Michael C Lu

CSU Mentor, Long Beach, California, United States

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Publications (78)121.34 Total impact

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    ABSTRACT: Unintended births are especially frequent among minority women. Predictors of unintended births among adult Mexican women living in the United States are poorly characterized.
    Women's health issues : official publication of the Jacobs Institute of Women's Health. 05/2014;
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    ABSTRACT: This study aimed to identify actual and perceived barriers to postpartum care among a probability sample of women who gave birth in Los Angeles County, California in 2007. Survey data from the 2007 Los Angeles Mommy and Baby (LAMB) study (N = 4,075) were used to identify predictors and barriers to postpartum care use. The LAMB study was a cross-sectional, population-based study that examined maternal and child health outcomes during the preconception, prenatal, and postpartum periods. Multivariable analyses identified low income, being separated/divorced and never married, trying hard to get pregnant or trying to prevent pregnancy, Medi-Cal insurance holders, and lack of prenatal care to be risk factors of postpartum care nonuse, while Hispanic ethnicity was protective. The most commonly reported barriers to postpartum care use were feeling fine, being too busy with the baby, having other things going on, and a lack of need. Findings from this study can inform the development of interventions targeting subgroups at risk for not obtaining postpartum care. Community education and improved access to care can further increase the acceptability of postpartum visits and contribute to improvements in women's health. Postpartum care can serve as a gateway to engage underserved populations in the continuum of women's health care.
    Journal of pregnancy 01/2014; 2014:530769.
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    ABSTRACT: Background Unintended births are especially frequent among minority women. Predictors of unintended births among adult Mexican women living in the United States are poorly characterized. Methods Data are from vital statistics and the 2005 Los Angeles Mommy and Baby (LAMB) survey, a population-based study of women delivering a live birth in Los Angeles County, California (n = 1,214). Multivariable logistic regression assessed the relation of unintended birth with acculturation variables adjusting for background and psychosocial characteristics. Multinomial models assessed these relations for women with an unintended birth who did and did not use contraception. Findings Forty-one percent of women reported an unintended birth. Being a long-term immigrant and U.S.-born were positively associated with unintended birth compared with shorter term immigrants, but the adjusted relation was significant only for U.S.-born women (odds ratio [OR], 2.01; 95% CI, 1.19–3.39). Women reporting an unintended birth were younger, unmarried, and higher parity. If using contraception, the odds of unintended birth were increased for cohabiting women, those with high education, and those with greater stress during pregnancy. When not using contraception and reporting an unintended birth, women also have no usual place for health care, have depressive symptoms during pregnancy, and are dissatisfied with partner support. Conclusions Women's background and psychosocial characteristics were central to explaining unintended birth among immigrant women but less so for U.S.-born Mexican mothers. Interventions to improve birth intentions should not only target effective contraception, but also important social determinants.
    Women's Health Issues. 01/2014;
  • Michael C Lu
    Maternal and Child Health Journal 12/2013; · 2.24 Impact Factor
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    ABSTRACT: This randomised controlled pilot trial tested a six-week mindfulness-based intervention in a sample of pregnant women experiencing high levels of perceived stress and pregnancy anxiety. Forty-seven women enrolled between 10 and 25 weeks gestation were randomly assigned to either a series of weekly Mindful Awareness Practices classes (n = 24) with home practice or to a reading control condition (n = 23). Hierarchical linear models of between-group differences in change over time demonstrated that participants in the mindfulness intervention experienced larger decreases from pre-to post-intervention in pregnancy-specific anxiety and pregnancy-related anxiety (PRA) than participants in the reading control condition. However, these effects were not sustained through follow-up at six weeks post-intervention. Participants in both groups experienced increased mindfulness, as well as decreased perceived stress and state anxiety over the course of the intervention and follow-up periods. This study is one of the first randomised controlled pilot trials of a mindfulness meditation intervention during pregnancy and provides some evidence that mindfulness training during pregnancy may effectively reduce PRA and worry. We discuss some of the dilemmas in pursuing this translational strategy and offer suggestions for researchers interested in conducting mind-body interventions during pregnancy.
