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Masters C, Lewis JB, Hagaman A, Thomas JL, Carandang RR, Ickovics JR, Cunningham SD. Discrimination and perinatal depressive symptoms: The protective role of social support and resilience. J Affect Disord 2024; 354:656-661. [PMID: 38484882 DOI: 10.1016/j.jad.2024.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/26/2024] [Accepted: 03/09/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Discrimination is an important social determinant of perinatal depression; however, evidence is limited regarding modifiable social and psychological factors that may moderate this association. We examined whether social support and resilience could protect against the adverse effects of discrimination on perinatal depressive symptoms. METHODS Pregnant people (N = 589) receiving Expect With Me group prenatal care in Nashville, TN and Detroit, MI completed surveys during third trimester of pregnancy and six months postpartum. Linear regression models tested the association between discrimination and depressive symptoms, and the moderating effects of social support and resilience, during pregnancy and postpartum. RESULTS The sample was predominantly Black (60.6 %), Hispanic (15.8 %) and publicly insured (71 %). In multivariable analyses, discrimination was positively associated with depressive symptoms during pregnancy (B = 4.44, SE = 0.37, p ≤0.001) and postpartum (B = 3.78, SE = 0.36, p < 0.001). Higher social support and resilience were associated with less depressive symptoms during pregnancy (B = -0.49, SE = 0.08, p < 0.001 and B = -0.67, SE = 0.10, p < 0.001, respectively) and postpartum (B = -0.32, SE = 0.07, p < 0.001 and B = -0.56, SE = 0.08, p < 0.001, respectively). Social support was protective against discrimination (pregnancy interaction B = -0.23, SE = 0.09, p = 0.011; postpartum interaction B = -0.35, SE = 0.07, p < 0.001). There was no interaction between discrimination and resilience at either time. LIMITATIONS The study relied on self-reported measures and only included pregnant people who received group prenatal care in two urban regions, limiting generalizability. CONCLUSIONS Social support and resilience may protect against perinatal depressive symptoms. Social support may also buffer the adverse effects of discrimination on perinatal depressive symptoms, particularly during the postpartum period.
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Affiliation(s)
- Claire Masters
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT 06510, USA
| | - Jessica B Lewis
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06519, USA
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA; Center for Methods in Implementation and Prevention Sciences, Yale University, New Haven, CT 06510, USA
| | - Jordan L Thomas
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
| | - Rogie Royce Carandang
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA
| | - Shayna D Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
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Masters C, Carandang RR, Lewis JB, Hagaman A, Metrick R, Ickovics JR, Cunningham SD. Group prenatal care successes, challenges, and frameworks for scaling up: a case study in adopting health care innovations. Implement Sci Commun 2024; 5:20. [PMID: 38439113 PMCID: PMC10913654 DOI: 10.1186/s43058-024-00556-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/12/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Group prenatal care enhances quality of care, improves outcomes, and lowers costs. However, this healthcare innovation is not widely available. Using a case-study approach, our objectives were to (1) examine organizational characteristics that support implementation of Expect With Me group prenatal care and (2) identify key factors influencing adoption and sustainability. METHODS We studied five clinical sites implementing group prenatal care, collecting qualitative data including focus group discussions with clinicians (n = 4 focus groups, 41 clinicians), key informant interviews (n = 9), and administrative data. We utilized a comparative qualitative case-study approach to characterize clinical sites and explain organizational traits that fostered implementation success. We characterized adopting and non-adopting (unable to sustain group prenatal care) sites in terms of fit for five criteria specified in the Framework for Transformational Change: (1) impetus to transform, (2) leadership commitment to quality, (3) improvement initiatives that engage staff, (4) alignment to achieve organization-wide goals, and (5) integration. RESULTS Two sites were classified as adopters and three as non-adopters based on duration, frequency, and consistency of group prenatal care implementation. Adopters had better fit with the five criteria for transformational change. Adopting organizations were more successful implementing group prenatal care due to alignment between organizational goals and resources, dedicated healthcare providers coordinating group care, space for group prenatal care sessions, and strong commitment from organization leadership. CONCLUSIONS Adopting sites were more likely to integrate group prenatal care when stakeholders achieved alignment across staff on organizational change goals, leadership buy-in, and committed institutional support and dedicated resources to sustain it. TRIAL REGISTRATION The Expect With Me intervention's design and hypotheses were preregistered: https://clinicaltrials.gov/study/NCT02169024 . Date: June 19, 2014.
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Affiliation(s)
- Claire Masters
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Rogie Royce Carandang
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
| | - Jessica B Lewis
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06510, USA
- Center for Methods in Implementation and Prevention Sciences, Yale University, New Haven, CT, 06510, USA
| | - Rebecca Metrick
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06510, USA
- Sinai Urban Health Institute, Chicago, IL, 60608, USA
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Shayna D Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, 06030, USA.
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Carandang RR, Epel E, Radin R, Lewis JB, Ickovics JR, Cunningham SD. Perceived Stress and Depressive Symptoms Are Associated With Emotional Eating but Not Nutritional Intake During Pregnancy: A Prospective Cohort Study. J Midwifery Womens Health 2024; 69:64-70. [PMID: 37358371 DOI: 10.1111/jmwh.13537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Pregnancy is a major life event during which women may experience increased psychological distress and changes in eating behaviors. However, few studies have investigated the influence of psychological distress on pregnant women's eating behaviors. The primary objective of this prospective study was to examine the associations of changes in perceived stress and depressive symptoms with emotional eating and nutritional intake during pregnancy. In addition, we examined the direct and moderating effects of perceived social support. METHODS Participants were racially diverse pregnant women (14-42 years) from 4 clinical sites in Detroit, MI, and Nashville, TN (N = 678). We used multiple linear and logistic regression models to determine if changes in stress and depressive symptoms across pregnancy were associated with changes in emotional eating and nutritional intake. We examined residualized change in stress and depressive symptoms from second to third trimester of pregnancy; positive residualized change scores indicated increased stress and depressive symptoms. RESULTS Participants showed significant improvement in emotional eating and nutritional intake from second to third trimester of pregnancy (P < .001 for both). At second trimester, higher depressive symptoms were associated with a greater likelihood of emotional eating (P < .001) and worse nutritional intake (P = .044) at third trimester. Increased stress and depressive symptoms during pregnancy were both associated with increased risk, whereas increased perceived social support reduced risk of emotional eating at third trimester (stress: adjusted odds ratio [AOR], 1.17; 95% CI, 1.08-1.26; depressive symptoms: AOR, 1.05; 95% CI, 1.01-1.08; social support: AOR, 0.93; 95% CI, 0.88-0.99). None were associated with changes in nutritional intake. Perceived social support did not show any moderating effects. DISCUSSION Increased psychological distress during pregnancy may increase emotional eating. Efforts to promote healthy eating behaviors among pregnant women should consider and address mental health.
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Affiliation(s)
- Rogie Royce Carandang
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Elissa Epel
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
- Center for Health and Community, University of California San Francisco, San Francisco, California
| | - Rachel Radin
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
- Center for Health and Community, University of California San Francisco, San Francisco, California
| | - Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Shayna D Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut
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Cunningham SD, Carandang RR, Boyd LM, Lewis JB, Ickovics JR, Rickey LM. Psychosocial Factors Associated with Lower Urinary Tract Symptoms One Year Postpartum. Int J Environ Res Public Health 2023; 21:40. [PMID: 38248505 PMCID: PMC10815698 DOI: 10.3390/ijerph21010040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024]
Abstract
Pregnancy carries substantial risk for developing lower urinary tract symptoms (LUTSs), with potential lifelong impacts on bladder health. Little is known about modifiable psychosocial factors that may influence the risk of postpartum LUTSs. We examined associations between depressive symptoms, perceived stress, and postpartum LUTSs, and the moderating effects of perceived social support, using data from a cohort study of Expect With Me group prenatal care (n = 462). One year postpartum, 40.3% participants reported one or more LUTS. The most frequent LUTS was daytime frequency (22.3%), followed by urinary incontinence (19.5%), urgency (18.0%), nocturia (15.6%), and bladder pain (6.9%). Higher odds of any LUTS were associated with greater depressive symptoms (adjusted odds ratio (AOR) 1.08, 95% confidence interval (CI) 1.04-1.11) and perceived stress (AOR 1.12, 95% CI 1.04-1.19). Higher perceived social support was associated with lower odds of any LUTS (AOR 0.94, 95% CI 0.88-0.99). Perceived social support mitigated the adverse effects of depressive symptoms (interaction AOR 0.99, 95% CI 0.98-0.99) and perceived stress (interaction AOR 0.97, 95% CI 0.95-0.99) on experiencing any LUTS. Greater depressive symptoms and perceived stress may increase the likelihood of experiencing LUTSs after childbirth. Efforts to promote bladder health among postpartum patients should consider psychological factors and social support.
