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Arrington LA, Kramer B, Ogunwole SM, Harris TL, Dankwa L, Knight S, Creanga AA, Bower KM. Interrupting false narratives: applying a racial equity lens to healthcare quality data. BMJ Qual Saf 2024; 33:340-344. [PMID: 38216312 DOI: 10.1136/bmjqs-2023-016612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/08/2023] [Indexed: 01/14/2024]
Affiliation(s)
| | - Briana Kramer
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Lois Dankwa
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Andreea A Creanga
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly M Bower
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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Stierman EK, Kramer B, Bower KM, Creanga AA. A call to address teamwork and patient safety culture in hospital maternity units: findings from a survey of maternal healthcare professionals in Maryland. Am J Obstet Gynecol MFM 2024; 6:101274. [PMID: 38184012 DOI: 10.1016/j.ajogmf.2024.101274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Affiliation(s)
- Elizabeth K Stierman
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205.
| | - Briana Kramer
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205
| | - Kelly M Bower
- Johns Hopkins University School of Nursing in Baltimore, MD
| | - Andreea A Creanga
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
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Spinosa CZ, Burrell L, Bower KM, O'Neill K, Duggan AK. Moving toward precision in prenatal evidence-based home visiting to achieve good birth outcomes: assessing the alignment of local programs with their national models. BMC Health Serv Res 2023; 23:812. [PMID: 37516820 PMCID: PMC10386274 DOI: 10.1186/s12913-023-09815-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 07/14/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Low birthweight and preterm birth rates are higher in the United States than in other developed countries and exhibit pronounced racial inequities. Home visiting is a strategy to promote equity in birth outcomes. Research points to precision home visiting as the path to equity. The purpose of this study is to describe local programs' risk reduction priorities, intended behavioral pathways, and expectations of home visitors; compare these local program features with those of their national model; and assess the strength of implementation systems to support staff in meeting job expectations. METHODS We surveyed local programs implementing one of four evidence-based home visiting models that aim to promote good birth outcomes: Family Spirit, Healthy Families America, Nurse-Family Partnership, and Parents as Teachers. RESULTS Representatives from 169 local programs completed the survey. Overall, 59% endorsed all their model's high priority risks, 16% endorsed all its required behavioral pathways, and 11% endorsed all its required techniques. Local programs went beyond their national model's explicit intentions. Overall, 91% of local programs prioritized risks beyond those of their model, 85% endorsed behavioral pathways beyond those of their model, 95% endorsed visitors' use of techniques not explicitly endorsed by their model but compatible with it, and 19% endorsed use of techniques judged incompatible by their model. Implementation system strength was positively associated with local program and model expectations. CONCLUSIONS Precision home visiting to achieve health equity requires shared learning of what works best for whom. This observational study showed the Precision Paradigm's usefulness for cross-model research to advance precision.
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Affiliation(s)
- Ciara Z Spinosa
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Lori Burrell
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Kelly M Bower
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Kay O'Neill
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Anne K Duggan
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Ogunwole SM, Oguntade HA, Bower KM, Cooper LA, Bennett WL. Health Experiences of African American Mothers, Wellness in the Postpartum Period and Beyond (HEAL): A Qualitative Study Applying a Critical Race Feminist Theoretical Framework. Int J Environ Res Public Health 2023; 20:6283. [PMID: 37444130 PMCID: PMC10341853 DOI: 10.3390/ijerph20136283] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023]
Abstract
The objective of this study is to explore the cultural, social, and historical factors that affect postpartum primary care utilization among Black women with cardiometabolic risk factors and to identify the needs, barriers, and facilitators that are associated with it. We conducted in-depth interviews of 18 Black women with one or more cardiometabolic complications (pre-pregnancy chronic hypertension, diabetes, obesity, preeclampsia, or gestational diabetes) within one year of delivery. We recruited women from three early home-visiting programs in Baltimore, Maryland, between May 2020 and June 2021. We used Critical Race Feminism theory and a behavioral model for healthcare utilization as an analytical lens to develop a codebook and code interview transcripts. We identified and summarized emergent patterns and themes using textual and thematic analysis. We categorized our findings into six main themes: (1) The enduring influence of structural racism, (2) personally mediated racism in healthcare and beyond, (3) sociocultural beliefs about preventative healthcare, (4) barriers to postpartum care transitions, such as education and multidisciplinary communication, (5) facilitators of postpartum care transitions, such as patient-provider relationships and continuity of care, and (6) postpartum health and healthcare needs, such as mental health and social support. Critical race feminism provides a valuable lens for exploring drivers of postpartum primary care utilization while considering the intersectional experiences of Black women.