    Psychology & Health 11/2013; · 1.95 Impact Factor
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    ABSTRACT: The objectives of this study were to determine if racial and ethnic differences in personal capital during pregnancy exist and to estimate the extent to which any identified racial and ethnic differences in personal capital are related to differences in maternal sociodemographic and acculturation characteristics. Data are from the 2007 Los Angeles Mommy and Baby study (n = 3,716). Personal capital comprised internal resources (self-esteem and mastery) and social resources (partner, social network, and neighborhood support) during pregnancy. The relationships between race/ethnicity and personal capital were assessed using multivariable generalized linear models, examining the impact of sociodemographic and acculturation factors on these relationships. Significant racial and ethnic disparities in personal capital during pregnancy exist. However, socioeconomic status (i.e., income and education) and marital status completely explained Black-White disparities and Hispanic-White disparities in personal capital, whereas acculturation factors, especially nativity and language spoken at home, partially mediated the disparities in personal capital between Asian/Pacific Islander women and White women. Findings suggest that the risks associated with low socioeconomic status, single motherhood, and low acculturation, rather than race or ethnicity, contribute to low personal capital for many pregnant women. As personal capital during pregnancy may influence subsequent maternal and child health outcomes, the development of interventions should consider addressing sociodemographic and acculturation factors in order to reduce racial and ethnic disparities in personal capital and ultimately in poor maternal and child health outcomes.
    Maternal and Child Health Journal 03/2013; · 2.24 Impact Factor
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    ABSTRACT: Many Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) partially or completely exclude pregnant women. Both postoperative hemorrhage or hematoma (PSI 9; hemorrhage), and Postoperative Sepsis (PSI 13; infection) appear to be adaptable to pregnancy hospitalizations. Using the 2009 California Patient Discharge Dataset (N [total] = 508,842), the hemorrhage and infection PSIs were examined for their potential to include pregnant women in gynecological, antepartum, postpartum, and delivery subpopulations. The statewide and hospital-level indicator rates were calculated using hierarchical models adjusted for case mix. Only the delivery population had sufficient cases for hospital-level analysis. Both PSIs required major changes to the technical specifications because of pregnancy-specific codes and coding practices. Nevertheless, these revised indicators identified substantial morbidity that varied widely across hospitals. The hemorrhage indicator rate was 2.50% (95% confidence interval [CI], 2.45-2.54) for all deliveries, compared with 0.26% (95% CI, 0.25-0.27) in the AHRQ population and 0.18% (95% CI, 0.15-0.21) for nonpregnant women of reproductive age. Adjusted hospital rates averaged 2.52%, with a midquartile range of 1.16% to 3.09% Although infection rates were lower for all deliveries than for the AHRQ population (0.18% versus 1.20%), they were highly associated with cesarean versus vaginal birth (0.43% versus 0.05%) and ranged from 0% to 1.15% across hospitals. Although codes and coding practices for pregnancy hospitalizations differ from those used for nonpregnant adults, hospital-level measures of childbirth-associated hemorrhage and infection are feasible, vary widely, and demonstrate considerable opportunity for improvement.
    Joint Commission journal on quality and patient safety / Joint Commission Resources 03/2013; 39(3):114-22.
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    ABSTRACT: BACKGROUND: We propose a methodology for identifying and analysing 'elective' preterm births (PTBs) using administrative data, and apply this methodology to California data with the objective of providing a framework to further explore the potential rationales for early delivery. METHODS: Using the California linked birth cohorts for 1999, 2002 and 2005, singleton PTBs were identified using birth certificate gestational age ≥ 24 and <37 weeks. Through a hierarchical scheme that first removed cases with standard or 'hard' indications for early delivery (e.g. severe preeclampsia, placenta previa), cases of 'elective' PTB were identified with coding for medical intervention, that is, elective caesarean or labour induction. We calculated rates of elective PTB, with subanalyses of early (<34 weeks of gestational age) and late PTB (34 to <37 weeks of gestational age) using hierarchical logistic regression models. RESULTS: Of 1 387 565 singleton deliveries, 99 614 (7.2%) were preterm. Elective PTBs increased 27.7% over the 6-year study period, with nearly all cases confined to the late PTB stratum; elective late PTB rates rose from 10.5% to 13.5% of all late PTBs (P < 0.0001). Indications for delivery in this Elective Group ('soft indications') included prior pelvic floor repair, mental health conditions, fetal anomalies, malpresentation and oligohydramnios. Six per cent of patients with a late PTB had a medical intervention with no hard or soft indication for delivery. CONCLUSIONS: Using administrative data, we developed a method for identifying and trending the proportion of PTBs that is 'elective'. This method can be used to explore and monitor potential strategies for the prevention of elective PTB.
    Paediatric and Perinatal Epidemiology 01/2013; 27(1):44-53. · 2.16 Impact Factor
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    ABSTRACT: Background To reduce perinatal HIV transmission, the U.S. Preventive Services Task Force and medical professional organizations recommend universal HIV counseling and voluntary testing as part of routine prenatal care. Methods To evaluate HIV counseling in Los Angeles County (LAC), we analyzed data from the 2007 LAMB survey (n=6,264), which asked new mothers whether their doctor or health care workers discussed getting tested for HIV during prenatal care visit. LAMB is a population-based mail survey of LAC residents who recently gave birth to a live-born infant. All calculations were performed using data weighted to 2007 LAC population data. Results: Overall, 73% of mothers received HIV test counseling. High proportions of African American and Latino mothers received counseling (79% and 76%, respectively), followed by Asian/Pacific Islanders (66.2%) and whites (63.5%). Racial disparities remained after controlling for maternal age, education level, and family income. African American mothers were 1.7 times more likely to receive HIV counseling than whites (aOR=1.7, 95% CI=1.3, 2.1); Latinas were 1.5 times more likely to receive HIV counseling than whites (aOR=1.5, 95% CI=1.1,1.6). An annual family income less than $40,000 was also a predictor of receiving HIV counseling (aOR=2.0, 95% CI=1.4, 2.1). However, having adequate prenatal care and insurance type (Medi-Cal) were not. Discussions: Prenatal providers in LAC aren't providing universal HIV counseling. Our data emphasizes the need to improve prenatal HIV test counseling services among all women regardless of maternal characteristics. LAMB data can be used to monitor prenatal care counseling on HIV prevention in LAC.
    139st APHA Annual Meeting and Exposition 2011; 11/2011
  • Michael C. Lu
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    ABSTRACT: Background: In the U.S. there are significant racial-ethnic disparities in preconceptional health and healthcare. Furthermore, there are major gaps in research, practice, and policy related to preconception health and healthcare for minority women and men of childbearing age. The purpose of this presentation is to 1) identify existing gaps in research, practice, and policy, 2) discuss strategies and opportunities for closing these gaps, and 3) discuss next steps to move toward developing a national agenda to improving preconception health and healthcare amongst minority women and men of childbearing age. Methods: Using a life-course framework, I will identify existing gaps in research, practice, and policy. I will also summarize recommendations from Select Panel on Preconception Care as well as the Commission on Paternal Involvement in Pregnancy Outcomes. Results: In research, more community-based, primary prevention research to promote preconception health and health care amongst minority women and men of childbearing age is needed. More attention is needed on issues related to recruitment and retention of women and men of color. There is also an urgent need to improve public health surveillance of preconception health status and healthcare of US population, particularly among minority women and men of childbearing age. In practice, there is a need to redesign preconception care using a community-based, systems approach, moving from the current 1.0 medical model to the 2.0 or 3.0 model with greater vertical, horizontal, and longitudinal integration. In policy, there is a tremendous need to address disparities in preconception health status and healthcare through policy, including policies that promote greater father involvement before, during, and beyond pregnancy among men of color. Conclusion: A national research, practice, and policy agenda is needed to improve preconception health and healthcare among minority women and men of childbearing age.
