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Latham-Mintus K, Ortiz B, Irby A, Turman J. Supporting the Development of Grassroots Maternal and Childhood Health Leaders through a Public-Health-Informed Training Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:460. [PMID: 38673371 PMCID: PMC11050473 DOI: 10.3390/ijerph21040460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/01/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024]
Abstract
The purpose of this research was to assess leadership growth (i.e., changes in personal capacity and social capital) among women living in high-risk infant mortality zip codes who completed a grassroots maternal and childhood health leadership (GMCHL) training program. We used semi-structured qualitative interviews and thematic analysis. Three major themes associated with the training program experience were identified: (1) building personal capacity and becoming community brokers; (2) linking and leveraging through formal organizations; and (3) how individual change becomes community change. Although many of the grassroots leaders were already brokers (i.e., connecting individuals to information/services), they were able to become community brokers by gaining new skills and knowledge about strategies to reduce adverse birth outcomes in their community. In particular, joining and participation in formal organizations aimed at improving community health led to the development of linking or vertical ties (e.g., "people in high places"). The grassroots leaders gained access to people in power, such as policymakers, which enabled leaders to access more resources and opportunities for themselves and their social networks. We outline the building blocks for supporting potential grassroots leaders by enhancing personal capacity and social capital, thus leading to increases in collective efficacy and collective action.
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Affiliation(s)
- Kenzie Latham-Mintus
- Department of Sociology, Indiana University School of Liberal Arts, IUPUI, 425 University Blvd., Indianapolis, IN 46202, USA;
| | - Brittney Ortiz
- Department of Sociology, Indiana University School of Liberal Arts, IUPUI, 425 University Blvd., Indianapolis, IN 46202, USA;
| | - Ashley Irby
- Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health, IUPUI, Indianapolis, IN 46202, USA
| | - Jack Turman
- Department of Pediatrics, Indiana University School of Medicine, IUPUI, Indianapolis, IN 46202, USA;
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Adegoke YO, Mbonigaba J, George G. Macro-economic determinants, maternal and infant SDG targets in Nigeria: Correlation and predictive modeling. Front Public Health 2022; 10:999514. [PMID: 36579062 PMCID: PMC9791089 DOI: 10.3389/fpubh.2022.999514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives Unambiguously, Nigeria is off-track in achieving the health-related SDGs. Consequentially, this study aligns with SDG 3 which calls for "good health and wellbeing for people by ensuring healthy lives and promoting wellbeing for all at all ages". This article examines the combined effect of health expenditure and other key macro-economic factors on health indices such as maternal and newborn and child mortality in Nigeria. Contrary to existing literature, we formulated a model that predicts the level of macro-economic determinants needed to achieve the SDG targets for maternal and newborn and child mortality in Nigeria by 2030. Methodology The study used Autoregressive Distributed Lag (ARDL), which is usually used for large T models. The study period spans from 1995 to 2020. Results We found a significant negative relationship between health outcomes and macro-economic determinants namely, household consumption, total health expenditure, and gross fixed capital while we determined a significant positive relationship between health outcomes and unemployment. Our findings are further supported by out-of-sample forecast results suggesting a reduction in unemployment to 1.84 percent and an increase in health expenditure, gross fixed capital, household consumption, control of corruption to 1,818.87 billon (naira), 94.46 billion (naira), 3.2 percent, and -4.2 percent respectively to achieve SDG health targets in Nigeria by 2030. Policy implication The outcome of this result will give the Nigerian government and stakeholders a deeper understanding of the workings of the macro-economic factors, concerning health performance and will help position Nigeria, and other SSA countries by extension, toward reducing maternal mortality to 70 per 100,000 and newborn and child mortality to 25 per 1,000 births by 2030. The African leaders should consider passing into law the need for improvement in macro-economic factors for better health in Africa. We also recommend that the Nigerian government should steadily increase health expenditure to reach and move beyond the forecast level for improvement in maternal and infant mortality, given the present low and unimpressive funding for the health sector in the country.
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Affiliation(s)
| | - Josue Mbonigaba
- School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
| | - Gavin George
- Health Economics and HIV and AIDS Research Division (HEARDS), University of KwaZulu-Natal, Durban, South Africa
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Crockett AH, Chen L, Heberlein EC, Britt JL, Covington-Kolb S, Witrick B, Doherty E, Zhang L, Borders A, Keenan-Devlin L, Smart B, Heo M. Group vs traditional prenatal care for improving racial equity in preterm birth and low birthweight: the Centering and Racial Disparities randomized clinical trial study. Am J Obstet Gynecol 2022; 227:893.e1-893.e15. [PMID: 36113576 PMCID: PMC9729420 DOI: 10.1016/j.ajog.2022.06.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/01/2022] [Accepted: 06/20/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The United States has persistently high rates of preterm birth and low birthweight and is characterized by significant racial disparities in these rates. Innovative group prenatal care models, such as CenteringPregnancy, have been proposed as a potential approach to improve the rates of preterm birth and low birthweight and to reduce disparities in these pregnancy outcomes. OBJECTIVE This study aimed to test whether participation in group prenatal care would reduce the rates of preterm birth and low birthweight compared with individual prenatal care and whether group prenatal care would reduce the racial disparity in these rates between Black and White patients. STUDY DESIGN This was a randomized controlled trial among medically low-risk pregnant patients at a single study site. Eligible patients were stratified by self-identified race and ethnicity and randomly allocated 1:1 between group and individual prenatal care. The primary outcomes were preterm birth at <37 weeks of gestation and low birthweight of <2500 g. The primary analysis was performed according to the intent-to-treat principle. The secondary analyses were performed according to the as-treated principle using modified intent-to-treat and per-compliance approaches. The analysis of effect modification by race and ethnicity was planned. RESULTS A total of 2350 participants were enrolled, with 1176 assigned to group prenatal care and 1174 assigned to individual prenatal care. The study population included 952 Black (40.5%), 502 Hispanic (21.4%), 863 White (36.8%), and 31 "other races or ethnicity" (1.3%) participants. Group prenatal care did not reduce the rate of preterm birth (10.4% vs 8.7%; odds ratio, 1.22; 95% confidence interval, 0.92-1.63; P=.17) or low birthweight (9.6% vs 8.9%; odds ratio, 1.08; 95% confidence interval, 0.80-1.45; P=.62) compared with individual prenatal care. In subgroup analysis, greater attendance in prenatal care was associated with lower rates of preterm birth and low birthweight. This effect was most noticeable for the rates of low birthweight for Black participants in group care: intent to treat (51/409 [12.5%]), modified intent to treat (36/313 [11.5%]), and per compliance (20/240 [8.3%]). Although the rates of low birthweight were significantly higher for Black participants than White participants seen in individual care (adjusted odds ratio, 2.00; 95% confidence interval, 1.14-3.50), the difference was not significant for Black participants in group care compared with their White counterparts (adjusted odds ratio, 1.58; 95% confidence interval, 0.74-3.34). CONCLUSION There was no difference in the overall rates of preterm birth or low birthweight between group and individual prenatal care. With increased participation in group prenatal care, lower rates of preterm birth and low birthweight for Black participants were observed. The role of group care models in reducing racial disparities in these birth outcomes requires further study.
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Affiliation(s)
- Amy H Crockett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Prisma Health and the University of South Carolina School of Medicine, Greenville, SC.