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Affiliation(s)
- S. Michelle Ogunwole
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Johns Hopkins Center for Health Equity, Baltimore, MD 21287, USA
| | - Habibat A. Oguntade
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA
| | - Kelly M. Bower
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Lisa A. Cooper
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Johns Hopkins Center for Health Equity, Baltimore, MD 21287, USA
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Wendy L. Bennett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
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5
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Klepper M, Deng A, Sherman ADF, Lawrence C, Ling C, Talbert S, Bower KM. LGBTQI+ representation in pre-licensure nursing textbooks: A qualitative descriptive analysis. Nurse Educ Today 2023; 127:105858. [PMID: 37247591 DOI: 10.1016/j.nedt.2023.105858] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/03/2023] [Accepted: 05/22/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND To improve health equity, nursing curricula should include content specific to the needs of marginalized and underserved communities, such as lesbian, gay, bisexual, transgender, queer, and intersex groups (LGBTQI+). Harmful and absent academic discussions of LGBTQI+ patients lead to provider discomfort and inadequacy in treating this patient population. Nursing schools are well-positioned to increase comfort with LGBTQI+ content as part of pre-licensure curricula. This article presents a systematic evaluation of LGBTQI+ content in nursing pre-licensure textbooks and the nature and quality of the representations. METHODS A qualitative descriptive analysis of LGBTQI+ content from 14 nursing-specific textbooks required by a pre-licensure degree program at the Johns Hopkins School of Nursing was conducted by a student-led team with faculty oversight. A priori and iterative search terms were used to identify and extract text segments that referenced LGBTQI+ content in each textbook. An iterative codebook was developed, codes were applied, and analysis of the information and context in which the terms were presented was performed. RESULTS The research team observed gaps and notable patterns in distribution of LGBTQI+ terms and health content areas across the textbooks reviewed. The majority of LGBTQI+ search terms were identified in the following health content areas: social determinants of health, sexual/reproductive health, pediatric sexual & gender diversity, intersectionality, and infectious disease. Based on qualitative descriptive analyses, the data were organized into the following categories: a) Language; b) Medicalization; c) Vague, Incomplete, or Lacking Specificity; and d) Comprehensive Approach. CONCLUSION Findings highlight the need for increased academic exposure for pre-licensure nursing students regarding the care of LGBTQI+ patients. Thoughtful inclusion of LGBTQI+ content may better foster the delivery of evidence-based care for this patient population. These findings underscore the need for improved nursing curricula to support nurses in delivering affirming care for LGBTQI+ populations.
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Affiliation(s)
- Meredith Klepper
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
| | - Angie Deng
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
| | - Athena D F Sherman
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
| | - Carissa Lawrence
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
| | - Catherine Ling
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
| | - Sierra Talbert
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
| | - Kelly M Bower
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
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Moore SE, Coleman CL, Hughes TL, Dorsen C, Smith SK, Bower KM, Clochesy JM, Clark K, Sherman ADF. A systematic review of U.S. nursing faculty's knowledge, awareness, inclusion, and perceived importance of sexual and gender minority-related content in nursing curricula. Nurs Outlook 2023; 71:101950. [PMID: 36924597 PMCID: PMC10363215 DOI: 10.1016/j.outlook.2023.101950] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND In the US, sexual and gender minority (SGM) individuals continue to experience health inequities, and nursing curricula content and nursing faculty with SGM health expertise in the US remain limited. Addressing health disparities begins with the preparation of future nurses-US nursing faculty must be supported to meet these growing needs. PURPOSE To describe, appraise, and synthesize research from 2000-2020 on US nursing faculty knowledge, awareness, inclusion, and perceived importance of SGM health content. METHODS Following PRISMA 2020 guidelines, we registered a systematic review and appraisal protocol in PROSPERO, and then executed the protocol and synthesized the literature. DISCUSSION We found an empirical evidence base surrounding US nursing faculty and SGM health much more limited than expected. Only four cross-sectional, descriptive empirical articles fit the a priori inclusion criteria. The studies were of moderate quality at best and often relied on unvalidated or older measures. In general, the studies focused on examining characteristics of nursing programs, faculty comfort with content, faculty perceptions of content importance, and hours dedicated to content. CONCLUSION Since the close of the review, new commentaries and editorials expanding the call for change in the US were published-the time for commentary has passed. It remains unclear whether US nursing faculty are adequately prepared to educate future nurses about SGM health issues-and an unprepared healthcare workforce is yet another barrier to SGM health equity. The evidence base supporting US nursing faculty development desperately needs more studies using rigorous methodologies.
