1
|
Keefe-Oates B, Janiak E, Gottlieb B, Chen JT. Disparities in Postpartum Care Visits: The Dynamics of Parental Leave Duration and Postpartum Care Attendance. Matern Child Health J 2024; 28:1506-1516. [PMID: 38795280 PMCID: PMC11358175 DOI: 10.1007/s10995-024-03929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVES To understand differences in the relationship between parental leave duration and postpartum care across sociodemographic and income groups. METHODS We used data from six states participating in the Center for Disease Control and Prevention's yearly PRAMS study from 2016 to 2019 with a total sample of 12,442 people. Bivariable analyses assessed demographics among those who took more or less parental leave and estimated the prevalence of not accessing postpartum care by demographics, stratified by leave length. We used propensity score weighting to estimate the predicted risk and risk ratios of not accessing postpartum care with < 7 as compared to > = 7 weeks of leave, stratified by income. RESULTS There were significant differences in the prevalence of not accessing care stratified by leave duration, and disparities in utilization by race, ethnicity, and income. A shorter leave duration was associated with a higher risk of not accessing care (RR: 1.98 [CI 1.25-3.20] in higher income group, RR: 1.45 [CI 1.08, 1.99] in lower). The absolute risk of not accessing care was highest in the lower income group regardless of leave duration, though patterns of increased utilization with longer leave duration were consistent in both groups. CONCLUSIONS FOR PRACTICE While shorter leave durations increased the risk of not attending postpartum care, those with lower incomes had the highest absolute risk of not attending care. Policies to support paid leave and extended leave duration are necessary, along with additional supports to increase postpartum care utilization, particularly among low-income families.
Collapse
Affiliation(s)
- Brianna Keefe-Oates
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.
| | - Elizabeth Janiak
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Barbara Gottlieb
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| |
Collapse
|
2
|
Warren KF, Dail RB, Dawson RM, Boghossian NS, Felder TM. When a baby is born, so is a parent: Understanding the effects of preterm birth on Black parents through the lens of the NIMHD framework. Nurs Outlook 2024; 72:102246. [PMID: 39116649 DOI: 10.1016/j.outlook.2024.102246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 06/29/2024] [Accepted: 07/06/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND The rate of preterm birth (PTB) is high in the United States and Black infants remain disproportionately affected, with the disparity between Black and White infant deaths greater today than it was under antebellum slavery. PURPOSE The National Institute on Minority Health and Disparities Research Framework reflects a unique set of determinants relevant to the understanding and promotion of minority health. METHODS We have applied this framework to better understand the effects of PTB on Black parents and the distribution of the social determinants of health, including structural determinants and root causes of inequities. DISCUSSION This adaptation shows the intersection in maternal and infant health that shapes individuals' experiences, drives disparities and impacts perinatal outcomes in critical periods over the lifecourse. CONCLUSION In our efforts to achieve health equity, it is imperative that we study the underlying mechanisms and recognize that policies, institutional structures, and social factors are drivers of racism.
Collapse
Affiliation(s)
- Karen F Warren
- University of South Carolina, College of Nursing, Columbia, SC.
| | - Robin B Dail
- University of South Carolina, College of Nursing, Columbia, SC
| | - Robin M Dawson
- University of South Carolina, College of Nursing, Columbia, SC
| | - Nansi S Boghossian
- University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Tisha M Felder
- University of South Carolina, College of Nursing, Columbia, SC
| |
Collapse
|
3
|
Austin AE, DePadilla L, Niolon P, Stone D, Bacon S. Intersection of adverse childhood experiences, suicide and overdose prevention. Inj Prev 2024:ip-2024-045295. [PMID: 39053926 DOI: 10.1136/ip-2024-045295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024]
Abstract
Adverse childhood experiences (ACEs), suicide and overdose are linked across the life course and across generations and share common individual-, interpersonal-, community- and societal-level risk factors. The purpose of this review is to summarise the shared aetiology of these public health issues, synthesise evidence regarding potential community- and societal-level prevention strategies and discuss future research and practice directions.Growing evidence shows the potential for community- and societal-level programmes and policies, including higher minimum wage; expanded Medicaid eligibility; increased earned income tax credits, child tax credits and temporary assistance for needy families benefits; Paid Family Leave; greater availability of affordable housing and rental assistance; and increased participation in the Supplemental Nutrition Assistance Program (SNAP), to contribute to ACEs, suicide and overdose prevention. Considerations for future prevention efforts include (1) expanding the evidence base through rigorous research and evaluation; (2) assessing the implications of prevention strategies for equity; (3) incorporating a relational health perspective; (4) enhancing community capacity to implement, scale and sustain evidenced-informed prevention strategies; and (5) acknowledging that community- and societal-level prevention strategies are longer-term strategies.
Collapse
Affiliation(s)
- Anna E Austin
- Centers for Disease Control and Prevention National Center for Injury Prevention and Control, Atlanta, Georgia, USA
| | | | - Phyllis Niolon
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Sarah Bacon
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
4
|
Chin HB, Howards PP, Kramer MR, Johnson CY. Understanding the roles of state demographics and state policies in epidemiologic studies of maternal-child health disparities. Am J Epidemiol 2024; 193:819-826. [PMID: 38055631 DOI: 10.1093/aje/kwad240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
Disparities in maternal-child health outcomes by race and ethnicity highlight structural differences in the opportunity for optimal health in the United States. Examples of these differences include access to state-level social policies that promote maternal-child health. States vary in their racial and ethnic composition as a result of the complex history of policies and laws related to slavery, Indigenous genocide and relocation, segregation, immigration, and settlement in the United States. States also vary in the social policies they enact. As a result, correlations exist between the demographic makeup of a state's population and the presence or absence of social policies in that state. These correlations become a mechanism by which racial and ethnic disparities in maternal-child health outcomes can operate. In this commentary, we use the example of 3 labor-related policies actively under consideration at state and federal levels (paid parental leave, paid sick leave, and reasonable accommodations during pregnancy) to demonstrate how correlations between state demographics and presence of these state policies could cause or exacerbate racial and ethnic disparities in maternal-child health outcomes. We conclude with a call for researchers to consider how the geographic distribution of racialized populations and state policies could contribute to maternal-child health disparities.
Collapse
Affiliation(s)
- Helen B Chin
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA 22030, United States
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States
| | - Candice Y Johnson
- Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC 27705, United States
| |
Collapse
|
5
|
Goodman JM, Crawford AM, Cottrell EK, Guise JM. "How Do I Prepare for This?" Patient Perspectives on Providers' Employment-related Support During Pregnancy. Womens Health Issues 2024; 34:291-302. [PMID: 38383227 PMCID: PMC11116059 DOI: 10.1016/j.whi.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/29/2023] [Accepted: 01/12/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Health care providers can offer employment-related support to pregnant patients by providing information about occupational risks and benefits, discussing adjustments, and/or completing paperwork to help patients obtain accommodations or benefits, but little research has examined whether and how this support is provided. METHODS We conducted interviews with 20 adults who had been employed while pregnant within the 5 years preceding data collection. Eligible participants had low incomes, were hourly wage earners, or were employed in service or retail occupations. Applied thematic analysis was used to identify emergent themes. RESULTS People who had been employed while pregnant described a range of experiences during that time, including physical and psychological demands from work, lack of access to appropriate accommodations, difficulties combining breastfeeding with work, and work-related challenges accessing health care. Participants described four primary roles that health care providers played: 1) completing paperwork needed to apply for benefits or receive work modification; 2) providing information about how to mitigate employment-related risks; 3) providing referrals to social or medical services; and 4) advocating for patients to ensure receipt of accommodations, resources, and information. Strategies identified by patients that could be enacted within health care to help them better navigate the work-pregnancy interface include increasing appointment flexibility, providing information about work-related risks and benefits programs and referrals to legal support, and helping providers to understand and support their patients' individual work-related concerns. CONCLUSIONS Health care providers have a critical role to play in supporting employed pregnant people to achieve flexibility in managing their work and to be active participants in discussions about recommended workplace accommodations.
Collapse
Affiliation(s)
| | | | - Erika K Cottrell
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon; OCHIN, Inc., Portland, Oregon
| | - Jeanne-Marie Guise
- Harvard Medical School, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts
| |
Collapse
|
6
|
Wicklund L, Epstein A, Szugye H, Schleicher M, Lam SK. Association Between Length of Maternity Leave and Breastfeeding Duration in the United States: A Systematic Review. Obstet Gynecol 2024; 143:e107-e124. [PMID: 38207334 DOI: 10.1097/aog.0000000000005502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To perform a systematic review to assess the association between the length of maternity leave and breastfeeding duration in the United States. DATA SOURCES AND METHODS OF STUDY SELECTION This review was conducted with a five-stage model for reviews. We included publications from 2000 to 2023, U.S.-based studies written in English, and primary research and peer-reviewed articles. In February 2023, a medical librarian conducted a search across seven databases, yielding 1,540 results. ClinicalTrials.gov was later searched, yielding no results. After duplicates were removed, 835 abstracts were screened. A full-text article review was then conducted of the remaining 34 articles. TABULATION, INTEGRATION, AND RESULTS Twenty-three articles met inclusion criteria, two of which were reviews. Of the nonreview articles, all found a positive relationship between increased maternity leave and duration of breastfeeding. Data showed that earlier return to work for the birth parent decreased the odds of breastfeeding dyads meeting breastfeeding recommendations. Many studies adjusted for confounders (eg, race, socioeconomic status); however, Black or Latinx mothers still experience shorter breastfeeding durations or lower breastfeeding exclusivity when given equal leave compared with White mothers. CONCLUSION Results show a positive relationship between length of maternity leave and breastfeeding duration. Advocacy for longer, paid parental leave and more robust research rooted in rigorous methods are needed.
Collapse
Affiliation(s)
- Lorena Wicklund
- Case Western Reserve University School of Medicine, the Cleveland Clinic Lerner College of Medicine, and the Cleveland Clinic Foundation, Cleveland Ohio
| | | | | | | | | |
Collapse
|
7
|
Duh-Leong C, Canfield CF, Fuller AE, Gross RS, Reichman NE. Early Childcare Precarity and Subsequent Maternal Health. Womens Health Issues 2024; 34:115-124. [PMID: 37978038 PMCID: PMC10978296 DOI: 10.1016/j.whi.2023.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE We examined prospective associations between early childcare precarity, or the security and reliability of childcare arrangements, and subsequent maternal health. STUDY DESIGN We conducted a secondary analysis of survey responses from mothers of 2,836 children in the Future of Families and Child Wellbeing study. We assessed the following childcare measures: insecure childcare, insecure childcare with missed work, inadequate childcare, and emergency childcare support. We used linear and logistic regression models with robust standard errors to examine associations between these measures when the index child was age 3 and maternal health outcomes (overall health, depression, and parenting stress) later when the child was age 9. We then examined additive experiences of childcare measures across child ages 1 and 3 on maternal health outcomes. RESULTS Early inadequate childcare was associated with higher odds of later poor maternal overall health (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.11-2.41). All early childcare precarity measures were associated with higher odds of maternal depression (insecure childcare [aOR, 1.64; 95% CI, 1.23-2.18]; insecure childcare with missed work [aOR, 1.58; 95% CI, 1.13-2.22]; and inadequate childcare [aOR, 1.75; 95% CI, 1.22-2.51]). Emergency childcare support was associated with lower odds of adverse maternal health outcomes (poor overall health [aOR, 0.65; 95% CI, 0.48 to 0.88]; depression [aOR, 0.73; 95% CI, 0.54 to 0.99]; and parenting stress [B -0.45; 95% CI, -0.80 to -0.10]). Prolonged experiences had stronger associations with maternal health than shorter experiences. CONCLUSION Early childcare precarity has long-term adverse associations with maternal health, and emergency childcare support seems to be favorable for maternal health. These findings highlight childcare precarity as a social determinant of women's health for researchers, clinicians, and decision-makers.
Collapse
Affiliation(s)
- Carol Duh-Leong
- Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York, New York.
| | - Caitlin F Canfield
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York, New York
| | - Anne E Fuller
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Rachel S Gross
- Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York, New York
| | - Nancy E Reichman
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey; Child Health Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| |
Collapse
|
8
|
Sajja A, Tundealao S. Commentary: Disparities and Racial Barriers Among African American Women Despite Breastfeeding Workplace Policies. FAMILY & COMMUNITY HEALTH 2024; 47:59-61. [PMID: 37830515 DOI: 10.1097/fch.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Affiliation(s)
- Anusha Sajja
- The University of Texas Health Science Center at Houston
| | | |
Collapse
|
9
|
Pac J, Bartel A, Ruhm C, Waldfogel J. Paid family leave and parental investments in infant health: Evidence from California. ECONOMICS AND HUMAN BIOLOGY 2023; 51:101308. [PMID: 37812832 DOI: 10.1016/j.ehb.2023.101308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 07/28/2023] [Accepted: 09/26/2023] [Indexed: 10/11/2023]
Abstract
This paper evaluates the effect of Paid Family Leave (PFL) on breastfeeding and immunizations- two critical parental investments in infant health - which we identify using California's 2004 PFL policy that ensured mothers up to six weeks of leave at a 55% wage replacement rate. We employ difference-in-difference and difference-in-difference-in-differences models for a large, representative sample of children (N = 314,532) born between 2000 and 2013 drawn from the restricted-use versions of the 2003-2014 National Immunization Surveys. Our most conservative estimates indicate that access to PFL is associated with at least a 15% increase in breastfeeding exclusively for at least six months. We find substantially large effects for disadvantaged mothers, adding to the existing evidence that access to state-sanctioned paid family leave might benefit children overall and disadvantaged children in particular.
Collapse
Affiliation(s)
- Jessica Pac
- University of Wisconsin-Madison Institute for Research on Poverty and Sandra Rosenbaum School of Social Work, 1350 University Ave., Madison, WI 53706, USA.
| | - Ann Bartel
- Columbia University, Columbia Business School, 623 Uris, New York, NY 10027, USA
| | - Christopher Ruhm
- University of Virginia, Frank Batten School of Leadership and Public Policy, Garrett Hall 108, Charlottesville, VA 22904, USA
| | - Jane Waldfogel
- Columbia School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY 10027, USA
| |
Collapse
|
10
|
Goodman JM, Schneider D. Racial/ethnic and gender inequities in the sufficiency of paid leave during the COVID-19 pandemic: Evidence from the service sector. Am J Ind Med 2023; 66:928-937. [PMID: 37640673 PMCID: PMC10684272 DOI: 10.1002/ajim.23533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Access to paid family and medical leave (PFML), including leave to care for a seriously ill loved one or recover from one's own serious illness, conveys health and economic benefits for workers and their families. However, without a national PFML policy, access to paid leave remains limited and unequal. Previous work documenting inequitable access by socioeconomic status and race/ethnicity primarily focuses on parental leave, measures theoretical access to paid leave rather than actual leave uptake, and lacks an accounting for why workers of color and women may have less access to PFML. We extend this literature by looking at leave-taking for medical needs or caregiving among a high-risk population during the COVID-19 pandemic. METHODS We draw on data from 2595 service-sector workers surveyed by the Shift Project in 2020 and 2021 to estimate inequities in leave uptake among workers who experienced qualifying events. We then estimate the relative importance of worker demographic characteristics, qualifying event types (medical vs. caregiving leave), proxies for access to state and employer PFML policies, job characteristics, and ultimately within-firm differences to these gaps. RESULTS Overall, one-fifth of workers reported sufficient leave. Women are significantly more likely than men to report insufficient or no leave. Hispanic and Black workers are more likely to take insufficient or no leave, respectively, but these differences were attenuated when controlling for covariates. CONCLUSIONS The dearth of PFML laws leaves women and workers of color without access to leave that is paid and of sufficient duration when facing a qualifying event.
Collapse
Affiliation(s)
- Julia M. Goodman
- Oregon Health & Science University—Portland State University School of Public Health
| | | |
Collapse
|
11
|
Catalao R, Zephyrin L, Richardson L, Coghill Y, Smylie J, Hatch SL. Tackling racism in maternal health. BMJ 2023; 383:e076092. [PMID: 37875287 DOI: 10.1136/bmj-2023-076092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Affiliation(s)
- Raquel Catalao
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Laurie Zephyrin
- Advancing Health Equity, Commonwealth Fund, New York, NY, USA
| | - Lisa Richardson
- Institute of Women and Ethnic Studies, UNO Research and Technology Foundation, New Orleans, USA
| | - Yvonne Coghill
- Excellence in Action, Workforce Race Equality, NHS London, UK
| | - Janet Smylie
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health, Toronto Canada
- Dalla Lana School of Public Health and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, UK
| |
Collapse
|
12
|
Richardson MB, Toluhi AA, Baskin ML, Budhwani H, Julian ZI, Knight CC, Sinkey R, Szychowski JM, Tita AT, Wingate MS, Turan JM. Community and Systems Contributors and Strategies to Reduce Racial Inequities in Maternal Health in the Deep South: Provider Perspectives. Health Equity 2023; 7:581-591. [PMID: 37736520 PMCID: PMC10510686 DOI: 10.1089/heq.2023.0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 09/23/2023] Open
Abstract
Purpose Black pregnant individuals in Alabama are disproportionately affected by severe maternal morbidity and mortality (SMM). To understand why racial disparities in maternal health outcomes persist and identify potential strategies to reduce these inequities, we sought perspectives from obstetric health care providers, health administrators, and members of local organizations who provide pregnancy, delivery, and postpartum care services in Alabama. Methods We conducted qualitative in-depth interviews with stakeholders (n=20), purposively recruited from community-based organizations, clinical settings, government organizations, and academic institutions. Interview guides were based on Howell's conceptual model of pathways to racial disparities in maternal mortality. Data were coded using a modified framework theory approach and analyzed thematically. Results Racism, unjust laws and policies, and poverty/lack of infrastructure in communities emerged as major themes contributing to racial disparities in maternal health at the community and systems levels. Inadequate health insurance coverage was described as a strong driver of the disparities. Service providers suggested strategies for Alabama should be community focused, evidence based, and culturally sensitive. These should include Medicaid expansion, expanded parental leave, and removal of laws restricting choice. Community- and systems-level interventions should include community infrastructure improvements, choice in maternity services, and provision of digital communication options. Conclusions Providers shared perspectives on community and structural areas of intervention to reduce racial inequities in SMM. These results can inform discussions with health system and community partners about Alabama and other Deep South initiatives to improve maternal health outcomes in black communities.
Collapse
Affiliation(s)
- Molly B. Richardson
- Department of Health Policy and Organization, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Angelina A. Toluhi
- Department of Health Policy and Organization, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Monica L. Baskin
- Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
| | - Henna Budhwani
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University (FSU), Tallahassee, Florida, USA
| | - Zoë I. Julian
- Department of Obstetrics and Gynecology, WellStar Kennestone Regional Medical Center, Marietta, Georgia, USA
| | - Candace C. Knight
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
- School of Nursing, UAB, Birmingham, Alabama, USA
| | - Rachel Sinkey
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, UAB, Birmingham, Alabama, USA
| | - Jeff M. Szychowski
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
- Department of Biostatistics, UAB, Birmingham, Alabama, USA
| | - Alan T.N. Tita
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, UAB, Birmingham, Alabama, USA
| | - Martha S. Wingate
- Department of Health Policy and Organization, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
| | - Janet M. Turan
- Department of Health Policy and Organization, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- Center for Women's Reproductive Health, UAB, Birmingham, Alabama, USA
| |
Collapse
|
13
|
Hamilton C, Sariscsany L, Waldfogel J, Wimer C. Experiences of Poverty Around the Time of a Birth: A Research Note. Demography 2023; 60:965-976. [PMID: 37326011 DOI: 10.1215/00703370-10837403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
While research highlights that, on average, women's income and labor force participation fall around the time of a birth, little is known about how women's experiences of poverty around childbirth vary by birth parity or race and ethnicity. Using data from the Survey of Income and Program Participation and the Supplemental Poverty Measure (a comprehensive measure of poverty), this research note examines the poverty rate of mothers overall and by birth parity and racial and ethnic group in the six months before and after childbirth. We also assess the role of current government support programs in moderating financial losses during the time around a birth. We find that poverty rates among mothers increase after childbirth, with the magnitude varying by birth parity and racial and ethnic group. While current government programs help reduce poverty among mothers around childbirth, these programs do not protect mothers from falling into poverty after childbirth nor do they reduce the inequities in poverty by race or ethnicity. Our results highlight the need for greater public assistance for mothers with recent births to ensure improved child and family well-being and also call attention to the need for policies to address long-standing racial and ethnic inequities in child and family well-being.
Collapse
Affiliation(s)
- Christal Hamilton
- Center on Poverty and Social Policy, Columbia University, New York, NY, USA
| | - Laurel Sariscsany
- Grace Abbott School of Social Work, University of Nebraska, Omaha, NE, USA
| | - Jane Waldfogel
- School of Social Work, Columbia University, New York, NY, USA
| | - Christopher Wimer
- Center on Poverty and Social Policy, Columbia University, New York, NY, USA
| |
Collapse
|
14
|
Estrada KA, Govindaraj S, Abdi H, Moraglia LE, Wolff JJ, Meera SS, Dager SR, McKinstry RC, Styner MA, Zwaigenbaum L, Piven J, Swanson MR. Language exposure during infancy is negatively associated with white matter microstructure in the arcuate fasciculus. Dev Cogn Neurosci 2023; 61:101240. [PMID: 37060675 PMCID: PMC10130606 DOI: 10.1016/j.dcn.2023.101240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/17/2023] Open
Abstract
Decades of research have established that the home language environment, especially quality of caregiver speech, supports language acquisition during infancy. However, the neural mechanisms behind this phenomenon remain under studied. In the current study, we examined associations between the home language environment and structural coherence of white matter tracts in 52 typically developing infants from English speaking homes in a western society. Infants participated in at least one MRI brain scan when they were 3, 6, 12, and/or 24 months old. Home language recordings were collected when infants were 9 and/or 15 months old. General linear regression models indicated that infants who heard the most adult words and participated in the most conversational turns at 9 months of age also had the lowest fractional anisotropy in the left posterior parieto-temporal arcuate fasciculus at 24 months. Similarly, infants who vocalized the most at 9 months also had the lowest fractional anisotropy in the same tract at 6 months of age. This is one of the first studies to report significant associations between caregiver speech collected in the home and white matter structural coherence in the infant brain. The results are in line with prior work showing that protracted white matter development during infancy confers a cognitive advantage.
Collapse
Affiliation(s)
- Katiana A Estrada
- Department of Psychological Sciences, Purdue University, West Lafayette, IN 47906, USA; Department of Psychology, The University of Texas at Dallas, Richardson, TX 75080, USA
| | - Sharnya Govindaraj
- Department of Psychology, The University of Texas at Dallas, Richardson, TX 75080, USA
| | - Hervé Abdi
- Department of Psychology, The University of Texas at Dallas, Richardson, TX 75080, USA
| | - Luke E Moraglia
- Department of Psychology, The University of Texas at Dallas, Richardson, TX 75080, USA
| | - Jason J Wolff
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Shoba Sreenath Meera
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, India
| | - Stephen R Dager
- Department of Radiology, University of Washington, Seattle, WA 98195, USA
| | - Robert C McKinstry
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Martin A Styner
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton AB T6G 2R3, Canada
| | - Joseph Piven
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Meghan R Swanson
- Department of Psychology, The University of Texas at Dallas, Richardson, TX 75080, USA.
| |
Collapse
|
15
|
Guez-Barber D, Eisch AJ, Cristancho AG. Developmental Brain Injury and Social Determinants of Health: Opportunities to Combine Preclinical Models for Mechanistic Insights into Recovery. Dev Neurosci 2023; 45:255-267. [PMID: 37080174 PMCID: PMC10614252 DOI: 10.1159/000530745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/14/2023] [Indexed: 04/22/2023] Open
Abstract
Epidemiological studies show that social determinants of health are among the strongest factors associated with developmental outcomes after prenatal and perinatal brain injuries, even when controlling for the severity of the initial injury. Elevated socioeconomic status and a higher level of parental education correlate with improved neurologic function after premature birth. Conversely, children experiencing early life adversity have worse outcomes after developmental brain injuries. Animal models have provided vital insight into mechanisms perturbed by developmental brain injuries, which have indicated directions for novel therapeutics or interventions. Animal models have also been used to learn how social environments affect brain maturation through enriched environments and early adverse conditions. We recognize animal models cannot fully recapitulate human social circumstances. However, we posit that mechanistic studies combining models of developmental brain injuries and early life social environments will provide insight into pathways important for recovery. Some studies combining enriched environments with neonatal hypoxic injury models have shown improvements in developmental outcomes, but further studies are needed to understand the mechanisms underlying these improvements. By contrast, there have been more limited studies of the effects of adverse conditions on developmental brain injury extent and recovery. Uncovering the biological underpinnings for early life social experiences has translational relevance, enabling the development of novel strategies to improve outcomes through lifelong treatment. With the emergence of new technologies to analyze subtle molecular and behavioral phenotypes, here we discuss the opportunities for combining animal models of developmental brain injury with social construct models to deconvolute the complex interactions between injury, recovery, and social inequity.
Collapse
Affiliation(s)
- Danielle Guez-Barber
- Division of Child Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amelia J. Eisch
- Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ana G. Cristancho
- Division of Child Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
16
|
Johnson TJ, Meier PP, Robinson DT, Suzuki S, Kadakia S, Garman AN, Patel AL. The Role of Work as a Social Determinant of Health in Mother's Own Milk Feeding Decisions for Preterm Infants: A State of the Science Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:416. [PMID: 36979974 PMCID: PMC10046918 DOI: 10.3390/children10030416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/28/2022] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
In the United States, 10% of infants are born preterm (PT; <37 weeks gestational age) each year and are at higher risk of complications compared to full term infants. The burden of PT birth is borne disproportionately by Black versus non-Black families, with Black mothers significantly more likely to give birth to a PT infant. One proven strategy to improve short- and long-term health outcomes in PT infants is to feed mother's own milk (MOM; breast milk from the mother). However, mothers must make decisions about work and MOM provision following PT birth, and more time spent in paid work may reduce time spent in unpaid activities, including MOM provision. Non-Black PT infants are substantially more likely than Black PT infants to receive MOM during the birth hospitalization, and this disparity is likely to be influenced by the complex decisions mothers of PT infants make about allocating their time between paid and unpaid work. Work is a social determinant of health that provides a source of income and health insurance coverage, and at the same time, has been shown to create disparities through poorer job quality, lower earnings, and more precarious employment in racial and ethnic minority populations. However, little is known about the relationship between work and disparities in MOM provision by mothers of PT infants. This State of the Science review synthesizes the literature on paid and unpaid work and MOM provision, including: (1) the complex decisions that mothers of PT infants make about returning to work, (2) racial and ethnic disparities in paid and unpaid workloads of mothers, and (3) the relationship between components of job quality and duration of MOM provision. Important gaps in the literature and opportunities for future research are summarized, including the generalizability of findings to other countries.
Collapse
Affiliation(s)
- Tricia J. Johnson
- Department of Health Systems Management, Rush University, Chicago, IL 60612, USA
| | - Paula P. Meier
- College of Nursing, Rush University, Chicago, IL 60612, USA
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| | - Daniel T. Robinson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Sumihiro Suzuki
- Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL 60612, USA
| | - Suhagi Kadakia
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| | - Andrew N. Garman
- Department of Health Systems Management, Rush University, Chicago, IL 60612, USA
| | - Aloka L. Patel
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| |
Collapse
|
17
|
Pereira EL, Estabrooks PA, Arjona A, Cotton-Curtis W, Lin JCP, Saetermoe CL, Blackman KCA. A systematic literature review of breastfeeding interventions among Black populations using the RE-AIM framework. Int Breastfeed J 2022; 17:86. [PMID: 36528606 PMCID: PMC9758845 DOI: 10.1186/s13006-022-00527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/15/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Lactation support resources are less likely to be located in close proximity to where Black families live and there is a systemic racist health care belief that Black women prefer bottle feeding (with infant formula) over breastfeeding. Together, these lead to lower reported breastfeeding rates of Black babies compared to other racial / ethnic groups. It is imperative to have a deeper understanding of the cultural aspects as well as the underlying limitations that prevent Black women / persons from being supported to breastfeed. There is a need to know how effective breastfeeding interventions are in reaching the intended population; how well they work in promoting breastfeeding initiation and continuation; and how successful they are when implemented at the setting and staff level. The purpose of this investigation was to establish the level of internal and external validity that was reported by breastfeeding intervention studies among Black communities. METHODS Studies on breastfeeding interventions on Black people that were published between the years 1990 and 2019 were carefully examined through PubMed, EBSCOhost, Web of Science, and OneSearch. A total of 31 studies fulfilled the requirements to be included for this evaluation. In order to extract the information from the articles, the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework extraction tool was utilized. RESULTS On average, the proportion of studies that reported across reach, effectiveness, adoption, implementation, and maintenance indicators was 54, 35, 19, 48, and 9%, respectively. Across core RE-AIM indicators only sample size (100%) and breastfeeding outcomes (90%) were reported consistently. External validity indicators related to representativeness of participants (16%) and sites (3%) were rarely reported. Similarly, adherence to intervention protocol, and indicator of internal validity, was reported in a small proportion of articles (19%). CONCLUSION This body of literature under-reported on aspects associated to both internal and external validity across all RE-AIM domains. The reporting of the individual level of representativeness; the setting level of representativeness; the intervention's adherence to the protocol; the expenses; and the factors of sustainability would benefit from improvement in future research.
Collapse
Affiliation(s)
| | - Paul A Estabrooks
- Department of Health & Kinesiology, University of Utah, Salt Lake City, USA
| | - Alejandro Arjona
- Department of Family & Consumer Sciences, California State University Northridge, Northridge, USA
| | - Wyconda Cotton-Curtis
- Department of Health Sciences, California State University Northridge, Northridge, USA
| | - Judith C P Lin
- The Health Equity Research and Education Center, California State University Northridge, Northridge, USA
| | - Carrie L Saetermoe
- The Health Equity Research and Education Center, California State University Northridge, Northridge, USA
| | - Kacie C A Blackman
- Department of Health Sciences, California State University Northridge, Northridge, USA.
- The Health Equity Research and Education Center, California State University Northridge, Northridge, USA.
| |
Collapse
|
18
|
Clark SG, Cohen A, Heard-Garris N. Moving Beyond Words: Leveraging Financial Resources to Improve Diversity, Equity, and Inclusion in Academic Medical Centers. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09914-4. [PMID: 36495346 PMCID: PMC9739343 DOI: 10.1007/s10880-022-09914-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 12/14/2022]
Abstract
Diversity, equity, and inclusion (DEI) efforts at academic medical centers (AMCs) began prior to 2020, but have been accelerated after the death of George Floyd, leading many AMCs to recommit their support for DEI. Institutions crafted statements to decry racism, but we assert that institutions must make a transparent, continuous, and robust financial investment to truly show their commitment to DEI. This financial investment should focus on (1) advocacy efforts for programs that will contribute to DEI in health, (2) pipeline programs to support and guide minoritized students to enter health professions, and (3) the recruitment and retention of minoritized faculty. While financial investments will not eliminate all DEI concerns within AMCs, investing significant financial resources consistently and intentionally will better position AMCs to truly advance diversity, equity, and inclusion within healthcare, the community, and beyond.
Collapse
Affiliation(s)
- Shawnese Gilpin Clark
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL USA ,Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E Chicago Avenue, Box 162, Chicago, IL 60611 USA
| | - Alyssa Cohen
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL USA ,Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Nia Heard-Garris
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL USA ,Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E Chicago Avenue, Box 162, Chicago, IL 60611 USA ,Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| |
Collapse
|
19
|
Clark A, Wescott P, Mitchell N, Mahdi I, Crear-Perry J. Centering equity: Addressing structural and social determinants of health to improve maternal and infant health outcomes. Semin Perinatol 2022; 46:151661. [PMID: 36192244 DOI: 10.1016/j.semperi.2022.151661] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite decades of investment and improvements in infant health in the United States, efforts to ensure the health and well-being of birthing people, especially those from racialized and minoritized communities, have been underfunded and neglected. As a result, many birthing people do not have access to the quality care they deserve and suffer disproportionately from adverse health outcomes such as severe maternal morbidity and maternal mortality. Through a Reproductive Justice lens, this paper will discuss structural causes for maternal health disparities as well as some of the structural solutions necessary to support the correction of centuries of discrimination on the basis of race, sex, gender, and other minoritized identities.
Collapse
Affiliation(s)
- Aja Clark
- National Birth Equity Collaborative, 4747 Earhart Blvd., Suite I, New Orleans, LA 70125, United States.
| | - Phoebe Wescott
- National Birth Equity Collaborative, 4747 Earhart Blvd., Suite I, New Orleans, LA 70125, United States
| | - Nia Mitchell
- National Birth Equity Collaborative, 4747 Earhart Blvd., Suite I, New Orleans, LA 70125, United States
| | - Inas Mahdi
- National Birth Equity Collaborative, 4747 Earhart Blvd., Suite I, New Orleans, LA 70125, United States
| | - Joia Crear-Perry
- National Birth Equity Collaborative, 4747 Earhart Blvd., Suite I, New Orleans, LA 70125, United States
| |
Collapse
|
20
|
Tomori C, Palmquist AEL. Racial capitalism and the US formula shortage: A policy analysis of the formula industry as a neocolonial system. FRONTIERS IN SOCIOLOGY 2022; 7:961200. [PMID: 36386859 PMCID: PMC9644151 DOI: 10.3389/fsoc.2022.961200] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
The U.S. is currently experiencing a formula shortage and an infant feeding crisis that began with a formula recall and the hospitalization of 4 infants, 2 of whom died. Since 1981, governments around the world have been calling for an end to blatant human rights violations made by the commercial milk formula (CMF) industry. These practices not only involve targeting nutritionally vulnerable populations of mothers and newborns to turn a profit, but also actively undermining the implementation of policies, legislation, and regulatory oversight that might compromise their accumulation of wealth. In this paper we analyze the 2022 formula-shortage-as-infant-feeding-crisis through the lens of the history of colonialism and critical theory in the anthropology of reproduction. First, we provide an overview of the colonial roots of the formula industry from a global perspective. We then focus on how the mechanisms of racial exploitation remain entrenched in the U.S. approach to infant feeding policies, regulation and investment, setting the stage for the current infant feeding crisis. Through our analysis of the 2022 infant feeding crisis we demonstrate how the multinational CMF industry perpetuates racial capitalism and racialized health inequities and disparities through its operations as a neocolonial enterprise. Finally, we offer policy interventions and potential solutions that are grounded in structural interventions for more equitable, anticolonial, antiracist infant feeding systems.
Collapse
Affiliation(s)
- Cecília Tomori
- Johns Hopkins University School of Nursing and the Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Aunchalee E. L. Palmquist
- Department of Maternal and Child Health, Gillings School of Global Public Health, Carolina Global Breastfeeding Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
21
|
Karasek D, Raifman S, Dow WH, Hamad R, Goodman JM. Evaluating the Effect of San Francisco's Paid Parental Leave Ordinance on Birth Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191911962. [PMID: 36231264 PMCID: PMC9565022 DOI: 10.3390/ijerph191911962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 06/12/2023]
Abstract
Since 2017, San Francisco's Paid Parental Leave Ordinance (PPLO) has allowed parents who work for private-sector employers to take 6 weeks of fully paid postnatal parental leave. Previous studies have linked paid parental leave with health improvements for birthing people and babies, although evidence for birth outcomes is limited. We hypothesized that the PPLO may have improved birth outcomes via reduced stress during pregnancy due to anticipation of increased financial security and postnatal leave. We used linked California birth certificate and hospital discharge records from January 2013 to December 2018 (n = 1,420,781). We used quasi-experimental difference-in-difference (DD) models to compare outcomes among SF births before and after PPLO to outcomes among births in control counties. Births from January 2017 through December 2018 among working San Francisco (SF) people were considered "exposed" to PPLO; births during this time among working people outside of SF, as well as all births before 2017, served as controls. We conducted subgroup analyses by race/ethnicity, education and Medicaid coverage at delivery. Overall analyses adjusting for covariates and indicators for time and seasonality indicated no association between PPLO and birth outcomes. Our results indicate that PPLO may not have affected the birth outcomes we examined among marginalized groups who, due to structural racism, are at heightened risk of poor outcomes. We speculate that this result is due to the PPLO's design and focus on postnatal leave. Future work should examine the policy's effects on other outcomes.
Collapse
Affiliation(s)
- Deborah Karasek
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA 94143, USA
| | - Sarah Raifman
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94158, USA
| | - William H. Dow
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Rita Hamad
- Department of Family and Community Medicine, University of California, San Francisco, CA 94143, USA
| | - Julia M. Goodman
- Oregon Health & Science University—Portland State University School of Public Health, Portland, OR 97201, USA
| |
Collapse
|
22
|
Goodman JM, Richardson DM, Dow WH. Racial and Ethnic Inequities in Paid Family and Medical Leave: United States, 2011 and 2017-2018. Am J Public Health 2022; 112:1050-1058. [PMID: 35728032 DOI: 10.2105/ajph.2022.306825] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine racial and ethnic inequities in paid family and medical leave (PFML) access and the extent to which these inequities are mediated by employment characteristics. Methods. We used data from the 2011 and 2017-2018 American Time Use Survey in the United States to describe paid leave access by race/ethnicity. We present unadjusted models, models stratified by policy-targetable employment characteristics, and adjusted regression models. Results. We found that 54.4% of non-Hispanic White workers reported access to PFML in 2017-2018 but that access was significantly lower among Asian, Black, and Hispanic workers. Inequities were strongest among private-sector and nonunionized workers. Leave access improved slightly between 2011 and 2017-2018, but the inequity patterns were unchanged. Conclusions. We observed large and significant racial and ethnic inequities in access to PFML that were only weakly mediated by job characteristics. PFML has a range of health benefits for workers and their families, but access remains limited and inequitable. Public Health Implications. Our findings suggest that broad PFML mandates (such as those in other high-income countries) may be needed to substantially narrow racial and ethnic gaps in paid leave access. (Am J Public Health. 2022;112(7):1050-1058. https://doi.org/10.2105/AJPH.2022.306825).
Collapse
Affiliation(s)
- Julia M Goodman
- Julia M. Goodman and Dawn M. Richardson are with the Oregon Health and Science University and Portland State University School of Public Health, Portland. William H. Dow is with the School of Public Health, University of California, Berkeley
| | - Dawn M Richardson
- Julia M. Goodman and Dawn M. Richardson are with the Oregon Health and Science University and Portland State University School of Public Health, Portland. William H. Dow is with the School of Public Health, University of California, Berkeley
| | - William H Dow
- Julia M. Goodman and Dawn M. Richardson are with the Oregon Health and Science University and Portland State University School of Public Health, Portland. William H. Dow is with the School of Public Health, University of California, Berkeley
| |
Collapse
|
23
|
Kossek EE, Kelliher C. Making Flexibility More I-Deal: Advancing Work-Life Equality Collectively. GROUP & ORGANIZATION MANAGEMENT 2022. [DOI: 10.1177/10596011221098823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Current research on negotiated individualized flexible work arrangements focuses on highly paid, skilled professional workers. We refer to this as “flexibility through privilege,” the ability to obtain “flexibility I-deals,” due to high labor market power. Yet as work-life tensions grow across occupations globally, most individuals need increased access to flexibility. As the COVID-19 pandemic illuminated, work-life equality, the ability of workers to have equal access to, opportunity to use, and benefit from flexible working arrangements is a rising form of job inequality. We examine how existing flexibility i-deals can be reconceptualized more broadly to include collectively bargained arrangements across many occupations, and flexible working forms. Our essay advances understanding by (1) broadening notions of the typical employee and occupation involved; (2) expanding negotiation processes beyond an organizational sphere of control; (3) identifying new forms of negotiated flexibility such as control over work-life boundaries and technological availability; and (4) addressing not only employer-employee mutual benefits, but larger societal interests concurrent with new tensions and unintended consequences of mainstreamed implementation. We propose the term “collective flexibility” as the collective right of workers to customize their work schedule, place, workload, boundaries, connectivity, and employment mode with their employer and other stakeholders to benefit employers, employees, and society. We offer a future research agenda. Expanding how we frame and study what a flexibility i-deal is with a collective approach regarding how they are accessed, negotiated, maintained, and who they serve may enhance their potential as a lever for social change to advance economic, social, and health employment rights.
Collapse
Affiliation(s)
- Ellen Ernst Kossek
- Krannert School of Management, Purdue University, West Lafayette, IN, USA
| | - Clare Kelliher
- School of Management, Cranfield University, Bedfordshire, UK
| |
Collapse
|
24
|
Goodman JM. Public Health Benefits of Paid Family Leave Policies Depend on Equitable Policy Design. Am J Public Health 2022; 112:194-196. [PMID: 35080953 PMCID: PMC8802572 DOI: 10.2105/ajph.2021.306632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Julia M. Goodman
- Julia M. Goodman is with the Oregon Health and Science University and Portland State University School of Public Health, Portland
| |
Collapse
|