 02:05:16,400 --> 02:05:18,360 WE LOVED OUR NEIGHBORHOOD AND 3225 02:05:18,360 --> 02:05:19,480 THE PANDEMIC HAPPENED. 3226 02:05:19,480 --> 02:05:21,320 I STILL LOVE THE NEIGHBORHOOD 3227 02:05:21,320 --> 02:05:23,520 AND ONCE THINGS STARTED EASING, 3228 02:05:23,520 --> 02:05:24,360 THE NEIGHBORHOOD ITSELF CHANGED 3229 02:05:24,360 --> 02:05:27,120 AND IT DIDN'T FEEL LIKE THE SAME 3230 02:05:27,120 --> 02:05:27,560 PLACE. 3231 02:05:27,560 --> 02:05:30,960 YOU COULD SEE, I MEAN I LIVED IN 3232 02:05:30,960 --> 02:05:32,480 HARLEM, IT WAS ROUGH AROUND THE 3233 02:05:32,480 --> 02:05:35,560 EDGES BUT I NEVER FELT UNSAFE. 3234 02:05:35,560 --> 02:05:38,280 THERE WAS A WAY MORE DRUG USE 3235 02:05:38,280 --> 02:05:39,760 THAT WAS SORT OF OBVIOUS. 3236 02:05:39,760 --> 02:05:44,720 THERE WAS AN INCREASE IN GUN 3237 02:05:44,720 --> 02:05:45,640 VIOLENCE. 3238 02:05:45,640 --> 02:05:47,600 I KNOW IT HAPPENS AND THERE'S 3239 02:05:47,600 --> 02:05:49,000 SOME BLOCKS HOTTER THAN OTHERS 3240 02:05:49,000 --> 02:05:50,320 BUT I NEVER EXPERIENCED HEARING 3241 02:05:50,320 --> 02:05:52,840 GUNSHOTS LIKE THAT. 3242 02:05:52,840 --> 02:05:53,600 THE WHOLE COMMUNITY. 3243 02:05:53,600 --> 02:05:55,800 I DIDN'T WANT TO BRING MY KID ON 3244 02:05:55,800 --> 02:05:56,560 THE SUBWAY. 3245 02:05:56,560 --> 02:06:00,040 I DON'T WANT TO BE STUCK TO MY 3246 02:06:00,040 --> 02:06:00,400 NEIGHBORHOOD. 3247 02:06:00,400 --> 02:06:01,920 IF I DON'T REALLY FEEL 3248 02:06:01,920 --> 02:06:03,200 COMFORTABLE GETTING ON THE 3249 02:06:03,200 --> 02:06:04,560 SUBWAY WITH PEOPLE THAT ARE 3250 02:06:04,560 --> 02:06:07,200 SUPPOSED TO BE MASKING BUT 3251 02:06:07,200 --> 02:06:08,720 AREN'T MASKING. 3252 02:06:08,720 --> 02:06:11,800 WE'RE HEARING ABOUT INCREASED 3253 02:06:11,800 --> 02:06:12,880 HOUSEHOLD VIOLENCE, PROBABLY THE 3254 02:06:12,880 --> 02:06:14,960 SADDEST QUOTE AND ALSO ONE OF MY 3255 02:06:14,960 --> 02:06:16,160 FAVORITES. 3256 02:06:16,160 --> 02:06:18,880 I MADE A PHOTO JOURNAL AS THE AM 3257 02:06:18,880 --> 02:06:20,240 OF IMAGERY OF COVID BECAME MORE 3258 02:06:20,240 --> 02:06:22,080 PRESENT IN MY LIFE. 3259 02:06:22,080 --> 02:06:23,080 I TOOK PHOTOS. 3260 02:06:23,080 --> 02:06:24,800 THE FIRST TIME I WALKED DOWN THE 3261 02:06:24,800 --> 02:06:26,320 STREET I SAW SOMEONE WEARING A 3262 02:06:26,320 --> 02:06:28,200 MASK, I TOOK A PICTURE BECAUSE I 3263 02:06:28,200 --> 02:06:29,840 HAD NEVER SEEN THAT BEFORE. 3264 02:06:29,840 --> 02:06:32,240 THE WEIRD THING IS THAT BECAUSE 3265 02:06:32,240 --> 02:06:34,440 BEING ISOLATED WITH MY ABUSER, 3266 02:06:34,440 --> 02:06:37,600 BECAUSE OF THE PANDEMIC, MADE 3267 02:06:37,600 --> 02:06:39,200 THE ABUSE SO BAD, I HAVE THIS 3268 02:06:39,200 --> 02:06:42,200 DARK JOKE THAT I SAY THAT MY 3269 02:06:42,200 --> 02:06:43,840 ABUSE REALLY RUINED MY PANDEMIC 3270 02:06:43,840 --> 02:06:45,040 FOR ME. 3271 02:06:45,040 --> 02:06:47,680 BECAUSE I COULD BARELY EVEN FEEL 3272 02:06:47,680 --> 02:06:49,560 THE PANDEMIC BECAUSE MY 3273 02:06:49,560 --> 02:06:50,680 EXISTENTIAL CRISIS WAS LIKE AM I 3274 02:06:50,680 --> 02:06:53,720 GOING TO LIVE TO SEE TOMORROW? 3275 02:06:53,720 --> 02:06:55,360 I FELT THE PANDEMIC BECAUSE I 3276 02:06:55,360 --> 02:06:57,560 WAS CAGED WITH MY ABUSER BECAUSE 3277 02:06:57,560 --> 02:06:59,200 OF THE PANDEMIC, AND I HAD TO 3278 02:06:59,200 --> 02:07:01,280 LEAVE THE HOUSE, AND I FELT THE 3279 02:07:01,280 --> 02:07:02,480 OPPRESSION OF THE VIRUS AROUND 3280 02:07:02,480 --> 02:07:04,440 ME WHEN I LEFT THE HOUSE. 3281 02:07:04,440 --> 02:07:06,080 I WAS MORE AFRAID OF WHAT MY 3282 02:07:06,080 --> 02:07:07,960 HUSBAND WAS GOING TO DO TO ME 3283 02:07:07,960 --> 02:07:09,640 THAN WHAT THE VIRUS WAS GOING TO 3284 02:07:09,640 --> 02:07:12,320 DO TO ME, ON THE 3285 02:07:12,320 --> 02:07:13,760 MOMENT-TO-MOMENT BASIS EVEN 3286 02:07:13,760 --> 02:07:14,960 THOUGH I WAS ALSO TERRIFIED OF 3287 02:07:14,960 --> 02:07:15,480 THE VIRUS. 3288 02:07:15,480 --> 02:07:17,360 THE VIRUS DIDN'T LIVE IN MY 3289 02:07:17,360 --> 02:07:19,560 HOUSE, AND HAVE A MOUSTACHE, AND 3290 02:07:19,560 --> 02:07:22,720 SIX FEET TALL NEXT TO ME, YOU 3291 02:07:22,720 --> 02:07:22,920 KNOW? 3292 02:07:22,920 --> 02:07:24,800 AND FINALLY I WILL END WITH ONE 3293 02:07:24,800 --> 02:07:26,520 OF THE POSITIVE EXPERIENCES THAT 3294 02:07:26,520 --> 02:07:28,720 WE'VE SEEN. 3295 02:07:28,720 --> 02:07:31,120 THIS IS RELATED TO COMING TO A 3296 02:07:31,120 --> 02:07:32,120 NEW CULTURE. 3297 02:07:32,120 --> 02:07:34,400 I'M NOT SURE WHETHER I'M 3298 02:07:34,400 --> 02:07:37,280 PROBABLY NOT THAT BIG A 3299 02:07:37,280 --> 02:07:39,120 DIFFERENCE, BECAUSE ACTUALLY -- 3300 02:07:39,120 --> 02:07:40,240 OOPS, IN TRADITIONAL CHINA WE 3301 02:07:40,240 --> 02:07:42,320 HAVE A LOT OF RULES FOR THE 3302 02:07:42,320 --> 02:07:43,800 PREGNANCY AND THE BABY 3303 02:07:43,800 --> 02:07:47,200 DELIVERIES, THAT'S A LOT OF 3304 02:07:47,200 --> 02:07:48,880 RULES BUT LUCKY I'M HERE, I 3305 02:07:48,880 --> 02:07:50,200 DON'T LIKE THOSE RULES. 3306 02:07:50,200 --> 02:07:52,800 I THINK THAT WAS PROBABLY NOT 3307 02:07:52,800 --> 02:07:54,120 THAT SCIENTIFIC BECAUSE TOO MUCH 3308 02:07:54,120 --> 02:07:55,760 BECAUSE IN CHINA YOU JUST SAY, 3309 02:07:55,760 --> 02:07:57,000 OH, IF YOU'RE PREGNANT YOU 3310 02:07:57,000 --> 02:07:59,280 CANNOT DO A LOT OF THINGS. 3311 02:07:59,280 --> 02:08:00,040 YOU CANNOT DO SPORTS. 3312 02:08:00,040 --> 02:08:03,240 YOU NEED TO WORK SLOWLY, 3313 02:08:03,240 --> 02:08:04,720 CAREFULLY, AND I REALLY DON'T 3314 02:08:04,720 --> 02:08:06,160 LIKE THOSE RULES. 3315 02:08:06,160 --> 02:08:07,280 ACTUALLY DURING THE SECOND 3316 02:08:07,280 --> 02:08:08,960 PERIOD OF THE PREGNANCY I STILL 3317 02:08:08,960 --> 02:08:10,240 GO SWIMMING AND EVERYTHING. 3318 02:08:10,240 --> 02:08:13,280 I THINK THE CHINESE WAY IS NOT 3319 02:08:13,280 --> 02:08:15,080 AS SCIENTIFIC. 3320 02:08:15,080 --> 02:08:16,400 AFTER BABY DELIVERY, THEY WOULD 3321 02:08:16,400 --> 02:08:17,800 SAY ESPECIALLY FOR THE FIRST 3322 02:08:17,800 --> 02:08:20,000 MONTH AFTER THE BABY DELIVERY, 3323 02:08:20,000 --> 02:08:20,960 THAT'S VERY IMPORTANT, YOU NEED 3324 02:08:20,960 --> 02:08:23,160 TO STAY AT HOME, YOU CANNOT GO 3325 02:08:23,160 --> 02:08:25,440 ANYWHERE, YOU CAN ONLY STAY HOME 3326 02:08:25,440 --> 02:08:27,440 TO LIE ON BED OR SOMETHING LIKE 3327 02:08:27,440 --> 02:08:27,680 THAT. 3328 02:08:27,680 --> 02:08:29,400 YOU CANNOT WASH YOUR HAIR. 3329 02:08:29,400 --> 02:08:30,800 THAT'S NOT SCIENTIFIC SO I'M 3330 02:08:30,800 --> 02:08:32,680 GOOD, I'M HERE, AND I DON'T NEED 3331 02:08:32,680 --> 02:08:34,640 TO FOLLOW THOSE RULES. 3332 02:08:34,640 --> 02:08:37,080 AND WITH THAT I WANT TO AGAIN 3333 02:08:37,080 --> 02:08:39,320 THANK MY VERY LARGE TEAM AND THE 3334 02:08:39,320 --> 02:08:40,880 INCREDIBLE FUNDING WE'VE 3335 02:08:40,880 --> 02:08:42,560 RECEIVED FOR THIS WORK. 3336 02:08:42,560 --> 02:08:43,000 THANK YOU. 3337 02:08:43,000 --> 02:08:45,240 >>THANK YOU. 3338 02:08:45,240 --> 02:08:46,880 WE'RE LOOKING FORWARD TO DIVING 3339 02:08:46,880 --> 02:08:48,800 INTO THE RESEARCH DURING THE Q&A 3340 02:08:48,800 --> 02:08:49,320 SESSION. 3341 02:08:49,320 --> 02:08:57,200 NEXT WE'LL HAVE OUR PRESENTATION 3342 02:08:57,200 --> 02:09:00,360 FROM DR. HARVILLE, THE PODIUM IS 3343 02:09:00,360 --> 02:09:00,560 YOURS. 3344 02:09:00,560 --> 02:09:04,040 >>CAN YOU SEE THE SLIDES? 3345 02:09:04,040 --> 02:09:05,880 >>YES, WE CAN. 3346 02:09:05,880 --> 02:09:06,600 >>GREAT. 3347 02:09:06,600 --> 02:09:09,480 I'D LIKE TO THANK THE ORGANIZERS 3348 02:09:09,480 --> 02:09:13,160 FOR INVITING US TO PRESENT. 3349 02:09:13,160 --> 02:09:16,160 I AM PRESENTING ON BEHALF OF A 3350 02:09:16,160 --> 02:09:18,120 TEAM FROM TULANE PENNINGTON 3351 02:09:18,120 --> 02:09:20,080 RESEARCH AND WOMEN'S HOSPITAL 3352 02:09:20,080 --> 02:09:22,480 AND LEE ANN REDMOND IS THE 3353 02:09:22,480 --> 02:09:25,360 PRINCIPAL INVESTIGATOR ON THIS 3354 02:09:25,360 --> 02:09:26,080 PROJECT. 3355 02:09:26,080 --> 02:09:29,840 SO AS YOU KNOW GESTATIONAL 3356 02:09:29,840 --> 02:09:33,440 WEIGHT GAIN IS ASSOCIATED WITH 3357 02:09:33,440 --> 02:09:34,880 COMPLICATIONS IN PREGNANCY. 3358 02:09:34,880 --> 02:09:40,000 AND SOCIAL DISTANCING AND 3359 02:09:40,000 --> 02:09:42,960 LOCKDOWN LED TO TIME BEING SPENT 3360 02:09:42,960 --> 02:09:44,160 SEDENTARY, LESS HEALTHY EATING, 3361 02:09:44,160 --> 02:09:45,680 WORSE ANXIETY AND DEPRESSION. 3362 02:09:45,680 --> 02:09:46,800 AL THOSE HAVE BEEN ASSOCIATED 3363 02:09:46,800 --> 02:09:49,560 WITH CHANGES IN WEIGHT GAIN. 3364 02:09:49,560 --> 02:09:50,320 THERE'S BEEN STUDIES FROM CHINA 3365 02:09:50,320 --> 02:09:52,320 AND THE UNITED STATES THAT HAVE 3366 02:09:52,320 --> 02:09:54,600 SUGGESTED THAT THERE WAS HIGHER 3367 02:09:54,600 --> 02:09:55,760 GESTATIONAL WEIGHT GAIN IN THE 3368 02:09:55,760 --> 02:09:57,080 FIRST YEAR OF THE PANDEMIC 3369 02:09:57,080 --> 02:09:59,560 COMPARED TO DELIVERY IN THE 3370 02:09:59,560 --> 02:10:00,560 PREVIOUS YEARS. 3371 02:10:00,560 --> 02:10:03,280 SO IN THIS ANALYSIS WE WERE 3372 02:10:03,280 --> 02:10:04,840 LOOKING TO EXTEND THAT FURTHER, 3373 02:10:04,840 --> 02:10:07,680 INTO THE SECOND YEAR, INTO MARCH 3374 02:10:07,680 --> 02:10:12,600 OF 2022, AND ALSO TO EXAMINE A 3375 02:10:12,600 --> 02:10:17,760 BIT BY CONSIDERING BOTH 3376 02:10:17,760 --> 02:10:21,040 CROSS-SECTIONAL AND COHORT MODEL 3377 02:10:21,040 --> 02:10:22,480 OF DATA. 3378 02:10:22,480 --> 02:10:24,200 SO WE'RE USING ELECTRONIC HEALTH 3379 02:10:24,200 --> 02:10:25,800 RECORDS FROM WOMEN'S HOSPITAL IN 3380 02:10:25,800 --> 02:10:28,160 BATON ROUGE, ONE OF THE LARGEST 3381 02:10:28,160 --> 02:10:29,920 SPECIALTY HOSPITALS IN THE 3382 02:10:29,920 --> 02:10:30,160 COUNTRY. 3383 02:10:30,160 --> 02:10:32,000 THEY DO ABOUT 8,000 DELIVERIES 3384 02:10:32,000 --> 02:10:33,400 PER YEAR. 3385 02:10:33,400 --> 02:10:36,880 OUR INITIAL DATABASE WAS ALL 3386 02:10:36,880 --> 02:10:38,760 DELIVERIES BETWEEN JANUARY OF 3387 02:10:38,760 --> 02:10:40,400 2017 AND JULY OF 2022, YOU'LL 3388 02:10:40,400 --> 02:10:43,280 SEE WE NARROWED DOWN A LITTLE 3389 02:10:43,280 --> 02:10:43,720 BIT. 3390 02:10:43,720 --> 02:10:46,760 WE COMPILED DATA BASED ON ICD 3391 02:10:46,760 --> 02:10:49,200 CODES, ADMITTING AND DISCHARGE 3392 02:10:49,200 --> 02:10:52,560 DATA, AS WELL AS NURSE TO 3393 02:10:52,560 --> 02:10:53,520 PHYSICIAN CHARTING WHERE 3394 02:10:53,520 --> 02:10:57,720 NECESSARY, LINKED TO STATE LEVEL 3395 02:10:57,720 --> 02:11:02,840 BIRTH CERTIFICATE DATA USING 3396 02:11:02,840 --> 02:11:04,160 SEVERAL IDENTIFIERS TO LINK. 3397 02:11:04,160 --> 02:11:07,000 WHEN WE'RE LOOKING AT TIME 3398 02:11:07,000 --> 02:11:09,280 PERIODS FOR COMPARISON, AND 3399 02:11:09,280 --> 02:11:10,800 THERE'S FAIRLY ROBUST DISCUSSION 3400 02:11:10,800 --> 02:11:12,840 OF THIS IN THE PERINATAL 3401 02:11:12,840 --> 02:11:14,440 EPIDEMIOLOGY LITERATURE BUT THIS 3402 02:11:14,440 --> 02:11:18,480 IS WHAT WE LANDED ON. 3403 02:11:18,480 --> 02:11:20,080 FIRST WE USED CROSS-SECTIONAL 3404 02:11:20,080 --> 02:11:21,240 DATA, DELIVERY DATES. 3405 02:11:21,240 --> 02:11:23,840 THERE WE JUST USED THE YEAR 3406 02:11:23,840 --> 02:11:26,040 BEFORE THE PANDEMIC, THE YEAR, 3407 02:11:26,040 --> 02:11:28,960 FIRST YEAR POST-PANDEMIC, SECOND 3408 02:11:28,960 --> 02:11:30,520 YEAR POST-PANDEMIC, AND MARCH 3409 02:11:30,520 --> 02:11:32,600 13, 2020 IS WHEN THERE STARTED 3410 02:11:32,600 --> 02:11:35,160 TO BE RESTRICTIONS AT WOMEN'S 3411 02:11:35,160 --> 02:11:37,080 HOSPITAL AROUND VISITORS AND SO 3412 02:11:37,080 --> 02:11:40,600 FORTH, SO WE USED THAT AS A 3413 02:11:40,600 --> 02:11:41,000 CUTOFF. 3414 02:11:41,000 --> 02:11:42,880 WE ALSO USED CONCEPTION DATE TO 3415 02:11:42,880 --> 02:11:46,040 LINE UP COHORTS, AND THAT ALLOWS 3416 02:11:46,040 --> 02:11:48,600 FOR A LITTLE EASIER COMPARISON 3417 02:11:48,600 --> 02:11:50,480 OF TIMING OF EXPOSURE. 3418 02:11:50,480 --> 02:11:52,320 AND THAT WAS BASED ON 3419 02:11:52,320 --> 02:11:53,680 GESTATIONAL AGE, AND SO THERE WE 3420 02:11:53,680 --> 02:11:57,520 HAVE A COHORT THAT AGAIN IS 3421 02:11:57,520 --> 02:11:59,040 COMPLETELY PRE-PANDEMIC, ONE 3422 02:11:59,040 --> 02:12:02,440 THAT WAS EXPOSED DURING PART OF 3423 02:12:02,440 --> 02:12:05,320 THE PREGNANCY, ONE WHERE THE 3424 02:12:05,320 --> 02:12:06,360 ENTIRE PREGNANCY OCCURRED 3425 02:12:06,360 --> 02:12:07,920 POST-PANDEMIC OR DURING THAT 3426 02:12:07,920 --> 02:12:11,200 FIRST YEAR PANDEMIC, SO AFTER 3427 02:12:11,200 --> 02:12:12,840 MARCH 2020, AND THEN LAST GROUP 3428 02:12:12,840 --> 02:12:14,400 THAT WAS CONCEIVED AFTER THE 3429 02:12:14,400 --> 02:12:16,480 MAJORITY OF THE RESTRICTIONS 3430 02:12:16,480 --> 02:12:19,440 WERE LIFTED, WHICH OCCURRED IN 3431 02:12:19,440 --> 02:12:20,640 MARCH 2021, IN LOUISIANA. 3432 02:12:20,640 --> 02:12:23,280 AND WE ALSO LOOKED AT THE 3433 02:12:23,280 --> 02:12:28,120 OUTCOMES MONTH TO MONTH, FOR A 3434 02:12:28,120 --> 02:12:29,520 LITTLE MORE NUANCE. 3435 02:12:29,520 --> 02:12:32,440 OUR MAJOR OUTCOME WAS TOTAL 3436 02:12:32,440 --> 02:12:33,760 GESTATIONAL WEIGHT GAIN WHICH WE 3437 02:12:33,760 --> 02:12:36,600 DID WEIGHT AT DELIVERY MINUS 3438 02:12:36,600 --> 02:12:38,680 PRE-PREGNANCY, HAD OTHER 3439 02:12:38,680 --> 02:12:40,360 ANALYSES WHERE WE CONTROLLED FOR 3440 02:12:40,360 --> 02:12:41,640 LENGTH OF GESTATION, IT DIDN'T 3441 02:12:41,640 --> 02:12:43,960 MAKE A DIFFERENCE SO WE'RE DOING 3442 02:12:43,960 --> 02:12:47,000 TOTAL HERE. 3443 02:12:47,000 --> 02:12:48,200 AND WE ALSO CATEGORIZED 3444 02:12:48,200 --> 02:12:50,640 GESTATIONAL WEIGHT GAIN BASED ON 3445 02:12:50,640 --> 02:12:52,160 INSTITUTE OF MEDICINE 3446 02:12:52,160 --> 02:12:54,120 CATEGORIES, WHICH VARY BASED ON 3447 02:12:54,120 --> 02:12:56,080 THE PRE-PREGNANCY BMI AS WELL AS 3448 02:12:56,080 --> 02:12:57,640 WHETHER THE PREGNANCY IS 3449 02:12:57,640 --> 02:13:01,120 MULTIPLE OR SINGLETON BIRTH. 3450 02:13:01,120 --> 02:13:03,960 AND WOMEN WERE CATEGORIZED AS 3451 02:13:03,960 --> 02:13:05,320 EXCEEDING RECOMMENDATIONS, 3452 02:13:05,320 --> 02:13:07,120 MEETING THEM OR BELOW. 3453 02:13:07,120 --> 02:13:09,480 SEEMED LIKE THE MAJOR 3454 02:13:09,480 --> 02:13:10,960 DIFFERENCES WERE AMONG THAT 3455 02:13:10,960 --> 02:13:15,040 COMPETEDDED GROUP SO THE -- 3456 02:13:15,040 --> 02:13:18,000 EXCEEDED GROUP SO WE HAD 3457 02:13:18,000 --> 02:13:19,080 DICHOTOMY THERE. 3458 02:13:19,080 --> 02:13:21,600 MODELS LOOKING AT ADJUSTED IT 3459 02:13:21,600 --> 02:13:22,240 CONTROLLED FOR SOME COVARIATES 3460 02:13:22,240 --> 02:13:24,800 THAT SEEMED TO SHIFT IN 3461 02:13:24,800 --> 02:13:27,440 DISTRIBUTION OVER THE PANDEMIC, 3462 02:13:27,440 --> 02:13:29,960 SO MATERNAL AGE, PARITY, 3463 02:13:29,960 --> 02:13:34,760 RACE/ETHNICITY, MARITAL STATUS 3464 02:13:34,760 --> 02:13:37,400 AND EDUCATION, USED LINEAR 3465 02:13:37,400 --> 02:13:38,800 REGRESSION, GENERALIZED 3466 02:13:38,800 --> 02:13:40,120 ESTIMATING EQUATIONS TO CONTROL 3467 02:13:40,120 --> 02:13:42,520 FOR SITUATIONS WHERE THERE WERE 3468 02:13:42,520 --> 02:13:45,160 MULTIPLE BIRTHS PER WOMAN DUE TO 3469 02:13:45,160 --> 02:13:46,720 TWINS OR DUE TO MULTIPLE 3470 02:13:46,720 --> 02:13:49,360 PREGNANCIES WITHIN THAT THREE OR 3471 02:13:49,360 --> 02:13:51,600 FOUR YEAR TIME SPAN, AND WE ALSO 3472 02:13:51,600 --> 02:13:54,680 DID A SIBLING ANALYSIS WHERE WE 3473 02:13:54,680 --> 02:13:56,760 COMPARED GROUP WITH ONE BIRTH 3474 02:13:56,760 --> 02:13:59,160 PRIOR TO THE PANDEMIC TO ONE 3475 02:13:59,160 --> 02:14:02,560 BIRTH AFTER THAT. 3476 02:14:02,560 --> 02:14:04,520 THERE WERE 1300 WOMEN IN THE 3477 02:14:04,520 --> 02:14:05,520 CATEGORY. 3478 02:14:05,520 --> 02:14:09,680 THEN WE ALSO LOOKED AT -- 3479 02:14:09,680 --> 02:14:10,680 GESTATIONAL WEIGHT GAIN VARIES 3480 02:14:10,680 --> 02:14:13,720 SO WE LOOKED AT INTERACTION WITH 3481 02:14:13,720 --> 02:14:17,560 THAT PRE-PREGNANCY BMI TO SEE IF 3482 02:14:17,560 --> 02:14:18,480 THERE WERE CHANGES THERE. 3483 02:14:18,480 --> 02:14:22,520 IF WE LOOK AT THE POPULATION AS 3484 02:14:22,520 --> 02:14:25,880 A WHOLE, YOU CAN SEE THAT 3485 02:14:25,880 --> 02:14:27,880 OVERALL ABOUT HALF OF THE 3486 02:14:27,880 --> 02:14:29,960 POPULATION GIVING BIRTH AT 3487 02:14:29,960 --> 02:14:32,440 WOMEN'S IS WHITE, ANOTHER 40% OR 3488 02:14:32,440 --> 02:14:33,440 SO IS BLACK. 3489 02:14:33,440 --> 02:14:36,840 WITH THE NEXT GROUP BEING 3490 02:14:36,840 --> 02:14:37,480 HISPANIC. 3491 02:14:37,480 --> 02:14:38,680 WERE THERE WERE SHIFTS OR TRENDS 3492 02:14:38,680 --> 02:14:42,440 IN SOME OF THE COVARIATES IF WE 3493 02:14:42,440 --> 02:14:44,520 COMPARE ACROSS THE PANDEMIC, YOU 3494 02:14:44,520 --> 02:14:46,920 CAN SEE THESE ARE QUITE SMALL, 3495 02:14:46,920 --> 02:14:48,880 JUST A PERCENTAGE POINT OR TWO. 3496 02:14:48,880 --> 02:14:53,720 BUT WE CAN PICK THEM UP 3497 02:14:53,720 --> 02:14:54,560 STATISTICALLY. 3498 02:14:54,560 --> 02:14:57,400 SO IF WE LOOK AT GESTATIONALLY 3499 02:14:57,400 --> 02:15:01,600 WEIGHT GAIN WE DO SEE 3500 02:15:01,600 --> 02:15:03,240 STATISTICAL DIFFERENCES ACROSS 3501 02:15:03,240 --> 02:15:04,840 THE PANDEMIC. 3502 02:15:04,840 --> 02:15:06,280 THE MAGNITUDE IS QUITE SMALL, 3503 02:15:06,280 --> 02:15:08,280 WE'RE LOOKING AT HALF A 3504 02:15:08,280 --> 02:15:10,680 KILOGRAM, SO MAYBE A POUND OR 3505 02:15:10,680 --> 02:15:12,560 TWO ON AVERAGE. 3506 02:15:12,560 --> 02:15:16,040 AND THE PATTERN SEEMED TO BE 3507 02:15:16,040 --> 02:15:18,200 THAT THE GESTATIONAL WEIGHT GAIN 3508 02:15:18,200 --> 02:15:23,160 ON AVERAGE ROSE A BIT FOR THAT 3509 02:15:23,160 --> 02:15:24,360 FIRST YEAR, AFTER MARCH 2020, 3510 02:15:24,360 --> 02:15:26,320 AND THEN FELL DOWN A BIT. 3511 02:15:26,320 --> 02:15:28,720 WE SEE THAT REGARDLESS OF 3512 02:15:28,720 --> 02:15:31,360 WHETHER WE LOOKED AT DATE OF 3513 02:15:31,360 --> 02:15:33,880 DELIVERY OR TIME OF CONCEPTION 3514 02:15:33,880 --> 02:15:37,160 WITH A RISE EARLIER AND THEN 3515 02:15:37,160 --> 02:15:38,840 PERHAPS A FALLBACK. 3516 02:15:38,840 --> 02:15:42,680 FOR PRE-PREGNANCY WEIGHT WE SEE 3517 02:15:42,680 --> 02:15:46,040 THERE WAS AN INCREASE IN 3518 02:15:46,040 --> 02:15:46,880 PRE-PREGNANCY WEIGHT, AGAIN 3519 02:15:46,880 --> 02:15:48,760 SMALL BUT SEEMED TO BE A 3520 02:15:48,760 --> 02:15:49,520 CONSISTENT RISE. 3521 02:15:49,520 --> 02:15:52,920 AND IF WE LOOK AT THE 3522 02:15:52,920 --> 02:15:56,640 CATEGORIZED OUTCOME AGAIN WE SEE 3523 02:15:56,640 --> 02:15:59,040 A RISE IN THOSE ABOVE THE 3524 02:15:59,040 --> 02:16:01,800 RECOMMENDED WEIGHT GAIN AND 3525 02:16:01,800 --> 02:16:07,480 FALLBACK AND SIMILAR PATTERN 3526 02:16:07,480 --> 02:16:07,880 HERE. 3527 02:16:07,880 --> 02:16:11,000 IF WE LOOK AT ADJUSTED MODELS WE 3528 02:16:11,000 --> 02:16:12,640 GET THE SAME IDEA. 3529 02:16:12,640 --> 02:16:16,120 WE HAVE THE SMALL INCREASE IN 3530 02:16:16,120 --> 02:16:18,200 GESTATIONAL WEIGHT GAIN IN THE 3531 02:16:18,200 --> 02:16:21,040 PEAK AND SHORTLY AFTER, AND 3532 02:16:21,040 --> 02:16:22,360 PERHAPS A FALLBACK AGAIN 3533 02:16:22,360 --> 02:16:24,440 REGARDLESS OF HOW THE TIMING IS 3534 02:16:24,440 --> 02:16:26,640 SPLIT UP HERE. 3535 02:16:26,640 --> 02:16:29,360 WE DO SEE A SIGNIFICANT 3536 02:16:29,360 --> 02:16:30,920 INTERACTION WITH PRE-PREGNANCY 3537 02:16:30,920 --> 02:16:32,640 BMI FOR THE UNDERWEIGHT GROUP 3538 02:16:32,640 --> 02:16:35,160 WHICH IS THE SMALLEST, WE DIDN'T 3539 02:16:35,160 --> 02:16:38,560 SEE ANY CHANGE FOR THE NORMAL 3540 02:16:38,560 --> 02:16:40,520 WEIGHT GROUP HERE AT LEAST IF WE 3541 02:16:40,520 --> 02:16:42,480 DEFINE BY DELIVERY WE DON'T SEE 3542 02:16:42,480 --> 02:16:44,040 A CHANGE THOUGH WE SEE PATTERN 3543 02:16:44,040 --> 02:16:45,800 OF RISE AND FALL. 3544 02:16:45,800 --> 02:16:48,640 IF WE LOOK BY CONCEPTION COHORT 3545 02:16:48,640 --> 02:16:52,880 WE SEE RISE FOR EARLY OR FIRST 3546 02:16:52,880 --> 02:16:54,760 YEAR AND PERHAPS FALLBACK. 3547 02:16:54,760 --> 02:16:57,920 IN THE NORMAL WEIGHT GROUP WE 3548 02:16:57,920 --> 02:16:59,840 SEE CONSISTENT RISE ACROSS THE 3549 02:16:59,840 --> 02:17:02,400 TIME FRAME, AND IN THE OBESE 3550 02:17:02,400 --> 02:17:04,040 GROUP IT'S A LITTLE 3551 02:17:04,040 --> 02:17:05,720 INCONSISTENT, WE SEE A RISE AND 3552 02:17:05,720 --> 02:17:07,320 FALL HERE BUT HERE WE SEE A RISE 3553 02:17:07,320 --> 02:17:10,880 AND FALL AND THEN A RISE AGAIN. 3554 02:17:10,880 --> 02:17:13,600 SO STILL WORKING ON FIGURING OUT 3555 02:17:13,600 --> 02:17:17,400 TO SEE HOW THE TRENDS CONTINUE 3556 02:17:17,400 --> 02:17:19,160 TO PLAY OUT. 3557 02:17:19,160 --> 02:17:22,480 HERE ARE SOME DATA MONTH BY 3558 02:17:22,480 --> 02:17:24,520 MONTH, AS YOU CAN SEE THIS DATA 3559 02:17:24,520 --> 02:17:25,960 LOOKS MORE EXCITING IF WE 3560 02:17:25,960 --> 02:17:27,600 PRESENT IT LIKE THIS THAN IF 3561 02:17:27,600 --> 02:17:28,560 LIKE THIS. 3562 02:17:28,560 --> 02:17:30,520 THIS GIVES AN IDEA HOW SMALL 3563 02:17:30,520 --> 02:17:31,440 THESE CHANGES ARE. 3564 02:17:31,440 --> 02:17:34,280 BUT THE ONE THING WE DID NOTICE 3565 02:17:34,280 --> 02:17:36,440 MONTH BY MONTH THAT WE FOUND 3566 02:17:36,440 --> 02:17:39,760 INTERESTING WAS THERE WAS THIS 3567 02:17:39,760 --> 02:17:50,240 DIP IN MARCH 2020, AND WE SEE 3568 02:18:02,800 --> 02:18:05,520 THAT SHORT-TERM THERE MIGHT HAVE 3569 02:18:05,520 --> 02:18:07,240 BEEN FOOD SHORTAGES, IN THE 3570 02:18:07,240 --> 02:18:08,360 SHORT TERM. 3571 02:18:08,360 --> 02:18:09,760 THE OTHER POSSIBILITY IS THAT 3572 02:18:09,760 --> 02:18:13,280 WHILE DATA ARE COMING OUT OF 3573 02:18:13,280 --> 02:18:14,320 MEDICAL RECORDS AND VITAL 3574 02:18:14,320 --> 02:18:16,440 STATISTICS A LOT OF THOSE DATA 3575 02:18:16,440 --> 02:18:18,320 ACTUALLY DO COME FROM THE 3576 02:18:18,320 --> 02:18:20,400 SELF-REPORT OF THE WOMAN, SO 3577 02:18:20,400 --> 02:18:23,120 IT'S POSSIBLE THAT IF SHE DIDN'T 3578 02:18:23,120 --> 02:18:24,920 HAVE HER LAST IN-PERSON PRENATAL 3579 02:18:24,920 --> 02:18:26,200 VISIT SHE MIGHT NOT HAVE BEEN 3580 02:18:26,200 --> 02:18:28,360 AWARE OF HOW MUCH WEIGHT SHE 3581 02:18:28,360 --> 02:18:30,120 GAINED AND PERHAPS UNDERREPORTED 3582 02:18:30,120 --> 02:18:34,360 DUE TO THAT. 3583 02:18:34,360 --> 02:18:35,920 BUT THOSE ARE SPECULATION. 3584 02:18:35,920 --> 02:18:38,880 AND THEN FINALLY WHEN WE LOOKED 3585 02:18:38,880 --> 02:18:41,960 AT COMPARE THOSE WHO GAINED OR 3586 02:18:41,960 --> 02:18:45,960 HAD THE TWO PREGNANCIES, WE SAW 3587 02:18:45,960 --> 02:18:47,720 SIMILAR PROPORTION TO 3588 02:18:47,720 --> 02:18:48,720 DISCREPANCY EARLY AND LATER, IN 3589 02:18:48,720 --> 02:18:51,120 IN THE EARLY AND LATER 3590 02:18:51,120 --> 02:18:52,200 PREGNANCIES, AND ONCE WE HAD 3591 02:18:52,200 --> 02:18:54,080 CONTROLLED FOR AGE AND PARITY WE 3592 02:18:54,080 --> 02:18:55,040 DIDN'T SEE ANY DIFFERENCE 3593 02:18:55,040 --> 02:19:00,240 REGARDLESS OF HOW WE SPLIT UP 3594 02:19:00,240 --> 02:19:02,640 THE TIME. 3595 02:19:02,640 --> 02:19:03,920 STRENGTHS AND LIMITATIONS, LARGE 3596 02:19:03,920 --> 02:19:05,800 ELECTRONIC HEALTH RECORD, 3597 02:19:05,800 --> 02:19:07,800 DIVERSE POPULATION, ABLE TO TAKE 3598 02:19:07,800 --> 02:19:13,040 THE DATA OUT TO MARCH 2022 FOR 3599 02:19:13,040 --> 02:19:14,240 MORE TIME CONSIDERING HORIZON 3600 02:19:14,240 --> 02:19:15,600 BUT AS I MENTIONED MUCH WEIGHT 3601 02:19:15,600 --> 02:19:17,320 GAIN DATA IN THE MEDICAL RECORDS 3602 02:19:17,320 --> 02:19:19,320 AND BIRTH CERTIFICATES IS 3603 02:19:19,320 --> 02:19:21,040 SELF-REPORTED AND THAT'S A 3604 02:19:21,040 --> 02:19:22,920 DEFINITE LIMITATION FOR 3605 02:19:22,920 --> 02:19:24,880 UNDERSTANDING THINGS. 