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Noroña-Zhou AN, Ashby BD, Richardson G, Ehmer A, Scott SM, Dardar S, Marshall L, Talmi A. Rates of Preterm Birth and Low Birth Weight in an Adolescent Obstetric Clinic: Achieving Health Equity Through Trauma-Informed Care. Health Equity 2023; 7:562-569. [PMID: 37731783 PMCID: PMC10507928 DOI: 10.1089/heq.2023.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 09/22/2023] Open
Abstract
Objectives Adolescents who are pregnant and identify as Black are exposed to more societal harms that increase their and their offspring's risk for poor health outcomes. The Colorado Adolescent Maternity Program (CAMP) offers comprehensive, multidisciplinary (medical, behavioral health, nutrition, case management), trauma-informed obstetric care to pregnant adolescents to ensure the healthiest pregnancy and birth possible and pursue health equity. The present study aimed to examine ethnic and racial disparities in preterm birth and low birth weight before and after implementation of a trauma-informed model of care. Methods Participants were 847 pregnant adolescents (ages 12-22 years; 41% self-identified as Hispanic, 32% as non-Hispanic Black, 21% as non-Hispanic white) who received prenatal treatment-as-usual (TAU) or trauma-informed treatment. Demographic information, mental health symptoms, and birth outcomes were abstracted from medical records. Results Overall, findings provided support that implementation of a trauma-informed model of prenatal care led to equitable birth outcomes across racial and ethnic groups. Specifically, Black adolescents in the TAU group were more than twice as likely to deliver preterm or low birth weight infants compared with white and Hispanic adolescents. In the trauma-informed group, however, there were no statistical differences in birth outcomes across racial/ethnic groups, indicating an elimination of disparities in both preterm birth and low birth weight in this population. These more equitable birth outcomes occurred even in the context of adolescents of color having reported more severe depression symptoms postimplementation. Conclusions These findings provide evidence that a health system-level intervention, herein trauma-informed obstetric care for adolescents, can play a meaningful role in the reduction of racial disparities in birth outcomes.
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Affiliation(s)
- Amanda N. Noroña-Zhou
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
- Children's Hospital Colorado, Aurora, Colorado, USA
| | - Bethany D. Ashby
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Georgette Richardson
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Psychological Health and Learning Sciences, College of Education, University of Houston, Houston, Texas, USA
| | - Amelia Ehmer
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stephen M. Scott
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shaleah Dardar
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ladean Marshall
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ayelet Talmi
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Lanier Y, Cornelius T, Morillo C, Lavarin C, Brawner BM, Kershaw T. A Dyadic Analysis Exploring the Mediating Role of Relationship Quality on Discrimination and HIV/STI Risk Among Young Black and Latino Expecting Couples. AIDS Behav 2023; 27:1269-1276. [PMID: 36156173 PMCID: PMC10038914 DOI: 10.1007/s10461-022-03863-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/25/2022]
Abstract
Encounters with discrimination are a normative experience for many Black and Latino adolescents and young adults (AYAs); these experiences may be even more common for expecting AYAs. While the harmful effects of discriminatory experiences on mental and physical health have been well explored, relatively little is known regarding the impact of discrimination on relationship quality and sexual health-specifically HIV/STI risk.Using the Actor Partner Interdependence Model, we examined both actor and partner effects of discrimination on relationship quality and willingness to be non-monogamous in a sample of 259 pregnant adolescent and young adult couples. There was a significant indirect actor effect, such that one's own discrimination was associated with a decrease in their own relationship quality which, in turn, was associated with their own greater willingness to be non-monogamous. The partner effect for the association of one's partner's discrimination on one's own relationship quality was not significant. Findings highlight the need for more attention to the implications of discrimination on relational and sexual health.
