1
|
Boonjindasup W, Marchant JM, McElrea MS, Yerkovich ST, Newcombe PA, Chang AB. Clinical determinants for State-Trait Anxiety Inventory of the parents of children with respiratory problems. Pediatr Pulmonol 2024; 59:31-40. [PMID: 37750592 PMCID: PMC10952396 DOI: 10.1002/ppul.26702] [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] [Received: 03/05/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUNDS Understanding factors associated with anxiety of parents/carers of children with respiratory problems is clinically important yet there is relative paucity of data. In 106 children seen in the respiratory clinic of a pediatric hospital, we evaluated (a) the determinants for parental anxiety and (b) whether the anxiety scores correlate with quality-of-life (QoL) scores in the subset with chronic cough. METHODS We opportunistically re-analyzed data of our main study that examined the benefits of using spirometry for pediatric respiratory consultation where parents completed an anxiety questionnaire (State-Trait Anxiety Inventory, STAI) pre- and postconsultation. A subset (children with chronic cough) also completed the parent-proxy quality-of-life (PC-QoL) tool. We computed the association between clinical characteristics and anxiety scores using multivariable regression and between the two patient-reported outcome measures using Spearman's correlation. RESULTS The majority of parents/carers were women (n = 89, 84%). Most children (mean age = 10.9 years, SD = 3.7 years) were previously seen at the clinic (n = 67, 63.2%). In multivariate regression, parental anxiety score was significantly associated with reported presence of cough [coefficient β = 17.31 (95% confidence interval 9.62, 25.1)] and lower forced expiratory volume in first second (FEV1 )/forced vital capacity (FVC) [-3.88 (-7.05, -0.71)] at preconsultation, but associated with cough only [coefficient β = 12.04 (5.24, 18.84)] at postconsultation, all p < .05. STAI strongly correlated with PC-QoL scores at pre- but only modestly at postconsultation (rs = -.63 and -.39, respectively, p < .05). CONCLUSION Parental anxiety levels of children attending respiratory clinics are influenced by the presence of cough and low FEV1 /FVC of their child and are associated with poorer QoL. These highlight the need for on-going research to reduce parental anxiety focusing on cough and lung function indices.
Collapse
Affiliation(s)
- Wicharn Boonjindasup
- Child Health Division, Menzies School of Health Research, NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE)Charles Darwin UniversityDarwinNorthern TerritoryAustralia
- Australian Centre for Health Services Innovation, Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Department of Pediatrics, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Julie M. Marchant
- Australian Centre for Health Services Innovation, Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Department of Respiratory & Sleep MedicineQueensland Children's HospitalBrisbaneQueenslandAustralia
| | - Margaret S. McElrea
- Australian Centre for Health Services Innovation, Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Department of Respiratory & Sleep MedicineQueensland Children's HospitalBrisbaneQueenslandAustralia
| | - Stephanie T. Yerkovich
- Child Health Division, Menzies School of Health Research, NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE)Charles Darwin UniversityDarwinNorthern TerritoryAustralia
- Australian Centre for Health Services Innovation, Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Peter A. Newcombe
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Anne B. Chang
- Child Health Division, Menzies School of Health Research, NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE)Charles Darwin UniversityDarwinNorthern TerritoryAustralia
- Australian Centre for Health Services Innovation, Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Department of Respiratory & Sleep MedicineQueensland Children's HospitalBrisbaneQueenslandAustralia
| |
Collapse
|
2
|
Zhjeqi V, Kundi M, Shahini M, Ahmetaj H, Ahmetaj L, Krasniqi S. Correlation between parents and child’s version of the child health survey for asthma questionnaire. Eur Clin Respir J 2023; 10:2194165. [PMID: 37006411 PMCID: PMC10054174 DOI: 10.1080/20018525.2023.2194165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Background The American Academy of Pediatrics Children's Health Survey for Asthma (CHSA) is a widely used instrument to assess various aspects of health and well-being in relation to asthma. There is a parent and a child version of this questionnaire and little is known about the concordance between these versions. Method In a cross-sectional study conducted in 13 facilities, hospitals and outpatient clinics covering all areas of Kosovo, children with asthma aged 7-16 years were enrolled. Information about asthma diagnosis was obtained from the treating physician. Children and parents answered the CHSA, parent or child version (CHSA-C) as well as a number of questions about environmental conditions, health insurance and socio-demographic characteristics. Results The survey included 161 Kosovar children with asthma and their caregivers. Although there were significant differences between parents and child versions regarding physical health, child activity and emotional health, with parents rating physical and emotional health higher and child activity lower, there were significant correlations (R > 0.7) for physical and child activity scales but only a low one (R = 0.25) for emotional health. Inspection of concordance for single items revealed very high correlations (>0.9) for all disease events, but a significant underestimation of the number of wheezing episodes by parents. Good agreement was found for statements about disease severity. Conclusions The high correlation between information about children's health obtained from parents and children underlines the usefulness of parents as source of information on child's asthma. Impact of the disease on emotional health is, however, underestimated by parents.
Collapse
|
3
|
Baumgartel K, Saint Fleur A, Prescott S, Fanfan D, Elliott A, Yoo JY, Koerner R, Harringon M, Dutra SO, Duffy A, Ji M, Groer MW. Social Determinants of Health Among Pregnant Hispanic Women and Associated Psychological Outcomes. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01852-7. [PMID: 37973772 DOI: 10.1007/s40615-023-01852-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND There has been a concerning surge in maternal mortality among Hispanic women in recent years. Compromised mental health is present in nearly half of all maternal deaths, and risk factors include poor social support and depression. OBJECTIVE Among Hispanic women who were born in the USA versus those not born in the USA, we sought to describe and compare social determinants of health and maternal psychological outcomes. METHODS Hispanic pregnant women (n = 579) were recruited from two clinics in Tampa, FL, and completed various questionnaires related to social determinants of health, depression, stress, and social support. STATISTICAL ANALYSIS Descriptive statistics, t-tests, and chi-square analyses were used to compare relationships between maternal nativity and subsequent psychosocial outcomes. Pearson correlations were used to explore associations between variables. RESULTS Hispanic pregnant women who were not born in the USA had lower incomes (χ2 = 5.68, p = 0.018, df = 1), were more likely to be unemployed (χ2 = 8.12, p = 0.004, df = 1), and were more likely to be married (χ2 = 4.79, p = 0.029, df = 1) when compared with those born in the USA. Those not born in the USA reported lower social support (t = 3.92, p<0.001), specifically the tangible (t = 4.18, p < 0.001) and emotional support subscales (t = 4.4, p<0.001). When compared with those born in the USA, foreign-born Hispanic women reported less stress (t = 3.23, p = 0.001) and depression (t = 3.3, p = 0.002). CONCLUSION Pregnant Hispanic women not born in the USA are at increased risk for suboptimal social determinants of health, including less social support. US-born women were more stressed and depressed and had higher BMIs.
Collapse
Affiliation(s)
- Kelley Baumgartel
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA.
| | - Angeline Saint Fleur
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA
| | - Stephanie Prescott
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA
| | - Dany Fanfan
- University of Florida College of Nursing, 1225 Center Drive, Gainesville, FL, 32619, USA
| | - Amanda Elliott
- University of Florida College of Medicine Psychiatry and Behavioral Neurosciences, 3515 Ave Tampa, Fletcher, FL, 33613, USA
| | - Ji Youn Yoo
- University of Tennessee Knoxville College of Nursing, 1412 Circle Dr, Knoxville, TN, 37996, USA
| | - Rebecca Koerner
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA
| | - Monalisa Harringon
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA
| | - Samia Ozorio Dutra
- University of Hawaii at Manoa Nancy Atmospera-Walch School of Nursing, 2528 McCarthy Mall, Webster Hall 440, Honolulu, HI, 96822, USA
| | - Allyson Duffy
- University of South Florida College of Nursing, 12912 USF Health Dr, Tampa, FL, 33612, USA
| | - Ming Ji
- University of New Mexico Health Sciences, 2500 Marble Ave NE, Albuquerque, NM, 87106, USA
| | - Maureen W Groer
- University of Tennessee Knoxville College of Nursing, 1412 Circle Dr, Knoxville, TN, 37996, USA
| |
Collapse
|
4
|
Kub JE, DePriest KN, Bellin MH, Butz A, Lewis-Land C, Morphew T. Predictors of Depressive Symptoms in Caregivers of Children With Poorly Controlled Asthma: Is the Neighborhood Context Important? FAMILY & COMMUNITY HEALTH 2022; 45:10-22. [PMID: 34783687 PMCID: PMC9600613 DOI: 10.1097/fch.0000000000000313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Children residing in low-income neighborhoods are disproportionately affected by asthma morbidity and mortality. Neighborhood violence has been explored in relationship to child morbidity and health and developmental outcomes, but less is known about the relationship of violence to caregiver mental health. The purpose of this study was to examine the relationship of neighborhood violent crime victimization (objective and subjective measures), perceptions of community well-being and support, and depressive symptoms among a sample of primarily single female caregivers of children with uncontrolled asthma. This is a secondary analysis of baseline data obtained from a randomized controlled trial of a home-based environmental control intervention for children aged 3 to 12 years, who were primarily African American, and diagnosed with persistent, uncontrolled asthma. Results showed that both objective and subjective measures of crime, particularly in those with relatively low life stress (P < .001), limited education of the caregiver (P < .001), and fewer children (P < .01) in the household had direct associations with depressive symptoms in caregivers of children with uncontrolled asthma. Neighborhood perceptions of satisfaction and a sense of community, as well as perceptions of social support, were not associated with depressive symptoms. Our findings emphasize the need to screen for depressive symptoms, life stress, as well as both objective and subjective perceptions of neighborhood violence among caregivers of children with poorly controlled asthma. Furthermore, when providing holistic care to these caregivers, stress reduction and the provision of mental health resources are paramount.