3606 02:19:24,880 --> 02:19:26,000 TO CONCLUDE WE FOUND GESTATIONAL 3607 02:19:26,000 --> 02:19:27,400 WEIGHT GAIN ON AVERAGE ROSE A 3608 02:19:27,400 --> 02:19:30,120 SMALL AMOUNT DURING THE 3609 02:19:30,120 --> 02:19:34,200 PANDEMIC, THESE CHANGES DIFFERED 3610 02:19:34,200 --> 02:19:36,320 BY PRE-PREGNANCY BMI, AND SEEMS 3611 02:19:36,320 --> 02:19:38,240 LIKE SOME INCREASES MAY HAVE 3612 02:19:38,240 --> 02:19:39,360 PLATEAUED OR EVEN STARTED TO 3613 02:19:39,360 --> 02:19:49,760 SINK BACK A LITTLE BIT. 3614 02:20:04,360 --> 02:20:04,840 THANK YOU. 3615 02:20:04,840 --> 02:20:09,120 >>DR. KISNER, THE FLOOR IS 3616 02:20:09,120 --> 02:20:13,840 OURS I WANT TO REMIND MEMBERS WE 3617 02:20:13,840 --> 02:20:14,480 WELCOME YOU JOINING THE 3618 02:20:14,480 --> 02:20:17,000 DIALOGUE, FEEL FREE TO SUBMIT 3619 02:20:17,000 --> 02:20:18,640 QUESTIONS FOR ANY PRESENTERS 3620 02:20:18,640 --> 02:20:19,600 USING THE "SEND LIVE FEEDBACK" 3621 02:20:19,600 --> 02:20:25,760 BUTTON ON THE INDIVIDUAL 3622 02:20:25,760 --> 02:20:26,160 VIDEOCAST. 3623 02:20:26,160 --> 02:20:26,440 DR. KINSER? 3624 02:20:26,440 --> 02:20:33,000 >>THANK YOU. 3625 02:20:33,000 --> 02:20:41,680 HAPPY TO BE HERE. 3626 02:20:41,680 --> 02:20:43,640 THE FOCUS TODAY IS TO DISCUSS 3627 02:20:43,640 --> 02:20:48,240 IMPACT OF RISK AND RESILIENCE 3628 02:20:48,240 --> 02:20:50,000 FACTORS ON MATERNAL HEALTH 3629 02:20:50,000 --> 02:20:52,200 OUTCOMES DURING THE COVID 3630 02:20:52,200 --> 02:20:53,080 PANDEMIC, REPRESENTING A LARGER 3631 02:20:53,080 --> 02:20:57,800 TEAM BUT I'M THE P.I. OF THE 3632 02:20:57,800 --> 02:21:00,440 STUDY. 3633 02:21:00,440 --> 02:21:01,720 NEXT SLIDE PLEASE. 3634 02:21:01,720 --> 02:21:03,600 I'D LIKE TO ACKNOWLEDGE NICHD 3635 02:21:03,600 --> 02:21:09,960 AND THE NIMH FOR FUNDING FOR 3636 02:21:09,960 --> 02:21:12,040 THIS WORK. 3637 02:21:12,040 --> 02:21:14,240 I DON'T NEED TO SPEND TIME ON 3638 02:21:14,240 --> 02:21:15,800 BACKGROUND BECAUSE THE WONDERFUL 3639 02:21:15,800 --> 02:21:17,000 PRESENTERS BEFORE ME HAVE DONE 3640 02:21:17,000 --> 02:21:19,080 SUCH A GREAT JOB. 3641 02:21:19,080 --> 02:21:21,240 CLEARLY THE COVID-19 PANDEMIC IS 3642 02:21:21,240 --> 02:21:24,560 A COLLECTIVE STRESSOR THAT HAS 3643 02:21:24,560 --> 02:21:25,680 HAD WIDESPREAD EFFECTS ACROSS 3644 02:21:25,680 --> 02:21:27,840 THE GLOBE, AS WE'VE HEARD FROM 3645 02:21:27,840 --> 02:21:29,480 OTHER PRESENTERS EFFECTS HAVE 3646 02:21:29,480 --> 02:21:34,520 BEEN DIRECT, SAY ON RELATING TO 3647 02:21:34,520 --> 02:21:37,800 INFECTION AND MORTALITY OR 3648 02:21:37,800 --> 02:21:39,880 INDIRECT WITH STRESS, ISOLATION, 3649 02:21:39,880 --> 02:21:42,560 CHANGES IN SUPPORT, HEALTH CARE 3650 02:21:42,560 --> 02:21:45,040 DELIVERY HAS BEEN DISRUPTED. 3651 02:21:45,040 --> 02:21:46,800 MINORITY POPULATIONS HAVE BEEN 3652 02:21:46,800 --> 02:21:47,880 DISPROPORTIONATELY AFFECTED AT 3653 02:21:47,880 --> 02:21:49,440 HIGHER RISK FOR EXPERIENCING 3654 02:21:49,440 --> 02:21:53,040 ADVERSE EFFECTS RELATED TO 3655 02:21:53,040 --> 02:21:54,120 STRUCTURAL RACISM AND 3656 02:21:54,120 --> 02:21:54,760 DISCRIMINATION. 3657 02:21:54,760 --> 02:21:57,080 THERE HAVE BEEN SEVERAL STUDIES 3658 02:21:57,080 --> 02:22:00,320 THAT CAME OUT, THAT LOOK AT 3659 02:22:00,320 --> 02:22:08,680 MENTAL HEALTH IMPACT, 62 STUDIES 3660 02:22:08,680 --> 02:22:13,000 FINDING PREVALENCE TO BE 28%, 3661 02:22:13,000 --> 02:22:15,280 ANXIETY 33%, BOTH ARE HIGHER 3662 02:22:15,280 --> 02:22:17,000 THAN GENERAL POPULATION 3663 02:22:17,000 --> 02:22:18,040 ESTIMATES OUTSIDE OF THE 3664 02:22:18,040 --> 02:22:26,360 PANDEMIC AND ARE HIGHER AMONG 3665 02:22:26,360 --> 02:22:31,400 THOSE WITH PREEXISTING 3666 02:22:31,400 --> 02:22:31,720 CONDITIONS. 3667 02:22:31,720 --> 02:22:33,920 MORE CONTEXT FROM THE COVID 3668 02:22:33,920 --> 02:22:37,200 SURVEY, SHOWING MANY AMERICANS 3669 02:22:37,200 --> 02:22:39,960 REPORTED SUBSTANTIAL ECONOMIC 3670 02:22:39,960 --> 02:22:41,240 HARDSHIP THAT LATINX AND BLACK 3671 02:22:41,240 --> 02:22:46,280 EXPERIENCE AT HIGHER RATES THAN 3672 02:22:46,280 --> 02:22:47,240 WHITE PEOPLE AND LATINX AND 3673 02:22:47,240 --> 02:22:49,040 BLACK PEOPLE AS WELL AS WOMEN 3674 02:22:49,040 --> 02:22:51,080 AND THOSE WITH LOWER INCOMES ARE 3675 02:22:51,080 --> 02:22:53,200 AT MOST RISK FOR MENTAL HEALTH 3676 02:22:53,200 --> 02:22:55,120 CONCERNS BECAUSE OF COVID. 3677 02:22:55,120 --> 02:22:56,560 INTERSECTIONALITY OF THESE 3678 02:22:56,560 --> 02:22:58,760 FACTORS IS IMPORTANT TO CONSIDER 3679 02:22:58,760 --> 02:23:07,320 AND IS OF PARTICULAR INTEREST TO 3680 02:23:07,320 --> 02:23:07,920 OUR RESEARCH TEAM. 3681 02:23:07,920 --> 02:23:10,920 OUR TEAM HAS BEEN RUNNING A 3682 02:23:10,920 --> 02:23:13,120 TRIAL TO EVALUATE A 3683 02:23:13,120 --> 02:23:14,800 NON-PHARMACOLOGIC AND SCALABLE 3684 02:23:14,800 --> 02:23:16,720 INTERNET BASED INTERVENTION 3685 02:23:16,720 --> 02:23:19,560 DESIGNED TO PREVENT PERINATAL 3686 02:23:19,560 --> 02:23:20,880 DEPRESSIVE SYMPTOMS. 3687 02:23:20,880 --> 02:23:22,440 NEARLY 20% OF PREGNANT 3688 02:23:22,440 --> 02:23:24,720 INDIVIDUALS IN THE U.S. 3689 02:23:24,720 --> 02:23:25,360 EXPERIENCE CLINICALLY 3690 02:23:25,360 --> 02:23:26,120 SIGNIFICANT DEPRESSIVE SYMPTOMS 3691 02:23:26,120 --> 02:23:29,000 IN THE PREGNANCY OR INTO THE 3692 02:23:29,000 --> 02:23:30,520 POSTPARTUM PERIOD AND THE 3693 02:23:30,520 --> 02:23:32,720 PANDEMIC AND OTHER STRESSORS 3694 02:23:32,720 --> 02:23:34,480 SUCH AS RACISM AND 3695 02:23:34,480 --> 02:23:41,000 DISCRIMINATION MIGHT BE RISK 3696 02:23:41,000 --> 02:23:43,440 FACTORS FOR ONGOING SYMPTOMS. 3697 02:23:43,440 --> 02:23:48,600 THE FUNDING HAS SUPPORTED OUR 3698 02:23:48,600 --> 02:23:49,240 INVESTIGATION INTO 3699 02:23:49,240 --> 02:23:49,880 PANDEMIC-RELATED DISCRIMINATION 3700 02:23:49,880 --> 02:23:53,000 BASED STRESSORS AS WELL AS 3701 02:23:53,000 --> 02:23:54,480 POSSIBLE PRODUCTIVE FACTORS INTO 3702 02:23:54,480 --> 02:23:59,320 DEPRESSIVE SYMPTOM OUTCOMES IN 3703 02:23:59,320 --> 02:24:00,040 LARGE ONGOING RANDOMIZED 3704 02:24:00,040 --> 02:24:00,960 CONTROLLED TRIAL. 3705 02:24:00,960 --> 02:24:03,040 THE PURPOSE IS TO EXAMINE IMPACT 3706 02:24:03,040 --> 02:24:04,360 OF STRESSORS AND POSSIBLE 3707 02:24:04,360 --> 02:24:14,920 PROTECTIVE FACTORS ON THE COURSE 3708 02:24:18,880 --> 02:24:19,920 OF DEPRESSIVE SYMPTOMS. 3709 02:24:19,920 --> 02:24:22,640 THIS IS A THREE ARM RANDOMIZED 3710 02:24:22,640 --> 02:24:24,280 CONTROLLED TRIAL DESIGNED TO 3711 02:24:24,280 --> 02:24:27,040 EVALUATE EFFICACY AND MECHANISMS 3712 02:24:27,040 --> 02:24:34,800 OF EFFECT OF THE MAMMA MIA 3713 02:24:34,800 --> 02:24:37,640 INTERVENTION TO BE USED IN 3714 02:24:37,640 --> 02:24:39,680 PREGNANCY AND POSTPARTUM PERIOD 3715 02:24:39,680 --> 02:24:44,840 AND PROVIDES ACCESS TO RESOURCES 3716 02:24:44,840 --> 02:24:47,600 SUCH AS MINDFULNESS TECHNIQUES, 3717 02:24:47,600 --> 02:24:49,440 RELATIONSHIP TIPS, PLANNING FOR 3718 02:24:49,440 --> 02:24:58,080 BREASTFEEDING AND INFANT CARE 3719 02:24:58,080 --> 02:24:58,560 AND MORE. 3720 02:24:58,560 --> 02:25:06,000 MORE CAN BE LEARNED HERE ON THE 3721 02:25:06,000 --> 02:25:06,320 WEBSITE. 3722 02:25:06,320 --> 02:25:07,200 NEXT SLIDE. 3723 02:25:07,200 --> 02:25:09,040 AND MORE DETAILS ON THE STUDY 3724 02:25:09,040 --> 02:25:10,720 PROTOCOL ARE AVAILABLE IN THE 3725 02:25:10,720 --> 02:25:12,280 PUBLICATION INDICATED IN THE TOP 3726 02:25:12,280 --> 02:25:15,080 RIGHT CORNER OF THE SLIDE, 3727 02:25:15,080 --> 02:25:18,440 BRIEFLY WE'RE ENROLLING CLOSE TO 3728 02:25:18,440 --> 02:25:19,520 2,000 PREGNANT INDIVIDUALS TO 3729 02:25:19,520 --> 02:25:22,280 PARTICIPATE IN THE LONGITUDINAL 3730 02:25:22,280 --> 02:25:24,120 THREE ARM RCT, RECRUITMENT IS 3731 02:25:24,120 --> 02:25:27,560 ONGOING AT THIS TIME. 3732 02:25:27,560 --> 02:25:28,720 WE HAVE RECRUITED APPROXIMATELY 3733 02:25:28,720 --> 02:25:32,120 1500 OF THE CLOSE TO 2,000 3734 02:25:32,120 --> 02:25:34,840 PARTICIPANTS THAT WE INTEND TO 3735 02:25:34,840 --> 02:25:39,880 ENROLL IN THIS STUDY. 3736 02:25:39,880 --> 02:25:40,760 NEXT SLIDE. 3737 02:25:40,760 --> 02:25:43,560 SO WITH THE SUPPLEMENT WHAT I'M 3738 02:25:43,560 --> 02:25:46,240 REPORTING ON TODAY THE PURPOSES 3739 02:25:46,240 --> 02:25:52,480 TO EVALUATE HOW THE SARS-COV-2 3740 02:25:52,480 --> 02:25:54,000 INFECTION CAN AFFECT THE 3741 02:25:54,000 --> 02:25:55,640 POPULATION, AND TO EVALUATE 3742 02:25:55,640 --> 02:25:58,480 FACTORS THAT MIGHT IMPACT HEALTH 3743 02:25:58,480 --> 02:26:00,560 OUTCOMES FOR THESE PARTICIPANTS 3744 02:26:00,560 --> 02:26:03,840 SUCH AS PERCEIVED IMPACT OF THE 3745 02:26:03,840 --> 02:26:05,400 COVID-19 PANDEMIC, STRUCTURAL 3746 02:26:05,400 --> 02:26:07,440 RACISM AND DISCRIMINATION, AND 3747 02:26:07,440 --> 02:26:12,160 RESILIENCE AND RISK FACTORS FROM 3748 02:26:12,160 --> 02:26:13,600 COPING TO ECONOMIC STRESS AND 3749 02:26:13,600 --> 02:26:15,320 FOOD AND HOUSING INSECURITY. 3750 02:26:15,320 --> 02:26:17,520 YOU'LL SEE MEASURES INCLUDED IN 3751 02:26:17,520 --> 02:26:26,920 THE FOCUS OF THE SUPPLEMENT, AND 3752 02:26:26,920 --> 02:26:27,280 ANALYTIC PLAN. 3753 02:26:27,280 --> 02:26:30,400 WHAT I'M REPORTING TODAY IS THAT 3754 02:26:30,400 --> 02:26:32,520 PRELIMINARY ANALYSIS SO THIS IS 3755 02:26:32,520 --> 02:26:33,920 THE DATASET THAT WAS AVAILABLE 3756 02:26:33,920 --> 02:26:40,280 IN TIME TO PREPARE FOR THIS 3757 02:26:40,280 --> 02:26:40,520 MEETING. 3758 02:26:40,520 --> 02:26:44,080 SO THERE ARE A COLUMN OF 3759 02:26:44,080 --> 02:26:46,520 EXCLUDED CATEGORY, PEOPLE WHO 3760 02:26:46,520 --> 02:26:48,480 HAVE MISSING DATA FOR COVARIATES 3761 02:26:48,480 --> 02:26:51,320 BECAUSE OF TIMING. 3762 02:26:51,320 --> 02:26:52,760 THE SUPPLEMENT WAS FUNDED AFTER 3763 02:26:52,760 --> 02:26:55,280 THE STUDY WAS RUNNING SO NOT ALL 3764 02:26:55,280 --> 02:26:58,120 DATA WAS COLLECTED AND THOSE 3765 02:26:58,120 --> 02:26:58,920 RECRUITED INITIALLY. 3766 02:26:58,920 --> 02:27:00,880 AND THEN ALSO DOES NOT INCLUDE 3767 02:27:00,880 --> 02:27:02,320 THOSE MORE RECENTLY ENROLLED AND 3768 02:27:02,320 --> 02:27:09,640 HAVE NOT YET MOVED THROUGH THE 3769 02:27:09,640 --> 02:27:11,800 LONGITUDINAL ASSESSMENTS YET. 3770 02:27:11,800 --> 02:27:14,360 WE SEE THE ANALYSIS CONTAINS A 3771 02:27:14,360 --> 02:27:16,160 HIGHER PERCENTAGE OF NON-WHITE 3772 02:27:16,160 --> 02:27:19,800 RESPONDENTS, THAN THOSE IN THE 3773 02:27:19,800 --> 02:27:20,360 EXCLUDED DATASET. 3774 02:27:20,360 --> 02:27:21,000 SIGNIFICANTLY LOWER PERCENTAGE 3775 02:27:21,000 --> 02:27:24,880 OF THOSE WITH LESS THAN THE 3776 02:27:24,880 --> 02:27:26,080 COLLEGE EDUCATION, AND 3777 02:27:26,080 --> 02:27:27,360 SIGNIFICANTLY HIGHER PERCENTAGE 3778 02:27:27,360 --> 02:27:30,120 OF RESPONDENTS WITH AN ANNUAL 3779 02:27:30,120 --> 02:27:33,160 INCOME LESS THAN $50,000. 3780 02:27:33,160 --> 02:27:34,800 SOME DIFFERENCE IS DUE TO FOCUS 3781 02:27:34,800 --> 02:27:37,760 EFFORTS OF OUR STUDY TEAM THANKS 3782 02:27:37,760 --> 02:27:39,640 TO THE ADMINISTRATIVE SUPPLEMENT 3783 02:27:39,640 --> 02:27:42,400 TO TARGET RECRUITMENT STRATEGIES 3784 02:27:42,400 --> 02:27:43,160 FOCUSED ON MARGINALIZED 3785 02:27:43,160 --> 02:27:45,560 POPULATIONS SUCH AS THOSE WHO 3786 02:27:45,560 --> 02:27:47,800 ARE HISTORICALLY MINORITIZED AND 3787 02:27:47,800 --> 02:27:56,600 HAVE A LOWER ANNUAL INCOME. 3788 02:27:56,600 --> 02:27:59,800 NEXT SLIDE PLEASE. 3789 02:27:59,800 --> 02:28:03,520 SO OUR ANALYTIC PLAN WE USE 3790 02:28:03,520 --> 02:28:06,000 PURPOSEFUL SELECTION TO BUILD 3791 02:28:06,000 --> 02:28:07,880 MULTIVARIATE MODEL AT 37 WEEKS 3792 02:28:07,880 --> 02:28:08,320 GESTATION. 3793 02:28:08,320 --> 02:28:13,360 I'LL PAUSE FOR A MOMENT AND 3794 02:28:13,360 --> 02:28:14,760 ACKNOWLEDGE THAT WE'RE TRACKING 3795 02:28:14,760 --> 02:28:15,600 DEPRESSIVE SYMPTOMS INTO THE 3796 02:28:15,600 --> 02:28:17,440 POSTPARTUM SO THIS IS JUST A 3797 02:28:17,440 --> 02:28:21,720 MOMENT IN TIME WE'RE LOOKING AT 3798 02:28:21,720 --> 02:28:24,120 THAT LATE PREGNANCY POINT. 3799 02:28:24,120 --> 02:28:28,040 AND AS WE FIT OUR COVARIATES AT 3800 02:28:28,040 --> 02:28:30,560 THE UNIVARIATE LEVEL BASELINE 3801 02:28:30,560 --> 02:28:33,080 DEPRESSION TREATMENT GROUP 3802 02:28:33,080 --> 02:28:34,280 EDUCATION INCOME DISCRIMINATION 3803 02:28:34,280 --> 02:28:36,800 PERCEIVED PANDEMIC IMPACT 3804 02:28:36,800 --> 02:28:39,200 RESILIENCE AND CONTEXTUALIZED 3805 02:28:39,200 --> 02:28:41,320 STRESS WERE RELATED TO OUTCOME. 3806 02:28:41,320 --> 02:28:43,040 BUT IN OUR FINAL MULTIVARIATE 3807 02:28:43,040 --> 02:28:47,000 MODEL WE FOUND THAT ONLY 3808 02:28:47,000 --> 02:28:48,520 BASELINE SYMPTOMS, TREATMENT 3809 02:28:48,520 --> 02:28:51,240 GROUP, INCOME, EXPERIENCES OF 3810 02:28:51,240 --> 02:28:52,000 DISCRIMINATION AND RESILIENCE 3811 02:28:52,000 --> 02:29:00,840 WERE RELATED TO THE OUTCOME. 3812 02:29:00,840 --> 02:29:04,280 ADJUSTED R SQUARED INDICATES 3813 02:29:04,280 --> 02:29:05,560 APPROXIMATELY 38% OF VARIABILITY 3814 02:29:05,560 --> 02:29:07,080 IN DEPRESSION IN LATE PREGNANCY 3815 02:29:07,080 --> 02:29:17,560 IS PREDICTED BY THIS MODEL. 3816 02:29:25,200 --> 02:29:26,680 THE MODEL PREDICTED AT 37 WEEKS 3817 02:29:26,680 --> 02:29:33,640 COUNTING FOR 38% OF VARIANCE, 3818 02:29:33,640 --> 02:29:38,080 FINAL MODEL FOUND BASELINE 3819 02:29:38,080 --> 02:29:41,360 DEPRESSIVE SYMPTOMS, 3820 02:29:41,360 --> 02:29:42,920 SIGNIFICANTLY RELATED TO OUTCOME 3821 02:29:42,920 --> 02:29:44,320 BUT MODERATED EFFECT OF 3822 02:29:44,320 --> 02:29:46,120 TREATMENT CONDITION SO WHAT DOES 3823 02:29:46,120 --> 02:29:49,360 THIS MEAN? 3824 02:29:49,360 --> 02:29:51,000 NEXT SLIDE. 3825 02:29:51,000 --> 02:29:54,240 THE IMPLICATIONS HERE ARE THAT 3826 02:29:54,240 --> 02:29:55,840 AGAIN PRELIMINARY FINDINGS WE 3827 02:29:55,840 --> 02:29:57,040 ACKNOWLEDGE THIS IS VERY 3828 02:29:57,040 --> 02:29:58,040 PRELIMINARY BUT THESE 3829 02:29:58,040 --> 02:30:01,400 PRELIMINARY FIND EGGS DO SUGGEST 3830 02:30:01,400 --> 02:30:04,640 THAT MAMMA MIA, THE ONLINE 3831 02:30:04,640 --> 02:30:07,440 MOBILE BASED APPROACH, MIGHT BE 3832 02:30:07,440 --> 02:30:09,320 REASONABLE INTERVENTION FOR 3833 02:30:09,320 --> 02:30:10,760 PREVENTING PERINATAL DEPRESSIVE 3834 02:30:10,760 --> 02:30:12,280 SYMPTOMS IN PREGNANT PERSONS 3835 02:30:12,280 --> 02:30:14,280 ACROSS THE U.S. 3836 02:30:14,280 --> 02:30:16,880 THIS FINDING HELD UP WHEN 3837 02:30:16,880 --> 02:30:18,640 CONTROLLING FOR LOW INCOME 3838 02:30:18,640 --> 02:30:20,720 PERCEPTIONS OF DISCRIMINATION 3839 02:30:20,720 --> 02:30:24,360 AND RESILIENCE WHICH ALSO SHOWED 3840 02:30:24,360 --> 02:30:26,560 SIGNIFICANT ASSOCIATIONS WITH 3841 02:30:26,560 --> 02:30:27,120 SCORES. 3842 02:30:27,120 --> 02:30:27,600 THERE ARE LIMITATIONS. 3843 02:30:27,600 --> 02:30:30,000 THERE WERE LARGE NUMBER OF 3844 02:30:30,000 --> 02:30:32,440 MISSING VALUES FOR THE 3845 02:30:32,440 --> 02:30:33,080 CONTEXTUALIZED STRESS AND 3846 02:30:33,080 --> 02:30:34,080 RESILIENCE MEASURES DUE TO THE 3847 02:30:34,080 --> 02:30:36,520 FACT THE MEASURES WERE ONLY PART 3848 02:30:36,520 --> 02:30:39,240 OF THE SUPPLEMENTAL DATA 3849 02:30:39,240 --> 02:30:39,560 COLLECTION. 3850 02:30:39,560 --> 02:30:42,000 AND WE INTEND TO TAKE THIS 3851 02:30:42,000 --> 02:30:44,280 FURTHER, OUR PLAN FOR FUTURE 3852 02:30:44,280 --> 02:30:47,880 ANALYSIS INCLUDE A LATENT GROWTH 3853 02:30:47,880 --> 02:30:49,120 CURVE ANALYSIS ON SYMPTOMS 3854 02:30:49,120 --> 02:30:51,280 ACROSS THE STUDY AND CONDUCTING 3855 02:30:51,280 --> 02:30:53,480 MODERATION ANALYSIS AS TO HOW 3856 02:30:53,480 --> 02:30:57,520 RISK AND RESILIENCE FACTORS CAN 3857 02:30:57,520 --> 02:30:59,000 INFLUENCE DEPRESSIVE SYMPTOM 3858 02:30:59,000 --> 02:31:00,280 TRAJECTORIES ACROSS TIME 3859 02:31:00,280 --> 02:31:02,240 EXAMINING COVID-RELATED CHANGES, 3860 02:31:02,240 --> 02:31:08,160 COVID INFECTION, COPING AND 3861 02:31:08,160 --> 02:31:08,520 DISCRIMINATION. 3862 02:31:08,520 --> 02:31:08,840 NEXT SLIDE. 3863 02:31:08,840 --> 02:31:10,440 I'D LIKE TO EXTEND GRATITUDE TO 3864 02:31:10,440 --> 02:31:12,640 ALL OF THE TEAM MEMBERS INVOLVED 3865 02:31:12,640 --> 02:31:16,680 IN THIS WORK, RANGING FROM OUR 3866 02:31:16,680 --> 02:31:18,000 CO-INVESTIGATORS AT VCU AND 3867 02:31:18,000 --> 02:31:19,000 ARIZONA STATE UNIVERSITY, STUDY 3868 02:31:19,000 --> 02:31:22,800 TEAM ON THE GROUND WORKING DAY 3869 02:31:22,800 --> 02:31:26,440 BY DAY WITH OUR PREGNANT AND 3870 02:31:26,440 --> 02:31:27,400 POSTPARTUM PARTICIPANTS, 3871 02:31:27,400 --> 02:31:31,560 RESEARCH ASSISTANTS AND 3872 02:31:31,560 --> 02:31:34,080 COMMUNITY CONSULTANTS. 3873 02:31:34,080 --> 02:31:34,840 AND NEXT SLIDE. 3874 02:31:34,840 --> 02:31:36,920 I'D LIKE TO THANK OUR 3875 02:31:36,920 --> 02:31:38,000 PARTICIPANTS ACROSS THE NATION 3876 02:31:38,000 --> 02:31:40,080 FOR ENGAGING AS PARTNERS WITH US 3877 02:31:40,080 --> 02:31:42,040 IN THIS WORK, AND I'D LIKE TO 3878 02:31:42,040 --> 02:31:43,840 THANK OUR MULTIPLE COMMUNITY 3879 02:31:43,840 --> 02:31:47,640 PARTNERS WHO HAVE SHARED ABOUT 3880 02:31:47,640 --> 02:31:50,160 THIS PROJECT. 3881 02:31:50,160 --> 02:31:52,120 I WILL FINISH WITH OFFERING 3882 02:31:52,120 --> 02:31:54,000 MYSELF TO ANSWER ANY QUESTIONS 3883 02:31:54,000 --> 02:32:03,160 AND WELCOMING ANYONE TO GO TO 3884 02:32:03,160 --> 02:32:05,960 OUR STUDY WEBSITE. 3885 02:32:05,960 --> 02:32:07,760 >>WE'RE EXCITED TO HAVE YOU 3886 02:32:07,760 --> 02:32:10,400 HERE TODAY AND SHARE SOME MORE 3887 02:32:10,400 --> 02:32:11,400 THOUGHTFUL ENGAGEMENT AROUND 3888 02:32:11,400 --> 02:32:12,240 YOUR SPECIFIC WORK. 3889 02:32:12,240 --> 02:32:22,760 SO LET'S START WITH A QUESTION 3890 02:32:30,840 --> 02:32:32,160 TO DR. KINSNER. 3891 02:32:32,160 --> 02:32:34,480 CAN YOU TALK ABOUT HOW YOUR WORK 3892 02:32:34,480 --> 02:32:39,280 SPECIFICALLY ADDRESSED SOME OF 3893 02:32:39,280 --> 02:32:44,880 THE ACUTE STRESSORS CALMING 3894 02:32:44,880 --> 02:32:46,720 PATHWAYS THAT INCREASED RISK? 3895 02:32:46,720 --> 02:32:51,400 >>SO, THAT'S A BIG QUESTION. 3896 02:32:51,400 --> 02:32:52,040 >>IT IS. 3897 02:32:52,040 --> 02:32:53,520 >>PRELIMINARY DATA ALONE I 3898 02:32:53,520 --> 02:32:57,280 CAN'T GUARANTEE ANY OF THAT. 3899 02:32:57,280 --> 02:33:00,400 CERTAINLY WE HYPOTHESIZE THAT 3900 02:33:00,400 --> 02:33:03,400 PROVIDING THAT THROUGH AN 3901 02:33:03,400 --> 02:33:04,920 INTERVENTION LIKE THIS THAT 3902 02:33:04,920 --> 02:33:06,120 PROVIDES COMPREHENSIVE 3903 02:33:06,120 --> 02:33:11,960 INFORMATION AND PRACTICES, IT'S 3904 02:33:11,960 --> 02:33:13,920 AN OPPORTUNITY FOR INDIVIDUALS 3905 02:33:13,920 --> 02:33:16,080 TO THINK ADDITIONAL SUPPORT GAIN 3906 02:33:16,080 --> 02:33:16,880 GAIN SOCIAL SUPPORT AS WELL EVEN 3907 02:33:16,880 --> 02:33:25,200 THOUGH THEY ARE NOT DIRECTLY 3908 02:33:25,200 --> 02:33:27,840 INTERACTING WITH OTHERS THROUGH 3909 02:33:27,840 --> 02:33:28,720 THE PROGRAM. 3910 02:33:28,720 --> 02:33:29,560 THESE INTERVENTIONS THAT WE'RE 3911 02:33:29,560 --> 02:33:34,640 DISCUSSING WE HAVE TO LOOK AT 3912 02:33:34,640 --> 02:33:36,920 CONTEXT, AND THE CONTEXT IN ONE 3913 02:33:36,920 --> 02:33:40,520 OTHER OTHER OUR TEAM IS 3914 02:33:40,520 --> 02:33:42,720 INTERESTED IN IS WHAT PORTION OF 3915 02:33:42,720 --> 02:33:46,960 OUR PARTICIPANTS WERE IN RURAL 3916 02:33:46,960 --> 02:33:49,400 AREAS VERSUS URBAN AREAS. 3917 02:33:49,400 --> 02:33:50,200 ARE THERE TEMPORAL DIFFERENCES 3918 02:33:50,200 --> 02:33:53,400 ACCORDING TO AREAS OF THE 3919 02:33:53,400 --> 02:33:55,960 NATION, WHAT WAS HAPPENING WHEN 3920 02:33:55,960 --> 02:33:57,240 THESE PERCEIVED DISCRIMINATION 3921 02:33:57,240 --> 02:33:59,240 AND RACISM QUESTIONS WERE ASKED. 3922 02:33:59,240 --> 02:34:01,960 SO, A LOT OF THOSE TEMPORAL 3923 02:34:01,960 --> 02:34:03,080 DIFFERENCES WILL BE CRITICAL IN 3924 02:34:03,080 --> 02:34:03,880 ANSWERING THAT QUESTION. 3925 02:34:03,880 --> 02:34:06,440 I'M NOT SURE I HAVE THE FINAL 3926 02:34:06,440 --> 02:34:08,720 ANSWER TO THAT REALLY IMPORTANT 3927 02:34:08,720 --> 02:34:09,080 QUESTION YET. 3928 02:34:09,080 --> 02:34:10,920 >>THANK YOU SO MUCH. 3929 02:34:10,920 --> 02:34:12,040 THAT WAS SUPER HELPFUL. 3930 02:34:12,040 --> 02:34:14,120 THIS COULD BE A QUESTION FOR OUR 3931 02:34:14,120 --> 02:34:15,640 WHOLE PANEL. 3932 02:34:15,640 --> 02:34:16,960 HOW DOES YOUR INDIVIDUAL 3933 02:34:16,960 --> 02:34:18,280 INTERVENTION PROGRAM FIT INTO 3934 02:34:18,280 --> 02:34:20,480 EFFORTS TO IMPROVE MENTAL HEALTH 3935 02:34:20,480 --> 02:34:23,000 COVERAGE, ACCESS TO MENTAL 3936 02:34:23,000 --> 02:34:24,200 HEALTH PROVIDERS AND REDUCED 3937 02:34:24,200 --> 02:34:25,920 STIGMA AMONG PREGNANT AND 3938 02:34:25,920 --> 02:34:31,000 BIRTHING PERSONS WHO NEED 3939 02:34:31,000 --> 02:34:31,800 TREATMENT? 3940 02:34:31,800 --> 02:34:33,840 ANY THOUGHTS FROM ANYONE? 3941 02:34:33,840 --> 02:34:35,480 >>I CAN QUICKLY SAY MINE WAS 3942 02:34:35,480 --> 02:34:37,680 NOT AN INTERVENTION SO I CAN'T 3943 02:34:37,680 --> 02:34:41,000 ANSWER THAT QUESTION. 3944 02:34:41,000 --> 02:34:42,160 3945 02:34:42,160 --> 02:34:43,560 >>OURS NEITHER. 3946 02:34:43,560 --> 02:34:47,080 AND WE'RE STILL GETTING INTO 3947 02:34:47,080 --> 02:34:48,080 INDIVIDUAL LEVEL DATA. 3948 02:34:48,080 --> 02:34:50,480 >>I'D BE HAPPY TO TAKE -- I 3949 02:34:50,480 --> 02:34:56,280 THINK THE BENEFIT OF HAVING A 3950 02:34:56,280 --> 02:34:57,240 UNIVERSALLY AVAILABLE PREVENTION 3951 02:34:57,240 --> 02:35:00,200 TOOL WILL HELP WITH ADDRESSING 3952 02:35:00,200 --> 02:35:04,920 STIGMA TO SOME DEGREE BECAUSE IT 3953 02:35:04,920 --> 02:35:10,080 DOESN'T REQUIRE THE VERY 3954 02:35:10,080 --> 02:35:11,160 COMPLICATED PROCESS OF SOMEBODY 3955 02:35:11,160 --> 02:35:12,360 IDENTIFYING I NEED HELP OR I 3956 02:35:12,360 --> 02:35:15,960 NEED TO HAVE SOME PREVENTION 3957 02:35:15,960 --> 02:35:17,520 STRATEGIES, AND THEN CONTACTING 3958 02:35:17,520 --> 02:35:20,040 A PROVIDER, YOU KNOW, MAKING 3959 02:35:20,040 --> 02:35:21,200 THOSE MULTIPLE STEPS AND THE 3960 02:35:21,200 --> 02:35:22,960 REALITIES THAT WE KNOW TO BE 3961 02:35:22,960 --> 02:35:26,720 TRUE OVER THE PAST 2 1/2 YEARS 3962 02:35:26,720 --> 02:35:28,480 WERE ALSO THAT ACCESS TO MENTAL 3963 02:35:28,480 --> 02:35:31,760 HEALTH PROVIDERS HAS BEEN 3964 02:35:31,760 --> 02:35:34,160 SEVERELY LIMITED AND NOT MEETING 3965 02:35:34,160 --> 02:35:35,480 REAL NEED MOST PREGNANT AND 3966 02:35:35,480 --> 02:35:38,080 POSTPARTUM INDIVIDUALS ARE 3967 02:35:38,080 --> 02:35:39,440 FACING IN OUR COUNTRY, SO THAT'S 3968 02:35:39,440 --> 02:35:43,680 WHY MANY OF US HAVE GOTTEN INTO 3969 02:35:43,680 --> 02:35:44,760 THE PREVENTION INTERVENTION 3970 02:35:44,760 --> 02:35:48,800 WORLD, BECAUSE IF WE CAN OFFER 3971 02:35:48,800 --> 02:35:50,560 STRATEGIES FOR PREVENTION AND/OR 3972 02:35:50,560 --> 02:35:56,360 EASY INTERVENTION TOOLS THAT ARE 3973 02:35:56,360 --> 02:35:57,880 EASILY ACCESSIBLE AND 3974 02:35:57,880 --> 02:36:00,520 NON-PHARMACOLOGIC LOW COST, THAT 3975 02:36:00,520 --> 02:36:03,480 IDEALLY WE'LL BE ABLE TO START 3976 02:36:03,480 --> 02:36:07,040 ADDRESSING STIGMA RELATING TO 3977 02:36:07,040 --> 02:36:07,400 MENTAL HEALTH. 