1
|
Ross A, MacPherson C, Baker L, Kim S, Njau G, Williams AD. Impact of Breastfeeding Barriers on Racial/Ethnic Disparities in Breastfeeding Outcomes in North Dakota. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01943-z. [PMID: 38393463 DOI: 10.1007/s40615-024-01943-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Exclusive breastfeeding is recommended for the first 6 months of life, but there are racial/ethnic disparities in meeting this recommendation. METHODS 2017-2020 North Dakota Pregnancy Risk Assessment Monitoring System (weighted N = 11,754) data were used to examine racial/ethnic differences in the association between self-reported breastfeeding barriers and breastfeeding duration. Breastfeeding duration was self-reported breastfeeding at 2 and 4 months, and number of weeks until breastfeeding cessation. Self-reported breastfeeding barriers were yes/no responses to 13 barriers (e.g., "difficulty latching," "household duties"). Logistic regression estimated odds ratios and 95% confidence intervals to determine if barriers accounted for breastfeeding disparities by race/ethnicity. Cox proportional hazard models estimated hazard ratios for stopping breastfeeding for American Indian and other race/ethnicity individuals, compared to White individuals. Models were adjusted for birthing parents' demographic and medical factors. RESULTS Logistic regression results suggest American Indian birthing parents had similar odds for breastfeeding duration (2-month duration: OR 0.94 (95%CI 0.50, 1.77); 4-month duration: OR 1.24 (95%CI 0.43, 3.62)) compared to White birthing parents, after accounting for breastfeeding barriers. Cox proportional hazard models suggest American Indian birthing parents had a lower hazard of stopping breastfeeding (HR 0.76 (95%CI 0.57, 0.99)) than White parents, after accounting for breastfeeding barriers. CONCLUSIONS Accounting for breastfeeding barriers eliminated observed disparities in breastfeeding outcomes between American Indian and White birthing parents. Targeted and culturally safe efforts to reduce barriers to breastfeeding are warranted to reduce racial/ethnic disparities in breastfeeding.
Collapse
Affiliation(s)
- Anna Ross
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC, 20037, USA
| | - Cora MacPherson
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC, 20037, USA
| | - Lannesse Baker
- University of North Dakota School of Medicine and Health Sciences, Room E166, 1301 North Columbia Road Stop 9037, Grand Forks, ND, 58202-9037, USA
| | - Soojung Kim
- Department of Communication, University of North Dakota, O'Kelly Hall Room 202, 221 Centennial Drive Stop 7169, Grand Forks, ND, 58202-7169, USA
| | - Grace Njau
- North Dakota Department of Health & Human Services, 600 E Boulevard Ave Dept 325, Bismarck, ND, 58505, USA
| | - Andrew D Williams
- University of North Dakota School of Medicine and Health Sciences, Room E166, 1301 North Columbia Road Stop 9037, Grand Forks, ND, 58202-9037, USA.
| |
Collapse
|
2
|
Schmidt L, Kanichy M, Njau G, Schmidt M, Stepanov A, Anderson R, Stiffarm A, Williams A. Adverse Childhood Experiences, Interpersonal Violence, and Racial Disparities in Early Prenatal Care in North Dakota (ND PRAMS 2017-2019). J Interpers Violence 2024; 39:237-262. [PMID: 37644756 DOI: 10.1177/08862605231195802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
In North Dakota (ND), American Indian women are more likely to be exposed to adverse childhood experiences (ACEs) and interpersonal violence, and receive late prenatal care (PNC) compared to other racial groups. In a sample of 1,849 (weighted n = 26,348) women from the 2017 to 2019 North Dakota Pregnancy Risk Assessment Monitoring System, we performed a series of logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for AI and Other Racial Identity women compared to White women regarding risk of late PNC (initiated after week 13) and dissatisfaction of PNC timing. Models were adjusted for interpersonal violence (from husband/partner, family member, someone outside of family, ex-husband/partner, or any) to determine if violence accounts for racial/ethnic disparities in PNC. AI women experienced two-fold higher risk of late PNC (OR: 2.25, 95% CI: 1.55, 3.26) and dissatisfaction of PNC timing (OR: 2.34, 95% CI: 1.61, 3.40) than White women. In the analyses for the association between joint ACEs (Higher: ≥4; Lower: <4)/Race and PNC outcomes, odds of late PNC were two-fold among AI women with Higher ACEs (OR: 2.35, 95% CI: 1.41, 3.94) and Lower ACEs (OR: 2.73, 95% CI: 1.69, 4.41), compared to White women with Lower ACEs. Results were similar for dissatisfaction of PNC timing. Accounting for violence did not significantly change odds ratios in any analyses. Thus, interpersonal violence surrounding pregnancy does not explain racial disparities in PNC in ND. To understand disparities in PNC among AI women, risk factors like historic trauma and systemic oppression should be examined.
Collapse
Affiliation(s)
| | | | - Grace Njau
- North Dakota Department of Health & Human Services, Bismarck, ND, USA
| | - Matthew Schmidt
- North Dakota Department of Health & Human Services, Bismarck, ND, USA
| | | | | | - Amy Stiffarm
- University of North Dakota, Grand Forks, ND, USA
| | | |
Collapse
|
3
|
Deb Nath N, Khan MM, Schmidt M, Njau G, Odoi A. Geographic disparities and temporal changes of COVID-19 incidence risks in North Dakota, United States. BMC Public Health 2023; 23:720. [PMID: 37081453 PMCID: PMC10116449 DOI: 10.1186/s12889-023-15571-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND COVID-19 is an important public health concern due to its high morbidity, mortality and socioeconomic impact. Its burden varies by geographic location affecting some communities more than others. Identifying these disparities is important for guiding health planning and service provision. Therefore, this study investigated geographical disparities and temporal changes of the percentage of positive COVID-19 tests and COVID-19 incidence risk in North Dakota. METHODS COVID-19 retrospective data on total number of tests and confirmed cases reported in North Dakota from March 2020 to September 2021 were obtained from the North Dakota COVID-19 Dashboard and Department of Health, respectively. Monthly incidence risks of the disease were calculated and reported as number of cases per 100,000 persons. To adjust for geographic autocorrelation and the small number problem, Spatial Empirical Bayesian (SEB) smoothing was performed using queen spatial weights. Identification of high-risk geographic clusters of percentages of positive tests and COVID-19 incidence risks were accomplished using Tango's flexible spatial scan statistic. ArcGIS was used to display and visiualize the geographic distribution of percentages of positive tests, COVID-19 incidence risks, and high-risk clusters. RESULTS County-level percentages of positive tests and SEB incidence risks varied by geographic location ranging from 0.11% to 13.67% and 122 to 16,443 cases per 100,000 persons, respectively. Clusters of high percentages of positive tests were consistently detected in the western part of the state. High incidence risks were identified in the central and south-western parts of the state, where significant high-risk spatial clusters were reported. Additionally, two peaks (August 2020-December 2020 and August 2021-September 2021) and two non-peak periods of COVID-19 incidence risk (March 2020-July 2020 and January 2021-July 2021) were observed. CONCLUSION Geographic disparities in COVID incidence risks exist in North Dakota with high-risk clusters being identified in the rural central and southwest parts of the state. These findings are useful for guiding intervention strategies by identifying high risk communities so that resources for disease control can be better allocated to communities in need based on empirical evidence. Future studies will investigate predictors of the identified disparities so as to guide planning, disease control and health policy.
