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Macintyre AK, Shipton D, Sarica S, Scobie G, Craig N, McCartney G. Assessing the effects of population-level political, economic and social exposures, interventions and policies on inclusive economy outcomes for health equity in high-income countries: a systematic review of reviews. Syst Rev 2024; 13:58. [PMID: 38331910 PMCID: PMC10851517 DOI: 10.1186/s13643-023-02429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/11/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND A fairer economy is increasingly recognised as crucial for tackling widening social, economic and health inequalities within society. However, which actions have been evaluated for their impact on inclusive economy outcomes is yet unknown. OBJECTIVE Identify the effects of political, economic and social exposures, interventions and policies on inclusive economy (IE) outcomes in high-income countries, by systematically reviewing the review-level evidence. METHODS We conducted a review of reviews; searching databases (May 2020) EconLit, Web of Science, Sociological Abstracts, ASSIA, International Bibliography of the Social Sciences, Public Health Database, Embase and MEDLINE; and registries PROSPERO, Campbell Collaboration and EPPI Centre (February 2021) and grey literature (August/September 2020). We aimed to identify reviews which examined social, political and/or economic exposures, interventions and policies in relation to two IE outcome domains: (i) equitable distribution of the benefits of the economy and (ii) equitable access to the resources needed to participate in the economy. Reviews had to include primary studies which compared IE outcomes within or between groups. Quality was assessed using a modified version of AMSTAR-2 and data synthesised informed by SWiM principles. RESULTS We identified 19 reviews for inclusion, most of which were low quality, as was the underlying primary evidence. Most reviews (n = 14) had outcomes relating to the benefits of the economy (rather than access to resources) and examined a limited set of interventions, primarily active labour market programmes and social security. There was limited high-quality review evidence to draw upon to identify effects on IE outcomes. Most reviews focused on disadvantaged groups and did not consider equity impacts. CONCLUSIONS Review-level evidence is sparse and focuses on 'corrective' approaches. Future reviews should examine a diverse set of 'upstream' actions intended to be inclusive 'by design' and consider a wider range of outcomes, with particular attention to socioeconomic inequalities.
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Affiliation(s)
- Anna K Macintyre
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK.
| | - Deborah Shipton
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Shifa Sarica
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Graeme Scobie
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Neil Craig
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Gerry McCartney
- School of Social & Political Sciences, University of Glasgow, Glasgow, UK
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Marçal KE, Maguire-Jack K. Informal supports, housing insecurity, and adolescent outcomes: Implications for promoting resilience. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 70:178-196. [PMID: 35156209 DOI: 10.1002/ajcp.12589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 12/09/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
Adolescents in low-income, marginalized families are vulnerable to behavior problems that impede healthy functioning and threaten long-term well-being. Informal supports may fill an important gap for these households as they navigate financial and social stressors. Instrumental support from social networks and neighborhood cohesion may promote family stability and youth well-being; further, these informal supports may promote resilience to housing insecurity, which is linked with a range of adverse adolescent outcomes. The present study utilized data from a large sample of at-risk families with children (N = 2425) to investigate whether instrumental support and neighborhood cohesion predicted adolescent behavior problems over 10 years and whether these links were mediated by housing insecurity. Results of structural equation modeling with latent variables showed direct links from instrumental support to anxious/depressed behaviors and from neighborhood cohesion to aggressive behaviors, as well as an indirect link from instrumental support to aggressive behavior via housing insecurity. Findings suggest informal supports are an important source of resilience for low-income families who may be excluded from or are reluctant to engage with formal social systems. Further, stable, connected communities with highly embedded social networks can promote housing stability and youth well-being in a virtuous cycle.
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Affiliation(s)
- Katherine E Marçal
- Greenspun College of Urban Affairs, University of Nevada, Las Vegas, Nevada, USA
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Radey M, Ledermann T, McWey L. Informal support and obligation contribute to fewer child behavior problems over time. FAMILY RELATIONS 2022; 71:1004-1017. [PMID: 36034315 PMCID: PMC9414893 DOI: 10.1111/fare.12659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study used longitudinal data from a sample of low-income mothers and their children to examine how informal support and obligation, or informal networks, contribute to children's behavior. We also tested the potential mediating role of maternal parenting stress. BACKGROUND Many studies document the importance of informal support for maternal stress and child behavior to offset the negative impact of poverty for low-income families. Evidence suggests the importance of also considering the obligations that such informal support access may impart. METHOD Using data from the Welfare, Children, Families Study, a longitudinal study of diverse, low-income, urban mothers in three cities (n = 2,142), we used a parallel process latent growth curve model approach to examine how informal support and obligation contributed to maternal stress and child behavior. RESULTS Models indicated that mothers with healthy safety nets, including informal support and manageable obligations, had children with fewer behavior problems, and parenting stress partially accounted for the positive effects. CONCLUSIONS Results highlight the importance of considering reciprocity norms among low-income mothers; one-sided support or obligation can be problematic for both maternal stress and child behavior problems. IMPLICATION Results suggest the merit of empirically supported interventions to teach relationship skills and facilitate healthy relationships among low-income mothers.
