Maternal Child Health Disparities
Our program of research targets the health and health care of Medicaid insured pregnant women, many of whom live in difficult life circumstances, experience racism, have a higher prevalence of depressive disorders, and are more likely to have chronic health conditions and health risk behaviours. They are also more likely to have limited access to care, face health literacy barriers when they do seek care, and given their competing family priorities, have difficulty participating in health care. Their infants are more likely to be born preterm and/or at low birth weight, with long term consequences for school success. This is especially true for African American women and infants, who have more than double the rates of adverse birth outcomes and infant mortality. We focus our research on interventions and programs that are designed to improve health care and health outcomes for these vulnerable populations.
Our research is considered “engaged scholarship”, that is we use the tools of science and partner with providers, communities and policymakers to create new knowledge that drives innovation in “real world” settings to improve health care—and ultimately the health and life chances of low income women and infants. We work in multi-disciplinary research teams with collaborators in epidemiology, economics, psychology and human development and other disciplines. We have developed a longitudinal linked data set (vital records, Medicaid claims, and Medicaid program data) that includes all Medicaid births from 2008 to present that, with appropriate data use agreements with the Michigan Department of Community Health, can be used to support research.
From a population perspective, we have a long term relationship with Michigan Medicaid policymakers to conduct research that informed the redesign of the state sponsored Medicaid enhanced prenatal care program, the Maternal and Infant Health Program (MIHP). A rigorous evaluation of the program is in progress and the research has already shown improved service utilization and reduction of risk for adverse birth outcomes for program participants. However, only 30% of Medicaid-insured women state-wide participate in the MIHP program that offers care coordination for every woman.
To address underutilization of services, we now have a five year Agency for Health Care Research and Quality (AHRQ) research demonstration project to develop and test a county population perinatal system of care in Kent County/Grand Rapids Michigan. Our primary community partners are Spectrum Health, Cherry Street Health Services, Kent County Health Department, Arbor Circle, Priority Health, as well as, the Michigan Department of Community Health. The system of care model was developed using the well-established Chronic Care Model and will be tested for population health impacts.
We also have a special research interest in Community Health Workers (CHW) who are particularly successful in engaging women in services who live in difficult life circumstances. Our current work builds on a prior randomized trial comparing state-sponsored Medicaid MIHP services delivered by professionals, with a nurse-CHW team approach focused on women’s stress and mental health. Funded by the W.K. Kellogg Foundation, we are now conducting a study of the Grand Rapids Strong Beginnings Program that further enhanced the MIHP-CHW program.
Dr. Johnson is a clinical psychologist who conducts NIH-funded randomized trials of effectiveness, cost-effectiveness, and implementation of mental health and substance use interventions for high-risk women (including perinatal women) and justice-involved populations (such as prisoners and jail detainees). She has been Principal Investigator of 7 NIH awards, with overall total costs of more than $7.5 million. NIH-funded projects of which she is PI include:
- Effectiveness of IPT for men and women prisoners with major depression (R01 MH095230; 2011-2015)
- AA linkage for alcohol abusing women leaving jail (R01 AA021732; 2013-2018)
- Sober Network IPT for perinatal women with comorbid substance use and depression (R34 DA030428; 2011-2015)
- Group IPT for major depression following perinatal loss (R34 MH086682; 2010-2015)
- HIV/STI risk reduction for incarcerated women with interpersonal violence (R34 MH094188; 2011-2015)
- Effects of prisoner re-entry context on cognitive ability to manage mental health at re-entry (R21 MH105626; 2015-2017)
- Group IPT for women prisoners with comorbid substance use and depression (K23 DA021159; 2006-2011)
Dr. Johnson came to MSU from Brown University in January, 2015 to help build an academically vibrant and socially responsive team of community engaged scientists based in Flint, Michigan, who will contribute to the Flint revitalization effort. She is the first member of the MSU’s new Public Health Research Group in Flint, and is happy to make her new home to live and work in Flint.
Dr. Meghea is an NIH-funded Assistant Professor in the Department of Obstetrics, Gynecology and Reproductive Biology at Michigan State University. His expertise is in maternal and child health, global health, health services research, health policy, and women’s health. His research focuses on the prenatal and perinatal period as a window of opportunity to improve the long-term health of mothers and their children. He brings quantitative skills and data analysis expertise to his field of research.
Dr. Meghea was recently awarded a 5-year K01 career development award from National Institutes of Health for an intensive, mentored research career development experience in US and Romania leading to an independent research career focused on global health. The objective of this project is to adapt, enhance, and test the implementation feasibility and initial efficacy, in Romania, of an evidence-based pregnancy and postnatal couple intervention for smoking cessation. Dr. Meghea is also directing a randomized controlled trial in Romania assessing the effectiveness of a postnatal smoking relapse intervention. The long term goal of the research program is to develop, implement, and disseminate effective and sustainable interventions to prevent and reduce smoking in families over the reproductive life span.
Dr. Meghea is also leading a research and policy project that established the effectiveness of the Medicaid enhanced prenatal services program in Michigan (MIHP) using quasi-experimental methods. MIHP participation improves the healthcare utilization of mothers and infants and reduces the risk of adverse birth outcomes and infant mortality, with results published in Pediatrics, the American Journal of Preventive Medicine, and in JAMA Pediatrics. The research program continues as a partnership between Michigan State University and Michigan Department of Health and Human Services.
National Institutes of Health (NIH), Agency for Health Care Quality (AHRQ), W.K. Kellogg Foundation)
Three major research projects include:
1) Defining how in utero inflammation caused by environmental factors results in atypical fetal development and offspring disease. Maternal adiposity, viral/bacterial infection and toxins have all been shown to induce placental inflammation and are associated with the development of multiple diseases in the future offspring. Our studies address how dysregulation of the placenta or maternal immune response affects fetal programming and development of diseases such as allergic asthma.
2) Characterizing the role of placental microflora in fetal immune development. While historically the upper reproductive tract was thought to be a sterile environment during pregnancy, there is now evidence the healthy placenta is home to a vibrant microflora. We hypothesize the fetal environment is influenced by both the presence of these microflora and the placental/maternal response that they elicit, and they contribute to the development and maturation of the fetal immune system.
3) Identification of non-invasive biomarkers that are predictive of placental function in early pregnancy. We aim to identify “biological signatures” during early pregnancy that are associated with abnormal or insufficient placental development and offspring disease. This test will have the potential to be a screening tool used to determine if women require treatment to ensure placental and fetal health.