Collapse
Affiliation(s)
- Nirmalendu Deb Nath
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Md Marufuzzaman Khan
- Department of Public Health, College of Education, Health, and Human Sciences, University of Tennessee, Knoxville, TN, USA
| | - Matthew Schmidt
- North Dakota Department of Health and Human Services, Special Projects and Health Analytics, Bismarck, ND, USA
| | - Grace Njau
- North Dakota Department of Health and Human Services, Special Projects and Health Analytics, Bismarck, ND, USA
| | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA.
| |
Collapse
|
4
|
Kanichy (Makah) M, Schmidt L, Anderson R, Njau G, Stiffarm (Aaniiih) A, Schmidt M, Stepanov A, Williams A. Examining the Role of Interpersonal Violence in Racial Disparities in Breastfeeding in North Dakota (ND PRAMS 2017-2019). Int J Environ Res Public Health 2023; 20:ijerph20085445. [PMID: 37107727 PMCID: PMC10138366 DOI: 10.3390/ijerph20085445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/01/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND The 2019 overall breastfeeding initiation rate in the US was 84.1%, yet only 76.6% of American Indian (AI) women initiated breastfeeding. In North Dakota (ND), AI women have greater exposure to interpersonal violence than other racial/ethnic groups. Stress associated with interpersonal violence may interfere with processes important to breastfeeding. We explored whether interpersonal violence partially explains racial/ethnic disparities in breastfeeding in ND. METHODS Data for 2161 women were drawn from the 2017-2019 ND Pregnancy Risk Assessment Monitoring System. Breastfeeding questions in PRAMS have been tested among diverse populations. Breastfeeding initiation was self-report to "Did you ever breastfeed or pump breast milk to feed your new baby, even for a short period?" (yes/no). Breastfeeding duration (2 months; 6 months) was self-reported how many weeks or months of breastmilk feeding. Interpersonal violence for both 12 months before and during pregnancy based on self-report (yes/no) of violence from a husband/partner, family member, someone else, or ex-husband/partner. An "Any violence" variable was created if participants reported "yes" to any violence. Logistic regression models estimated crude and adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for breastfeeding outcomes among AI and Other Race women compared to White women. Sequential models were adjusted for interpersonal violence (husband/partner, family member, someone else, ex-husband/partner, or any). RESULTS AI women had 45% reduced odds of initiating breastfeeding (OR: 0.55, 95% CI: 0.36, 0.82) compared to white women. Including interpersonal violence during pregnancy did not change results. Similar patterns were observed for all breastfeeding outcomes and all interpersonal violence exposures. DISCUSSION Interpersonal violence does not explain the disparity in breastfeeding in ND. Considering cultural ties to the tradition of breastfeeding and the role of colonization may provide a better understanding of breastfeeding among AI populations.
Collapse
Affiliation(s)
- MichaeLynn Kanichy (Makah)
- Public Health Program, Department of Population Health, School of Medicine & Health Sciences, The University of North Dakota, 1301 North Columbia Road Stop 9037, Grand Forks, ND 58202, USA
| | - Lexie Schmidt
- Public Health Program, Department of Population Health, School of Medicine & Health Sciences, The University of North Dakota, 1301 North Columbia Road Stop 9037, Grand Forks, ND 58202, USA
| | - RaeAnn Anderson
- Department of Psychology, University of North Dakota, 501 North Columbia Road Stop 8380, Grand Forks, ND 58202, USA
| | - Grace Njau
- North Dakota Department of Health & Human Services, 600 East Boulevard Ave, Department 325, Bismarck, ND 58505, USA
| | - Amy Stiffarm (Aaniiih)
- Department of Indigenous Health, School of Medicine & Health Sciences, University of North Dakota, 1301 North Columbia Road Stop 9037, Grand Forks, ND 58202, USA
| | - Matthew Schmidt
- North Dakota Department of Health & Human Services, 600 East Boulevard Ave, Department 325, Bismarck, ND 58505, USA
| | - Anastasia Stepanov
- North Dakota Department of Health & Human Services, 600 East Boulevard Ave, Department 325, Bismarck, ND 58505, USA
| | - Andrew Williams
- Public Health Program, Department of Population Health, School of Medicine & Health Sciences, The University of North Dakota, 1301 North Columbia Road Stop 9037, Grand Forks, ND 58202, USA
- Department of Indigenous Health, School of Medicine & Health Sciences, University of North Dakota, 1301 North Columbia Road Stop 9037, Grand Forks, ND 58202, USA
- Correspondence:
| |
Collapse
|
5
|