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
| | - Emily C Heberlein
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA
| | - Jessica L Britt
- Department of Obstetrics and Gynecology, Prisma Health, Greenville, SC
| | - Sarah Covington-Kolb
- Center for Community Health Alignment, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Brian Witrick
- Department of Public Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC
| | - Emily Doherty
- Department of Public Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC
| | - Lu Zhang
- Department of Public Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC
| | - Ann Borders
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - Lauren Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - Britney Smart
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - Moonseong Heo
- Department of Public Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC
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Abstract
Population-based solutions are needed to stabilize and then reverse the continued upward trends in obesity prevalence in the US population and worldwide. This review focuses on the related, urgent issue of disparities in obesity prevalence affecting US racial/ethnic minority and other socially marginalized populations. The review provides background on these disparities from a health equity perspective and highlights evidence of progress in equity-focused obesity efforts. Five recommendations for advancing equity efforts are offered as potential approaches to build on progress to date: (a) give equity issues higher priority, (b) adopt a health equity lens, (c) strengthen approaches by using health equity frameworks, (d) broaden the types of policies considered, and (e) emphasize implementation science concepts and tools. Potential challenges and opportunities are identified, including the prospect of longer-term, transformative solutions that integrate global and national initiatives to address obesity, undernutrition, and climate change.
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Affiliation(s)
- Shiriki K Kumanyika
- Dornsife School of Public Health, Drexel University, and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
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Gollust SE, Call KT, Moon JR, Cluxton B, Bailey Z. Designing and Implementing a Curriculum to Support Health Equity Research Leaders: The Interdisciplinary Research Leaders Experience. Front Public Health 2022; 10:876847. [PMID: 35646764 PMCID: PMC9136100 DOI: 10.3389/fpubh.2022.876847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/13/2022] [Indexed: 12/05/2022] Open
Abstract
Health inequities in the United States are well-documented. However, research that is focused on solutions, rather than just describing the problem, and research that is designed explicitly to inform needed policy and practice change, is still too rare. The Robert Wood Johnson Foundation Interdisciplinary Research Leaders (IRL) program launched in 2016 with the goal of filling this gap: to generate community-engaged research to catalyze policy action in communities, while promoting leadership among researchers and community partners. In this paper, we describe the creation and implementation of a curriculum for IRL program participants over the first 5 years of the program. The curriculum—spanning domains of leadership, policy, communication, community engagement, and research methodologies—was designed to cultivate leaders who use research evidence in their efforts to promote change to advance health equity in their communities. The curriculum components implemented by IRL might be applied to other educational programs or fellowships to amplify and accelerate the growth of leaders nationwide who can use research and action to respond to grave and ongoing threats to community health.
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Affiliation(s)
- Sarah E. Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, United States
- *Correspondence: Sarah E. Gollust
| | - Kathleen T. Call
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, United States
| | - J. Robin Moon
- Department of Health Policy and Management, CUNY Graduate School of Public Health and Health Policy, New York, NY, United States
| | | | - Zinzi Bailey
- Divisions of Medical Oncology and Epidemiology, Department of Medicine, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
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Wouk K, Morgan I, Johnson J, Tucker C, Carlson R, Berry DC, Stuebe AM. A Systematic Review of Patient-, Provider-, and Health System-Level Predictors of Postpartum Health Care Use by People of Color and Low-Income and/or Uninsured Populations in the United States. J Womens Health (Larchmt) 2021; 30:1127-1159. [PMID: 33175652 PMCID: PMC8403215 DOI: 10.1089/jwh.2020.8738] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: People of color and low-income and uninsured populations in the United States have elevated risks of adverse maternal health outcomes alongside low levels of postpartum visit attendance. The postpartum period is a critical window for delivering health care services to reduce health inequities and their transgenerational effects. Evidence is needed to identify predictors of postpartum visit attendance in marginalized populations. Methods: We conducted a systematic review of the peer-reviewed literature to identify studies that quantified patient-, provider-, and health system-level predictors of postpartum health care use by people of color and low-income and uninsured populations. We extracted study design, sample, measures, and outcome data from studies meeting our eligibility criteria, and used a modified Cochrane Risk of Bias tool to evaluate risk of bias. Results: Out of 2,757 studies, 36 met our criteria for inclusion in this review. Patient-level factors consistently associated with postpartum care included higher socioeconomic status, rural residence, fewer children, older age, medical complications, and previous health care use. Perceived discrimination during intrapartum care and trouble understanding the health care provider were associated with lower postpartum visit use, while satisfaction with the provider and having a provider familiar with one's health history were associated with higher use. Health system predictors included public facilities, group prenatal care, and services such as patient navigators and appointment reminders. Discussion: Postpartum health service research in marginalized populations has predominantly focused on patient-level factors; however, the multilevel predictors identified in this review reflect underlying inequities and should be used to inform the design of structural changes.
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Affiliation(s)
- Kathryn Wouk
- Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Isabel Morgan
- Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jasmine Johnson
- Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christine Tucker
- Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebecca Carlson
- Health Sciences Library, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Diane C. Berry
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alison M. Stuebe
- Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Poor Medication Adherence in African Americans Is a Matter of Trust. J Racial Ethn Health Disparities 2020; 8:927-942. [PMID: 33215358 DOI: 10.1007/s40615-020-00850-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/30/2022]
Abstract
The purpose of this paper was to explore the lack of medication adherence in the African American patient community. The paper will address myths that many African American patients believe related to type 2 diabetes, hypertension treatment, and natural remedies. Research has shown that the disparities in the acceptance of healthcare provider advice and prescriptions are a significant concern particularly in African American patients. The acceptance of a provider's diagnosis and subsequent intervention can vary based on several issues including healthcare access, patient preferences, trust of a provider, and treatment recommendations. Patient influences can range from their ability to trust the provider (and what he/she says) to following through with their advice. Several studies have looked at the beliefs and misconceptions some African Americans hold regarding the treatment of hypertension and diabetes with some showing a preference for "natural remedies." This paper will leverage a literature review to seek out myths from African American patients to understand why they are dealing with challenges related to adherence with medication. The searches identified 58 research papers. The study applied an inductive content analysis approach to assess the research papers and identify themes. The barriers identified in this study include disbelief of the diagnosis, distrust for medication, mistrust for physicians and healthcare system, belief in alternative medicine, cultural/generation norms, and access/affordability of care. One of the most prominent factors that crossed all barriers was medical mistrust.
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Martin-Howard S, Farmbry K. Framing a Needed Discourse on Health Disparities and Social Inequities: Drawing Lessons from a Pandemic. PUBLIC ADMINISTRATION REVIEW 2020; 80:839-844. [PMID: 32836464 PMCID: PMC7361609 DOI: 10.1111/puar.13265] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 05/14/2023]
Abstract
COVID-19 provides numerous opportunities for policy makers to consider matters of social equity in relation to the field of public health. Specifically, by reflecting on health disparities in relation to the disproportionate impact of COVID-19 on minority and historically underserved populations, we can leverage a needed discourse on health outcomes for many communities. Grounded in the social determinants of health conceptual framework, this essay explores the application of the disproportionate impact of COVID-19 to vulnerable populations and communities of color for a discussion of strategies for minimizing health disparities.