Collapse
Affiliation(s)
- Joan E Kub
- Johns Hopkins University School of Nursing, Baltimore, Maryland (Drs Kub and DePriest); University of Maryland School of Social Work, Baltimore (Dr Bellin); Department of Pediatrics (Dr Butz) and Institute for Clinical & Translation Research (Ms Lewis-Land), Johns Hopkins University School of Medicine, Baltimore, Maryland; and Morphew Consulting, LLC, Bothell, Washington (Ms Morphew)
| | | | | | | | | | | |
Collapse
|
5
|
Kaji N, Ando S, Nishida A, Yamasaki S, Kuwabara H, Kanehara A, Satomura Y, Jinde S, Kano Y, Hiraiwa-Hasegawa M, Igarashi T, Kasai K. Children with special health care needs and mothers' anxiety/depression: Findings from the Tokyo Teen Cohort study. Psychiatry Clin Neurosci 2021; 75:394-400. [PMID: 34549856 DOI: 10.1111/pcn.13301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/20/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022]
Abstract
AIM Children with special health care needs (CSHCN) are those who require more care for their physical, developmental, or emotional differences than their typically developing peers. Among a wide range of burdens that caregivers of CSHCN experience, the mental burden of caregivers is still not well investigated. This study aimed at examining the relationship between caring for CSHCN and mothers' anxiety/depression. METHODS This study used data from the Tokyo Early Adolescence Survey, a population-based cross-sectional survey. Using screening questionnaires, we evaluated the prevalence of CSHCN and identified their primary caregivers. Focusing on mothers as caregivers, we analyzed the relationship between having CSHCN and mothers' anxiety/depression, and between the severity of children's condition and mothers' anxiety/depression. We further determined what mediates these relationships using path analyses. RESULTS Among 4003 participants, we identified 502 CSHCN (12.5%), and 93% of responding caregivers were mothers. We found that mothers with CSHCN were significantly more anxious/depressed than those without CSHCN, which was closely related to the severity of children's condition. The mediation effect of social support on the relation between CSHCN and mothers' anxiety/depression was statistically significant. CONCLUSION Mothers of CSHCN were more anxious/depressed than other mothers in this study. Social support was indicated to have a significant mediating effect on the relationship between CSHCN and mothers' anxiety/depression. Our results suggest that considering ways to offer social support may effectively relieve the mental stress experienced by mothers of CSHCN.
Collapse
Affiliation(s)
- Namiko Kaji
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Office for Mental Health Support, Division of Counseling and Support, The University of Tokyo, Tokyo, Japan
| | - Shuntaro Ando
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Atsushi Nishida
- Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Syudo Yamasaki
- Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Hitoshi Kuwabara
- Department of Psychiatry, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Akiko Kanehara
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihiro Satomura
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seiichiro Jinde
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukiko Kano
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mariko Hiraiwa-Hasegawa
- School of Advanced Science, SOKENDAI (Graduate University for Advanced Studies), Hayama, Japan
| | | | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,The International Research Center for Neurointelligence (WPI-IRCN), Institutes for Advanced Study (UTIAS), University of Tokyo, Tokyo, Japan.,University of Tokyo Center for Integrative Science of Human Behavior (CiSHuB), The University of Tokyo, Tokyo, Japan
| |
Collapse
|
6
|
Kim P, Tribble R, Olsavsky AK, Dufford AJ, Erhart A, Hansen M, Grande L, Gonzalez DM. Associations between stress exposure and new mothers' brain responses to infant cry sounds. Neuroimage 2020; 223:117360. [PMID: 32927083 PMCID: PMC8291268 DOI: 10.1016/j.neuroimage.2020.117360] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/24/2020] [Accepted: 09/03/2020] [Indexed: 01/16/2023] Open
Abstract
Exposure to severe stress has been linked to negative postpartum outcomes among new mothers including mood disorders and harsh parenting. Non-human animal studies show that stress exposure disrupts the normative adaptation of the maternal brain, thus identifying a neurobiological mechanism by which stress can lead to negative maternal outcomes. However, little is known about the impact of stress exposure on the maternal brain response to infant cues in human mothers. We examined the association of stress exposure with brain response to infant cries and maternal behaviors, in a socioeconomically diverse (low- and middle-income) sample of first-time mothers (N=53). Exposure to stress across socioeconomic, environmental, and psychosocial domains was associated with reduced brain response to infant cry sounds in several regions, including the right insula/inferior frontal gyrus and superior temporal gyrus. Reduced activation in these regions was further associated with lower maternal sensitivity observed during a mother-infant interaction. The findings demonstrate that higher levels of stress exposure may be associated with reduced brain response to an infant’s cry in regions that are important for emotional and social information processing, and that reduced brain responses may further be associated with increased difficulties in developing positive mother-infant relationships.
Collapse
Affiliation(s)
- Pilyoung Kim
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States.
| | - Rebekah Tribble
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Aviva K Olsavsky
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States; University of Colorado Anschutz School of Medicine/Children's Hospital Colorado, 13123 E. 16th Avenue, CO 80045, United States
| | - Alexander J Dufford
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Andrew Erhart
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Melissa Hansen
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Leah Grande
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Daniel M Gonzalez
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States; Harvard Medical School, Boston, 25 Shattuck St, Boston, MA 02115, United States
| |
Collapse
|
7
|
Weinstein SM, Orozco K, Pugach O, Rosales G, Songthangtham N, Martin MA. Parent Nativity and Child Asthma Control in Families of Mexican Heritage: The Effects of Parent Depression and Social Support. Acad Pediatr 2020; 20:967-974. [PMID: 32407888 PMCID: PMC7483789 DOI: 10.1016/j.acap.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Research has repeatedly demonstrated that parent foreign nativity has a protective effect on child asthma outcomes among Mexican Americans, but the mechanisms underlying this relationship are not well understood. The current study explored parent depression as a mediator and social support as a moderator of the parent nativity-child asthma control pathway. METHODS Data come from the baseline sample of a trial (NCT02481986) testing community interventions for 223 children aged 5 to 16 with uncontrolled asthma. We focused on parent/child dyads of Mexican heritage (N = 165; mean age = 9.08, standard deviation = 2.94; 57.3% with Mexico-born parent). Asthma control was defined using the child and adult versions of the Asthma Control Test (ACT). Psychosocial factors included parent depression symptoms and social (instrumental, informational, and emotional) support. RESULTS Mexican-born parents had fewer depressive symptoms (β^ = -2.03, SE^ = 0.24) and children with better asthma control (β^ = 1.78, SE^ = 0.24) than US-born parents, P < .0001. Analyses suggested partial mediation of the nativity-ACT path via parent depression (P < .001). An interaction between Instrumental Support and Nativity was marginally significant (β^ = -0.10, SE^ = 0.05, P = .07), with protective effects only observed at higher support levels. Last, among Mexico-born parents, the protective nativity effects on ACT declined with increasing residential years in the United States through 12 years. CONCLUSIONS This study is novel in identifying parent depression as one mechanism underlying the effects of parent nativity on child asthma control, but results suggest that the health advantages may depend on availability of support. Providing resources for parent depression and instrumental support (transportation, childcare) can optimize asthma interventions in this population.
Collapse
|
8
|
Teach SJ, Shelef DQ, Fousheé N, Horn IB, Yadav K, Wang Y, Rand CS, Streisand R. Randomized clinical trial of parental psychosocial stress management to improve asthma outcomes. J Asthma 2019; 58:121-132. [PMID: 31545115 DOI: 10.1080/02770903.2019.1665063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Because higher parental psychosocial stress is associated with worsened asthma outcomes in children, we sought to determine if a parent-focused stress management intervention would improve outcomes among their at-risk African American children. METHODS We enrolled self-identified African American parent-child dyads (children aged 4-12 years old with persistent asthma, no co-morbidities, on Medicaid) in a prospective, single-blind, randomized clinical trial with follow-up at 3, 6, and 12 months. All children received care based on the guidelines of the National Institutes of Health. Developed with extensive local stakeholder engagement, the intervention consisted of four individual sessions with a community wellness coach (delivered over 3 months) supplemented with weekly text messaging and twice monthly group sessions (both delivered for 6 months). The main outcome was asthma symptom-free days in the prior 14 days by repeated measures at 3 and 6 months follow-up. RESULTS We randomized 217 parent-child dyads and followed 196 (90.3%) for 12 months. Coaches completed 338/428 (79%) of all individual sessions. Symptom-free days increased significantly from baseline in both groups at 3, 6, and 12 months, but there were no significant differences between groups over the first 6 months. At 12 months, the intervention group sustained a significantly greater increase in symptom-free days from baseline [adjusted difference = 0.92 days, 95% confidence interval (0.04, 1.8)]. CONCLUSION The intervention did not achieve its primary outcome. The efficacy of providing psychosocial stress management training to parents of at-risk African American children with persistent asthma in order to improve the children's outcomes may be limited. CLINICALTRIALS.GOV NCT02374138.
Collapse
Affiliation(s)
- Stephen J Teach
- Pediatrics, Children's National Medical Center, George Washington University, Washington, DC, USA.,School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Deborah Q Shelef
- Pediatrics, Children's National Medical Center, George Washington University, Washington, DC, USA
| | - Naja Fousheé
- Pediatrics, Children's National Medical Center, George Washington University, Washington, DC, USA
| | | | - Kabir Yadav
- Los Angeles Medical Center, Harbor-University of California, Torrance, CA, USA
| | - Yunfei Wang
- Duke Human Vaccine Institute, Duke University, Durham, NC, USA
| | - Cynthia S Rand
- Medicine, Johns Hopkins Medical Institute, Baltimore, MD, USA
| | - Randi Streisand
- Pediatrics, Children's National Medical Center, George Washington University, Washington, DC, USA.,School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| |
Collapse
|
9
|
Chen KWK, Huang DTN, Chou LT, Nieh HP, Fu RH, Chang CJ. Childhood otitis media: Relationship with daycare attendance, harsh parenting, and maternal mental health. PLoS One 2019; 14:e0219684. [PMID: 31310620 PMCID: PMC6634415 DOI: 10.1371/journal.pone.0219684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/30/2019] [Indexed: 02/05/2023] Open
Abstract
Psychological stress has been linked to developmental problems and poor health in children, but it is unclear whether it is also related to otitis media (OM). As part of a long-term study surveying the characteristics of childcare and development in Taiwan, we analyzed the relationship between OM and sources of psychological stress in children, such as poor maternal mental health and harsh parental discipline. We analyzed the data of 1998 children from the “Kids in Taiwan: National Longitudinal Study of Child Development & Care (KIT) Project” at the age of 3 years. Using bivariate and multivariate logistic regression models, we tested several risk factors as potential independent predictors of two outcomes: parent-reported incidence of OM and child health. The proportion of children who had developed OM in the first 3 years of their life was 12.5%. Daycare attendance (odds ratio [OR]: 1.475; 95% confidence interval [CI]: 1.063–2.046), poor maternal mental health (OR: 1.913; 95% CI: 1.315–2.784), and harsh parental discipline (OR: 1.091; 95% CI: 1.025–1.161) correlated with parent-reported occurrence of OM. These findings suggest that providing psychosocial support to both parents and children might be a novel strategy for preventing OM.