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Affiliation(s)
- Shayna D Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Rogie Royce Carandang
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Lisa M Boyd
- Virginia Polytechnic Institute, State University, Blacksburg, VA 24061, USA
| | - Jessica B Lewis
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA
| | - Leslie M Rickey
- Departments of Urology and Obstetrics, Gynecology & Reproductive Services, Yale School of Medicine, New Haven, CT 06510, USA
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Mehra R, Alspaugh A, Dunn JT, Franck LS, McLemore MR, Keene DE, Kershaw TS, Ickovics JR. "'Oh gosh, why go?' cause they are going to look at me and not hire": intersectional experiences of black women navigating employment during pregnancy and parenting. BMC Pregnancy Childbirth 2023; 23:17. [PMID: 36627577 PMCID: PMC9830615 DOI: 10.1186/s12884-022-05268-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/30/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Workplace legal protections are important for perinatal health outcomes. Black birthing people are disproportionally affected by pregnancy discrimination and bias in the employment context and lack of family-friendly workplace policies, which may hinder their participation in the labor force and lead to gender and racial inequities in income and health. We aimed to explore Black pregnant women's experiences of pregnancy discrimination and bias when looking for work, working while pregnant, and returning to work postpartum. Additionally, we explored Black pregnant women's perspectives on how these experiences may influence their health. METHODS Using an intersectional framework, where oppression is based on intersecting social identities such as race, gender, pregnancy, and socioeconomic status, we conducted an analysis of qualitative data collected for a study exploring the lived experience of pregnancy among Black pregnant women in New Haven, Connecticut, United States. Twenty-four women participated in semi-structured interviews (January 2017-August 2018). Interview transcripts were analyzed using grounded theory techniques. RESULTS Participants expressed their desire to provide a financially secure future for their family. However, many described how pregnancy discrimination and bias made it difficult to find or keep a job during pregnancy. The following three themes were identified: 1) "You're a liability"; difficulty seeking employment during pregnancy; 2) "This is not working"; experiences on the job and navigating leave and accommodations while pregnant and parenting; and 3) "It's really depressing. I wanna work"; the stressors of experiencing pregnancy discrimination and bias. CONCLUSION Black pregnant women in this study anticipated and experienced pregnancy discrimination and bias, which influenced financial burden and stress. We used an intersectional framework in this study which allowed us to more fully examine how racism and economic marginalization contribute to the lived experience of Black birthing people. Promoting health equity and gender parity means addressing pregnancy discrimination and bias and the lack of family-friendly workplace policies and the harm they cause to individuals, families, and communities, particularly those of color, throughout the United States.
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Affiliation(s)
- Renee Mehra
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St, CT, 06520, New Haven, USA.
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, UCSF Box 0606, CA, 94143, San Francisco, USA.
| | - Amy Alspaugh
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, UCSF Box 0606, CA, 94143, San Francisco, USA.
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd, Knoxville, 37916, USA.
| | - Jennifer T Dunn
- Department of Social and Behavioral Sciences, School of Nursing, University of California, 490 Illinois Street, CA, San Francisco, 94158, USA
| | - Linda S Franck
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, UCSF Box 0606, CA, 94143, San Francisco, USA
| | - Monica R McLemore
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, UCSF Box 0606, CA, 94143, San Francisco, USA
| | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, CT, 06520, New Haven, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, CT, 06520, New Haven, USA
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, CT, 06520, New Haven, USA
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Mehra R, Alspaugh A, Franck LS, McLemore MR, Kershaw TS, Ickovics JR, Keene DE, Sewell AA. “Police shootings, now that seems to be the main issue” – Black pregnant women’s anticipation of police brutality towards their children. BMC Public Health 2022; 22:146. [PMID: 35057776 PMCID: PMC8781435 DOI: 10.1186/s12889-022-12557-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/05/2022] [Indexed: 01/14/2023] Open
Abstract
Background A disproportionate number of people who are killed by police each year are Black. While much attention rightly remains on victims of police brutality, there is a sparse literature on police brutality and perinatal health outcomes. We aimed to explore how Black pregnant women perceive police brutality affects them during pregnancy and might affect their children. Methods This qualitative study involved semi-structured interviews among 24 Black pregnant women in New Haven, Connecticut (January 2017 to August 2018). Interview questions explored neighborhood factors, safety, stressors during pregnancy, and anticipated stressors while parenting. Grounded theory informed the analysis. Results Participants, regardless of socioeconomic status, shared experiences with police and beliefs about anticipated police brutality, as summarized in the following themes: (1) experiences that lead to police distrust – “If this is the way that mommy’s treated [by police]”; (2) anticipating police brutality – “I’m always expecting that phone call”; (3) stress and fear during pregnancy – “It’s a boy, [I feel] absolutely petrified”; and (4) ‘the talk’ about avoiding police brutality – “How do you get prepared?” Even participants who reported positive experiences with police anticipated brutality towards their children. Conclusions Interactions between Black people and police on a personal, familial, community, and societal level influenced how Black pregnant women understand the potential for police brutality towards their children. Anticipated police brutality is a source of stress during pregnancy, which may adversely influence maternal and infant health outcomes. Police brutality must be addressed in all communities to prevent harming the health of birthing people and their children.
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Lewis JB, Cunningham SD, Shabanova V, Hassan SS, Magriples U, Rodriguez MG, Ickovics JR. Group prenatal care and improved birth outcomes: Results from a type 1 hybrid effectiveness-implementation study. Prev Med 2021; 153:106853. [PMID: 34678329 DOI: 10.1016/j.ypmed.2021.106853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022]
Abstract
To compare birth outcomes for patients receiving Expect With Me (EWM) group prenatal care or individual care only, we conducted a type 1 hybrid effectiveness-implementation trial (Detroit and Nashville, 2014-2016). Participants entered care <24 weeks gestation, had singleton pregnancy, and no prior preterm birth (N = 2402). Mean participant age was 27.1 (SD = 5.77); 49.5% were Black; 15.3% were Latina; 59.7% publicly insured. Average treatment effect of EWM compared to individual care only was estimated using augmented inverse probability weighting (AIPW). This doubly-robust analytic method produces estimates of causal association between treatment and outcome in the absence of randomization. AIPW was effective at creating equivalent groups for potential confounders. Compared to those receiving individual care only, EWM patients did significantly better on three of four primary outcomes: lower risk of infants born preterm (<37 weeks gestation; 6.4% vs. 15.1%, risk ratio (RR) 0.42, 95% Confidence Interval (CI) 0.29, 0.54), low birthweight (<2500 g; 4.3% vs. 11.6%, RR 0.37, 95% CI 0.24, 0.49), and admission to NICU (9.4% vs. 14.6%, RR 0.64, 95% CI 0.49, 0.78). There was no difference in small for gestational age (<10% percentile of weight for gestational age). EWM patients attended a mean of 5.9 group visits (SD = 2.7); 70% attended ≥5 group visits. Post-hoc analyses indicated EWM patients utilizing the integrated information technology platform had lower risk for low birthweight infants (RR 0.47, 95% CI 0.24, 0.86) than non-users. Future research is needed to understand mechanisms by which group prenatal care improves outcomes, best practices for implementation, and health systems savings. Trial registration: ClinicalTrials.govNCT02169024.
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Affiliation(s)
- Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America.
| | - Shayna D Cunningham
- Department of Public Health Sciences, UConn Health, Farmington, CT, United States of America
| | - Veronika Shabanova
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States of America
| | - Sonia S Hassan
- Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI, United States of America; Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI, United States of America
| | - Urania Magriples
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States of America
| | - Marisa G Rodriguez
- Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI, United States of America
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
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Thomas JL, Lewis JB, Ickovics JR, Cunningham SD. Associations between Adverse Childhood Experiences and Sexual Risk among Postpartum Women. Int J Environ Res Public Health 2021; 18:ijerph18073848. [PMID: 33917634 PMCID: PMC8038841 DOI: 10.3390/ijerph18073848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 11/16/2022]
Abstract
Epidemiological evidence suggests that exposure to adverse childhood experiences (ACEs) is associated with sexual risk, especially during adolescence, and with maternal and child health outcomes for women of reproductive age. However, no work has examined how ACE exposure relates to sexual risk for women during the postpartum period. In a convenience sample of 460 postpartum women, we used linear and logistic regression to investigate associations between ACE exposure (measured using the Adverse Childhood Experiences Scale) and five sexual risk outcomes of importance to maternal health: contraceptive use, efficacy of contraceptive method elected, condom use, rapid repeat pregnancy, and incidence of sexually transmitted infections (STIs). On average, women in the sample were 25.55 years of age (standard deviation = 5.56); most identified as Black (60.4%), White (18%), or Latina (14.8%). Approximately 40% were exposed to adversity prior to age 18, with the modal number of experiences among those exposed as 1. Women exposed to ACEs were significantly less likely to use contraception; more likely to elect less-efficacious contraceptive methods; and used condoms less frequently (p = 0.041 to 0.008). ACE exposure was not associated with rapid repeat pregnancy or STI acquisition, p > 0.10. Screening for ACEs during pregnancy may be informative to target interventions to reduce risky sexual behavior during the postpartum period.