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Fareed N, Swoboda CM, Jonnalagadda P, Griesenbrock T, Gureddygari HR, Aldrich A. Visualizing Opportunity Index Data Using a Dashboard Application: A Tool to Communicate Infant Mortality-Based Area Deprivation Index Information. Appl Clin Inform 2020; 11:515-527. [PMID: 32757202 PMCID: PMC7406368 DOI: 10.1055/s-0040-1714249] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/09/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND An area deprivation index (ADI) is a geographical measure that accounts for socioeconomic factors (e.g., crime, health, and education). The state of Ohio developed an ADI associated with infant mortality: Ohio Opportunity Index (OOI). However, a powerful tool to present this information effectively to stakeholders was needed. OBJECTIVES We present a real use-case by documenting the design, development, deployment, and training processes associated with a dashboard solution visualizing ADI data. METHODS The Opportunity Index Dashboard (OID) allows for interactive exploration of the OOI and its seven domains-transportation, education, employment, housing, health, access to services, and crime. We used a user-centered design approach involving feedback sessions with stakeholders, who included representatives from project sponsors and subject matter experts. We assessed the usability of the OID based on the effectiveness, efficiency, and satisfaction dimensions. The process of designing, developing, deploying, and training users in regard to the OID is described. RESULTS We report feedback provided by stakeholders for the OID categorized by function, content, and aesthetics. The OID has multiple, interactive components: choropleth map displaying OOI scores for a specific census tract, graphs presenting OOI or domain scores between tracts to compare relative positions for tracts, and a sortable table to visualize scores for specific county and census tracts. Changes based on parameter and filter selections are described using a general use-case. In the usability evaluation, the median task completion success rate was 83% and the median system usability score was 68. CONCLUSION The OID could assist health care leaders in making decisions that enhance care delivery and policy decision making regarding infant mortality. The dashboard helps communicate deprivation data across domains in a clear and concise manner. Our experience building this dashboard presents a template for developing dashboards that can address other health priorities.
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Affiliation(s)
- Naleef Fareed
- CATALYST – The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Department of Biomedical Informatics, College of Medicine, Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, United States
| | - Christine M. Swoboda
- CATALYST – The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Pallavi Jonnalagadda
- CATALYST – The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Department of Biomedical Informatics, College of Medicine, Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, United States
| | - Tyler Griesenbrock
- CATALYST – The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Harish R. Gureddygari
- CATALYST – The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Alison Aldrich
- CATALYST – The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
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Dubay L, Hill I, Garrett B, Blavin F, Johnston E, Howell E, Morgan J, Courtot B, Benatar S, Cross-Barnet C. Improving Birth Outcomes And Lowering Costs For Women On Medicaid: Impacts Of ‘Strong Start For Mothers And Newborns’. Health Aff (Millwood) 2020; 39:1042-1050. [DOI: 10.1377/hlthaff.2019.01042] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lisa Dubay
- Lisa Dubay is a senior fellow in the Health Policy Center, Urban Institute, in Washington, D.C
| | - Ian Hill
- Ian Hill is a senior fellow in the Health Policy Center, Urban Institute
| | - Bowen Garrett
- Bowen Garrett is a senior fellow in the Health Policy Center, Urban Institute
| | - Fredric Blavin
- Fredric Blavin is a principal research associate in the Health Policy Center, Urban Institute
| | - Emily Johnston
- Emily Johnston is a research associate in the Health Policy Center, Urban Institute
| | - Embry Howell
- Embry Howell is a nonresident fellow in the Health Policy Center, Urban Institute
| | - Justin Morgan
- Justin Morgan is a PhD student at the Harvard T. H. Chan School of Public Health. At the time this research was conducted, he was a research analyst at the Urban Institute
| | - Brigette Courtot
- Brigette Courtot is a principal research associate in the Health Policy Center, Urban Institute
| | - Sarah Benatar
- Sarah Benatar is a principal research associate in the Health Policy Center, Urban Institute
| | - Caitlin Cross-Barnet
- Caitlin Cross-Barnet is a social science research analyst at the Center for Medicare and Medicaid Innovation, in Baltimore, Maryland
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Heo S, Fong KC, Bell ML. Risk of particulate matter on birth outcomes in relation to maternal socio-economic factors: a systematic review. ENVIRONMENTAL RESEARCH LETTERS : ERL [WEB SITE] 2019; 14. [PMID: 34108997 PMCID: PMC8186490 DOI: 10.1088/1748-9326/ab4cd0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
A growing number of studies provide evidence of an association between exposure to maternal air pollution during pregnancy and adverse birth outcomes including low birth weight and preterm birth. Prevention of these health effects of air pollution is critical to reducing the adverse infant outcomes, which can have impacts throughout the life course. However, there is no consensus on whether the association between air pollution exposure and birth outcomes varies by maternal risk factors including demographic characteristics and socio-economic status. Such information is vital to understand potential environmental health disparities. Our search found 859 unique studies, of which 45 studies met our inclusion criteria (Jan. 2000- July. 2019). We systematically reviewed the 45 identified epidemiologic studies and summarized the results on effect modifications by maternal race/ethnicity, educational attainment, income, and area-level socio-economic status. We considered adverse birth outcomes of preterm birth, low birth weight, small for gestational age (SGA), and stillbirth. Suggestive evidence of higher risk of particulate matter in infants of African-American/black mothers than infants of other women was found for preterm birth and low birth weight. We found weak evidence that particulate matter risk was higher for infants of mothers with lower educational attainment for preterm birth and low birth weight. Due to the small study numbers, we were unable to conclude whether effect modification is present for income, occupation, and area-level socio-economic status, and additional research is needed. Furthermore, adverse birth outcomes such as SGA and stillbirth need more study to understand potential environmental justice issues regarding the impact of particulate matter exposure during pregnancy on birth outcomes.
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Affiliation(s)
- Seulkee Heo
- School of Forestry and Environmental Studies, Yale University
| | - Kelvin C Fong
- School of Forestry and Environmental Studies, Yale University
| | - Michelle L Bell
- School of Forestry and Environmental Studies, Yale University
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Disproportionate Preterm Delivery Among Black Women: a State-Level Analysis. J Racial Ethn Health Disparities 2019; 7:290-297. [PMID: 31768962 DOI: 10.1007/s40615-019-00657-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/20/2019] [Accepted: 10/22/2019] [Indexed: 01/22/2023]
Abstract
Preterm delivery occurs at extraordinarily higher rates among Black women than among women of any other race or ethnicity. For those children who survive, many face a lifetime of health and developmental challenges as well as difficulties in school and life. Previous studies have provided substantive evidence that the preterm delivery disparity experienced by Black women is associated with ongoing distress caused by racism. Our study examines rates of preterm delivery for Black women in the USA to determine the level of risk associated with living in specific states. Using a logistic regression model, we examined the impact of the delivery state, controlling for known clinical, economic, and demographic risk factors. We found that 32 of the 35 states included in our analysis were associated with a statistically significantly increased risk of preterm delivery among Black women, as compared to the state with the lowest preterm delivery rate for Black women. These findings allowed us to organize states into a continuum of preterm delivery risk. Because of the harmful effects of preterm delivery and its disproportionate impact among Black women and infants, we recommend that a measure of preterm delivery be included in any state plan to assess, intervene in, and monitor racial disparities.