Khan MM, Deb Nath N, Schmidt M, Njau G, Odoi A. Geographic disparities and temporal changes of COVID-19 hospitalization risks in North Dakota. Front Public Health 2023; 11:1062177. [PMID: 37006524 PMCID: PMC10061029 DOI: 10.3389/fpubh.2023.1062177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundAlthough the burden of the coronavirus disease 2019 (COVID-19) has been different across communities in the US, little is known about the disparities in COVID-19 burden in North Dakota (ND) and yet this information is important for guiding planning and provision of health services. Therefore, the objective of this study was to identify geographic disparities of COVID-19 hospitalization risks in ND.MethodsData on COVID-19 hospitalizations from March 2020 to September 2021 were obtained from the ND Department of Health. Monthly hospitalization risks were computed and temporal changes in hospitalization risks were assessed graphically. County-level age-adjusted and spatial empirical Bayes (SEB) smoothed hospitalization risks were computed. Geographic distributions of both unsmoothed and smoothed hospitalization risks were visualized using choropleth maps. Clusters of counties with high hospitalization risks were identified using Kulldorff's circular and Tango's flexible spatial scan statistics and displayed on maps.ResultsThere was a total of 4,938 COVID-19 hospitalizations during the study period. Overall, hospitalization risks were relatively stable from January to July and spiked in the fall. The highest COVID-19 hospitalization risk was observed in November 2020 (153 hospitalizations per 100,000 persons) while the lowest was in March 2020 (4 hospitalizations per 100,000 persons). Counties in the western and central parts of the state tended to have consistently high age-adjusted hospitalization risks, while low age-adjusted hospitalization risks were observed in the east. Significant high hospitalization risk clusters were identified in the north-west and south-central parts of the state.ConclusionsThe findings confirm that geographic disparities in COVID-19 hospitalization risks exist in ND. Specific attention is required to address counties with high hospitalization risks, especially those located in the north-west and south-central parts of ND. Future studies will investigate determinants of the identified disparities in hospitalization risks.
Collapse
Affiliation(s)
- Md Marufuzzaman Khan
- Department of Public Health, College of Education, Health, and Human Sciences, University of Tennessee, Knoxville, TN, United States
| | - Nirmalendu Deb Nath
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States
| | - Matthew Schmidt
- North Dakota Department of Health and Human Services, Special Projects and Health Analytics, Bismarck, ND, United States
| | - Grace Njau
- North Dakota Department of Health and Human Services, Special Projects and Health Analytics, Bismarck, ND, United States
| | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States
- *Correspondence: Agricola Odoi
| |
Collapse
|
6
|
Chandra Deb L, Hove H, Miller TK, Pinks K, Njau G, Hagan JJ, Jansen RJ. Epidemiology of Hepatitis C virus infection among incarcerated populations in North Dakota. PLoS One 2022; 17:e0266047. [PMID: 35349606 PMCID: PMC8963564 DOI: 10.1371/journal.pone.0266047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/12/2022] [Indexed: 12/09/2022] Open
Abstract
This retrospective cohort study was conducted to determine the prevalence of HCV infections among individuals incarcerated in a state prison system and identify potential contributing factors to HCV infection. North Dakota Department of Corrections and Rehabilitation (NDDOCR) data from 2009 to 2018 was used and period prevalence was calculated for this 10-year time period. The period prevalence of HCV infection was (15.13% (95% CI 14.39–15.90) with a marginally significant (p-value: 0.0542) increasing linear trend in annual prevalence over this period. Multivariate logistic regression analysis was used to identify risk factors associated with HCV infection. The main significant independent risk factors for HCV infection in this incarcerated population were age >40 years [OR: 1.78 (1.37–2.32)]; sex [OR: 1.21 (1.03–1.43)]; race/ethnicity [OR: 1.97 (1.69–2.29)]; history of intravenous drug use (IVDU) [OR: 7.36 (6.41–8.44)]; history of needle or syringe sharing [OR: 7.57 (6.62–8.67)]; and alcohol use [OR: 0.87 (0.77–0.99)]. Study limitations include uncollected information on sexual history, frequency or duration of injection drug use and blood transfusion history of the incarcerated population. Considering the high prevalence of HCV infection and its associated risk factors, it is important to implement prevention programs such as syringe/needle exchanges and counsel with imprisoned IVD users.
