Michael C Lu

CSU Mentor, Long Beach, California, United States

Are you Michael C Lu?

Claim your profile

Publications (91)163.83 Total impact

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The Title V Maternal and Child Health (MCH) Block Grant is the linchpin for US MCH services. The first national performance measures (NPMs) for MCH were instituted in 1997. Changing trends in MCH risk factors, outcomes, health services, data sources, and advances in scientific knowledge, in conjunction with budgetary constraints led the Maternal and Child Health Bureau (MCHB) to design a new performance measurement system. A workgroup was formed to develop a new system. The following guiding principles were used: (1) Afford States more flexibility and reduce the overall reporting burden; (2) Improve accountability to better document Title V's impact; (3) Develop NPMs that encompass measures in: maternal and women's health, perinatal health, child health, children with special health care needs, adolescent health, and cross-cutting areas. A three-tiered performance measurement system was proposed with national outcome measures (NOMs), NPMs and evidence-based/informed strategy measures (ESMs). NOMs are the ultimate goals that MCHB and States are attempting to achieve. NPMs are measures, generally associated with processes or programs, shown to affect NOMs. ESMs are evidence-based or informed measures that each State Title V program develops to affect the NPMs. There are 15 NPMs from which States select eight, with at least one from each population area. MCHB will provide the data for the NOMs and NPMs, when possible. The new performance measurement system increases the flexibility and reduces the reporting burden for States by allowing them to choose 8 NPMs to target, and increases accountability by having States develop actionable ESMs. The new national performance measure framework for maternal and child health will allow States more flexibility to address their areas of greatest need, reduce their data reporting burden by having the Maternal and Child Health Bureau provide data for the National Outcome and Performance Measures, yet afford States the opportunity to develop measurable strategies to address their selected performance measures.
    Maternal and Child Health Journal 04/2015; 19(5). DOI:10.1007/s10995-015-1739-5 · 2.24 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper describes the transformation of the Title V Maternal and Child Health (MCH) Services Block Grant. The Maternal and Child Health Bureau of the Health Resources and Services Administration led a 21-month visioning process to engage input from MCH stakeholders and other national, state and local MCH leaders, families and other partners to improve, innovate, and transform the Title V MCH Services Block Grant. The process has helped inform the development of a new grant guidance for the next 5-year cycle beginning in fiscal year 2016. The triple aims of the transformation are to reduce burden, maintain flexibility, and increase accountability. State reporting burden is reduced by aligning and streamlining the needs assessment, annual report and application, reducing the number of forms States have to fill out, eliminating Health Systems Capacity Indicators, and prepopulating the annual report and application with State data using national data sources. State flexibility is maintained through the needs assessment process whereby State needs and priorities drive the selection of National Performance Measures and State-specific Performance Measures, and the development of State Action Plan and Evidence-based/informed Strategy Measures. Accountability is increased through the new three-tiered performance measurement framework, which will help States tell a more coherent and compelling story about the impact of Title V on the health of the Nation’s mothers, children, and families. The ultimate success of the transformation will be measured by how much the transformed Title V program moves the needle in MCH in the States and for the Nation.
    Maternal and Child Health Journal 02/2015; DOI:10.1007/s10995-015-1736-8 · 2.24 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We examined the association between life events stressors during pregnancy and low birth weight (LBW) among African Americans and Whites, while systematically controlling for potential confounders including individual characteristics and city-level variations and clustering. We analyzed data from 4970 women with singleton births who participated in the 2007 and 2010 Los Angeles Mommy and Baby Surveys. Multilevel logistic regression was used to assess the association between emotional, financial, spousal and traumatic stressors and LBW among African Americans and Whites. Potential confounders