A tripartite model for recruiting African-Americans into fatherhood intervention research

Associations between Paternal Co-residence and Child Health among African American Children

We investigated the associations between paternal co-residence and asthma, obesity, and blood pressure among children aged 3-5 years. Mother/child dyads (N = 250) self-identified as African American or Black. Mothers reported on father's co-residence and child's asthma diagnosis. Height, weight, and blood pressure were measured. Regression models were used to examine paternal co-residence with child health outcomes (i.e., asthma, obesity, and blood pressure). Confounders included maternal and child age, child sex, maternal smoking, and insurance status. Children who lived with their fathers were less likely to have asthma (OR = 0.39, 95% CI 0.18-0.79), though this association was not significant after adjustment for confounders (aOR = 0.47, 95% CI 0.22-1.01). Paternal co-residence was not significantly associated with child obesity (aOR = 0.78, 95% CI 0.35-1.73), systolic (β = 0.57, SE = 1.2, p = .64), or diastolic (β = 1.91, SE = 1.0, p = .07) blood pressure. More research is necessary to understand the diversity of family living situations and how they affect child health.

Black fathers' contributions to maternal mental health

This mixed-methods research study aimed to assess the contribution of interparental relationship quality and paternal support for mothers to maternal mental health among Black parents in a metro area characterized by severe racial disparities. We also explored Black parents' understanding of meaningful paternal support for mothers. Using survey data collected from Black mothers (N = 75), we examined correlations among the study variables, then conducted mediation and moderation analyses to examine whether relationship quality would mediate the association between paternal support and maternal mental health and to test whether relationship quality would moderate the association between paternal support and maternal self-reported overall health. We used inductive thematic analysis to analyze data from focus groups with Black parents (N = 15). We found that mothers' mental health was positively correlated with relationship quality, mothers' subjective health was positively correlated with paternal support, and relationship quality significantly mediates the relationship between paternal support and maternal mental health while controlling for relationship status. Our thematic analysis yielded four themes to characterize meaningful paternal support for mothers and a high quality interparental relationship: (1) Teammates; (2) Multidimensional, everyday support; (3) Communication is key; and (4) Challenge racism and disrupt intergenerational trauma. Findings suggest that paternal support and interparental relationship quality can play a protective role, promoting maternal mental health and wellbeing. Providers of perinatal services should support Black parents to support one another, including as advocates in confronting racism.

Listening to the "HITS:" Screening for IPV in African American Co-Parents of Young Children

Relationships among African American (AA) parents living apart can be contentious. A common assumption is that men are the perpetrators and women are the victims of violence. Research examining the symmetry of intimate partner violence (IPV) has not focused enough on AA parents who are co-parenting their young children while living apart. The purpose of this study is to explore reports of IPV among non-cohabiting AA co-parents of 2-6-year-old children enrolled in the Dedicated African American Dad Study (DAADS). Our objectives for this study are to characterize the nature of intimate partner relationships among non-co-residing co-parents by exploring the association between the quality of relationship and co-parenting fathers' and mothers' Hurt, Insult, Threaten, and Scream (HITS) scores. The HITS is a domestic violence screening tool for use in the community. As part of the screening protocol for study inclusion, we administered the HITS to father-mother dyads. Fathers were ineligible for participation if either parent reported HITS cut-off scores >10 and identified safety concerns for themselves when interacting with their co-parent. Among DAAD study parenting dyads, we noted symmetry in reports of IPV (i.e., both parents reported elevated HITS scores). The most frequently elevated HITS items were "insult or talk down to" and "scream or curse" indicating the preponderance of verbal conflict among parents in the study. The nature of IPV among co-parents in this study is predominantly verbal. In light of the potential for reciprocity in IPV, interventions for families in this context should focus on communication and problem solving to support fathers and mothers and minimize child harm.

Facilitators and Barriers to Pediatric Clinical Trial Recruitment and Retention in Rural and Community Settings: A Scoping Review of the Literature

Children in rural settings are underrepresented in clinical trials, potentially contributing to rural health disparities. We performed a scoping review describing available literature on barriers and facilitators impacting participation in pediatric clinical trials in rural and community-based (non-clinical) settings. Articles identified via PubMed, CINAHL, Embase, and Web of Science were independently double-screened at title/abstract and full-text levels to identify articles meeting eligibility criteria. Included articles reported on recruitment or retention activities for U.S.-based pediatric clinical studies conducted in rural or community-based settings and were published in English through January 2021. Twenty-seven articles describing 31 studies met inclusion criteria. Most articles reported on at least one study conducted in an urban or suburban or unspecified community setting (n=23 articles; 85%); fewer (n=10; 37%) reported on studies that spanned urban and rural settings or were set in rural areas. More studies discussed recruitment facilitators (n=25 studies; 81%) and barriers (n=19; 61%) versus retention facilitators (n=15; 48%) and barriers (n=8; 26%). Descriptions of recruitment and retention barriers and facilitators were primarily experiential or subjective. Recruitment and retention facilitators were similar across settings and included: contacts/reminders, community engagement and relationship-building, consideration of participant logistics, and incentives. Inadequate staff and resources were commonly cited recruitment and retention barriers. Few studies have rigorously examined optimal ways to recruit and retain rural participants in pediatric clinical trials. To expand the evidence base, future studies examining recruitment and retention strategies should systematically assess and report rurality and objectively compare relative impact of different strategies.

Recruitment, Retention, and Intervention Outcomes from the Dedicated African American Dad (DAAD) Study

A significant proportion of African American (AA) fathers live in households apart from their young children. This living arrangement can have detrimental effects for children, families, and fathers. One hundred seventy-eight (n = 178) AA fathers, not residing with their 2-6-year-old children, were enrolled in a randomized trial to test the Building Bridges to Fatherhood (BBTF) program against a financial literacy comparison condition. BBTF is an intervention that was developed collaboratively with a fathers' advisory council of AA fathers who oversaw all aspects of program development. Based upon advisory council feedback, short video scenes captured fathers interacting with their children, their children's mothers, and other fathers. These video scenes were used to jump start the discussion around fatherhood, parenting, communication, and problem solving during the intervention group meetings. The actors in the video scenes were recruited from the community. Two trained group leaders, using a standardized group leader manual, delivered the intervention. The Money Smart Financial Literacy Program (MSFLP), which served as the comparator, was also delivered by AA men. Program satisfaction was high in both conditions. Even so recruitment and retention challenges influenced the ability to detect father and child outcomes. This study informs the participation of vulnerable urban AA fathers in community-based fatherhood intervention research and provides insight into bolstering engagement in studies focused on this population.