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Affiliation(s)
- Scott Emory Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH.
| | | | | | | | - Sheila K Smith
- School of Nursing, University of Minnesota, Minneapolis, MN
| | - Kelly M Bower
- Johns Hopkins University, School of Nursing, Baltimore, MD
| | - John M Clochesy
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL
| | - Kristen Clark
- College of Health and Human Services, University of New Hampshire, The University of New Hampshire, Durham, NH
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Sherman ADF, Smith SK, Moore SE, Coleman CL, Hughes TL, Dorsen C, Balthazar MS, Klepper M, Mukerjee R, Bower KM. Nursing pre-licensure and graduate education for LGBTQ health: A systematic review. Nurs Outlook 2023; 71:101907. [PMID: 36623984 PMCID: PMC10133000 DOI: 10.1016/j.outlook.2022.12.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/09/2022] [Accepted: 12/13/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, and queer plus (LGBTQ) people experience discrimination and health disparities compared to heterosexual cisgender people. Clinicians report discomfort and insufficient preparation for providing care to LGBTQ people and nursing has been slow to integrate LGBTQ health into curricula. PURPOSE Conduct a systematic review to examine and critically appraise peer-reviewed literature on nursing student knowledge, skills, and attitudes (KSAs) regarding LGBTQ health and the development/evaluation of LGBTQ health content in nursing curricula. METHODS A systematic review was conducted (N = 1275 articles from PubMed, LGBT Health, CINAHL, ERIC, and Health Source-Nursing/Academic Edition). FINDINGS Twenty articles met inclusion criteria. Twelve studies described curricular interventions; however, there were few validated tools to evaluate content coverage or KSAs. Four themes emerged specific to LGBTQ health content inclusion. DISCUSSION While an emerging science of LGBTQ nursing education has been identified, more work is needed to build and evaluate a comprehensive curricular approach for full programmatic integration of LGBTQ health. CONCLUSION As nursing programs build LGBTQ content into nursing curricula, care must be taken to integrate this content fully with the depth of curricular content in population health, social determinants of health, social justice, intersectionality, cultural competence, and political advocacy. TWEETABLE ABSTRACT Greater integration of LGBTQ health content into nursing education should be a priority for nursing education.
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Affiliation(s)
| | - Sheila K Smith
- School of Nursing, University of Minnesota, Minneapolis, MN
| | - Scott Emory Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| | | | | | | | - Monique S Balthazar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA; Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA
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Bower KM, Kramer B, Warren N, Ahmed S, Callaghan-Koru J, Stierman E, Wilson C, Lawson S, Creanga AA. Development of an instrument to measure awareness and mitigation of bias in maternal healthcare. Am J Obstet Gynecol MFM 2023; 5:100872. [PMID: 36682457 DOI: 10.1016/j.ajogmf.2023.100872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/03/2023] [Accepted: 01/14/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Implicit bias among maternal healthcare professionals contributes to disrespectful care and racial and ethnic disparities in patient outcomes, and there is growing consensus that implicit bias training is a key component of birth equity initiatives. A requirement for implicit bias training for healthcare professionals has become more widespread, but the impact training has is largely unknown, in part, because of a lack of validated instruments. Therefore, there is an urgent need for a psychometrically valid instrument for use in the evaluation of implicit bias training. OBJECTIVE This study aimed to develop a valid and reliable instrument to assess implicit bias awareness and mitigation practices among maternal care professionals and that can be used to evaluate interventions aimed at mitigating such bias in clinical practice. STUDY DESIGN We conducted an instrument development and validation study in 3 phases. In phase 1, item development, we generated a 43-item bank from literature and consultation and established content validity with subject matter experts. In phase 2, instrument development, we administered a revised set of 33 items to 307 nurses and midwives and conducted exploratory factor analysis to demonstrate construct validity and reliability. In phase 3, instrument evaluation, we confirmed the factor structure and compared the means of implicit bias training-exposed and -unexposed participants to further demonstrate construct validity with a representative state sample of 2096 maternal healthcare professionals (physicians, midwives, and nurses). RESULTS Based on phase 2 results, we retained 23 items for the Bias in Maternal Health Care scale, which showed high internal consistency (Cronbach's alpha, 0.86). We identified 3 subscales, namely a 9-item Bias Awareness subscale (Cronbach's alpha, 0.86), a 7-item Bias Mitigation Practice subscale (Cronbach's alpha, 0.82), and a 7-item Bias Mitigation Self-Efficacy subscale (Cronbach's alpha, 0.81). Validation of the Bias Awareness and Bias Mitigation Practice subscales in phase 3 demonstrated the instrument's high reliability (Cronbach's alpha 0.86 and 0.83, respectively) and discriminating performance among maternal healthcare professionals. CONCLUSION We developed a reliable and valid instrument for measuring awareness and mitigation of bias among maternal healthcare professionals. It can be used to evaluate implicit bias training and other bias mitigation interventions in maternal healthcare settings.
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Affiliation(s)
- Kelly M Bower
- Johns Hopkins University School of Nursing, Baltimore, MD (Drs Bower and Warren).
| | - Briana Kramer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Ms Kramer and Drs Stierman and Creanga)
| | - Nicole Warren
- Johns Hopkins University School of Nursing, Baltimore, MD (Drs Bower and Warren)
| | - Saifuddin Ahmed
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Dr Ahmed)
| | - Jennifer Callaghan-Koru
- Department of Sociology, Anthropology, and Public Health, University of Maryland, Baltimore, MD (Dr Callaghan-Koru)
| | - Elizabeth Stierman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Ms Kramer and Drs Stierman and Creanga)
| | - Cheri Wilson
- Office of Diversity, Inclusion and Health Equity, Johns Hopkins Medicine, Baltimore, MD (Ms Wilson)
| | - Shari Lawson
- Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Drs Lawson and Creanga)
| | - Andreea A Creanga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Ms Kramer and Drs Stierman and Creanga); Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Drs Lawson and Creanga)
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Bower KM, Geller RJ, Jeffers N, McDonald M, Alhusen J. Experiences of racism and perinatal depression: Findings from the pregnancy risk assessment monitoring system, 2018. J Adv Nurs 2023; 79:1982-1993. [PMID: 36630188 DOI: 10.1111/jan.15519] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 10/17/2022] [Accepted: 11/10/2022] [Indexed: 01/12/2023]
Abstract
AIM To estimate the association between feeling upset by experiences of racism and self-reported depression during pregnancy among non-Hispanic Black women using a large population-based sample from the United States. DESIGN We conducted a secondary analysis of nationally representative cross-sectional survey data with retrospective measures. METHODS Analysis of Phase 8 (2018) data from the Pregnancy Risk Assessment Monitoring System survey included 7328 non-Hispanic Black respondents with a recent live birth from 11 states and New York City. Multivariable logistic regression models were used to estimate the association between self-report of feeling upset due to experience of racism during the year prior to delivery and self-reported depression during pregnancy, controlling for potential confounders. RESULTS The prevalence of feeling upset due to experiences of racism was 11.4% and the prevalence of depression during pregnancy was 11.4%. Respondents who reported feeling upset due to the experience of racism had over two-fold higher odds (OR 2.37, 95% CI 1.67, 3.37) of experiencing depression during pregnancy compared to respondents who did not report feeling upset due to the experience of racism, adjusted for maternal age, educational attainment, marital status, pre-pregnancy insurance type, region, and pre-pregnancy depression. CONCLUSION Respondents who felt upset due to the experience of racism in the year prior to delivery experienced significantly higher odds of depression during pregnancy, and thus are at an increased risk for adverse maternal outcomes. IMPACT Stress from racism and racial discrimination during the perinatal period may contribute to maternal morbidity, including perinatal depression, among Black women. NO PATIENT OR PUBLIC CONTRIBUTION The data in this study were collected by the Centers for Disease Control and Prevention for the Pregnancy Risk Assessment Monitoring System. To our knowledge, the conduct of the study did not include patient or public contribution. Neither did the analysis, interpretation, nor manuscript preparation include patient or public contribution because we did not have funding to support the study or their involvement.
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Affiliation(s)
- Kelly M Bower
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Ruth J Geller
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Noelene Jeffers
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maria McDonald
- University of Virginia School of Nursing, Charlottesville, Virginia, USA
| | - Jeanne Alhusen
- University of Virginia School of Nursing, Charlottesville, Virginia, USA
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Chu H, Kirby L, Booth A, Klepper M, Sherman ADF, Bower KM, Wright EM. Providing gender affirming and inclusive care to transgender men experiencing pregnancy. Midwifery 2023; 116:103550. [PMID: 36423562 PMCID: PMC9850418 DOI: 10.1016/j.midw.2022.103550] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES AND DESIGN Information about providing professional and appropriate perinatal care to transgender men in the perinatal setting is scarce, and healthcare providers often have insufficient knowledge or skills to provide this care. In response, a quality improvement educational program for nursing staff was developed and implemented, with the goal of evaluating the impact of this intervention on nurses' knowledge, skills, and attitudes when caring for pregnant transgender men. SETTING AND PARTICIPANTS The training was offered to nursing staff of a 24-bed inpatient perinatal unit at a large, private academic medical center in a major East Coast city during the unit's quarterly staff meeting in March 2020. INTERVENTION The training covered the provision of affirming and inclusive perinatal care for transgender men. The content of the training was based on recommendations in the literature and reviewed by content experts. MEASUREMENTS Pre-test (N = 55) and post-test (N = 23) online self-administered surveys assessed nursing staff's knowledge of, comfort, and interest in providing gender affirming care for transgender men. Mann-Whitney U and Fischer's exact tests were used to determine significant changes in knowledge and attitudes over time. FINDINGS Findings suggest the training improved nursing staff's self-reported knowledge and skills in providing gender affirming care to pregnant transgender men over time, with participants demonstrating improved knowledge about communication around pronouns, gender identity, reproductive systems, and obstetric history. Awareness of resources for both professional development and to refer transgender patients also improved. However, persistent deficits in other knowledge, skills, and attitudes remained, suggesting that nurses would likely benefit from further support and training in transgender-specific health issues. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Findings support the utility of unit-based training in improving affirming and inclusive care in the perinatal setting. This highlights opportunities for supporting nurses' professional practice of caring for transgender patients experiencing pregnancy and may be adapted for use in other specialty units.
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Affiliation(s)
- Hillary Chu
- Johns Hopkins School of Nursing, 525N. Wolfe Street, Baltimore, MD 21205, United States.
| | - Lee Kirby
- Johns Hopkins School of Nursing, 525N. Wolfe Street, Baltimore, MD 21205, United States.
| | - Ashley Booth
- Johns Hopkins School of Nursing, 525N. Wolfe Street, Baltimore, MD 21205, United States.
| | - Meredith Klepper
- Johns Hopkins School of Nursing, 525N. Wolfe Street, Baltimore, MD 21205, United States.
| | - Athena D F Sherman
- The Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd., Atlanta, GA 30322, United States.
| | - Kelly M Bower
- Johns Hopkins School of Nursing, 525N. Wolfe Street, Baltimore, MD 21205, United States.
| | - Erin M Wright
- Johns Hopkins School of Nursing, 525N. Wolfe Street, Baltimore, MD 21205, United States.
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Ogunwole SM, Karbeah J, Bozzi DG, Bower KM, Cooper LA, Hardeman R, Kozhimannil K. Health Equity Considerations in State Bills Related to Doula Care (2015-2020). Womens Health Issues 2022; 32:440-449. [PMID: 35610121 PMCID: PMC10224765 DOI: 10.1016/j.whi.2022.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/07/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Racial inequities in birth outcomes persist in the United States. Doula care may help to decrease inequities and improve some perinatal health indicators, but access remains a challenge. Recent doula-related state legislative action seeks to improve access, but the prioritization of equity is unknown. We reviewed recent trends in doula-related legislation and evaluated the extent to which new legislation addresses racial health equity. METHODS We conducted a landscape analysis of the LegiScan database to systematically evaluate state legislation mentioning the word "doula" between 2015 and 2020. We identified and applied nine criteria to assess the equity focus of the identified doula-related legislative proposals. Our final sample consisted of 73 bills across 24 states. RESULTS We observed a three-fold increase in doula-related state legislation introduced over the study period, with 15 bills proposed before 2019 and 58 proposed in 2019-2020. Proposed policies varied widely in content and scope, with 53.4% focusing on Medicaid reimbursement for doula care. In total, 12 bills in 7 states became law. Seven of these laws (58.3%) contained measures for Medicaid reimbursement for doula services, but none guaranteed a living wage based on the cost of living or through consultation with doulas. Only two states (28.6%; Virginia and Oregon) that passed Medicaid reimbursement for doulas also addressed other racial equity components. CONCLUSIONS There has been an increase in proposed doula-related legislation between 2015 and 2020, but racial health equity is not a focus among the laws that passed. States should consider using racial equity assessments to evaluate proposed doula-related legislation.