3978 02:36:07,400 --> 02:36:08,400 >>THANK YOU. 3979 02:36:08,400 --> 02:36:11,120 THE NEXT QUESTION IS FOR DR. 3980 02:36:11,120 --> 02:36:11,440 HARVILLE. 3981 02:36:11,440 --> 02:36:14,840 WHAT ARE YOUR THOUGHTS ABOUT 3982 02:36:14,840 --> 02:36:16,400 FUTURE COLLABORATIONS ON 3983 02:36:16,400 --> 02:36:18,800 RIGOROUS STUDIES ACROSS MULTIPLE 3984 02:36:18,800 --> 02:36:19,480 COMMUNITIES THAT EXAMINE 3985 02:36:19,480 --> 02:36:20,040 RELATIONSHIP BETWEEN FEATURE 3986 02:36:20,040 --> 02:36:23,160 RESPECT OF THE BUILT ENVIRONMENT 3987 02:36:23,160 --> 02:36:29,160 AND GESTATIONAL WEIGHT GAIN IN 3988 02:36:29,160 --> 02:36:29,720 PREGNANT WOMEN? 3989 02:36:29,720 --> 02:36:32,760 >>YEAH, SO DR. REDMOND, THE 3990 02:36:32,760 --> 02:36:35,400 P.I. ON THIS PROJECT, THIS WAS 3991 02:36:35,400 --> 02:36:37,920 ALL THESE SUPPLEMENT TO EXISTING 3992 02:36:37,920 --> 02:36:39,600 PROJECT, RIGHT? 3993 02:36:39,600 --> 02:36:42,080 HER EXISTING PROJECT ACTUALLY IS 3994 02:36:42,080 --> 02:36:44,280 IN CONJUNCTION WITH THE WIC 3995 02:36:44,280 --> 02:36:45,840 CLINIC, I DON'T THINK IT'S AS 3996 02:36:45,840 --> 02:36:48,320 MUCH ABOUT THE BUILT ENVIRONMENT 3997 02:36:48,320 --> 02:36:51,080 BUT LOOKING AT SOME 3998 02:36:51,080 --> 02:36:53,400 INTERVENTIONS TO IMPROVE 3999 02:36:53,400 --> 02:36:56,120 NUTRITION AND SO FORTH DURING 4000 02:36:56,120 --> 02:36:57,720 PREGNANCY AND POSTPARTUM. 4001 02:36:57,720 --> 02:37:00,600 I'M ALL FOR INTERVENTIONS THAT 4002 02:37:00,600 --> 02:37:03,120 IMPROVE THE BUILT ENVIRONMENT. 4003 02:37:03,120 --> 02:37:06,080 I THINK TO FIND THE STRONG 4004 02:37:06,080 --> 02:37:09,240 EFFECT WE WILL HAVE TO BE LIKE 4005 02:37:09,240 --> 02:37:10,520 MULTIPLE SITES AND A WHOLE LOT 4006 02:37:10,520 --> 02:37:13,960 OF PEOPLE BECAUSE I THINK THE 4007 02:37:13,960 --> 02:37:16,240 EFFECT IS SUBTLE SO I'M ALL FOR 4008 02:37:16,240 --> 02:37:17,360 THAT FOR A NUMBER OF REASONS BUT 4009 02:37:17,360 --> 02:37:18,640 TRYING TO PICK OUT THE SIGNAL 4010 02:37:18,640 --> 02:37:24,120 THERE I KNOW IS GOING TO BE 4011 02:37:24,120 --> 02:37:24,400 DIFFICULT. 4012 02:37:24,400 --> 02:37:27,280 >>THANK YOU. 4013 02:37:27,280 --> 02:37:30,760 NEXT QUESTION IS FOR DR. 4014 02:37:30,760 --> 02:37:31,040 DUMITRU. 4015 02:37:31,040 --> 02:37:37,480 MENTAL HEALTH RELATED STIGMA IS 4016 02:37:37,480 --> 02:37:38,160 WIDESPREAD, INTERDISCIPLINARY 4017 02:37:38,160 --> 02:37:40,960 COLLABORATION IS SUCH AN 4018 02:37:40,960 --> 02:37:43,160 IMPORTANT PART TO WOMEN, DURING 4019 02:37:43,160 --> 02:37:44,160 PREGNANCY, BIRTHING PERIOD AND 4020 02:37:44,160 --> 02:37:45,040 POSTPARTUM. 4021 02:37:45,040 --> 02:37:46,360 TALK ABOUT THE FEASIBILITY AND 4022 02:37:46,360 --> 02:37:49,280 IMPORTANCE OF TRAINING THE WHOLE 4023 02:37:49,280 --> 02:37:52,360 CARE TEAM TO CONDUCT MENTAL 4024 02:37:52,360 --> 02:37:54,640 HEALTH SCREENINGS AND PROVIDE 4025 02:37:54,640 --> 02:37:55,680 THE ENTREE INTO PSYCHOSOCIAL 4026 02:37:55,680 --> 02:38:01,320 CARE AND SUPPORTS DURING THE 4027 02:38:01,320 --> 02:38:01,600 ENCOUNTER. 4028 02:38:01,600 --> 02:38:02,920 >>YEAH, THE MULTI-DISCIPLINARY 4029 02:38:02,920 --> 02:38:06,520 NATURE IS REALLY MY FAVORITE 4030 02:38:06,520 --> 02:38:08,440 PART OF THE WORK. 4031 02:38:08,440 --> 02:38:12,520 I ALSO WANT TO REITERATE I'M A 4032 02:38:12,520 --> 02:38:14,480 PEDIATRICIAN WHICH IS I KNOW A 4033 02:38:14,480 --> 02:38:17,120 BIT UNIQUE FOR THIS PARTICULAR 4034 02:38:17,120 --> 02:38:19,600 VENUE, BUT I CAN OFFER 4035 02:38:19,600 --> 02:38:20,600 PERSPECTIVE EVEN IN PEDIATRICS 4036 02:38:20,600 --> 02:38:22,840 WE'RE REALLY TALKING ABOUT HOW 4037 02:38:22,840 --> 02:38:27,200 DO WE AS PEDIATRICIANS TAKE ON 4038 02:38:27,200 --> 02:38:30,120 THE PARENT AS OUR PATIENT AS 4039 02:38:30,120 --> 02:38:31,280 WELL, AND PERHAPS DO UNIVERSAL 4040 02:38:31,280 --> 02:38:35,480 SCREENING, FOR EXAMPLE, IN THE 4041 02:38:35,480 --> 02:38:38,440 PEDIATRICIAN'S OFFICE. 4042 02:38:38,440 --> 02:38:40,120 IT'S INCREDIBLY IMPORTANT TO 4043 02:38:40,120 --> 02:38:45,280 THINK IN VERY BROAD TERMS AS I 4044 02:38:45,280 --> 02:38:48,120 ALSO MENTIONED MY OWN PERSONAL 4045 02:38:48,120 --> 02:38:53,440 MAIN FOCUS OF RESEARCH IS ON 4046 02:38:53,440 --> 02:38:54,800 RELATIONAL HEALTH, PARENT-CHILD 4047 02:38:54,800 --> 02:38:56,080 RELATIONAL HEALTH, WE'RE TRYING 4048 02:38:56,080 --> 02:39:00,040 TO THINK CREATIVELY OF HOW TO DO 4049 02:39:00,040 --> 02:39:01,640 THAT IN A PEDIATRIC OFFICE AND 4050 02:39:01,640 --> 02:39:03,400 HOW TO DO THAT AT SCALE. 4051 02:39:03,400 --> 02:39:04,960 SO I THINK IT'S INCREDIBLY 4052 02:39:04,960 --> 02:39:05,680 IMPORTANT. 4053 02:39:05,680 --> 02:39:09,520 I WANT TO SAY THAT HAVING WORKED 4054 02:39:09,520 --> 02:39:12,360 WITH A VERY LARGE TEAM AND 4055 02:39:12,360 --> 02:39:17,320 COMBO, WORKED WITH LOTS OF OB 4056 02:39:17,320 --> 02:39:19,720 DOCS, PSYCHOLOGISTS, 4057 02:39:19,720 --> 02:39:20,360 PSYCHIATRISTS, ADULT 4058 02:39:20,360 --> 02:39:21,360 NEUROLOGISTS, ENTs, IT'S 4059 02:39:21,360 --> 02:39:23,800 REALLY WHAT COMES OUT OF 4060 02:39:23,800 --> 02:39:26,800 SOMETHING LIKE THAT IS TRULY 4061 02:39:26,800 --> 02:39:29,320 UNIQUE AND DIFFERENT, AND SORT 4062 02:39:29,320 --> 02:39:31,280 OF EMERGENT PROPERTY OF A GROUP 4063 02:39:31,280 --> 02:39:37,760 SO I REALLY THINK IT'S 4064 02:39:37,760 --> 02:39:38,040 IMPORTANT. 4065 02:39:38,040 --> 02:39:38,960 >>THANK YOU. 4066 02:39:38,960 --> 02:39:41,480 ONE OF YOUR FELLOW PANELISTS 4067 02:39:41,480 --> 02:39:48,280 HAVE A QUESTION, FOR DR. 4068 02:39:48,280 --> 02:39:49,880 KINSNER. 4069 02:39:49,880 --> 02:39:51,440 DISCRIMINATION HAD A UNIQUE 4070 02:39:51,440 --> 02:39:59,400 EFFECT, WHAT ARE IMPLICATIONS 4071 02:39:59,400 --> 02:40:03,920 FOR TREATMENT? 4072 02:40:03,920 --> 02:40:07,000 THAT'S AROUND THE MAMMA MIA 4073 02:40:07,000 --> 02:40:07,200 STUDY. 4074 02:40:07,200 --> 02:40:11,280 >>MY UNMUTE WOULDN'T UNMUTE. 4075 02:40:11,280 --> 02:40:13,080 TO CLARIFY DISCRIMINATION DID 4076 02:40:13,080 --> 02:40:20,000 NOT HAVE A UNIQUE EFFECT 4077 02:40:20,000 --> 02:40:20,960 SEPARATE FROM INTERVENTION, 4078 02:40:20,960 --> 02:40:24,480 WHICH WAS SURPRISING TO US. 4079 02:40:24,480 --> 02:40:26,240 NONETHELESS I THINK THERE WOULD 4080 02:40:26,240 --> 02:40:28,120 BE AN OBVIOUS COMMENT THAT ANY 4081 02:40:28,120 --> 02:40:32,480 OF US WOULD GIVE THAT THERE ARE 4082 02:40:32,480 --> 02:40:34,440 OPPORTUNITIES TO ADDRESS 4083 02:40:34,440 --> 02:40:37,640 DISCRIMINATION ACROSS HEALTH 4084 02:40:37,640 --> 02:40:39,840 CARE SYSTEMS, ACROSS SOCIETY, I 4085 02:40:39,840 --> 02:40:44,840 THINK IMPLICATIONS FOR TREATMENT 4086 02:40:44,840 --> 02:40:47,120 OF WHAT WOULD BE MY QUESTION 4087 02:40:47,120 --> 02:40:49,880 BACK IMPLICATIONS FOR TREATMENT 4088 02:40:49,880 --> 02:40:51,400 OF DEPRESSION SYMPTOMS AND 4089 02:40:51,400 --> 02:40:53,040 DISCRIMINATION, I WONDER IF SHE 4090 02:40:53,040 --> 02:40:56,760 WANTS TO CLARIFY HER QUESTION. 4091 02:40:56,760 --> 02:41:05,560 4092 02:41:05,560 --> 02:41:09,600 I'LL ECHO ONE THING SAID THAT 4093 02:41:09,600 --> 02:41:10,800 TREATING THE PARENT-CHILD DYAD 4094 02:41:10,800 --> 02:41:14,360 IS SO CRITICAL BECAUSE IN 4095 02:41:14,360 --> 02:41:16,800 PREGNANCY THEY ARE A DYAD, IN 4096 02:41:16,800 --> 02:41:18,120 THE POSTPARTUM PERIOD THEY DO 4097 02:41:18,120 --> 02:41:21,720 CONTINUE TO BE THAT DYAD. 4098 02:41:21,720 --> 02:41:24,320 AND SO HAVING THAT DYAD AT THE 4099 02:41:24,320 --> 02:41:27,960 CENTER OR TRIAD IF WE HAVE TWO 4100 02:41:27,960 --> 02:41:30,960 PARENTS AND CHILD, AND PAYING 4101 02:41:30,960 --> 02:41:32,400 ATTENTION TO DEPRESSIVE AND 4102 02:41:32,400 --> 02:41:33,600 OTHER RELATED SYMPTOMS THAT ARE 4103 02:41:33,600 --> 02:41:35,480 ARISING IS GOING TO BE CRITICAL 4104 02:41:35,480 --> 02:41:37,200 FOR THE HEALTH AND WELLNESS OF 4105 02:41:37,200 --> 02:41:39,600 THE CHILD AS WELL AS FAMILY 4106 02:41:39,600 --> 02:41:42,640 FUNCTIONING SO I LOVE TO HEAR 4107 02:41:42,640 --> 02:41:44,280 THESE CONVERSATIONS WHERE WE'RE 4108 02:41:44,280 --> 02:41:48,240 ALL -- WE ALL HAVE THIS AS 4109 02:41:48,240 --> 02:41:49,720 COMMON GOAL AND ADDRESSING 4110 02:41:49,720 --> 02:41:50,960 STIGMA IN A PEDIATRIC SETTING 4111 02:41:50,960 --> 02:41:54,800 JUST AS MUCH AS WE ADDRESS IT IN 4112 02:41:54,800 --> 02:41:57,160 AN OBSTETRIC OR WOMEN'S HEALTH 4113 02:41:57,160 --> 02:41:59,320 SETTING IS SO CRITICAL FOR 4114 02:41:59,320 --> 02:42:00,560 ADVANCING PERINATAL MENTAL 4115 02:42:00,560 --> 02:42:01,120 HEALTH. 4116 02:42:01,120 --> 02:42:03,640 ANOTHER THING I'LL SAY THERE ARE 4117 02:42:03,640 --> 02:42:05,080 OPPORTUNITIES FOR ENHANCING HOW 4118 02:42:05,080 --> 02:42:08,720 WE SCREEN AND HOW WE HAVE 4119 02:42:08,720 --> 02:42:09,360 NORMALIZING CONVERSATIONS ABOUT 4120 02:42:09,360 --> 02:42:13,200 SOME OF THE QUESTIONS THAT ARE 4121 02:42:13,200 --> 02:42:18,000 IN SCREENINGS, IT'S AN 4122 02:42:18,000 --> 02:42:19,320 INCREDIBLE OPPORTUNITY FOR 4123 02:42:19,320 --> 02:42:20,040 IMPROVEMENT. 4124 02:42:20,040 --> 02:42:20,520 >>THANK YOU. 4125 02:42:20,520 --> 02:42:23,680 THAT BRINGS ME TO A QUESTION FOR 4126 02:42:23,680 --> 02:42:25,760 THE ENTIRE PANEL, WHAT ARE SOME 4127 02:42:25,760 --> 02:42:27,320 BARRIERS TO CLINICAL TRIALS WITH 4128 02:42:27,320 --> 02:42:29,640 PREGNANT WOMEN THAT ARE SEEKING 4129 02:42:29,640 --> 02:42:32,120 TO EXPLORE SOME MODIFIABLE RISK 4130 02:42:32,120 --> 02:42:33,880 FACTORS AND LEVERAGE POLICY 4131 02:42:33,880 --> 02:42:38,520 INTERVENTIONS TO REDUCE WHETHER 4132 02:42:38,520 --> 02:42:39,560 WEIGHT GAIN, MENTAL HEALTH 4133 02:42:39,560 --> 02:42:42,760 IMPACT ON WOMEN DURING THIS 4134 02:42:42,760 --> 02:42:44,520 IMPORTANT PERIOD, OTHER THINGS? 4135 02:42:44,520 --> 02:42:45,200 DEFINITELY SOME CLEAR 4136 02:42:45,200 --> 02:42:46,680 OPPORTUNITIES AND I THOUGHT IT 4137 02:42:46,680 --> 02:42:53,240 WOULD BE OPPORTUNITY TO DIALOGUE 4138 02:42:53,240 --> 02:42:54,280 ABOUT THAT. 4139 02:42:54,280 --> 02:42:58,160 >>I'M NOT THE OBSTETRICIAN BUT 4140 02:42:58,160 --> 02:42:59,080 PREGNANT WOMEN ARE CONSIDERED A 4141 02:42:59,080 --> 02:43:02,120 HIGH RISK GROUP IN GENERAL, IT 4142 02:43:02,120 --> 02:43:06,200 IS ALWAYS A LITTLE BIT TOUGHER 4143 02:43:06,200 --> 02:43:07,720 TO CONDUCT RCTs, MOST OF THE 4144 02:43:07,720 --> 02:43:12,160 STUFF WE'RE TALKING ABOUT IS LOW 4145 02:43:12,160 --> 02:43:14,960 RISK BUT THERE'S A LOT OF 4146 02:43:14,960 --> 02:43:17,160 CHALLENGES BECAUSE IT'S NOT JUST 4147 02:43:17,160 --> 02:43:19,320 ONE INDIVIDUAL. 4148 02:43:19,320 --> 02:43:20,000 THERE ARE TWO INDIVIDUALS 4149 02:43:20,000 --> 02:43:22,880 INVOLVED. 4150 02:43:22,880 --> 02:43:26,880 ALSO THERE'S A LOT OF CHALLENGES 4151 02:43:26,880 --> 02:43:28,840 WITHIN OUR FIELD. 4152 02:43:28,840 --> 02:43:31,480 WE'VE BEEN SUCCESSFUL IN FORGING 4153 02:43:31,480 --> 02:43:33,680 A TRUE COLLABORATION BETWEEN 4154 02:43:33,680 --> 02:43:35,000 OBSTETRICS AND PEDIATRICS AT 4155 02:43:35,000 --> 02:43:36,920 COLUMBIA BUT IT TOOK SOME TIME, 4156 02:43:36,920 --> 02:43:39,800 IT TAKES A LOT OF PATIENCE AND 4157 02:43:39,800 --> 02:43:41,680 YOU HAVE TO BE REALLY WILLING TO 4158 02:43:41,680 --> 02:43:44,280 LISTEN TO A VERY DIFFERENT 4159 02:43:44,280 --> 02:43:45,160 PERSPECTIVE AND THAT'S NOT 4160 02:43:45,160 --> 02:43:47,800 ALWAYS EASY. 4161 02:43:47,800 --> 02:43:48,680 4162 02:43:48,680 --> 02:43:54,680 >>I THINK WE CAN SAY THAT EVEN 4163 02:43:54,680 --> 02:43:57,240 BEYOND THE RESTRICTIONS OR 4164 02:43:57,240 --> 02:43:59,640 REGULATION TO PROTECT PREGNANT 4165 02:43:59,640 --> 02:44:00,480 WOMEN, FETUSES, SO FORTH, WHICH 4166 02:44:00,480 --> 02:44:02,880 ANY OF US WHO DO RESEARCH IN 4167 02:44:02,880 --> 02:44:04,760 THAT GROUP KNOW ABOUT THE EXTRA 4168 02:44:04,760 --> 02:44:06,920 FORMS WE HAVE TO FILL OUT. 4169 02:44:06,920 --> 02:44:09,480 THERE'S A LOT OF CONSERVATISM ON 4170 02:44:09,480 --> 02:44:12,520 THE PART OF IRBs AND 4171 02:44:12,520 --> 02:44:14,720 REGULATORY AGENCIES EVEN BEYOND 4172 02:44:14,720 --> 02:44:17,360 WHAT IS MAYBE INDICATED BY THE 4173 02:44:17,360 --> 02:44:18,720 STRENGTH OF THE EVIDENCE. 4174 02:44:18,720 --> 02:44:23,480 THE OTHER THING I THINK THAT IS 4175 02:44:23,480 --> 02:44:24,640 IMPORTANT IS RELEVANT TO 4176 02:44:24,640 --> 02:44:25,120 MATERNAL HEALTH. 4177 02:44:25,120 --> 02:44:32,120 A LOT IS HOW THE WOMAN ENTERS 4178 02:44:32,120 --> 02:44:34,760 PREGNANCY, AND A LOT ARE 4179 02:44:34,760 --> 02:44:35,480 UNPLANNED, AND THE TIME WE 4180 02:44:35,480 --> 02:44:38,040 REALLY WANT TO BE INTERVENING 4181 02:44:38,040 --> 02:44:40,040 MIGHT BE, YOU KNOW, A YEAR 4182 02:44:40,040 --> 02:44:41,640 EARLIER OR TWO YEARS EARLIER AND 4183 02:44:41,640 --> 02:44:44,600 THAT IS EVEN HARDER BECAUSE THE 4184 02:44:44,600 --> 02:44:45,920 POPULATION IS IMPOSSIBLE TO 4185 02:44:45,920 --> 02:44:46,560 DEFINE EVEN. 4186 02:44:46,560 --> 02:44:49,640 BUT I THINK THAT'S ANOTHER 4187 02:44:49,640 --> 02:44:50,000 CHALLENGE. 4188 02:44:50,000 --> 02:44:51,960 CONCENTRATING ON NOT EVEN THE 4189 02:44:51,960 --> 02:44:54,000 WHOLE PREGNANCY AS YOUR TIME 4190 02:44:54,000 --> 02:44:57,400 FRAME OF INTEREST, IT'S A TALL 4191 02:44:57,400 --> 02:44:58,520 ORDER TO REVERSE ANYTHING, 4192 02:44:58,520 --> 02:45:01,360 RIGHT? WHETHER A MEDICAL 4193 02:45:01,360 --> 02:45:02,640 CONDITION OR SOCIETAL 4194 02:45:02,640 --> 02:45:03,320 DISCRIMINATION, WITHIN THREE 4195 02:45:03,320 --> 02:45:06,040 MONTHS, SO I THINK THAT'S 4196 02:45:06,040 --> 02:45:06,600 ANOTHER CHALLENGE. 4197 02:45:06,600 --> 02:45:08,120 >>THANK YOU. 4198 02:45:08,120 --> 02:45:11,760 WE DO NEED A BROADER INVESTMENT 4199 02:45:11,760 --> 02:45:12,640 OVERALL, WONDERFUL INVESTIGATORS 4200 02:45:12,640 --> 02:45:14,520 LIKE YOU DO HELP US WORK TOWARDS 4201 02:45:14,520 --> 02:45:18,440 GETTING TO A PLACE WE GET TO A 4202 02:45:18,440 --> 02:45:19,760 POPULATION HEALTH WITH RESPECT 4203 02:45:19,760 --> 02:45:21,440 TO POPULATIONS OF WOMEN 4204 02:45:21,440 --> 02:45:22,200 THROUGHOUT THE REPRODUCTIVE 4205 02:45:22,200 --> 02:45:23,800 PERIOD AND THROUGHOUT THEIR LIFE 4206 02:45:23,800 --> 02:45:24,160 COURSE AS WELL. 4207 02:45:24,160 --> 02:45:29,600 THANK YOU FOR SHARING YOUR WOR. 4208 02:45:29,600 --> 02:45:31,160 WE'LL BREAK AND ALLOW OUR 4209 02:45:31,160 --> 02:45:35,240 PANELISTS AS WELL AS AUDIENCE TO 4210 02:45:35,240 --> 02:45:36,080 TAKE A QUICK BREAK. 4211 02:45:36,080 --> 02:45:38,960 THANK YOU FOR JOINING US. 4212 02:45:38,960 --> 02:45:41,480 WE APPRECIATE IT. 4213 02:45:41,480 --> 02:45:44,720 >>WELCOME BACK. 4214 02:45:44,720 --> 02:45:49,880 I'M DARA BLACHMAN-DEMNER, I'M 4215 02:45:49,880 --> 02:45:51,520 THRILLED TO BE MODERATING THE 4216 02:45:51,520 --> 02:45:54,600 NEXT PANEL ON SHAPING OUTCOMES 4217 02:45:54,600 --> 02:45:56,800 THROUGH TRANSLATIONAL RESEARCH. 4218 02:45:56,800 --> 02:46:00,000 FIRST WE WOULD LIKE TO WELCOME 4219 02:46:00,000 --> 02:46:01,520 DR. SHERYL FRANKLIN FROM 4220 02:46:01,520 --> 02:46:05,040 MOREHOUSE AND DR. NASIM KATEBI 4221 02:46:05,040 --> 02:46:06,680 FROM EMORY UNIVERSITY, 4222 02:46:06,680 --> 02:46:09,720 PRESENTING TODAY ON 4223 02:46:09,720 --> 02:46:12,800 IMPLEMENTATION AND FEASIBILITY 4224 02:46:12,800 --> 02:46:14,640 STUDY OF BESPOKE SMARTPHONE 4225 02:46:14,640 --> 02:46:15,320 BASED FOR APPLICATION MONITORING 4226 02:46:15,320 --> 02:46:17,080 OF PATIENT BLOOD PRESSURE AND 4227 02:46:17,080 --> 02:46:18,480 RELATED OUTCOME TO AVOID 4228 02:46:18,480 --> 02:46:19,680 PREVENTIBLE DELAYS IN HEALTH 4229 02:46:19,680 --> 02:46:21,440 CARE DURING THE POSTPARTUM 4230 02:46:21,440 --> 02:46:21,680 PERIOD. 4231 02:46:21,680 --> 02:46:23,520 THIS IS PART OF THE GEORGIA 4232 02:46:23,520 --> 02:46:34,000 IMPROVE PROGRAM ON MATERNAL 4233 02:46:36,040 --> 02:46:36,640 HEALTH, STRUCTURAL RACISM, 4234 02:46:36,640 --> 02:46:37,000 DISCRIMINATION. 4235 02:46:37,000 --> 02:46:41,040 >>I'M DR. CHERYL FRANKLIN, 4236 02:46:41,040 --> 02:46:47,040 PLEASED TO PRESENT OUR WORK TO 4237 02:46:47,040 --> 02:46:48,240 YOU TODAY. 4238 02:46:48,240 --> 02:46:52,520 WE HAVE BEEN PRIVILEGED TO HAVE 4239 02:46:52,520 --> 02:46:56,160 TWO GEORGIA -- TWO IMPROVE 4240 02:46:56,160 --> 02:46:57,880 INITIATIVE PROJECTS, THE FIRST 4241 02:46:57,880 --> 02:46:59,600 OF WHICH WAS GEORGIA IMPROVE, 4242 02:46:59,600 --> 02:47:02,360 AND THE SECOND OF WHICH WAS 4243 02:47:02,360 --> 02:47:04,520 GEORGIA IMPROVE ON MATERNAL 4244 02:47:04,520 --> 02:47:07,400 HEALTH, STRUCTURAL RACISM AND 4245 02:47:07,400 --> 02:47:11,440 DISCRIMINATION, AND COVID-19. 4246 02:47:11,440 --> 02:47:13,280 AND I'D LIKE TO PRESENT SOME 4247 02:47:13,280 --> 02:47:16,400 WORK FROM THE EFFORTS BUT WE'LL 4248 02:47:16,400 --> 02:47:19,440 FOCUS ON A TRANSLATIONAL 4249 02:47:19,440 --> 02:47:22,040 RESEARCH TOPIC THAT WE UNDERTOOK 4250 02:47:22,040 --> 02:47:24,560 WITHIN OUR GEORGIA IMPROVE ON 4251 02:47:24,560 --> 02:47:25,880 MATERNAL HEALTH STRUCTURAL 4252 02:47:25,880 --> 02:47:29,400 RACISM AND DISCRIMINATION AND 4253 02:47:29,400 --> 02:47:30,080 COVID-19. 4254 02:47:30,080 --> 02:47:35,080 I'M JOINED BY MY COLLEAGUE, DR. 4255 02:47:35,080 --> 02:47:43,640 NASIM KATEBI, FROM EMORY 4256 02:47:43,640 --> 02:47:44,360 UNIVERSITY. 4257 02:47:44,360 --> 02:47:49,120 WE'RE THRILLED AT RECEIVING 4258 02:47:49,120 --> 02:47:52,640 FUNDING FROM NIH IMPROVE 4259 02:47:52,640 --> 02:47:53,240 INITIATIVE, SPECIFICALLY THROUGH 4260 02:47:53,240 --> 02:47:56,440 THE NATIONAL CENTER FOR 4261 02:47:56,440 --> 02:47:58,080 ADVANCING TRANSLATIONAL 4262 02:47:58,080 --> 02:47:59,920 SCIENCES, THROUGH AN 4263 02:47:59,920 --> 02:48:06,400 ADMINISTRATIVE SUPPLEMENT TO THE 4264 02:48:06,400 --> 02:48:08,680 GEORGIA CTSA. 4265 02:48:08,680 --> 02:48:09,480 THERE'S OTHER FUNDING FOR 4266 02:48:09,480 --> 02:48:10,760 DEVELOPING TECHNOLOGY USED IN 4267 02:48:10,760 --> 02:48:12,200 OUR APPLICATION. 4268 02:48:12,200 --> 02:48:14,360 AS WE KNOW, MATERNAL MORTALITY 4269 02:48:14,360 --> 02:48:15,360 RATES IN THE UNITED STATES ARE 4270 02:48:15,360 --> 02:48:18,440 SOME OF THE HIGHEST IN THE 4271 02:48:18,440 --> 02:48:21,280 WORLD, AND WITHIN THE COUNTRY WE 4272 02:48:21,280 --> 02:48:23,040 LIVE IN GEORGIA, AND THE RATES 4273 02:48:23,040 --> 02:48:27,080 IN GEORGIA ARE SECOND HIGHEST IN 4274 02:48:27,080 --> 02:48:28,360 THE COUNTRY. 4275 02:48:28,360 --> 02:48:32,360 WE HAD -- THERE ARE ALSO 4276 02:48:32,360 --> 02:48:35,080 SIGNIFICANT RACIAL AND ETHNIC 4277 02:48:35,080 --> 02:48:38,280 DISPARITIES WITH BLACK WOMEN, 4278 02:48:38,280 --> 02:48:38,880 NON-HISPANIC BLACK WOMEN BEING 4279 02:48:38,880 --> 02:48:41,080 TWO TO THREE TIMES MORE LIKELY 4280 02:48:41,080 --> 02:48:44,960 TO DIE AS A RESULT OF A 4281 02:48:44,960 --> 02:48:45,720 PREGNANCY-RELATED ILLNESS AFTER 4282 02:48:45,720 --> 02:48:47,040 CHILD BIRTH. 4283 02:48:47,040 --> 02:48:47,960 SO WE WANT TO -- 4284 02:48:47,960 --> 02:48:49,120 >>I'M SORRY TO INTERRUPT. 4285 02:48:49,120 --> 02:48:53,040 I WANT TO LET YOU KNOW WE'RE 4286 02:48:53,040 --> 02:48:54,600 SEEING THE SPEAKER VIEW, SO WE 4287 02:48:54,600 --> 02:48:57,440 CAN SEE YOUR NOTES. 4288 02:48:57,440 --> 02:48:59,520 I DON'T KNOW IF YOU WANT TO KEEP 4289 02:48:59,520 --> 02:49:03,600 GOING BUT I DID WANT TO LET YOU 4290 02:49:03,600 --> 02:49:03,800 KNOW. 4291 02:49:03,800 --> 02:49:04,480 >>OKAY. 4292 02:49:04,480 --> 02:49:04,920 THAT'S INTERESTING. 4293 02:49:04,920 --> 02:49:07,640 >>I DON'T KNOW IF OUR TECH 4294 02:49:07,640 --> 02:49:08,200 FOLKS ARE ON. 4295 02:49:08,200 --> 02:49:11,040 MAYBE THEY CAN PROVIDE SOME 4296 02:49:11,040 --> 02:49:12,600 GUIDANCE. 4297 02:49:12,600 --> 02:49:15,320 I APOLOGIZE FOR INTERRUPTING. 4298 02:49:15,320 --> 02:49:16,280 >>QUITE ALL RIGHT. 4299 02:49:16,280 --> 02:49:19,640 NOW I CAN'T SEE MY NOTES BUT 4300 02:49:19,640 --> 02:49:22,320 I'LL WING IT. 4301 02:49:22,320 --> 02:49:22,640 >>THANK YOU. 4302 02:49:22,640 --> 02:49:26,360 >>I DON'T KNOW WHY THAT 4303 02:49:26,360 --> 02:49:26,680 HAPPENED. 4304 02:49:26,680 --> 02:49:30,840 BUT OF COURSE WE WERE TALKING 4305 02:49:30,840 --> 02:49:33,120 ABOUT HEALTH DISPARITIES IN THE 4306 02:49:33,120 --> 02:49:35,200 ISSUES IN GEORGIA, AND SOME 4307 02:49:35,200 --> 02:49:36,480 GEORGIA RECOMMENDATIONS THAT 4308 02:49:36,480 --> 02:49:40,040 HAVE COME OUT OF OUR MATERNAL 4309 02:49:40,040 --> 02:49:41,280 MORTALITY REVIEW COMMITTEE 4310 02:49:41,280 --> 02:49:43,640 INCLUDE THAT THERE SHOULD BE 4311 02:49:43,640 --> 02:49:48,000 BLOOD PRESSURE CHECKS AT 72 4312 02:49:48,000 --> 02:49:50,320 HOURS AFTER DELIVERY IN PERSONS 4313 02:49:50,320 --> 02:49:53,800 WITH PREECLAMPSIA AND WE SHOULD 4314 02:49:53,800 --> 02:49:56,440 DO -- PROVIDERS SHOULD EDUCATE 4315 02:49:56,440 --> 02:49:58,520 PATIENTS AND FAMILIES ABOUT 4316 02:49:58,520 --> 02:50:03,440 WARNING SIGNS AND SYMPTOMS THAT 4317 02:50:03,440 --> 02:50:05,440 COULD INDICATE WHEN THEY NEED TO 4318 02:50:05,440 --> 02:50:09,240 SEEK CARE AND WHEN THEY HAVE A 4319 02:50:09,240 --> 02:50:10,120 POTENTIAL LIFE-THREATENING 4320 02:50:10,120 --> 02:50:10,720 CONDITION. 4321 02:50:10,720 --> 02:50:16,040 AND SO WE TOOK THESE AND USED 4322 02:50:16,040 --> 02:50:17,760 THE THREE DELAY RUBRICS OR 4323 02:50:17,760 --> 02:50:19,960 FRAMEWORK HOW TO GUIDE OUR WORK. 4324 02:50:19,960 --> 02:50:24,480 AND WITH THIS FIRST CRITICAL 4325 02:50:24,480 --> 02:50:28,320 DELAY AFTER DELIVERY, BEING OR 4326 02:50:28,320 --> 02:50:29,200 DURING PREGNANCY, BEING 4327 02:50:29,200 --> 02:50:30,520 RECOGNIZING DANGER SIGNS AND 4328 02:50:30,520 --> 02:50:36,200 SYMPTOMS, A LACK OF AWARENESS, 4329 02:50:36,200 --> 02:50:37,040 EDUCATION, PATIENT AND FAMILY 4330 02:50:37,040 --> 02:50:39,480 EDUCATION, AS WELL AS SOME 4331 02:50:39,480 --> 02:50:42,000 CULTURAL NORMS AND PERSONAL 4332 02:50:42,000 --> 02:50:42,440 CHOICES. 4333 02:50:42,440 --> 02:50:45,920 SECOND CRITICAL DELAY THAT MIGHT 4334 02:50:45,920 --> 02:50:49,640 DELAY A PERSON'S ABILITY TO GET 4335 02:50:49,640 --> 02:50:52,720 APPROPRIATE CARE WOULD BE 4336 02:50:52,720 --> 02:50:53,320 SOCIOECONOMIC CONSTRAINTS, 4337 02:50:53,320 --> 02:50:56,040 DECIDING WHEN TO SEEK CARE, 4338 02:50:56,040 --> 02:51:00,760 ACCESS TO CARE, ABSENCE OF 4339 02:51:00,760 --> 02:51:03,240 FAMILY SUPPORT, POOR REFERRALS. 4340 02:51:03,240 --> 02:51:05,640 THE THIRD DELAY BEING ONCE A 4341 02:51:05,640 --> 02:51:08,920 PERSON IS IN A SUITABLE SITE OF 4342 02:51:08,920 --> 02:51:14,960 CARE BEING ABLE TO RECEIVE 4343 02:51:14,960 --> 02:51:16,160 APPROPRIATE CARE. 4344 02:51:16,160 --> 02:51:19,320 OUR FIRST GEORGIA IMPROVE 4345 02:51:19,320 --> 02:51:21,920 PROJECT WAS REALLY AN 4346 02:51:21,920 --> 02:51:22,640 INFRASTRUCTURE FACILITATION TYPE 4347 02:51:22,640 --> 02:51:23,840 OF A PROJECT. 4348 02:51:23,840 --> 02:51:31,720 WE WANTED TO BE ABLE TO EXTENDS 4349 02:51:31,720 --> 02:51:33,760 OR WORK INTO THE COMMUNITY IN 4350 02:51:33,760 --> 02:51:34,960 GEORGIA. 4351 02:51:34,960 --> 02:51:38,600 AND SO WE SET ABOUT DEVELOPING A 4352 02:51:38,600 --> 02:51:42,560 PERINATAL CARE RESEARCH AND 4353 02:51:42,560 --> 02:51:44,960 INTERVENTION NETWORK OF 4354 02:51:44,960 --> 02:51:45,960 PATIENTS, PROVIDERS, HEALTH 4355 02:51:45,960 --> 02:51:48,880 SYSTEMS THROUGHOUT THE STATE OF 4356 02:51:48,880 --> 02:51:51,840 GEORGIA TO BE ABLE TO 4357 02:51:51,840 --> 02:51:53,720 DEMOCRATIZE RESEARCH EFFORTS AND 4358 02:51:53,720 --> 02:51:56,320 GET SOME OF OUR RESEARCH OUT 4359 02:51:56,320 --> 02:51:59,720 INTO THE COMMUNITY. 