Lawton and Rhea Chiles Center for Healthy Mothers and Babies

Research Programs

Central Hillsborough Healthy Start Project Evaluation

The Central Hillsborough Healthy Start Project Evaluation evaluated the impact of the Healthy Start intervention program on feto-infant morbidity within a community setting. Prospective data from 2002 to 2007 within the ongoing, federally-funded project were merged with corresponding birth outcomes data from the Florida Department of Health. The impact of the project on the following feto-infant morbidity indices was assessed among service recipients: low birth weight (LBW), very low birth weight (VLBW), preterm, very preterm, small for gestational (SGA), and a composite feto-infant morbidity outcome. The results of the evaluation showed that the risk for low birth weight, preterm, and the composite feto-infant morbidity outcomes was reduced among service recipients as compared to non-recipients. A clinically important level of risk reduction was also noted for very low birth weight and very preterm. Evaluation of the project will continue through 2012.

Multi-level, multi-source MCH data linkages
Principal Investigator: Hamisu Salihu, MD, Ph.D Funded by NIH

The aim of this study is to create a large, reliable statewide database that contains clinical and non-clinical information which will be useful for comparative effectiveness research and will serve as a tool for quality improvement with the overall objective of enhancing overall population health. The newly-created dataset from the project will encompass information from the following data sources: the birth certificate, in-patient hospital discharge data, ambulatory and emergency department data, financial data, and Florida maternal mortality data. The project enjoys a strong, statewide collaborative partnership that has been working together for some time now to attain some of the objectives spelled out for this project.

Community University Training Projects

In 2007, the Black Infant Health Practice Initiative (BIHPI) was created in order to determine the medical and social factors contributing to the elevated rates of infant mortality among Black infants in Florida and to develop community-based strategies and recommend policy changes at the local and state levels to address the disparity. A statewide collaborative was formed to implement this initiative. The collaborative consists of eight Florida counties and receives technical assistance and scientific guidance from USF and FAMU in order to develop and implement research to understand the medical and social factors contributing to the racial disparity in infant deaths. The initiative sponsors statewide conferences and workshops that provide training in assessing and addressing racial disparity in infant mortality, and allow communities to share lessons learned since the initiative’s inception.

Florida Covering Kids and Families Evaluation

The evaluation project works to assess the process, impact and outcome measures of proposed activities intended to increase enrollment and retention in Florida KidCare. The evaluation project encompasses three main component areas: (1) Development and Implementation of an Information Systems Database (2) Evaluation of Enrollment and Retention Activities; and (3) Evaluation of Training and Capacity Building of Hospital Partners. The evaluation project strategies are as follow:

  • Assess overall quality & outcome performance measures to establish program effectiveness.
  • Evaluate the effectiveness & efficiency of strategies linked to outreach activities within target areas.

The development and implementation of an electronic information system database, a type of data collection system, will be used to adequately capture applicant and enrollment information. The data obtained via the information system database will be utilized for the evaluation and analysis of enrollment and retention activities conducted by the 10 local coalitions and the Refugee and Entrant project. Such data collection system will serve to assess the effectiveness and efficacy of the FL-CKF program strategies to reduce the high rates of uninsured children among low-income families. The data obtained will be used to perform descriptive analysis to describe trends and generate growth curves for program stakeholders and contractors. Such analysis will bring light to the effectiveness of each contracting site as well as its strategies in enrolling underinsured children. Furthermore, the evaluation project works to evaluate the various training performed at various partner hospitals. An assessment of the effectiveness of the training in its ability to expand the knowledge of counselor and/or social workers as to what constitutes uninsured, but eligible children and to introduce and increase participant awareness on the outreach opportunities provided by children’s hospitals and of the enrollment and renewal process into FL-CKF. For more information click here.

Smoking and Birth Outcomes
Principal Investigator: Hamisu Salihu, MD, Ph.D Funded by: USF Neuroscience Collaborative – Seed Grant Program

A grant program through the USF Health Center for Transformation and Innovation Smoking accounts for a significant proportion of morbidity and mortality in the US with approximately half a million deaths attributed to smoking, and more than eight million people suffering from smoking-related illnesses. Despite smoking cessation programs, most smokers continue to smoke during pregnancy (prenatal smoking) leading to considerable fetal morbidity and mortality. An important consequence of prenatal smoking is its impact on the developing fetal brain leading to reduced intellectual capacity and subsequent adult-onset neurological disorders. Human studies on the mechanisms linking tobacco smoke to fetal brain damage are lacking, which limits our understanding and ability to formulate targeted interventions early in life. Accordingly, this study has the following specific aims:

  • Specific Aim 1: To determine whether prenatal smoking reduces fetal brain size;
  • Specific Aim 2: To identify and quantify alterations in brain regulatory gene expressions in cord blood of fetuses exposed to intra-uterine tobacco smoke;
  • Specific Aim 3: To determine whether normal epigenetic modifications in specific genes responsible for normal fetal brain development are altered in fetuses exposed to intra-uterine tobacco smoke.
The study will be conducted at the Tampa General Hospital delivery ward over the course of two years. The study will also potentially provide compelling data for a subsequent R01 application to the NIH on the role of tobacco smoke in the fetal origins of childhood and adult-onset neuro-behavioral disorders.

