Maternal Socioeconomic Status and the Odds of Failing to Receive Preconception Counseling: An Epidemiologic Study Using 2009-2011 PRAMS Data

Abstract

s / Annals of Epidemiology 25 (2015) 702e719 718 Results: Geometric means for serum cotinine level and FeNOwere 0.29ng/ml and 13.04 ppb, respectively. There was a statistically significant inverse relationship between serum cotinine levels and FeNO (r2 1⁄40.172, b1⁄4.061, p-value<0.001). The inverse relationship was strongest among current smokers (b1⁄40.101, p-value <0.001), followed by ex/non-smokers (b1⁄4.025, pvalue< 0.001), adjusted for potential confounders. Conclusion: The results of the study show that serum cotinine suppresses FeNO levels regardless of the smoking status. However, the inverse relationship between serum cotinine and FeNO levels among ex/non-smokers suggest that secondhand smoke may predispose susceptible individuals to adverse health outcomes. P66. Maternal Socioeconomic Status and the Odds of Failing to Receive Preconception Counseling: An Epidemiologic Study Using 2009-2011 PRAMS Data Katherine Nystrom MPH. Emory University Rollins School of Public Health Purpose: While scientific evidence is growing to support the improvement of women’s preconception health as an effective way to reduce poor pregnancy and infant outcomes, maternal socioeconomic status has not been explored as an exposure in the preconception health paradigm. The purpose of this study was to determine the degree to which maternal characteristics, psychosocial factors, and health behaviors explain or mediate the influence of socioeconomic factors on the receipt of preconception counseling. Methods: This study was a secondary analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) data from 6 states that included the following question in their PRAMS questionnaire: “Before you got pregnant with your new baby, did a doctor, nurse, or other health care worker talk to you about how to prepare for a healthy pregnancy and baby?” The sample is a population-based sample of 27,458 womenwho gave birth to a live infant during the years 2009-2011. Results: Only 32.7% of respondents reported receiving preconception counseling. By using multivariable logistic regression, we found modest evidence for income and education variation, although not in a clear dose-response gradient. We observed a protective, albeit non-significant, effect of extreme poverty (annual income <$10,000) against the failure to receive preconception counseling. Women earning between $10,000 and $49,999 annually or having less than 16 years of education were less likely to receive preconception counseling. Conclusions: Based on our findings, it appears that the provision of preconception care, or women’s recognition of the receipt of preconception care, remains substandard. P67. Estimation of the Burden of CIN Lesions Preventable by Vaccination with Bivalent, Quadrivalent or 9-Valent HPV Vaccines Chandrika Piyathilake PhD, Michelle Chambers MS, Suguna Badiga PhD, Walter Bell MD, Ronald Alvarez MD, Edward Partridge MD, Maurizio Macaluso MD, DrPH. UAB Purpose: To estimate and compare the potential impact of currently available prophylactic HPV vaccines on preventing varying grades of histologically confirmed cervical intraepithelial neoplasia (CIN2+). Methods: 2296 women with histological diagnoses were tested for 37 HPV genotypes. To estimate the proportion of CIN 2 and 3 lesions that could have been prevented by immunization with bivalent (16/18), quadrivalent (6/11/ 16/18) or 9-valent (6/11/16/18/31/35/45/52/58) vaccines, we used the histology profile of women in the same race and age category who were negative for the HPV vaccine genotypes to compute the expected number of CIN 2 and 3 lesions in the absence of infection with the vaccine genotypes, and subtracted the expected numbers from the observed. We estimated alternative expected and preventable numbers using more specific patterns of infection as the reference, and a regression model including terms for genotype groups and relevant interactions. Results: The proportion of preventable CIN 2+ lesions, especially CIN 2 lesions, among African American (AA) women increased with the 9-valent vaccine compared to bivalent or quadrivalent vaccines (from 4% to 42%). However, 20-30% of CIN 3 lesions are not preventable by the 9-valent vaccine. Alternative estimation methods yielded similar results. Conclusions: Widespread use of the 9-valent HPV vaccine would considerably reduce the prevalence of CIN 3 in our population, but the prevalence of CIN 2+ associated with HPVs not included in the 9-valent vaccine would be sufficiently high to warrant follow-up. It is unclear whether these CIN 2 + lesions would progress to more advanced lesions over time.