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Affiliation(s)
- Jordan L. Thomas
- Department of Psychology, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA;
| | - Jessica B. Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT 06510, USA;
| | - Jeannette R. Ickovics
- Yale-NUS College, Singapore 138527, Singapore;
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA
| | - Shayna D. Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06032, USA
- Correspondence: ; Tel.: +1-860-679-7642
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Mehra R, Boyd LM, Magriples U, Kershaw TS, Ickovics JR, Keene DE. Black Pregnant Women "Get the Most Judgment": A Qualitative Study of the Experiences of Black Women at the Intersection of Race, Gender, and Pregnancy. Womens Health Issues 2020; 30:484-492. [PMID: 32900575 PMCID: PMC7704604 DOI: 10.1016/j.whi.2020.08.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pronounced racial disparities in maternal and infant health outcomes persist in the United States. Using an ecosocial and intersectionality framework and biopsychosocial model of health, we aimed to understand Black pregnant women's experiences of gendered racism during pregnancy. METHODS We conducted semistructured interviews with 24 Black pregnant women in New Haven, Connecticut. We asked women about their experience of being pregnant, experiences of gendered racism, and concerns related to pregnancy and parenting Black children. Transcripts were coded by three trained analysts using grounded theory techniques. RESULTS Women experienced gendered racism during pregnancy-racialized pregnancy stigma-in the form of stereotypes stigmatizing Black motherhood that devalued Black pregnancies. Women reported encountering assumptions that they had low incomes, were single, and had multiple children, regardless of socioeconomic status, marital status, or parity. Women encountered racialized pregnancy stigma in everyday, health care, social services, and housing-related contexts, making it difficult to complete tasks without scrutiny. For many, racialized pregnancy stigma was a source of stress. To counteract these stereotypes, women used a variety of coping responses, including positive self-definition. CONCLUSIONS Racialized pregnancy stigma may contribute to poorer maternal and infant outcomes by way of reduced access to quality health care; impediments to services, resources, and social support; and poorer psychological health. Interventions to address racialized pregnancy stigma and its adverse consequences include anti-bias training for health care and social service providers; screening for racialized pregnancy stigma and providing evidence-based coping strategies; creating pregnancy support groups; and developing a broader societal discourse that values Black women and their pregnancies.
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Affiliation(s)
- Renee Mehra
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.
| | - Lisa M Boyd
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
| | - Urania Magriples
- Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut; Yale-NUS College, Singapore
| | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
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Duffany KO, McVeigh KH, Lipkind HS, Kershaw TS, Ickovics JR. Large for Gestational Age and Risk for Academic Delays and Learning Disabilities: Assessing Modification by Maternal Obesity and Diabetes. Int J Environ Res Public Health 2020; 17:E5473. [PMID: 32751314 PMCID: PMC7432935 DOI: 10.3390/ijerph17155473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/23/2022]
Abstract
The objective of this study was to examine academic delays for children born large for gestational age (LGA) and assess effect modification by maternal obesity and diabetes and then to characterize risks for LGA for those with a mediating condition. Cohort data were obtained from the New York City Longitudinal Study of Early Development, linking birth and educational records (n = 125,542). Logistic regression was used to compare children born LGA (>90th percentile) to those born appropriate weight (5-89th percentile) for risk of not meeting proficiency on assessments in the third grade and being referred to special education. Among children of women with gestational diabetes, children born LGA had an increased risk of underperforming in mathematics (ARR: 1.18 (95% CI: 1.07-1.31)) and for being referred for special education (ARR: 1.18 (95% CI: 1.02-1.37)). Children born LGA but of women who did not have gestational diabetes had a slightly decreased risk of academic underperformance (mathematics-ARR: 0.94 (95% CI: 0.90-0.97); Language arts-ARR: 0.96 (95% CI: 0.94-0.99)). Children born to women with gestational diabetes with an inadequate number of prenatal care visits were at increased risk of being born LGA, compared to those receiving extensive care (ARR: 1.67 (95% CI: 1.20-2.33)). Children born LGA of women with diabetes were at increased risk of delays; greater utilization of prenatal care among these diabetic women may decrease the incidence of LGA births.
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Affiliation(s)
- Kathleen O’Connor Duffany
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06410, USA; (T.S.K.); (J.R.I.)
| | - Katharine H. McVeigh
- Division of Family and Child Health, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA;
| | - Heather S. Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Science, Yale University School of Medicine, New Haven, CT 06510, USA;
| | - Trace S. Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06410, USA; (T.S.K.); (J.R.I.)
| | - Jeannette R. Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06410, USA; (T.S.K.); (J.R.I.)
- Division of Social Sciences, Yale-NUS College, Singapore 138527, Singapore
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Simons HR, Thorpe LE, Jones HE, Lewis JB, Tobin JN, Ickovics JR. Perinatal Depressive Symptom Trajectories Among Adolescent Women in New York City. J Adolesc Health 2020; 67:84-92. [PMID: 32268996 DOI: 10.1016/j.jadohealth.2019.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 12/14/2019] [Accepted: 12/18/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of the study was to estimate distinct trajectories of depressive symptoms among adolescent women across the perinatal period. METHODS Using longitudinal depressive symptom data (Center for Epidemiologic Studies Depression Scale) from control participants in the Centering Pregnancy Plus Project (2008-2012), we conducted group-based trajectory modeling to identify depressive symptomatology trajectories from early pregnancy to 1-year postpartum among 623 adolescent women in New York City. We examined associations between sociodemographic, psychosocial, and pregnancy characteristics and the outcome, depressive symptom trajectories. RESULTS We identified three distinct trajectory patterns: stable low or no depressive symptoms (58%), moderate depressive symptoms declining over time (32%), and chronically high depressive symptoms (11%). Women with chronically high symptoms reported higher levels of pregnancy distress and social conflict and lower perceived quality of social support than other women. CONCLUSIONS This study found heterogeneity in perinatal depressive symptom trajectories and identified a group with chronically high symptoms that might be detected during prenatal care. Importantly, we did not identify a trajectory group with new-onset high depressive symptoms postpartum. Findings have important implications for screening and early treatment.
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Affiliation(s)
- Hannah R Simons
- City University of New York School of Public Health, New York, New York.
| | - Lorna E Thorpe
- City University of New York School of Public Health, New York, New York
| | - Heidi E Jones
- City University of New York School of Public Health, New York, New York
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Ickovics JR, Lewis JB, Cunningham SD, Thomas J, Magriples U. Transforming prenatal care: Multidisciplinary team science improves a broad range of maternal-child outcomes. ACTA ACUST UNITED AC 2020; 74:343-355. [PMID: 30945896 DOI: 10.1037/amp0000435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Every 8 seconds a baby is born in the United States. Maternal and newborn care are the nation's most expensive clinical services, and despite spending more per capita on health services, the United States experiences worse perinatal outcomes than most other developed countries, and even worse than many developing countries when it comes to maternal and infant mortality, preterm birth, and other comorbid conditions. We established a transdisciplinary clinical research team nearly 2 decades ago to improve maternal and child health through an innovative approach to maternal care delivery: group prenatal care. Our team has included psychologists (social, health, clinical, community), physicians (obstetrics, maternal fetal medicine, pediatrics), nurse-midwives, epidemiologists, biostatisticians, sociologists, social workers, and others. Though we come from different disciplines, we share a commitment to women's health, to using empirical evidence to design the best interventions, to social justice and health equity, and to transdisciplinary team science. In authentic collaboration, we have drawn on the best of each discipline to meet the triple aim (enhanced quality, improved outcomes, lower costs) for maternal care and to develop a deeper understanding of risk and protective factors for pregnant women and their families. This article describes how we leveraged and integrated our diverse perspectives to achieve these goals, including the theoretical and clinical foundations underlying the development and evaluation of the group prenatal care approach, research methodology employed, impact on the field, and lessons learned. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Martinez I, Kershaw TS, Keene D, Perez-Escamilla R, Lewis JB, Tobin JN, Ickovics JR. Acculturation and Syndemic Risk: Longitudinal Evaluation of Risk Factors Among Pregnant Latina Adolescents in New York City. Ann Behav Med 2019; 52:42-52. [PMID: 28707175 DOI: 10.1007/s12160-017-9924-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Syndemics are co-occurring epidemics that synergistically contribute to specific risks or health outcomes. Although there is substantial evidence demonstrating their existence, little is known about their change over time in adolescents. Purpose The objectives of this paper were to identify longitudinal changes in a syndemic of substance use, intimate partner violence, and depression and determine whether immigration/cultural factors moderate this syndemic over time. Methods In a cohort of 772 pregnant Latina adolescents (ages 14-21) in New York City, we examined substance use, intimate partner violence, and depression as a syndemic. We used longitudinal mixed-effect modeling to evaluate whether higher syndemic score predicted higher syndemic severity, from pregnancy through 1 year postpartum. Interaction terms were used to determine whether immigrant generation and separated orientation were significant moderators of change over time. Results We found a significant increasing linear effect for syndemic severity over time (β = 0.0413, P = 0.005). Syndemic score significantly predicted syndemic severity (β = -0.1390, P ≤ 0.0001), as did immigrant generation (βImmigrant = -0.1348, P ≤ 0.0001; β1stGen = -0.1932, P = 0.0005). Both immigrant generation (βImmigrant = -0.1125, P = 0.0035; β1stGen = -0.0135, P = 0.7279) and separated orientation (β = 0.0946, P = 0.0299) were significantly associated with change in severity from pregnancy to 1 year postpartum. Conclusion Pregnancy provides an opportunity for reducing syndemic risk among Latina adolescents. Future research should explore syndemic changes over time, particularly among high-risk adolescents. Prevention should target syndemic risk reduction in the postpartum period to ensure that risk factors do not increase after pregnancy.
