title: Effectiveness of a federal healthy start program in reducing the impact of particulate air pollutants on feto-infant morbidity outcomes.
abstract: We sought to assess (1) the relationship between air particulate pollutants and feto-infant morbidity outcomes and (2) the impact of a Federal Healthy Start program on this relationship. This is a retrospective cohort study using de-identified hospital discharge information linked to vital records, and air pollution data from 2000 through 2007 for the zip codes served by the Central Hillsborough Federal Healthy Start Project in Tampa, Florida. Mathematical modeling was employed to compute minimal Euclidean distances to capture exposure to ambient air particulate matter. The outcomes of interest were low birth weight (LBW), very low birth weight (VLBW), small for gestational age, preterm (PTB), and very preterm birth. We used odds ratios to approximate relative risks. A total of 12,356 live births were analyzed. Overall, women exposed to air particulate pollutants were at elevated risk for LBW (AOR = 1.24; 95% CI = 1.07-1.43), VLBW (AOR = 1.58; 95% CI = 1.09-2.29) and PTB (AOR = 1.18; 95% CI = 1.03-1.34). Analysis by race/ethnicity revealed that the adverse effects of air particulate pollutants were most profound among black infants. Infants of women who received services provided by the Central Hillsborough Federal Healthy Start Project experienced improved feto-infant morbidity outcomes despite exposure to air particulate pollutants. Environmental air pollutants represent important risk factors for adverse birth outcomes, particularly among black women. Multi-level interventional approaches implemented by the Central Hillsborough Federal Healthy Start were found to be associated with reduced likelihood for feto-infant morbidities triggered by exposure to ambient air particulate pollutants.
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B. Downs, MDC56, Tampa, FL 33612, USA. hsalihu@health.usf.edu
authors.forename: Hamisu M
authors.initials: HM
authors.lastname: Salihu
authors.forename: Euna M
authors.initials: EM
authors.lastname: August
authors.forename: Alfred K
authors.initials: AK
authors.lastname: Mbah
authors.forename: Amina P
authors.initials: AP
authors.lastname: Alio
authors.forename: Raymond
authors.initials: R
authors.lastname: de Cuba
authors.forename: Foday M
authors.initials: FM
authors.lastname: Jaward
authors.forename: Estrellita Lo
authors.initials: EL
authors.lastname: Berry
mesh_terms: D000328:Adult; D000393:Air Pollutants / Q000009:adverse effects* / Q000032:analysis; D000397:Air Pollution / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D005260:Female; D005315:Fetal Diseases / Q000453:epidemiology*; D005431:Florida / Q000453:epidemiology; D005865:Gestational Age; D006078:Government Programs; D006293:Health Promotion; D040361:Healthy People Programs; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D016015:Logistic Models; D018811:Maternal Exposure; D009017:Morbidity; D052638:Particulate Matter / Q000009:adverse effects* / Q000032:analysis; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000139:chemically induced; D016730:Program Development; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter