Missed opportunities to improve food security for pregnant people: a qualitative study of prenatal care settings in Northern New England during the COVID-19 pandemic

Background: Food insecurity during pregnancy has important implications for maternal and newborn health. There is increasing commitment to screening for social needs within health care settings. However, little is known about current screening processes or the capacity for prenatal care clinics to address food insecurity among their patients. We aimed to assess barriers and facilitators prenatal care clinics face in addressing food insecurity among pregnant people and to identify opportunities to improve food security among this population. Methods: We conducted a qualitative study among prenatal care clinics in New Hampshire and Vermont. Staff and clinicians engaged in food security screening and intervention processes at clinics affiliated with the Northern New England Perinatal Quality Improvement Network (NNEPQIN) were recruited to participate in key informant interviews. Thematic analysis was used to identify prominent themes in the interview data. Results: Nine staff members or clinicians were enrolled and participated in key informant interviews. Key barriers to food security screening and interventions included lack of protocols and dedicated staff at the clinic as well as community factors such as availability of food distribution services and transportation. Facilitators of screening and intervention included a supportive culture at the clinic, trusting relationships between patients and clinicians, and availability of clinic-based and community resources. Conclusion: Prenatal care settings present an important opportunity to identify and address food insecurity among pregnant people, yet most practices lack specific protocols for screening. Our findings indicate that more systematic processes for screening and referrals, dedicated staff, and onsite food programs that address transportation and other access barriers could improve the capacity of prenatal care clinics to improve food security during pregnancy

0881 The Clinical and Policy Impact of Increasing Awareness about Sleep and CVD Health through Public health Programs for Women

Abstract Introduction Sleep is important for cardiometabolic health (CVH) and cardiovascular disease (CVD) prevention, especially for women. Relative to men, women have less awareness of CVD risk factors. Particularly, minority women have disproportionately higher prevalence of short sleep and CVD risk awareness. The primary objective of this review is to investigate the clinical, public health, and policy implications of three major public health programs: the Go Red for Women campaign, the Heart Centers for Women initiative, and the HEART for Women Act, on increasing CVD and sleep health awareness among women in the United States. The secondary objective is to create public health action plan to increase awareness of sleep health and CVD risk. The third objective is to describe barriers and facilitators of implementing the public health action plan for minority women. Methods To assess the impact of these interventions, a systematic review was conducted. Studies that directly examined the impact of the 3 CVD awareness programs on the prevalence of CVD in the U.S. Next, studies that evaluated the level of awareness of CVD risk factors and sleep were identified. The current literature was synthesized and described qualitatively to elucidate individual, provider, community and policy knowledge gaps in CVD and sleep health programs for women. Results Prevalence of CVD deaths among women decreased from 459,000/ year in 2004 to 339,500/year in 2015. Majority of these interventions include diet, exercise, and smoking cessation and exclude sleep and. Of the three programs, the Go Red for Women campaign proved to have the greatest public health and policy impact. From the results of systematic review, we created a public health action plan to increase awareness of sleep health and CVD risk. Third, we found patient, provider, and policy barriers and facilitators of implementing the public health action plan for minority women. Conclusion Public health action plans that focus on sleep health should be culturally sensitive to all women and accessible to those that live in both rural and urban areas addressing the importance of sufficient sleep and its benefits to CVH. Support (if any) K01HL135452, K07AG052685, R01AG072644, R01HL152453, R01MD007716, R01HL142066, R01AG067523, R01AG056031, and R01AG07500

EFFECTS OF A COMBINED RESISTANCE AND AEROBIC EXERCISE PROGRAM ON CARDIOVASCULAR OUTCOMES IN SURVIVORS OF CANCER

BACKGROUND: Cardiovascular disease (CVD) is one of the greatest long-term health concerns for survivors of cancer. Research highlights exercise as a potential means to mitigate CVD risk. The measurement of augmentation index (Alx) and pulse wave velocity (PWV), key CVD risk factors, have gained prominence due to the non-invasive nature and time-efficiency of the measurements. However, their response to exercise in survivors of cancer remains unexplored. As such, this study aimed to investigate the effects of an exercise program on cardiovascular outcomes in survivors of cancer. METHODS: Participants were recruited from local hospital systems in the Midlands region of South Carolina. All participants completed supervised exercise sessions 2 days/week for 8 weeks. Sessions consisted of 6-8 resistance exercises targeting each of the major muscle groups of the upper and lower body. This was followed by 15-20 minutes of moderate-to-vigorous intensity aerobic activity. One week prior to and following the exercise program, brachial systolic blood pressure (SBP), brachial diastolic blood pressure (DBP), resting heart rate (RHR), Alx standardized to a heart rate of 75 BPM (Alx@75), and PWV were measured using an oscillometric cuff and applanation tonometry (SphygmoCor Xcel, AtCor Medical). Measurements were taken in a quiet room after 5-10 minutes of rest in the supine position. Paired samples t-test and Cohen’s d effect sizes (ES) were used to compare differences in means with significance defined as p \u3c 0.05. RESULTS: Ten female cancer survivors (age: 65 ± 9 yrs, BMI: 29 ± 5.3, time since diagnosis (mths): 47 ± 51.9, cancer type: breast n=7, ovarian n=1, kidney n=1, multiple myeloma n=1, history of CVD n=2) completed assessments prior to and following the exercise program. No significant differences were detected for changes in SBP (mmHg) (Pre: 139 ± 8.7, Post: 137 ± 9.5, p = 0.33, ES = .14), DBP (mmHg) (Pre: 79 ± 5.1, Post: 79 ± 8.3, p = 0.50, ES = .00), RHR (bpm) (Pre: 73 ± 8.1, Post: 71 ± 12.6, p = 0.21, ES = .26), Alx@75 (%) (Pre: 29.2 ± 9.2, Post: 31.0 ± 8.0, p = 0.3, ES = .16) or PWV (m/s) (Pre: 6.1 ± .72, Post: 6.0 ± 1.17, P = 0.36, ES = .12). CONCLUSION: These findings suggest that the exercise program used in this study did not result in changes to several cardiovascular outcomes. A limitation of this study is the inclusion of individuals without the presence of CVD at baseline, potentially preventing further improvements in cardiovascular outcomes. Future studies should aim to investigate the impacts of longer and/or more comprehensive interventions in addition to controlling for additional factors such as pre-existing CVD, disease type, and previous treatment regimen