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Affiliation(s)
- Isabel Martinez
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Trace S Kershaw
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | - Danya Keene
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | - Rafael Perez-Escamilla
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | - Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | | | - Jeannette R Ickovics
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
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Mehra R, Keene DE, Kershaw TS, Ickovics JR, Warren JL. Racial and ethnic disparities in adverse birth outcomes: Differences by racial residential segregation. SSM Popul Health 2019; 8:100417. [PMID: 31193960 PMCID: PMC6545386 DOI: 10.1016/j.ssmph.2019.100417] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 11/26/2022] Open
Abstract
Racial and ethnic disparities in adverse birth outcomes have persistently been wide and may be explained by individual and area-level factors. Our primary objective was to determine if county-level black-white segregation modified the association between maternal race/ethnicity and adverse birth outcomes using birth records from the National Center for Health Statistics (2012). Based on maternal residence at birth, county-level black-white racial residential segregation was calculated along five dimensions of segregation: evenness, exposure, concentration, centralization, and clustering. We conducted a two-stage analysis: (1) county-specific logistic regression to determine whether maternal race and ethnicity were associated with preterm birth and term low birth weight; and (2) Bayesian meta-analyses to determine if segregation moderated these associations. We found greater black-white and Hispanic-white disparities in preterm birth in racially isolated counties (exposure) relative to non-isolated counties. We found reduced Hispanic-white disparities in term low birth weight in racially concentrated and centralized counties relative to non-segregated counties. Area-level poverty explained most of the moderating effect of segregation on disparities in adverse birth outcomes, suggesting that area-level poverty is a mediator of these associations. Segregation appears to modify racial/ethnic disparities in adverse birth outcomes. Therefore, policy interventions that reduce black-white racial isolation, or buffer the poor social and economic correlates of segregation, may help to reduce disparities in preterm birth and term low birth weight.
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Affiliation(s)
- Renee Mehra
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Danya E. Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Trace S. Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Jeannette R. Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Joshua L. Warren
- Department of Biostatistics, Yale School of Public Health, 60 College St, New Haven, CT, 06510, United States
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Fernandes CSF, Schwartz MB, Ickovics JR, Basch CE. Educator Perspectives: Selected Barriers to Implementation of School-Level Nutrition Policies. J Nutr Educ Behav 2019; 51:843-849. [PMID: 30704936 DOI: 10.1016/j.jneb.2018.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To improve understanding about selected barriers to the implementation of 2 school food policies by examining the perceptions of those responsible for implementation. DESIGN Semistructured qualitative interviews were conducted. SETTING Policies were implemented in an urban district in the northeastern US. PARTICIPANTS Participants were 67 educators, including principals, assistant principals, school wellness facilitators, teachers, and staff. The majority were female (n = 49; 73.13%) and white (n = 55; 82.09%). INTERVENTIONS Two school nutrition policies: Food as a Reward and In-School Celebrations. PHENOMENON OF INTEREST This study focused on educators' responses related to barriers to implementation. ANALYSIS Transcripts were uploaded to NVivo for organization and coding. RESULTS The following themes emerged: student hunger and cultural norms. CONCLUSIONS AND IMPLICATIONS Understanding the challenges of those who are implementing school-level policies is necessary to advancing school nutrition reform effectively. Next steps for practice and research include addressing basic needs such as a sense of belonging and food insecurity, within school-family, adapting policies to meet those needs in schools, and including local educators as equal partners in developing policies to ensure that policies are acceptable and implemented as planned. By involving educators and ensuring that basic needs are met first, educators may feel more motivated to implement classroom policies.
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Affiliation(s)
| | - Marlene B Schwartz
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT
| | - Jeannette R Ickovics
- Social and Behavioral Sciences Department, Yale School of Public Health, New Haven, CT; Department of Health & Behavior Studies, Columbia University Teachers College, New York, NY
| | - Charles E Basch
- Department of Social Sciences (Public Health and Psychology), Yale-National University of Singapore College, Singapore
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Yee CW, Cunningham SD, Ickovics JR. Application of the Social Vulnerability Index for Identifying Teen Pregnancy Intervention Need in the United States. Matern Child Health J 2019; 23:1516-1524. [DOI: 10.1007/s10995-019-02792-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Thomas JL, Lewis JB, Martinez I, Cunningham SD, Siddique M, Tobin JN, Ickovics JR. Associations between intimate partner violence profiles and mental health among low-income, urban pregnant adolescents. BMC Pregnancy Childbirth 2019; 19:120. [PMID: 31023259 PMCID: PMC6485079 DOI: 10.1186/s12884-019-2256-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 03/21/2019] [Indexed: 11/12/2022] Open
Abstract
Background Intimate partner violence (IPV) during pregnancy is associated with adverse maternal and child health outcomes, including poor mental health. Previous IPV research has largely focused on women’s victimization experiences; however, evidence suggests young women may be more likely to engage in bilateral violence (report both victimization and perpetration) or perpetrate IPV (unilateral perpetration) during pregnancy than to report being victimized (unilateral victimization). This study examined prevalence of unilateral victimization, unilateral perpetration, and bilateral violence, and the association between these IPV profiles and mental health outcomes during pregnancy among young, low-income adolescents. Methods Survey data were collected from 930 adolescents (14–21 years; 95.4% Black and Latina) from fourteen Community Health Centers and hospitals in New York City during second and third trimester of pregnancy. Multivariable regression models tested the association between IPV profiles and prenatal depression, anxiety, and distress, adjusting for known predictors of psychological morbidity. Results Thirty-eight percent of adolescents experienced IPV during their third trimester of pregnancy. Of these, 13% were solely victims, 35% were solely perpetrators, and 52% were engaged in bilateral violence. All women with violent IPV profiles had significantly higher odds of having depression and anxiety compared to individuals reporting no IPV. Adolescents experiencing bilateral violence had nearly 4-fold higher odds of depression (OR = 3.52, 95% CI: 2.43, 5.09) and a nearly 5-fold increased likelihood of anxiety (OR = 4.98, 95% CI: 3.29, 7.55). Unilateral victims and unilateral perpetrators were also at risk for adverse mental health outcomes, with risk of depression and anxiety two- to three-fold higher, compared to pregnant adolescents who report no IPV. Prenatal distress was higher among adolescents who experienced bilateral violence (OR = 2.84, 95% CI: 1.94, 4.16) and those who were unilateral victims (OR = 2.21, 95% CI: 1.19, 4.12). Conclusions All violent IPV profiles were associated with adverse mental health outcomes among pregnant adolescents, with bilateral violence having the most detrimental associations. Comprehensive IPV screening for both victimization and perpetration experiences during pregnancy is warranted. Clinical and community prevention efforts should target pregnant adolescents and their partners to reduce their vulnerability to violence and its adverse consequences. Trial registration ClinicalTrials.gov, NCT00628771. Registered 29 February 2008.
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Affiliation(s)
- Jordan L Thomas
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
| | | | | | | | | | - Jonathan N Tobin
- Clinical Directors Network (CDN), New York, NY, USA.,The Rockefeller University Center for Clinical and Translational Science, New York, NY, USA
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Mehra R, Shebl FM, Cunningham SD, Magriples U, Barrette E, Herrera C, Kozhimannil KB, Ickovics JR. Area-level deprivation and preterm birth: results from a national, commercially-insured population. BMC Public Health 2019; 19:236. [PMID: 30813938 PMCID: PMC6391769 DOI: 10.1186/s12889-019-6533-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 02/12/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Area-level deprivation is associated with multiple adverse birth outcomes. Few studies have examined the mediating pathways through which area-level deprivation affects these outcomes. The objective of this study was to investigate the association between area-level deprivation and preterm birth, and examine the mediating effects of maternal medical, behavioural, and psychosocial factors. METHODS We conducted a retrospective cohort study using national, commercial health insurance claims data from 2011, obtained from the Health Care Cost Institute. Area-level deprivation was derived from principal components methods using ZIP code-level data. Multilevel structural equation modeling was used to examine mediating effects. RESULTS In total, 138,487 women with a live singleton birth residing in 14,577 ZIP codes throughout the United States were included. Overall, 5.7% of women had a preterm birth. In fully adjusted generalized estimation equation models, compared to women in the lowest quartile of area-level deprivation, odds of preterm birth increased by 9.6% among women in the second highest quartile (odds ratio (OR) 1.096; 95% confidence interval (CI) 1.021, 1.176), by 11.3% in the third highest quartile (OR 1.113; 95% CI 1.035, 1.195), and by 24.9% in the highest quartile (OR 1.249; 95% CI 1.165, 1.339). Hypertension and infection moderately mediated this association. CONCLUSIONS Even among commercially-insured women, area-level deprivation was associated with increased risk of preterm birth. Similar to individual socioeconomic status, area-level deprivation does not have a threshold effect. Implementation of policies to reduce area-level deprivation, and the screening and treatment of maternal mediators may be associated with a lower risk of preterm birth.