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Affiliation(s)
- S Michelle Ogunwole
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins Center for Health Equity, Baltimore, Maryland.
| | - J'Mag Karbeah
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Debra G Bozzi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kelly M Bower
- Johns Hopkins University School of Nursing, Baltimore, Maryland; Johns Hopkins Center for Health Disparities Solutions, Baltimore, Maryland
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins Center for Health Equity, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rachel Hardeman
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota; Center for Antiracism Research for Health Equity, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Katy Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
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Callaghan-Koru JA, Wahid I, Lawson SM, Bower KM, Wilburn CS, Creanga AA. Maternal Warning Signs Education During Home Visiting: Results from a Formative Evaluation in Maryland. Women's Health Reports 2022; 3:633-642. [PMID: 35982773 PMCID: PMC9380880 DOI: 10.1089/whr.2022.0027] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
Abstract
Background: Maternal mortality rate reviews have identified the need for improved patient education regarding the warning signs of maternal complications to reduce preventable deaths. Maternal and child home visiting programs have the potential to deliver this education in communities. Aims: This study sought to evaluate the baseline provision of warning signs education among home visiting programs in Maryland and to assess the acceptability of and preferences for warning signs education materials among program staff. Materials and Methods: This sequential exploratory, mixed-methods study included qualitative interviews and focus group discussions followed by a web-based survey of all home visiting programs providing early postpartum visits in Maryland. Results: Twenty-five home visiting program staff took part in qualitative data collection, and survey responses were submitted by a manager from 40 of 58 eligible home visiting programs (69% response rate). All survey respondents agreed that home visiting programs should provide warning signs education and more than 80% of programs provided some warning signs education during pregnancy and the postpartum period. Printed pamphlets were provided by 68% of programs for pregnancy complications and 43% for postpartum complications. Only 33% of respondents were satisfied with their existing warnings signs education materials; 98% were interested in new illustrated pamphlets and 88% were interested in education videos. Qualitative participants considered pamphlets with simple designs, limited text, and visuals, as the most accessible for home visiting clients. Conclusions: There are opportunities to strengthen and expand warning signs education in Maryland through home visiting programs using new printed and video education materials.
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Affiliation(s)
- Jennifer A. Callaghan-Koru
- Department of Sociology, Anthropology, and Public Health, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Inaya Wahid
- Department of Sociology, Anthropology, and Public Health, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Shari M. Lawson
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly M. Bower
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Colleen S. Wilburn
- Maternal and Child Health Bureau, Maryland Department of Health, Baltimore, Maryland, USA
| | - Andreea A. Creanga
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Duggan AK, Bower KM, Spinosa CZ, O'Neill K, Daro D, Harding K, Ingalls A, Kemner A, Marchesseault C, Thorland W. Changing the home visiting research paradigm: models' perspectives on behavioral pathways and intervention techniques to promote good birth outcomes. BMC Public Health 2022; 22:1024. [PMID: 35597986 PMCID: PMC9123293 DOI: 10.1186/s12889-022-13010-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The US is scaling up evidence-based home visiting to promote health equity in expectant families and families with young children. Persistently small average effects for full models argue for a new research paradigm to understand what interventions within models work best, for which families, in which contexts, why, and how. Historically, the complexity and proprietary nature of most evidence-based models have been barriers to such research. To address this, stakeholders are building the Precision Paradigm, a common framework and language to define and test interventions and their mediators and moderators. This observational study used portions of an early version of the Precision Paradigm to describe models' intended behavioral pathways to good birth outcomes and their stance on home visitors' use of specific intervention technique categories to promote families' progress along intended pathways. METHODS Five evidence-based home visiting models participated. Model representatives independently completed three structured surveys focused on 41 potential behavioral pathways to good birth outcomes, and 23 behavior change technique categories. Survey data were used to describe and compare models' intended behavioral pathways, explicit endorsement of behavior change technique categories, expectations for home visitors' relative emphasis in using endorsed technique categories, and consistency in endorsing technique categories across intended pathways. RESULTS Models differed substantially in nearly all respects: their intended pathways to good birth outcomes (range 16-41); the number of technique categories they endorsed in any intended pathway (range 12-23); the mean number of technique categories they endorsed per intended pathway (range 1.5-20.0); and their consistency in endorsing technique categories across intended pathways (22%-100% consistency). Models were similar in rating nearly all behavior change technique categories as at least compatible with their model, even if not explicitly endorsed. CONCLUSIONS Models successfully used components of the Precision Paradigm to define and differentiate their intended behavioral pathways and their expectations for home visitors' use of specific technique categories to promote family progress on intended pathways. Use of the Precision Paradigm can accelerate innovative cross-model research to describe current models and to learn which interventions within home visiting work best for which families, in which contexts, why and how.