Collapse
Affiliation(s)
- Kai-Wei Kevin Chen
- Division of Infectious Diseases, Department of Pediatrics, MacKay Children's Hospital, Taipei City, Taiwan, R.O.C
| | - Daniel Tsung-Ning Huang
- Division of Infectious Diseases, Department of Pediatrics, MacKay Children's Hospital, Taipei City, Taiwan, R.O.C
- Department of Medicine, MacKay Medical College, Sanzhi District, New Taipei City, Taiwan, R.O.C
| | - Li-Tuan Chou
- Department of Human Development and Family Studies, National Taiwan Normal University, Taipei City, Taiwan, R.O.C
| | - Hsi-Ping Nieh
- Department of Human Development and Family Studies, National Taiwan Normal University, Taipei City, Taiwan, R.O.C
| | - Ren-Huei Fu
- Chang Gung Medical Education Research Center, Division of Neonatology, Department of Pediatric, Chang Gung Memorial Hospital Linkou Branch, Guishan District, Taoyuan City, Taiwan, R.O.C
| | - Chien-Ju Chang
- Department of Human Development and Family Studies, National Taiwan Normal University, Taipei City, Taiwan, R.O.C
- * E-mail:
| |
Collapse
|
10
|
Margolis R, Bellin MH, Sacco P, Harrington D, Butz A. Evaluation of MOS social support in low-income caregivers of African American children with poorly controlled asthma. J Asthma 2018; 56:951-958. [PMID: 30273501 DOI: 10.1080/02770903.2018.1510504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective: The purpose of this study was to examine the factor structure of the Medical Outcomes Study Social Support Survey (MOS-SSS) in a sample of low-income, urban caregivers of African American children with poorly controlled asthma. Although the MOS-SSS is a commonly used measure of social support, its psychometric properties have not been studied in this population. Methods: Confirmatory factor analysis was conducted to determine the most appropriate factor structure for the MOS-SSS in caregivers of African American children with frequent Emergency Department visits for uncontrolled asthma. The following models were tested and compared using established fit statistics: an 18-item second-order four factor model, an 18-item four factor model, a bifactor model and an 18-item one factor model with nested models. Results: Participating caregivers were single (75.6%) and female (97%). An 18-item one factor version of the scale had the best fit statistics compared to the other models tested: χ2 (142) = 308.319, p > 0.001; Root mean square error of approximation (RMSEA) = 0.077; CFI (Comparative Fit Index) = 0.990; and Tucker-Lewis Index (TLI) = 0.988. Construct validity was supported by a statistically significant negative relationship between our final MOS-SSS model and caregiver depressive symptoms ( β = -0.374, p < 0.001). Conclusions: The 18-item one factor MOS-SSS may be appropriate for use in research and clinical practice with caregivers of African American children with poorly controlled asthma. It appears promising as a mechanism to advance understanding of relationships between social support and asthma outcomes in this vulnerable population.
Collapse
Affiliation(s)
- Rachel Margolis
- a School of Social Work, University of Maryland , Baltimore , MD , USA
| | - Melissa H Bellin
- a School of Social Work, University of Maryland , Baltimore , MD , USA
| | - Paul Sacco
- a School of Social Work, University of Maryland , Baltimore , MD , USA
| | - Donna Harrington
- a School of Social Work, University of Maryland , Baltimore , MD , USA
| | - Arlene Butz
- b Department of Pediatrics, The Johns Hopkins University School of Medicine , Freeland , MD , USA
| |
Collapse
|
11
|
Deng Q, Deng L, Lu C, Li Y, Norbäck D. Parental stress and air pollution increase childhood asthma in China. ENVIRONMENTAL RESEARCH 2018; 165:23-31. [PMID: 29655040 DOI: 10.1016/j.envres.2018.04.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/28/2018] [Accepted: 04/04/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Although air pollution and social stress may independently increase childhood asthma, little is known on their synergistic effect on asthma, particularly in China with high levels of stress and air pollution. OBJECTIVES To examine associations between exposure to a combination of parental stress and air pollution and asthma prevalence in children. METHODS We conducted a cohort study of 2406 preschool children in Changsha (2011-2012). A questionnaire was used to collect children's lifetime prevalence of asthma and their parental stress. Parental socioeconomic and psychosocial stresses were respectively defined in terms of housing size and difficulty concentrating. Children's exposure to ambient air pollutants was estimated using concentrations measured at monitoring stations. Associations between exposure to parental stress and air pollution and childhood asthma were estimated by multiple logistic regression models using odds ratio (OR) and 95% confidence interval (CI). RESULTS Life time prevalence of asthma in preschool children (6.7%) was significantly associated with parental socioeconomic and psychosocial stresses with OR (95% CI) respectively 1.48 (1.02-2.16) and 1.64 (1.00-2.71). Asthma was also associated with exposure to air pollutants, with adjusted OR (95% CI) during prenatal and postnatal periods respectively 1.43 (1.10-1.86) and 1.35 (1.02-1.79) for SO2 and 1.61 (1.19-2.18) and 1.76 (1.19-2.61) for NO2. The association with air pollution was significant only in children exposed to high parental stress, the association with parental stress was significant only in children exposed to high air pollution, and the association was the strongest in children exposed to a combination of parental stress and air pollution. Sensitivity analysis showed that the synergistic effects of parental stress and air pollution on childhood asthma were stronger in boys. CONCLUSIONS Parental stress and air pollution were synergistically associated with increased childhood asthma, indicating a common biological effect of parental stress and air pollution during both prenatal and postnatal periods.
Collapse
Affiliation(s)
- Qihong Deng
- School of Energy Science and Engineering, Central South University, Changsha, Hunan, China; XiangYa School of Public Health, Central South University, Changsha, Hunan, China.
| | - Linjing Deng
- School of Energy Science and Engineering, Central South University, Changsha, Hunan, China
| | - Chan Lu
- School of Energy Science and Engineering, Central South University, Changsha, Hunan, China
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Dan Norbäck
- School of Energy Science and Engineering, Central South University, Changsha, Hunan, China; Department of Medical Sciences/Occupational & Environmental Medicine, Uppsala University, Uppsala, Sweden
| |
Collapse
|
12
|
Condon EM, Sadler LS. Toxic Stress and Vulnerable Mothers: A Multilevel Framework of Stressors and Strengths. West J Nurs Res 2018; 41:872-900. [PMID: 30019624 DOI: 10.1177/0193945918788676] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Toxic stress is associated with poor health outcomes that extend across the life span. Although caregivers can protect their children from toxic stress through supportive caregiving, this can be challenging for vulnerable mothers living in socioeconomically disadvantaged environments. We aim to advance the science of toxic stress prevention by exploring the stressors and strengths experienced by vulnerable mothers through application of a theoretical framework, Bronfenbrenner's bioecological model. Following Arksey and O'Malley's five-stage scoping study framework, 179 articles were included. Key information was abstracted and each article was reviewed for relevance to the bioecological model. Results revealed that the sources of stress and strength are multilayered, transactional, and have a complex influence on caregiving in families at risk of toxic stress. Future research should include empirical investigations of the complex relationships among these stressors and strengths, and the development of preventive interventions to support vulnerable families at risk of toxic stress.
Collapse
Affiliation(s)
| | - Lois S Sadler
- 1 Yale School of Nursing, Orange, CT, USA.,2 Yale Child Study Center, New Haven, CT, USA
| |
Collapse
|
13
|
Wood BL, Brown ES, Lehman HK, Khan DA, Lee MJ, Miller BD. The effects of caregiver depression on childhood asthma: Pathways and mechanisms. Ann Allergy Asthma Immunol 2018; 121:421-427. [PMID: 29981440 DOI: 10.1016/j.anai.2018.06.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/14/2018] [Accepted: 06/28/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To review the literature regarding the effects of caregiver depression on childhood asthma and integrate the findings into a multilevel model of pathways by which these effects occur to further the understanding of the complex biopsychosocial nature of childhood asthma and the key role that is played by caregiver depression. DATA SOURCES PubMed was searched for articles published from 2007 to the present (10-year search), and Google Scholar was searched for articles published in 2017 and 2018 to identify the most recent publications. STUDY SELECTIONS Studies selected were recent, empirical, or meta-analytic, conducted in humans, and had specific relevance to one or more of the identified pathways. Articles published before 2007 were included if deemed essential because they addressed key pathways, for which there were no more recent articles. RESULTS Review of the literature substantiates that caregiver depression plays a key role in the socioeconomic, familial, psychological, and biological cascade of effects on childhood asthma. Childhood asthma outcomes are affected indirectly by socioeconomic status and family stress mediated by caregiver depression, which affects disease management, and/or stress and depression in the child, which, in turn, affect asthma through alterations in immune modulation and autonomic regulation. CONCLUSION Findings indicate that future research should concentrate on mediators and moderators to further clarify the complex interplay of these factors that affect childhood asthma. The findings also have substantial translational implications. Given that child stress and depression contribute to asthma disease activity and that treating caregiver depression improves child stress and depression, there is strong rationale for treating depressed caregivers of children with asthma as a component means of improving childhood asthma control.