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Affiliation(s)
- Renee Mehra
- Yale School of Public Health, PO Box 208034, New Haven, CT, 06520-8034, USA.
| | - Fatma M Shebl
- Yale School of Public Health, PO Box 208034, New Haven, CT, 06520-8034, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Boston, MA, 02114, USA
| | | | - Urania Magriples
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, PO Box 208063, New Haven, CT, 06520, USA
| | - Eric Barrette
- Health Care Cost Institute, 1100 G Street NW, Suite 600, Washington, DC, 20005, USA
- Medtronic, 950 F Street NW, Suite 500, Washington, DC, 20004, USA
| | - Carolina Herrera
- Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Katy B Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Jeannette R Ickovics
- Yale School of Public Health, PO Box 208034, New Haven, CT, 06520-8034, USA
- Yale-NUS College, 20 College Avenue West #03-401, Singapore, 138529, Singapore
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Mehra R, Cunningham SD, Lewis JB, Thomas JL, Ickovics JR. Recommendations for the Pilot Expansion of Medicaid Coverage for Doulas in New York State. Am J Public Health 2019; 109:217-219. [PMID: 30649953 PMCID: PMC6336076 DOI: 10.2105/ajph.2018.304797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Renee Mehra
- Renee Mehra is with the Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT. Shayna D. Cunningham, Jessica B. Lewis, and Jordan L. Thomas are with the Department of Social and Behavioral Sciences, Yale School of Public Health. Jeannette R. Ickovics is with the Department of Social and Behavioral Sciences, Yale School of Public Health, and Yale-NUS College, Singapore
| | - Shayna D Cunningham
- Renee Mehra is with the Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT. Shayna D. Cunningham, Jessica B. Lewis, and Jordan L. Thomas are with the Department of Social and Behavioral Sciences, Yale School of Public Health. Jeannette R. Ickovics is with the Department of Social and Behavioral Sciences, Yale School of Public Health, and Yale-NUS College, Singapore
| | - Jessica B Lewis
- Renee Mehra is with the Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT. Shayna D. Cunningham, Jessica B. Lewis, and Jordan L. Thomas are with the Department of Social and Behavioral Sciences, Yale School of Public Health. Jeannette R. Ickovics is with the Department of Social and Behavioral Sciences, Yale School of Public Health, and Yale-NUS College, Singapore
| | - Jordan L Thomas
- Renee Mehra is with the Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT. Shayna D. Cunningham, Jessica B. Lewis, and Jordan L. Thomas are with the Department of Social and Behavioral Sciences, Yale School of Public Health. Jeannette R. Ickovics is with the Department of Social and Behavioral Sciences, Yale School of Public Health, and Yale-NUS College, Singapore
| | - Jeannette R Ickovics
- Renee Mehra is with the Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT. Shayna D. Cunningham, Jessica B. Lewis, and Jordan L. Thomas are with the Department of Social and Behavioral Sciences, Yale School of Public Health. Jeannette R. Ickovics is with the Department of Social and Behavioral Sciences, Yale School of Public Health, and Yale-NUS College, Singapore
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Ickovics JR, Duffany KO, Shebl FM, Peters SM, Read MA, Gilstad-Hayden KR, Schwartz MB. Implementing School-Based Policies to Prevent Obesity: Cluster Randomized Trial. Am J Prev Med 2019; 56:e1-e11. [PMID: 30573151 PMCID: PMC7050629 DOI: 10.1016/j.amepre.2018.08.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Healthier school environments can benefit students, and school wellness policies may result in meaningful enhancements. Schools participating in federal child nutrition programs must implement wellness policies as mandated by law. The primary study objective is to assess effectiveness of implementing school-based nutrition and physical activity policies on student BMI trajectories. STUDY DESIGN Cluster randomized trial using 2 × 2 factorial design. SETTING/PARTICIPANTS Twelve randomly selected schools in an urban district. Students were followed for 3 years through middle school, fifth to eighth grades (2011-2015, n=595 students, 92.3% participation, 85.2% retention). INTERVENTION Specific to randomized condition, support was provided for implementation of nutrition policies (e.g., alternatives to food-based rewards/celebrations) and physical activity policies (e.g., opportunities for physical activity during/after school). MAIN OUTCOME MEASURES Sex-/age-adjusted BMI percentile and BMI z-score; behavioral indicators. Data collected via standardized protocols. RESULTS Analyses followed intention-to-treat principles, with planned secondary analyses (conducted 2016-2018). Students at schools randomized to receive support for nutrition policy implementation had healthier BMI trajectories over time (F=3.20, p=0.02), with a greater magnitude over time and cumulatively significant effects 3 years post-intervention (β=-2.40, p=0.04). Overall, students at schools randomized to receive the nutrition intervention had an increase in BMI percentile of <1%, compared with students in other conditions, whereas BMI percentile increased 3%-4%. There was no difference in student BMI between those in schools with and without physical activity policy implementation. Examining behavioral correlates in eighth grade, students at schools randomized to the nutrition condition consumed fewer unhealthy foods and sugar-sweetened beverages, and ate less frequently at fast-food restaurants (all p<0.03). CONCLUSIONS This cluster randomized trial demonstrated effectiveness of providing support for implementation of school-based nutrition policies, but not physical activity policies, to limit BMI increases among middle school students. Results can guide future school interventions. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02043626.
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Affiliation(s)
- Jeannette R Ickovics
- Yale School of Public Health, New Haven, Connecticut; Yale-NUS College, Singapore.
| | | | - Fatma M Shebl
- Yale School of Public Health, New Haven, Connecticut
| | - Sue M Peters
- New Haven Public Schools, New Haven, Connecticut
| | - Margaret A Read
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut
| | | | - Marlene B Schwartz
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut
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Cunningham SD, Lewis JB, Shebl FM, Boyd LM, Robinson MA, Grilo SA, Lewis SM, Pruett AL, Ickovics JR. Group Prenatal Care Reduces Risk of Preterm Birth and Low Birth Weight: A Matched Cohort Study. J Womens Health (Larchmt) 2019; 28:17-22. [DOI: 10.1089/jwh.2017.6817] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | | | | | - Lisa M. Boyd
- Yale School of Public Health, New Haven, Connecticut
| | | | | | - Susan M. Lewis
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anne L. Pruett
- Vanderbilt University Medical Center, Nashville, Tennessee
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Cunningham SD, Mokshagundam S, Chai H, Lewis JB, Levine J, Tobin JN, Ickovics JR. Postpartum Depressive Symptoms: Gestational Weight Gain as a Risk Factor for Adolescents Who Are Overweight or Obese. J Midwifery Womens Health 2018; 63:178-184. [PMID: 29569357 PMCID: PMC5878115 DOI: 10.1111/jmwh.12686] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 07/13/2017] [Accepted: 07/18/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Obesity is a risk factor for adverse physical health outcomes during pregnancy. Much less is known about the association between obesity and maternal mental health. Evidence suggests that prenatal depression is associated with excessive weight gain during pregnancy and that this relationship may vary according to pregravid body mass index (BMI). Young women may be particularly vulnerable to postpartum depression. The objective of this study is to examine the association between prepregnancy BMI, gestational weight gain, and postpartum depressive symptoms among adolescents. METHODS Participants were 505 pregnant adolescents aged 14 to 21 years followed during pregnancy and 6 months postpartum. Data were collected via interviews and medical record abstraction. Multilevel linear mixed models were used to test the association between excessive gestational weight gain as defined by National Academy of Medicine Guidelines and postpartum depressive symptoms measured via the validated Center for Epidemiologic Studies Depression (CES-D) scale. Analyses controlled for sociodemographic factors (maternal age, race, ethnicity, relationship status), health behaviors (nutrition, physical activity), prenatal depressive symptoms, and postpartum weight retention. RESULTS Prepregnancy BMI was classified as follows: 11% underweight, 53% healthy weight, 19% overweight, and 18% obese. One-half (50%) of participants exceeded recommended guidelines for gestational weight gain. Adolescents with excessive gestational weight gain who entered pregnancy overweight or obese had significantly higher postpartum depressive symptoms (β, 2.41; SE, 1.06 vs β, 2.58; SE, 1.08, respectively; both P < .05) compared with those with healthy prepregnancy BMI and appropriate gestational weight gain. Adolescents who gained gestational weight within clinically recommended guidelines were not at risk for increased depressive symptoms. DISCUSSION Adolescents who enter pregnancy overweight or obese and experience excessive weight gain may be at increased risk for postpartum depressive symptoms. Health care providers should offer preventive interventions during pregnancy and the interconceptional period to support healthy weight gain and safeguard women's mental health.