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Affiliation(s)
- Anne K Duggan
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Kelly M Bower
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Ciara Z Spinosa
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Kay O'Neill
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Deborah Daro
- Chapin Hall at the University of Chicago, 1313 E. 60th Street, Chicago, IL, 60637, USA
| | - Kathryn Harding
- Healthy Families America at Prevent Child Abuse America, 228 S. Wabash, 10th Floor, Chicago, IL, 60604, USA
| | - Allison Ingalls
- Department of International Health, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Baltimore, MD, 21231, USA
| | - Allison Kemner
- Parents As Teachers National Center, 2228 Ball Drive, St. Louis, MO, 63146, USA
| | - Crista Marchesseault
- Minding the Baby National Office: Yale Child Study Center & Yale School of Nursing, Yale University, P.O. Box 208056, New Haven, CT, 06520, USA
| | - William Thorland
- Nurse-Family Partnership, National Service Office, 1900 Grant Street, Suite 400, Denver, CO, 80203, USA
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Bower KM, Alexander KA, Levin MB, Jaques KA, Kub J. Using Critical Service-Learning Pedagogy to Prepare Graduate Nurses to Promote Health Equity. J Nurs Educ 2021; 60:38-43. [PMID: 33400807 DOI: 10.3928/01484834-20201217-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/15/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite calls from professional organizations to prepare a nursing workforce with the requisite skills to address social determinants of health (SDOH), there is little guidance for nurse educators about how to actively promote student learning of these complex issues. METHOD We applied a critical service-learning (CSL) pedagogy to enhance graduate public health nursing curriculum and support learner skill building in approaches to combat health disparities by addressing the underlying social conditions. RESULTS Course content and critical reflection activities were built incrementally across four courses and semesters to introduce and apply antioppressive frameworks, encourage students to examine their personal identities of privilege and oppression, and examine historical context and systems of power in public health settings. CONCLUSION CSL supports student development of structural competence and their understanding of approaches that can dismantle inequitable systems by addressing SDOH that contribute to health disparities. [J Nurs Educ. 2021;60(1):38-43.].
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Ogunwole SM, Bennett WL, Williams AN, Bower KM. Community-Based Doulas and COVID-19: Addressing Structural and Institutional Barriers to Maternal Health Equity. Perspect Sex Reprod Health 2020; 52:199-204. [PMID: 33399272 DOI: 10.1363/psrh.12169] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 05/06/2023]
Affiliation(s)
- S Michelle Ogunwole
- Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore
| | - Wendy L Bennett
- Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore
| | - Andrea N Williams
- Nzuri Malkia Birth Cooperative and Baltimore Community Doulas, Baltimore
| | - Kelly M Bower
- School of Nursing and Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins University, Baltimore
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McDowell A, Bower KM. Transgender Health Care for Nurses: An Innovative Approach to Diversifying Nursing Curricula to Address Health Inequities. J Nurs Educ 2017; 55:476-9. [PMID: 27459437 DOI: 10.3928/01484834-20160715-11] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 06/01/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Transgender people experience high rates of discrimination in health care settings, which is linked to decreases in physical and mental wellness. By increasing the number of nurses who are trained to deliver high-quality care to transgender patients, health inequities associated with provider discrimination can be mitigated. At present, baccalaureate nursing curricula do not adequately prepare nurses to care for transgender people, which is a shortcoming that has been attributed to limited teaching time and lack of guidance regarding new topics. METHOD We developed transgender health content for students in a baccalaureate nursing program and used a student-faculty partnership model to integrate new content into the curriculum. RESULTS We incorporated new transgender health content into five required courses over three semesters. CONCLUSION We mitigated common barriers to developing and integrating new, diversity-related topics into a baccalaureate nursing curriculum. Added transgender health content was well received by students and faculty. [J Nurs Educ. 2016;55(8):476-479.].
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Abstract
INTRODUCTION This article presents an integrative review of the literature examining the relationship between racial discrimination and adverse birth outcomes. METHODS Searches for research studies published from 2009 to 2015 were conducted using PubMed, CINAHL, Scopus, PsycINFO, Web of Science, and Embase. Articles were assessed for potential inclusion using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2009 framework. RESULTS Fifteen studies met criteria for review. The majority of the studies found a significant relationship between racial discrimination and low birth weight, preterm birth, and small for gestational age. Each of the studies that examined more proximal variables related to birth outcomes such as entry into prenatal care, employment opportunities, neighborhood characteristics, or inflammatory markers found significant associations between the specific variables examined and racial discrimination. Participants in qualitative studies discussed experiences of institutional racism with regard to several components of prenatal care including access and quality of care. DISCUSSION Racial discrimination is a significant risk factor for adverse birth outcomes. To best understand the mechanisms by which racial discrimination impacts birth outcomes, and to inform the development of effective interventions that eliminate its harmful effects on health, longitudinal research that incorporates comprehensive measures of racial discrimination is needed. Health care providers must fully acknowledge and address the psychosocial factors that impact health outcomes in minority racial/ethnic women.
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Abstract
Community problems have been associated with higher, and community resources and social cohesion with lower, blood pressure. However, prior studies have not accounted for potential confounding by residential racial segregation. This study tested associations between community characteristics and blood pressure levels and prevalent hypertension in a racially integrated community. The Exploring Health Disparities in Integrated Communities Study measured blood pressure in residents of two contiguous racially integrated and low-income US Census Tracts. Community characteristics included a standardized community problem score and binary indicators for community social cohesion, having a community leader available, and having at least one community resource observed on the participant's block. In adjusted models, greater community problems and proximity to resources were associated with lower systolic (β = -2.020, p = 0.028; β = -4.132, p = 0.010) and diastolic (β = -1.261, p = 0.038; β = -2.290, 0.031) blood pressure, respectively, among whites (n = 548). Social cohesion was associated with higher systolic (β = 4.905, p = 0.009) and diastolic blood pressure (β = 3.379, p = 0.008) among African Americans (n = 777). In one racially integrated low-income community, community characteristics were associated with blood pressure levels, and associations differed by race. Directions of associations for two findings differed from prior studies; greater community problem was associated with lower blood pressure in whites and community social cohesion was associated with higher blood pressure in African Americans. These findings may be due to exposure to adverse environmental conditions and hypertensive risk factors in this low-income community.
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Affiliation(s)
- L J Samuel
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA,
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Kavanagh KF, Lou Z, Burney JL, Greer BP, Bower KM, Nicklas JC. Lyophilization of Infant‐formula Samples Collected from Low‐income Mothers at ~ 2 Months of Infant Age. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.404.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Z Lou
- Nutrition Dept Univ of TNUnited States
| | - JL Burney
- Family & Consumer Sciences Dept Univ of TNUnited States
| | - B P Greer
- Family & Consumer Sciences Dept Univ of TNUnited States
| | - KM Bower
- Nutrition Dept Univ of TNUnited States
| | - JC Nicklas
- WIC City and County of BroomfieldUnited States
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Bower KM, Nicklas JC, Burney JL, Greer BP, Lou Z, Kavanagh KF. Cereal‐in‐the‐Bottle Associated with Increased Time Between Feeds Among a Sample of Low‐Income Women. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.404.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- KM Bower
- Nutrition Dept.Univ. of TNUnited States
| | - JC Nicklas
- WIC City and County of BroomfieldUnited States
| | - JL Burney
- Dept. of Family and Consumer Sciences Univ. of TNUnited States
| | - B P Greer
- Dept. of Family and Consumer Sciences Univ. of TNUnited States
| | - Z Lou
- Nutrition Dept.Univ. of TNUnited States
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Abstract
This study examined the relationship between perceived racial discrimination and the presence of anxiety and depression in a sample of low-income, urban-dwelling whites. Data were analyzed from a cross-sectional survey of low-income whites living in an inner-city neighborhood in the mid-Atlantic United States. Perceived racial discrimination was reported by 39 percent of participants. Rates of depression in the population exceed prevalence rates in the general U.S. population. Those who perceived racial discrimination and were bothered by it experienced significantly greater odds of being depressed (OR = 2.78, 95% CI 1.60-4.82) and had higher anxiety scores (b = 2.02, SE 0.55, p = 0.000) than those who did not perceive racial discrimination. Low-income, urban white populations have been largely ignored in public health research. This study demonstrates that perceived racial discrimination is common in poor urban whites. Further, exposure to discrimination that is perceived as a stressor is associated with mental illness.
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Affiliation(s)
- Kelly M Bower
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
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