4360 02:51:59,720 --> 02:52:02,240 WE TRAINED PROVIDERS, 4361 02:52:02,240 --> 02:52:03,600 COMMUNITY-BASED PROVIDERS, IN 4362 02:52:03,600 --> 02:52:05,000 RESEARCH METHODS. 4363 02:52:05,000 --> 02:52:07,400 WE HELPED THEM TO GET CERTIFIED 4364 02:52:07,400 --> 02:52:09,160 TO DO RESEARCH. 4365 02:52:09,160 --> 02:52:13,200 AND WE GAVE -- SHARED SOME OF 4366 02:52:13,200 --> 02:52:13,760 THE INFRASTRUCTURE FROM 4367 02:52:13,760 --> 02:52:16,800 MOREHOUSE SCHOOL OF MEDICINE 4368 02:52:16,800 --> 02:52:18,680 WITH PROVIDERS IN ORDER TO EQUIP 4369 02:52:18,680 --> 02:52:21,840 THEM TO BE ABLE TO SHARE IN 4370 02:52:21,840 --> 02:52:23,720 RESEARCH EFFORTS. 4371 02:52:23,720 --> 02:52:28,400 WE ALSO DID STAKEHOLDER NEEDS 4372 02:52:28,400 --> 02:52:30,680 ASSESSMENTS, AND WE PARTNERED 4373 02:52:30,680 --> 02:52:34,880 WITH THE GEORGIA DEPARTMENT OF 4374 02:52:34,880 --> 02:52:38,360 PUBLIC HEALTH TO DEVELOP A PEER 4375 02:52:38,360 --> 02:52:39,880 LEARNING NETWORK IN MATERNAL 4376 02:52:39,880 --> 02:52:40,680 HEALTH. 4377 02:52:40,680 --> 02:52:43,840 WE EMBARKED UPON THE GEORGIA 4378 02:52:43,840 --> 02:52:49,600 IMPROVE ON STRUCTURAL RACISM AND 4379 02:52:49,600 --> 02:52:51,480 DISCRIMINATION AND COVID-19 4380 02:52:51,480 --> 02:52:55,800 STUDY, AND THAT STUDY IS A 4381 02:52:55,800 --> 02:52:57,800 LARGER STUDY WITH FOUR SPECIFIC 4382 02:52:57,800 --> 02:53:00,480 AIMS, THE FIRST BEING ONE WHERE 4383 02:53:00,480 --> 02:53:06,160 WE LOOKED, DID A MULTI-LEVEL 4384 02:53:06,160 --> 02:53:08,280 ASSESSMENT OF FACTORS THAT 4385 02:53:08,280 --> 02:53:11,440 EXACERBATE OR AMELIORATE THE 4386 02:53:11,440 --> 02:53:14,320 OVERALL IMPACT OF COVID-19 ON 4387 02:53:14,320 --> 02:53:15,960 PREGNANT AND POSTPARTUM WOMEN. 4388 02:53:15,960 --> 02:53:18,440 SECONDLY, WE LOOKED AT SOME OF 4389 02:53:18,440 --> 02:53:22,280 THE STRESSORS, BOTH ACUTE AND 4390 02:53:22,280 --> 02:53:23,040 CHRONIC STRESSORS, AND 4391 02:53:23,040 --> 02:53:25,200 MEASURED -- WANTED TO MEASURE 4392 02:53:25,200 --> 02:53:27,640 THE BURDEN OF THAT CHRONIC 4393 02:53:27,640 --> 02:53:30,600 STRESS OF DUAL PANDEMICS, 4394 02:53:30,600 --> 02:53:31,680 STRUCTURAL RACISM AND 4395 02:53:31,680 --> 02:53:40,680 DISCRIMINATION AND COVID-19 ON 4396 02:53:40,680 --> 02:53:43,720 PREGNANT AND POSTPARTUM WOMEN. 4397 02:53:43,720 --> 02:53:46,920 FOURTH TO DO ASSESSMENT TO 4398 02:53:46,920 --> 02:53:50,520 MEASURE ASSOCIATIONS BETWEEN 4399 02:53:50,520 --> 02:53:51,520 STRUCTURAL RACISM AND 4400 02:53:51,520 --> 02:53:53,920 DISCRIMINATION, AND HEALTH AND 4401 02:53:53,920 --> 02:53:57,280 RACIAL DISPARITIES IN MATERNAL 4402 02:53:57,280 --> 02:53:57,520 HEALTH. 4403 02:53:57,520 --> 02:54:00,520 TIME DOES NOT PERMIT ME TO GO 4404 02:54:00,520 --> 02:54:02,800 INTO DETAIL, AID LIKE TO FOCUS 4405 02:54:02,800 --> 02:54:08,160 ON OUR THIRD AIM WHICH WAS PILOT 4406 02:54:08,160 --> 02:54:09,680 FEASIBILITY STUDY TO MONITOR 4407 02:54:09,680 --> 02:54:12,080 BLOOD PRESSURE SYMPTOMS AND 4408 02:54:12,080 --> 02:54:15,920 MENTAL HEALTH IMPACTS OF 4409 02:54:15,920 --> 02:54:17,560 COVID-19 DURING THE PERINATAL 4410 02:54:17,560 --> 02:54:18,680 PERIOD, AND SRD. 4411 02:54:18,680 --> 02:54:22,720 THAT'S THE AIM WE DID OUR 4412 02:54:22,720 --> 02:54:24,800 TRANSLATIONAL RESEARCH PROJECT 4413 02:54:24,800 --> 02:54:28,200 THAT WE WOULD LIKE TO PRESENT TO 4414 02:54:28,200 --> 02:54:28,520 YOU NOW. 4415 02:54:28,520 --> 02:54:31,680 THIS WAS A PILOT FEASIBILITY 4416 02:54:31,680 --> 02:54:36,000 STUDY LOOKING AT A 4417 02:54:36,000 --> 02:54:37,240 SMARTPHONE-BASED APPLICATION, 4418 02:54:37,240 --> 02:54:39,280 MORE MONITORING PATIENT BLOOD 4419 02:54:39,280 --> 02:54:42,760 PRESSURE AND RELATED OUTCOMES TO 4420 02:54:42,760 --> 02:54:43,520 AVOID PREVENTIBLE DELAYS IN 4421 02:54:43,520 --> 02:54:45,280 HEALTH CARE DURING THE 4422 02:54:45,280 --> 02:54:45,680 POSTPARTUM PERIOD. 4423 02:54:45,680 --> 02:54:50,520 AND NOW I'D LIKE TO INVITE MY 4424 02:54:50,520 --> 02:54:54,040 COLLEAGUE, DR. NASIM KATEBI, 4425 02:54:54,040 --> 02:54:55,560 FROM THE BIOMEDICAL INFORMATICS 4426 02:54:55,560 --> 02:55:02,760 LAB AT EMORY UNIVERSITY TO SHARE 4427 02:55:02,760 --> 02:55:03,280 ON OUR APPLICATION. 4428 02:55:03,280 --> 02:55:08,240 >>THANK YOU SO MUCH. 4429 02:55:08,240 --> 02:55:11,080 HI, EVERYONE. 4430 02:55:11,080 --> 02:55:13,720 HOW WE ANALYZED DATA, IN THE 4431 02:55:13,720 --> 02:55:14,920 STUDY. 4432 02:55:14,920 --> 02:55:21,960 IT TRACKS CHANGES IN BLOOD 4433 02:55:21,960 --> 02:55:25,480 PRESSURE DATA. 4434 02:55:25,480 --> 02:55:27,440 THE DESIGN TO MEASURE POSTPARTUM 4435 02:55:27,440 --> 02:55:29,560 COMMUNICATION BETWEEN PATIENT 4436 02:55:29,560 --> 02:55:36,120 AND CLINICIANS. 4437 02:55:36,120 --> 02:55:39,840 AND NEXT SLIDE PLEASE. 4438 02:55:39,840 --> 02:55:46,240 USERS HAVE INCENTIVIZED TO 4439 02:55:46,240 --> 02:55:48,280 ANSWER SURVEYS, ALSO TO RECORD 4440 02:55:48,280 --> 02:55:49,280 SYMPTOMS AND REGULARLY MEASURE 4441 02:55:49,280 --> 02:55:53,120 THEIR BLOOD PRESSURE USING THE 4442 02:55:53,120 --> 02:55:58,520 PROVIDED BLOOD PRESSURE CUFF. 4443 02:55:58,520 --> 02:56:00,920 SEVERE RANGE OF BLOOD PRESSURES 4444 02:56:00,920 --> 02:56:07,320 AND SYMPTOMS OF HYPERTENSIVE 4445 02:56:07,320 --> 02:56:08,960 COMPLICATIONS WITH CLINICIANS 4446 02:56:08,960 --> 02:56:13,640 AND USERS, ALSO TO INSTRUCT THEM 4447 02:56:13,640 --> 02:56:17,600 TO SEEK EMERGENCY CARE. 4448 02:56:17,600 --> 02:56:21,000 YOU CAN SEE THE MOBILE APP 4449 02:56:21,000 --> 02:56:23,720 INTERFACE DESIGN AND THIS IS 4450 02:56:23,720 --> 02:56:28,440 MADE OF SUPPORT OF MECHANISMS 4451 02:56:28,440 --> 02:56:30,720 INCLUDING SYMPTOMS OF SEVERE 4452 02:56:30,720 --> 02:56:33,280 COVID-19, HYPERTENSION, MOOD, 4453 02:56:33,280 --> 02:56:34,560 PERSONAL EXPERIENCE RELATED TO 4454 02:56:34,560 --> 02:56:40,800 MENTAL HEALTH STRUCTURE RACISM 4455 02:56:40,800 --> 02:56:41,640 AND DISCRIMINATION. 4456 02:56:41,640 --> 02:56:42,640 ADDITIONAL INFORMATION RELATED 4457 02:56:42,640 --> 02:56:47,840 TO EACH FEATURE FOR USERS, AND 4458 02:56:47,840 --> 02:56:58,080 COLOR CODED. 4459 02:57:01,760 --> 02:57:05,880 PARTICIPANTS WERE RECRUITED AND 4460 02:57:05,880 --> 02:57:12,120 ELECTRONICALLY ENROLLED AT GRADY 4461 02:57:12,120 --> 02:57:14,200 HOSPITAL IN ATLANTA. 4462 02:57:14,200 --> 02:57:22,040 AFRICAN AMERICAN WOMEN MOST 4463 02:57:22,040 --> 02:57:26,800 UNDER 30 YEARS OLD, 34% BEYOND 4464 02:57:26,800 --> 02:57:28,680 HIGH SCHOOL DIPLOMA, 66% 4465 02:57:28,680 --> 02:57:29,280 EMPLOYED. 4466 02:57:29,280 --> 02:57:32,080 MOST WERE MEDICAID INSURED, MANY 4467 02:57:32,080 --> 02:57:33,840 DEMONSTRATED SOCIAL NEEDS 4468 02:57:33,840 --> 02:57:38,520 ESPECIALLY FOR FOOD AND 4469 02:57:38,520 --> 02:57:38,920 UTILITIES. 4470 02:57:38,920 --> 02:57:41,160 NEXT SLIDE. 4471 02:57:41,160 --> 02:57:44,840 WE COLLECTED 776 BLOOD PRESSURE 4472 02:57:44,840 --> 02:57:47,200 DATA FROM 48 PARTICIPANTS. 4473 02:57:47,200 --> 02:57:48,920 YOU CAN SEE DISTRIBUTION OF 4474 02:57:48,920 --> 02:57:52,520 BLOOD PRESSURE, NUMBER OF BLOOD 4475 02:57:52,520 --> 02:57:55,440 PRESSURE DATA, ALSO TIME OF THE 4476 02:57:55,440 --> 02:58:00,320 RECORDING OF THE BLOOD PRESSURE 4477 02:58:00,320 --> 02:58:01,400 WE HAD 21 PARTICIPANTS WITH 4478 02:58:01,400 --> 02:58:06,000 BLOOD PRESSURE IN THE RANGE OF 4479 02:58:06,000 --> 02:58:11,480 HYPERTENSION STAGE 2, RECORDED 4480 02:58:11,480 --> 02:58:12,960 SEVERELY HYPERTENSIVE BLOOD 4481 02:58:12,960 --> 02:58:16,560 PRESSURE, ALSO 47 SYMPTOMS OF 4482 02:58:16,560 --> 02:58:25,920 SEVERE HYPERTENSION FROM 39 4483 02:58:25,920 --> 02:58:26,360 PARTICIPANTS. 4484 02:58:26,360 --> 02:58:27,560 THIS TRANSCRIBES MEASUREMENTS 4485 02:58:27,560 --> 02:58:30,720 FROM DEVICES, THE AIM IS TO 4486 02:58:30,720 --> 02:58:31,800 ADJUST CHALLENGES ASSOCIATED 4487 02:58:31,800 --> 02:58:34,760 WITH TRANSMITTING BLOOD PRESSURE 4488 02:58:34,760 --> 02:58:36,640 READINGS IN HOME-BASED 4489 02:58:36,640 --> 02:58:46,960 MONITORING SYSTEMS. 4490 02:58:50,800 --> 02:58:54,680 THIS HAS STEPS. 4491 02:58:54,680 --> 02:58:56,040 FAR BELOW REQUIREMENTS, PROPOSED 4492 02:58:56,040 --> 02:59:00,480 MODELS SUITABLE FOR GENERAL USE. 4493 02:59:00,480 --> 02:59:01,920 COMPARED MANUAL TRANSCRIPTION 4494 02:59:01,920 --> 02:59:04,240 AND AUTOMATIC TRANSCRIPTION 4495 02:59:04,240 --> 02:59:07,720 METHODS AND SHOWED THERE WAS NO 4496 02:59:07,720 --> 02:59:10,680 STATISTICAL SIGNIFICANT 4497 02:59:10,680 --> 02:59:12,040 DIFFERENCE BETWEEN THESE TWO 4498 02:59:12,040 --> 02:59:12,280 METHODS. 4499 02:59:12,280 --> 02:59:14,520 >>ONE MINUTE LEFT PLEASE. 4500 02:59:14,520 --> 02:59:23,600 >>THE NEXT SLIDE PLEASE. 4501 02:59:23,600 --> 02:59:25,120 >>I HEAR YOU. 4502 02:59:25,120 --> 02:59:28,000 I CAN'T GET IT TO GO, FOR 4503 02:59:28,000 --> 02:59:30,280 WHATEVER REASON. 4504 02:59:30,280 --> 02:59:35,000 4505 02:59:35,000 --> 02:59:43,440 >>WE STUDIED POSTPARTUM 4506 02:59:43,440 --> 02:59:46,080 DEPRESSION AND BLOOD PRESSURE, 4507 02:59:46,080 --> 02:59:49,920 FOR 33 WITH EPDS AND BLOOD 4508 02:59:49,920 --> 02:59:51,520 PRESSURE DATA HIGHER 4509 02:59:51,520 --> 02:59:53,280 SELF-REPORTED SIGNIFICANTLY 4510 02:59:53,280 --> 02:59:56,240 ASSOCIATED WITH LOWER SYSTOLIC 4511 02:59:56,240 --> 02:59:59,760 BLOOD PRESSURE, YOU CAN SEE IN 4512 02:59:59,760 --> 03:00:01,720 THIS FIGURE SIGNIFICANT 4513 03:00:01,720 --> 03:00:03,920 CORRELATION BETWEEN THE TWO. 4514 03:00:03,920 --> 03:00:06,200 I PASS IT TO DR. FRANKLIN FOR 4515 03:00:06,200 --> 03:00:07,960 THE CONCLUSION. 4516 03:00:07,960 --> 03:00:08,280 >>OKAY. 4517 03:00:08,280 --> 03:00:10,480 IN CONCLUSION, WE FOUND THAT 4518 03:00:10,480 --> 03:00:12,440 THIS WAS AN EFFICIENT AND 4519 03:00:12,440 --> 03:00:15,200 RELIABLE METHOD FOR 4520 03:00:15,200 --> 03:00:16,680 AUTOMATICALLY TRANSCRIBING AND 4521 03:00:16,680 --> 03:00:18,520 TRANSMITTING DATA THAT WE SAW 4522 03:00:18,520 --> 03:00:20,760 FROM OUR BLOOD PRESSURE DEVICES, 4523 03:00:20,760 --> 03:00:23,160 IT WAS ACCURATE. 4524 03:00:23,160 --> 03:00:27,000 WE WERE ABLE TO SHOW THAT IT WAS 4525 03:00:27,000 --> 03:00:28,560 SUITABLE FOR GENERAL USE. 4526 03:00:28,560 --> 03:00:31,520 WE WERE ABLE TO COMMUNICATE BACK 4527 03:00:31,520 --> 03:00:33,680 AND FORTH BETWEEN PARTICIPANTS 4528 03:00:33,680 --> 03:00:36,840 AND THEIR PROVIDERS. 4529 03:00:36,840 --> 03:00:41,120 WE DID ENTIRE ELECTRONIC 4530 03:00:41,120 --> 03:00:43,000 PARTICIPANT RECRUITMENT, 4531 03:00:43,000 --> 03:00:44,200 ENGAGING ENGAGEMENT CONSENTING 4532 03:00:44,200 --> 03:00:45,840 ENROLLMENT, OUR PROVIDERS FOUND 4533 03:00:45,840 --> 03:00:49,280 THIS TO BE A USEFUL WAY TO 4534 03:00:49,280 --> 03:00:51,200 MONITOR THEIR PARTICIPANTS' 4535 03:00:51,200 --> 03:00:52,480 BLOOD PRESSURES, OR THEIR 4536 03:00:52,480 --> 03:00:53,680 PATIENTS' BLOOD PRESSURES. 4537 03:00:53,680 --> 03:00:59,120 WE WERE ABLE TO DO DIGITAL 4538 03:00:59,120 --> 03:01:01,320 EPIDEMIOLOGY, COLLECTING 4539 03:01:01,320 --> 03:01:02,080 SENSITIVE DATA FROM 4540 03:01:02,080 --> 03:01:05,040 PARTICIPANTS, IN TERMS OF 4541 03:01:05,040 --> 03:01:06,240 DEPRESSION, COVID IMPACT, 4542 03:01:06,240 --> 03:01:07,560 SOCIODEMOGRAPHIC DATA, ET 4543 03:01:07,560 --> 03:01:11,600 CETERA, THAT CAN BE ANALYZED 4544 03:01:11,600 --> 03:01:12,160 FURTHER. 4545 03:01:12,160 --> 03:01:13,240 AND MOST IMPORTANT OR VERY 4546 03:01:13,240 --> 03:01:17,640 IMPORTANT WE WERE ABLE TO ENGAGE 4547 03:01:17,640 --> 03:01:20,480 THE COMMUNITY IN OUR RESEARCH 4548 03:01:20,480 --> 03:01:22,240 AND FURTHER DEVELOPING OUR 4549 03:01:22,240 --> 03:01:25,000 PERINATAL CARE RESEARCH AND 4550 03:01:25,000 --> 03:01:28,080 INTERVENTION NETWORK TO BRING IN 4551 03:01:28,080 --> 03:01:29,720 COMMUNITY PRACTICES AND 4552 03:01:29,720 --> 03:01:31,160 PROVIDERS TRAINING THEM IN 4553 03:01:31,160 --> 03:01:35,520 RESEARCH METHODS AND BEING ABLE 4554 03:01:35,520 --> 03:01:41,160 TO EQUIP THEM TO HELP WITH OUR 4555 03:01:41,160 --> 03:01:43,520 RESEARCH AND TO IMPLEMENT 4556 03:01:43,520 --> 03:01:44,440 EVIDENCE-BASED INTERVENTIONS. 4557 03:01:44,440 --> 03:01:49,920 THANK YOU FOR YOUR ATTENTION. 4558 03:01:49,920 --> 03:01:51,360 >>THANK YOU. 4559 03:01:51,360 --> 03:01:54,080 AND NEXT AND FINAL SPEAKER FOR 4560 03:01:54,080 --> 03:01:57,880 THIS PANEL IS DR. MELISSA SIMON 4561 03:01:57,880 --> 03:01:58,480 FROM NORTHWESTERN UNIVERSITY 4562 03:01:58,480 --> 03:02:01,640 FEINBERG SCHOOL OF MEDICINE ON 4563 03:02:01,640 --> 03:02:05,560 THE OPTIMIZED STUDY, ROUTINE 4564 03:02:05,560 --> 03:02:05,920 PERINATAL CARE. 4565 03:02:05,920 --> 03:02:07,120 >>HELLO, EVERYONE. 4566 03:02:07,120 --> 03:02:08,760 I'M TRYING TO SHARE MY SCREEN 4567 03:02:08,760 --> 03:02:14,000 BUT IT'S NOT LETTING ME. 4568 03:02:14,000 --> 03:02:15,000 ALL RIGHT. 4569 03:02:15,000 --> 03:02:16,880 THANK YOU FOR INVITING ME. 4570 03:02:16,880 --> 03:02:18,720 I REALLY APPRECIATE IT. 4571 03:02:18,720 --> 03:02:22,440 THANK YOU FOR STAYING TO NEAR 4572 03:02:22,440 --> 03:02:26,280 ALMOST THE END OF THIS WONDERFUL 4573 03:02:26,280 --> 03:02:26,600 SYMPOSIUM. 4574 03:02:26,600 --> 03:02:27,960 THANK YOU TO THE "IMPROVE" 4575 03:02:27,960 --> 03:02:28,280 INITIATIVE. 4576 03:02:28,280 --> 03:02:30,480 IT'S DONE WONDERS, IT'S GOING TO 4577 03:02:30,480 --> 03:02:33,440 ADVANCE THE SCIENCE AND CARE OF 4578 03:02:33,440 --> 03:02:34,880 PREGNANT AND BIRTHING PERSONS IN 4579 03:02:34,880 --> 03:02:37,280 THIS COUNTRY AND HOPEFULLY 4580 03:02:37,280 --> 03:02:38,320 IMPROVE ON EGREGIOUS INEQUITIES 4581 03:02:38,320 --> 03:02:39,680 THAT EXIST. 4582 03:02:39,680 --> 03:02:49,280 SO, OUR OPTIMIZE STUDY WAS 4583 03:02:49,280 --> 03:02:52,120 FUNDED BY NIMHD R01 IMPROVE 4584 03:02:52,120 --> 03:02:52,400 INITIATIVE. 4585 03:02:52,400 --> 03:02:53,560 THE ENTIRE TEAM INCLUDING NIMHD 4586 03:02:53,560 --> 03:02:56,520 HELPED FUND THIS, AND ALL THE 4587 03:02:56,520 --> 03:02:59,360 PARTNERS ACROSS NIH THAT HAVE 4588 03:02:59,360 --> 03:03:01,800 REALLY HELPED PROMOTE AND CREATE 4589 03:03:01,800 --> 03:03:02,560 THIS WONDERFUL IMPROVE 4590 03:03:02,560 --> 03:03:05,280 INITIATIVE ACROSS MULTIPLE 4591 03:03:05,280 --> 03:03:05,880 I.C.s. 4592 03:03:05,880 --> 03:03:07,560 AND SPECIAL THANKS TO 4593 03:03:07,560 --> 03:03:09,520 COLLABORATORS AND CLEARLY OUR 4594 03:03:09,520 --> 03:03:11,440 COMMUNITY PARTNERS WHO HELPED 4595 03:03:11,440 --> 03:03:16,560 REALLY DRIVE THIS IN CHICAGO AND 4596 03:03:16,560 --> 03:03:19,040 THE COMMUNITY CLINICS, GRASS 4597 03:03:19,040 --> 03:03:20,400 ROOTS ORGANIZATIONS AND OF 4598 03:03:20,400 --> 03:03:21,800 COURSE BLACK PREGNANT ANT 4599 03:03:21,800 --> 03:03:22,880 BIRTHING PERSONS THEMSELVES. 4600 03:03:22,880 --> 03:03:25,360 I'M A MEMBER OF THE NIH OFFICE 4601 03:03:25,360 --> 03:03:30,680 OF RESEARCH OF WOMEN'S HEALTH 4602 03:03:30,680 --> 03:03:32,440 ADVISORY COMMITTEE. 4603 03:03:32,440 --> 03:03:35,480 SO YOU HEARD FROM DR. FRANKLIN 4604 03:03:35,480 --> 03:03:37,360 AND COLLEAGUES ABOUT THE 4605 03:03:37,360 --> 03:03:39,480 EGREGIOUS HEALTH INEQUITIES IN 4606 03:03:39,480 --> 03:03:42,320 MORTALITY AND SEVERE MORBIDITY, 4607 03:03:42,320 --> 03:03:45,600 AND IN THIS COUNTRY, AND REALLY 4608 03:03:45,600 --> 03:03:47,920 ROUTINE PERINATAL CARE WHICH THE 4609 03:03:47,920 --> 03:03:50,400 MAJORITY OF PEOPLE RECEIVE IN 4610 03:03:50,400 --> 03:03:52,960 THIS COUNTRY, ESPECIALLY THOSE 4611 03:03:52,960 --> 03:03:55,360 WHO IDENTIFY AS BLACK RECEIVE IN 4612 03:03:55,360 --> 03:03:58,280 THIS COUNTRY HAS NEVER REALLY 4613 03:03:58,280 --> 03:04:02,760 BEEN CHANGED OR EXAMINED TO 4614 03:04:02,760 --> 03:04:04,440 ACTUALLY CHANGE DIFFERENT TYPES 4615 03:04:04,440 --> 03:04:05,840 OF COMPONENTS OR CADENCE OR 4616 03:04:05,840 --> 03:04:08,280 ANYTHING LIKE THAT, CADENCE OF 4617 03:04:08,280 --> 03:04:09,880 VISITS, CONTENT OF VISITS, OTHER 4618 03:04:09,880 --> 03:04:11,760 THAN GROUP MODELS CENTERING 4619 03:04:11,760 --> 03:04:14,160 PREGNANCY, OTHER TYPES OF GROUP 4620 03:04:14,160 --> 03:04:18,960 PRENATAL CARE. 4621 03:04:18,960 --> 03:04:20,160 REALLY REENGINEERING THIS, 4622 03:04:20,160 --> 03:04:24,440 UNDERSTANDING THAT THOSE 4623 03:04:24,440 --> 03:04:26,280 STRUCTURES, ORIGINAL PERINATAL 4624 03:04:26,280 --> 03:04:28,040 CARE, WAS DESIGNED UNDERPINNED 4625 03:04:28,040 --> 03:04:30,040 BY SYSTEMS OF OPPRESSION AND 4626 03:04:30,040 --> 03:04:32,720 RACISM, AND SO WE REALLY DO NEED 4627 03:04:32,720 --> 03:04:34,160 TO REENGINEER AND RETHINK THE 4628 03:04:34,160 --> 03:04:35,680 ROUTINE CARE THAT WE GIVE ON THE 4629 03:04:35,680 --> 03:04:38,440 GROUND TO MEET THE TRUE NEEDS OF 4630 03:04:38,440 --> 03:04:39,200 BLACK PREGNANT AND BIRTHING 4631 03:04:39,200 --> 03:04:39,640 PERSONS. 4632 03:04:39,640 --> 03:04:43,240 I'M AN OB/GYN AT NORTHWESTERN IN 4633 03:04:43,240 --> 03:04:45,200 CHICAGO, FULL DISCLOSURE. 4634 03:04:45,200 --> 03:04:49,160 SO WE DECIDED TO CREATE A HYBRID 4635 03:04:49,160 --> 03:04:53,880 TYPE 1 CLUSTER RANDOMIZED 4636 03:04:53,880 --> 03:04:57,920 EFFECTIVENESS TRIAL. 4637 03:04:57,920 --> 03:05:02,200 AND TO EVALUATE EFFECTIVENESS OF 4638 03:05:02,200 --> 03:05:03,040 A CHECKLIST. 4639 03:05:03,040 --> 03:05:05,160 WE HAVE GREAT SAFETY IN AVIATION 4640 03:05:05,160 --> 03:05:07,440 IN OUR COUNTRY, AROUND THE 4641 03:05:07,440 --> 03:05:09,520 WORLD, BECAUSE OF ALL THE 4642 03:05:09,520 --> 03:05:12,120 CHECKLISTS, AND CHECK LISTS HAVE 4643 03:05:12,120 --> 03:05:15,200 BEEN STUDIED IN POSTPARTUM 4644 03:05:15,200 --> 03:05:18,360 HEMORRHAGE, THERE ARE SETS OF 4645 03:05:18,360 --> 03:05:21,320 CARE SETS FOR HIGH BLOOD 4646 03:05:21,320 --> 03:05:23,640 PRESSURE IN PREGNANCY, CHECK 4647 03:05:23,640 --> 03:05:25,320 LISTS ARE IMPORTANT, TIMEOUTS IN 4648 03:05:25,320 --> 03:05:27,200 THE OPERATING ROOM, PRE AND POST 4649 03:05:27,200 --> 03:05:28,560 PROCEDURE, ET CETERA. 4650 03:05:28,560 --> 03:05:31,920 WHY NOT REALLY THINK ABOUT HOW 4651 03:05:31,920 --> 03:05:34,560 TO EMBED CERTAIN EQUITY MEASURES 4652 03:05:34,560 --> 03:05:35,800 INTO PERINATAL CARE THROUGH 4653 03:05:35,800 --> 03:05:39,160 THINGS LIKE CHECK LISTS BECAUSE 4654 03:05:39,160 --> 03:05:42,080 THE PERINATAL CARE FORM, THE 4655 03:05:42,080 --> 03:05:43,320 HOLLISTER FORM ORIGINALLY 4656 03:05:43,320 --> 03:05:46,880 CREATED BY ACOG AND THE AMERICAN 4657 03:05:46,880 --> 03:05:48,080 ASSOCIATION OF PEDIATRICS, YOU 4658 03:05:48,080 --> 03:05:50,200 KNOW, IT IS A CHECKLIST OF A 4659 03:05:50,200 --> 03:05:51,120 SORT. 4660 03:05:51,120 --> 03:05:53,360 IT'S JUST NOT REALLY DESIGNED 4661 03:05:53,360 --> 03:05:55,240 WITH CENTERING PATIENTS AND 4662 03:05:55,240 --> 03:05:56,680 ESPECIALLY BLACK PREGNANT AND 4663 03:05:56,680 --> 03:05:58,760 BIRTHING PERSONS IN MIND. 4664 03:05:58,760 --> 03:06:03,480 AND SO HOW CAN YOU ALSO THEN 4665 03:06:03,480 --> 03:06:05,760 IMPLEMENT -- EMBED NAVIGATION 4666 03:06:05,760 --> 03:06:06,880 SUPPORT IN THAT PERINATAL CARE 4667 03:06:06,880 --> 03:06:07,400 TRAJECTORY? 4668 03:06:07,400 --> 03:06:10,560 AND THEN HOW CAN YOU MODIFY THE 4669 03:06:10,560 --> 03:06:12,480 CADENCE AND CONTENT OF ROUTINE 4670 03:06:12,480 --> 03:06:13,240 PERINATAL VISITS? 4671 03:06:13,240 --> 03:06:15,160 FOR EXAMPLE, DOES THE FIRST 4672 03:06:15,160 --> 03:06:19,120 PRENATAL VISIT REALLY NEED TO 4673 03:06:19,120 --> 03:06:20,480 HAVE LIKE THIS DELUGE OF 4674 03:06:20,480 --> 03:06:22,200 INFORMATION GIVEN TO THE 4675 03:06:22,200 --> 03:06:24,080 PREGNANT AND BIRTHING PERSON UP 4676 03:06:24,080 --> 03:06:24,920 FRONT? 4677 03:06:24,920 --> 03:06:27,320 WHY CAN'T THERE BE TWO VISITS IN 4678 03:06:27,320 --> 03:06:30,320 THE FIRST TWO WEEKS APART OR SO, 4679 03:06:30,320 --> 03:06:31,600 WHY NOT? 4680 03:06:31,600 --> 03:06:34,760 WHEN WE STEP BACK AND START 4681 03:06:34,760 --> 03:06:36,080 ASKING QUESTIONS LIKE THAT, IT'S 4682 03:06:36,080 --> 03:06:36,960 NOT ACCEPTABLE TO HEAR THAT'S 4683 03:06:36,960 --> 03:06:39,160 THE WAY WE ALWAYS DO IT OR 4684 03:06:39,160 --> 03:06:40,800 THAT'S THE WAY BILLING WILL 4685 03:06:40,800 --> 03:06:43,160 ALLOW IT BECAUSE THAT'S WHEN WE 4686 03:06:43,160 --> 03:06:45,800 PERPETUATE THE SYSTEM OF 4687 03:06:45,800 --> 03:06:47,440 OPPRESSION AND UNDERLYING 4688 03:06:47,440 --> 03:06:48,640 STRUCTURAL RACISM AND DRIVE 4689 03:06:48,640 --> 03:06:50,360 INEQUITIES BECAUSE THAT'S HOW WE 4690 03:06:50,360 --> 03:06:51,600 GOT THE PHENOTYPES WE HAVE 4691 03:06:51,600 --> 03:06:53,400 TODAY, THAT'S HOW WE GOT TO 4692 03:06:53,400 --> 03:06:57,680 WHERE WE ARE IN THE EGREGIOUS 4693 03:06:57,680 --> 03:06:59,560 DISPARITIES, IN OUR COUNTRY. 4694 03:06:59,560 --> 03:07:02,840 SO WE REALLY HAVE TO ASK HARD 4695 03:07:02,840 --> 03:07:04,120 QUESTIONS AS WHY, SOUNDS LIKE 4696 03:07:04,120 --> 03:07:09,280 IT'S NOT A HARD QUESTION TO ASK 4697 03:07:09,280 --> 03:07:09,440 WHY. 4698 03:07:09,440 --> 03:07:10,520 THE OTHER THING WHAT IS 4699 03:07:10,520 --> 03:07:12,240 DELIVERED IN THE FIRST VISIT 4700 03:07:12,240 --> 03:07:14,800 THAT COULD BE BETTER IN ORDER TO 4701 03:07:14,800 --> 03:07:17,200 START BRIDGING TRUST? 4702 03:07:17,200 --> 03:07:18,800 THE REALLY IMPORTANT PART OF 4703 03:07:18,800 --> 03:07:21,560 THIS IS THAT WE IN THE HEALTH 4704 03:07:21,560 --> 03:07:23,320 CARE SYSTEM AND SCIENTISTS, I'M 4705 03:07:23,320 --> 03:07:27,360 BOTH, A SCIENTIST AND OB/GYN 4706 03:07:27,360 --> 03:07:30,320 PHYSICIAN, WE'VE EARNED THIS 4707 03:07:30,320 --> 03:07:30,800 TRUST. 4708 03:07:30,800 --> 03:07:35,560 WE'VE BEEN ABUSIVE AND OUTRIGHT 4709 03:07:35,560 --> 03:07:37,000 WRONG TO PREGNANT AND BIRTHING 4710 03:07:37,000 --> 03:07:38,880 PERSONS, PEOPLE IN GENERAL, 4711 03:07:38,880 --> 03:07:41,480 ESPECIALLY THOSE WHO IDENTIFY AS 4712 03:07:41,480 --> 03:07:43,120 RACIALIZED AND MINORITIZED, WHO 4713 03:07:43,120 --> 03:07:48,240 IDENTIFY AS BLACK FOR CERTAIN, 4714 03:07:48,240 --> 03:07:50,560 EVEN THE UNDERPINNINGS OF MARION 4715 03:07:50,560 --> 03:07:55,600 SIMS, THE GODFATHER OF OB/GYN, 4716 03:07:55,600 --> 03:07:56,280 EGREGIOUS ABUSE. 4717 03:07:56,280 --> 03:07:58,880 WE HAVE TO EARN THE TRUST BACK. 4718 03:07:58,880 --> 03:08:00,680 WHY CAN'T THE FIRST PERINATAL 4719 03:08:00,680 --> 03:08:03,000 CARE VISIT BE A FEW QUESTIONS 4720 03:08:03,000 --> 03:08:03,600 ABOUT TRUST? 4721 03:08:03,600 --> 03:08:05,320 WHAT ARE YOUR HOPES AND DREAMS 4722 03:08:05,320 --> 03:08:06,560 FOR THIS PREGNANCY? 4723 03:08:06,560 --> 03:08:08,320 WHAT ARE YOUR FEARS? 4724 03:08:08,320 --> 03:08:09,600 HOW CAN I HELP YOU? 4725 03:08:09,600 --> 03:08:12,680 HOW CAN WE WALK WITH YOU? 4726 03:08:12,680 --> 03:08:14,840 START TO GET THAT SENSE OF -- 4727 03:08:14,840 --> 03:08:18,680 GARNER A SENSE OF BELONGING AND 4728 03:08:18,680 --> 03:08:22,760 CENTERING THE PATIENT AND THE 4729 03:08:22,760 --> 03:08:24,680 BLACK BIRTHING PERSON THEMSELF 4730 03:08:24,680 --> 03:08:26,560 INTO THAT CONVERSATION AND GET 4731 03:08:26,560 --> 03:08:32,040 THEM IN CONTROL OF THAT CARE TO 4732 03:08:32,040 --> 03:08:32,920 HELP GUIDE. 