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Danielson R, Saxena D. Connecting adverse childhood experiences and community health to promote health equity. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2019. [DOI: 10.1111/spc3.12486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ramona Danielson
- Department of Public Health, College of Health ProfessionsNorth Dakota State University Fargo ND U.S.A
| | - Divya Saxena
- Department of Public Health, College of Health ProfessionsNorth Dakota State University Fargo ND U.S.A
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Hill I, Cross-Barnet C, Courtot B, Benatar S, Thornburgh S. What do women in Medicaid say about enhanced prenatal care? Findings from the national Strong Start evaluation. Birth 2019; 46:244-252. [PMID: 31087393 DOI: 10.1111/birt.12431] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Medicaid pays for approximately half of United States births, yet little research has explored Medicaid beneficiaries' perspectives on their maternity care. Typical maternity care in the United States has been criticized as too medically focused while insufficiently addressing psychosocial risks and patient education. Enhanced care strives for a more holistic approach. METHODS The perspectives of participants in the Strong Start for Mothers and Newborns II initiative, which provided enhanced prenatal care to women covered by Medicaid or the Children's Health Insurance Program (CHIP) during pregnancy through Birth Centers, Group Prenatal Care, and Maternity Care Homes, are evaluated. Strong Start intended to improve care quality and birth outcomes while lowering costs. We analyzed data from 133 focus groups with 951 pregnant or postpartum women who participated in Strong Start from 2013 to 2017. RESULTS The majority of focus group participants said that Strong Start's enhanced care offered numerous important benefits over typical maternity care, including considerably more focus on women's psychosocial risk factors and need for education. They praised increased support; nutrition, breastfeeding, and family planning education; community referrals; longer time with practitioners; and involvement of partners in their care. Maternity Care Home participants, however, occasionally voiced concerns over lack of practitioner continuity and short clinical appointments, whereas Group Prenatal Care participants sometimes said they could not attend visits because of lack of childcare. CONCLUSIONS Medicaid and CHIP beneficiaries reported positive experiences with Strong Start care. If more Medicaid practitioners could adopt aspects of the prenatal care approaches that women praised most, it is likely that women's risk factors could be more effectively addressed and their overall care experiences could be improved.
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Affiliation(s)
- Ian Hill
- Urban Institute, Washington, District of Columbia
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15
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Wint K, Elias TI, Mendez G, Mendez DD, Gary-Webb TL. Experiences of Community Doulas Working with Low-Income, African American Mothers. Health Equity 2019; 3:109-116. [PMID: 31289769 PMCID: PMC6608698 DOI: 10.1089/heq.2018.0045] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: The aim of this study was to learn from doulas the components of their services that might best serve low-income, African American (AA) women and to show the significance of doulas in helping these women have healthy, positive, birth experiences. Methods: Ten doulas were recruited from a local community doula program and through word-of-mouth referrals from participants and completed in-depth interviews. Interviews were transcribed verbatim and analyzed using Atlas.ti software to identify emerging themes. Thematic saturation was achieved in interviews. Results: Several themes emerged from the interviews including: (1) The influence of similarities of race, culture, and lived experience on doula care; (2) How doulas often provide birthing persons with support and resources beyond birth; and (3) How doulas recognize the institutional biases that exist in the health care system and try to mediate their effect on birthing persons. Conclusions: These themes highlight how doulas can support birthing persons to mitigate the negative effects of social determinants of health, specifically racism and classism, and highlight potential avenues for doulas to consider when working with birthing persons who have low income and are AA.
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Affiliation(s)
- Kristina Wint
- Department of Behavioral and Community Health Sciences, Pittsburgh, Pennsylvania
| | - Thistle I Elias
- Department of Behavioral and Community Health Sciences, Pittsburgh, Pennsylvania
| | - Gabriella Mendez
- Department of Behavioral and Community Health Sciences, Pittsburgh, Pennsylvania
| | - Dara D Mendez
- Department of Behavioral and Community Health Sciences, Pittsburgh, Pennsylvania.,Department of Epidemiology at the University of Pittsburgh Graduate School of Public Health in Pittsburgh, Pittsburgh, Pennsylvania
| | - Tiffany L Gary-Webb
- Department of Behavioral and Community Health Sciences, Pittsburgh, Pennsylvania.,Department of Epidemiology at the University of Pittsburgh Graduate School of Public Health in Pittsburgh, Pittsburgh, Pennsylvania
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Hogan V, Rowley DL, White SB, Faustin Y. Dimensionality and R4P: A Health Equity Framework for Research Planning and Evaluation in African American Populations. Matern Child Health J 2019; 22:147-153. [PMID: 29392541 DOI: 10.1007/s10995-017-2411-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Existing health disparities frameworks do not adequately incorporate unique interacting contributing factors leading to health inequities among African Americans, resulting in public health stakeholders' inability to translate these frameworks into practice. Methods We developed dimensionality and R4P to integrate multiple theoretical perspectives into a framework of action to eliminate health inequities experienced by African Americans. Results The dimensional framework incorporates Critical Race Theory and intersectionality, and includes dimensions of time-past, present and future. Dimensionality captures the complex linear and non-linear array of influences that cause health inequities, but these pathways do not lend themselves to approaches to developing empirically derived programs, policies and interventions to promote health equity. R4P provides a framework for addressing the scope of actions needed. The five components of R4P are (1) Remove, (2) Repair, (3) Remediate, (4) Restructure and (5) Provide. Conclusion R4P is designed to translate complex causality into a public health equity planning, assessment, evaluation and research tool.
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Affiliation(s)
- Vijaya Hogan
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.,WK Kellogg Foundation, Battle Creek, MI, USA
| | - Diane L Rowley
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | | | - Yanica Faustin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Handler A, Henderson V, Johnson R, Turino C, Gordon M, Franck M, Peacock N, Pecha D. The Well-Woman Project: Listening to Women's Voices. Health Equity 2018; 2:395-403. [PMID: 30623168 PMCID: PMC6323588 DOI: 10.1089/heq.2018.0031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: The U.S. Affordable Care Act (ACA) of 2010 included the Well-Woman Visit (WWV) as one of the preventive services, which must be covered without cost sharing. Despite concerted efforts to increase access to the WWV, data from the early years of the ACA demonstrated ongoing barriers, including insufficient consumer and provider awareness of the ACA's no cost-sharing provision for preventive services. As such, 2 years after full implementation of the ACA, the Well-Woman Project (WWP) used qualitative methods to learn about women's perceptions of the WWV and barriers that affect their ability to be healthy and seek well-woman care. Methods: Women's voices were captured by Listening Sessions in eight cities and through stories from women across the United States posted to a WWP Website, or reported over a WWP toll-free phone line. Thematic analysis of Listening Sessions and stories was conducted using Dedoose software. Results: In 2016, Listening Sessions (17) were held with 156 women; in addition, stories were collected from 102 women across the United States. Women are aware of the importance of preventive care, but report multiple barriers to seeking such care. However, they are able to articulate a variety of system and policy strategies that mitigate the complexity of navigating the health care system; help women prioritize their health and accessing health care; promote positive relationships with providers; empower women to advocate for themselves and others; promote positive mental health as well as access to safe environments, healthy food, and social support systems; decrease barriers related to lack of transportation and childcare; and support the provision of trauma informed care in the health care delivery system. Conclusion: To improve women's health status and reduce inequities, making the preventive well-care visit available without cost-sharing is necessary, but not a sufficient strategy.