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Cunningham SD, Grilo S, Lewis JB, Novick G, Rising SS, Tobin JN, Ickovics JR. Group Prenatal Care Attendance: Determinants and Relationship with Care Satisfaction. Matern Child Health J 2018; 21:770-776. [PMID: 27485493 DOI: 10.1007/s10995-016-2161-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives Group prenatal care results in improved birth outcomes in randomized controlled trials, and better attendance at group prenatal care visits is associated with stronger clinical effects. This paper's objectives are to identify determinants of group prenatal care attendance, and to examine the association between proportion of prenatal care received in a group context and satisfaction with care. Methods We conducted a secondary data analysis of pregnant adolescents (n = 547) receiving group prenatal care in New York City (2008-2012). Multivariable linear regression models were used to test associations between patient characteristics and percent of group care sessions attended, and between the proportion of prenatal care visits that occurred in a group context and care satisfaction. Results Sixty-seven groups were established. Group sizes ranged from 3 to 15 women (mean = 8.16, SD = 3.08); 87 % of groups enrolled at least five women. Women enrolled in group prenatal care supplemented group sessions with individual care visits. However, the percent of women who attended each group session was relatively consistent, ranging from 56 to 63 %. Being born outside of the United States was significantly associated with higher group session attendance rates [B(SE) = 11.46 (3.46), p = 0.001], and women who received a higher proportion of care in groups reported higher levels of care satisfaction [B(SE) = 0.11 (0.02), p < 0.001]. Conclusions Future research should explore alternative implementation structures to improve pregnant women's ability to receive as much prenatal care as possible in a group setting, as well as value-based reimbursement models and other incentives to encourage more widespread adoption of group prenatal care.
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Affiliation(s)
- Shayna D Cunningham
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA.
| | - Stephanie Grilo
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA
| | - Jessica B Lewis
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA
| | - Gina Novick
- Yale University School of Nursing, New Haven, CT, USA
| | | | - Jonathan N Tobin
- Clinical Directors Network (CDN), New York, NY, USA.,Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA
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Earnshaw VA, Rosenthal L, Gilstad-Hayden K, Carroll-Scott A, Kershaw TS, Santilli A, Ickovics JR. Intersectional experiences of discrimination in a low-resource urban community: An exploratory latent class analysis. J Community Appl Soc Psychol 2018. [DOI: 10.1002/casp.2342] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Valerie A. Earnshaw
- Community Alliance for Research and Engagement; Yale School of Public Health; New Haven CT USA
- Department of Human Development and Family Sciences; University of Delaware; Newark DE USA
| | - Lisa Rosenthal
- Community Alliance for Research and Engagement; Yale School of Public Health; New Haven CT USA
- Department of Psychology; Pace University; New York City NY USA
| | - Kathryn Gilstad-Hayden
- Community Alliance for Research and Engagement; Yale School of Public Health; New Haven CT USA
| | - Amy Carroll-Scott
- Community Alliance for Research and Engagement; Yale School of Public Health; New Haven CT USA
- Department of Community Health and Prevention; Drexel School of Public Health; Philadelphia PA USA
| | - Trace S. Kershaw
- Department of Social and Behavioral Sciences; Yale School of Public Health; New Haven CT USA
| | - Alycia Santilli
- Community Alliance for Research and Engagement; Yale School of Public Health; New Haven CT USA
- School of Health and Human Services; Southern Connecticut State University; New Haven CT USA
| | - Jeannette R. Ickovics
- Community Alliance for Research and Engagement; Yale School of Public Health; New Haven CT USA
- Department of Social and Behavioral Sciences; Yale School of Public Health; New Haven CT USA
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Mehra R, Boyd LM, Ickovics JR. Racial residential segregation and adverse birth outcomes: A systematic review and meta-analysis. Soc Sci Med 2017; 191:237-250. [PMID: 28942206 DOI: 10.1016/j.socscimed.2017.09.018] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 08/25/2017] [Accepted: 09/08/2017] [Indexed: 11/30/2022]
Abstract
RATIONALE Persistent racial disparities in adverse birth outcomes are not fully explained by individual-level risk factors. Racial residential segregation-degree to which two or more groups live apart from one another-may contribute to the etiology of these birth outcome disparities. Our aim was to assess associations between segregation and adverse birth outcomes by race. This review focused on formal measures of segregation, using Massey and Denton's framework (1998) that identifies five distinct operationalizations of segregation, in addition to proxy measures of segregation such as racial composition, in order to gain a deeper understanding of the operationalizations of segregation most salient for birth outcomes. METHOD Review and meta-analyses were conducted using PubMed, PsycINFO and Web of Science and included articles from inception through April 30, 2017. RESULTS Forty-two articles examined associations between segregation and adverse birth outcomes among Black and White mothers separately. Meta-analyses showed that among Black mothers, exposure was associated with increased risk of preterm birth (OR = 1.17, 95% CI = 1.10, 1.26), and low birth weight (OR = 1.13, 95% CI=1.06, 1.21), and Black racial composition was associated with increased risk of preterm birth (OR = 1.20, 95% CI=1.05, 1.37), among those living in most- compared to least-segregated neighborhoods. Few studies were conducted among White mothers and only exposure was associated with increased risk of preterm birth and low birth weight. Qualitative analyses indicated that among Black mothers, exposure and hypersegregation were associated with multiple adverse birth outcomes; findings were mixed for evenness and clustering. CONCLUSIONS AND FUTURE DIRECTIONS Associations between segregation and adverse birth outcomes differ by race. Methodological heterogeneity between studies may obscure true associations. Research can be advanced through use of multilevel frameworks and by examining mechanistic pathways between segregation and adverse birth outcomes. Elucidation of pathways may provide opportunities to intervene to reduce seemingly intractable racial disparities in adverse birth outcomes.
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Cunningham SD, Herrera C, Udo IE, Kozhimannil KB, Barrette E, Magriples U, Ickovics JR. Maternal Medical Complexity: Impact on Prenatal Health Care Spending among Women at Low Risk for Cesarean Section. Womens Health Issues 2017; 27:551-558. [DOI: 10.1016/j.whi.2017.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
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Cunningham SD, Magriples U, Thomas JL, Kozhimannil KB, Herrera C, Barrette E, Shebl FM, Ickovics JR. Association Between Maternal Comorbidities and Emergency Department Use Among a National Sample of Commercially Insured Pregnant Women. Acad Emerg Med 2017; 24:940-947. [PMID: 28471532 DOI: 10.1111/acem.13215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 04/18/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Evidence suggests that, despite routine engagement with the health system, pregnant women commonly seek emergency care. The objectives of this study were to examine the association between maternal comorbidities and emergency department (ED) use among a national sample of commercially insured pregnant women. METHODS We conducted a retrospective cohort study using multipayer medical claims data maintained by the Health Care Cost Institute for women ages 18 to 44 years with a live singleton birth in 2011 (N = 157,786). The association between common maternal comorbidities (e.g., hypertension, gestational diabetes) and ED use during pregnancy was examined using multilevel models, while controlling for age, region, and residential zip code. RESULTS Twenty percent (n = 31,413) of pregnant women had one or more ED visit (mean ± SD = 1.52 ± 1.15). Among those who used the ED, 29% had two or more visits, and 11% had three or more visits. Emergency care seekers were significantly more likely to have one or more comorbid condition compared to those with no emergency care: 30% versus 21%, respectively (p < 0.001). Pregnant women with asthma had 2.5 times the likelihood of having had any ED visit (adjusted odds ratio [AOR] = 2.46, 95% confidence interval [CI] = 2.32-2.62). There was a significant increase in the probability (approximately 50%) of ED use among pregnant women with diabetes (AOR = 1.47, 95% CI = 1.33-1.63) or hypertension (AOR = 1.49, 95% CI = 1.43-1.55) or who were obese (AOR = 1.55, 95% CI = 1.47-1.64). Increased odds associated with gestational diabetes were more modest, resulting in a 13% increased odds of using the ED (AOR = 1.13, 95% CI = 1.07-1.18). Less than 0.6% of pregnant women (n = 177) received emergency care that resulted in a hospital admission. The admission rate was 0.4% (189 admissions/47,608 ED visits). CONCLUSIONS Among pregnant women, comorbidity burden was associated with more ED utilization. Efforts to reduce acute unscheduled care and improve care coordination during pregnancy should target interventions to patient comorbidity.