4733 03:08:32,920 --> 03:08:35,680 SO, WE ALWAYS START OUR STUDIES 4734 03:08:35,680 --> 03:08:36,960 CENTERED WITH THE COMMUNITIES 4735 03:08:36,960 --> 03:08:38,720 THAT WE'RE GOING TO WORK WITH SO 4736 03:08:38,720 --> 03:08:40,720 WE DID LOTS OF QUALITATIVE 4737 03:08:40,720 --> 03:08:42,920 RESEARCH AND THIS WAS DURING 4738 03:08:42,920 --> 03:08:46,120 COVID, WE HAD PATIENT INTERVIEWS 4739 03:08:46,120 --> 03:08:48,000 ABOUT EXPERIENCES WITH CARE, 4740 03:08:48,000 --> 03:08:49,400 BELIEFS, VIEWS OF MEDICINE, 4741 03:08:49,400 --> 03:08:51,360 HEALTH CARE BEHAVIORS, PRIOR 4742 03:08:51,360 --> 03:08:52,360 EXPERIENCES WITH NAVIGATORS AND 4743 03:08:52,360 --> 03:08:55,000 CARE, ET CETERA. 4744 03:08:55,000 --> 03:08:58,040 AND STAKEHOLDER INTERVIEWS OF 4745 03:08:58,040 --> 03:08:59,720 PEOPLE WHO CARE FOR BLACK 4746 03:08:59,720 --> 03:09:02,800 PREGNANT AND BIRTHING PERSONS AS 4747 03:09:02,800 --> 03:09:03,000 WELL. 4748 03:09:03,000 --> 03:09:09,320 TO GET FEEDBACK ON THE 4749 03:09:09,320 --> 03:09:10,520 BEGINNINGS, ITERATIVE FEEDBACK. 4750 03:09:10,520 --> 03:09:12,600 A LITTLE BIT ABOUT QUALITATIVE 4751 03:09:12,600 --> 03:09:16,920 FINDINGS, WHEN TRUST IS 4752 03:09:16,920 --> 03:09:18,120 ESTABLISHED PATIENTS ATTEND 4753 03:09:18,120 --> 03:09:18,960 APPOINTMENTS, FEEL ENGAGED, PART 4754 03:09:18,960 --> 03:09:22,160 OF THE TEAM, THE BELONGING IS 4755 03:09:22,160 --> 03:09:24,560 REALLY IMPORTANT CONCEPT. 4756 03:09:24,560 --> 03:09:25,400 TRUST INCREASES. 4757 03:09:25,400 --> 03:09:26,200 PATIENTS BELIEVE THE INFORMATION 4758 03:09:26,200 --> 03:09:27,880 IS IN THEIR BEST INTEREST THAT 4759 03:09:27,880 --> 03:09:34,880 IS GIVEN TO THEM WHEN YOU START 4760 03:09:34,880 --> 03:09:37,400 TO RE-TAILOR HOW YOU APPROACH A 4761 03:09:37,400 --> 03:09:38,480 PERSON, TREAT THEM AS HUMAN, 4762 03:09:38,480 --> 03:09:40,320 PART OF THE TEAM. 4763 03:09:40,320 --> 03:09:41,000 HEALTH LITERACY INCREASES 4764 03:09:41,000 --> 03:09:45,280 BECAUSE THEY CAN HEAR YOU. 4765 03:09:45,280 --> 03:09:46,800 PATIENTS OPEN UP AND WILL WORK 4766 03:09:46,800 --> 03:09:47,480 WITH YOU. 4767 03:09:47,480 --> 03:09:48,440 PATIENTS EXPRESSED IMPORTANCE OF 4768 03:09:48,440 --> 03:09:50,200 TRUST AND DESIRE FOR PROVIDERS 4769 03:09:50,200 --> 03:09:51,480 TO ASK PATIENTS HOW THEY ARE 4770 03:09:51,480 --> 03:09:53,800 FEELING AND ASK THE RIGHT 4771 03:09:53,800 --> 03:09:54,240 QUESTIONS. 4772 03:09:54,240 --> 03:09:56,240 INCLUDE QUESTIONS THAT SHOW THE 4773 03:09:56,240 --> 03:09:56,880 PROVIDER CARES. 4774 03:09:56,880 --> 03:09:59,720 PATIENTS SHOULD BE ABLE TO ASK 4775 03:09:59,720 --> 03:10:01,880 MORE QUESTIONS, OPEN THAT SPACE, 4776 03:10:01,880 --> 03:10:03,640 CREATE THAT SPACE TO ASK 4777 03:10:03,640 --> 03:10:04,640 QUESTIONS. 4778 03:10:04,640 --> 03:10:05,760 PATIENTS BE MORE COMFORTABLE 4779 03:10:05,760 --> 03:10:09,120 ASKING SENSITIVE QUESTIONS IF 4780 03:10:09,120 --> 03:10:11,320 THE PROVIDER BROUGHT IT UP FIRST 4781 03:10:11,320 --> 03:10:15,920 AND ANSWERING PATIENT QUESTIONS 4782 03:10:15,920 --> 03:10:17,280 INCREASES TRUST. 4783 03:10:17,280 --> 03:10:22,480 THIS WAS AN RCT WITH SAMPLE SIZE 4784 03:10:22,480 --> 03:10:25,120 OF 600. 4785 03:10:25,120 --> 03:10:28,040 THE CLINICS ARE UNITS OF 4786 03:10:28,040 --> 03:10:28,640 RANDOMIZATION. 4787 03:10:28,640 --> 03:10:29,960 EVALUATE EFFECTIVENESS OF 4788 03:10:29,960 --> 03:10:37,000 INTERVENTION FOR PARTICIPANTS IN 4789 03:10:37,000 --> 03:10:38,880 IMPROVING CARE, SOCIAL 4790 03:10:38,880 --> 03:10:40,360 DETERMINANTS OF HEALTH 4791 03:10:40,360 --> 03:10:42,960 SCREENING, REFERRAL, REDUCING 4792 03:10:42,960 --> 03:10:44,200 DEPRESSION, INCREASING 4793 03:10:44,200 --> 03:10:44,960 BREASTFEEDING, VACCINE, 4794 03:10:44,960 --> 03:10:46,200 CONTRACEPTION UPTAKE. 4795 03:10:46,200 --> 03:10:48,360 SO WE ARE FOLLOWING PATIENTS 4796 03:10:48,360 --> 03:10:52,200 OVER TIME SO BASELINE AND AROUND 4797 03:10:52,200 --> 03:10:54,400 32 WEEKS GESTATION, POSTPARTUM, 4798 03:10:54,400 --> 03:10:56,920 6 WEEKS, 3 MONTHS, 6 MONTHS, 4799 03:10:56,920 --> 03:10:57,920 MIXED METHODS. 4800 03:10:57,920 --> 03:10:59,320 THIS IS JUST ONE EXAMPLE OF WHAT 4801 03:10:59,320 --> 03:11:02,600 WE HAD TO DO WITH THE CLINICS. 4802 03:11:02,600 --> 03:11:03,160 PART OF IMPLEMENTATION IS 4803 03:11:03,160 --> 03:11:04,560 UNDERSTANDING EACH OF THE 4804 03:11:04,560 --> 03:11:06,640 CLINICS YOU'LL WORK IN, WHETHER 4805 03:11:06,640 --> 03:11:08,760 THEY ARE INTERVENTION OR CONTROL 4806 03:11:08,760 --> 03:11:10,800 GROUPS, AND YOU REALLY NEED TO 4807 03:11:10,800 --> 03:11:12,200 UNDERSTAND THE DESIGN, FLOW OF 4808 03:11:12,200 --> 03:11:15,640 THE WORK, WHO IS THERE, ALL THE 4809 03:11:15,640 --> 03:11:17,160 PLAYERS, STAKEHOLDERS, AND 4810 03:11:17,160 --> 03:11:23,080 THAT'S JUST AN EXAMPLE. 4811 03:11:23,080 --> 03:11:24,160 KEY TAKEAWAYS, TAKES TIME, 4812 03:11:24,160 --> 03:11:26,320 NECESSARY FOR THE INTERVENTION 4813 03:11:26,320 --> 03:11:28,120 TO BE MOST EFFECTIVE, PANDEMIC 4814 03:11:28,120 --> 03:11:29,520 HAS HAD AND WILL CONTINUE TO 4815 03:11:29,520 --> 03:11:31,160 HAVE IMPACT ON CARE AND 4816 03:11:31,160 --> 03:11:34,440 RESEARCH, AND SOME CHALLENGES WE 4817 03:11:34,440 --> 03:11:36,000 CONTINUE TO FACE, ENROLLMENT HAS 4818 03:11:36,000 --> 03:11:38,280 BEEN AN ISSUE, BUT THERE'S 4819 03:11:38,280 --> 03:11:43,320 COMPETING PRIORITIES FOR 4820 03:11:43,320 --> 03:11:44,080 CLINICS, WORKFORCE SHORTAGES, 4821 03:11:44,080 --> 03:11:46,920 ACROSS THESE, CHURN, TRYING TO 4822 03:11:46,920 --> 03:11:49,120 MAKE STRUCTURAL CHANGE IS HARD. 4823 03:11:49,120 --> 03:11:51,200 ANYTIME YOU TRY TO CHANGE 4824 03:11:51,200 --> 03:11:53,480 SOMETHING LIKE PRENATAL CARE 4825 03:11:53,480 --> 03:11:55,240 TEMPLATE, IMAGINE THAT, REALLY 4826 03:11:55,240 --> 03:11:55,880 HARD. 4827 03:11:55,880 --> 03:11:58,640 SO I WANT TO THANK YOU ALL AND 4828 03:11:58,640 --> 03:12:00,160 I'M LOOKING FORWARD TO THE 4829 03:12:00,160 --> 03:12:02,360 QUESTION AND ANSWER. 4830 03:12:02,360 --> 03:12:03,960 >>FABULOUS. 4831 03:12:03,960 --> 03:12:04,720 THANK YOU. 4832 03:12:04,720 --> 03:12:07,360 I'LL INVITE OUR OTHER PRESENTERS 4833 03:12:07,360 --> 03:12:09,560 TO TURN THEIR CAMERAS ON AND I 4834 03:12:09,560 --> 03:12:13,160 THINK WE ONLY HAVE TIME FOR ONE 4835 03:12:13,160 --> 03:12:14,160 OR TWO QUESTIONS FOR EACH 4836 03:12:14,160 --> 03:12:21,000 PRESENTER SO WE CAN GET OUR 4837 03:12:21,000 --> 03:12:22,080 SELVES BACK ON TIME. 4838 03:12:22,080 --> 03:12:24,840 I DON'T SEE ANY QUESTIONS COMING 4839 03:12:24,840 --> 03:12:31,280 IN SO I CAN TAKE THE PREROGATIVE 4840 03:12:31,280 --> 03:12:32,680 AS MODERATOR. 4841 03:12:32,680 --> 03:12:36,520 FOR DR. FRANKLIN AND DR. KATEBI, 4842 03:12:36,520 --> 03:12:38,520 YOU HAD TO GO THROUGH YOUR 4843 03:12:38,520 --> 03:12:41,440 SLIDES QUICKLY AT THE END BUT 4844 03:12:41,440 --> 03:12:47,240 DID I SEE CORRECTLY THAT IN YOUR 4845 03:12:47,240 --> 03:12:49,320 FINDINGS YOU WERE SEEING THAT AS 4846 03:12:49,320 --> 03:12:50,520 BLOOD PRESSURE WENT UP 4847 03:12:50,520 --> 03:12:51,480 DEPRESSION WENT DOWN? 4848 03:12:51,480 --> 03:12:54,680 DID I SEE THAT CORRECTLY? 4849 03:12:54,680 --> 03:12:56,520 WAS WONDERING IF YOU HAVE 4850 03:12:56,520 --> 03:12:57,240 THOUGHTS ABOUT THAT. 4851 03:12:57,240 --> 03:13:01,600 >>AS DEPRESSION SCORES WENT UP 4852 03:13:01,600 --> 03:13:05,280 WE FOUND LOWER BLOOD PRESSURE IN 4853 03:13:05,280 --> 03:13:06,480 THAT GROUP, SURPRISING TO US. 4854 03:13:06,480 --> 03:13:09,320 >>WONDERING IF HAD YOU THOUGHTS 4855 03:13:09,320 --> 03:13:10,080 ABOUT THAT. 4856 03:13:10,080 --> 03:13:12,080 >>WELL, I'LL LET DR. KATEBI 4857 03:13:12,080 --> 03:13:13,280 ANSWER. 4858 03:13:13,280 --> 03:13:16,640 WE FOUND IN THE LITERATURE THAT 4859 03:13:16,640 --> 03:13:18,320 AMONG NON-PREGNANT ADULTS THERE 4860 03:13:18,320 --> 03:13:25,520 WAS A SIMILAR TYPE OF 4861 03:13:25,520 --> 03:13:25,800 PHENOMENON. 4862 03:13:25,800 --> 03:13:26,600 >>INTERESTING. 4863 03:13:26,600 --> 03:13:30,360 >>IT WAS VERY INTERESTING AND 4864 03:13:30,360 --> 03:13:32,560 WE FOUND THAT THERE'S NOT 4865 03:13:32,560 --> 03:13:36,080 SIMILAR STUDIES ON POSTPARTUM OR 4866 03:13:36,080 --> 03:13:40,880 DURING PREGNANCY, BUT IN GENERAL 4867 03:13:40,880 --> 03:13:42,320 THIS RELATIONSHIP LIKE NEGATIVE 4868 03:13:42,320 --> 03:13:44,120 RELATIONSHIP BETWEEN THE 4869 03:13:44,120 --> 03:13:47,640 DEPRESSION AND THE BLOOD 4870 03:13:47,640 --> 03:13:47,920 PRESSURE. 4871 03:13:47,920 --> 03:13:49,960 >>DEFINITELY SOMETHING WE WANT 4872 03:13:49,960 --> 03:13:54,440 TO STUDY MORE AND TO GET MORE 4873 03:13:54,440 --> 03:13:54,760 INSIGHT ON. 4874 03:13:54,760 --> 03:13:56,600 >>GREAT. 4875 03:13:56,600 --> 03:14:00,040 THANK YOU VERY MUCH. 4876 03:14:00,040 --> 03:14:02,600 AND FOR DR. SIMON, I REALLY 4877 03:14:02,600 --> 03:14:04,200 APPRECIATED HOW YOU WERE FRAMING 4878 03:14:04,200 --> 03:14:08,920 THIS IDEA OF TRUST, AND 4879 03:14:08,920 --> 03:14:11,280 CONNECTION, AND SORT OF 4880 03:14:11,280 --> 03:14:11,560 CENTERING. 4881 03:14:11,560 --> 03:14:15,720 THERE'S BEEN TALK ABOUT KIND OF, 4882 03:14:15,720 --> 03:14:17,760 YOU KNOW, IMPORTANCE OF HAVING 4883 03:14:17,760 --> 03:14:19,120 OTHER PROVIDERS THAT LOOK LIKE 4884 03:14:19,120 --> 03:14:21,200 THE PATIENT AND WE KNOW THERE'S 4885 03:14:21,200 --> 03:14:23,040 A SHORTAGE OF THOSE PROVIDERS SO 4886 03:14:23,040 --> 03:14:23,920 I'M WONDERING IF THAT'S 4887 03:14:23,920 --> 03:14:25,240 SOMETHING THAT YOU WERE ABLE TO 4888 03:14:25,240 --> 03:14:28,000 LOOK AT OR YOU PLAN TO LOOK AT, 4889 03:14:28,000 --> 03:14:30,080 OR IF NOT I KNOW YOU TALKED 4890 03:14:30,080 --> 03:14:32,200 ABOUT SOME OF THE KINDS OF 4891 03:14:32,200 --> 03:14:33,400 QUESTIONS THAT PROVIDERS CAN ASK 4892 03:14:33,400 --> 03:14:35,560 TO START TO BUILD THAT TRUST BUT 4893 03:14:35,560 --> 03:14:38,960 I'M WONDERING IF YOU HAVE ANY 4894 03:14:38,960 --> 03:14:41,480 INSIGHT INTO THAT PARTICULAR 4895 03:14:41,480 --> 03:14:42,480 ASPECT OF THAT RELATIONSHIP. 4896 03:14:42,480 --> 03:14:43,680 >>IT IS ABSOLUTELY AN IMPORTANT 4897 03:14:43,680 --> 03:14:46,080 PART OF THE RELATIONSHIP BUT 4898 03:14:46,080 --> 03:14:47,720 IT'S NOT AN END-ALL, BE-ALL 4899 03:14:47,720 --> 03:14:51,480 BECAUSE AT THIS POINT, UNTIL WE 4900 03:14:51,480 --> 03:14:52,640 IMPROVE OUR WORKFORCE 4901 03:14:52,640 --> 03:14:53,760 DIVERSIFICATION AND STABILIZE WE 4902 03:14:53,760 --> 03:14:56,160 HAVE TO STABILIZE OUR WORKFORCE 4903 03:14:56,160 --> 03:15:00,200 FIRST, THERE'S BEEN A MASS 4904 03:15:00,200 --> 03:15:02,400 EXODUS, 20% OF NURSES ACROSS THE 4905 03:15:02,400 --> 03:15:04,800 COUNTRY LEFT, THE PROFESSION, 4906 03:15:04,800 --> 03:15:06,880 PHYSICIANS ARE LEAVING, WE NEED 4907 03:15:06,880 --> 03:15:07,800 TO STABILIZE THE WORKFORCE 4908 03:15:07,800 --> 03:15:13,800 COMING OUT OF THE PANDEMIC FIRST 4909 03:15:13,800 --> 03:15:17,720 AND FOREMOST. 4910 03:15:17,720 --> 03:15:19,280 I CAN'T REPORT ON CONCORDANCE. 4911 03:15:19,280 --> 03:15:21,120 WE WILL. 4912 03:15:21,120 --> 03:15:22,760 BUT ONE THING, THESE QUESTIONS 4913 03:15:22,760 --> 03:15:25,280 AND JUST PAUSING AND TAKING A 4914 03:15:25,280 --> 03:15:27,920 MOMENT IN THE FIRST PRENATAL 4915 03:15:27,920 --> 03:15:30,200 CARE VISIT INSTEAD OF DELUGE OF 4916 03:15:30,200 --> 03:15:32,720 ALL THOSE QUESTIONS, WE TALK 4917 03:15:32,720 --> 03:15:33,800 ABOUT GENETIC SCREENING AND ALL 4918 03:15:33,800 --> 03:15:34,680 KINDS OF STUFF. 4919 03:15:34,680 --> 03:15:36,320 IF YOU HAVE DIABETES AND 4920 03:15:36,320 --> 03:15:37,640 HYPERTENSION, ALL THIS STUFF ON 4921 03:15:37,640 --> 03:15:40,400 TOP OF THAT, THAT MAKES THAT IS 4922 03:15:40,400 --> 03:15:43,280 HAVE IT EVEN WORSE WITH HEALTH 4923 03:15:43,280 --> 03:15:43,720 INFORMATION. 4924 03:15:43,720 --> 03:15:48,680 SO IF WE TAKE A PAUSE, ASK THESE 4925 03:15:48,680 --> 03:15:50,520 QUESTIONS ABOUT WHAT ARE YOUR 4926 03:15:50,520 --> 03:15:52,360 FEARS, YOUR WORRIES ABOUT THIS 4927 03:15:52,360 --> 03:15:54,120 PREGNANCY, HOPES AND DREAMS, 4928 03:15:54,120 --> 03:15:56,400 WHAT CAN WE DO, SLOW IT DOWN, I 4929 03:15:56,400 --> 03:16:00,720 THINK WE HAVE A BETTER CHANCE OF 4930 03:16:00,720 --> 03:16:02,200 STARTING THAT BRIDGE OF BUILDING 4931 03:16:02,200 --> 03:16:07,120 TRUST REGARDLESS OF THE 4932 03:16:07,120 --> 03:16:07,400 CONCORDANCE. 4933 03:16:07,400 --> 03:16:08,400 >>ABSOLUTELY. 4934 03:16:08,400 --> 03:16:10,560 THANK YOU SO MUCH. 4935 03:16:10,560 --> 03:16:12,320 I THINK WITH THAT I DON'T SEE 4936 03:16:12,320 --> 03:16:13,480 ANY OTHER QUESTIONS COMING IN. 4937 03:16:13,480 --> 03:16:16,360 I WANT TO MAKE SURE WE HAVE TIME 4938 03:16:16,360 --> 03:16:21,160 FOR OUR FINAL SESSION OF THE 4939 03:16:21,160 --> 03:16:21,400 DAY. 4940 03:16:21,400 --> 03:16:23,280 I'M GOING TO THANK THE SPEAKERS 4941 03:16:23,280 --> 03:16:28,560 AND TURN IT OVER TO MY 4942 03:16:28,560 --> 03:16:33,720 COLLEAGUES SARAH YOON MODERATING 4943 03:16:33,720 --> 03:16:38,840 THE LAST SESSION. 4944 03:16:38,840 --> 03:16:41,200 >>THANK YOU. 4945 03:16:41,200 --> 03:16:43,400 I APOLOGIZE FOR MY 4946 03:16:43,400 --> 03:16:46,360 PRONUNCIATIONS, I'LL DO MY BEST. 4947 03:16:46,360 --> 03:16:49,320 I'M SARAH YOON, PROGRAM DIRECTOR 4948 03:16:49,320 --> 03:16:51,040 AT NINR. 4949 03:16:51,040 --> 03:16:54,120 I WILL MODERATE CARDIOVASCULAR 4950 03:16:54,120 --> 03:16:56,640 AND ENVIRONMENTAL RISKS SESSION. 4951 03:16:56,640 --> 03:17:00,480 AND IN THIS SESSION WE HAVE 4952 03:17:00,480 --> 03:17:04,120 THREE SPEAKERS, FIRST DR. 4953 03:17:04,120 --> 03:17:06,320 DOCTORS RICHARDSON AND TOLUHI 4954 03:17:06,320 --> 03:17:11,120 FROM THE UNIVERSITY OF ALABAMA 4955 03:17:11,120 --> 03:17:15,040 BIRMINGHAM. 4956 03:17:15,040 --> 03:17:17,760 SECONDS IS DR. KARAGAS AND DR. 4957 03:17:17,760 --> 03:17:24,040 ROMANO FROM DARTMOUTH SCHOOL OF 4958 03:17:24,040 --> 03:17:27,200 MEDICINE. 4959 03:17:27,200 --> 03:17:29,720 LAST PRESENTERS DOCTORS CHARRON 4960 03:17:29,720 --> 03:17:32,760 AND FULORIA FROM ALBERT EINSTEIN 4961 03:17:32,760 --> 03:17:34,560 COLLEGE OF MEDICINE. 4962 03:17:34,560 --> 03:17:37,040 WE'LL START WITH DR. RICHARDSON, 4963 03:17:37,040 --> 03:17:38,920 MULTI-LEVEL DETERMINANTS OF 4964 03:17:38,920 --> 03:17:42,160 MATERNAL MORTALITY AND SEVERE 4965 03:17:42,160 --> 03:17:45,800 MATERNAL MORBIDITY AND 4966 03:17:45,800 --> 03:17:46,880 ASSOCIATED HEALTH DISPARITIES. 4967 03:17:46,880 --> 03:17:50,880 PLEASE GO AHEAD FOR YOUR 4968 03:17:50,880 --> 03:17:51,800 PRESENTATION, DR. RICHARDSON. 4969 03:17:51,800 --> 03:17:55,080 >>THANK YOU, DR. YOON. 4970 03:17:55,080 --> 03:17:56,760 I'M EXCITED TO PRESENT THIS WORK 4971 03:17:56,760 --> 03:18:00,680 ON BEHALF OF A LARGE 4972 03:18:00,680 --> 03:18:01,280 MULTI-DISCIPLINARY COLLABORATION 4973 03:18:01,280 --> 03:18:03,640 ACROSS UAB SCHOOLS OF MEDICINE, 4974 03:18:03,640 --> 03:18:04,920 NURSING, PUBLIC HEALTH. 4975 03:18:04,920 --> 03:18:15,320 THIS WORK IS FUNDED AS 4976 03:18:21,240 --> 03:18:21,720 ADMINISTRATIVE SUPPLEMENT. 4977 03:18:21,720 --> 03:18:23,640 I'D LIKE TO ACKNOWLEDGE 4978 03:18:23,640 --> 03:18:31,320 LEADERSHIP AND SUPPORT FROM UAB 4979 03:18:31,320 --> 03:18:32,840 CENTER WORKING GROUP AND 4980 03:18:32,840 --> 03:18:35,840 DIVISIONS AND DEPARTMENTS. 4981 03:18:35,840 --> 03:18:38,440 NEXT SLIDE PLEASE. 4982 03:18:38,440 --> 03:18:39,720 ALABAMA HAS THE THIRD WORST 4983 03:18:39,720 --> 03:18:42,080 MATERNAL MORTALITY RATIO IN THE 4984 03:18:42,080 --> 03:18:44,560 U.S., THREE TIMES AS LIKELY 4985 03:18:44,560 --> 03:18:47,480 AMONG BLACK VERSUS WHITE WOMEN 4986 03:18:47,480 --> 03:18:49,280 IN THE U.S. 4987 03:18:49,280 --> 03:18:51,600 CONCEPTUAL MODELS ON THE RIGHT 4988 03:18:51,600 --> 03:18:54,360 ILLUSTRATE PATHWAYS TO RACIAL 4989 03:18:54,360 --> 03:18:55,640 DISPARITIES AND MATERNAL 4990 03:18:55,640 --> 03:18:58,600 MORTALITY, SHOWING FACTORS AT 4991 03:18:58,600 --> 03:19:00,720 MULTIPLE LEVELS. 4992 03:19:00,720 --> 03:19:02,240 OUR TEAM IDENTIFIED MULTI-LEVEL 4993 03:19:02,240 --> 03:19:04,320 DETERMINANTS OF MATERNAL HEALTH 4994 03:19:04,320 --> 03:19:07,600 DISPARITIES AND FACTORS THAT 4995 03:19:07,600 --> 03:19:11,200 CONTRIBUTE TO OPTIMAL OUTCOMES. 4996 03:19:11,200 --> 03:19:12,720 NEXT SLIDE PLEASE. 4997 03:19:12,720 --> 03:19:15,800 WE EXAMINED THE RELATIONSHIP 4998 03:19:15,800 --> 03:19:17,480 BETWEEN INDIVIDUALS, COMMUNITY, 4999 03:19:17,480 --> 03:19:19,680 SYSTEMS FACTORS AND COMPOSITE OF 5000 03:19:19,680 --> 03:19:23,800 MATERNAL MORTALITY AND SEVERE 5001 03:19:23,800 --> 03:19:26,200 MORBIDITY, RECEIVING OB CARE AT 5002 03:19:26,200 --> 03:19:28,640 ALABAMA HEALTH SYSTEM. 5003 03:19:28,640 --> 03:19:30,400 WE CONDUCTED RETROSPECTIVE 5004 03:19:30,400 --> 03:19:33,440 COHORT STUDY OF ALL OBSTETRIC 5005 03:19:33,440 --> 03:19:36,600 PATIENTS FROM 2010 TO 2019, 5006 03:19:36,600 --> 03:19:42,280 USING DATA FROM THE INFORMATICS 5007 03:19:42,280 --> 03:19:43,280 FRAMEWORK. 5008 03:19:43,280 --> 03:19:44,480 UTILIZED MULTI-LEVEL MODELING 5009 03:19:44,480 --> 03:19:47,680 AND SPATIAL ANALYSIS TO EXAMINE 5010 03:19:47,680 --> 03:19:54,000 ASSOCIATION BETWEEN PREDICTORS 5011 03:19:54,000 --> 03:19:55,440 AND COMBINED MORBIDITY AND 5012 03:19:55,440 --> 03:19:58,040 MORTALITY OUTCOME. 5013 03:19:58,040 --> 03:19:59,800 WE IDENTIFIED AND INCLUDED 5014 03:19:59,800 --> 03:20:07,800 32,000 LIVE BIRTHS, LOOKING AT A 5015 03:20:07,800 --> 03:20:09,320 PARTIAL TABLE. 5016 03:20:09,320 --> 03:20:12,280 YOU'LL NOTE ADI BROKEN DOWN INTO 5017 03:20:12,280 --> 03:20:14,280 QUINTILES ON THE FAR LEFT, 5018 03:20:14,280 --> 03:20:15,680 SIGNIFICANT ADJUSTED ODDS RATIOS 5019 03:20:15,680 --> 03:20:17,080 NOTED ON THE RIGHT. 5020 03:20:17,080 --> 03:20:19,880 FULL TABLE IN THE PAPER DETAILS 5021 03:20:19,880 --> 03:20:25,760 THE OTHER VARIABLES LIKE 5022 03:20:25,760 --> 03:20:31,880 INSURANCE, AGE, RESIDENCE IN 5023 03:20:31,880 --> 03:20:33,520 MEDICALLY UNDERSERVED AREAS. 5024 03:20:33,520 --> 03:20:36,680 WE FOUND RESIDENTS WITHIN 5025 03:20:36,680 --> 03:20:38,200 DISADVANTAGED NEIGHBORS MAY 5026 03:20:38,200 --> 03:20:40,720 CONTRIBUTE TO SEVERE MATERNAL 5027 03:20:40,720 --> 03:20:42,920 MORBIDITY AND MORTALITY EVEN 5028 03:20:42,920 --> 03:20:44,240 AFTER ADJUSTING FOR PATIENT 5029 03:20:44,240 --> 03:20:45,400 LEVEL FACTORS. 5030 03:20:45,400 --> 03:20:48,520 THIS TELLS US THAT MEASURES SUCH 5031 03:20:48,520 --> 03:20:51,480 AS AREA DEPRIVATION INDEX ADI 5032 03:20:51,480 --> 03:20:53,680 CAN HELP IDENTIFY MOST 5033 03:20:53,680 --> 03:20:55,640 VULNERABLE POPULATIONS AND 5034 03:20:55,640 --> 03:20:57,920 PROVIDE POINTS TO POTENTIALLY 5035 03:20:57,920 --> 03:20:58,640 INTERVENE. 5036 03:20:58,640 --> 03:20:59,720 NEXT SLIDE PLEASE. 5037 03:20:59,720 --> 03:21:05,160 NEXT WE AIM TO IDENTIFY 5038 03:21:05,160 --> 03:21:06,360 PROVIDER, SYSTEM, 5039 03:21:06,360 --> 03:21:08,040 COMMUNITY-BASED PERSPECTIVES ON 5040 03:21:08,040 --> 03:21:16,000 FACTORS RESPONSIBLE FOR 5041 03:21:16,000 --> 03:21:25,520 DISPARITIES TO INTERVENE, 5042 03:21:25,520 --> 03:21:26,880 CONDUCTING 20 INTERVIEWS TO 5043 03:21:26,880 --> 03:21:36,280 THOSE WHO PROVIDE SERVICES TO 5044 03:21:36,280 --> 03:21:37,480 INDIVIDUALS IN ALABAMA. 5045 03:21:37,480 --> 03:21:40,560 DESCRIBING FACTORS CONTRIBUTING 5046 03:21:40,560 --> 03:21:43,200 TO DISPARITIES, ORGANIZED BY 5047 03:21:43,200 --> 03:21:49,120 LEVEL. 5048 03:21:49,120 --> 03:21:51,520 NEXT SLIDE PLEASE. 5049 03:21:51,520 --> 03:21:54,400 THESE ARE ORGANIZED BY LEVELS, 5050 03:21:54,400 --> 03:21:58,280 VARYING WIDELY FROM RACISM TO 5051 03:21:58,280 --> 03:21:59,960 WORK FORCE SHORTAGES, LACK OF 5052 03:21:59,960 --> 03:22:02,800 DIVERSITY AT THE HEALTH SERVICES 5053 03:22:02,800 --> 03:22:04,320 LEVEL, LACK OF CULTURAL 5054 03:22:04,320 --> 03:22:07,200 COMPETENCE AT THE PROVIDER LEVEL 5055 03:22:07,200 --> 03:22:10,480 TO NAME JUST A FEW. 5056 03:22:10,480 --> 03:22:12,360 NEXT SLIDE PLEASE. 5057 03:22:12,360 --> 03:22:16,480 STRATEGIES TO ADDRESS THESE 5058 03:22:16,480 --> 03:22:18,440 DISPARITIES NOTED THAT 5059 03:22:18,440 --> 03:22:20,080 STRATEGIES SHOULD BE 5060 03:22:20,080 --> 03:22:21,040 EVIDENCE-BASED, CULTURALLY 5061 03:22:21,040 --> 03:22:22,920 APPROPRIATE, ADDRESS FACTORS AT 5062 03:22:22,920 --> 03:22:25,120 MULTIPLE LEVELS. 5063 03:22:25,120 --> 03:22:26,960 THEY ALSO IDENTIFIED SPECIFIC 5064 03:22:26,960 --> 03:22:29,080 STRATEGIES FOR PROVIDER AND 5065 03:22:29,080 --> 03:22:30,480 MATERNITY HEALTH SERVICE LEVELS, 5066 03:22:30,480 --> 03:22:32,760 LIKE TRAININGS, SPECIFIC 5067 03:22:32,760 --> 03:22:34,280 RESEARCH TOPICS, INCREASING 5068 03:22:34,280 --> 03:22:34,840 WORKFORCE DIVERSITY. 5069 03:22:34,840 --> 03:22:38,040 AT THE COMMUNITY AND SYSTEMS 5070 03:22:38,040 --> 03:22:40,920 LEVELS THEY EMPHASIZED NEED TO 5071 03:22:40,920 --> 03:22:42,400 INCORPORATE CARE INTO 5072 03:22:42,400 --> 03:22:44,480 COMMUNITIES, INCREASE SOCIAL 5073 03:22:44,480 --> 03:22:46,240 SUPPORT, EXPAND HEALTH COVERAGE, 5074 03:22:46,240 --> 03:22:49,120 ENACT POLICIES TO SUPPORT HEALTH 5075 03:22:49,120 --> 03:22:51,800 AND REMOVE RESTRICTIVE ONES. 5076 03:22:51,800 --> 03:22:54,240 NEXT SLIDE PLEASE. 5077 03:22:54,240 --> 03:22:58,720 YOU CAN SEE ILLUSTRATIVE QUOTES 5078 03:22:58,720 --> 03:23:04,280 WHICH EMPHASIZE FACTORS AROUND 5079 03:23:04,280 --> 03:23:07,480 SYSTEMIC RACISM CONTRIBUTING TO 5080 03:23:07,480 --> 03:23:07,960 INEQUITIES. 5081 03:23:07,960 --> 03:23:10,400 THEY ALSO NOTICED NEED FOR 5082 03:23:10,400 --> 03:23:13,920 OPTION FOR HOME VISITS, 5083 03:23:13,920 --> 03:23:15,200 NAVIGATORS, AND EVIDENCE-BASED 5084 03:23:15,200 --> 03:23:16,120 INTERVENTION. 5085 03:23:16,120 --> 03:23:19,040 DUE TO TIME CONSTRAINTS WE CAN'T 5086 03:23:19,040 --> 03:23:22,160 GO IN DEPTH INTO THE VOICES. 5087 03:23:22,160 --> 03:23:25,240 FIND MORE DETAILS IN THE 5088 03:23:25,240 --> 03:23:25,720 ABSTRACT. 5089 03:23:25,720 --> 03:23:26,800 NEXT SLIDE PLEASE. 5090 03:23:26,800 --> 03:23:28,800 WE TOOK A MIX THE METHODS 5091 03:23:28,800 --> 03:23:37,520 APPROACH TO ASK HEALTH HEALTH E 5092 03:23:37,520 --> 03:23:38,960 SYSTEM DISTRESS. 5093 03:23:38,960 --> 03:23:42,560 WE FIRST USED EVIDENCE-BASED 5094 03:23:42,560 --> 03:23:43,560 SURVEYS POSTPARTUM, STRATIFIED 5095 03:23:43,560 --> 03:23:46,320 RESPONSES BY PERCEIVED LEVELS OF 5096 03:23:46,320 --> 03:23:48,280 RACISM AND DISTRUST. 5097 03:23:48,280 --> 03:23:49,800 WE INTERVIEWED THOSE REPORTING 5098 03:23:49,800 --> 03:23:54,280 HIGH AND LOW LEVELS, TO BETTER 5099 03:23:54,280 --> 03:23:55,480 UNDERSTAND THEIR EXPERIENCES AND 5100 03:23:55,480 --> 03:23:57,240 LOOK FORWARD TO SHARING THESE 5101 03:23:57,240 --> 03:24:00,080 RESULTS ONCE AVAILABLE. 5102 03:24:00,080 --> 03:24:01,720 NEXT SLIDE PLEASE. 5103 03:24:01,720 --> 03:24:07,200 WE FOUND FACTORS CONTRIBUTING TO 5104 03:24:07,200 --> 03:24:08,400 DISPARITIES ACROSS LEVELS. 5105 03:24:08,400 --> 03:24:10,680 STRATEGIES TO OVERCOME THESE 5106 03:24:10,680 --> 03:24:12,520 DISPARITIES MAY USE MEASURES OF 5107 03:24:12,520 --> 03:24:14,640 ADI TO IDENTIFY MOST VULNERABLE 5108 03:24:14,640 --> 03:24:16,520 POPULATIONS AND PROVIDE POINTS 5109 03:24:16,520 --> 03:24:18,120 TO INTERVENE. 5110 03:24:18,120 --> 03:24:20,640 STRATEGIES SHOULD BE 5111 03:24:20,640 --> 03:24:22,640 EVIDENCE-BASED, CULTURALLY 5112 03:24:22,640 --> 03:24:24,040 APPROPRIATE, ADDRESS MULTIPLE 5113 03:24:24,040 --> 03:24:24,720 LEVELS. 