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Affiliation(s)
- Arden Handler
- Community Health Sciences, University of Illinois School of Public Health, Chicago, Illinois
| | - Vida Henderson
- Cancer Center, University of Illinois, Chicago, Illinois
| | - Regan Johnson
- CityMatCH, University of Nebraska Medical Center, Omaha, Nebraska
| | - Cristina Turino
- CountyCare, Cook County Health and Hospitals System, Chicago, Illinois
| | - Megan Gordon
- Community Health Sciences, University of Illinois School of Public Health, Chicago, Illinois
| | - Megan Franck
- Department of Epidemiology, University of Illinois School of Public Health, Chicago, Illinois
| | - Nadine Peacock
- Community Health Sciences, University of Illinois School of Public Health, Chicago, Illinois
| | - Denise Pecha
- CityMatCH, University of Nebraska Medical Center, Omaha, Nebraska
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18
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Griswold MK, Crawford SL, Perry DJ, Person SD, Rosenberg L, Cozier YC, Palmer JR. Experiences of Racism and Breastfeeding Initiation and Duration Among First-Time Mothers of the Black Women's Health Study. J Racial Ethn Health Disparities 2018; 5:1180-1191. [PMID: 29435898 PMCID: PMC6681652 DOI: 10.1007/s40615-018-0465-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/16/2018] [Accepted: 01/29/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Breastfeeding rates are lower for black women in the USA compared with other groups. Breastfeeding and lactation are sensitive time points in the life course, centering breastfeeding as a health equity issue. In the USA, experiences of racism have been linked to poor health outcomes but racism relative to breastfeeding has not been extensively investigated. AIMS This study aims to investigate the association between experiences of racism, neighborhood segregation, and nativity with breastfeeding initiation and duration. METHODS This is a prospective secondary analysis of the Black Women's Health Study, based on data collected from 1995 through 2005. Daily and institutional (job, housing, police) racism, nativity, and neighborhood segregation in relation to breastfeeding were examined. Odds ratios and 95% confidence intervals were calculated using binomial logistic regression for the initiation outcomes (N = 2705) and multinomial logistic regression for the duration outcomes (N = 2172). RESULTS Racism in the job setting was associated with lower odds of breastfeeding duration at 3-5 months. Racism with the police was associated with higher odds of breastfeeding initiation and duration at 3-5 and 6 months. Being born in the USA or having a parent born in the USA predicted lower odds of breastfeeding initiation and duration. Living in a segregated neighborhood (primarily black residents) as a child was associated with decreased breastfeeding initiation and duration relative to growing up in a predominantly white neighborhood. CONCLUSION Experiences of institutionalized racism influenced breastfeeding initiation and duration. Structural-level interventions are critical to close the gap of racial inequity in breastfeeding rates in the USA.
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Affiliation(s)
- Michele K Griswold
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sybil L Crawford
- Department of Medicine, Division of Preventive and Behavioral Medicine University of Massachusetts Medical School , Worcester, MA, USA
| | - Donna J Perry
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sharina D Person
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Yvette C Cozier
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA.
- , Boston, USA.
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19
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Atreya MR, Muglia LJ, Greenberg JM, DeFranco EA. Racial Differences in the Influence of Interpregnancy Interval on Fetal Growth. Matern Child Health J 2018; 21:562-570. [PMID: 27475828 DOI: 10.1007/s10995-016-2140-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives Assess the influence of maternal race on the association between interpregnancy interval (IPI) and risk of small for gestational age (SGA) and large for gestational age (LGA) births. Methods Statewide population-based cohort study of 380,520 singleton births. We calculated risk of SGA and LGA births following IPIs of 0 to <6, 6 to <12, 12 to <24 (referent), 24 to <60 months, and ≥60 months, by maternal race after adjustment for confounding influences. Results The highest risk for SGA among white women followed short IPI of 0 to <6 months [adjRR 1.14 (95 % CI 1.08-1.21)], and long IPI ≥ 60 months [adjRR 1.37 (95 % CI 1.31-1.43)]. Only long IPI ≥ 60 months increased SGA risk in black women [adjRR 1.22 (95 % CI 1.13-1.32)]. LGA risk in white women was lowest with shortest and longest IPIs, 0 to <6 [adjRR 0.80 (95 % CI 0.76-0.84)] and ≥60 months [adjRR 0.68 (95 % CI 0.66-0.70)]. The crude risk of LGA was directly proportional to longer IPIs in black women. However, after adjusting for confounding effects of age, obesity, excessive gestational weight gain, and gestational diabetes, the effect was reversed to reduced risk following long IPI ≥ 60 months [adjRR 0.82 (95 % CI 0.74-0.91)], similar to that of white women. Conclusions In black and white women, an interpregnancy interval of 1-2 years is associated with optimal fetal growth. In addition to birth spacing, addressing modifiable factors such as pre-pregnancy BMI, monitoring gestational weight gain, and control of gestational diabetes in black women may help optimize fetal growth.
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Affiliation(s)
- Mihir R Atreya
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Louis J Muglia
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, MSB-4553B, Cincinnati, OH, 45267-0526, USA.,Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James M Greenberg
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Emily A DeFranco
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, MSB-4553B, Cincinnati, OH, 45267-0526, USA. .,Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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20
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Hogan VK, Rowley DL, Brooks PE, Gonzalez-Nahm SN, Berthiaume R, Thompson Y, Derige D. Achieving Breastfeeding Equity: A Study of a National Breastfeeding Initiative. Breastfeed Med 2018; 13:142-148. [PMID: 29489388 DOI: 10.1089/bfm.2017.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Equity in breastfeeding could reduce excess morbidity and mortality among children and mothers of color. Few programs that support breastfeeding have been evaluated for their capacity to create equity. The aim of this study was to assess the extent to which a diverse set of national breastfeeding programs actively promoted equity. SUBJECTS AND METHODS Qualitative data collection was conducted between December 2012 and July 2013 by visits to 29 of 58 breastfeeding programs selected by the funder. Programs underwent a site visit with open-ended interviews of staff. Investigators used Atlas.ti software to code data and content analysis of qualitative evaluation data. Key categories and themes were identified to answer the questions: how do the programs conceptualize equity? and how do the organizations operationalize an approach to equity? RESULTS Programs had widely divergent and often limited conceptualizations of equity. Nine categories describe the equity approaches' programs used. The social, political, and environmental contexts in which programs operated varied in the degree of challenge they pose for implementing equity-focused breastfeeding methods. We found only a few programs that matched the social, cultural, and economic realities and context of women of color. CONCLUSIONS Breastfeeding equity programs need to explicitly define and envision outcomes, and need to identify equity inhibiting policies and practices. Equity attainment is more likely to emerge from institutional transformational processes that collaborate with the populations at risk. These findings have implications for other programs addressing equity in health.
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Affiliation(s)
- Vijaya K Hogan
- 1 Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.,2 W.K. Kellogg Foundation , Battle Creek, Michigan
| | - Diane L Rowley
- 1 Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Pauline E Brooks
- 1 Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.,3 Pauline E. Brooks Consulting , LLC, Los Angeles, California
| | - Sarah N Gonzalez-Nahm
- 1 Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.,4 Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Rachel Berthiaume
- 1 Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Yvette Thompson
- 1 Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Diana Derige
- 2 W.K. Kellogg Foundation , Battle Creek, Michigan
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Kane JB, Miles G, Yourkavitch J, King K. Neighborhood context and birth outcomes: Going beyond neighborhood disadvantage, incorporating affluence. SSM Popul Health 2017; 3:699-712. [PMID: 29349258 PMCID: PMC5769105 DOI: 10.1016/j.ssmph.2017.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 07/17/2017] [Accepted: 08/13/2017] [Indexed: 11/25/2022] Open
Abstract
Neighborhood affluence protects against the risk of poor birth outcome.
The protective effect of affluence holds for Whites, Blacks, Hispanics and Asians.
Mediation of these pathways by prenatal smoking varies by racial group.
The discourse on neighborhoods and birth outcomes should include affluence.