Collapse
Affiliation(s)
- Beatrice L Wood
- Department of Psychiatry, Jacobs School of Medicine, University at Buffalo, Buffalo, New York; Department of Pediatrics, Jacobs School of Medicine, University at Buffalo, Buffalo, New York.
| | - E Sherwood Brown
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas
| | - Heather K Lehman
- Department of Pediatrics, Jacobs School of Medicine, University at Buffalo, Buffalo, New York
| | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, UT Southwestern Medical Center, Dallas, Texas
| | - Min Jung Lee
- Department of Internal Medicine, Division of Allergy & Immunology, UT Southwestern Medical Center, Dallas, Texas; Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas
| | - Bruce D Miller
- Department of Psychiatry, Jacobs School of Medicine, University at Buffalo, Buffalo, New York; Department of Pediatrics, Jacobs School of Medicine, University at Buffalo, Buffalo, New York
| |
Collapse
|
14
|
Bellin MH, Collins KS, Osteen P, Kub J, Bollinger ME, Newsome A, Lewis-Land C, Butz AM. Characterization of Stress in Low-Income, Inner-City Mothers of Children with Poorly Controlled Asthma. J Urban Health 2017; 94:814-823. [PMID: 28560612 PMCID: PMC5722723 DOI: 10.1007/s11524-017-0162-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The goal of this longitudinal analysis was to characterize factors associated with the experience of life stress in low-income, inner-city mothers of minority children with high-risk asthma.Participants (n = 276) reported on family demographics, child asthma control and healthcare utilization, social support, contemporary life difficulties (housing, finances, violence exposure) measured by the validated Crisis in Family Systems scale, and daily stress. Latent growth curve modeling examined predictors of life stress across 12 months as a function of home and community difficulties, asthma-specific factors, and social support. Mothers were primarily single (73%), unemployed (55%), and living in extreme poverty with most (73%) reporting an annual family income <$20,000 (73%). The children were young (mean age = 5.59, SD = 2.17), African-American (96%), and had poorly controlled asthma (94%) at study enrollment. Higher daily stress was associated with financial difficulties, safety concerns in the home and community, and housing problems. Access to social support was consistently related to reduced stress. The only asthma-specific factor associated with life stress was healthcare utilization, with more emergency services for asthma related to higher daily stress. Findings underscore the clinical significance of assessing diverse home and community stressors and social support in low-income, inner-city caregivers of children with poorly controlled asthma.
Collapse
Affiliation(s)
- Melissa H Bellin
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD, 21201, USA.
| | - Kathryn S Collins
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD, 21201, USA
| | - Philip Osteen
- Florida State University College of Social Work, Tallahassee, USA
| | - Joan Kub
- Department of Nursing, University of Southern California, Los Angeles, USA
| | - Mary Elizabeth Bollinger
- Division of Pediatric Pulmonary and Allergy, University of Maryland School of Medicine, Baltimore, USA
| | - Angelica Newsome
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD, 21201, USA
| | - Cassie Lewis-Land
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Arlene M Butz
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| |
Collapse
|
15
|
The association between the parenting stress of the mother and the incidence of allergic rhinitis in their children. Int J Pediatr Otorhinolaryngol 2017; 101:37-40. [PMID: 28964307 DOI: 10.1016/j.ijporl.2017.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 06/19/2017] [Accepted: 07/19/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The prevalence of allergic rhinitis and the social burden related to the management of allergic rhinitis have persistently increased. There are many studies investigating the association between the allergic diseases of children and the stress of their parent. However, the relationship between parenting stress and the incidence of allergic rhinitis among children requires further investigation. We aimed to investigate the significance of parenting stress for mothers with children treated for allergic rhinitis. METHODS The mothers of 250 children in the second and third grade of elementary school were involved in this study. The Parenting Stress Index-Short Form (PSI-SF) was used to measure parenting stress. Additionally, the monthly household income, treatment history for allergic diseases (atopic dermatitis, asthma, and allergic rhinitis) during the past 12 months, and maternal education status were investigated using the questionnaire. RESULTS Parenting stress index score was significantly higher among the mothers of children treated for allergic rhinitis (76.41 ± 9.35) compared with the parents of children without treatment history for allergic rhinitis (70.06 ± 13.74). Nonetheless, there were no significant differences between the cases of children with atopic dermatitis and those with asthma. We analyzed the association between allergic rhinitis and parenting stress adjusted for the monthly household income, and maternal education status, and showed that a treatment history of allergic rhinitis was significantly associated with parenting stress (coefficient 7.477, 95% interval 1.703-13.252; p = 0.011). CONCLUSION Treatment of the children for allergic rhinitis significantly affects the parenting stress of their mother. We recommend that mothers with children with allergic rhinitis should receive appropriate counseling about parenting stress.
Collapse
|
16
|
Pedro CR, Freitas PP, Papoila AL, Dias SS, Caires I, Martins P, Neuparth N. Respiratory diseases in children attending kindergartens: Health-related variables and mothers' psychological, parental, and marital functioning. Health Psychol Open 2017; 4:2055102917724334. [PMID: 29379614 PMCID: PMC5779923 DOI: 10.1177/2055102917724334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to examine the differences between mothers of children with and without respiratory problems in variables related to psychological, parental, and marital functioning and to determine which contributed more to parenting stress, because there is a lack of information in this field. Participants were 459 mothers of children attending kindergartens, who accepted to participate. The instruments were The International Study of Asthma and Allergies in Childhood questionnaire, Hospital Anxiety and Depression Scale, Parenting Stress Index-Short Form, Parenting Stress Index-Long Form, and Escala de Avaliação da Satisfação em Áreas da Vida Conjugal. Anxiety, depression, and parenting stress were higher in the more symptomatic children and parenting stress was associated with anxiety, depression, and marital satisfaction. Findings support the relevance of children's respiratory-related variables to mothers' psychological, parental, and marital functioning.
Collapse
Affiliation(s)
| | | | | | - Sara S Dias
- Universidade Nova de Lisboa, Portugal
- Instituto Politécnico de Leiria, Portugal
| | | | | | | |
Collapse
|
17
|
Kub J, Bellin MH, Butz A, Elizabeth Bollinger M, Lewis-Land C, Osteen P. The Chronicity of Depressive Symptoms in Mothers of Children With Asthma. West J Nurs Res 2017; 40:1581-1597. [PMID: 28508700 DOI: 10.1177/0193945917705858] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depression can disproportionately affect low-income women. The purpose of this study was to explore the chronicity of depressive symptoms in a sample of 276 low-income inner-city mothers of children with high-risk asthma. The aims were to identify factors (asthma health status, stress, social support) associated with change in depressive symptomatology over 12 months as well as to ascertain what factors are most consistently associated with depressive symptoms. Using latent growth curve analysis, demographic variables, asthma severity, stress, and social support failed to explain changes in depressive symptomatology. The growth curve models, however, were predictive of Center for Epidemiologic Studies-Depression Scale (CES-D) scores at distinct time points indicating that higher daily stress and lower social support were associated with increased depressive symptoms. Our data highlight the chronic nature of depressive symptoms in low-income mothers of children with poorly controlled asthma. Integrating questions about caregiver psychological state across all clinical encounters with the family may be indicated.
Collapse
Affiliation(s)
- Joan Kub
- 1 University of Southern California, Los Angeles, CA, USA
| | | | - Arlene Butz
- 3 Johns Hopkins University, Baltimore, MD, USA
| | | | | | | |
Collapse
|
18
|
Abstract
This review focuses on obesity, asthma and mental health functioning as salient health issues affecting Hispanic youth. Burden of these conditions and consequences for adult health are also discussed. Hispanic youth are affected by obesity at an early age; the prevalence of obesity among Hispanic children 6-11 years old is twice as high as the prevalence for non-Hispanic White children of the same age, but among 2-5 years old is 4 times higher. Asthma disproportionally affects certain Hispanic groups, notably children of Puerto Rican ancestry, and the comorbidity of asthma and obesity is an emerging health issue. Another area of concern is the scant data on mental health functioning among Hispanic youth. Research on Hispanic youth mental health have reported high rates of depressive symptomatology and high rates of alcohol use among Hispanic adolescents but despite these findings, they have inadequate access to mental health services. This review highlights the need for better data to gain a better understanding of the health status of Hispanic youth and help develop preventive programs that addresses the need of this population. Improving access to health services, in particular mental health services, is also a crucial aspect.
Collapse
Affiliation(s)
- Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine
| | - Deepa Rastogi
- Department of Pediatrics, Albert Einstein College of Medicine
| | | |
Collapse
|
19
|
Brigham EL, Goldenberg L, Stolfi A, Mueller GA, Forbis SG. Associations Between Parental Health Literacy, Use of Asthma Management Plans, and Child's Asthma Control. Clin Pediatr (Phila) 2016; 55:111-7. [PMID: 25994320 DOI: 10.1177/0009922815587089] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND There are some studies demonstrating the effectiveness of the provision of written asthma action plans in improving asthma outcomes. There exist little data on the ability of parents to use these plans to make asthma care decisions. OBJECTIVE To assess the associations between parental health literacy (HL), parental ability to use a written asthma management plan (WAMP), and child's asthma control. METHODS Parents completed a survey with questions related to WAMPs and child's asthma, a HL screening tool, and 5 asthma vignettes. For vignettes, parents identified asthma control zone and then made decisions about asthma management. WAMP scores were totaled (0-32) and converted to a percent correct score. Associations between parental HL, WAMP scores, child's asthma control, and demographics were determined with independent t tests or 1-way analysis of variance, and chi-square tests. Variables significantly associated with WAMP scores or asthma control were included in multiple logistic regression or multiple linear regression analyses. RESULTS A total of 176 surveys were included; the mean ± SD WAMP score was 58.9% ± 22.2%, and 25% of respondents had limited HL. Of respondents' children, 38% had not well/poorly controlled asthma. In multiple regression analysis controlling for education level, limited HL was significantly associated with WAMP score (b = 11.3, standard error 3.8, P = .004). WAMP score was not associated with asthma control. Limited HL was associated with poor asthma control in univariate analysis, but not in a logistic regression model controlling for other significant variables. Only unmarried marital status (adjusted odds ratio 4.4, 95% CI 1.8-10.8, P = .001) was associated with asthma control. CONCLUSION HL is associated with parental ability to use WAMPs to respond to asthma scenarios. Parental HL may play a role in parents' ability to appropriately use WAMPs.
