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Yakubu RA, Ajayi KV, Dhaurali S, Carvalho K, Kheyfets A, Lawrence BC, Amutah-Onukagha N. Investigating the Role of Race and Stressful Life Events on the Smoking Patterns of Pregnant and Postpartum Women in the United States: A Multistate Pregnancy Risk Assessment Monitoring System Phase 8 (2016-2018) Analysis. Matern Child Health J 2023; 27:166-176. [PMID: 37737325 PMCID: PMC10692264 DOI: 10.1007/s10995-023-03773-7] [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] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To examine the smoking patterns of women who experienced stressful life events and the impact of racial disparities on the relationship between stressful life events, and prenatal/ postpartum smoking. METHODS The study analyzed data from the Pregnancy Risk Assessment Monitoring System Phase 8 (2016-2018) survey across five states (CT, LA, MA, MO, WI). Four stressful life event categories were created using thirteen affiliated questions: financial, trauma, partner, and emotional. We assessed: 1) the association between smoking and stressful life events, 2) the impact of race on the relation between smoking and stressful life events, and 3) the long-term effects of smoking on health by assessing the association between smoking and maternal morbidity. Bivariate statistics and multivariate Poisson regression models were conducted. RESULTS A total of 24,209 women from five states were included. 8.9% of respondents reported smoking during pregnancy, and 12.7% reported smoking postpartum. There was a significant association between all stressful life events and smoking. Trauma stressful life event had the strongest association with smoking during pregnancy (adjusted PR=2.01; CI: 1.79-2.27) and postpartum (adjusted PR= 1.80; CI: 1.64-1.98). Race and stressful life event interaction effects on smoking had varied significant findings, but at least one racial/ ethnic minority group (Black, Hispanic, Asian) had a higher smoking prevalence than non-Hispanic White per stressful life event category. Lastly, the prevalence of maternal morbidity was higher for smoking during pregnancy (adjusted PR= 1.28; CI: 1.19-1.38) and postpartum (adjusted PR= 1.30; CI: 1.22-1.38) compared to no smoking. CONCLUSIONS FOR PRACTICE Culturally congruent, multi-disciplinary care teams are needed to address both clinical and social needs to reduce stressful life events and smoking. Screenings for stress should be standardized with a referral system in place to provide ongoing support.
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Affiliation(s)
- Rauta Aver Yakubu
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA.
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, 63104, USA.
| | - Kobi V Ajayi
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
- Texas A&M University, College Station, TX, 77845, USA
| | - Shubhecchha Dhaurali
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
- School of Arts & Sciences, Tufts University, Medford, MA, 02155, USA
| | - Keri Carvalho
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Anna Kheyfets
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
- School of Medicine, Tufts University, Boston, MA, 02111, USA
| | - Blessing Chidiuto Lawrence
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Ndidiamaka Amutah-Onukagha
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
- School of Medicine, Tufts University, Boston, MA, 02111, USA
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Salomon RE, Dobbins S, Harris C, Haeusslein L, Lin CX, Reeves K, Richoux S, Roussett G, Shin J, Dawson-Rose C. Antiracist symptom science: A call to action and path forward. Nurs Outlook 2022; 70:794-806. [PMID: 36400578 PMCID: PMC10916506 DOI: 10.1016/j.outlook.2022.07.014] [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: 04/06/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/17/2022]
Abstract
Nurse scientists recognize the experience of racism as a driving force behind health. However, symptom science, a pillar of nursing, has rarely considered contributions of racism. Our objective is to describe findings within symptom science research related to racial disparities and/or experiences of racism and to promote antiracist symptom science within nursing research. In this manuscript, we use an antiracist lens to review a predominant symptom science theory and literature in three areas of symptom science research-oncology, mental health, and perinatal health. Finally, we make recommendations for increasing antiracist research in symptom science by altering (a) research questions, (b) recruitment methods, (c) study design, (d) data analysis, and (e) dissemination of findings. Traditionally, symptom science focuses on individual level factors rather than broader contexts driving symptom experience and management. We urge symptom science researchers to embrace antiracism by designing research with the specific intent of dismantling racism at multiple levels.
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Affiliation(s)
- Rebecca E Salomon
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Sarah Dobbins
- San Francisco Department of Public Health, San Francisco, California
| | | | | | - Chen-Xi Lin
- University of California, San Francisco, San Francisco, California
| | - Katie Reeves
- University of California, San Francisco, San Francisco, California
| | - Sarah Richoux
- University of California, San Francisco, San Francisco, California
| | - Greg Roussett
- University of California, San Francisco, San Francisco, California
| | - Joosun Shin
- University of California, San Francisco, San Francisco, California
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Dailey RK, Peoples A, Zhang L, Dove‐Medows E, Price M, Misra DP, Giurgescu C. Assessing Perception of Prenatal Care Quality Among Black Women in the United States. J Midwifery Womens Health 2022; 67:235-243. [PMID: 35060657 PMCID: PMC10181860 DOI: 10.1111/jmwh.13319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/12/2021] [Accepted: 10/17/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There has been little attention to measuring quality of prenatal care from a Black person's perspective. We examined validity and reliability of the Quality of Prenatal Care Questionnaire (QPCQ) and perceptions of the quality of prenatal care among pregnant Black women. METHODS A total of 190 women had complete data on the postpartum questionnaire containing the QPCQ within 8 weeks after birth. Internal consistency reliability was assessed using Cronbach's α. Construct validity was assessed through hypothesis testing using select questions from the Pregnancy Risk Assessment Monitoring System (PRAMS) and Pearson's r correlation. RESULTS The mean (SD) maternal age was 26.5 (5.5) years, and 85.3% of births were term (>37 weeks' 0 days' gestation). The total mean (SD) QPCQ score was 191.3 (27.9) points (range 46-230), and the mean (SD) item score for the subscales ranged from 3.88 (0.80) points to 4.27 (0.64). The Cronbach's α for the overall QPCQ score was .97 and ranged from .72 to .96 for the 6 subscale scores, which indicated acceptable internal consistency reliability. All but one subscale had a Cronbach's α higher than .80. The Approachability subscale had a Cronbach's α of .72. Construct validity demonstrated a moderate and significant positive correlation between the PRAMS items and the QPCQ (r = .273, P < .001). DISCUSSION To our knowledge, this is the first study to examine the validity and reliability of the QPCQ and perceptions of quality of prenatal care among Black women from the United States. The results indicate that participants rate the quality of their prenatal care highly and that the QPCQ is a reliable and valid measure of the quality of prenatal care. Use of a convenient and reliable instrument to measure the quality of prenatal care rather than prenatal care satisfaction or utilization may help to elucidate the factors of prenatal care that are protective specifically among Black women.
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Affiliation(s)
- Rhonda K. Dailey
- Department of Family Medicine and Public Health Sciences Wayne State University School of Medicine Detroit Michigan
| | - Ashleigh Peoples
- Department of Family Medicine University of Pittsburgh Medical Center Shadyside Pittsburgh Pennsylvania
| | - Liying Zhang
- Department of Family Medicine and Public Health Sciences Wayne State University School of Medicine Detroit Michigan
| | | | - Mercedes Price
- Department of Epidemiology and Biostatistics Michigan State University College of Human Medicine East Lansing Michigan
| | - Dawn P. Misra
- Department of Epidemiology and Biostatistics Michigan State University College of Human Medicine East Lansing Michigan
| | - Carmen Giurgescu
- College of Nursing University of Central Florida Orlando Florida
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Experiences of Discrimination and Depression Trajectories over Pregnancy. Womens Health Issues 2022; 32:147-155. [PMID: 34774402 PMCID: PMC9701536 DOI: 10.1016/j.whi.2021.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 09/27/2021] [Accepted: 10/08/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Research on risk factors for prenatal depression is critical to improve the understanding, prevention, and treatment of women's psychopathology. The current study examines the relation between experiences of racial discrimination and trajectories of depression symptoms over the course of pregnancy. METHOD Participants completed standardized measures regarding symptoms of depression at four timepoints during pregnancy and reported on experiences of racial discrimination at one timepoint. Latent growth curve modeling was used to examine the relation between discrimination and initial levels (intercept) and trajectories (slope) of depression symptoms over pregnancy. RESULTS Participants were 129 pregnant individuals recruited from obstetric clinics and oversampled for elevated depression symptoms. Thirty-six percent of the participants were living at or below 200% of the federal poverty line. Fifty-four percent of the sample identified as non-Latinx White, 26% as Latinx, and 13% as non-Latinx Black. An unconditional latent growth curve modeling revealed a negative quadratic trajectory of depression symptoms during pregnancy. When women's report of discrimination was added as a predictor of depression trajectories, discrimination predicted the initial value (intercept) of depression symptoms, but not change over the course of pregnancy (slope). Specifically, higher levels of experiences of discrimination were associated with higher levels of depression symptoms. When sociodemographic and contextual covariates were included in the model, a low family income-to-needs ratio was also related to higher levels of depression symptoms. CONCLUSIONS These findings provide evidence that women's experiences of racial discrimination and family financial strain are risk factors for prenatal depression, with implications for screening, treatment, and policy.
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Zhang L, Dailey RK, Price M, Misra DP, Giurgescu C. Intimate partner violence, prenatal stress, and substance use among pregnant Black women. Public Health Nurs 2021; 38:555-563. [PMID: 33590543 PMCID: PMC10478037 DOI: 10.1111/phn.12878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We examine the mediation effects of prenatal stress on the associations between intimate partner violence (IPV) experience and the most common forms of substance use (i.e., cigarette smoking, alcohol drinking, and marijuana use) among pregnant Black women. DESIGN Cross-sectional. SAMPLE Black women (N = 203) from metropolitan Detroit, Michigan and Columbus, Ohio, were recruited between 8 and 29 weeks of gestation. MEASUREMENTS Women were asked about IPV experience during 12 months prior to the start of the pregnancy, perceived stress during pregnancy, and substance use during pregnancy. RESULTS Intimate partner violence prior to pregnancy was positively associated with cigarette smoking and marijuana use but not with alcohol use during pregnancy. IPV prior to pregnancy was also positively associated with higher levels of perceived stress during pregnancy after controlling for covariates. Path analysis indicated that IPV had an indirect effect on marijuana use through perceived stress (standardized indirect effect = 0.026, SE = 0.020, 95% CI = 0.005-0.064, p =.017). CONCLUSIONS Perceived stress during pregnancy partially mediated the association between previous experience of IPV and marijuana use among pregnant Black women. Interventions are needed to reduce IPV that would lower stress during pregnancy and consequently substance abuse to improve pregnancy outcomes and maternal and newborn health.
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Affiliation(s)
- Liying Zhang
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA
- Integrative Biosciences Center, Clinical Research Division, Wayne State University, Detroit, MI, USA
| | - Rhonda K. Dailey
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA
- Integrative Biosciences Center, Clinical Research Division, Wayne State University, Detroit, MI, USA
| | - Mercedes Price
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Dawn P. Misra
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Carmen Giurgescu
- College of Nursing, University of Central Florida, Orlando, FL, USA
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