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Affiliation(s)
- Jennifer B Kane
- Department of Sociology, University of California, Irvine, 4171 Social Sciences Plaza A, Irvine, CA 92697, United States
| | - Gandarvaka Miles
- Department of Epidemiology, University of North Carolina, 2101 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7435, United States
| | - Jennifer Yourkavitch
- Department of Epidemiology, University of North Carolina, 2101 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7435, United States
| | - Katherine King
- Department of Family and Community Medicine, Duke University, Durham, NC 27708, United States
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"We black women have to kill a lion everyday": An intersectional analysis of racism and social determinants of health in Brazil. Soc Sci Med 2017; 199:96-105. [PMID: 28760333 DOI: 10.1016/j.socscimed.2017.07.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 07/07/2017] [Accepted: 07/12/2017] [Indexed: 11/24/2022]
Abstract
The concept of intersectionality has been used to analyze and understand how multiple forms of identity and oppression interact to shape life experiences of marginalized groups. We conducted a qualitative study to explore how Black Brazilian women experience the intersections of race, class, and gender and the ways in which these intersecting experiences act as social determinants of health. Nine focus groups were conducted with Black, White, and mixed-race women of childbearing age (n = 37), social and health activists (n = 11), and health professionals (n = 20). The focus groups took place in two cities in the Brazilian state of Bahia during October and November 2012. Using a comparative approach, we describe participants' responses regarding the life experiences of women of differing racial and class backgrounds. Our findings highlight how the intersectional relationship between race, class, and gender alters women's social context and life course opportunities, as well as their stressors and protective buffers. We argue that the differing intersectional experiences of women due to race and class create unique social contexts that define the parameters of health and wellness. In addition, we argue that the experiences at each intersection (i.e., raceXclass, raceXgender, classXgender, raceXclassXgender) have a unique character that can be qualitatively described. Improved specification of exposures experienced by marginalized populations who experience intersecting forms of oppression can help explain intra- and inter-group differences in health outcomes, and may also lead to improved intervention models.
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Abstract
Since the police-involved deaths of Michael Brown and Freddie Gray, activists have argued for connecting police violence with reproductive justice. We argue that systematic violence, including police violence, should be evaluated in relation to reproductive health outcomes of individual patients and communities. Beyond emphasizing the relationship between violence and health outcomes, both qualitative and epidemiologic data can be used by activists and caregivers to effectively care for individuals from socially marginalized communities.
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Vines AI, Ward JB, Cordoba E, Black KZ. Perceived Racial/Ethnic Discrimination and Mental Health: a Review and Future Directions for Social Epidemiology. CURR EPIDEMIOL REP 2017; 4:156-165. [PMID: 28920011 PMCID: PMC5596659 DOI: 10.1007/s40471-017-0106-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Recent literature on racial or ethnic discrimination and mental health was reviewed to assess the current science and identify key areas of emphasis for social epidemiology. Objectives of this review were to: 1) Determine whether there have been advancements in the measurement and analysis of perceived discrimination; 2) Identify the use of theories and/or frameworks in perceived discrimination and mental health research; and 3) Assess the extent to which stress buffers are being considered and evaluated in the existing literature. RECENT FINDINGS Metrics and analytic approaches used to assess discrimination remain largely unchanged. Theory and/or frameworks such as the stress and coping framework continue to be underused in majority of the studies. Adolescents and young adults experiencing racial/ethnic discrimination were at greater risk of adverse mental health outcomes, and the accumulation of stressors over the life course may have an aggregate impact on mental health. Some growth seems evident in studies examining the mediation and moderation of stress buffers and other key factors with the findings suggesting a reduction in the effects of discrimination on mental health. SUMMARY Discrimination scales should consider the multiple social identities of a person, the context where the exposure occurs, how the stressor manifests specifically in adolescents, the historical traumas, and cumulative exposure. Life course theory and intersectionality may help guide future work. Despite existing research, gaps remain in in elucidating the effects of racial and ethnic discrimination on mental health, signaling an opportunity and a call to social epidemiologists to engage in interdisciplinary research to speed research progress.
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Affiliation(s)
- Anissa I Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 266 Rosenau Hall, CB #7435, 135 Dauer Drive, Chapel Hill, NC 27599-7435
| | - Julia B Ward
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7435, Chapel Hill, NC 27599-7435
| | - Evette Cordoba
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7435, Chapel Hill, NC 27599-7435
| | - Kristin Z Black
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7440, Chapel Hill, NC 27599-7440
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Brown Speights JS, Goldfarb SS, Wells BA, Beitsch L, Levine RS, Rust G. State-Level Progress in Reducing the Black-White Infant Mortality Gap, United States, 1999-2013. Am J Public Health 2017; 107:775-782. [PMID: 28323476 PMCID: PMC5388953 DOI: 10.2105/ajph.2017.303689] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To assess state-level progress on eliminating racial disparities in infant mortality. METHODS Using linked infant birth-death files from 1999 to 2013, we calculated state-level 3-year rolling average infant mortality rates (IMRs) and Black-White IMR ratios. We also calculated percentage improvement and a projected year for achieving equality if current trend lines are sustained. RESULTS We found substantial state-level variation in Black IMRs (range = 6.6-13.8) and Black-White rate ratios (1.5-2.7), and also in percentage relative improvement in IMR (range = 2.7% to 36.5% improvement) and in Black-White rate ratios (from 11.7% relative worsening to 24.0% improvement). Thirteen states achieved statistically significant reductions in Black-White IMR disparities. Eliminating the Black-White IMR gap would have saved 64 876 babies during these 15 years. Eighteen states would achieve IMR racial equality by the year 2050 if current trends are sustained. CONCLUSIONS States are achieving varying levels of progress in reducing Black infant mortality and Black-White IMR disparities. Public Health Implications. Racial equality in infant survival is achievable, but will require shifting our focus to determinants of progress and strategies for success.