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Affiliation(s)
- Melissa Radey
- College of Social Work, Florida State University, Tallahassee, FL
| | - Tom Ledermann
- College of Health and Human Sciences, Florida State University, Tallahassee, FL
| | - Lenore McWey
- College of Health and Human Sciences, Florida State University, Tallahassee, FL
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Radey M, Lowe S, Langenderfer-Magruder L, Posada K. "Showing Everybody's True Colors": Informal networks of low-income single mothers and their young children during the COVID-19 pandemic. CHILDREN AND YOUTH SERVICES REVIEW 2022; 137:106479. [PMID: 35311026 PMCID: PMC8923715 DOI: 10.1016/j.childyouth.2022.106479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 02/24/2022] [Accepted: 03/13/2022] [Indexed: 05/24/2023]
Abstract
Extensive evidence suggests low-income mothers depend upon their families and friends for emotional, practical, and economic support in times of need. This is the first study to examine the operation of low-income mothers' informal support networks and the impact of such networks on maternal well-being during the COVID-19 pandemic. We interviewed low-income, single mothers of young children (<12 years; N = 34) twice over Summer 2020 to consider mothers' decisions around network engagement and how their interactions contributed to their well-being. Consistent with the social capital framework and previous studies, most mothers turned to their networks and exchanged support. Thematic analysis uncovered 4 inter-related themes of mothers' experiences: (1) discovering emotionally-available networks, (2) navigating resource-limited networks, (3) reassessing network member relationships, and (4) establishing boundaries for in-person contact. Although emotionally valuable, networks could not meet increased economic and child care needs. The COVID-19 pandemic's economic impact and its impact on time use tested network relationships with some relationships strengthening and others dissolving. Widely-available emotional support was essential to mothers adapting to the pandemic. Safe, affordable child care options coupled with accessible, economic supplements can promote well-being among single mothers and their children.
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Affiliation(s)
- Melissa Radey
- Florida State University, College of Social Work, United States
| | - Sarah Lowe
- Yale University, School of Public Health, United States
| | | | - Kristine Posada
- Florida State University, College of Social Work, United States
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Larotonda A, Mason KA. New life, new feelings of loss: Journaling new motherhood during Covid-19. SSM - MENTAL HEALTH 2022; 2:100120. [PMID: 35665094 PMCID: PMC9148859 DOI: 10.1016/j.ssmmh.2022.100120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/26/2022] Open
Abstract
In this article we analyze the longitudinal journals of 32 Pandemic Journaling Project (PJP) participants who were pregnant, planned a pregnancy, or gave birth between January 2020 and July 2021. Employing a grounded theory approach, we coded journals in NVivo for emerging themes related to the influence of the Covid-19 pandemic on perinatal experiences in North America and Europe. In the paper we first provide some brief background on perinatal mental health and on the particular conditions for pregnancy and birth during Covid-19, before introducing major themes that emerged from the data, along with three in-depth case studies. We argue that the new mothers and prospective mothers in our sample associated new life with new feelings of loss during Covid-19. New motherhood during Covid-19 has meant for PJP participants a loss of seemingly irretrievable opportunities and moments that they see as necessary for establishing themselves as mothers and integrating their babies into their families through a process of “kinning” (Howell, 2003). Feelings of loss associated with disruptions to kinning may be partially responsible for the increase in perinatal mental distress observed during the pandemic.
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Holmes SC, Callinan L, Facemire VC, Williams MT, Ciarleglio MM, Smith MV. Material hardship is associated with posttraumatic stress disorder symptoms among low-income Black women. J Trauma Stress 2021; 34:905-916. [PMID: 34644417 PMCID: PMC8941674 DOI: 10.1002/jts.22741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/11/2022]
Abstract
The link between socioeconomic status and posttraumatic stress disorder (PTSD) symptoms is well established. Given that Black women are disproportionately burdened by both poverty and PTSD symptoms, research focusing on these constructs among this population is needed. The current study assessed the association between material hardship (i.e., difficulty meeting basic needs) and PTSD symptoms among 227 low-income Black women in the United States. We explored several potential explanations for the association between poverty and PTSD symptoms (e.g., individuals living in poverty may experience higher levels of trauma exposure; individuals living in poverty may have less access to relevant protective resources, like social support; poverty itself may represent a traumatic stressor). Using robust negative binomial regression, a positive association between material hardship and PTSD symptoms emerged, B = 0.10, p = .009, SMD = 0.08. When trauma exposure was added to the model, it was positively associated with PTSD symptoms, B = 0.18, p < .001, SMD = 0.16, and material hardship remained positively associated with PTSD symptoms, B = 0.10, p =.019, SMD = 0.08. When social support indicators were added to the model, they were not associated with PTSD symptoms; however, material hardship remained significantly associated, B = 0.10, p = .021, SMD = 0.08. In the model with material hardship and trauma exposure, a significant interaction between material hardship and trauma exposure on PTSD symptoms emerged, B = -0.04, p = .027. These results demonstrate the importance of including material hardship in trauma research, assessment, and treatment.
