Maternal Health-Seeking on Behalf of Low-Income Children

Combined Sewer Overflows and Gastrointestinal Illness in Atlanta, 2002-2013: Evaluating the Impact of Infrastructure Improvements

BACKGROUND

Combined sewer overflows (CSOs) discharge untreated sewage into surface and recreational water, often following heavy precipitation. Given projected increases in frequency and intensity of precipitation due to climate change, it is important to understand the health impacts of CSOs and mediating effects of sewerage systems.

OBJECTIVES

In this study we estimate associations of CSO events and emergency department (ED) visits for gastrointestinal (GI) illness among City of Atlanta, Georgia, residents and explore how these associations vary with sewerage improvements.

METHODS

We estimate associations using Poisson generalized linear models, controlling for time trends. We categorized CSOs by overflow volume and assessed effects of CSO events prior to ED visits with 1-, 2- and 3-wk lags. Similarly, we evaluated effects of weekly cumulative precipitation greater than the 90th percentile at the same lags. We also evaluated effect modification by ZIP Code Tabulation Area (ZCTA)-level poverty and infrastructure improvement period using interaction terms.

RESULTS

Occurrence of a large volume CSO in the previous week was associated with a 9% increase in daily ED visits for GI illness. We identified significant interaction by ZCTA-level poverty, with stronger CSO-GI illness associations in low than high poverty areas. Among areas with low poverty, we observed associations at 1-wk and longer lags, following both large and lower volume CSO events. We did not observe significant interaction by infrastructure improvement period for CSO- nor precipitation-GI illness associations; however, the number of CSO events decreased from 2.31 per week before improvements to 0.49 after improvements.

DISCUSSION

Our findings suggest that CSOs contribute to acute GI illness burden in Atlanta and that the magnitude of this risk may be higher among populations living in areas of low poverty. We did not find a protective effect of sewerage system improvements. Nonetheless, observed reductions in CSO frequency may lower the absolute burden of GI illness attributable to these events. https://doi.org/10.1289/EHP10399.

Differences in help-seeking behaviours and perceived helpfulness of services between abused and non-abused women: A cross-sectional survey of Australian postpartum women

New mothers may face substantial physical and mental health challenges during the postpartum period and are at a greater risk of intimate partner violence. Healthcare services provide support, however, acknowledging a problem and seeking help for it can be difficult. Research on where postpartum women seek help and how helpful they perceive it is limited. Additionally, little is known of how these help-seeking behaviours differ between abused and non-abused postpartum women. The aim of this study was to examine the help-seeking behaviour and perceived helpfulness of services in abused and non-abused postpartum women. Secondary analysis was undertaken of data collected during the MOVE (Improving Maternal and Child Health Care for Vulnerable Mothers) cluster randomised controlled trial of a nurse, intimate partner violence screening and supportive care intervention. MOVE was set in eight community-based nurse teams in Melbourne, Australia. The trial (2010-2013) included a survey of n = 2,621 postpartum Australian women who had given birth within the previous 8 months. Data were analysed using descriptive and interferential statistics. Findings indicate that abused women who had experienced partner violence sought informal family support less frequently (81.3% compared with 92.4%, p < .001) and were more frequent users of hospital emergency departments (p = .03), nurse home visiting programs (p = .02) and some breastfeeding services (p = .001), compared with non-abused women. They were also more frequent users of psychiatrists (p ≤ 0.001), early parenting centres (both day stay (p = .006) and residential (p = .008), child welfare services (p < .001), and were generally less satisfied with the help received. Postpartum women experiencing partner violence seek help from certain formal services more frequently and are less satisfied with the care received, compared with non-abused women. Access to potential protective supports from family and friends is limited. Further qualitative research is needed to gain a greater understanding of abused postpartum women's experiences and help-seeking behaviours.

Cumulative family risks across income levels predict deterioration of children's general health during childhood and adolescence

Family is considered an important agent in the health development of children. This process is significant but quite complex because the prevalence of potential risk factors in the family can hinder children’s health. This study examined if multiple family risks might have cumulative effect on children and youth’s health across various levels of household income. The data in this study were drawn from the 2011–2012 U.S. National Survey of Children’s Health (N = 79,601). A cumulative family risk (CFR) index was developed, which included such constructs as single-parenthood, unstable employment, large family, parenting stress, poor maternal education, poor maternal general health and poor maternal mental health. Multiple logistic regression analyses showed that CFR level was significantly related to children and youth’s poor health outcome (p < .001). When poverty levels were considered, however, the impact of CFRs on children and youth’s health was attenuated. The impact of CFRs was higher on children and youth from affluent families than on those from poor families. Overall there was a consistent pattern of trend in the point estimate as well as confidence limits as levels of affluence and numbers of family risk increased although some of the confidence intervals overlapped. Living in disadvantaged families might serve as a protective factor against CFRs possibly through repeated exposure to hardships and subsequent formation of resilience among some of the disadvantaged children.