5114 03:24:24,720 --> 03:24:25,920 OUR RESULTS WILL INFORM 5115 03:24:25,920 --> 03:24:29,840 INTERVENTIONS AND TOOLS TO WORK 5116 03:24:29,840 --> 03:24:32,560 TOWARDS EQUITY AND MATERNAL 5117 03:24:32,560 --> 03:24:33,560 HEALTH, SPECIFICALLY INFORMING 5118 03:24:33,560 --> 03:24:36,080 DISCUSSIONS WITH HEALTH SYSTEM 5119 03:24:36,080 --> 03:24:38,160 AND COMMUNITY PARTNERS ABOUT 5120 03:24:38,160 --> 03:24:40,680 ALABAMA AND OTHER DEEP SOUTH 5121 03:24:40,680 --> 03:24:42,000 LOCAL AND STATEWIDE INITIATIVES 5122 03:24:42,000 --> 03:24:43,720 TO ADDRESS RACIAL DISPARITIES 5123 03:24:43,720 --> 03:24:45,080 AND MATERNAL HEALTH. 5124 03:24:45,080 --> 03:24:48,320 WE LOOK FORWARD TO FUTURE 5125 03:24:48,320 --> 03:24:50,080 INTERVENTIONAL INITIATIVES TO 5126 03:24:50,080 --> 03:24:51,920 FURTHER THIS WORK IN ONE OF THE 5127 03:24:51,920 --> 03:24:53,120 MOST UNDERSERVED STATES. 5128 03:24:53,120 --> 03:24:54,240 WE'RE EXCITED TO CONTINUE THIS 5129 03:24:54,240 --> 03:24:58,400 LINE OF WORK THROUGH THE P3 5130 03:24:58,400 --> 03:25:00,160 EQUATE NETWORK WHICH SUPPORTS 5131 03:25:00,160 --> 03:25:01,600 THE DISSERTATION WORK, PART OF 5132 03:25:01,600 --> 03:25:04,760 THE Q&A SESSION, OTHER PROJECTS 5133 03:25:04,760 --> 03:25:06,960 ARE THE HRSA FUNDED ALABAMA 5134 03:25:06,960 --> 03:25:10,560 MATERNAL HEALTH INNOVATION AND 5135 03:25:10,560 --> 03:25:15,600 DATA CAPACITY PROGRAM AND POPPY 5136 03:25:15,600 --> 03:25:19,440 STUDY TESTING HYPOTHESIS CARE 5137 03:25:19,440 --> 03:25:24,920 WITH MOBILE HEALTH INTERVENTION 5138 03:25:24,920 --> 03:25:26,520 WILL IMPROVE OUTCOMES. 5139 03:25:26,520 --> 03:25:28,400 NEXT SLIDE. 5140 03:25:28,400 --> 03:25:30,160 THANKS FOR YOUR ATTENTION. 5141 03:25:30,160 --> 03:25:36,240 PLEASE FIND OUR REFERENCES HERE. 5142 03:25:36,240 --> 03:25:41,320 >>THANK YOU. 5143 03:25:41,320 --> 03:25:46,960 MAY I ASK DR. KARAGAS TO TAKE 5144 03:25:46,960 --> 03:26:00,880 OVER WITH YOUR PRESENTATION, PER 5145 03:26:00,880 --> 03:26:05,040 AND POLYFLUOROALKYL MIXTURES 5146 03:26:05,040 --> 03:26:06,840 DURING PREGNANCY. 5147 03:26:06,840 --> 03:26:08,280 >>THANK YOU. 5148 03:26:08,280 --> 03:26:12,120 I'M DR. ROMANO PRESENTING THE 5149 03:26:12,120 --> 03:26:12,400 RESEARCH. 5150 03:26:12,400 --> 03:26:13,480 DR. KARAGAS IS THE P.I. 5151 03:26:13,480 --> 03:26:16,080 I WANT TO SAY THANK YOU TO THE 5152 03:26:16,080 --> 03:26:18,280 ORGANIZERS FOR INVITING US TO BE 5153 03:26:18,280 --> 03:26:19,880 HERE TODAY. 5154 03:26:19,880 --> 03:26:22,320 IT'S INCREDIBLY HUM BING TO BE 5155 03:26:22,320 --> 03:26:26,040 PART OF THE DAY OF ALL OF THIS 5156 03:26:26,040 --> 03:26:27,520 IMPACTFUL RESEARCH. 5157 03:26:27,520 --> 03:26:29,480 SO I HOPE TO KEEP THAT GOING AS 5158 03:26:29,480 --> 03:26:32,000 I TELL YOU ABOUT OUR WORK IN THE 5159 03:26:32,000 --> 03:26:39,680 NEW HAMPSHIRE BIRTH COHORT 5160 03:26:39,680 --> 03:26:39,760 STUDY. 5161 03:26:39,760 --> 03:26:41,880 PER AND POLYFLUOROALKYL 5162 03:26:41,880 --> 03:26:42,720 SUBSTANCES WITH PERSISTENT 5163 03:26:42,720 --> 03:26:49,320 CHEMICALS USED IN A VARIETY OF 5164 03:26:49,320 --> 03:26:50,960 INDUSTRIAL PROCESSES, PRESENT IN 5165 03:26:50,960 --> 03:26:52,560 CONSUMER PRODUCTS. 5166 03:26:52,560 --> 03:26:54,560 A FEW LEGACY PFAS ARE DETECTED 5167 03:26:54,560 --> 03:26:58,720 IN BLOOD OF THE GENERAL 5168 03:26:58,720 --> 03:27:01,440 POPULATION, IN ADDITION TO 5169 03:27:01,440 --> 03:27:02,520 RESISTING DEGRADATION THEY STAY 5170 03:27:02,520 --> 03:27:05,160 IN OUR BODIES FOR A LONG TIME 5171 03:27:05,160 --> 03:27:06,240 AFTER INITIAL EXPOSURE. 5172 03:27:06,240 --> 03:27:09,000 THIS IS A LARGE GROUP OF 5173 03:27:09,000 --> 03:27:10,400 CHEMICALS, DEPENDING ON WHOSE 5174 03:27:10,400 --> 03:27:11,840 DEFINITION AND HOW YOU COUNT 5175 03:27:11,840 --> 03:27:13,680 THERE ARE MORE THAN 12,000 PFAS 5176 03:27:13,680 --> 03:27:16,240 WITH ABOUT A THOUSAND COMMONLY 5177 03:27:16,240 --> 03:27:17,640 USED IN COMMERCE CURRENTLY. 5178 03:27:17,640 --> 03:27:20,280 IN ADDITION TO KNOWN HEALTH 5179 03:27:20,280 --> 03:27:22,920 EFFECTS INCLUDING HEPATIC AND 5180 03:27:22,920 --> 03:27:24,320 RENAL DYSFUNCTION, 5181 03:27:24,320 --> 03:27:25,080 IMMUNOTOXICITY, HIGH 5182 03:27:25,080 --> 03:27:25,640 CHOLESTEROL, HYPERTENSIVE 5183 03:27:25,640 --> 03:27:28,840 DISORDERS IN PREGNANCY AND 5184 03:27:28,840 --> 03:27:30,880 CERTAIN CANCERS, THEY ARE 5185 03:27:30,880 --> 03:27:34,720 SUSPECTED TO BE METABOLIC 5186 03:27:34,720 --> 03:27:35,200 DISRUPTORS. 5187 03:27:35,200 --> 03:27:41,400 WE KNOW MORE ABOUT EXPOSURE AS 5188 03:27:41,400 --> 03:27:43,800 OPPOSED TO HAVING INFLUENCE 5189 03:27:43,800 --> 03:27:46,040 ADIPOSITY IN MOTHERS. 5190 03:27:46,040 --> 03:27:47,520 NEXT SLIDE PLEASE. 5191 03:27:47,520 --> 03:27:51,360 IN ORDER TO INVESTIGATE HOW PFAS 5192 03:27:51,360 --> 03:27:52,440 IN PREGNANCY INFLUENCE 5193 03:27:52,440 --> 03:27:53,320 POSTPARTUM WEIGHT AMONG MOTHERS 5194 03:27:53,320 --> 03:27:55,600 WE USED DATA AND BIOLOGICAL 5195 03:27:55,600 --> 03:27:58,560 SPECIMENS FROM NEW HAMPSHIRE 5196 03:27:58,560 --> 03:28:01,560 BIRTH COHORT STUDY, THIS COHORT 5197 03:28:01,560 --> 03:28:09,760 IS DIRECTED BY DR. KARAGAS. 5198 03:28:09,760 --> 03:28:12,040 WOMEN PROVIDE A BLOOD SAMPLE, 5199 03:28:12,040 --> 03:28:14,040 AND WE PREVIOUSLY MEASURED PFAS 5200 03:28:14,040 --> 03:28:16,000 AMONG A THOUSAND OF THE MOTHERS 5201 03:28:16,000 --> 03:28:23,080 ENROLLED IN THE COHORT PRIOR TO 5202 03:28:23,080 --> 03:28:24,960 2018, THROUGH MY PROJECT GRANT 5203 03:28:24,960 --> 03:28:26,720 WHICH WAS GEARED TO 5204 03:28:26,720 --> 03:28:28,480 INVESTIGATING ASSOCIATION OF 5205 03:28:28,480 --> 03:28:35,160 PFAS WITH INFANT GROWTH 5206 03:28:35,160 --> 03:28:37,880 TRAJECTORY MATERNAL WEIGHT GAIN. 5207 03:28:37,880 --> 03:28:40,320 THE CHILDREN ARE FOLLOWED INTO 5208 03:28:40,320 --> 03:28:42,480 ADOLESCENCE, THE IMPROVE PROGRAM 5209 03:28:42,480 --> 03:28:44,440 SUPPLEMENT ALLOWED US TO OBTAIN 5210 03:28:44,440 --> 03:28:46,280 FUNDING THAT LED US TO NEW 5211 03:28:46,280 --> 03:28:48,400 FOLLOW-UP WITH MOTHERS TO HELP 5212 03:28:48,400 --> 03:28:50,040 US BETTER UNDERSTAND THEIR 5213 03:28:50,040 --> 03:28:55,200 HEALTH IN THE YEARS POSTPARTUM. 5214 03:28:55,200 --> 03:28:56,160 NEXT SLIDE PLEASE. 5215 03:28:56,160 --> 03:29:01,600 THIS IS A FORM OF A ONE-TIME 5216 03:29:01,600 --> 03:29:02,400 SURVEY ADMINISTERED IN 2020. 5217 03:29:02,400 --> 03:29:06,560 ALL OF THE WOMEN WHO WERE TWO OR 5218 03:29:06,560 --> 03:29:07,320 MORE YEARS POSTPARTUM, ELIGIBLE 5219 03:29:07,320 --> 03:29:09,200 TO PARTICIPATE IN THE SURVEY. 5220 03:29:09,200 --> 03:29:10,520 WE DID ADMINISTER THE SURVEY 5221 03:29:10,520 --> 03:29:13,160 ONLINE AS WE DO WITH MANY OF OUR 5222 03:29:13,160 --> 03:29:15,360 SURVEYS, IN THE BIRTH COHORT. 5223 03:29:15,360 --> 03:29:18,280 AND PARTICIPANTS WERE ABLE TO 5224 03:29:18,280 --> 03:29:19,160 SELF-REPORT ADDITIONAL PREGNANCY 5225 03:29:19,160 --> 03:29:22,880 HISTORY AND OF COURSE SINCE 5226 03:29:22,880 --> 03:29:23,840 THEIR PARTICIPATION IN THE STUDY 5227 03:29:23,840 --> 03:29:27,680 PREGNANCY MEASURES OF GLOBAL 5228 03:29:27,680 --> 03:29:28,800 HEALTH, HEALTH CONDITIONS, 5229 03:29:28,800 --> 03:29:30,760 RELATED MEDICATIONS AFTER THE 5230 03:29:30,760 --> 03:29:32,080 STUDY PREGNANCY, AS WELL AS 5231 03:29:32,080 --> 03:29:34,360 CURRENT WEIGHT AND TO GIVE US 5232 03:29:34,360 --> 03:29:35,480 UPDATED INFORMATION ABOUT 5233 03:29:35,480 --> 03:29:38,840 LIFESTYLE FACTORS SUCH AS 5234 03:29:38,840 --> 03:29:41,280 SMOKING AND PHYSICAL ACTIVITY. 5235 03:29:41,280 --> 03:29:43,440 WE CALCULATED WEIGHT CHANGE AS 5236 03:29:43,440 --> 03:29:44,760 BEING SELF-REPORTED WEIGHT IN 5237 03:29:44,760 --> 03:29:47,280 KILOGRAMS FROM THE SURVEY, MINUS 5238 03:29:47,280 --> 03:29:49,040 PRE-PREGNANCY WEIGHT ABSTRACTED 5239 03:29:49,040 --> 03:29:56,240 FROM THE MEDICAL RECORDS. 5240 03:29:56,240 --> 03:29:57,440 NEXT SLIDE PLEASE. 5241 03:29:57,440 --> 03:29:59,680 ONE MORE. 5242 03:29:59,680 --> 03:30:00,880 THANK YOU. 5243 03:30:00,880 --> 03:30:03,480 IN TERMS OF STATISTICAL ANALYSIS 5244 03:30:03,480 --> 03:30:06,200 WE USED BAYESIAN KERNEL MACHINE 5245 03:30:06,200 --> 03:30:08,160 REGRESSION TO MODEL RELATIONSHIP 5246 03:30:08,160 --> 03:30:09,920 BETWEEN WEIGHT CHANGE AND 5247 03:30:09,920 --> 03:30:12,240 MULTIPLE PFAS AND MANNER THAT 5248 03:30:12,240 --> 03:30:14,080 ALLOWS FOR NON-LINEAR 5249 03:30:14,080 --> 03:30:16,160 RELATIONSHIPS AND INTERACTIONS 5250 03:30:16,160 --> 03:30:18,920 AMONG EXPOSURE VARIABLES. 5251 03:30:18,920 --> 03:30:20,840 UNDERLYING MECHANISM IS COMPLEX 5252 03:30:20,840 --> 03:30:23,520 BUT BECAME THE KERNEL FUNCTION 5253 03:30:23,520 --> 03:30:25,600 THAT ESTIMATES EXPOSURE RESPONSE 5254 03:30:25,600 --> 03:30:26,600 SURFACE, EXPLOITING ASSUMPTION 5255 03:30:26,600 --> 03:30:28,880 TWO INDIVIDUALS WITH SIMILAR 5256 03:30:28,880 --> 03:30:30,840 EXPOSURE PROFILES WILL HAVE 5257 03:30:30,840 --> 03:30:32,160 SIMILAR OUTCOMES. 5258 03:30:32,160 --> 03:30:33,880 MODEL IS SIMILAR TO TRADITIONAL 5259 03:30:33,880 --> 03:30:36,800 LINEAR MODEL EXCEPT WE USE THIS 5260 03:30:36,800 --> 03:30:37,760 KERNEL FUNCTION TO ESTIMATE 5261 03:30:37,760 --> 03:30:44,560 WHICH OF OUR EXPOSURE VARIABLES 5262 03:30:44,560 --> 03:30:46,120 ARE ASSOCIATED WITH OUTCOME. 5263 03:30:46,120 --> 03:30:49,040 WE ADJUSTED FOR A NUMBER OF 5264 03:30:49,040 --> 03:30:49,680 SOCIODEMOGRAPHIC AND PERINATAL 5265 03:30:49,680 --> 03:30:51,560 FACTORS AS WELL AS MEASURES OF 5266 03:30:51,560 --> 03:30:55,560 DIET AND PHYSICAL ACTIVITY 5267 03:30:55,560 --> 03:30:57,040 DURING PREGNANCY. 5268 03:30:57,040 --> 03:31:00,760 NEXT SLIDE PLEASE. 5269 03:31:00,760 --> 03:31:02,920 AMONG NINE PFAS, FIVE WERE 5270 03:31:02,920 --> 03:31:04,400 FREQUENTLY DETECTED IN THE 5271 03:31:04,400 --> 03:31:06,640 PLASMA OF OUR PARTICIPANTS. 5272 03:31:06,640 --> 03:31:11,480 SO THESE WERE PFAS RETAINED IN 5273 03:31:11,480 --> 03:31:13,320 OUR MODELS. 5274 03:31:13,320 --> 03:31:15,320 CONCENTRATIONS IN POPULATION 5275 03:31:15,320 --> 03:31:18,520 WERE GENERALLY COMPARABLE TO 5276 03:31:18,520 --> 03:31:22,680 THOSE OBSERVED IN NHANES, BUT 5277 03:31:22,680 --> 03:31:24,080 PERHAPS SLIGHTLY ON THE LOWER 5278 03:31:24,080 --> 03:31:28,360 END IN TERMS OF OVERALL PFAS 5279 03:31:28,360 --> 03:31:29,560 CONCENTRATION IN THIS RURAL 5280 03:31:29,560 --> 03:31:33,800 PREGNANCY COHORT. 5281 03:31:33,800 --> 03:31:36,120 NEXT SLIDE PLEASE. 5282 03:31:36,120 --> 03:31:37,840 WE HAD JUST OVER 1100 WOMEN 5283 03:31:37,840 --> 03:31:40,160 PARTICIPATE IN THE ONLINE 5284 03:31:40,160 --> 03:31:41,480 SURVEY, RANGING FROM TWO TO 5285 03:31:41,480 --> 03:31:43,920 ELEVEN YEARS POSTPARTUM WITH 5286 03:31:43,920 --> 03:31:46,600 MAJORITY BEING 7 YEARS 5287 03:31:46,600 --> 03:31:47,920 POSTPARTUM ON AVERAGE. 5288 03:31:47,920 --> 03:31:49,920 LESS THAN 15% OF THE RESPONDENTS 5289 03:31:49,920 --> 03:31:55,040 RANKED GLOBAL HEALTH AS 5290 03:31:55,040 --> 03:31:55,320 EXCELLENT. 5291 03:31:55,320 --> 03:31:57,800 AND OVERALL 15% RECORDED AT 5292 03:31:57,800 --> 03:32:00,200 LEAST ONE CARDIOMETABOLIC 5293 03:32:00,200 --> 03:32:00,880 OUTCOME. 5294 03:32:00,880 --> 03:32:03,400 FEW IRTHAN 1% REPORTED DIABETES 5295 03:32:03,400 --> 03:32:04,600 OR CARDIOVASCULAR DISEASE 5296 03:32:04,600 --> 03:32:06,560 INCLUDING STROKE OR HEART ATTACK 5297 03:32:06,560 --> 03:32:07,640 WHICH MAKES SENSE BECAUSE THESE 5298 03:32:07,640 --> 03:32:09,400 WOMEN ARE IN THEIR 40s AND 5299 03:32:09,400 --> 03:32:13,520 50s SO SOME OF THESE 5300 03:32:13,520 --> 03:32:14,680 CARDIOMETABOLIC OUTCOMES WE 5301 03:32:14,680 --> 03:32:16,280 WOULD ANTICIPATE TO OBSERVE WITH 5302 03:32:16,280 --> 03:32:26,840 ADDITIONAL YEARS OF FOLLOW-UP. 5303 03:32:32,720 --> 03:32:34,920 48 2 RESPONDENTS RESPONDED. 5304 03:32:34,920 --> 03:32:36,800 NEXT SLIDE PLEASE. 5305 03:32:36,800 --> 03:32:39,840 THESE ANALYSES WERE COMPLETED BY 5306 03:32:39,840 --> 03:32:45,080 MY Ph.D. STUDENT, ESTIMATING 5307 03:32:45,080 --> 03:32:46,520 DURING PREGNANCY RELATED TO 5308 03:32:46,520 --> 03:32:50,080 POSTPARTUM WEIGHT RETENTION, 5309 03:32:50,080 --> 03:32:52,200 SEVEN YEARS ON AVERAGE. 5310 03:32:52,200 --> 03:32:54,400 THERE WASN'T A CLEAR OVERALL 5311 03:32:54,400 --> 03:32:59,560 EFFECT ON WEIGHT RETENTION BUT 5312 03:32:59,560 --> 03:33:02,120 PFOS, PFOA AND PFNA SEEMED TO 5313 03:33:02,120 --> 03:33:03,680 CONTRIBUTE TO GREATER RETENTION 5314 03:33:03,680 --> 03:33:10,520 OF WEIGHT IN THE POSTPARTUM 5315 03:33:10,520 --> 03:33:12,160 PERIOD. 5316 03:33:12,160 --> 03:33:13,160 THANK YOU. 5317 03:33:13,160 --> 03:33:17,200 WE ALSO FOUND EVIDENCE OF 5318 03:33:17,200 --> 03:33:18,720 MODIFICATION, EFFECT OF PFOS IN 5319 03:33:18,720 --> 03:33:21,360 PARTICULAR WAS STRONGEST AMONG 5320 03:33:21,360 --> 03:33:24,080 WOMEN WHO WERE OVERWEIGHT OR 5321 03:33:24,080 --> 03:33:28,560 OBESE PRIOR TO PREGNANCY. 5322 03:33:28,560 --> 03:33:35,760 WE FOUND EACH DOUBLING OF PLASMA 5323 03:33:35,760 --> 03:33:38,160 CONCENTRATION WAS ASSOCIATED 5324 03:33:38,160 --> 03:33:42,120 WITH 1.7, 1.4, 1.1 KILOGRAMS 5325 03:33:42,120 --> 03:33:44,400 RESPECTIVELY AMONG PARTICIPANTS 5326 03:33:44,400 --> 03:33:45,960 WITH OVERWEIGHT OR OBESE BMI 5327 03:33:45,960 --> 03:33:50,120 PRIOR TO THE STUDY PREGNANCY. 5328 03:33:50,120 --> 03:33:52,640 NEXT SLIDE PLEASE. 5329 03:33:52,640 --> 03:33:53,560 THESE FINDINGS SUGGEST PRENATAL 5330 03:33:53,560 --> 03:33:55,600 PFAS EXPOSURE MAY BE ASSOCIATED 5331 03:33:55,600 --> 03:33:58,680 WITH INCREASED WEIGHT RETENTION 5332 03:33:58,680 --> 03:33:59,320 AFTER PREGNANCY, PARTICULARLY 5333 03:33:59,320 --> 03:34:00,640 AMONG WOMEN WITH GREATER BODY 5334 03:34:00,640 --> 03:34:04,360 MASS INDEX PRIOR TO THE STUDY 5335 03:34:04,360 --> 03:34:04,880 PREGNANCY. 5336 03:34:04,880 --> 03:34:06,000 WE'RE OPTIMISTIC FINDINGS CAN 5337 03:34:06,000 --> 03:34:08,760 HELP TO INFORM FUTURE STRATEGIES 5338 03:34:08,760 --> 03:34:11,560 FOR PFAS REDUCING INTERVENTIONS 5339 03:34:11,560 --> 03:34:13,560 GEARED AT PREVENTING LONG-TERM 5340 03:34:13,560 --> 03:34:14,800 ADVERSE CARDIOMETABOLIC HEALTH 5341 03:34:14,800 --> 03:34:16,200 OUTCOMES, WE'RE SEEKING FUNDING 5342 03:34:16,200 --> 03:34:17,200 TO CONTINUE FOLLOWING THE 5343 03:34:17,200 --> 03:34:19,000 MOTHERS IN OUR STUDY AS THEY AGE 5344 03:34:19,000 --> 03:34:21,760 SO WE CAN BETTER UNDERSTAND HOW 5345 03:34:21,760 --> 03:34:24,720 HEALTH DURING PREGNANCY 5346 03:34:24,720 --> 03:34:25,760 INFLUENCES LONG-TERM 5347 03:34:25,760 --> 03:34:27,040 CARDIOMETABOLIC HEALTH IN THIS 5348 03:34:27,040 --> 03:34:27,280 COHORT. 5349 03:34:27,280 --> 03:34:28,360 NEXT SLIDE. 5350 03:34:28,360 --> 03:34:29,800 I'D LIKE TO ACKNOWLEDGE MY 5351 03:34:29,800 --> 03:34:31,440 COLLABORATORS AS WELL AS FUNDING 5352 03:34:31,440 --> 03:34:33,080 SOURCE AND THANK YOU FOR YOUR 5353 03:34:33,080 --> 03:34:35,920 TIME AND ATTENTION TODAY. 5354 03:34:35,920 --> 03:34:41,120 5355 03:34:41,120 --> 03:34:44,280 >>THANK YOU. 5356 03:34:44,280 --> 03:34:48,640 BEFORE WE MOVE ON, I WOULD LIKE 5357 03:34:48,640 --> 03:34:52,800 TO REMIND YOU THAT THE QUESTIONS 5358 03:34:52,800 --> 03:34:53,840 CAN BE SUBMITTED THROUGH THE 5359 03:34:53,840 --> 03:35:00,400 "LIVE FEEDBACK" BUTTON ON THE 5360 03:35:00,400 --> 03:35:01,040 VIDEOCAST WHICH WE WILL DISCUSS 5361 03:35:01,040 --> 03:35:02,680 IN THE Q&A. 5362 03:35:02,680 --> 03:35:04,440 PLEASE SUBMIT YOUR QUESTIONS. 5363 03:35:04,440 --> 03:35:14,960 NOW I WOULD LIKE TO MOVE TO OUR 5364 03:35:21,880 --> 03:35:24,160 NEXT SPEAKER. 5365 03:35:24,160 --> 03:35:27,520 >>I'M PRESENTING FOR DR. 5366 03:35:27,520 --> 03:35:27,760 CHARRON. 5367 03:35:27,760 --> 03:35:32,760 WE'RE BOTH P.I.s ON THE 5368 03:35:32,760 --> 03:35:33,000 PROJECT. 5369 03:35:33,000 --> 03:35:34,080 >>OKAY, ADVERSE SOCIAL 5370 03:35:34,080 --> 03:35:36,160 DETERMINANTS OF HEALTH, EFFECT 5371 03:35:36,160 --> 03:35:39,880 ON MATERNAL AND NEONATAL HEALTH. 5372 03:35:39,880 --> 03:35:40,360 THANK YOU. 5373 03:35:40,360 --> 03:35:43,080 >>I'M GOING TO SHARE MY SCREEN 5374 03:35:43,080 --> 03:35:50,600 NOW. 5375 03:35:50,600 --> 03:35:51,920 GOOD AFTERNOON. 5376 03:35:51,920 --> 03:35:53,480 IT IS AN INCREDIBLE HONOR TO 5377 03:35:53,480 --> 03:36:00,680 HAVE THE OPPORTUNITY TO PRESENT 5378 03:36:00,680 --> 03:36:02,440 OUR WORK HERE TODAY. 5379 03:36:02,440 --> 03:36:04,960 THE DATA WAS COLLECTED FROM 5380 03:36:04,960 --> 03:36:06,400 PARTICIPANTS IN THE BRONX 5381 03:36:06,400 --> 03:36:10,120 MATERNAL MENTAL HEALTH STUDY, A 5382 03:36:10,120 --> 03:36:14,800 SUPPLEMENT TO ONGOING GRANT ON 5383 03:36:14,800 --> 03:36:15,800 UNDERSTANDING MOLECULAR 5384 03:36:15,800 --> 03:36:21,600 SIGNALING MECHANISMS UNDERLYING 5385 03:36:21,600 --> 03:36:22,920 PATHOGENESIS OF CHILDHOOD 5386 03:36:22,920 --> 03:36:29,480 OBESITY, EXPLORING RACISM AND 5387 03:36:29,480 --> 03:36:32,280 COPING SKILLS AND HOW THESE 5388 03:36:32,280 --> 03:36:33,600 AFFECT OUTCOMES AND MENTAL 5389 03:36:33,600 --> 03:36:34,080 HEALTH. 5390 03:36:34,080 --> 03:36:36,040 FOR THE AFTERNOON WE'VE 5391 03:36:36,040 --> 03:36:37,120 DISCUSSED HOW SOCIAL DISPARITIES 5392 03:36:37,120 --> 03:36:38,760 CONTRIBUTE TO POOR HEALTH 5393 03:36:38,760 --> 03:36:40,440 OUTCOMES ACROSS THE LIFE COURSE. 5394 03:36:40,440 --> 03:36:43,680 IT IS ALSO VERY CLEAR THAT 5395 03:36:43,680 --> 03:36:48,520 HEALTH BEHAVIORS AND LIFESTYLE 5396 03:36:48,520 --> 03:36:49,760 FACTORS ARE IMPORTANT DRIVERS, 5397 03:36:49,760 --> 03:36:51,840 THEY CANNOT FULLY EXPLAIN THE 5398 03:36:51,840 --> 03:36:53,720 POOR HEALTH OUTCOMES OF 5399 03:36:53,720 --> 03:36:59,800 INDIVIDUALS WHO FACE 5400 03:36:59,800 --> 03:37:00,560 ADVERSITIES. 5401 03:37:00,560 --> 03:37:04,320 BIOLOGICAL EMBEDDING MAY 5402 03:37:04,320 --> 03:37:09,560 CONTRIBUTE TO SUBOPTIMAL 5403 03:37:09,560 --> 03:37:12,280 OUTCOMES. 5404 03:37:12,280 --> 03:37:18,080 ADVERSITY CAN ALTER THE 5405 03:37:18,080 --> 03:37:19,880 HYPOTHALAMIC AXIS. 5406 03:37:19,880 --> 03:37:22,280 LEPTIN WAS DISCOVERED IN THE 5407 03:37:22,280 --> 03:37:24,000 DEVELOPMENT OF METABOLIC 5408 03:37:24,000 --> 03:37:24,600 SYNDROME. 5409 03:37:24,600 --> 03:37:25,520 HOWEVER, ALTERATIONS IN LEVELS 5410 03:37:25,520 --> 03:37:28,480 HAVE BEEN OBSERVED IN PRESENTS 5411 03:37:28,480 --> 03:37:32,560 OF PSYCHOLOGICAL STRESS AND 5412 03:37:32,560 --> 03:37:33,320 DEPRESSION. 5413 03:37:33,320 --> 03:37:36,760 OUR GOAL HERE WAS TO DETERMINE 5414 03:37:36,760 --> 03:37:37,840 ASSOCIATION BETWEEN ADVERSE 5415 03:37:37,840 --> 03:37:38,880 SOCIAL DETERMINANTS OF HEALTH 5416 03:37:38,880 --> 03:37:42,160 AND MEDICAL CONDITIONS DURING 5417 03:37:42,160 --> 03:37:43,560 PREGNANCY AND PERINATAL 5418 03:37:43,560 --> 03:37:46,520 OUTCOMES, ALSO TO DETERMINE 5419 03:37:46,520 --> 03:37:51,560 ASSOCIATION BETWEEN LEPTIN AND 5420 03:37:51,560 --> 03:37:53,680 PERINATAL OUTCOMES. 5421 03:37:53,680 --> 03:37:55,840 ENROLLING PREGNANT WOMEN WHO 5422 03:37:55,840 --> 03:38:00,200 DELIVER AT THE HOSPITAL OF 5423 03:38:00,200 --> 03:38:02,520 MONTEFIORE MEDICAL CENTER, 5424 03:38:02,520 --> 03:38:03,720 COLLECTING DATA ON 5425 03:38:03,720 --> 03:38:05,000 CHARACTERISTICS, OUTCOMES, 5426 03:38:05,000 --> 03:38:07,400 MEASURES OF PSYCHOSOCIAL 5427 03:38:07,400 --> 03:38:08,600 ADVERSITY USING QUESTIONNAIRES 5428 03:38:08,600 --> 03:38:19,040 FROM THE PhenX TOOL KIT, 5429 03:38:19,960 --> 03:38:22,520 INCLUDING LEPTIN, TELOMERE 5430 03:38:22,520 --> 03:38:24,040 LENGTH. 5431 03:38:24,040 --> 03:38:27,760 ASSOCIATIONS BETWEEN CATEGORICAL 5432 03:38:27,760 --> 03:38:32,360 VARIABLES WERE ASSESSED, T-TEST 5433 03:38:32,360 --> 03:38:33,040 AND PEARSON'S CORRELATION 5434 03:38:33,040 --> 03:38:34,760 ASSESSED CATEGORICAL AND 5435 03:38:34,760 --> 03:38:35,760 CONTINUOUS VARIABLES. 5436 03:38:35,760 --> 03:38:37,760 LINEAR REGRESSION ANALYSES WERE 5437 03:38:37,760 --> 03:38:39,160 PERFORMED TO EXAMINE ASSOCIATION 5438 03:38:39,160 --> 03:38:42,800 BETWEEN BIRTH WEIGHT AND RACE, 5439 03:38:42,800 --> 03:38:46,960 PSYCHOSOCIAL ADVERSITY, OTHER 5440 03:38:46,960 --> 03:38:48,840 PERINATAL OUTCOMES. 5441 03:38:48,840 --> 03:38:52,320 THIS TABLE SHOWS THE MATERNAL 5442 03:38:52,320 --> 03:38:52,960 CHARACTERISTICS OF THE COHORT, 5443 03:38:52,960 --> 03:38:55,920 100 SO FAR. 5444 03:38:55,920 --> 03:39:00,320 YOU CAN SEE 6% ARE BLACK, 58% 5445 03:39:00,320 --> 03:39:01,640 HISPANIC, SIGNIFICANT PROPORTION 5446 03:39:01,640 --> 03:39:03,720 OF PREGNANT MOTHERS WERE EITHER 5447 03:39:03,720 --> 03:39:12,480 OVERWEIGHT OR OBESE PRIOR TO 5448 03:39:12,480 --> 03:39:17,200 BECOMING PREGNANT. 5449 03:39:17,200 --> 03:39:20,040 17% HYPERGLYCEMIC. 5450 03:39:20,040 --> 03:39:22,320 THIS DESCRIBES NEONATAL 5451 03:39:22,320 --> 03:39:22,680 CHARACTERISTICS. 5452 03:39:22,680 --> 03:39:24,960 87 OF THE 100 PREGNANT WOMEN 5453 03:39:24,960 --> 03:39:29,360 DELIVERED SO FAR. 5454 03:39:29,360 --> 03:39:30,560 ALMOST 30% WERE PRE-TERM, 5455 03:39:30,560 --> 03:39:33,840 APPROXIMATELY 37 WEEKS WITH 5456 03:39:33,840 --> 03:39:39,960 RANGE BETWEEN 24 TO 39 WEEKS 5457 03:39:39,960 --> 03:39:40,920 GESTATION. 5458 03:39:40,920 --> 03:39:42,360 APPROXIMATELY ONE-FIFTH NEONATES 5459 03:39:42,360 --> 03:39:44,360 ADMITTED TO THE NICU. 5460 03:39:44,360 --> 03:39:50,920 THIS SHOWS EXPOSURE TO 5461 03:39:50,920 --> 03:39:51,680 PSYCHOSOCIAL STRESSORS, 5462 03:39:51,680 --> 03:39:53,520 INFORMATION COLLECTED INCLUDED 5463 03:39:53,520 --> 03:39:55,480 JOB, HOUSING, FINANCIAL 5464 03:39:55,480 --> 03:39:56,400 INSECURITY, PERCEIVED 5465 03:39:56,400 --> 03:39:57,280 DISCRIMINATION, NEED FOR PUBLIC 5466 03:39:57,280 --> 03:39:57,840 HEALTH INSURANCE. 5467 03:39:57,840 --> 03:40:03,080 AS YOU CAN SEE FROM THE TABLE, 5468 03:40:03,080 --> 03:40:06,120 ALMOST 75% REPORTED EXPOSURE TO 5469 03:40:06,120 --> 03:40:08,120 TWO PSYCHOSOCIAL STRESSORS, A 5470 03:40:08,120 --> 03:40:11,160 QUARTER TO THREE STRESSORS. 5471 03:40:11,160 --> 03:40:14,000 ONLY 13% REPORTED NO 5472 03:40:14,000 --> 03:40:15,320 PSYCHOSOCIAL ADVERSITY. 5473 03:40:15,320 --> 03:40:17,520 WE CLASSIFIED AS BEING LOW, IF 5474 03:40:17,520 --> 03:40:20,480 THERE WAS NO EXPOSURE OR 5475 03:40:20,480 --> 03:40:23,760 EXPOSURE TO ONLY ONE. 5476 03:40:23,760 --> 03:40:25,800 CONSIDERED MODERATE IF A 5477 03:40:25,800 --> 03:40:28,320 PREGNANT PERSON WAS EXPOSED, 5478 03:40:28,320 --> 03:40:35,280 HIGH IF THREE OR MORE. 5479 03:40:35,280 --> 03:40:36,920 PERFORMED TO DETERMINE 5480 03:40:36,920 --> 03:40:37,480 ASSOCIATION BETWEEN ADVERSE 5481 03:40:37,480 --> 03:40:39,120 SOCIAL DETERMINANTS OF HEALTH 5482 03:40:39,120 --> 03:40:41,960 AND PERINATAL OUTCOMES. 5483 03:40:41,960 --> 03:40:43,280 PREGNANT WOMEN WHO REPORTED 5484 03:40:43,280 --> 03:40:44,800 DISCRIMINATION MORE LIKELY TO 5485 03:40:44,800 --> 03:40:47,960 HAVE MINIMAL CHANGE IN BMI 5486 03:40:47,960 --> 03:40:49,000 DURING PREGNANCY. 5487 03:40:49,000 --> 03:40:50,280 PERCEIVED DISCRIMINATION WAS NOT 5488 03:40:50,280 --> 03:40:54,560 ASSOCIATED WITH BIRTH WEIGHT, 5489 03:40:54,560 --> 03:40:56,400 GESTATIONAL OR ADMISSION TO 5490 03:40:56,400 --> 03:40:56,840 NICU. 5491 03:40:56,840 --> 03:40:58,840 GREATER LIKELIHOOD OF HAVING 5492 03:40:58,840 --> 03:41:00,600 DISORDERS OF GLUCOSE METABOLISM 5493 03:41:00,600 --> 03:41:02,360 IN PREGNANCY WITH HIGHER EXPOSE 5494 03:41:02,360 --> 03:41:04,240 YOU ARE TO PSYCHOSOCIAL STRESS. 