    139st APHA Annual Meeting and Exposition 2011; 11/2011
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    ABSTRACT: Background: Pregnant women are at high-risk for poor outcomes with influenza. Provider counseling has been shown to be an important mediator of women's receipt of flu vaccination. Objective: To investigate both patient characteristics and system level factors associated with provider counseling for flu vaccination in the prenatal setting. Methods: We used data from the 2007 LAMB survey, a population-based survey with multistage clustered sampling of women with live births (N=6264). Prenatal vaccination counseling was assessed by an item asking if providers discussed getting a flu vaccine during pregnancy.' Weighted Pearson's chi-square examined associations between provider counseling and race/ethnicity, language barriers, education, insurance type and site of prenatal care. Results: Only 41% of women reported having discussed flu vaccination with their prenatal care provider. Forty-five percent of white women, 38% of Latinas, 43% of African Americans and 40% of Asians received vaccine counseling (p<0.0004). Among women who reported a language barrier with their provider, 58% did not receive counseling about flu vaccine (p=0.027). College educated women were more often counseled (48%) than women who only completed high school (34%, p<0.0001). Insurance type was not significantly associated with counseling rates. At the system-level, 62% percent of women seen in private physician's offices did not receive counseling, compared with only 51% of women in HMOs (p<0.0002). Discussion: The overall rate of counseling about flu vaccination for pregnant women is unacceptably low and ethnic disparities exist. Providers and public health practitioners should improve counseling for all women and develop strategies to overcome language barriers.
    139st APHA Annual Meeting and Exposition 2011; 11/2011
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    ABSTRACT: OBJECTIVE: To examine the relationship between postpartum contraceptive counseling and birth control use. METHODS: We used data from the 2007 LAMB survey, a population-based, mail sample survey with telephone follow-up for non-respondents based on a multistage clustered design. Analyses were based on weighted responses of 6264 women with live births. Women were asked if a doctor or nurse spoke to them about birth control use during their postpartum checkup and if they were currently doing anything to keep from getting pregnant. Associations between postpartum contraceptive counseling and birth control use were examined using Pearson's chi square tests. RESULTS: Eighty-nine percent of women were asked about contraception during the postpartum visit and 77% were attempting to prevent pregnancy. Women who received postpartum contraceptive counseling were twice as likely to use birth control (OR 2.03, p<0.01). Of the racial/ethnic categories considered, Asian/Pacific Islanders were less likely to be counseled about contraceptive use postpartum (OR 0.50, p<0.01) and African American women were less likely to use birth control (OR 0.75, p<0.01) when compared to white women. CONCLUSIONS: Our findings suggest that providers are addressing contraception during postpartum visits. Postpartum contraceptive counseling is strongly associated with birth control use. However, racial/ethnic disparities exist in postpartum contraceptive counseling and birth control use.
    139st APHA Annual Meeting and Exposition 2011; 11/2011
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    ABSTRACT: OBJECTIVE: To determine associations between neighborhood support and prenatal care utilization and to discern if this relationship differs based on maternal nativity. METHODS: We used data from the 2007 LAMB survey, a population-based, mail sample survey with telephone follow-up for non-respondents based on a multistage clustered design. Analyses were based on weighted responses of 6264 women with live births. Neighborhood support was assessed by asking women how often their neighbors do favors for each other, have get-togethers where neighbors were invited, if their neighbors were willing to help each other, and can be trusted. The Kotelchuck Adequacy of Prenatal Care Utilization Index was used to classify prenatal care utilization as either adequate (including Adequate Plus and Adequate groups) or inadequate (including Intermediate and Inadequate groups). Relationships between neighborhood support and prenatal care utilization were analyzed using Pearson's chi square tests. RESULTS: Eighty-five percent of the respondents had adequate prenatal care utilization. Women who reported higher neighborhood support were more likely to access adequate prenatal care (favors for neighbors: OR 1.28, p<0.01; neighbors helpful: OR 1.30, p<0.01; trust between neighbors: OR 1.21, p<0.03). When stratified by maternal nativity, the positive association between neighborhood support characteristics and prenatal care utilization remained significant for U.S.-born women (p<0.04) but not for foreign-born women. CONCLUSIONS: U.S.-born but not foreign-born women who reported higher neighborhood support were more likely to utilize prenatal care adequately. Further research is warranted to elucidate the relationship between maternal nativity, neighborhood support, and prenatal care utilization.