Collapse
Affiliation(s)
- Erin L Brigham
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | | | - Adrienne Stolfi
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Gary A Mueller
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Shalini G Forbis
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| |
Collapse
|
20
|
Scheckner B, Arcoleo K, Feldman JM. The effect of parental social support and acculturation on childhood asthma control. J Asthma 2015; 52:606-13. [PMID: 25428771 PMCID: PMC4662868 DOI: 10.3109/02770903.2014.991969] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/23/2014] [Accepted: 11/22/2014] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There exists large ethnic disparities in asthma among Latino children; Puerto Ricans (PRs) are disproportionately affected, while Mexicans have the lowest prevalence and morbidity. Disparities are poorly understood, however, acculturation and social support are suggested to influence asthma control among children. This study investigated the relationship between acculturation, social support and asthma control among PR and Mexican children and their caregivers. METHODS Primary caregiver-child dyads (n = 267) of PR (n = 79) and Mexican (n = 188) descent were recruited from clinics at two inner-city hospitals in Bronx, NY and three clinics in Phoenix, AZ. Children were 5-12 years of age and had a confirmed asthma diagnosis. Dyads completed measures of social support, acculturation and asthma control; logistic regression was used for analysis. RESULTS Mexican children had better asthma control than PR children (p < 0.001). PR caregivers were more acculturated than Mexican caregivers (p < 0.05); however, acculturation did not predict control. Across Latino subgroups caregivers' total level of social support predicted better asthma control among children (p < 0.05), and support received from family and friends each independently predicted better control (p < 0.05). CONCLUSIONS Results suggest that social support reduces some of the burden associated with asthma management enabling caretakers to better control their children's asthma.
Collapse
Affiliation(s)
- Bari Scheckner
- Ferkauf Graduate School of Psychology, Yeshiva University, NY
| | | | - Jonathan M. Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, NY
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, NY
| |
Collapse
|
21
|
Contextual Effects of Ethnicity, Gender, and Place on Depression; Case Study of War Related Stress for Kurdish Women. INTERNATIONAL JOURNAL OF TRAVEL MEDICINE AND GLOBAL HEALTH 2015. [DOI: 10.20286/ijtmgh-030267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
22
|
Wood BL, Miller BD, Lehman HK. Review of family relational stress and pediatric asthma: the value of biopsychosocial systemic models. FAMILY PROCESS 2015; 54:376-389. [PMID: 25683472 DOI: 10.1111/famp.12139] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Asthma is the most common chronic disease in children. Despite dramatic advances in pharmacological treatments, asthma remains a leading public health problem, especially in socially disadvantaged minority populations. Some experts believe that this health gap is due to the failure to address the impact of stress on the disease. Asthma is a complex disease that is influenced by multilevel factors, but the nature of these factors and their interrelations are not well understood. This paper aims to integrate social, psychological, and biological literatures on relations between family/parental stress and pediatric asthma, and to illustrate the utility of multilevel systemic models for guiding treatment and stimulating future research. We used electronic database searches and conducted an integrated analysis of selected epidemiological, longitudinal, and empirical studies. Evidence is substantial for the effects of family/parental stress on asthma mediated by both disease management and psychobiological stress pathways. However, integrative models containing specific pathways are scarce. We present two multilevel models, with supporting data, as potential prototypes for other such models. We conclude that these multilevel systems models may be of substantial heuristic value in organizing investigations of, and clinical approaches to, the complex social-biological aspects of family stress in pediatric asthma. However, additional systemic models are needed, and the models presented herein could serve as prototypes for model development.
Collapse
Affiliation(s)
- Beatrice L Wood
- Psychiatry and Pediatrics, University at Buffalo, Buffalo, NY
| | - Bruce D Miller
- Psychiatry and Pediatrics, University at Buffalo, Buffalo, NY
| | - Heather K Lehman
- Allergy and Immunology, Woman and Children's Hospital of Buffalo, Buffalo, NY
| |
Collapse
|
23
|
Easter G, Sharpe L, Hunt CJ. Systematic Review and Meta-Analysis of Anxious and Depressive Symptoms in Caregivers of Children With Asthma. J Pediatr Psychol 2015; 40:623-32. [PMID: 25829528 DOI: 10.1093/jpepsy/jsv012] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 02/02/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To provide a review of the literature comparing anxious and depressive symptoms in caregivers of children with asthma with caregivers of healthy children. METHOD A systematic search identified 25 studies from 17 articles, reporting outcomes on 4,300 caregivers of children with asthma and 25,064 caregivers of healthy children. RESULTS Overall, anxious (d = 0.50) and depressive symptoms (d = 0.44) were higher in caregivers of children with asthma compared with caregivers of healthy children. Age, site of recruitment, and whether the asthma diagnosis was medically confirmed were included as potential moderators. The relationship between parental psychopathology and asthma was stronger in those with medically confirmed asthma and participants recruited from clinical settings. Other moderators were not significant. CONCLUSIONS Caregivers of children with asthma appear to have greater anxious and depressive symptoms than caregivers of healthy children, but the reasons are unclear. More research that investigates modifiable factors that may moderate this association is urgently needed.
Collapse
|
24
|
Tooley EM, Busch A, McQuaid EL, Borrelli B. Structural and Functional Support in the Prediction of Smoking Cessation in Caregivers of Children with Asthma. Behav Med 2015; 41:203-10. [PMID: 24911559 PMCID: PMC4261041 DOI: 10.1080/08964289.2014.931274] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Caregivers of children with asthma smoke at rates similar to the general population. Research on the relative importance of structural or functional social support in smoking cessation has been mixed. Participants were smokers (N = 154) who were caregivers of children with asthma. Both functional (Interpersonal Support Evaluation List) and structural social support (living with another smoker, partner status, and the proportion of smoking friends) were measured at baseline. Participants received an asthma-education and smoking cessation intervention based on Motivational Interviewing. Biochemically-verified abstinence was assessed at six months post treatment. Results indicated that functional support predicted smoking abstinence even when controlling for relevant covariates and structural support (OR = .896, p = .025). Exploratory analyses revealed that this effect was driven primarily by the self-esteem ISEL subscale. Smoking cessation that focuses on building general functional support, particularly self-esteem support, may be beneficial for smoking cessation in caregivers of children with asthma.
Collapse
Affiliation(s)
- Erin M. Tooley
- Postdoctoral NIH Research Fellow, The Warren Alpert Medical School of Brown University and The Miriam Hospital, Program in Nicotine and Tobacco
| | - Andrew Busch
- Assistant Professor of Psychiatry and Human Behavior and The Miriam Hospital, Program in Nicotine and Tobacco, The Warren Alpert Medical School of Brown University and The Miriam Hospital
| | - Elizabeth L. McQuaid
- Associate Professor of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University and Rhode Island Hospital
| | - Belinda Borrelli
- Professor of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University and The Miriam Hospital, Program in Nicotine and Tobacco
| |
Collapse
|
25
|
Liu PC, Gau BS, Hung CC. Development and psychometric testing of a chinese version of the caregiver burden index for parents of children with allergies. J Pediatr Nurs 2015; 30:208-18. [PMID: 24813162 DOI: 10.1016/j.pedn.2014.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 04/09/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED BACKGROUNG: No specific instrument has thus far been developed for measuring the caregiver burden perceived by parents of children with allergies (CWA). OBJECTIVES To determine the psychometric properties of the Caregiver Burden Index (CBI). METHODS A mixed-methods design was adopted to evaluate the psychometric properties of the scale. RESULTS The content validity index was 0.89, and the internal consistency was high with a coefficient alpha of 0.98. Three factors were extracted after exploratory factor analysis. CONCLUSION The study findings suggest that the CBI has sufficient reliability and validity to evaluate the caregiver burden of parents of CWA.
Collapse
Affiliation(s)
- Pei-Ching Liu
- Department of Nursing, MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan; Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Bih-Shya Gau
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chao-Chia Hung
- School of Nursing, Yuan-Pei Institute of Technology, Hsin-Chu, Taiwan
| |
Collapse
|
26
|
Ferro MA, Boyle MH, Alati R, Scott JG, Dingle K. Maternal psychological distress mediates the relationship between asthma and physician visits in a population-based sample of adolescents. J Asthma 2014; 52:170-5. [PMID: 25134785 DOI: 10.3109/02770903.2014.955191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study examined whether maternal psychological distress mediates the relationship between presence of adolescent asthma and number of physician visits and whether the association between maternal psychological distress and physician visits is moderated by adolescent general health. METHODS Data were obtained from the Mater University Study of Pregnancy and included 4025 adolescents. Path analysis was used to examine mediating and moderating effects. RESULTS Maternal psychological distress was found to partially mediate the relationship between adolescent asthma and number of physician visits, accounting for 25% of the effect of adolescent asthma on physician visits (p = 0.046). There was no evidence to suggest that adolescent general health moderated the association between maternal psychological distress and physician visits (p = 0.093). CONCLUSIONS These findings suggest that maternal psychological distress is associated with increased physician visits, regardless of adolescents' general health. Lowering maternal psychological distress may serve to reduce health care utilization and costs among adolescents with asthma.
Collapse
Affiliation(s)
- Mark A Ferro
- Department of Psychiatry & Behavioral Neurosciences, McMaster University , Ontario , Canada
| | | | | | | | | |
Collapse
|
27
|
Cano-Garcinuño A, Bercedo-Sanz A, Mora-Gandarillas I, Callén-Blecua MT, Castillo-Laita JA, Forns-Serrallonga D, Casares-Alonso I, Alonso-Bernardo LM, García-Merino A, Moneo-Hernández I, Cortés-Rico O, Tauler-Toro E, Carvajal-Urueña IL, Morell-Bernabé JJ, Martín-Ibáñez I, Rodríguez-Fernández-Oliva CR, Asensi-Monzó MT, Fernández-Carazo C, Murcia-García J, Durán-Iglesias C, Montón-Álvarez JL, Domínguez-Aurrecoechea B, Praena-Crespo M. Association between quality of life in parents and components of asthma control in children. J Asthma 2014; 51:1089-95. [PMID: 25050835 DOI: 10.3109/02770903.2014.943372] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Describe the association between parents' quality of life and the two components of asthma control in children: impairment and risk. METHODS Cross-sectional study with children between 4 and 14 years of age with active asthma recruited at primary care centers in Spain. Asthma control was assessed according to the Third National Asthma Expert Panel Report, classifying "impairment" in three levels (well-controlled asthma, partially controlled, and poorly controlled), and "risk" as high or low. The parents' quality of life was evaluated using the specific Family Impact of Childhood Bronchial Asthma Questionnaire instrument (IFABI-R). The association between asthma control and the parents' quality of life was analyzed using multivariate regression models adjusted for other social and family variables. RESULTS Data from 408 children were analyzed. The parents' quality of life was affected in the partially controlled asthma group when compared with well-controlled asthma, as showed by an increase in IFABI-R scores in all dimensions: functional 17.2% (p < 0.001), emotional 10.4% (p = 0.021), and socio-occupational 6.8% (p = 0.056). The differences were higher in poorly controlled asthma compared with well-controlled asthma: functional 24.3% (p = 0.001), emotional 18.9% (p = 0.008), and socio-occupational 11.5% (p = 0.036). The "risk" component was independently associated with the parents' quality of life. Of all the elements used to assess the control, the only one independently associated with the parents' quality of life was recurrent asthma crisis. CONCLUSIONS In asthma control, both "impairment" and "risk" in children are gradually associated with the parents' quality of life. The global assessment of the control surpasses the importance of each individual element used in this assessment.