5495 03:41:04,240 --> 03:41:05,440 WOMEN WHO REPORTED HOUSING 5496 03:41:05,440 --> 03:41:09,120 INSECURITY WERE MORE LIKELY TO 5497 03:41:09,120 --> 03:41:11,520 GAIN EXCESSIVE WEIGHT DURING 5498 03:41:11,520 --> 03:41:14,400 PREGNANCY. 5499 03:41:14,400 --> 03:41:16,480 WOMEN WHO REPORTED USE OF 5500 03:41:16,480 --> 03:41:18,000 GOVERNMENT ASSISTANCE MORE 5501 03:41:18,000 --> 03:41:22,480 LIKELY TO HAVE A NEONATE 5502 03:41:22,480 --> 03:41:24,680 ADMITTED TO ICU. 5503 03:41:24,680 --> 03:41:26,240 WE PERFORMED TO DETERMINE 5504 03:41:26,240 --> 03:41:29,600 ASSOCIATION WHEN PREGNANCY 5505 03:41:29,600 --> 03:41:31,440 RELATED FACTORS AND PERINATAL 5506 03:41:31,440 --> 03:41:32,320 OUTCOMES. 5507 03:41:32,320 --> 03:41:33,880 DISORDERS OF GLUCOSE METABOLISM 5508 03:41:33,880 --> 03:41:35,760 WERE ASSOCIATED WITH INCREASED 5509 03:41:35,760 --> 03:41:38,600 WEIGHT GAIN DURING PREGNANCY. 5510 03:41:38,600 --> 03:41:49,040 HIGHER PRE-PREGNANCY BMI 5511 03:41:51,040 --> 03:41:52,720 ASSOCIATED WITH WITH INCREASED 5512 03:41:52,720 --> 03:42:03,200 LIKELIHOOD OF C C-SECTION. 5513 03:42:10,520 --> 03:42:13,200 THIS DEPICTS ASSOCIATION, X-AXIS 5514 03:42:13,200 --> 03:42:15,280 OF STRESSORS, Y-AXIS LEPTIN 5515 03:42:15,280 --> 03:42:15,640 LEVELS. 5516 03:42:15,640 --> 03:42:17,800 INTERESTINGLY PREGNANT WOMEN WHO 5517 03:42:17,800 --> 03:42:19,560 REPORTED FINANCIAL INSECURITY 5518 03:42:19,560 --> 03:42:20,840 HAD SIGNIFICANTLY LOWER LEPTIN 5519 03:42:20,840 --> 03:42:22,360 LEVELS, COMPARED TO THOSE WHO 5520 03:42:22,360 --> 03:42:24,560 DID NOT REPORT FINANCIAL 5521 03:42:24,560 --> 03:42:25,160 INSECURITY. 5522 03:42:25,160 --> 03:42:26,880 WE DO NOT OBSERVE DIFFERENCES IN 5523 03:42:26,880 --> 03:42:31,560 LEPTIN LEVELS WITH REGARDS TO 5524 03:42:31,560 --> 03:42:32,440 OTHER STRESSORS. 5525 03:42:32,440 --> 03:42:36,040 WE NEXT EXAMINED THE ASSOCIATION 5526 03:42:36,040 --> 03:42:37,440 BETWEEN MATERNAL FACTORS AND 5527 03:42:37,440 --> 03:42:39,560 PERINATAL OUTCOMES. 5528 03:42:39,560 --> 03:42:44,800 THERE WAS NO ASSOCIATION BETWEEN 5529 03:42:44,800 --> 03:42:51,840 RACE, ETHNICITY AND LEPTIN 5530 03:42:51,840 --> 03:42:52,280 LEVELS. 5531 03:42:52,280 --> 03:42:54,880 THERE WAS A TREND TO HAVING 5532 03:42:54,880 --> 03:42:57,960 HIGHER LEVELS IN PREGNANT WOMEN 5533 03:42:57,960 --> 03:43:00,160 WITH HYPERTENSIVE DISORDERS. 5534 03:43:00,160 --> 03:43:02,000 THIS TABLE SHOWS ASSOCIATIONS 5535 03:43:02,000 --> 03:43:05,120 BETWEEN MATERNAL FACTORS AND 5536 03:43:05,120 --> 03:43:06,880 PERINATAL OUTCOMES, AS EXPECTED 5537 03:43:06,880 --> 03:43:08,840 THERE WAS POSITIVE CORRELATION 5538 03:43:08,840 --> 03:43:11,000 BETWEEN PRE-PREGNANCY BMI AND AT 5539 03:43:11,000 --> 03:43:12,880 DELIVERY AND MATERNAL LEPTIN 5540 03:43:12,880 --> 03:43:13,320 LEVELS. 5541 03:43:13,320 --> 03:43:19,440 THERE WAS NEGATIVE CORRELATION 5542 03:43:19,440 --> 03:43:22,520 BETWEEN AGE AND LEVELS. 5543 03:43:22,520 --> 03:43:29,200 WE CONSTRUCTED LINEAR REGRESSION 5544 03:43:29,200 --> 03:43:29,440 MODELS. 5545 03:43:29,440 --> 03:43:30,400 FIRST INCLUDED RACE, 5546 03:43:30,400 --> 03:43:32,120 PRE-PREGNANCY BMI, EXPOSURE TO 5547 03:43:32,120 --> 03:43:38,560 THREE OR MORE PSYCHOSOCIAL 5548 03:43:38,560 --> 03:43:43,480 STRESSORS. . 5549 03:43:43,480 --> 03:43:45,880 THE SECOND MODEL WAS ADJUSTED 5550 03:43:45,880 --> 03:43:50,480 FOR WEIGHT GAIN, DISORDERS OF 5551 03:43:50,480 --> 03:43:51,240 GLUCOSE METABOLISM, ASSOCIATION 5552 03:43:51,240 --> 03:43:54,200 BETWEEN BLACK RACE AND LOWER 5553 03:43:54,200 --> 03:43:55,840 BIRTH WEIGHT PERSISTED. 5554 03:43:55,840 --> 03:43:56,880 AS EXPECTED HYPERTENSIVE 5555 03:43:56,880 --> 03:43:58,560 DISORDERS IN PREGNANCY WERE 5556 03:43:58,560 --> 03:44:01,280 ASSOCIATED WITH LOWER BIRTH 5557 03:44:01,280 --> 03:44:02,280 WEIGHT. 5558 03:44:02,280 --> 03:44:04,280 THERE WAS POSITIVE CORRELATION 5559 03:44:04,280 --> 03:44:05,720 BETWEEN BMI AND WEIGHT GAIN 5560 03:44:05,720 --> 03:44:07,440 DURING PREGNANCY AND BIRTH 5561 03:44:07,440 --> 03:44:08,120 WEIGHT. 5562 03:44:08,120 --> 03:44:09,360 KNOWING CORRELATION BETWEEN 5563 03:44:09,360 --> 03:44:12,720 LEPTIN LEVELS OF A BIRTH WEIGHT, 5564 03:44:12,720 --> 03:44:15,760 DID NOT REACH STATISTICAL 5565 03:44:15,760 --> 03:44:16,320 SIGNIFICANCE. 5566 03:44:16,320 --> 03:44:21,240 STRESSORS WERE REMOVED, THESE 5567 03:44:21,240 --> 03:44:22,960 BORDERLINE ASSOCIATIONS BECAME 5568 03:44:22,960 --> 03:44:23,240 SIGNIFICANT. 5569 03:44:23,240 --> 03:44:25,640 PREGNANT WOMEN IN THE BRONX HAVE 5570 03:44:25,640 --> 03:44:28,800 HIGH EXPOSURES TO PSYCHOSOCIAL 5571 03:44:28,800 --> 03:44:32,960 STRESSORS, APPROXIMATELY 5572 03:44:32,960 --> 03:44:38,200 THREE-FOURTH TO TWO, A QUARTER 5573 03:44:38,200 --> 03:44:40,600 TO THREE. 5574 03:44:40,600 --> 03:44:42,800 PREGNANT WOMEN EXPOSED TO SOME 5575 03:44:42,800 --> 03:44:45,680 FACETS WERE MORE LIKE THROW 5576 03:44:45,680 --> 03:44:51,160 EXPERIENCE ABNORMAL WEIGHT GAI. 5577 03:44:51,160 --> 03:44:54,320 REPORTING USE OF FOOD PANTRY OR 5578 03:44:54,320 --> 03:44:55,000 TEMPORARY GOVERNMENT ASSISTANCE 5579 03:44:55,000 --> 03:45:04,720 WERE MORE LIKELY TO HAVE A 5580 03:45:04,720 --> 03:45:09,000 NEONATE ADMITTED TO THE NICU. 5581 03:45:09,000 --> 03:45:11,600 FINANCIAL INSECURITY WAS 5582 03:45:11,600 --> 03:45:14,680 ASSOCIATED WITH LOWER LEPTIN 5583 03:45:14,680 --> 03:45:15,000 LEVELS. 5584 03:45:15,000 --> 03:45:17,200 WE CONCLUDE EXPOSURE TO 5585 03:45:17,200 --> 03:45:18,440 PSYCHOSOCIAL STRESSORS IS 5586 03:45:18,440 --> 03:45:20,080 ASSOCIATED WITH ADVERSE 5587 03:45:20,080 --> 03:45:23,880 PERINATAL OUTCOMES, LIMITED 5588 03:45:23,880 --> 03:45:24,920 ASSOCIATIONS WE OBSERVED BETWEEN 5589 03:45:24,920 --> 03:45:27,840 ADVERSE SOCIAL DETERMINANTS OF 5590 03:45:27,840 --> 03:45:28,840 HEALTH AND PERINATAL OUTCOMES 5591 03:45:28,840 --> 03:45:33,960 MAY BE RELATED TO VERY HIGH 5592 03:45:33,960 --> 03:45:35,640 PSYCHOSOCIAL STRESS EXPOSURES, 5593 03:45:35,640 --> 03:45:37,360 SUBSEQUENT ANALYSES DETERMINE 5594 03:45:37,360 --> 03:45:38,360 RELATIVE CONTRIBUTION OF 5595 03:45:38,360 --> 03:45:39,880 INDIVIDUAL HEALTH DETERMINANTS 5596 03:45:39,880 --> 03:45:41,280 ON PERINATAL OUTCOMES. 5597 03:45:41,280 --> 03:45:44,360 WE WILL PERFORM ADDITIONAL 5598 03:45:44,360 --> 03:45:45,920 ANALYSES FOR INDIVIDUAL 5599 03:45:45,920 --> 03:45:47,680 COMPONENTS OF SOCIAL 5600 03:45:47,680 --> 03:45:48,880 DETERMINANTS WEIGHTED BASED ON 5601 03:45:48,880 --> 03:45:50,880 ASSESSMENT OF CONTRIBUTION TO 5602 03:45:50,880 --> 03:45:52,280 HEALTH OUTCOMES. 5603 03:45:52,280 --> 03:46:02,800 HIGHER LEVELS ASSOCIATED WITH 5604 03:46:04,360 --> 03:46:05,440 ADVERSE OUTCOME. 5605 03:46:05,440 --> 03:46:07,680 THE FINDING OF LOWER LEPTIN 5606 03:46:07,680 --> 03:46:12,280 LEVELS IN WOMEN FACING FINANCIAL 5607 03:46:12,280 --> 03:46:13,480 INSECURITY IS INTERESTING, 5608 03:46:13,480 --> 03:46:15,720 POSSIBLY RELATED TO DEPRESSION 5609 03:46:15,720 --> 03:46:17,120 OR RESTRICTED FEEDING PRACTICES 5610 03:46:17,120 --> 03:46:17,920 IN PREGNANCY. 5611 03:46:17,920 --> 03:46:20,200 WE WOULD LIKE TO THANK 5612 03:46:20,200 --> 03:46:21,720 COLLABORATORS AND RESEARCH TEAM. 5613 03:46:21,720 --> 03:46:26,080 WE'RE GRATEFUL TO THE STUDY 5614 03:46:26,080 --> 03:46:27,280 PARTICIPANTS FOR WILLINGNESS AND 5615 03:46:27,280 --> 03:46:31,000 WOULD LIKE TO THANK THE NIH AND 5616 03:46:31,000 --> 03:46:32,880 IMPROVE INITIATIVE WITHOUT THEIR 5617 03:46:32,880 --> 03:46:34,680 SUPPORT THESE STUDIES COULD NOT 5618 03:46:34,680 --> 03:46:38,600 HAVE BEEN PERFORMED. 5619 03:46:38,600 --> 03:46:39,080 THANK YOU. 5620 03:46:39,080 --> 03:46:40,080 >>THANK YOU. 5621 03:46:40,080 --> 03:46:46,040 NOW I WILL OPEN THE MEETING FOR 5622 03:46:46,040 --> 03:46:50,520 DISCUSSION, SO TURN ON YOUR 5623 03:46:50,520 --> 03:46:52,920 SCREEN, THE CAMERA, FOR 5624 03:46:52,920 --> 03:46:53,160 SPEAKERS. 5625 03:46:53,160 --> 03:46:59,280 BEFORE WE START TAKING QUESTIONS 5626 03:46:59,280 --> 03:47:00,800 FROM THE CHAT BOX, LET ME SEE 5627 03:47:00,800 --> 03:47:09,640 WHETHER WE HAVE QUESTIONS. 5628 03:47:09,640 --> 03:47:09,840 NO. 5629 03:47:09,840 --> 03:47:14,880 I WILL TAKE THE OPPORTUNITY TO 5630 03:47:14,880 --> 03:47:15,680 HAVE QUESTIONS. 5631 03:47:15,680 --> 03:47:22,000 I WOULD LIKE TO START WITH DR. 5632 03:47:22,000 --> 03:47:22,320 RICHARDSON. 5633 03:47:22,320 --> 03:47:26,880 SO, IN YOUR SLIDE THAT I WAS 5634 03:47:26,880 --> 03:47:31,560 WONDERING YOU HAD THE PATIENT 5635 03:47:31,560 --> 03:47:36,040 LEVEL FACTORS IN YOUR ANALYSIS, 5636 03:47:36,040 --> 03:47:41,080 THE FACTOR WITHIN DISADVANTAGED 5637 03:47:41,080 --> 03:47:42,440 NEIGHBORHOODS MAY CONTRIBUTE, 5638 03:47:42,440 --> 03:47:44,800 EVEN AFTER ADJUSTING FOR PATIENT 5639 03:47:44,800 --> 03:47:48,880 LEVEL FACTORS, AND I'M WONDERING 5640 03:47:48,880 --> 03:47:53,440 HOW DID YOU DEFINE OR CATEGORIZE 5641 03:47:53,440 --> 03:47:56,840 THE MEDICALLY UNDERSERVED AREAS, 5642 03:47:56,840 --> 03:48:04,040 THIS IS ONE OF YOUR -- ONE 5643 03:48:04,040 --> 03:48:05,200 PATIENT LEVEL FACTORS. 5644 03:48:05,200 --> 03:48:12,920 >>THANKS FOR THAT QUESTION. 5645 03:48:12,920 --> 03:48:14,560 WE ARE REPRESENTING A LARGE 5646 03:48:14,560 --> 03:48:14,760 GROUP. 5647 03:48:14,760 --> 03:48:16,720 I CAN'T SPEAK TO THE DETAILS BUT 5648 03:48:16,720 --> 03:48:20,120 I DO KNOW WE LOOKED TO THE 5649 03:48:20,120 --> 03:48:26,680 LITERATURE , USED ESTABLISHED 5650 03:48:26,680 --> 03:48:27,000 DEFINITIONS. 5651 03:48:27,000 --> 03:48:30,440 >>IT'S A SIMILARITY WITH THE 5652 03:48:30,440 --> 03:48:31,840 VARIABLE, THE PATIENT LEVEL 5653 03:48:31,840 --> 03:48:35,360 FACTOR THAT IS MEDICALLY 5654 03:48:35,360 --> 03:48:36,760 UNDERSERVED AREA AND THE OTHER, 5655 03:48:36,760 --> 03:48:40,800 WHAT YOU'RE LOOKING AT IS 5656 03:48:40,800 --> 03:48:45,080 RESIDENTS WITHIN DISADVANTAGED 5657 03:48:45,080 --> 03:48:45,760 NEIGHBORHOODS. 5658 03:48:45,760 --> 03:48:47,200 IT MIGHT BE INTERESTING TO SEE 5659 03:48:47,200 --> 03:48:51,560 HOW YOU MAY LOOK AT INTERACTION 5660 03:48:51,560 --> 03:48:54,480 BETWEEN THOSE TWO VARIABLES, 5661 03:48:54,480 --> 03:49:02,720 THAT MIGHT SHOW VERY STRONG 5662 03:49:02,720 --> 03:49:03,560 INTERACTIONS BETWEEN TWO 5663 03:49:03,560 --> 03:49:06,960 VARIABLES, SO I'M GOING TO MOVE 5664 03:49:06,960 --> 03:49:10,640 TO THE NEXT OR CHECK WHETHER WE 5665 03:49:10,640 --> 03:49:19,160 HAVE ANY QUESTIONS. 5666 03:49:19,160 --> 03:49:29,200 5667 03:49:29,840 --> 03:49:30,080 OKAY. 5668 03:49:30,080 --> 03:49:32,920 I WONDER IF THE WEIGHT CHANGE IN 5669 03:49:32,920 --> 03:49:37,440 PREGNANCY WAS ON THE PATHWAY 5670 03:49:37,440 --> 03:49:42,560 BETWEEN SDOH AND BIRTH WEIGHT. 5671 03:49:42,560 --> 03:49:44,760 SO WOULD REMOVING WEIGHT CHANGE 5672 03:49:44,760 --> 03:49:47,160 FROM THE MOTHER CHANGE THE 5673 03:49:47,160 --> 03:49:50,320 ASSOCIATION OF SDOH WITH THE 5674 03:49:50,320 --> 03:49:51,120 BIRTH WEIGHT? 5675 03:49:51,120 --> 03:49:53,400 >>NO, IT DID NOT CHANGE. 5676 03:49:53,400 --> 03:49:54,200 >>DID NOT CHANGE. 5677 03:49:54,200 --> 03:49:56,640 >>THERE WAS NO CHANGE WHEN YOU 5678 03:49:56,640 --> 03:49:57,440 MOVE THAT. 5679 03:49:57,440 --> 03:50:00,600 THE ONLY THING WE SAW WAS WHEN 5680 03:50:00,600 --> 03:50:02,560 WE HAD REASON, SOCIAL 5681 03:50:02,560 --> 03:50:05,880 DETERMINANTS TOGETHER, WE WERE 5682 03:50:05,880 --> 03:50:07,640 NOT SEEING -- WE WEREN'T SEEING 5683 03:50:07,640 --> 03:50:11,720 ANY OTHER VARIABLES TO BE 5684 03:50:11,720 --> 03:50:15,840 SIGNIFICANT. 5685 03:50:15,840 --> 03:50:18,360 WE REMOVED SOCIAL DETERMINANTS 5686 03:50:18,360 --> 03:50:19,680 STARTED SEEING OTHER VARIABLES. 5687 03:50:19,680 --> 03:50:22,320 THAT MAY BE RELATED TO THE FACT 5688 03:50:22,320 --> 03:50:26,880 THAT IN THE BRONX WE HAVE A 5689 03:50:26,880 --> 03:50:29,520 VERY -- BRONX IS THE POOREST 5690 03:50:29,520 --> 03:50:31,040 CONGRESSIONAL DISTRICT IN THE 5691 03:50:31,040 --> 03:50:34,320 U.S., AND WE HAVE OBVIOUSLY A 5692 03:50:34,320 --> 03:50:35,440 LONGSTANDING HISTORY OF, YOU 5693 03:50:35,440 --> 03:50:37,480 KNOW, SOCIAL AND OTHER 5694 03:50:37,480 --> 03:50:39,600 INEQUITIES THAT HAVE BEEN, YOU 5695 03:50:39,600 --> 03:50:41,520 KNOW, PERSISTENT FOR DECADES. 5696 03:50:41,520 --> 03:50:43,160 AND SO I THINK WHAT WE'RE 5697 03:50:43,160 --> 03:50:45,520 SEEING, AGAIN THIS IS VERY 5698 03:50:45,520 --> 03:50:48,480 PRELIMINARY, IS THAT INDIVIDUAL 5699 03:50:48,480 --> 03:50:52,160 FACTORS, WE SEE DIFFERENCES 5700 03:50:52,160 --> 03:50:53,280 THERE. 5701 03:50:53,280 --> 03:50:55,160 FOR EXAMPLE, FOOD INSECURITY WAS 5702 03:50:55,160 --> 03:50:56,440 NOT SIGNIFICANT BUT WHEN WE 5703 03:50:56,440 --> 03:51:01,720 BROKE IT DOWN TO FOOD PANTRY 5704 03:51:01,720 --> 03:51:04,360 THAT WAS SIGNIFICANT. 5705 03:51:04,360 --> 03:51:06,320 USE OF THE TEMPORARY ASSISTANCE 5706 03:51:06,320 --> 03:51:07,320 WAS SIGNIFICANT. 5707 03:51:07,320 --> 03:51:09,480 WE MAY NEED TO BREAK DOWN THE 5708 03:51:09,480 --> 03:51:11,280 DATA EVEN FURTHER TO SEE WHERE 5709 03:51:11,280 --> 03:51:12,600 THE DIFFERENCES ARE. 5710 03:51:12,600 --> 03:51:15,000 WHEN YOU LOOK AT FOOD INSECURITY 5711 03:51:15,000 --> 03:51:17,880 WE LUMP SEVERAL GROUPS AS ONE 5712 03:51:17,880 --> 03:51:18,920 GROUP. 5713 03:51:18,920 --> 03:51:22,480 THAT INCLUDED FOOD PANTRY, 5714 03:51:22,480 --> 03:51:25,600 INCLUDED USE OF CHURCHES FOR 5715 03:51:25,600 --> 03:51:26,760 GETTING FOODS, RESOURCES, USED 5716 03:51:26,760 --> 03:51:30,160 OTHER AGENCIES THAT MIGHT BE 5717 03:51:30,160 --> 03:51:31,440 PROVIDING FOOD TO FAMILIES. 5718 03:51:31,440 --> 03:51:34,520 SO WE LURCH THOSE TOGETHER AND 5719 03:51:34,520 --> 03:51:37,240 WE -- WE LUMP THOSE TOGETHER, 5720 03:51:37,240 --> 03:51:37,800 HIGHLIGHTING THE FACT 5721 03:51:37,800 --> 03:51:39,120 INDIVIDUALS USING FOOD PANTRIES 5722 03:51:39,120 --> 03:51:40,760 MAY NOT HAVE SOCIAL SUPPORT 5723 03:51:40,760 --> 03:51:41,040 SYSTEMS. 5724 03:51:41,040 --> 03:51:43,360 WHEN YOU GO TO A CHURCH, THERE 5725 03:51:43,360 --> 03:51:46,880 IS A SUPPORT SYSTEM IN PLACE AND 5726 03:51:46,880 --> 03:51:48,920 THAT MAY OFFSET SOME DIFFERENCES 5727 03:51:48,920 --> 03:51:49,520 THAT WE'RE SEEING. 5728 03:51:49,520 --> 03:51:51,360 I THINK WE HAVE TO BREAK IT DOWN 5729 03:51:51,360 --> 03:51:55,200 AND I THINK WE REALLY HAVE TO 5730 03:51:55,200 --> 03:51:57,480 PROVIDE WEIGHT TO DIFFERENT 5731 03:51:57,480 --> 03:52:00,440 INSECURITIES AND ELEMENTS OF 5732 03:52:00,440 --> 03:52:02,480 DISCRIMINATION, AND INEQUITIES 5733 03:52:02,480 --> 03:52:07,320 TO BE ABLE TO TEASE APART SOME 5734 03:52:07,320 --> 03:52:07,600 DIFFERENCES. 5735 03:52:07,600 --> 03:52:07,760 5736 03:52:07,760 --> 03:52:10,840 >>THANK YOU. 5737 03:52:10,840 --> 03:52:11,600 5738 03:52:11,600 --> 03:52:16,200 I WOULD LIKE TO TAG ON THE 5739 03:52:16,200 --> 03:52:16,880 QUESTION. 5740 03:52:16,880 --> 03:52:19,160 THE ANSWER. 5741 03:52:19,160 --> 03:52:22,440 SO, I WAS WONDERING WHAT TIME 5742 03:52:22,440 --> 03:52:24,400 POINT YOUR DATA WAS COLLECTED, 5743 03:52:24,400 --> 03:52:28,760 IN THE METHOD THE SLIDE 5744 03:52:28,760 --> 03:52:30,080 PRESENTATION, YOU KNOW, THE 5745 03:52:30,080 --> 03:52:32,280 SHORT TIME, YOU CANNOT PUT ALL 5746 03:52:32,280 --> 03:52:36,080 THE INFORMATION, SO I WAS 5747 03:52:36,080 --> 03:52:41,120 WONDERING TIME POINT, THE PLASMA 5748 03:52:41,120 --> 03:52:43,440 WAS OBTAINED, AND OTHER 5749 03:52:43,440 --> 03:52:44,000 INFORMATION SO TIMING. 5750 03:52:44,000 --> 03:52:44,880 >>RIGHT. 5751 03:52:44,880 --> 03:52:47,920 THE MAJORITY OF THE SAMPLES WERE 5752 03:52:47,920 --> 03:52:50,000 OBTAINED CLOSER TO THE TIME OF 5753 03:52:50,000 --> 03:52:51,880 DELIVERY ALTHOUGH SOME SAMPLES 5754 03:52:51,880 --> 03:52:54,040 WERE OBTAINED EARLIER DURING 5755 03:52:54,040 --> 03:52:55,480 PREGNANCY, AND WE APPRECIATED 5756 03:52:55,480 --> 03:52:58,200 THE FACT THAT LEPTIN LEVELS GO 5757 03:52:58,200 --> 03:53:01,120 UP DURING PREGNANCY DURING THE 5758 03:53:01,120 --> 03:53:04,960 THREE TRIMESTERS AND DROP AFTER 5759 03:53:04,960 --> 03:53:08,560 DELIVERY. 5760 03:53:08,560 --> 03:53:10,480 WE HAVEN'T CONCLUDED FOR THE 5761 03:53:10,480 --> 03:53:13,360 TIMING BUT MAJORITY CLOSER TO 5762 03:53:13,360 --> 03:53:13,600 DELIVERY. 5763 03:53:13,600 --> 03:53:14,760 >>SO SINCE WE DON'T HAVE A 5764 03:53:14,760 --> 03:53:17,400 QUESTION I HAVE ONE MORE 5765 03:53:17,400 --> 03:53:20,440 QUESTION FOR YOU. 5766 03:53:20,440 --> 03:53:23,320 YOU DESCRIBE FOOD SECURITY OR 5767 03:53:23,320 --> 03:53:26,120 SOMETIMES TEMPORARY, YOU KNOW, 5768 03:53:26,120 --> 03:53:29,520 PEOPLE GET FOOD SUPPORT. 5769 03:53:29,520 --> 03:53:31,200 >>CORRECT. 5770 03:53:31,200 --> 03:53:34,640 >>IT IS REALLY HARD THAT WE 5771 03:53:34,640 --> 03:53:38,520 COLLECT INFORMATION FOR THE FOOD 5772 03:53:38,520 --> 03:53:40,960 SECURITY, TIME PERIOD TO 5773 03:53:40,960 --> 03:53:42,560 SOMETIMES PEOPLE HAVE A LITTLE 5774 03:53:42,560 --> 03:53:47,120 MORE MONEY THAN SOME OTHER 5775 03:53:47,120 --> 03:53:50,640 TIMES, SO HOW IN YOUR TIME 5776 03:53:50,640 --> 03:53:54,600 POINT -- LIKE WHEN YOU MEASURE 5777 03:53:54,600 --> 03:53:55,920 THIS MEASUREMENT CROSS-SECTIONAL 5778 03:53:55,920 --> 03:53:59,640 WAY IT IS HARD, HOW FAR YOU CAN 5779 03:53:59,640 --> 03:54:02,280 GO FOR WHETHER YOUR INFORMATION 5780 03:54:02,280 --> 03:54:05,360 IS FROM ONE YEAR OR -- 5781 03:54:05,360 --> 03:54:09,360 >>IT WAS FROM MAY 2022 TO 5782 03:54:09,360 --> 03:54:13,600 DECEMBER 2022. 5783 03:54:13,600 --> 03:54:16,360 >>OKAY. 5784 03:54:16,360 --> 03:54:16,920 THANK YOU. 5785 03:54:16,920 --> 03:54:27,440 I THINK I'M GOING TO MOVE ON TO 5786 03:54:28,600 --> 03:54:36,680 THE NEXT SPEAKER, DR. ROMANO. 5787 03:54:36,680 --> 03:54:40,720 MY QUESTION IS, THIS MEASUREMENT 5788 03:54:40,720 --> 03:54:43,760 WAS ONE-TIME MEASUREMENT AND 5789 03:54:43,760 --> 03:54:46,400 COMPARED BEFORE PREGNANCY AND 5790 03:54:46,400 --> 03:54:48,400 THE MEASUREMENT AFTER YOU 5791 03:54:48,400 --> 03:54:49,960 MEASURE. 5792 03:54:49,960 --> 03:54:51,800 I WAS WONDERING LIKE WHAT WEIGHT 5793 03:54:51,800 --> 03:54:57,040 LIKE IF YOU MEASURE NOT ONLY ONE 5794 03:54:57,040 --> 03:54:58,920 TIME, LONGITUDINAL WAY YOU 5795 03:54:58,920 --> 03:55:00,560 MEASURE BODY WEIGHTS, WHETHER 5796 03:55:00,560 --> 03:55:02,760 THIS OUTCOME WILL CHANGE BECAUSE 5797 03:55:02,760 --> 03:55:06,800 THE WEIGHT CHANGES ARE NOT 5798 03:55:06,800 --> 03:55:15,040 REALLY MUCH, 1.69 THROUGH 1.06 5799 03:55:15,040 --> 03:55:16,920 KILOGRAMS, SO IT'S KILOGRAMS, 5800 03:55:16,920 --> 03:55:19,640 ONE MEAL CAN CHANGE THAT MUCH SO 5801 03:55:19,640 --> 03:55:22,400 I WAS WONDERING WHETHER ACTUALLY 5802 03:55:22,400 --> 03:55:25,320 THIS WILL CHANGE THE BODY WEIGHT 5803 03:55:25,320 --> 03:55:30,040 IF YOU MEASURE LIKE WE HAVE 5804 03:55:30,040 --> 03:55:30,480 REPEAT MEASUREMENT. 5805 03:55:30,480 --> 03:55:34,440 >>YEAH, WE WOULD LOVE TO BE 5806 03:55:34,440 --> 03:55:35,640 ABLE TO LOOK LONGITUDINALLY, AND 5807 03:55:35,640 --> 03:55:36,800 FOLLOW THE WOMEN OVER TIME. 5808 03:55:36,800 --> 03:55:38,800 I THINK THE THING I CAN SAY 5809 03:55:38,800 --> 03:55:40,640 ABOUT THE DATA THAT WE HAVE ARE 5810 03:55:40,640 --> 03:55:44,080 THAT WE DID A NUMBER OF 5811 03:55:44,080 --> 03:55:46,720 SENSITIVITY ANALYSES WHERE WE 5812 03:55:46,720 --> 03:55:48,520 SORT OF RESTRICTED TO WOMEN WITH 5813 03:55:48,520 --> 03:55:50,560 THE MORE RECENT PREGNANCIES, 5814 03:55:50,560 --> 03:55:52,840 LOOKED AT THREE YEARS, OR 5815 03:55:52,840 --> 03:55:55,160 FURTHER OUT TIME POINTS, AND THE 5816 03:55:55,160 --> 03:56:01,600 RESULTS WERE FAIRLY ROBUST. 5817 03:56:01,600 --> 03:56:03,120 THREE PFAS BEING MAJOR PLAYERS 5818 03:56:03,120 --> 03:56:05,560 IN EACH OF THOSE SENSITIVITY 5819 03:56:05,560 --> 03:56:06,520 ANALYSES THAT WE CONDUCTED. 5820 03:56:06,520 --> 03:56:08,040 BUT I AGREE WITH YOU, I THINK IT 5821 03:56:08,040 --> 03:56:10,360 WOULD BE GREAT TO BE ABLE TO 5822 03:56:10,360 --> 03:56:12,520 LOOK LONGITUDINALLY AND TO 5823 03:56:12,520 --> 03:56:13,920 REALLY UNDERSTAND WHAT THE 5824 03:56:13,920 --> 03:56:18,440 WEIGHT CHANGE LOOKS LOOKS LIKE 5825 03:56:18,440 --> 03:56:19,880 OVER TIME AND INFLUENCE OF 5826 03:56:19,880 --> 03:56:21,440 CHEMICALS ON THESE CHANGES. 5827 03:56:21,440 --> 03:56:25,040 >>I'M SURE THIS IS SMALL STUDY, 5828 03:56:25,040 --> 03:56:29,400 AND STILL IT'S DEVELOPING STAGE, 5829 03:56:29,400 --> 03:56:31,920 ACTUALLY WHAT YOU HAVE, BUT ALSO 5830 03:56:31,920 --> 03:56:35,560 THIS IS VERY INTERESTING CONCEPT 5831 03:56:35,560 --> 03:56:38,280 AT THE SAME TIME, THIS IS A 5832 03:56:38,280 --> 03:56:42,480 LITTLE BIT SENSITIVE TOPIC TOO. 5833 03:56:42,480 --> 03:56:46,680 SO, I WAS WONDERING WHAT IS YOUR 5834 03:56:46,680 --> 03:56:47,840 IMPLEMENTATION? 5835 03:56:47,840 --> 03:56:50,360 WHAT WOULD YOU LIKE TO DO? 5836 03:56:50,360 --> 03:56:55,160 SO YOU SHOWED POSITIVE 5837 03:56:55,160 --> 03:56:57,360 RELATIONSHIP WITH THE CHEMICALS 5838 03:56:57,360 --> 03:56:59,640 AND THE BODY REACTION, THE 5839 03:56:59,640 --> 03:57:01,280 WEIGHT. 5840 03:57:01,280 --> 03:57:03,040 SO WHAT WOULD YOU DO AS 5841 03:57:03,040 --> 03:57:04,800 IMPLEMENTATION, WHAT WOULD YOU 5842 03:57:04,800 --> 03:57:06,160 LIKE TO DO? 5843 03:57:06,160 --> 03:57:10,360 >>YEAH, SO PART OF THE SORT OF 5844 03:57:10,360 --> 03:57:11,160 BROADER KIND OF THIS RESEARCH 5845 03:57:11,160 --> 03:57:13,240 HAS TO DO WITH THE FACT WE HAVE 5846 03:57:13,240 --> 03:57:15,640 ALSO SEEN INFLUENCES OF THESE 5847 03:57:15,640 --> 03:57:17,200 CHEMICALS ON DURATION OF 5848 03:57:17,200 --> 03:57:20,680 BREASTFEEDING, AND THAT WOMEN 5849 03:57:20,680 --> 03:57:21,560 WHO HAVE HIGHER CONCENTRATIONS 5850 03:57:21,560 --> 03:57:23,400 TEND TO NOT BE ABLE TO 5851 03:57:23,400 --> 03:57:26,480 BREASTFEED FOR AS MANY MONTHS, 5852 03:57:26,480 --> 03:57:27,200 FOLLOWING PREGNANCY. 5853 03:57:27,200 --> 03:57:28,520 AND ONE OF THE THINGS THAT I'M 5854 03:57:28,520 --> 03:57:29,960 REALLY INTERESTED IN TRYING TO 5855 03:57:29,960 --> 03:57:31,960 UNPACK IN THE LONGER TERM IS 5856 03:57:31,960 --> 03:57:34,240 TRYING TO UNDERSTAND WHAT THE 5857 03:57:34,240 --> 03:57:38,000 CONNECTION IS OF THE EXPOSURE TO 5858 03:57:38,000 --> 03:57:39,920 PFAS DURING PREGNANCY, ITS 5859 03:57:39,920 --> 03:57:43,320 INFLUENCE ON LACTATION, AND THEN 5860 03:57:43,320 --> 03:57:46,840 HOW THAT ALSO SUBSEQUENTLY 5861 03:57:46,840 --> 03:57:48,240 INFLUENCES WEIGHT RETENTION AND 5862 03:57:48,240 --> 03:57:50,560 WEIGHT GAIN IN THE POSTPARTUM 5863 03:57:50,560 --> 03:57:50,800 PERIOD. 5864 03:57:50,800 --> 03:57:53,960 AND THE HOPE WOULD BE THAT WE 5865 03:57:53,960 --> 03:57:55,600 COULD ULTIMATELY DEVELOP 5866 03:57:55,600 --> 03:57:57,560 INTERVENTIONS THAT SUPPORT 5867 03:57:57,560 --> 03:57:59,320 LACTATION AMONG WOMEN WHO WE 5868 03:57:59,320 --> 03:58:01,520 WOULD IDENTIFY AS BEING HIGH 5869 03:58:01,520 --> 03:58:03,160 RISK DUE TO THEIR EXPOSURE 5870 03:58:03,160 --> 03:58:05,160 CONCENTRATIONS AS WELL AS TO THE 5871 03:58:05,160 --> 03:58:09,280 MANY SOCIAL AND CULTURAL FACTORS 5872 03:58:09,280 --> 03:58:13,360 THAT INFLUENCE THAT DECISION TO 5873 03:58:13,360 --> 03:58:15,640 CONTINUE OR STOP BREASTFEEDING. 5874 03:58:15,640 --> 03:58:18,240 AND SO THAT'S KIND OF WHERE I 5875 03:58:18,240 --> 03:58:20,160 HOPE WE'RE HEADED WITH THIS 5876 03:58:20,160 --> 03:58:23,960 RESEARCH IN BEING ABLE TO 5877 03:58:23,960 --> 03:58:26,400 ULTIMATELY PROVIDE SOME SORT OF 5878 03:58:26,400 --> 03:58:30,320 MEASURE TO HELP WOMEN REDUCE THE 5879 03:58:30,320 --> 03:58:31,080 IMPACT OF THESE EXPOSURES. 