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Affiliation(s)
- Yzette Lanier
- Rory Meyers College of Nursing, New York University, New York, US.
| | | | - Cheyenne Morillo
- School of Global Public Health, New York University, New York, US
| | | | - Bridgette M Brawner
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, US
| | - Trace Kershaw
- School of Public Health, Yale University , New Haven, US
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Powell A, Kershaw T, Gordon DM. Double Impact: A Dyadic Discrimination Model for Poor, Minority, and Pregnant Couples. J Urban Health 2022; 99:1033-1043. [PMID: 36149546 PMCID: PMC9727055 DOI: 10.1007/s11524-022-00682-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 12/31/2022]
Abstract
Frequent daily discrimination compounds the negative health impacts of those with multiple marginalized identities, including pregnant mothers and their children. We used a dyadic, moderated, mediated model of 296 young, expectant, poor, urban, primarily minority couples. In this study, we explored if a multiple pathway discrimination model explained the relationship between multiple marginalized identities and health (depression and stress). We also examined if a mediated (discrimination moderated by gender) model, within a minority-stress and intersectional framework explained the relationship with depression and stress for couples. We observed that frequent daily discrimination was associated with negative health outcomes (depression and stress). Women reported significantly more depression than men. Frequent daily discrimination mediated the relationship between multiple marginalized identities and depression and stress and having a partner with multiple marginations increased one's personal depression and stress. Our observations suggest that discrimination's impact on health is experienced during pregnancy and the more marginalized identities one carries, the more impact it may have. Further, having a partner with multiple marginalized identities also impacts the depression and stress reported by women. Inventions to address depression and stress outcomes may be strengthened by considering multiple marginalized identities and include couples.
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Affiliation(s)
- Adeya Powell
- Yale Center for Interdisciplinary Research On AIDS, 135 College Street, New Haven, CT, USA.
- University of Portland, 5000 N. Willamette Blvd, Portland, OR, 97203-5798, USA.
| | - Trace Kershaw
- Yale Center for Interdisciplinary Research On AIDS, 135 College Street, New Haven, CT, USA
- School of Public Health, Yale University, 60 College Street, New Haven, CT, USA
| | - Derrick M Gordon
- Yale Center for Interdisciplinary Research On AIDS, 135 College Street, New Haven, CT, USA
- School of Public Health, Yale University, 60 College Street, New Haven, CT, USA
- The Consultation Center, 389 Whitney Ave, New Haven, CT, USA
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Sachs AL, Coringrato E, Sprague N, Turbyfill A, Tillema S, Litt J. Rationale, Feasibility, and Acceptability of the Meeting in Nature Together (MINT) Program: A Novel Nature-Based Social Intervention for Loneliness Reduction with Teen Parents and Their Peers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11059. [PMID: 36078775 PMCID: PMC9518349 DOI: 10.3390/ijerph191711059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
Recently, there has been an increase in feelings of loneliness and mental health conditions among adolescents. Within this population, parenting teens are at an increased risk for these conditions. Outdoor experiences are shown to be an antidote to loneliness and a way to promote social connectedness by amplifying the processes for supporting social relationships. In 2020-2021, we piloted the 8-week Meeting in Nature Together program (MINT) at a charter school for pregnant and parenting teenagers in Colorado, USA. MINT aimed to promote relatedness and nature connection for students ages 14 to 19. MINT included online and in-person group meetings with educational content, creative activities, discussion, park excursions, mindfulness activities, journaling, and nature photography. Here, we ask, can a school-level nature-based social intervention reduce loneliness among pregnant and parenting teens by promoting and sustaining social connections? How acceptable is MINT to participants? Methods included audiovisual recording transcriptions, surveys, and observation field notes. Results suggest that MINT fostered social connections through a tailored nature-based intervention delivered to a typically isolated community in culturally sensitive, developmentally appropriate ways. MINT proved feasible and effective as participants reported high levels of satisfaction and interest in continuing to engage in activities promoted in MINT.
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Affiliation(s)
- Ashby Lavelle Sachs
- Environmental Studies Program, University of Colorado Boulder, Boulder, CO 80309, USA
- Barcelona Institute for Global Health (ISGlobal), Barcelona 08003, Spain
| | - Eva Coringrato
- Environmental Studies Program, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Nadav Sprague
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Angela Turbyfill
- Young Mother’s Clinic at the Children’s Hospital of Colorado, Aurora, CO 80045, USA
| | - Sarah Tillema
- Young Mother’s Clinic at the Children’s Hospital of Colorado, Aurora, CO 80045, USA
| | - Jill Litt
- Environmental Studies Program, University of Colorado Boulder, Boulder, CO 80309, USA
- Barcelona Institute for Global Health (ISGlobal), Barcelona 08003, Spain
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