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Affiliation(s)
- Joedrecka S Brown Speights
- Joedrecka S. Brown Speights is with the Department of Family Medicine and Rural Health, Florida State University (FSU) College of Medicine, Tallahassee. Samantha Sittig Goldfarb and Brittny A. Wells are with the Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Leslie Beitsch and George Rust are with the Center for Medicine and Public Health, and Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Robert S. Levine is with the Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - Samantha Sittig Goldfarb
- Joedrecka S. Brown Speights is with the Department of Family Medicine and Rural Health, Florida State University (FSU) College of Medicine, Tallahassee. Samantha Sittig Goldfarb and Brittny A. Wells are with the Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Leslie Beitsch and George Rust are with the Center for Medicine and Public Health, and Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Robert S. Levine is with the Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - Brittny A Wells
- Joedrecka S. Brown Speights is with the Department of Family Medicine and Rural Health, Florida State University (FSU) College of Medicine, Tallahassee. Samantha Sittig Goldfarb and Brittny A. Wells are with the Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Leslie Beitsch and George Rust are with the Center for Medicine and Public Health, and Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Robert S. Levine is with the Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - Leslie Beitsch
- Joedrecka S. Brown Speights is with the Department of Family Medicine and Rural Health, Florida State University (FSU) College of Medicine, Tallahassee. Samantha Sittig Goldfarb and Brittny A. Wells are with the Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Leslie Beitsch and George Rust are with the Center for Medicine and Public Health, and Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Robert S. Levine is with the Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - Robert S Levine
- Joedrecka S. Brown Speights is with the Department of Family Medicine and Rural Health, Florida State University (FSU) College of Medicine, Tallahassee. Samantha Sittig Goldfarb and Brittny A. Wells are with the Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Leslie Beitsch and George Rust are with the Center for Medicine and Public Health, and Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Robert S. Levine is with the Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - George Rust
- Joedrecka S. Brown Speights is with the Department of Family Medicine and Rural Health, Florida State University (FSU) College of Medicine, Tallahassee. Samantha Sittig Goldfarb and Brittny A. Wells are with the Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Leslie Beitsch and George Rust are with the Center for Medicine and Public Health, and Department of Behavioral Sciences and Social Medicine, FSU College of Medicine. Robert S. Levine is with the Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
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Villavicencio J, Gillespie K, Bortoletto P, Chescheir NC. Connect the Dots—April 2017. Obstet Gynecol 2017; 129:747-748. [DOI: 10.1097/aog.0000000000001953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Verbiest S, Malin CK, Drummonds M, Kotelchuck M. Catalyzing a Reproductive Health and Social Justice Movement. Matern Child Health J 2017; 20:741-8. [PMID: 26740226 PMCID: PMC4792350 DOI: 10.1007/s10995-015-1917-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives The maternal and child health (MCH) community, partnering with women and their families, has the potential to play a critical role in advancing a new multi-sector social movement focused on creating a women’s reproductive and economic justice agenda. Since the turn of the twenty-first century, the MCH field has been planting seeds for change. The time has come for this work to bear fruit as many states are facing stagnant or slow progress in reducing infant mortality, increasing maternal death rates, and growing health inequities. Methods This paper synthesizes three current, interrelated approaches to addressing MCH challenges—life course theory, preconception health, and social justice/reproductive equity. Conclusion Based on these core constructs, the authors offer four directions for advancing efforts to improve MCH outcomes. The first is to ensure access to quality health care for all. The second is to facilitate change through critical conversations about challenging issues such as poverty, racism, sexism, and immigration; the relevance of evidence-based practice in disenfranchised communities; and how we might be perpetuating inequities in our institutions. The third is to develop collaborative spaces in which leaders across diverse sectors can see their roles in creating equitable neighborhood conditions that ensure optimal reproductive choices and outcomes for women and their families. Last, the authors suggest that leaders engage the MCH workforce and its consumers in dialogue and action about local and national policies that address the social determinants of health and how these policies influence reproductive and early childhood outcomes.
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Affiliation(s)
- Sarah Verbiest
- School of Social Work and the Center for Maternal and Infant Health, University of North Carolina at Chapel Hill, Campus Box 7181, Room 3018 Old Clinic Building, Chapel Hill, NC, 27599-7181, USA. .,National Preconception Health and Health Care Initiative, Chapel Hill, NC, USA.
| | - Christina Kiko Malin
- National Preconception Health and Health Care Initiative, Chapel Hill, NC, USA.,Alameda County Public Health Department, 1000 Broadway, Suite 500, Oakland, CA, 94607, USA
| | - Mario Drummonds
- National Preconception Health and Health Care Initiative, Chapel Hill, NC, USA.,Northern Manhattan Perinatal Partnership, Inc., 127 West 127th Street, 3rd Floor, New York, NY, 10027, USA
| | - Milton Kotelchuck
- National Preconception Health and Health Care Initiative, Chapel Hill, NC, USA.,Division of General Academic Pediatrics, Maternal and Child Health MGH, Center for Child & Adolescent Health Research and Policy, Mass General Hospital for Children, Pediatrics Harvard Medical School, Boston, MA, USA
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Garfield L, Mathews HL, Janusek LW. Inflammatory and Epigenetic Pathways for Perinatal Depression. Biol Res Nurs 2015; 18:331-43. [DOI: 10.1177/1099800415614892] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Depression during the perinatal period is common and can have adverse consequences for women and their children. Yet, the biobehavioral mechanisms underlying perinatal depression are not known. Adverse early life experiences increase the risk for adult depression. One potential mechanism by which this increased risk occurs is epigenetic embedding of inflammatory pathways. The purpose of this article is to propose a conceptual model that explicates the linkage between early life adversity and the risk for maternal depression. The model posits that early life adversity embeds a proinflammatory epigenetic signature (altered DNA methylation) that predisposes vulnerable women to depression during pregnancy and the postpartum period. As proposed, women with a history of early life adversity are more likely to exhibit higher levels of proinflammatory cytokines and lower levels of oxytocin in response to the demands of pregnancy and new motherhood, both of which are associated with the risk for perinatal depression. The model is designed to guide investigations into the biobehavioral basis for perinatal depression, with emphasis upon the impact of early life adversity. Testing this model will provide a better understanding of maternal depressive risk and improve identification of vulnerable women who would benefit from targeted interventions that can reduce the impact of perinatal depression on maternal–infant health.
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Affiliation(s)
- Lindsey Garfield
- Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
| | - Herbert L. Mathews
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Linda Witek Janusek
- Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
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Willis E, McManus P, Magallanes N, Johnson S, Majnik A. Conquering racial disparities in perinatal outcomes. Clin Perinatol 2014; 41:847-75. [PMID: 25459778 DOI: 10.1016/j.clp.2014.08.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Infant mortality rate (IMR) is a reference indicator for societal health status. Trend analysis of IMR highlights 2 challenges to overcome in the United States: (1) US IMR is higher than most industrialized countries and (2) there are persistent racial/ethnic disparities in birth outcomes, especially for blacks. Racial/ethnic infant mortality disparities result from the complex interplay of adverse social, economic, and environmental exposures. In this article, racial/ethnic disparities are discussed, highlighting trends, the role of epigenetics in understanding mechanisms, key domains of community action planning, and programs and policies addressing the racial gaps in adverse birth outcomes.
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Affiliation(s)
- Earnestine Willis
- Department of Pediatrics, Center for the Advancement of Underserved Children, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Patricia McManus
- Black Health Coalition of Wisconsin, Inc., 3020 West Vliet Street, Milwaukee, WI 53208-2461, USA
| | - Norma Magallanes
- Department of Pediatrics, Center for the Advancement of Underserved Children, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Sheri Johnson
- Department of Pediatrics, Center for the Advancement of Underserved Children, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Amber Majnik
- Department of Pediatrics, Division of Neonatology, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226, USA
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Wentz AE, Messer LC, Nguyen T, Boone-Heinonen J. Small and large size for gestational age and neighborhood deprivation measured within increasing proximity to homes. Health Place 2014; 30:98-106. [PMID: 25240489 DOI: 10.1016/j.healthplace.2014.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 08/04/2014] [Accepted: 08/21/2014] [Indexed: 11/28/2022]
Abstract
Neighborhood deprivation is consistently associated with greater risk of low birthweight. However, large birth size is increasingly relevant but overlooked in neighborhood health research, and proximity within which neighborhood deprivation may affect birth outcomes is unknown. We estimated race/ethnic-specific effects of neighborhood deprivation index (NDI) within 1, 3, 5, and 8km buffers around Oregon Pregnancy Risk Assessment Monitoring System (n=3716; 2004-2007) respondents׳ homes on small and large for gestational age (SGA, LGA). NDI was positively associated with LGA and SGA in most race/ethnic groups. The results varied little across the four buffer sizes.
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Affiliation(s)
- Anna E Wentz
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA; Population Studies Center, University of Michigan Institute for Social Research, 426 Thompson Street, Ann Arbor, MI, 48104, USA.
| | - Lynne C Messer
- Portland State University, Community Health - Urban & Public Affairs (SCH), PO Box 751, Portland, OR 97207, USA.
| | - Thuan Nguyen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA.
| | - Janne Boone-Heinonen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA.