Collapse
|
28
|
Bellin M, Osteen P, Collins K, Butz A, Land C, Kub J. The influence of community violence and protective factors on asthma morbidity and healthcare utilization in high-risk children. J Urban Health 2014; 91:677-89. [PMID: 24889008 PMCID: PMC4134443 DOI: 10.1007/s11524-014-9883-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We examined the longitudinal effects of community risk and protective factors on asthma morbidity and healthcare utilization. Three hundred urban caregivers of children with poorly controlled asthma were enrolled in a randomized controlled trial testing the effectiveness of a behavioral/educational intervention and completed measures of exposure to community violence (ECV), social cohesion (SC), informal social control (ISC), child asthma control, child asthma symptom days/nights, and healthcare utilization. Latent growth curve modeling examined the direct and interaction effects of ECV, SC, and ISC on the asthma outcomes over 12 months. Caregivers were primarily the biological mother (92 %), single (70 %), and poor (50 % earned less than $10,000). Children were African American (96 %) and young (mean age = 5.5 years, SD = 2.2). ECV at baseline was high, with 24.7 % of caregivers reporting more than two exposures to violence in the previous 6 months (M = 1.45, SD = 1.61). Caregiver ECV-predicted asthma-related healthcare utilization at baseline (b = 0.19, SE = 0.07, p = 0.003) and 2 months (b = 0.12, s.e. = 0.05, p = 0.04). ISC and SC moderated the effect of ECV on healthcare utilization. Our findings suggest that multifaceted interventions that include strategies to curb violence and foster feelings of cohesion among low-income urban residents may be needed to reduce asthma-related emergency services.
Collapse
|
29
|
Martin MA, Thomas AM, Mosnaim G, Greve M, Swider SM, Rothschild SK. Home asthma triggers: barriers to asthma control in Chicago Puerto Rican children. J Health Care Poor Underserved 2014; 24:813-27. [PMID: 23728047 DOI: 10.1353/hpu.2013.0073] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We sought objectively to measure, summarize, and contextualize the asthma triggers found in the homes of urban high-risk Puerto Rican children and adolescents with asthma in Chicago. Data were from the baseline home assessments of Project CURA. Research assistants interviewed caregivers, conducted a home visual inspection, and collected saliva samples for cotinine analysis. A trigger behavior summary score was created. The housing inspected was old with multiple units and obvious structural deficiencies. Many allergic and irritant triggers were observed. Having a controller medicine or private insurance was associated with lower trigger behavior summary scores; caregiver depression, caregiver perceived stress, and child negative life events were associated with high trigger scores. The final multivariate model retained had a controller medicine, private insurance, and caregiver perceived stress. The data from this high-risk cohort identified modifiable areas where environmental interventions could reduce morbidity in Puerto Rican children and adolescents.
Collapse
Affiliation(s)
- Molly A Martin
- Rush University Medical Center (RUMC), Department of Preventive Medicine, Chicago, Illinois, USA.
| | | | | | | | | | | |
Collapse
|
30
|
Collins BN, Nair US, Shwarz M, Jaffe K, Winickoff J. SHS-Related Pediatric Sick Visits are Linked to Maternal Depressive Symptoms among Low-Income African American Smokers: An Opportunity for Intervention in Pediatrics. JOURNAL OF CHILD AND FAMILY STUDIES 2013; 22:1013-1021. [PMID: 24339721 PMCID: PMC3856861 DOI: 10.1007/s10826-012-9663-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Maternal smoking and depressive symptoms are independently linked to poor child health outcomes. However, little is known about factors that may predict maternal depressive symptoms among low-income, African American maternal smokers - an understudied population with children known to have increased morbidity and mortality risks. The objective of this study was to test the hypothesis that secondhand smoke exposure (SHSe)-related pediatric sick visits are associated with significant maternal depressive symptoms among low-income, African American maternal smokers in the context of other depression-related factors. Prior to randomization in a behavioral counseling trial to reduce child SHSe, 307 maternal smokers in Philadelphia completed the CES-D and questionnaires measuring stressful events, nicotine dependence, social support, child health and demographics. CES-D was dichotomized at the clinical cutoff to differentiate mothers with significant vs. low depressive symptoms. Results from direct entry logistic regression demonstrated that maternal smokers reporting more than one SHSe-related sick visit (OR 1.38, p<.001), greater perceived life stress (OR 1.05, p<.001) and less social support (OR 0.82, p<.001) within the last 3 months were more likely to report significant depressive symptoms than mothers with fewer clinic visits, less stress, and greater social support. These results suggest opportunities for future hypothesis-driven evaluation, and exploration of intervention strategies in pediatric primary care. Maternal depression, smoking and child illness may present as a reciprocally-determined phenomenon that points to the potential utility of treating one chronic maternal condition to facilitate change in the other chronic condition, regardless of which primary presenting problem is addressed. Future longitudinal research could attempt to confirm this hypothesis.
Collapse
Affiliation(s)
- Bradley N. Collins
- Department of Public Health, Health Behavior Research Center, College of Health Professions and Social Work, Temple University
| | - Uma S. Nair
- Department of Public Health, Health Behavior Research Center, College of Health Professions and Social Work, Temple University
| | - Michelle Shwarz
- Department of Public Health, Health Behavior Research Center, College of Health Professions and Social Work, Temple University
| | - Karen Jaffe
- Department of Public Health, Health Behavior Research Center, College of Health Professions and Social Work, Temple University
| | | |
Collapse
|
31
|
Fedele DA, Koinis-Mitchell D, Kopel S, Lobato D, McQuaid EL. A Community-Based Intervention for Latina Mothers of Children With Asthma: What Factors Moderate Effectiveness? CHILDRENS HEALTH CARE 2013. [DOI: 10.1080/02739615.2013.816605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
32
|
Bellin MH, Kub J, Frick KD, Bollinger ME, Tsoukleris M, Walker J, Land C, Butz AM. Stress and quality of life in caregivers of inner-city minority children with poorly controlled asthma. J Pediatr Health Care 2013; 27:127-34. [PMID: 23414978 PMCID: PMC3575578 DOI: 10.1016/j.pedhc.2011.09.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 09/21/2011] [Accepted: 09/30/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Caregiver quality of life (QOL) is known to influence asthma management behaviors. Risk factors for low caregiver QOL in families of inner-city children with asthma remain unclear. This study evaluated the interrelationships of asthma control, stress, and caregiver QOL. METHOD Data were analyzed from a home-based behavioral intervention for children with persistent asthma after treatment for asthma in the emergency department. Caregivers reported on baseline demographics, asthma control, asthma management stress, life stress, and QOL. Hierarchical regression analysis examined the contributions of sociodemographic factors, asthma control, asthma management stress, and life stress in explaining caregiver QOL. RESULTS Children (N = 300) were primarily African American (96%) and young (mean age, 5.5 years). Caregivers were predominantly the biological mother (92%), single (70%), and unemployed (54%). Poor QOL was associated with higher caregiver education and number of children in the home, low asthma control, and increased asthma management stress and life stress. The model accounted for 28% of variance in caregiver QOL. DISCUSSION Findings underscore the need for multifaceted interventions to provide tools to caregivers of children with asthma to help them cope with asthma management demands and contemporary life stressors.
Collapse
Affiliation(s)
- Melissa H Bellin
- Health Specialization, School of Social Work, University of Maryland, Baltimore, MD 21201, USA.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Butz AM, Kub J, Bellin MH, Frick KD. Challenges in providing preventive care to inner-city children with asthma. Nurs Clin North Am 2013; 48:241-57. [PMID: 23659811 DOI: 10.1016/j.cnur.2013.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although the scientific understanding of the pathophysiology of asthma and the quality of asthma therapies have significantly improved over the past 30 years, asthma morbidity remains high and preventive care low for inner-city children. This article focuses on 4 major challenges to providing preventive care (family and patient attitudes and beliefs, lack of access to quality medical care, psychosocial factors, environmental factors) based on prior evidence and the authors' observation of these challenges in research with inner-city children with asthma over the past decade. Cost issues related to preventive care are addressed, and recommendations provide for pediatric nurses.
Collapse
Affiliation(s)
- Arlene M Butz
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | | | | | | |
Collapse
|
34
|
Letourneau NL, Dennis CL, Benzies K, Duffett-Leger L, Stewart M, Tryphonopoulos PD, Este D, Watson W. Postpartum depression is a family affair: addressing the impact on mothers, fathers, and children. Issues Ment Health Nurs 2012; 33:445-57. [PMID: 22757597 DOI: 10.3109/01612840.2012.673054] [Citation(s) in RCA: 204] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this paper is to present research on the effects of postpartum depression (PPD) on mothers, fathers, and children that point to a re-conceptualization of PPD as a mental health condition that affects the whole family. As such, the objectives of this paper are to discuss: (1) the incidence and effects of PPD on mothers and fathers; (2) common predictors of PPD in mothers and fathers, and (3) the effects of PPD on parenting and parent-child relationships, and (4) the effects of PPD on children's health, and their cognitive and social-emotional development. Finally, the implications for screening and intervention if depression is re-conceptualized as a condition of the family are discussed.
Collapse
|
35
|
Rand CS, Wright RJ, Cabana MD, Foggs MB, Halterman JS, Olson L, Vollmer WM, Wilson SR, Taggart V. Mediators of asthma outcomes. J Allergy Clin Immunol 2012; 129:S136-41. [PMID: 22386506 DOI: 10.1016/j.jaci.2011.12.987] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 12/23/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patient adherence, the level of asthma self-management skills, exposure to stress, and depression can have considerable influence on a wide range of asthma outcomes and thus are considered asthma outcome mediators. OBJECTIVE National Institutes of Health institutes and other federal agencies convened an expert group to recommend standardized measures for 7 domains of asthma clinical research outcomes measures. Although the review of mediators of these outcomes was not within the scope of any specific outcome topic, a brief summary is presented so that researchers might consider potential mediators. METHODS We prepared a summary of key mediators of asthma outcomes based on expertise and knowledge of the literature. RESULTS The rationale for including measures of adherence, self-management skills, and exposures to stress in asthma clinical research is presented, along with a brief review of instruments for collecting this information from clinical research participants. CONCLUSIONS Appropriate measurement of adherence, self-management skills, and exposures to stress will enhance characterization of study participants and provide information about the potential impact these factors can have on mediating the effects of treatment interventions.
