title: The impact of prenatal education on behavioral changes toward breast feeding and smoking cessation in a healthy start population.
abstract: OBJECTIVE
  To evaluate the impact of prenatal education by case managers on 2 social determinants of health behaviors-breast feeding and smoking cessation-among participants enrolled in Indianapolis Healthy Start (IHS).
  
  
  METHODS
  Birth and death data up to 1 year for IHS clients were collected from Marion County vital records for births 20 weeks or greater. Case managers provide education on the health benefits for mothers and infants on breast feeding and smoking cessation to all clients. Data were analyzed for differences between the IHS participants and other Marion County births.
  
  
  RESULTS
  Most participants (63%) were non-Hispanic blacks aged less than 25 years (56%), without a high school diploma or general education development (53%), and enrolled in Medicaid (91%). Program participants were more likely to initiate breast feeding than nonparticipants (OR, 1.33; 95% CI, 1.10-1.61), and 22% continued to breast feed for 6 months. Hispanic women were more likely to breast feed for at least 6 months (OR, 4.71; 95% CI, 2.32-9.58). Women with advanced education were more likely to have quit smoking, as were women who were breast feeding at hospital discharge. After controlling for education, IHS clients tended to be less likely to continue to smoke during the third trimester (OR, 0.76, 95% CI, 0.49-1.16), as were those with a first pregnancy (OR, 0.32; 95% CI, 0.10, 0.98) and no other smokers in the home (OR, 0.25; 95% CI, 0.08, 0.74).
  
  
  CONCLUSIONS
  Breast feeding and smoking cessation are modifiable risk factors that were impacted by behavioral interventions through case management education.
authors.affiliation: Division of Maternal and Child Health, Marion County Public Health Department, Indianapolis, IN, USA.
authors.forename: Virginia A
authors.initials: VA
authors.lastname: Caine
authors.forename: Mark
authors.initials: M
authors.lastname: Smith
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Beasley
authors.forename: Haywood L
authors.initials: HL
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000208:ethnology; D004522:Educational Status; D005260:Female; D006266:Health Education; D040361:Healthy People Programs; D006801:Humans; D007196:Indiana; D007231:Infant, Newborn; D016015:Logistic Models; D008425:Maternal Behavior / Q000208:ethnology; D011247:Pregnancy; D011295:Prenatal Care; D012307:Risk Factors; D016540:Smoking Cessation / Q000208:ethnology