VCU news

By Sathya Achia Abraham

Virginia Commonwealth University School of Medicine researchers are working toward changing some rather alarming statistics. Despite improvements to the nation's general health, African-Americans experience adverse pregnancy outcomes much more frequently than whites, resulting in infant death rates that are more than twice those of the white population.

Making strides toward eliminating health disparities among racial and ethnic populations through research in the field of maternal, infant and child health has become the key focus of several VCU School of Medicine researchers. Nearly $10 million in federal grants awarded recently will go a long way in furthering those goals.

According to the Centers for Disease Control, in 2000, infant mortality rates among African-Americans occurred at 14.1 deaths per 1,000 live births, compared with the national average of 6.9 deaths per 1,000 live births. Congenital abnormalities, pre-term and low birth weight, Sudden Infant Death Syndrome (SIDS), problems related to pregnancy and respiratory distress syndrome are among the leading causes of infant death.

Some expectant mothers in this population do not realize that the health of their babies is dependent on their lifestyles before and during pregnancy. A combination of behaviors, lifestyles and conditions that may include smoking, substance abuse, poor nutrition, lack of prenatal care, medical problems and chronic illness contribute to the poor birth outcomes of their infants.

Another piece to the puzzle may relate to genetics of preterm birth. Last year, VCU School of Medicine researchers identified a genetic variant that may account for the higher rates of premature delivery experienced by African-American women compared with European-American women. The findings may help physicians identify patients who may benefit from therapeutic interventions and preventative measures, including lifestyle change or medical therapy to reduce the risk of premature birth.

"Our discovery of an association between a gene variation that is more common in individuals of African descent and a cause of premature birth, can explain in part the disparity in prematurity rates in African-Americans," said Jerome F. Strauss III, M.D., Ph.D., dean of the VCU School of Medicine, who led the study. 

"More importantly, the genetic signature can help us identify women at risk of early breakage of the "bag of waters" so that appropriate monitoring and therapy can be applied in order to prevent this serious pregnancy complication."

Making a difference through multidisciplinary research

VCU School of Medicine researchers last year received two federal grants totaling more than $8 million to examine adverse pregnancy outcomes in African-Americans and potential interventions to prevent them; as well as identifying ways to increase prenatal awareness and reduce infant mortality.

The first, a five-year grant totaling nearly $6.4 million from the National Institutes of Health's National Center on Minority Health and Health Disparities, will support basic and clinical research that will help identify women at risk of adverse pregnancy outcomes and evaluate new interventions to improve maternal and neonatal health. The grant will also raise awareness and promote participation in evidence-based research among minority populations.

"This research program addresses a major unmet need in the United States and the Commonwealth of Virginia. In developing new ways to ensure healthy pregnancies with healthy outcomes, we will have a major impact on the cost of health care, and in the long term, reduce the burden of chronic diseases that have their roots in pregnancy complications," said Strauss, who is the primary investigator for the project.

Through the NIH grant, Strauss and a multidisciplinary research team at the VCU Center of Health Disparities Research will initiate three research projects that will focus on varying aspects of health disparities. They will investigate the genetics of preterm birth in African-Americans; immunological responses to periodontitis that may lead to premature birth; and ways to increase safe-sex awareness skills among pregnant women at high risk for HIV infection.

Additionally, two pilot projects will aim to enhance fetal exposure to antiretroviral medications and examine the geographic distribution of birth outcomes and environmental stressors.

The team hopes these findings will help researchers identify and implement new diagnostic tools and interventions that will address major health disparities.

Strauss said that the center will also provide research training opportunities for disparity population students. The grant designates funds for students from Virginia Union University, a historically black university in Richmond, to work with investigators through the health education intervention and other research projects.

Investigators from the VCU School of Medicine, the School of Dentistry, the Department of Psychology and VUU will collaborate with Strauss on this work.

Addressing infant mortality and prenatal awareness

The second grant, totaling nearly $2 million from the Centers for Disease Control and Prevention is to improve pregnancy outcomes among African-American populations in Richmond. VCU was one of 40 institutions selected nationwide to receive funding through the CDC's Racial and Ethnic Approaches to Community Health (REACH) U.S. program.

Through the five-year grant, principal investigator Dace Svikis, Ph.D., deputy director of the VCU Institute for Women's Health, professor of psychology, and director of Promoting Healthy Pregnancies in the VCU Department of Obstetrics and Gynecology, will support local efforts to address infant mortality and prenatal awareness among economically disadvantaged African-American populations in Richmond. The program will be a collaboration between the VCU Institute for Women's Health and the VCU Center on Health Disparities. 

"We have proposed an intervention model to improve infant mortality among this population with a focus on the cultural, social and environmental barriers to care," Svikis said.

According to Svikis, the model involves three components. The first calls for each expectant mother to be assigned a case navigator, who will guide each woman through the system of care and teach her the skills to eventually navigate on her own. The second component will help the case navigator increase a woman's level of motivation to participate in prenatal care by offering modest monetary incentives such as gift certificates to reward successful follow-through. The third component focuses on the practitioner, including educational training in health disparities as well as in how to identify personal biases and how to use culturally sensitive approaches when providing care to patients.

The REACH program will target five racial and ethnic groups: African-Americans, Hispanics/Latinos, Asian-Americans, Hawaiians/Pacific Islanders and American Indians/Alaska Natives. REACH U.S. activities focus on a range of key health areas that contribute to health disparities, including cardiovascular disease, diabetes, breast and cervical cancer, hepatitis B, asthma, infant mortality and adult immunizations.

Through the REACH U.S. initiative, 18 national and regional Centers of Excellence in the Elimination of Disparities (CEEDs) and 22 Action Communities will be established throughout the country. The CEEDs will serve as national resource centers with expertise in specific ethnic populations and will train additional communities to further spread the impact of REACH activities. The Action Communities will implement and evaluate successful approaches within a specific community to impact population groups, rather than individuals, and focus on key health conditions that contribute to health disparities.

Other VCU faculty involved in the project are Judith Bradford, Ph.D.; Susan Lanni, M.D.; Lori Keyser-Marcus, Ph.D.; Saba Masho, Ph.D.; and Tatyana Thweatt, Ph.D.

The proposed model was developed by the Promoting Healthy Pregnancies Coalition (PHPC), a group of community care providers that includes Richmond Healthy Start, the VCU Health System, Children's Health Involving Parents, Richmond Behavioral Health Authority, Healthy Families of Richmond, Virginia Premier Health Plan and Richmond City Health District.  PHPC has focused on infant mortality for more than 15 years and has established a network of services designed to meet the multiple needs of the predominantly African-American community that they serve.

Since 1999, the REACH program has demonstrated that fully engaging communities in health strategies that address the unique social, economic and cultural circumstances of racial and ethnic minority groups can reduce health disparities. For more information about the REACH program, visit CDC's Web site at www.cdc.gov/reach.