Collapse
|
36
|
Marques dos Santos L, Neves dos Santos D, Rodrigues LC, Barreto ML. Maternal mental health and social support: effect on childhood atopic and non-atopic asthma symptoms. J Epidemiol Community Health 2012; 66:1011-6. [PMID: 22495771 PMCID: PMC3465835 DOI: 10.1136/jech-2011-200278] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Atopic and non-atopic asthma have distinct risk factors and immunological mechanisms, and few studies differentiate between the impacts of psychosocial factors on the prevalence of these disease phenotypes. The authors aimed to identify whether the effect of maternal mental health on prevalence of asthma symptoms differs between atopic and non-atopic children, taking into account family social support. METHODS This is a cross-sectional study of 1013 children participating in the Social Change Allergy and Asthma in Latin America project. Psychosocial data were collected through a household survey utilising Self-Reporting Questionnaire and Medical Outcome Study Social Support Scale. Socioeconomic and wheezing information was obtained through the questionnaire of the International Study of Allergy and Asthma in Childhood, and level of allergen-specific IgE was measured to identify atopy. Polytomous logistic regression was used to estimate the association between maternal mental health, social support and atopic and non-atopic wheezing. Effect modification was evaluated through stratified polytomous regression according to social support level. RESULTS Maternal mental disorder had the same impact on atopic and non-atopic wheezing, even after adjusting for confounding variables. Affective, material and informational supports had protective effects on non-atopic asthma, and there is some evidence that social supports may act as a buffer for the impact of maternal mental disorder on non-atopic wheezing. CONCLUSION Poor maternal mental health is positively associated with wheezing, independent of whether asthma is atopic or non-atopic, but perception of high levels of social support appears to buffer this relationship in non-atopic wheezers only.
Collapse
Affiliation(s)
- Letícia Marques dos Santos
- Department of Collective Health, Institute of Collective Health, Federal University of Bahia, Salvador, Brazil.
| | | | | | | |
Collapse
|
37
|
Correia MADV, Rizzo JA, Sarinho SW, Sarinho ESC, Medeiros D, Assis F. Effect of exercise-induced bronchospasm and parental beliefs on physical activity of asthmatic adolescents from a tropical region. Ann Allergy Asthma Immunol 2012; 108:249-53. [DOI: 10.1016/j.anai.2012.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 01/19/2012] [Accepted: 01/20/2012] [Indexed: 10/28/2022]
|
38
|
Tu MT, Perreault G, Séguin L, Gauvin L. Child asthma and change in elevated depressive symptoms among mothers of children of a birth cohort from Quebec. Women Health 2012; 51:461-81. [PMID: 21797679 DOI: 10.1080/03630242.2011.590876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The authors examined the association between maternal reports of child asthma attacks since birth and occurrence of elevated maternal depressive symptoms at seventeen months postpartum in the present study. The modifying role of poverty in this association was also examined. Data from n = 1,696 mother-child dyads from the Quebec Longitudinal Study of Child Development, a birth cohort of children born in 1998, were used. Maternal depressive symptoms were measured with an abridged and validated twelve-item version of the Center for Epidemiologic Studies Depression Scale. Maternal reports of child asthma attacks since birth in relation to the occurrence of maternal depressive symptoms at 17 months postpartum and the potential modifying role of poverty were tested using multiple logistic regression models. When mothers reported child asthma attacks, those without elevated depressive symptoms at 5 months postpartum had lower odds of elevated depressive symptoms one year later (OR = 0.2, 95% CI: 0.1-0.7). Poverty was associated with increased odds of elevated maternal depressive symptoms (OR = 2.4, 95% CI: 1.5-3.9), without interacting with child asthma. Through this study, the authors suggest that in mothers without elevated symptoms at 5 months, reported child asthma attacks since birth did not contribute one year later to new occurrence of depressive symptoms.
Collapse
Affiliation(s)
- Mai Thanh Tu
- Department of Social & Preventive Medicine, Université de Montréal, Quebec, Canada
| | | | | | | |
Collapse
|
39
|
Abstract
The prevalence and burden of childhood asthma remain high and are increasing. Asthma hot spot neighborhoods around the country face particular challenges in controlling the effects of the condition. Increasing attention is being paid to developing interventions that recognize the child and family as the primary managers of disease and to introducing assistance that reaches beyond the clinical care setting into the places where families live and work. A range of types of community-focused interventions has been assessed in the past decade in schools, homes, and community health clinics, and programs using electronic media and phone links have been evaluated. Stronger evidence for all these approaches is needed. However, school-based programs and community coalitions designed to bring about policy and systems changes show particular promise for achieving sustainable improvements in asthma control. Research is needed that emphasizes comparisons among proven asthma control interventions, translation of effective approaches to new settings and communities, and institutionalization of effective strategies.
Collapse
Affiliation(s)
- Noreen M Clark
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, Michigan 48109, USA.
| |
Collapse
|
40
|
Feldman JM, Acosta Pérez E, Canino G, McQuaid EL, Goodwin RD, Ortega AN. The role of caregiver major depression in the relationship between anxiety disorders and asthma attacks in island Puerto Rican youth and young adults. J Nerv Ment Dis 2011; 199:313-8. [PMID: 21543950 PMCID: PMC3090724 DOI: 10.1097/nmd.0b013e3182174e84] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The goal of this study was to assess whether the association between asthma attacks and anxiety disorders in youth/young adults is reduced after adjusting for the caregivers' psychiatric disorders. An island-wide probability sample of 641 households in Puerto Rico with youth/young adults between ages 10 and 25 years participated along with their caregivers. The Diagnostic Interview Schedule for Children and the Composite International Diagnostic Interview were conducted to assess anxiety and depressive disorders. Youth/young adults with an anxiety disorder were more likely to have a lifetime history of asthma attacks versus youth/young adults without an anxiety disorder. Caregivers of participants with asthma attacks were more likely to have major depression than did the caregivers of participants without asthma attacks. The association between asthma attacks and anxiety disorders in youth was no longer significant after adjustment for caregiver major depression. It is important to consider the role of caregiver depression in asthma-anxiety comorbidity in youth/young adults.
Collapse
Affiliation(s)
- Jonathan M Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461, USA.
| | | | | | | | | | | |
Collapse
|
41
|
Lam K, Chan SWC, Lam SC. Level of psychological distress and social support among patients with limb fractures in Hong Kong. J Clin Nurs 2010; 20:784-93. [DOI: 10.1111/j.1365-2702.2010.03326.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
42
|
Quinn K, Kaufman JS, Siddiqi A, Yeatts KB. Stress and the city: housing stressors are associated with respiratory health among low socioeconomic status Chicago children. J Urban Health 2010; 87:688-702. [PMID: 20499191 PMCID: PMC2900574 DOI: 10.1007/s11524-010-9465-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Asthma disproportionately affects non-whites in urban areas and those of low socioeconomic status, yet asthma's social patterning is not well-explained by known risk factors. We hypothesized that disadvantaged urban populations experience acute and chronic housing stressors which produce psychological stress and impact health through biological and behavioral pathways. We examined eight outcomes: six child respiratory outcomes as well as parent and child general health, using data from 682 low-income, Chicago parents of diagnosed and undiagnosed asthmatic children. We created a continuous exposure, representing material, social and emotional dimensions of housing stressors, weighted by their parent-reported difficulty. We compared the 75th to the 25th quartile of exposure in adjusted binomial and negative binomial regression models. Higher risks and rates of poor health were associated with higher housing stressors for six of eight outcomes. The risk difference (RD) for poor/fair general health was larger for children [RD = 6.28 (95% CI 1.22, 11.35)] than for parents [RD = 3.88 (95% CI -1.87, 9.63)]. The incidence rate difference (IRD) for exercise intolerance was nearly one extra day per 2 weeks for the higher exposure group [IRD = 0.88 (95% CI 0.41, 1.35)]; nearly one-third extra day per 2 weeks for waking at night [IRD = 0.32 (95% CI 0.01, 0.63)]; and nearly one-third extra day per 6 months for unplanned medical visits [IRD = 0.30 (95% CI 0.059, 0.54)]. Results contribute to the conceptualization of urban stress as a "social pollutant" and to the hypothesized role of stress in health disparities. Interventions to improve asthma outcomes must address individuals' reactions to stress while we seek structural solutions to residential stressors and health inequities.
Collapse
Affiliation(s)
- Kelly Quinn
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | | | | | | |
Collapse
|
43
|
Özkaya E, Çetin M, Uğurad Z, Samancı N. Evaluation of family functioning and anxiety-depression parameters in mothers of children with asthma. Allergol Immunopathol (Madr) 2010; 38:25-30. [PMID: 19836874 DOI: 10.1016/j.aller.2009.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 06/04/2009] [Accepted: 06/05/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Psychological problems are more commonly observed in mothers of children with asthma when compared to the general population. Smoking in the house and parental cooperation are the other factors which influence psychological status in mothers of children with asthma. In our study, we aimed to investigate family functioning and frequency of psychological symptoms in mothers of children with asthma. METHODS The study group consisted of 160 mothers of 4-15 year old children with asthma and the control group consisted of 90 mothers of healthy children. Beck's inventory, continuous anxiety inventory and family assessment device were administered to each group of mothers. RESULTS Results indicated that levels of depression and anxiety symptoms were higher and perception of family functioning was less healthy in mothers of children with asthma compared to those in the control group (p<0.0001). Smoking status at home and level of communication with the father were found to have a significant impact on the evaluation scale in mothers in the case group. DISCUSSION Psychiatric symptoms observed in mothers of asthmatic children might be associated to influencing the functioning of the entire family rather that of the mother alone. Therefore, evaluation of family functioning in mothers of children with asthma might be beneficial in terms of follow-up and control of disease.