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Affiliation(s)
- Samantha C. Holmes
- Department of Psychology, City University of New York–College of Staten Island, Staten Island, New York
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Laura Callinan
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Vanessa C. Facemire
- Louis Stokes Cleveland Department of Veterans Affairs (VA) Medical Center, Cleveland, Ohio, USA
| | | | - Maria M. Ciarleglio
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Megan V. Smith
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Connecticut Hospital Association, Wallingford, Connecticut, USA
- Child Study Center Yale, School of Medicine, New Haven, USA
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Sokol RL, Mehdipanah R, Bess K, Mohammed L, Miller AL. When Families Do Not Request Help: Assessing a Social Determinants of Health Screening Tool in Practice. J Pediatr Health Care 2021; 35:471-478. [PMID: 34116869 DOI: 10.1016/j.pedhc.2021.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Using pediatric social determinants of health screening data from a large medical system, we explored social needs dislosures and identified which needs were associated with resource connection requests. METHOD Data came from records of outpatient pediatric patients (0-18 years) seen between October 2018 and March 2020 (39,251 encounters). We assessed percent of encounters where families (1) indicated a social need, and (2) requested a resource connection. We conducted multivariable logistic regression to identify which needs were associated with resource connection requests. RESULTS Among all encounters, 8% indicated a need and 2% requested a resource connection. Among families indicating a need, needs associated with resource requests included: housing (odds ratio [OR], 3.49 [2.42-5.03]), employment (OR, 3.15 [2.21-4.50]), food (OR, 1.89 [1.41-2.52]), and transportation (OR, 1.82 [1.30-2.56]). DISCUSSION Families seldom requested resource connections to address social needs. Better understanding families' interests in receiving assistance is an important next step in pediatric social determinants of health screening system development.
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Who Looks on the Bright Side? Expectations of Low-Income Parents with a Disruptive Young Child. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021; 43:766-777. [DOI: 10.1007/s10862-021-09888-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Parker A. Reframing the narrative: Black maternal mental health and culturally meaningful support for wellness. Infant Ment Health J 2021; 42:502-516. [PMID: 33470438 DOI: 10.1002/imhj.21910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Black mothers with young children have encountered pernicious, multidetermined, racial disparities in the United States for centuries. However, disorders, risks, and stressors among Black mothers with young children are presented in the extant literature with little attention to their strengths, supports, or culturally appropriate ways to intervene and this furthers racism and White supremacy. Further, incomplete and negative narratives about Black mothers are perpetuated. Therefore, this article uses the Afrocentric perspective to better understand the state of Black maternal mental health and supports for mental health. Culturally centered recommendations are presented to move the field of infant mental health toward racial justice-oriented practice, policy, and research.
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Affiliation(s)
- Amittia Parker
- School of Social Welfare, University of Kansas, Lawrence, Kansas
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Holmes SC, Ciarleglio MM, Song X, Clayton A, Smith MV. Testing the Family Stress Model among Black Women Receiving Temporary Assistance for Needy Families (TANF). JOURNAL OF CHILD AND FAMILY STUDIES 2020; 29:2667-2677. [PMID: 33776388 PMCID: PMC7988309 DOI: 10.1007/s10826-020-01791-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Black female primary caregivers who receive Temporary Assistance for Needy Families (TANF) are burdened not only by economic pressure but also by a disproportionate prevalence of psychological disorders. This is particularly pernicious given that poverty and maternal mental health impact child outcomes and may decrease the economic mobility of families. Consequently, it is imperative to understand the mechanisms that explain the association between economic pressure and child outcomes. The current study addressed this gap by testing an application of the Family Stress Model (FSM), which describes how economic pressure results in parental psychological distress, particularly depression, and in turn impacts parenting quality and child outcomes. Additionally, social support was assessed as a potential culturally-salient protective factor within the model. Four hundred sixteen Black female primary caregivers who receive TANF were administered a series of measures assessing mental health and family wellbeing. Structural equation modeling was utilized to test a single model that incorporated all hypotheses. Maternal depression and quality of parenting serially mediated the relationship between economic pressure and school performance. The relationship between economic pressure and adverse child outcomes, however, was mediated only by maternal depression. Social support did not significantly moderate the relationship between economic pressure and maternal depression; however, it did demonstrate a significant direct effect on maternal depression. The current study corroborates the application of FSM to another population. Further, it demonstrates the importance of interventions that target maternal mental health, parenting, social support, and family economic mobility as well as system-level policy interventions to address poverty.
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Affiliation(s)
| | | | - Xuemei Song
- Yale School of Public Health, Yale Center for Analytical Sciences
| | | | - Megan V Smith
- Yale School of Medicine, Department of Psychiatry
- Yale School of Medicine, Child Study Center
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