included were: the city-level Economic Hardship Index, maternal demographics, pre-pregnancy conditions, insurance, behavioral risk factors and social support. African Americans were significantly more likely to experience any domain of stressors during their pregnancy, compared to Whites (p < 0.001). Only the association between financial stressors and LBW was significantly different between African Americans and Whites (p for interaction = 0.015). Experience of financial stressors during pregnancy was significantly associated with LBW among African Americans (adjusted odds ratio = 1.49; 95 % confidence interval = 1.01-2.22) but not Whites. Differential impact of financial stressors during pregnancy may contribute to racial disparities in LBW between African Americans and Whites. We showed that financial life event stressors, but not other domains of stressors, were more likely to impact LBW among African Americans than Whites. Initiatives aimed at mitigating the negative impacts of financial stress during pregnancy may contribute to reducing disparities in birth outcomes between African Americans and Whites.
    Maternal and Child Health Journal 02/2015; DOI:10.1007/s10995-015-1734-x · 2.24 Impact Factor
  • Michael C Lu, Jessica R Jones
    Maternal and Child Health Journal 08/2014; 18(7). DOI:10.1007/s10995-014-1568-y · 2.24 Impact Factor
  • [Show abstract] [Hide abstract]
    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. Copyright (C) 2014 by the Jacobs Institute of Women's Health. Published by Elsevier Inc.
    Women s Health Issues 05/2014; 24(4). DOI:10.1016/j.whi.2014.03.005 · 1.61 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Infant mortality rates (IMRs) are disproportionally high in the U.S. South; however, the proximate contributors that could inform regional action remain unclear. To quantify the components of excess infant mortality in the U.S. South by maternal race/ethnicity, underlying cause of death, and gestational age. U.S. Period Linked Birth/Infant Death Data Files 2007-2009 (analyzed in 2013) were used to compare IMRs between the South (U.S. Public Health Regions IV and VI) and all other regions combined. Compared to other regions, there were 1.18 excess infant deaths per 1000 live births in the South, representing about 1600 excess infant deaths annually. New Mexico and Texas did not have elevated IMRs relative to other regions; excess death rates among other states ranged from 0.62 per 1000 in Kentucky to 3.82 per 1000 in Mississippi. Racial/ethnic compositional differences, generally the greater proportion of non-Hispanic black births in the South, explained 59% of the overall regional difference; the remainder was mostly explained by higher IMRs among non-Hispanic whites. The leading causes of excess Southern infant mortality were sudden unexpected infant death (SUID; 36%, range=12% in Florida to 90% in Kentucky) and preterm-related death (22%, range= -71% in Kentucky to 51% in North Carolina). Higher rates of preterm birth, predominantly <34 weeks, accounted for most of the preterm contribution. To reduce excess Southern infant mortality, comprehensive strategies addressing SUID and preterm birth prevention for both non-Hispanic black and white births are needed, with state-level findings used to tailor state-specific efforts.
    American journal of preventive medicine 03/2014; 46(3):219-27. DOI:10.1016/j.amepre.2013.12.006 · 4.28 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    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 02/2014; 2014:530769. DOI:10.1155/2014/530769
  • Michael C Lu, Kay A Johnson
    American Journal of Public Health 02/2014; 104 Suppl 1:S13-6. DOI:10.2105/AJPH.2013.301855 · 4.23 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives. In order to comprehensively examine the risks and resources associated with racial-ethnic disparities in adverse obstetric outcomes, the Los Angeles County Department of Public Health and the University of California, Los Angeles, joined efforts to design and implement the 2007 Los Angeles Mommy and Baby (LAMB) study. This paper aims to present the conceptual frameworks underlying the study's development, highlight the successful collaboration between a research institution and local health department, describe the distinguishing characteristics of its methodology, and discuss the study's implications for research, programs, and policies. Methods. The LAMB study utilized a multilevel, multistage cluster design with a mixed-mode methodology for data collection. Two samples were ultimately produced: the multilevel sample (n = 4,518) and the augmented final sample (n = 6,264). Results. The LAMB study allowed us to collect multilevel data on the risks and resources associated with racial-ethnic disparities in adverse obstetric outcomes. Both samples were more likely to be Hispanic, aged 20-34 years, completed at least 12 years of schooling, and spoke English. Conclusions. The LAMB study represents the successful collaboration between an academic institution and local health department and is a theoretically based research database and surveillance system that informs effective programmatic and policy interventions to improve outcomes among LAC's varied demographic groups.
    01/2014; 2014:293648. DOI:10.1155/2014/293648
  • [Show abstract] [Hide abstract]
    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.
  • Michael C Lu
    Maternal and Child Health Journal 12/2013; 18(2). DOI:10.1007/s10995-013-1400-0 · 2.24 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We examined the effects of prematurity (<37 weeks of gestation) and low birthweight (<2500 g) on mental health outcomes among US children aged 2-17 years. The 2011-2012 National Survey of Children's Health (N = 95,677) was used to estimate prevalence of parent-reported mental health problems in children. Prevalence of mental disorders was 22.9% among children born prematurely, 28.7% among very-low-birth-weight (<1500 g) children, and 18.9% among moderately low-birth-weight (1500-2499 g) children, compared with 15.5% in the general child population. Compared to those born full term, children born prematurely had 61% higher adjusted odds of serious emotional/behavioral problems, 33% higher odds of depression, and 58% higher odds of anxiety. Children born prematurely had 2.3 times higher odds of autism/ASD, 2.9 times higher odds of development delay, and 2.7 times higher odds of intellectual disability than term children. Very-low-birth-weight children had 3.2 times higher odds of autism/ASD, 1.7 times higher odds of ADD/ADHD, 5.4 times higher odds of development delay, and 4.4 times higher odds of intellectual disability than normal-birth-weight children. Social factors were significant predictors of mental disorders in both premature/low-birth-weight and term/normal-birth-weight children. Neurodevelopmental conditions accounted for the relationship between prematurity and depression/anxiety/conduct problems. Prematurity and low birthweight are significant risk factors for mental health problems among children.
    Depression research and treatment 11/2013; 2013:570743. DOI:10.1155/2013/570743
  • Source
    [Show abstract] [Hide abstract]
    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; DOI:10.1080/08870446.2013.852670 · 1.95 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This report presents data on the prevalence of diagnosed autism spectrum disorder (ASD) as reported by parents of school-aged children (ages 6-17 years) in 2011-2012. Prevalence changes from 2007 to 2011-2012 were evaluated using cohort analyses that examine the consistency in the 2007 and 2011-2012 estimates for children whose diagnoses could have been reported in both surveys (i.e., those born in 1994-2005 and diagnosed in or before 2007).
  • Source
    [Show abstract] [Hide abstract]
    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; DOI:10.1007/s10995-013-1256-3 · 2.24 Impact Factor
  • [Show abstract] [Hide abstract]
    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.
  • [Show abstract] [Hide abstract]
    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. DOI:10.1111/ppe.12018 · 2.81 Impact Factor
  • Michael C Lu, Rebekah E Gee
    Obstetrics and Gynecology 09/2012; 120(3):513-5. DOI:10.1097/AOG.0b013e318265e6e8 · 4.37 Impact Factor
  • Michael C. Lu
    [Show abstract] [Hide abstract]
    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
  • [Show abstract] [Hide abstract]
    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

Publication Stats

1k Citations
163.83 Total Impact Points

Institutions

  • 2014
    • CSU Mentor
      Long Beach, California, United States
  • 2005–2014
    • University of California, Los Angeles
      • • Department of Obstetrics and Gynecology
      • • Department of Community Health Sciences
      Los Ángeles, California, United States
  • 2013
    • U.S. Department of Health and Human Services
      • Health Resources and Services Administration (HRSA)
      Washington, Washington, D.C., United States
  • 2012
    • Louisiana State University Health Sciences Center New Orleans
      • Department of Health Policy & Systems Management
      New Orleans, Louisiana, United States
  • 2006
    • University of Southern California
      • Department of Obstetrics and Gynecology
      Los Angeles, CA, United States
  • 2004
    • County of Los Angeles Public Health
      Los Ángeles, California, United States
  • 2003
    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
      Torrance, California, United States