Collapse
|
44
|
Emin O, Mustafa S, Nedim S. Psychological stress and family functioning in mothers of children with allergic rhinitis. Int J Pediatr Otorhinolaryngol 2009; 73:1795-8. [PMID: 19853930 DOI: 10.1016/j.ijporl.2009.09.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 09/23/2009] [Accepted: 09/25/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Psychiatric symptoms are observed more commonly in mothers of children with allergic disease compared to the general population. In our study, we aimed to compare family functioning and anxiety parameters in mothers of children diagnosed allergic rhinitis and healthy controls. METHODS Study group consisted of 82 mothers of 7-15 years old children with allergic rhinitis. Control group consisted of 70 mothers of children with no chronic diseases. State-Trait Anxiety Inventory (STAI) and McMaster Family Assessment Device (FAD) scales was obtained from participants. RESULTS Anxiety scores in mother of children with allergic rhinitis were significantly higher than the ones in the control group (50+/-7.54, 32+/-5.44, p=0.02, respectively). Family assessment scores were higher in mother of children with allergic rhinitis when compared to the control group but did not reach statistical significance (1.89+/-0.12, 1.87+/-0.95, p=0.19, respectively). Smoking status at home and jobless father were found to have a significant impact on the evaluation scale in mothers in the case group. CONCLUSION Psychiatric symptoms observed in mothers of children with allergic rhinitis might be associated with child disease and the functioning of the entire family rather than features of the mother alone. Having a child with allergic rhinitis does not affect family functions according to the mother's aspect.
Collapse
Affiliation(s)
- Ozkaya Emin
- Department of Paediatrics, Vakif Gureba Education and Research Hospital, Istanbul, Turkey.
| | | | | |
Collapse
|
45
|
Otsuki M, Eakin MN, Arceneaux LL, Rand CS, Butz AM, Riekert KA. Prospective relationship between maternal depressive symptoms and asthma morbidity among inner-city African American children. J Pediatr Psychol 2009; 35:758-67. [PMID: 19850709 DOI: 10.1093/jpepsy/jsp091] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To examine prospective relationships between caregiver's depressive symptoms and child asthma morbidity among inner-city African American families. METHODS Phone surveys were conducted 6 months apart with 262 African American mothers of children with asthma. Cross-lagged structural path analysis was used for data analyses. RESULTS Using goodness-of-fit indices, the final model for asthma symptoms had a good fit to the data. Time 1 (T1) maternal depressive symptoms predicted T2 child asthma symptoms (beta =.16, p <.01); however, T1 asthma symptoms did not predict T2 maternal depressive symptoms (beta =.03, non-significant). In contrast, in the final model for emergency department (ED) visits there was no predictive association between maternal depressive symptoms and ED visits. CONCLUSION Maternal depressive symptoms may have a detrimental effect on child asthma morbidity among inner-city African American families, rather than vice versa. Ameliorating maternal depressive symptoms may result in better asthma outcomes for inner-city children.
Collapse
|
46
|
Kub J, Jennings JM, Donithan M, Walker JM, Land CL, Butz A. Life events, chronic stressors, and depressive symptoms in low-income urban mothers with asthmatic children. Public Health Nurs 2009; 26:297-306. [PMID: 19573208 DOI: 10.1111/j.1525-1446.2009.00784.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This secondary data analysis study examines the relationship between maternal sociodemographic variables, life events, chronic stressors, including asthma control and management and environmental stressors, and maternal depression. DESIGN Cross-sectional descriptive design study consisting of baseline data from participants enrolled in a randomized asthma communication educational intervention trial. SAMPLE 201 mothers of children with asthma (ages 6-12), recruited from community pediatric practices and emergency departments of 2 urban university hospitals. MEASUREMENT Life events were measured using standardized items. Chronic stressors were measured using items from the International Asthma and Allergies in Childhood study and maternal and child exposure to violence. Depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression scale. RESULTS Close to 25% of the mothers had high depressive symptoms. In separate multiple logistic regression models, education (adjusted odds ratio [AOR]=2.62; 95% confidence interval [CI]=1.07, 6.39) or unemployment (AOR=2.38; 95% CI=1.16, 4.90) and the use of quick relief medications (AOR=2.74; 95% CI=1.33, 5.66) for asthma were positively associated with depressive symptoms. CONCLUSIONS Implications include the need to assess maternal depressive symptoms of mothers of children with asthma, in order to improve asthma management for low-income urban children.
Collapse
Affiliation(s)
- Joan Kub
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.
| | | | | | | | | | | |
Collapse
|
47
|
Kruger DJ, Valerio MA. Association between psychosocial factors and asthma in a demographically representative adult sample. J Asthma 2009; 46:708-11. [PMID: 19728210 DOI: 10.1080/02770900903056211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We conducted an analysis of a demographically representative community health survey to examine the association between psychosocial factors and asthma. Data from the Speak to Your Health! Community Survey, a community-based survey designed and implemented by university and community partners using Community Based Public Health (CBPH) principles to investigate health and social issues in Genesee County, Michigan, was used in the analysis presented. The survey gathered information on self-reported mental and physical health status, disease diagnoses, health access and utilization, health-promoting and health-adverse behaviors, neighborhood conditions, and other topics. We sampled households in all residential census tracts in Genesee County, Michigan. One resident over 18 years of age was randomly selected within each household and participated in a telephone interview. The total sample size for the telephone survey in 2007 was 1,748. The mean age of the participants was 54.7 (SD = 15.69); 66% of participants were white, 26% African American, and 7% other race/ethnicity; and 15% of the population reported being diagnosed with asthma. Adults with asthma had significantly higher body mass index, higher levels of social support, and higher levels of stress than adults without asthma. Clinicians and researchers should be aware of psychosocial factors affecting their adult patient populations and tailor patient care, communication, and community-based educational interventions to specifically address these.
Collapse
Affiliation(s)
- Daniel J Kruger
- University of Michigan, School of Public Health, Ann Arbor, Michigan MI 48109-2029, USA.
| | | |
Collapse
|
48
|
Barreto do Carmo MB, Neves Santos D, Alves Ferreira Amorim LD, Fiaccone RL, Souza da Cunha S, Cunha Rodrigues L, Barreto ML. Minor psychiatric disorders in mothers and asthma in children. Soc Psychiatry Psychiatr Epidemiol 2009; 44:416-20. [PMID: 18974909 DOI: 10.1007/s00127-008-0450-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 10/02/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Recent studies have shown that asthma represents a major health issue not only in children of developed countries but also in urban centers in some middle-income countries. Brazil has one of the highest prevalences of asthma worldwide. Recently, interest has grown in the relationship between psychosocial factors and asthma. This article examines the relationship between maternal mental disorders and the prevalence of asthma in low-income children from an inner city area of Salvador in the state of Bahia, Brazil, and is part of the SCAALA program (Social Change, Allergy and Asthma in Latin America). PATIENTS AND METHODS A total of 1,087 children between the ages of 5 and 12 were investigated, together with their mothers. The mothers' mental health was evaluated using the SRQ-20, an instrument for the psychiatric screening of minor psychiatric disorders (depression, anxiety and somatic complaints). The prevalence of asthma was investigated using the ISAAC survey, a standardized, validated questionnaire for asthma and other allergic diseases. Cases were defined as asthma if the patient reported having had wheezing in the previous 12 months in addition to at least one of the following: having asthma, wheezing while exercising, waking during the night because of wheezing, or having had at least four episodes of wheezing in the previous 12 months. Atopy was defined as a positive skin prick test to allergens. RESULTS AND CONCLUSION The presence of minor psychiatric disorders in the mothers was significantly associated with the presence of asthma in the children, and this association was consistent with all forms of asthma, irrespective of whether it was atopic or nonatopic. Future studies should be carried out to further investigate this association and the potential biological mechanisms involved. Programs for asthma control should include strategies for stress reduction and psychological support for the families of asthmatic children.
Collapse
|
49
|
Abstract
PURPOSE The purposes of this study were to examine the relationships among maternal and environmental variables in the first 6 months postpartum and toddler health status, and to identify predictors of toddler health. DESIGN AND METHODS A secondary analysis was conducted on an existing dataset of a longitudinal parent-child survey. RESULTS Maternal stress predicted 8% of the variance in child health status at 18 months of age. Children in nonparental care more than 20 hr per week were perceived as less healthy. PRACTICE IMPLICATIONS Pediatric nurses should assess levels of maternal stress in the early months postpartum and anticipate poorer health status in toddlers who spend more than 20 hr per week in nonparental care.
Collapse
Affiliation(s)
- Eileen Fowles
- University of Texas at Austin, School of Nursing, Austin, TX, USA.
| | | |
Collapse
|
50
|
Braveman P, Marchi K, Egerter S, Kim S, Metzler M, Stancil T, Libet M. Poverty, near-poverty, and hardship around the time of pregnancy. Matern Child Health J 2008; 14:20-35. [PMID: 19037715 DOI: 10.1007/s10995-008-0427-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 11/11/2008] [Indexed: 10/21/2022]
Abstract
To describe income levels and the prevalence of major hardships among women during or just before pregnancy. We separately analyzed 2002-2006 population-based postpartum survey data from California's Maternal and Infant Health Assessment (n = 18,332) and 19 states participating in CDC's Pregnancy Risk Assessment Monitoring System (n = 143,452) to examine income and several hardships (divorce/separation, domestic violence, homelessness, financial difficulties, spouse/partner's or respondent's involuntary job loss or incarceration, and, in California only, food insecurity and no social support) during/just before pregnancy. In both samples, over 30% of women were poor (income </=100% of federal poverty level [FPL]) and 20% near-poor (101-200% FPL); and around 60% of low-income (poor or near-poor) women experienced at least one hardship. While hardship prevalence decreased significantly as income increased, many non-low-income women also experienced hardships; e.g., in California, 43% of all women and 13% with incomes >400% FPL experienced one or more hardships. These findings paint a disturbing picture of experiences around the time of pregnancy in the United States for many women giving birth and their children, particularly because 60% had previous births. The high prevalence of low income and of serious hardships during pregnancy is of concern, given previous research documenting the adverse health consequences of these experiences and recognition of pregnancy as a critical period for health throughout the life course. Low income and major hardships around the time of pregnancy should be addressed as mainstream U.S. maternal-infant health and social policy issues.
Collapse
Affiliation(s)
- Paula Braveman
- Center on Social Disparities in Health, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA 94118, USA.
| | | | | | | | | | | | | |
Collapse
|