Clinical Research Oriented Workshop (CROW) Meeting: Feb 14, 2013

Present: Marianne Burke, Abby Crocker, Kairn Kelley, Amanda Kennedy, Charlie MacLean, Connie van Eeghen

1.                  Start Up:   Group opinion: 15 %ile  is pretty good for chances of grant being funded – right at the funding line.  (Rodger & Connie’s R03 has progressed to “The Council” – looking good, so far.)

2.                  Presentation: Abby Crocker -  two drafts and seeking input on:

a.       A summary article/brief report (800 words or less) on breastfeeding barriers and intervention strategies, which have already been well documented based on several reports from American Pediatric Association, breastfeeding researchers, and Surgeon General’s Office.  The SG’s report provides a structure for Abby’s use in reporting on a specific population: NAS babies whose moms are in a treatment program.  However, the rate of breastfeeding for this select group of NAS moms in treatment is unknown, but this is good to identify in the “Research” section of this paper (intended for the American Journal of Public Health). Barriers and interventions that might apply:

                                                  i.      Barriers

1.      For moms

a.       Lack of knowledge: not sure it is safe

                                                                                                                          i.      Qualitative data? Ask Anne and Marj; anecdotal?

                                                                                                                        ii.      SES and BF knowledge may be correlated

                                                                                                                      iii.      New barrier?  Possibility of personality issues, such as being more impulsive, more prone to give up, or lacking coping mechanisms

b.      Social norms

c.       Poor family & social support

                                                                                                                          i.      Husband (baby’s father) and mother (baby’s grandmother) are key

d.      Embarrassment

e.       Lactation problems

                                                                                                                          i.      NAS symptoms

                                                                                                                        ii.      Smoking (80% smoking population)

f.       Employment & childcare

                                                                                                                          i.      Low SES barriers

2.      For healthcare services

a.       Many health care providers; high volume and diverse

b.      Avoided care (VNA)

c.       Delivery site – less likely to have supportive resources?

d.      Knowledge of providers: safety of breastfeeding in this population

e.       Mixed messages from diverse populations

                                                ii.      Interventions (Adapted from Socio-Ecological Model).  Many of the interventions listed below cross categories, affecting knowledge and attitude.  The work must be pre-planned and packaged, as the intervention must work at a specific time (immediately post-delivery) and be effective the first (and only) time it is tried.

1.      Mothers & families: Support mothers and educate fathers and grandmothers

a.       Education materials

b.      PH announcements

c.       Coordination of messages across sites/services

2.      Communities

a.       Mom to mom support groups

b.      Lactation consultants, volunteer and paid

3.      Health care

a.       Clarity of messages: checklists

b.      Integration of services to support breastfeeding

4.      Employment

5.      Research: more needed, including rates, safety issues, working interventions, understanding of women’s attitudes (qualitative data)

a.       Review existing studies on what is known about beliefs and attitudes

b.      Cultural differences; population differences

6.      Public Health infrastructure: better leadership

a.       Professional organizations can boost this effort

b.      Resource: IOM 2003 report on The Future of the Public’s Health in the 21^st Century as a source for more examples of PH interventions

                                              iii.      Other resources: Briggs, Suboxone manufacturer

                                              iv.      Title: Application of SG’s Call to Action in Suboxone Population (one of many possibilities; this one may be better as a sub-title)

b.      Predictors manuscript: Mort’s feedback:

                                                  i.      Need more population data; race, for example, is missing.  This information is not in the Icon registry; is it worth looking up 800 records on a birth certificate registry (if an electronic one exists) or OBNet.  May need permission from IRB. 

                                                ii.      Out of 800 records, only ~500 are complete.  Need to address; conduct study on 500, do the imputation calculation on the variables in the model (head circumference) and run a sensitivity analysis.  If no different, say so, and move on.

3.                  Next Workshop Meeting(s): Thursday, 2:00 p.m. – 3:30 p.m., at Given Courtyard South Level 4. 

a.       Feb 21: Kairn: F31 (no Amanda)

b.      Feb 28: Rodger – PCORI (no Connie, no Kairn)

c.       Mar 7: Connie: manuscript review (no Ben, no Kairn)

d.      Mar 14: Charlie: VCHURES Opiate Data Mining (everyone will be here!)

e.       Future agenda to consider:

                                                  i.      Christina Cruz, 3^rd year FM resident with questionnaire for mild serotonin withdrawal syndrome?

                                                ii.      Peter Callas or other faculty on multi-level modeling

                                              iii.      Charlie MacLean: demonstration of Tableau

                                              iv.      Journal article: Gomes, 2013, Opioid Dose and MVA in Canada (Charlie)

Recorder: Connie van Eeghen