5880 03:58:31,080 --> 03:58:32,880 >>THANK YOU. 5881 03:58:32,880 --> 03:58:37,680 WE HAVE THREE MINUTES. 5882 03:58:37,680 --> 03:58:38,840 ONE QUESTION. 5883 03:58:38,840 --> 03:58:41,600 SO THE MESSAGE TO EACH MEMBER, 5884 03:58:41,600 --> 03:58:44,120 NIH ALL INTERVENTION TO PROMOTE 5885 03:58:44,120 --> 03:58:46,760 CARDIOVASCULAR HEALTH OF MOTHERS 5886 03:58:46,760 --> 03:58:49,000 AND CHILDRENS IN WHICH PROGRAMS 5887 03:58:49,000 --> 03:58:53,760 WOULD FUNDED FOR SEVEN SITE AND 5888 03:58:53,760 --> 03:58:56,280 ONE COORDINATING CENTER FROM 5889 03:58:56,280 --> 03:58:58,200 2022 THROUGH 2029. 5890 03:58:58,200 --> 03:59:01,480 HOW MIGHT EACH TALK IN THIS 5891 03:59:01,480 --> 03:59:08,640 SESSION BE LINKED TO THE 5892 03:59:08,640 --> 03:59:11,560 INITIATIVES? 5893 03:59:11,560 --> 03:59:16,800 5894 03:59:16,800 --> 03:59:19,560 5895 03:59:19,560 --> 03:59:22,200 >>I'M NOT SURE IF I CAN ANSWER 5896 03:59:22,200 --> 03:59:24,600 THAT OR ADDRESS THAT DIRECTLY, 5897 03:59:24,600 --> 03:59:28,040 BUT THE MOTHERS THAT WE HAVE 5898 03:59:28,040 --> 03:59:29,840 ENROLLED ARE ALSO BEING FOLLOWED 5899 03:59:29,840 --> 03:59:31,880 OVER TIME, AT LEAST THAT'S THE 5900 03:59:31,880 --> 03:59:34,200 PLAN, THAT WE WANT TO MONITOR 5901 03:59:34,200 --> 03:59:41,880 OVER TIME. 5902 03:59:41,880 --> 03:59:44,640 AND WE DO HAVE SOME INFORMATION 5903 03:59:44,640 --> 03:59:48,160 ABOUT THEIR MEDICAL HISTORY 5904 03:59:48,160 --> 03:59:50,080 WHICH WE HAVEN'T NECESSARILY 5905 03:59:50,080 --> 03:59:51,400 STEPPED INTO BUT, FOR EXAMPLE, 5906 03:59:51,400 --> 03:59:52,200 BLOOD PRESSURE AND 5907 03:59:52,200 --> 03:59:56,240 CARDIOVASCULAR HEALTH, WE DO 5908 03:59:56,240 --> 03:59:59,960 HAVE SOME INFORMATION THAT'S 5909 03:59:59,960 --> 04:00:00,720 THERE. 5910 04:00:00,720 --> 04:00:03,280 THAT IS POTENTIALLY USEFUL FROM 5911 04:00:03,280 --> 04:00:06,960 THE PERSPECTIVE OF TRYING TO 5912 04:00:06,960 --> 04:00:08,280 BETTER UNDERSTAND CARDIOVASCULAR 5913 04:00:08,280 --> 04:00:10,120 HEALTH DURING PREGNANCY AND IN 5914 04:00:10,120 --> 04:00:12,120 THE POSTPARTUM PERIOD. 5915 04:00:12,120 --> 04:00:17,560 AND HOW ALL OF THESE FACTORS 5916 04:00:17,560 --> 04:00:21,600 INCLUDING ESPECIALLY IN OUR 5917 04:00:21,600 --> 04:00:23,560 POPULATION SO SOCIAL 5918 04:00:23,560 --> 04:00:29,400 DETERMINANTS AND EACH OF THESE 5919 04:00:29,400 --> 04:00:31,360 INDIVIDUAL -- INDIVIDUAL 5920 04:00:31,360 --> 04:00:33,800 DETERMINANTS, HOW THEY IMPACT 5921 04:00:33,800 --> 04:00:36,400 OTHER CARDIOVASCULAR RISK 5922 04:00:36,400 --> 04:00:38,480 FACTORS AND THAT ALSO GOES ALONG 5923 04:00:38,480 --> 04:00:40,880 WITH OUR OTHER ONE THAT IS, YOU 5924 04:00:40,880 --> 04:00:45,360 KNOW, WHICH IS NOT THE FINAL 5925 04:00:45,360 --> 04:00:47,520 STAGES OF COMPLETION WHERE WE'RE 5926 04:00:47,520 --> 04:00:49,840 LOOKING AT METABOLIC HEALTH, 5927 04:00:49,840 --> 04:00:53,240 AGAIN GRANTED IT'S CHARGED WITH 5928 04:00:53,240 --> 04:00:53,920 OBESITY, REALLY TO BETTER 5929 04:00:53,920 --> 04:01:02,440 UNDERSTAND SOME OF THE MOLECULAR 5930 04:01:02,440 --> 04:01:04,000 SIGNALING FOR PROGRAMMING, 5931 04:01:04,000 --> 04:01:05,520 RELATED TO SOME DETERMINANTS, 5932 04:01:05,520 --> 04:01:07,280 ALMOST LIKE IT'S EMBEDDED IN THE 5933 04:01:07,280 --> 04:01:08,480 DNA. 5934 04:01:08,480 --> 04:01:13,200 AND SOMEHOW WE HAVE TO STOP THAT 5935 04:01:13,200 --> 04:01:16,720 CYCLE THAT PERPETUATES THROUGH 5936 04:01:16,720 --> 04:01:17,200 GENERATIONS. 5937 04:01:17,200 --> 04:01:20,200 A MOTHER'S PRO CONCEPTION OF 5938 04:01:20,200 --> 04:01:23,360 HEALTH, DIRECTLY AFFECTS THE 5939 04:01:23,360 --> 04:01:23,560 CHILD. 5940 04:01:23,560 --> 04:01:26,080 I'M A NEONATOLOGIST, I'M SORRY, 5941 04:01:26,080 --> 04:01:28,080 BUT WE HAVE TO -- IT'S NOT JUST 5942 04:01:28,080 --> 04:01:29,080 THE PREGNANCY. 5943 04:01:29,080 --> 04:01:30,480 IT'S THE PRE-CONCEPTION WE HAVE 5944 04:01:30,480 --> 04:01:31,480 TO ADDRESS. 5945 04:01:31,480 --> 04:01:33,120 ONCE WE ADDRESS THE 5946 04:01:33,120 --> 04:01:35,000 PRE-CONCEPTION OF HEALTH, OTHER 5947 04:01:35,000 --> 04:01:36,840 THINGS WILL SORT OF -- I WON'T 5948 04:01:36,840 --> 04:01:38,840 SAY AUTOMATICALLY BUT THEY WILL 5949 04:01:38,840 --> 04:01:40,040 FALL INTO PLACE BETTER. 5950 04:01:40,040 --> 04:01:42,880 AND THEN WE CAN HAVE OBVIOUSLY 5951 04:01:42,880 --> 04:01:44,080 INTERVENTIONS THAT TAKE PLACE 5952 04:01:44,080 --> 04:01:45,600 DURING PREGNANCY BUT IT REALLY 5953 04:01:45,600 --> 04:01:48,240 HAS TO START IN CHILDHOOD. 5954 04:01:48,240 --> 04:01:51,200 WE HAVE TO ADDRESS DISPARITIES, 5955 04:01:51,200 --> 04:01:52,280 THESE ISSUES EARLY ON. 5956 04:01:52,280 --> 04:01:54,840 SO THAT WE CAN ACTUALLY IMPACT 5957 04:01:54,840 --> 04:01:58,640 HEALTH LONGER TERM. 5958 04:01:58,640 --> 04:01:59,840 >>THANK YOU. 5959 04:01:59,840 --> 04:02:01,400 WE HAVE ONE MORE QUESTION BUT I 5960 04:02:01,400 --> 04:02:08,400 HAVE TO RESPECT OF THE PEOPLE'S 5961 04:02:08,400 --> 04:02:09,160 TIME SO OKAY. 5962 04:02:09,160 --> 04:02:15,720 I THINK I HAVE TO MOVE TO THE 5963 04:02:15,720 --> 04:02:16,160 END. 5964 04:02:16,160 --> 04:02:18,480 THANK YOU ALL FOR SHARING YOUR 5965 04:02:18,480 --> 04:02:21,520 WORK AND JOINING US TODAY. 5966 04:02:21,520 --> 04:02:26,120 SO I'M JUST GOING TO GO TO TURN 5967 04:02:26,120 --> 04:02:29,000 OVER TO DR. CLAYTON FOR CLOSING 5968 04:02:29,000 --> 04:02:29,240 REMARK. 5969 04:02:29,240 --> 04:02:31,160 THANK YOU, EVERYONE. 5970 04:02:31,160 --> 04:02:34,960 >>THANK YOU SO MUCH, DR. YOON. 5971 04:02:34,960 --> 04:02:37,280 THANK YOU TO THE SPEAKERS OF THE 5972 04:02:37,280 --> 04:02:39,800 LAST SESSION AND THE WHOLE DAY. 5973 04:02:39,800 --> 04:02:41,240 LOOKS LIKE SLIDES ARE COMING UP. 5974 04:02:41,240 --> 04:02:41,680 GREAT. 5975 04:02:41,680 --> 04:02:45,400 MOVE TO THE NEXT SLIDE, THAT 5976 04:02:45,400 --> 04:02:46,240 WOULD BE WONDERFUL. 5977 04:02:46,240 --> 04:02:48,880 I WANT TO THANK EVERY SINGLE ONE 5978 04:02:48,880 --> 04:02:51,840 OF OUR SPEAKERS TODAY WHO 5979 04:02:51,840 --> 04:02:53,680 COVERED INCREDIBLY IMPORTANT 5980 04:02:53,680 --> 04:02:57,520 TOPICS, FAR RANGING TOPICS, 5981 04:02:57,520 --> 04:02:59,200 MULTIPLE POPULATIONS, DIFFERENT 5982 04:02:59,200 --> 04:03:00,840 CONTEXTS, FROM CHEMICAL 5983 04:03:00,840 --> 04:03:03,680 EXPOSURES AND GENDERED RACIAL 5984 04:03:03,680 --> 04:03:05,880 MICROAGGRESSIONS, ANXIETY, BLOOD 5985 04:03:05,880 --> 04:03:08,920 PRESSURE ELEVATION, RELATED TO 5986 04:03:08,920 --> 04:03:11,000 VARIETY OF INSULTS, AND BIRTHING 5987 04:03:11,000 --> 04:03:12,840 SUPPORT, AS WELL AS PERSPECTIVE 5988 04:03:12,840 --> 04:03:15,280 OF INDIVIDUALS DURING THE 5989 04:03:15,280 --> 04:03:16,800 BIRTHING EXPERIENCE AND MORE 5990 04:03:16,800 --> 04:03:19,640 RECENTLY IN THE LAST SESSION 5991 04:03:19,640 --> 04:03:23,040 EVEN CHEMICAL EXPOSURES AND 5992 04:03:23,040 --> 04:03:25,120 REFLECTION AND CONSEQUENCES ON 5993 04:03:25,120 --> 04:03:28,080 PREGNANCY AND WEIGHT. 5994 04:03:28,080 --> 04:03:29,280 THEY ARE NEW NUMEROUS TO COUNT 5995 04:03:29,280 --> 04:03:31,120 BUT I HAVE TO SAY THEY WERE EACH 5996 04:03:31,120 --> 04:03:33,640 AND EVERY ONE OF THEM 5997 04:03:33,640 --> 04:03:35,520 OUTSTANDING AND OFFERED A 5998 04:03:35,520 --> 04:03:36,840 PERSPECTIVE THAT'S IMPORTANT FOR 5999 04:03:36,840 --> 04:03:38,920 US TO CONSIDER IN THE OVERALL 6000 04:03:38,920 --> 04:03:43,400 IMPROVEMENT OF THE HEALTH OF 6001 04:03:43,400 --> 04:03:44,560 WOMEN AND MORBIDITY AND 6002 04:03:44,560 --> 04:03:46,040 MORTALITY OUTCOMES. 6003 04:03:46,040 --> 04:03:46,800 NEXT SLIDE PLEASE. 6004 04:03:46,800 --> 04:03:48,800 I WANT TO THANK OUR WORKSHOP 6005 04:03:48,800 --> 04:03:51,280 COORDINATORS BEFORE I MOVE ON. 6006 04:03:51,280 --> 04:03:53,960 THANK YOU TO THE ENTIRE TEAM. 6007 04:03:53,960 --> 04:03:56,880 NEXT ONE MORE TIME. 6008 04:03:56,880 --> 04:03:58,080 ONE MORE TIME. 6009 04:03:58,080 --> 04:03:59,520 OFFICE OF RESEARCH ON WOMEN'S 6010 04:03:59,520 --> 04:04:00,960 HEALTH, WE CONSIDER THE HEALTH 6011 04:04:00,960 --> 04:04:03,040 OF WOMEN IN THIS 6012 04:04:03,040 --> 04:04:04,040 MULTI-DIMENSIONAL FRAMEWORK WITH 6013 04:04:04,040 --> 04:04:06,120 A LIFE COURSE PERSPECTIVE RIGHT 6014 04:04:06,120 --> 04:04:09,280 IN THE CENTER, AND CONSIDERABLE 6015 04:04:09,280 --> 04:04:10,280 INTERNAL AND EXTERNAL FACTORS 6016 04:04:10,280 --> 04:04:12,160 THAT AFFECT HEALTH OF WOMEN, HOW 6017 04:04:12,160 --> 04:04:13,880 THEY INTERACT WITH EACH OTHER. 6018 04:04:13,880 --> 04:04:16,200 WHICH IS VERY MUCH IN CONCERT 6019 04:04:16,200 --> 04:04:18,720 WITH THE DISCUSSIONS AND 6020 04:04:18,720 --> 04:04:20,360 PRESENTATIONS TODAY. 6021 04:04:20,360 --> 04:04:22,400 AND FROM TODAY'S PRESENTERS WE 6022 04:04:22,400 --> 04:04:24,760 ALSO REALIZE HOW CRITICAL IT IS 6023 04:04:24,760 --> 04:04:27,800 TO ADDRESS THESE EXTERNAL 6024 04:04:27,800 --> 04:04:30,320 FACTORS IN DEFINITIVE WAY, 6025 04:04:30,320 --> 04:04:33,720 COMPREHENSIVE WAY AS WELL. 6026 04:04:33,720 --> 04:04:33,920 NEXT. 6027 04:04:33,920 --> 04:04:35,880 DURING THE BEGINNING OF THE 6028 04:04:35,880 --> 04:04:38,320 COVID-19 PANDEMIC THE OFFICE OF 6029 04:04:38,320 --> 04:04:40,120 RESEARCH ON WOMEN'S HEALTH 6030 04:04:40,120 --> 04:04:44,240 RECOGNIZED THE SITUATION AND 6031 04:04:44,240 --> 04:04:46,120 CHARACTERIZED IT AT A COLLISION 6032 04:04:46,120 --> 04:04:48,160 OF CRISES. 6033 04:04:48,160 --> 04:04:50,480 TODAY REMINDS ME OF THAT TERM, 6034 04:04:50,480 --> 04:04:52,240 COLLISION OF CRISES, CERTAINLY A 6035 04:04:52,240 --> 04:04:54,400 SITUATION THAT WE CAN'T IGNORE. 6036 04:04:54,400 --> 04:04:56,160 WHETHER WE'RE TALKING ABOUT THE 6037 04:04:56,160 --> 04:04:58,880 IMPORTANCE OF INCLUDE PREGNANT 6038 04:04:58,880 --> 04:04:59,680 AND LACTATING PEOPLE INTO 6039 04:04:59,680 --> 04:05:02,280 CLINICAL TRIAL SO WE HAVE DATA 6040 04:05:02,280 --> 04:05:04,160 UPON WHICH TO BASE TREATMENT 6041 04:05:04,160 --> 04:05:06,480 DECISIONS FOR THOSE INDIVIDUALS, 6042 04:05:06,480 --> 04:05:10,320 OR THE IMPORTANCE OF ADDRESSING 6043 04:05:10,320 --> 04:05:12,160 POSTPARTUM HEALTH AND RACISM AND 6044 04:05:12,160 --> 04:05:15,120 ITS CONSEQUENCES, THESE ISSUES 6045 04:05:15,120 --> 04:05:16,320 ARE CRITICAL TO ADDRESSING 6046 04:05:16,320 --> 04:05:18,400 MATERNAL HEALTH CRISIS AS WE 6047 04:05:18,400 --> 04:05:19,600 MOVE FORWARD. 6048 04:05:19,600 --> 04:05:20,720 AND THEY ALSO UNDERSCORE HOW 6049 04:05:20,720 --> 04:05:22,560 IMPORTANT IT IS TO INCLUDE 6050 04:05:22,560 --> 04:05:24,120 PREGNANT AND LACTATING PEOPLE IN 6051 04:05:24,120 --> 04:05:25,640 CLINICAL RESEARCH SO WE HAVE 6052 04:05:25,640 --> 04:05:27,560 EVIDENCE UPON WHICH TO MAKE 6053 04:05:27,560 --> 04:05:30,480 THEIR TREATMENT DECISIONS. 6054 04:05:30,480 --> 04:05:30,800 NEXT. 6055 04:05:30,800 --> 04:05:33,000 AS YOU HEARD EARLIER IN THIS 6056 04:05:33,000 --> 04:05:35,280 MORNING FROM DR. ZENK, FROM THE 6057 04:05:35,280 --> 04:05:37,920 NINR EFFORTS, A VARIETY OF 6058 04:05:37,920 --> 04:05:40,000 INSTITUTE CENTERS AND OFFICES AT 6059 04:05:40,000 --> 04:05:40,680 NIH ARE ADDRESSING MATERNAL 6060 04:05:40,680 --> 04:05:43,520 HEALTH AND IN A VARIETY OF WAYS 6061 04:05:43,520 --> 04:05:44,600 IN ADDITION TO THE "IMPROVE" 6062 04:05:44,600 --> 04:05:44,920 INITIATIVE. 6063 04:05:44,920 --> 04:05:47,440 I WANT TO SHARE A COUPLE OF 6064 04:05:47,440 --> 04:05:56,200 THESE WITH YOU FROM THE ORWH 6065 04:05:56,200 --> 04:05:56,800 PERSPECTIVE. 6066 04:05:56,800 --> 04:06:00,360 WE LEAD WOMEN OF STUNNED STUDIED 6067 04:06:00,360 --> 04:06:01,280 UNDERREPRESENTED AND 6068 04:06:01,280 --> 04:06:02,760 UNDERREPORTED POPULATIONS U3 TO 6069 04:06:02,760 --> 04:06:03,920 DRAW ATTENTION TO DISPARITIES IN 6070 04:06:03,920 --> 04:06:05,480 WOMEN'S HEALTH AND HEALTH CARE 6071 04:06:05,480 --> 04:06:08,000 TO SUPPORT RESEARCH AND 6072 04:06:08,000 --> 04:06:10,080 EVIDENCE-BASED PROGRAMS TO 6073 04:06:10,080 --> 04:06:12,400 ADDRESSES THAT GAP. 6074 04:06:12,400 --> 04:06:14,320 THIS PROGRAM HIGHLIGHTS 6075 04:06:14,320 --> 04:06:14,920 INTERSECTIONAL EXPERIENCES OF 6076 04:06:14,920 --> 04:06:16,880 WOMEN, EXPLORING THE WAYS IN 6077 04:06:16,880 --> 04:06:17,960 WHICH SOCIALLY DETERMINED 6078 04:06:17,960 --> 04:06:19,920 CATEGORIES LIKE RACE AND GENDER 6079 04:06:19,920 --> 04:06:22,000 OVERLAP AND INTERACT TO CREATE 6080 04:06:22,000 --> 04:06:23,560 DIFFERENT OUTCOMES FOR 6081 04:06:23,560 --> 04:06:26,760 INDIVIDUALS AND COMMUNITIES, AND 6082 04:06:26,760 --> 04:06:28,360 WE PARTNER WITH 16 INSTITUTES, 6083 04:06:28,360 --> 04:06:31,640 CENTERS AND OFFICES ON THIS 6084 04:06:31,640 --> 04:06:33,480 PROGRAM, FUNDED 70 AWARDS, 6085 04:06:33,480 --> 04:06:35,560 SEVERAL FOCUSED ON MATERNAL 6086 04:06:35,560 --> 04:06:36,240 HEALTH. 6087 04:06:36,240 --> 04:06:37,360 ORWH HAS ALSO PARTNERED WITH 6088 04:06:37,360 --> 04:06:43,840 NATIONAL 6089 04:06:43,840 --> 04:06:44,800 NATIONAL INSTITUTE MEDICAL 6090 04:06:44,800 --> 04:06:46,120 SCIENCES, ON A PROGRAM THAT 6091 04:06:46,120 --> 04:06:48,720 BUILDS RESEARCH CAPACITY IN 6092 04:06:48,720 --> 04:06:51,040 STATES THAT HISTORICALLY HAD LOW 6093 04:06:51,040 --> 04:06:55,120 LEVELS OF NIH FUNDING, RESIDENTS 6094 04:06:55,120 --> 04:06:58,720 INCLUDING WOMEN AND CHILDREN 6095 04:06:58,720 --> 04:07:00,560 ESPECIALLY IN RURAL AREAS OFTEN 6096 04:07:00,560 --> 04:07:03,400 SUFFER FROM POOR HEALTH OUTCOMES 6097 04:07:03,400 --> 04:07:05,880 THAN AVERAGE AMERICANS, SO WE'RE 6098 04:07:05,880 --> 04:07:07,240 PARTNERING WITH NIGMS ON A 6099 04:07:07,240 --> 04:07:08,920 WOMEN'S HEALTH RESEARCH PROGRAM 6100 04:07:08,920 --> 04:07:11,680 IN THE IDEA STATES PROGRAM, AND 6101 04:07:11,680 --> 04:07:13,000 SUPPORT SEVERAL GRANTS RELATED 6102 04:07:13,000 --> 04:07:16,240 TO MATERNAL HEALTH AND HAVE A 6103 04:07:16,240 --> 04:07:20,920 NEW PROGRAM CENTER OF BIOMEDICAL 6104 04:07:20,920 --> 04:07:23,040 RESEARCH EXCELLENCE AS WELL. 6105 04:07:23,040 --> 04:07:24,240 NEXT SLIDE PLEASE. 6106 04:07:24,240 --> 04:07:27,120 IN ADDITION TO THESE EFFORTS, 6107 04:07:27,120 --> 04:07:28,400 ORWH PARTNERED WITH OFFICE OF 6108 04:07:28,400 --> 04:07:30,800 DISEASE PREVENTION WHO LEADS THE 6109 04:07:30,800 --> 04:07:32,120 PATHWAYS TO PREVENTION PROGRAM, 6110 04:07:32,120 --> 04:07:36,160 AS WELL AS SEVERAL OTHER 6111 04:07:36,160 --> 04:07:40,760 INSTITUTES TO INITIATE A P2P 6112 04:07:40,760 --> 04:07:41,840 PATHWAYS TO PREVENTION PROGRAM 6113 04:07:41,840 --> 04:07:44,640 ON RISK AND INTERVENTION TO 6114 04:07:44,640 --> 04:07:45,480 OPTIMIZE POSTPARTUM HEALTH. 6115 04:07:45,480 --> 04:07:48,560 IN DECEMBER OF LAST YEAR WE HAD 6116 04:07:48,560 --> 04:07:51,640 FIRST WORKSHOP, ON THIS PROGRAM, 6117 04:07:51,640 --> 04:07:53,600 FOCUSING ON IDENTIFYING RISKS 6118 04:07:53,600 --> 04:07:54,920 AND INTERVENTION TO OPTIMIZE 6119 04:07:54,920 --> 04:07:57,200 POSTPARTUM HEALTH AND I WANT TO 6120 04:07:57,200 --> 04:07:58,640 HIGHLIGHT THE MULTIPLE PIECES OF 6121 04:07:58,640 --> 04:08:00,720 THE PROGRAM WHICH ARE DELINEATED 6122 04:08:00,720 --> 04:08:03,360 ON THE SLIDE HERE. 6123 04:08:03,360 --> 04:08:04,800 THE WORKSHOP USES INDEPENDENT 6124 04:08:04,800 --> 04:08:06,760 PANEL TO DEVELOP FAIR AND 6125 04:08:06,760 --> 04:08:10,400 OBJECTIVE REPORT ON THE MOST 6126 04:08:10,400 --> 04:08:12,000 SALIENT RESEARCH GAPS NEEDED TO 6127 04:08:12,000 --> 04:08:14,920 ADVANCE A FIELD, IN THIS CASE 6128 04:08:14,920 --> 04:08:17,520 PREVENTION OF POOR POSTPARTUM 6129 04:08:17,520 --> 04:08:18,040 OUTCOME. 6130 04:08:18,040 --> 04:08:24,680 AND IMPORTANT TAKEAWAYS, STRESS 6131 04:08:24,680 --> 04:08:26,200 TEST CONTINUES IN THE POSTPARTUM 6132 04:08:26,200 --> 04:08:28,800 PERIOD, WE NEED TO BRIDGE THAT 6133 04:08:28,800 --> 04:08:30,520 CHASM BETWEEN THE PREGNANCY 6134 04:08:30,520 --> 04:08:32,560 PERIOD AND THE POSTPARTUM AND 6135 04:08:32,560 --> 04:08:34,200 SUBSEQUENT HEALTH CARE OF A 6136 04:08:34,200 --> 04:08:39,840 PERSON, WE NEED TO TAKE A LIFE 6137 04:08:39,840 --> 04:08:43,240 COURSE PERSPECTIVE, POOR 6138 04:08:43,240 --> 04:08:44,360 OUTCOMES CAN PREDICT OTHER 6139 04:08:44,360 --> 04:08:46,480 SUBSEQUENT DISEASE RISKS AND 6140 04:08:46,480 --> 04:08:47,840 IMPORTANTLY LISTEN TO THE 6141 04:08:47,840 --> 04:08:52,240 PERSON, THE PATIENT, AND THEIR 6142 04:08:52,240 --> 04:08:52,480 FAMILIES. 6143 04:08:52,480 --> 04:08:53,080 NEXT SLIDE PLEASE. 6144 04:08:53,080 --> 04:08:55,600 I DON'T EXPECT YOU TO READ THIS 6145 04:08:55,600 --> 04:08:57,280 GRAPHIC BUT I WANT TO HIGHLIGHT 6146 04:08:57,280 --> 04:08:59,280 IT BECAUSE WE WERE SO DELIGHTED 6147 04:08:59,280 --> 04:09:03,720 TO HAVE THESE FROM THE PATHWAYS 6148 04:09:03,720 --> 04:09:04,560 2 PREVENTION WORKSHOP, AVAILABLE 6149 04:09:04,560 --> 04:09:10,520 ON THE WEBSITE FOR THE P2P 6150 04:09:10,520 --> 04:09:10,760 WEBSITE. 6151 04:09:10,760 --> 04:09:11,480 ELEVATING PATIENT CENTEREDNESS 6152 04:09:11,480 --> 04:09:14,440 WAS A CRITICAL ASPECT OF THE 6153 04:09:14,440 --> 04:09:18,800 PROGRAM, AND A CRITICAL WAY TO 6154 04:09:18,800 --> 04:09:19,600 AMELIORATE MATERNAL HEALTH, 6155 04:09:19,600 --> 04:09:20,920 IDENTIFYING RISKS AND 6156 04:09:20,920 --> 04:09:22,800 INTERVENTION TO OPTIMIZE 6157 04:09:22,800 --> 04:09:23,440 POSTPARTUM HEALTH, SYNTHESIZE 6158 04:09:23,440 --> 04:09:25,200 MANY STRATEGIES THAT ARE 6159 04:09:25,200 --> 04:09:27,360 REPRESENTED ON THIS GRAPHIC TO 6160 04:09:27,360 --> 04:09:28,440 IMPROVE PATIENT CENTEREDNESS AND 6161 04:09:28,440 --> 04:09:31,200 CARE, AND LOOKED AT HOW THEY MAY 6162 04:09:31,200 --> 04:09:32,960 INTERSECT FOR POSITIVE MATERNAL 6163 04:09:32,960 --> 04:09:34,680 HEALTH OUTCOMES, SO MANY OF 6164 04:09:34,680 --> 04:09:36,360 THESE STRATEGIES ARE DIRECTLY 6165 04:09:36,360 --> 04:09:37,920 RELATED TO DIFFERENT ASPECTS OF 6166 04:09:37,920 --> 04:09:39,520 SOCIAL DETERMINANTS OF HEALTH, 6167 04:09:39,520 --> 04:09:42,120 MANY WE HEARD ABOUT TODAY. 6168 04:09:42,120 --> 04:09:44,000 AND MOST OF THE PRESENTATIONS 6169 04:09:44,000 --> 04:09:46,080 HIGHLIGHTED THIS IS A REAL 6170 04:09:46,080 --> 04:09:48,480 PATHWAY FOR CHANGE AND HOW CARE 6171 04:09:48,480 --> 04:09:50,360 IS ADMINISTERED, INCREASING 6172 04:09:50,360 --> 04:09:51,360 QUALITY OF CARE, INCREASING 6173 04:09:51,360 --> 04:09:54,720 ACCESS TO CARE, STRATEGIES TO 6174 04:09:54,720 --> 04:09:55,920 REDUCE MATERNAL MORTALITY. 6175 04:09:55,920 --> 04:09:59,040 WE WANT TO HIGHLIGHT THE PANEL 6176 04:09:59,040 --> 04:10:02,040 REPORT WILL BE RELEASED AROUND 6177 04:10:02,040 --> 04:10:03,400 MARCH 28, FOR PUBLIC INPUT. 6178 04:10:03,400 --> 04:10:05,800 WE WOULD BE MOST GRATEFUL FOR 6179 04:10:05,800 --> 04:10:07,400 OUR IMPROVED GRANTEES AND OTHER 6180 04:10:07,400 --> 04:10:08,960 EXPERTS TO WEIGH IN SO PLEASE BE 6181 04:10:08,960 --> 04:10:13,880 ON THE LOOKOUT FOR THAT. 6182 04:10:13,880 --> 04:10:16,560 AND SHARE YOUR THOUGHTS. 6183 04:10:16,560 --> 04:10:18,480 SUMMER OF 2023 THE PROGRAM WILL 6184 04:10:18,480 --> 04:10:21,640 BE CONDUCTING A MEETING WITH 6185 04:10:21,640 --> 04:10:24,560 FEDERAL PARTNERS, THESE ARE 6186 04:10:24,560 --> 04:10:26,880 COLLEAGUES ACROSS THE FEDERAL 6187 04:10:26,880 --> 04:10:28,000 GOVERNMENT, FINDINGS WILL BE 6188 04:10:28,000 --> 04:10:31,280 USED TO INFORM FUTURE RESEARCH, 6189 04:10:31,280 --> 04:10:32,640 POLICY AND GUIDELINES RELATED TO 6190 04:10:32,640 --> 04:10:34,560 RISK AND INTERVENTION DURING THE 6191 04:10:34,560 --> 04:10:36,800 POSTPARTUM PERIOD AND TO OVERALL 6192 04:10:36,800 --> 04:10:38,960 MATERNAL HEALTH. 6193 04:10:38,960 --> 04:10:40,920 NEXT SLIDE PLEASE. 6194 04:10:40,920 --> 04:10:43,960 AS I END HERE, I KNOW WE'LL GO 6195 04:10:43,960 --> 04:10:45,120 BACK TO WHERE WE'RE STARTED, 6196 04:10:45,120 --> 04:10:46,600 UNITED STATES IS THE MOST 6197 04:10:46,600 --> 04:10:48,280 DANGEROUS PLACE IN THE DEVELOPED 6198 04:10:48,280 --> 04:10:51,000 WORLD TO DELIVER A BABY. 6199 04:10:51,000 --> 04:10:53,000 IT'S NOW BROADLY KNOWN. 6200 04:10:53,000 --> 04:10:56,040 WE KNOW THESE RATES DIFFER FOR 6201 04:10:56,040 --> 04:10:57,160 DIFFERENT POPULATIONS, HIGHEST 6202 04:10:57,160 --> 04:11:00,520 FOR AFRICAN AMERICAN AND 6203 04:11:00,520 --> 04:11:02,280 AMERICAN INDIAN AND ALASKA 6204 04:11:02,280 --> 04:11:03,440 NATIVE WOMEN, INCREASING. 6205 04:11:03,440 --> 04:11:08,080 A RECENT W.H.O. RECORD SHOWED 6206 04:11:08,080 --> 04:11:10,600 TRENDS CONTINUE IN THE SAME 6207 04:11:10,600 --> 04:11:10,880 DIRECTION. 6208 04:11:10,880 --> 04:11:15,240 FOR SEVERAL COUNTRIES INCLUDING 6209 04:11:15,240 --> 04:11:17,520 THE UNITED STATES. 6210 04:11:17,520 --> 04:11:19,360 THIS CRISIS FOR UNDERREPRESENTED 6211 04:11:19,360 --> 04:11:21,400 RACIAL AND ETHNIC MINORITY 6212 04:11:21,400 --> 04:11:24,400 GROUPS HAS CAUGHT THE ATTENTION 6213 04:11:24,400 --> 04:11:25,280 OF MANY INCLUDING THE 6214 04:11:25,280 --> 04:11:26,560 BIDEN-HARRIS ADMINISTRATION WHO 6215 04:11:26,560 --> 04:11:28,240 SET FORTH THE WHITE HOUSE 6216 04:11:28,240 --> 04:11:30,320 MATERNAL DAY OF ACTION, A CALL 6217 04:11:30,320 --> 04:11:34,240 TO ACTION TO REDUCE MATERNAL 6218 04:11:34,240 --> 04:11:35,800 MORBIDITY AND MORTALITY TO 6219 04:11:35,800 --> 04:11:38,200 ENSURE PROPER HEALTH CARE DURING 6220 04:11:38,200 --> 04:11:39,640 THE PERINATAL PERIOD, BIRTHING 6221 04:11:39,640 --> 04:11:41,680 PERSON AND CHILD. 6222 04:11:41,680 --> 04:11:42,560 AMONG THEIR COMMITMENTS ARE 6223 04:11:42,560 --> 04:11:43,760 SEVERAL KEY ACTIONS THAT WILL 6224 04:11:43,760 --> 04:11:46,320 HAVE A POSITIVE EFFECT ON 6225 04:11:46,320 --> 04:11:51,760 PREGNANT PEOPLE, SUCH AS THE 6226 04:11:51,760 --> 04:11:53,320 BUILD BACK BETTER HEALTH AND 6227 04:11:53,320 --> 04:11:55,240 RELEASE OF NEW GUIDANCE TO HELP 6228 04:11:55,240 --> 04:11:58,120 STATES PROVIDE 12 MONTHS OF 6229 04:11:58,120 --> 04:12:01,360 CONTINUOUS POSTPARTUM COVERAGE 6230 04:12:01,360 --> 04:12:02,160 THROUGH MEDICAID PROGRAMS. 6231 04:12:02,160 --> 04:12:04,000 AND AS I MOVE TO THE NEXT SLIDE 6232 04:12:04,000 --> 04:12:06,600 I DO WANT TO THANK YOU ALL FOR 6233 04:12:06,600 --> 04:12:09,040 THIS INFORMATIVE WORKSHOP AND 6234 04:12:09,040 --> 04:12:10,680 INNOVATIVE APPROACHES TO ENDING 6235 04:12:10,680 --> 04:12:13,280 THIS WIDESPREAD CHALLENGE OF 6236 04:12:13,280 --> 04:12:14,520 SEVERE MATERNAL MORBIDITY AND 6237 04:12:14,520 --> 04:12:16,160 MATERNAL MORTALITY. 6238 04:12:16,160 --> 04:12:16,920 FOR MORE INFORMATION ABOUT THE 6239 04:12:16,920 --> 04:12:17,880 "IMPROVE" INITIATIVE YOU CAN 6240 04:12:17,880 --> 04:12:21,160 TAKE A LOOK AT THIS WEBSITE, SO 6241 04:12:21,160 --> 04:12:23,280 WE CAN TRULY IMPLEMENT A 6242 04:12:23,280 --> 04:12:26,000 MATERNAL HEALTH AND PREGNANCY 6243 04:12:26,000 --> 04:12:28,160 OUTCOMES VISION FOR EVERYONE. 6244 04:12:28,160 --> 04:12:29,160 NEXT SLIDE PLEASE. 6245 04:12:29,160 --> 04:12:31,560 THANK YOU FOR JOINING US ONCE 6246 04:12:31,560 --> 04:12:33,320 AGAIN TO THE MEETING ORGANIZERS, 6247 04:12:33,320 --> 04:12:35,400 THE TEAM BEHIND THE SCENES, ALL 6248 04:12:35,400 --> 04:12:38,040 OF THE SPEAKERS TODAY AND 6249 04:12:38,040 --> 04:12:38,880 MODERATORS, THE IMPROVE TEAM, 6250 04:12:38,880 --> 04:12:41,600 AND ALL OF YOU JOINING US TODAY. 6251 04:12:41,600 --> 04:12:42,600 WE'RE ARE ADJOURNED. 6252 04:12:42,600 --> 00:00:00,000 THANK YOU VERY MUCH.