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Affiliation(s)
| | | | | | | | - Carolina Herrera
- Department of Health Law; Policy and Management; Boston University School of Public Health; Boston MA
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Thomas JL, Ickovics JR. Book Review: Women’s health communication: High-risk pregnancy and premature birth narratives. Psychology of Women Quarterly 2017. [DOI: 10.1177/0361684316666793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cunningham SD, Lewis JB, Thomas JL, Grilo SA, Ickovics JR. Expect With Me: development and evaluation design for an innovative model of group prenatal care to improve perinatal outcomes. BMC Pregnancy Childbirth 2017; 17:147. [PMID: 28521785 PMCID: PMC5437650 DOI: 10.1186/s12884-017-1327-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/10/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite biomedical advances and intervention efforts, rates of preterm birth and other adverse outcomes in the United States have remained relatively intransigent. Evidence suggests that group prenatal care can reduce these risks, with implications for maternal and child health as well as substantial cost savings. However, widespread dissemination presents challenges, in part because training and health systems have not been designed to deliver care in a group setting. This manuscript describes the design and evaluation of Expect With Me, an innovative model of group prenatal care with a strong integrated information technology (IT) platform designed to be scalable nationally. METHODS/DESIGN Expect With Me follows clinical guidelines from the American Congress of Obstetricians and Gynecologists. Expect With Me incorporates the best evidence-based features of existing models of group care with a novel integrated IT platform designed to improve patient engagement and support, enhance health behaviors and decision making, connect providers and patients, and improve health service delivery. A multisite prospective longitudinal cohort study is being conducted to examine the impact of Expect With Me on perinatal and postpartum outcomes, and to identify and address barriers to national scalability. Process and outcome evaluation will include quantitative and qualitative data collection at patient, provider, and organizational levels. Mixed-method data collection includes patient surveys, medical record reviews, patient focus groups; provider surveys, session evaluations, provider focus groups and in-depth interviews; an online tracking system; and clinical site visits. A two-to-one matched cohort of women receiving individual care from each site will provide a comparison group (n = 1,000 Expect With Me patients; n = 2,000 individual care patients) for outcome and cost analyses. DISCUSSION By bundling prevention and care services into a high-touch, high-tech group prenatal care model, Expect With Me has the potential to result in fundamental changes to the health care system to meet the "triple aim:" better healthcare quality, improved outcomes, and lower costs. Findings from this study will be used to optimize the dissemination and effectiveness of this model. TRIAL REGISTRATION ClinicalTrials.gov, NCT02169024 . Retrospectively registered on June 18, 2014.
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Affiliation(s)
- Shayna D Cunningham
- Yale School of Public Health, 135 College Street, Room 226, New Haven, CT, 06510, USA.
| | - Jessica B Lewis
- Yale School of Public Health, 135 College Street, Room 226, New Haven, CT, 06510, USA
| | - Jordan L Thomas
- Yale School of Public Health, 135 College Street, Room 226, New Haven, CT, 06510, USA
| | - Stephanie A Grilo
- Yale School of Public Health, 135 College Street, Room 226, New Haven, CT, 06510, USA
| | - Jeannette R Ickovics
- Yale School of Public Health, 135 College Street, Room 226, New Haven, CT, 06510, USA
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Felder JN, Epel E, Lewis JB, Cunningham SD, Tobin JN, Rising SS, Thomas M, Ickovics JR. Depressive symptoms and gestational length among pregnant adolescents: Cluster randomized control trial of CenteringPregnancy® plus group prenatal care. J Consult Clin Psychol 2017; 85:574-584. [PMID: 28287802 DOI: 10.1037/ccp0000191] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Depressive symptoms are associated with preterm birth among adults. Pregnant adolescents have high rates of depressive symptoms and low rates of treatment; however, few interventions have targeted this vulnerable group. Objectives are to: (a) examine impact of CenteringPregnancy® Plus group prenatal care on perinatal depressive symptoms compared to individual prenatal care; and (b) determine effects of depressive symptoms on gestational age and preterm birth among pregnant adolescents. METHOD This cluster-randomized controlled trial was conducted in 14 community health centers and hospitals in New York City. Clinical sites were randomized to receive standard individual prenatal care (n = 7) or CenteringPregnancy® Plus group prenatal care (n = 7). Pregnant adolescents (ages 14-21, N = 1,135) completed the Center for Epidemiologic Studies Depression Scale during pregnancy (second and third trimesters) and postpartum (6 and 12 months). Gestational age was obtained from medical records, based on ultrasound dating. Intention to treat analyses were used to examine objectives. RESULTS Adolescents at clinical sites randomized to CenteringPregnancy® Plus experienced greater reductions in perinatal depressive symptoms compared to those at clinical sites randomized to individual care (p = .003). Increased depressive symptoms from second to third pregnancy trimester were associated with shorter gestational age at delivery and preterm birth (<37 weeks gestation). Third trimester depressive symptoms were also associated with shorter gestational age and preterm birth. All p < .05. CONCLUSIONS Pregnant adolescents should be screened for depressive symptoms prior to third trimester. Group prenatal care may be an effective nonpharmacological option for reducing depressive symptoms among perinatal adolescents. (PsycINFO Database Record
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Affiliation(s)
| | - Elissa Epel
- Department of Psychiatry, University of California, San Francisco
| | | | | | | | | | - Melanie Thomas
- Department of Psychiatry, University of California, San Francisco
| | - Jeannette R Ickovics
- Departments of Chronic Disease Epidemiology and Psychology, Yale School of Public Health
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Martinez I, Kershaw TS, Lewis JB, Stasko EC, Tobin JN, Ickovics JR. Between Synergy and Travesty: A Sexual Risk Syndemic Among Pregnant Latina Immigrant and Non-immigrant Adolescents. AIDS Behav 2017; 21:858-869. [PMID: 27338951 DOI: 10.1007/s10461-016-1461-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Substance use, intimate partner violence, and depression contribute to sexual risk individually, yet have not been evaluated as a syndemic for adolescents. Using data from 772 pregnant Latina adolescents, we evaluated these factors as a syndemic and tested the moderating role of immigration. Bivariate analyses showed syndemic score (OR = 1.40, p = 0.02) and severity (OR = 1.68, p = 0.006) were predictors for multiple sex partners, and syndemic score predicting STIs (OR = 1.15, p = 0.05). Syndemic severity remained significant in multivariate analyses for multiple sex partners (OR = 1.53, p = 0.04). Moderation analyses showed higher syndemic severity was associated with more condom use among immigrants (OR = 1.75, p = 0.04) and less condom use (OR = 0.07, p = 0.011) among those with separated orientation. Higher syndemic severity also predicted greater odds for multiple partners (OR = 2.40, p = 0.01) among immigrants. This evidence suggests a sexual risk syndemic exists among Latina adolescents. Research should continue exploring this phenomenon, particularly exploring the role immigration plays for sexual health.
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Affiliation(s)
- Isabel Martinez
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, 135 College St, Suite 200, New Haven, CT, 06510, USA.
| | - Trace S Kershaw
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, 135 College St, Suite 200, New Haven, CT, 06510, USA
| | - Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, 135 College St, Suite 200, New Haven, CT, 06510, USA
| | - Emily C Stasko
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | | | - Jeannette R Ickovics
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, 135 College St, Suite 200, New Haven, CT, 06510, USA
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Udo IE, Lewis JB, Tobin JN, Ickovics JR. Udo et al. Respond. Am J Public Health 2017; 107:e1-e2. [PMID: 28177823 DOI: 10.2105/ajph.2016.303587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ifeyinwa E Udo
- Ifeyinwa E. Udo, Jessica B. Lewis and Jeannette R. Ickovics are with the Yale School of Public Health and the Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT. Jonathan N. Tobin is with the Clinical Directors Network, New York, NY
| | - Jessica B Lewis
- Ifeyinwa E. Udo, Jessica B. Lewis and Jeannette R. Ickovics are with the Yale School of Public Health and the Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT. Jonathan N. Tobin is with the Clinical Directors Network, New York, NY
| | - Jonathan N Tobin
- Ifeyinwa E. Udo, Jessica B. Lewis and Jeannette R. Ickovics are with the Yale School of Public Health and the Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT. Jonathan N. Tobin is with the Clinical Directors Network, New York, NY
| | - Jeannette R Ickovics
- Ifeyinwa E. Udo, Jessica B. Lewis and Jeannette R. Ickovics are with the Yale School of Public Health and the Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT. Jonathan N. Tobin is with the Clinical Directors Network, New York, NY
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Norris AH, Loewenberg Weisband Y, Wiles M, Ickovics JR. Prevalence of sexually transmitted infections among Tanzanian migrants: a cross-sectional study. Int J STD AIDS 2017; 28:991-1000. [PMID: 28134004 DOI: 10.1177/0956462416685486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For the many millions of migrants, mobility creates vulnerabilities and elevates risk for sexually transmitted infections (STIs). We document, among Tanzanian agricultural plantation residents, migrant characteristics and test associations between migrant status and prevalent STI (HSV-2, syphilis, and HIV). From 623 plantation resident participants, we limit this analysis to participants about whom we know migration status (migrants n = 242, non-migrants n = 291). We collected behavioral data via audio-computer assisted self-interview survey, and clinical data via STI testing. We used multivariate Poisson regression models, stratified by gender and controlling for behavioral risk factors, to measure associations between migrant status and STI. In men, HIV prevalence was 9% for migrants, and 6% for non-migrants. HSV-2 prevalence was 57% for migrants, and 32% for non-migrants. Syphilis prevalence was 12% for migrants, and 3% for non-migrants. Among women, there were few differences in STI prevalence by migrant status: prevalence of HIV was 6% vs. 5% (migrants vs. non-migrants); HSV-2 prevalence was 68% vs. 65%; and syphilis prevalence was 11% vs. 8%. Being a male migrant was significantly associated with increased prevalence of any STI after controlling for sociodemographic and behavioral characteristics (APR = 1.53, 95% CI 1.23-5.25). Migrant women did not have increased prevalence of STI as compared to non-migrant women (APR = 1.03, 95% CI 0.85-1.24). Amongst Tanzanian agricultural workers, male migrants experienced elevated risk for prevalent STI as compared to male non-migrants. We suggest structural interventions to reduce risks associated with migration, especially in male migrants, including workplace-based STI prevention programs, and connecting migrants to resources and support within new communities. The key messages are: migrant men experience significantly elevated risk for prevalent STI, above and beyond sociodemographic and behavioral risk factors, as compared to their non-migrant peers; women in this Tanzanian agricultural plantation community overall had higher prevalence of some STIs than men, migrant women had similar STI risk as non-migrant women; and migration for work, an economic strategy for millions, also creates vulnerabilities, so workplace-based STI prevention programs and connecting migrants to community resources are essential.