    139st APHA Annual Meeting and Exposition 2011; 11/2011
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    ABSTRACT: OBJECTIVE: To determine associations between partner support and maternal health habits during pregnancy. METHODS: We used data from the 2007 LAMB survey, a population-based, mail sample survey with telephone follow-up for non-respondents based on a multistage clustered design. Analyses were based on weighted responses of 6264 women with live births. Partner support was defined as a multidimensional construct based on instrumental and emotional support during pregnancy. Unhealthy habits were tobacco and alcohol use during pregnancy. Healthy habits were physical exercise in the last three months of the pregnancy and pre-pregnancy folic acid intake. The relationships between partner support and maternal habits during pregnancy were examined using Pearson's chi square tests. RESULTS: Women who had high partner support scores were more likely to start taking folic acid pre-pregnancy (OR 1.76, p<0.01) and more likely to exercise during pregnancy (OR 1.52, p<0.01). Women who had high partner support scores were also less likely to smoke (OR 0.22, p<0.01) and use alcohol during pregnancy (OR 0.75, p<0.04). Of all racial/ethnic groups, African Americans were significantly more likely than white women to report low partner support scores (OR 5.09, p<0.01). The relationship between partner support and maternal behavioral categories was strongest among African Americans. CONCLUSIONS: Racial/ethnic disparities exist in regards to partner support in pregnancy. Greater partner support is associated with healthier maternal practices and habits during pregnancy. Relationships between mothers and their partners may be utilized as a means of improving maternal habits in pregnancy.
    139st APHA Annual Meeting and Exposition 2011; 11/2011
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    ABSTRACT: OBJECTIVE: To examine the relationship between acculturation factors and folic acid use and knowledge during pregnancy. METHODS: We used data from the 2007 LAMB survey, a population-based, mail sample survey with telephone follow-up for non-respondents based on a multistage clustered design. Analyses were based on weighted responses of 6264 women with live births. Folic acid intake was measured by self-report of taking a vitamin pill with folic acid a month prior to conception. Knowledge of folic acid was assessed by the respondent's correct identification of a statement that folic acid prevents birth defects. Associations between maternal nativity, language spoken at home, folic acid intake and knowledge were examined using Pearson's chi square tests. RESULTS: Fifty-seven percent of women were aware that folic acid prevents birth defects and 54% did not take folic acid in the month prior to pregnancy. There was no significant difference in folic acid knowledge based on maternal nativity. Foreign-born women were less likely to take folic acid prior to pregnancy (OR 0.75, p<0.01) compared to U.S.-born women. Women who spoke English at home were more likely to identify the benefits of folic acid use (OR 1.16, p<0.03) and to take a multivitamin pre-pregnancy (OR 1.63, p<0.01). CONCLUSIONS: Almost half of the respondents did not know the indication for folic acid use in pregnancy. Significant differences in folic acid use and knowledge existed based on acculturation factors.
    139st APHA Annual Meeting and Exposition 2011; 11/2011
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    ABSTRACT: Maternal smoking during pregnancy is detrimental to infant health and has long-term effects on child development. Based on social disorganization theory and social capital theory, safe and cohesive neighborhood environments is associated with health-enhancing behaviors among residents through social interactions and reciprocity, shared values and collective monitoring, and resources available within the neighborhoods. Objective: To examine the associations between neighborhood-level determinants and smoking during pregnancy in Los Angeles County. Methods: Data were from the 2007 LAMB survey, a population-based, mail sample survey with telephone follow-up for non-respondents based on multistage clustered design. Multivariate logistic regressions were used to analyze weighted responses of 5,546 women. Neighborhood-level determinants include: neighborhood quality (α=.91) which measures safety, cleanness, and institutional resources; cohesion and trust (α=.77) and social interaction and reciprocity (α=.88) represent neighborhood social capital. Results: Forty-four percents of the sample were foreign-born, 21% received less than high school education, 15% had depression before pregnancy, and 3.3 % smoked during the last pregnancy. After controlling for race/ethnicity, income, education, foreign-born status, and depression, neighborhood quality was negatively associated (P=.008) with smoking during pregnancy. An educational gradient was observed: compared to women completed college education and beyond, those who received less than high school education, completed high school, and some college were 6 (P<.001), 4 (P<.001) and 3 times (P=.002) more likely to smoke during pregnancy, respectively. Conclusions: Social policies and welfare programs, which aim to improve neighborhood qualities and tailor smoking cessation services to young women in underserved communities, may reduce smoking during pregnancy.