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Integrating the life course into MCH service delivery: from theory to practice. Matern Child Health J 2014; 18:380-8. [PMID: 23456413 DOI: 10.1007/s10995-013-1242-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To describe the efforts of a community-based maternal and child health coalition to integrate the life course into its planning and programs, as well as implementation challenges and results of these activities. Jacksonville-Duval County has historically had infant mortality rates that are significantly higher than state and national rates, particularly among its African American population. In an effort to address this disparity, the Northeast Florida Healthy Start Coalition embraced the life course approach as a model. This model was adopted as a framework for (1) community needs assessment and planning; (2) delivery of direct services, including case management, education and support in the Magnolia Project, its federal Healthy Start program; (3) development of community collaborations, education and awareness; and, (4) advocacy and grass roots leadership development. Implementation experience as well as challenges in transforming traditional approaches to delivering maternal and child health services are described. Operationalizing the life course approach required the Coalition to think differently about risks, levels of intervention and the way services are organized and delivered. The organization set the stage by using the life course as a framework for its required local planning and needs assessments. Based on these assessments, the content of case management and other key services provided by our federal Healthy Start program was modified to address not only health behaviors but also underlying social determinants and community factors. Individual interventions were augmented with group activities to build interdependence among participants, increasing social capital. More meaningful inter-agency collaboration that moved beyond the usual referral relationships were developed to better address participants' needs. And finally, strategies to cultivate participant advocacy and community leadership skills, were implemented to promote social change at the neighborhood-level. Transforming traditional approaches to delivering maternal and child health services and sustaining change is a long and laborious process. The Coalition has taken the first steps; but its efforts are far from complete. Based on the agency's initial implementation experience, three areas presented particular challenges: staff, resources and evaluation. The life course is an important addition to the MCH toolbox. Community-based MCH programs should assess how a life course approach can be incorporated into existing programs to broaden their focus, and, potentially, their impact on health disparities and birth outcomes. Some areas to consider include planning and needs assessment, direct service delivery, inter-agency collaboration, and community leadership development. Continued disparities for people of color, despite medical advances, demand new interventions that purposefully address social inequities and promote advocacy among groups that bear a disproportionate burden of infant mortality. Successful transformation of current approaches requires investment in staff training to garner buy-in, flexible resources and the development of new metrics to measure the impact of the life course approach on individual and programmatic outcomes.
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Hogan VK, Culhane JF, Crews KJ, Mwaria CB, Rowley DL, Levenstein L, Mullings LP. The impact of social disadvantage on preconception health, illness, and well-being: an intersectional analysis. Am J Health Promot 2013; 27:eS32-42. [PMID: 23286654 DOI: 10.4278/ajhp.120117-qual-43] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To understand how social and structural contexts shape individual risk, vulnerability, and interconception health-related behaviors of African-American women. APPROACH OR DESIGN: A longitudinal ethnographic study was conducted. SETTING The study was conducted in Philadelphia, Pennsylvania. PARTICIPANTS The sample included 19 African-American women who were participants in the intervention group of a randomized clinical trial of interconceptional care. METHOD Data were collected through interaction with participants over a period of 6 to 12 months. Participant observation , structured and unstructured interviews, and Photovoice were used to obtain data; grounded theory was used for analysis. The analysis was guided by intersectional theory. RESULTS Social disadvantage influenced health and health care-seeking behaviors of African-American women, and the disadvantage centered on the experience of racism. The authors identify seven experiences grounded in the interactions among the forces of racism, class, gender, and history that may influence women's participation in and the effectiveness of preconception and interconception health care. CONCLUSION African-American women's health and wellness behaviors are influenced by an experience of racism structurally embedded and made more virulent by its intersection with class, gender, and history. These intersecting forces create what may be a unique exposure that contributes significantly to the proximal determinants of health inequities for African-American women. Health promotion approaches that focus on the individual as the locus of intervention must concomitantly unravel and address the intertwining structural forces that shape individual circumstance in order to improve women's interconceptional health and to reduce disparities.
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Affiliation(s)
- Vijaya K Hogan
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7445, USA.
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Haughton B, Eppig K, Looney SM, Cunningham-Sabo L, Spear BA, Spence M, Stang JS. Incorporating the life course model into MCH nutrition leadership education and training programs. Matern Child Health J 2013; 17:136-46. [PMID: 22350632 DOI: 10.1007/s10995-012-0959-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Life course perspective, social determinants of health, and health equity have been combined into one comprehensive model, the life course model (LCM), for strategic planning by US Health Resources and Services Administration's Maternal and Child Health Bureau. The purpose of this project was to describe a faculty development process; identify strategies for incorporation of the LCM into nutrition leadership education and training at the graduate and professional levels; and suggest broader implications for training, research, and practice. Nineteen representatives from 6 MCHB-funded nutrition leadership education and training programs and 10 federal partners participated in a one-day session that began with an overview of the models and concluded with guided small group discussions on how to incorporate them into maternal and child health (MCH) leadership training using obesity as an example. Written notes from group discussions were compiled and coded emergently. Content analysis determined the most salient themes about incorporating the models into training. Four major LCM-related themes emerged, three of which were about training: (1) incorporation by training grants through LCM-framed coursework and experiences for trainees, and similarly framed continuing education and skills development for professionals; (2) incorporation through collaboration with other training programs and state and community partners, and through advocacy; and (3) incorporation by others at the federal and local levels through policy, political, and prevention efforts. The fourth theme focused on anticipated challenges of incorporating the model in training. Multiple methods for incorporating the LCM into MCH training and practice are warranted. Challenges to incorporating include the need for research and related policy development.
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Affiliation(s)
- Betsy Haughton
- Department of Nutrition, University of Tennessee, 1215 W. Cumberland Avenue, Knoxville, TN 36996-1920, USA.
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Liu Y, Murphy SK, Murtha AP, Fuemmeler BF, Schildkraut J, Huang Z, Overcash F, Kurtzberg J, Jirtle R, Iversen ES, Forman MR, Hoyo C. Depression in pregnancy, infant birth weight and DNA methylation of imprint regulatory elements. Epigenetics 2012; 7:735-46. [PMID: 22677950 PMCID: PMC3414394 DOI: 10.4161/epi.20734] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Depressed mood in pregnancy has been linked to low birth weight (LBW, < 2,500 g), a risk factor for adult-onset chronic diseases in offspring. We examined maternal depressed mood in relation to birth weight and evaluated the role of DNA methylation at regulatory sequences of imprinted genes in this association. We measured depressed mood among 922 pregnant women using the CES-D scale and obtained birth weight data from hospital records. Using bisulfite pyrosequencing of cord blood DNA from 508 infants, we measured methylation at differentially methylated regions (DMRs) regulating imprinted genes IGF2/H19, DLK1/MEG3, MEST, PEG3, PEG10/SGCE, NNAT and PLAGL1. Multiple regression models were used to examine the relationship between depressed mood, birth weight and DMR methylation levels. Depressed mood was associated with a more that 3-fold higher risk of LBW, after adjusting for delivery mode, parity, education, cigarette smoking, folic acid use and preterm birth. The association may be more pronounced in offspring of black women and female infants. Compared with infants of women without depressed mood, infants born to women with severe depressed mood had a 2.4% higher methylation at the MEG3 DMR. Whereas LBW infants had 1.6% lower methylation at the IGF2 DMR, high birth weight (> 4,500 g) infants had 5.9% higher methylation at the PLAGL1 DMR compared with normal birth weight infants. Our findings confirm that severe maternal depressed mood in pregnancy is associated with LBW, and that MEG3 and IGF2 plasticity may play important roles.
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Affiliation(s)
- Ying Liu
- School of Medicine, Duke University, Durham, NC, USA
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