Ingram Grant on Depression and Smoking
Principal Investigator: Alfred Mbah, Ph.D Funded by Florida Department of Health, James & Esther King Biomedical Research Program

Dr. Mbah recently obtained a 3-year, $374,733 grant from the Florida Biomedical Society. In order to inform future intervention, the study aims to identify environmental insults, such as secondhand smoking, that could compromise maternal health. At its completion, this study will add knowledge on antenatal depression among African American women to the research on postpartum depression in the extant literature. The study’s objectives are guided by the following aims:

  • To determine the impact of passive smoking on the risk for antenatal and postpartum depression
  • To assess whether a dose-response relationship exists between passive smoking and the magnitude of risk for antenatal and postpartum depressive symptoms
Researchers hypothesize that women who are exposed to environmental tobacco smoke are more likely to report depressive symptoms during the antenatal and postpartum period than those who are not exposed. It is also predicted that the magnitude of maternal depression will be amplified by higher levels of maternal exposure to environmental tobacco smoke.

MCH Prevention Trials

Using a randomized trial, this proposal seeks to assess the efficacy of higher-strength folic acid (in comparison to standard of care) in combination with smoking cessation program in preventing the fetal growth-inhibitory effects of tobacco smoke. Following randomization, a total of three follow-up antenatal visits are planned during which study participants will be administered questionnaires and will undergo fetal Doppler ultrasound examinations to assess fetal body and brain growth. Maternal blood will also be collected for assessment of biomarkers (folate, vitamin B12, homocysteine and Methylenetetrahydrofolate reductase (MTHFR) polymorphism) ante-natally. All study participants will be followed until delivery to measure fetal body and brain growth parameters at birth. Umbilical cord blood will also be collected for genetic and epigenetic studies on markers of fetal brain growth and development. The two treatment groups will then be compared to determine the efficacy of higher-strength folic acid supplementation in improving fetal body and brain growth among smokers based on fetal growth measures collected during pregnancy and at birth.

Process Evaluation of the National Friendly AccessSM Program
Principal Investigator: Linda Detman, Ph.D.

The Process Evaluation of the National Friendly AccessSM Program project, funded by a cooperative agreement between the Association of Schools of Public Health and the Centers for Disease Control and Prevention (funded through September 2007), continues the process evaluation of the implementation and legacy of Friendly AccessSM.  Specifically, the evaluation aims to determine to what degree the four pilot communities of East Tennessee (16 counties surrounding Knoxville), Flint/Genesee County, MI, Indianapolis, IN, and Jacksonville, FL were able to implement a project based on the Friendly AccessSM program model and discover to what extent each community developed the capacity to change the culture and system of maternal and child health care.

Friendly AccessSM was a national program designed to help health care delivery institutions and staff collaborate with community residents and stakeholders from the public and private sectors to improve access to and use of quality maternal and child health services in order to reduce health disparities and improve population health.  This project refines and expands the process evaluation by:

  1. Gauging changes in the cohesion and collective efficacy of the coalitions since implementation of the Friendly AccessSM program;
  2. Obtaining the perspectives of coalition members and other key informants on the implementation of the Friendly AccessSM model and the achievements and challenges in enacting systems change;
  3. Assessing each community’s use of data to support and develop strategic planning initiatives; and
  4. Cataloguing lessons learned in carrying out data-driven, multi-site collaborations.

Comparative Effectiveness Research on MCH Outcomes
Principal Investigator: Salihu, MD, Ph.D Funded by COPH Interdisciplinary Research Development Grant

Preterm birth is the leading cause of infant morbidity and mortality and bears significant economic costs. In spite of intervention programs and other efforts at preventing preterm birth, the proportion of infants born preterm has continued to rise. Recent studies suggest that folic acid may prevent preterm birth but the evidence is scanty and the mechanism is poorly defined. Accordingly, this study has the following aims:

  • To determine the association between maternal folic acid levels and spontaneous preterm birth
  • To assess the role of DNA-methylation as a pathway linking folic acid deficiency and spontaneous preterm birth.
150 women delivering spontaneous preterm and 150 women delivering at term will be recruited for this study.