    139st APHA Annual Meeting and Exposition 2011; 10/2011
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    ABSTRACT: Preterm birth represents the most significant problem in maternal-child health, with maternal stress identified as a variable of interest. The effects of maternal stress on risk of preterm birth may vary as a function of context. This article focuses on select key issues and questions highlighting the need to develop a better understanding of which particular subgroups of pregnant women may be especially vulnerable to the potentially detrimental effects of maternal stress, and under what circumstances and at which stages of gestation. Issues related to the characterization and assessment of maternal stress and candidate biologic mechanisms are addressed.
    Clinics in perinatology 09/2011; 38(3):351-84. · 1.54 Impact Factor
  • Michael C Lu
    Current opinion in obstetrics & gynecology 12/2010; 22(6):487-91. · 2.49 Impact Factor
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    ABSTRACT: Abstract For morethan two decades, prenatal care has been a cornerstone of our nation?s strategy for preventing low birthweight (LBW). The enrollment of all pregnant women in prenatal care was promoted by the seminal 1985 Institute of Medicine report Preventing Low Birthweight (IOM, 1985a), following a comprehensive review of the literature by a select IOM committee on the effectiveness of prenatal care for preventing LBW. Because LBW contributes significantly to racial-ethnic disparities in infant mortality and morbidity, increasing access to prenatal care for all women has also become established as the key population-based public health intervention to address racial-ethnic disparities in perinatal outcomes. The purpose of this chapter is to review evidence on the overall effectiveness of prenatal care in preventing LBW and reducing racial-ethnic disparities in LBW.
    11/2010: pages 151-179;
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    ABSTRACT: Background: Depression during pregnancy is a prevalent and serious problem. We aim to investigate demographic and system level factors related to provider behavior in discussing maternal depression and anxiety at prenatal care visits in Los Angeles County. Methods: LAMB is a population-based survey with multi-level clustered sampling and an over-sample of low birth weight and pre-term births. Questions related to depression screening during pregnancy include: did your provider ask you if you felt anxious or depressed during your PNC visits. Chi-square tests were used to evaluate differences between groups in the occurrence of screening and logistic regression models were used to identify factors associated with depression screening during pregnancy while controlling for important confounders. Results: Data presented are from the 2007 LAMB survey (N=6,264). Forty-nine percent of White women, 65% of Latinos, 66% of African Americans, and 49% of Asians reported being screened for depression/anxiety at a PNC visit, (p<0.001). In multivariate models African American and Hispanic women were significantly more likely to be screened at PNC visits compared to White women (aOR 1.78 CI 1.42, 2.21 and aOR 1.54 CI 1.31, 1.82, respectively). Less educated women were more likely to be screened (aOR 1.60 CI 1.33, 1.93), but women who experienced depression/anxiety before pregnancy (21%) were no more likely to be screened. Contrary to expectations insurance type had no impact on PNC depression screening rates. Conclusion: Women's demographic factors impact the likelihood of PNC depression screening. Providers should work to educate and screen all women for depression during pregnancy.
    138st APHA Annual Meeting and Exposition 2010; 11/2010

Publication Stats

848 Citations
121.34 Total Impact Points

Institutions

  • 2014
    • CSU Mentor
      Long Beach, California, United States
  • 2005–2014
    • University of Southern California
      • Department of Obstetrics and Gynecology
      Los Angeles, California, United States
  • 2013
    • U.S. Department of Health and Human Services
      • Health Resources and Services Administration (HRSA)
      Washington, Washington, D.C., United States
  • 2011
    • University of California, Irvine
      Irvine, California, United States
  • 2003–2011
    • University of California, Los Angeles
      • Department of Obstetrics and Gynecology
      Los Angeles, California, United States
    • Children's Hospital Los Angeles
      Los Angeles, California, United States
  • 2008–2010
    • County of Los Angeles Public Health
      Los Angeles, California, United States
    • Providence Health and Services
      Renton, Washington, United States
  • 2009
    • Mayo Foundation for Medical Education and Research
      • Department of Family Medicine
      Scottsdale, AZ, United States