Collapse
Affiliation(s)
- Liton Chandra Deb
- Department of Public Health, North Dakota State University, Fargo, ND, United States of America
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States of America
| | - Hannah Hove
- Department of Public Health, North Dakota State University, Fargo, ND, United States of America
- University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States of America
| | - Tracy K. Miller
- North Dakota Department of Health, Bismarck, ND, United States of America
| | - Kodi Pinks
- North Dakota Department of Health, Bismarck, ND, United States of America
| | - Grace Njau
- North Dakota Department of Health, Bismarck, ND, United States of America
| | - John J. Hagan
- North Dakota Department of Corrections and Rehabilitation, Bismarck, ND, United States of America
| | - Rick J. Jansen
- Department of Public Health, North Dakota State University, Fargo, ND, United States of America
- Genomics, Phenomics, and Bioinformatics Program, North Dakota State University, Fargo, ND, United States of America
- Center for Immunization Research and Education (CIRE), North Dakota State University, Fargo, ND, United States of America
- Center for Diagnostic and Therapeutic Strategies in Pancreatic Cancer, North Dakota State University, Fargo, ND, United States of America
- * E-mail:
| |
Collapse
|
7
|
Frei D, Salottolo K, Njau G, Fanale CV, Wagner JC, Whaley M, McCarthy K, Loy D, Bar-Or D. Abstract W P7: Intra-Arterial Therapy is Safe and Effective in Patients Aged ≥80. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.wp7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Acute ischemic stroke (AIS) occurs most frequently in old age. Currently, conflicting evidence exists on the safety and efficacy of intra-arterial treatment (IAT) in the management of AIS in the elderly. We purported to compare the outcomes of patients ≥80 years receiving IAT after AIS to those of patients 55-79 years old. Methods: Data were retrospectively abstracted for consecutive AIS patients ≥55 years treated with IAT at an urban comprehensive stroke center between 2010 and 2013. The following outcomes were compared between patients 55-79 vs. ≥80 years following IAT: safety was assessed by incidence of sICH and in-hospital mortality; efficacy was examined using discharge mRS (favorable, ≤2) and improvement in NIHSS (decreased score at discharge). All analyses were performed with Pearson or Fisher’s exact chi-square tests. The subset of patients receiving IAT only was also examined. Results: IAT was performed in 300 patients, of which 241 were aged ≥55 and comprise our study cohort; of the 241, 104 received IAT only. There were no significant differences between the two age groups receiving IAT in race, presence of comorbidities and time to IAT while significant differences were observed for gender and NIHSS, with the ≥80 population presenting with lower mean stroke severity and more females (p <0.05 for both comparisons). Mortality and sICH rates were not significantly different following IAT between age groups, both in the overall cohort as well as the subset that received IAT only (table). Efficacy was similar between age groups in the overall cohort (table); in the subset that received IAT only, there was a trend towards a higher proportion of patients 55-79 years with improved NIHSS following treatment compared to those ≥80 years (p=0.07). Conclusion: These findings suggest that IAT is safe and effective in patients ≥80 years and age should not be used as a contraindication to IAT.
Collapse
Affiliation(s)
| | | | - Grace Njau
- Trauma Rsch Dept, Swedish Med Cntr, Englewood, CO
| | | | | | | | | | - David Loy
- Neurology, Swedish Med Cntr, Englewood, CO
| | - David Bar-Or
- Trauma Rsch Dept, Swedish Med Cntr, Englewood, CO
| |
Collapse
|