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Affiliation(s)
- Alison H Norris
- 1 Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA
| | | | - Melissa Wiles
- 1 Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA
| | - Jeannette R Ickovics
- 2 Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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Milan S, Kershaw TS, Lewis J, Westdahl C, Rising SS, Patrikios M, Ickovics JR. Caregiving History and Prenatal Depressive Symptoms in Low-Income Adolescent and Young Adult Women: Moderating and Mediating Effects. Psychology of Women Quarterly 2016. [DOI: 10.1111/j.1471-6402.2007.00367.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Prenatal depressive symptoms have been linked to negative outcomes for mothers and children. Using attachment theory as a framework, this study examined developmental differences in the interpersonal context of prenatal depressive symptoms among adolescents (age 14 to 19 years; n = 352) and young adults (age 20 to 24 years; n = 348). Participants included low-income, single, predominantly African American and Latina women. Moderating and mediating factors were found in the relation between caregiving history (perceived unavailability and inconsistency of maternal and paternal figures during childhood) and depressive symptoms. For pregnant adolescents, maternal unavailability predicted depressive symptoms whereas maternal inconsistency did not. In contrast, for pregnant young women, only maternal inconsistency predicted depressive symptoms; and this association was mediated by perceptions of prenatal support. For both groups, paternal caregiving history had a small yet independent association with depressive symptoms. Results highlight the need to consider developmental differences in the interpersonal context of prenatal depressive symptoms in delivering mental health interventions to young women of color.
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Affiliation(s)
- Stephanie Milan
- Stephanie Milan, Department of Psychology, University of Connecticut
| | - Trace S. Kershaw
- Trace S. Kershaw, Jessica Lewis, Mary Patrikios, and Jeannette R. Ickovics, Yale School of Public Health, Yale University
| | - Jessica Lewis
- Trace S. Kershaw, Jessica Lewis, Mary Patrikios, and Jeannette R. Ickovics, Yale School of Public Health, Yale University
| | - Claire Westdahl
- Claire Westdahl, Department of Gynecology and Obstetrics, Emory University
| | | | - Mary Patrikios
- Trace S. Kershaw, Jessica Lewis, Mary Patrikios, and Jeannette R. Ickovics, Yale School of Public Health, Yale University
| | - Jeannette R. Ickovics
- Trace S. Kershaw, Jessica Lewis, Mary Patrikios, and Jeannette R. Ickovics, Yale School of Public Health, Yale University
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Abstract
A path analytic model was used to examine the impact of three domains of life satisfaction and three employment-related variables on general well-being in a sample of 1,145 Army wives. The life domains included marital, financial, and role satisfaction. The employment-related variables included: (a) time spent employed (none, part, or full); (b) role fit; and (c) satisfaction with overall career development prospects. The employment-related variables were hypothesized to impact on general well-being both directly and indirectly through their relationship to role satisfaction. Time spent employed and role fit were found to be significantly related to role satisfaction, which in turn, was significantly related to general well-being. One variable—satisfaction with overall career development prospects—had a significant direct impact on general well-being.
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Earnshaw VA, Rosenthal L, Carroll-Scott A, Santilli A, Gilstad-Hayden K, Ickovics JR. Everyday discrimination and physical health: Exploring mental health processes. J Health Psychol 2016; 21:2218-28. [PMID: 25736390 PMCID: PMC4826316 DOI: 10.1177/1359105315572456] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Goals of this study were to examine the mental health processes whereby everyday discrimination is associated with physical health outcomes. Data are drawn from a community health survey conducted with 1299 US adults in a low-resource urban area. Frequency of everyday discrimination was associated with overall self-rated health, use of the emergency department, and one or more chronic diseases via stress and depressive symptoms operating in serial mediation. Associations were consistent across members of different racial/ethnic groups and were observed even after controlling for indicators of stressors associated with structural discrimination, including perceived neighborhood unsafety, food insecurity, and financial stress.
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Affiliation(s)
- Valerie A Earnshaw
- Yale School of Public Health, USA Harvard Medical School, USA Boston Children's Hospital, USA
| | | | - Amy Carroll-Scott
- Yale School of Public Health, USA Drexel School of Public Health, USA
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Hua SV, Ickovics JR. Vending Machines: A Narrative Review of Factors Influencing Items Purchased. J Acad Nutr Diet 2016; 116:1578-1588. [PMID: 27546077 DOI: 10.1016/j.jand.2016.06.378] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 06/24/2016] [Indexed: 11/18/2022]
Abstract
Vending machines are a ubiquitous part of our food environments. Unfortunately, items found in vending machines tend to be processed foods and beverages high in salt, sugar, and/or fat. The purpose of this review is to describe intervention and case studies designed to promote healthier vending purchases by consumers and identify which manipulations are most effective. All studies analyzed were intervention or case studies that manipulated vending machines and analyzed sales or revenue data. This literature review is limited to studies conducted in the United States within the past 2 decades (ie, 1994 to 2015), regardless of study population or setting. Ten articles met these criteria based on a search conducted using PubMed. Study manipulations included price changes, increase in healthier items, changes to the advertisements wrapped around vending machines, and promotional signs such as a stoplight system to indicate healthfulness of items and to remind consumers to make healthy choices. Overall, seven studies had manipulations that resulted in statistically significant positive changes in purchasing behavior. Two studies used manipulations that did not influence consumer behavior, and one study was equivocal. Although there was no intervention pattern that ensured changes in purchasing, price reductions were most effective overall. Revenue from vending sales did not change substantially regardless of intervention, which will be important to foster initiation and sustainability of healthier vending. Future research should identify price changes that would balance healthier choices and revenue as well as better marketing to promote purchase of healthier items.
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Milan S, Lewis J, Ethier K, Kershaw T, Ickovics JR. Relationship Violence among Adolescent Mothers: Frequency, Dyadic Nature, and Implications for Relationship Dissolution and Mental Health. Psychology of Women Quarterly 2016. [DOI: 10.1111/j.1471-6402.2005.00224.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article examines whether the frequency, dyadic nature, and potential implications of relationship violence differ in parenting ( n = 163) and nulliparous (i.e., never given birth; n = 165) adolescent females from low-income, urban communities. We found the frequency and dyadic nature of violence did not differ between parental status groups. Over half of the adolescents in both groups reported relationship violence in the past year, with female-enacted violence more common than male-enacted violence. However, significant group differences emerged in the relationship between violence and subsequent relationship dissolution and mental health. Higher levels of female-enacted violence predicted relationship dissolution among nulliparous adolescents but predicted increases in depression in parenting adolescents. Findings highlight the need for violence prevention programs tailored specifically to the developmental and contextual needs of adolescent mothers.
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Affiliation(s)
- Stephanie Milan
- Department of Epidemiology and Public Health and Center for Interdisciplinary Research on AIDS, Yale School of Medicine
| | - Jessica Lewis
- Department of Epidemiology and Public Health and Center for Interdisciplinary Research on AIDS, Yale School of Medicine
| | - Kathleen Ethier
- Division of STD Prevention, Behavioral Interventions and Research Branch, Centers for Disease Control and Prevention
| | - Trace Kershaw
- Department of Epidemiology and Public Health and Center for Interdisciplinary Research on AIDS, Yale School of Medicine
| | - Jeannette R. Ickovics
- Department of Epidemiology and Public Health and Center for Interdisciplinary Research on AIDS, Yale School of Medicine
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Abstract
OBJECTIVES To provide lifetime estimates of intimate partner victimization among pregnant adolescents and examine associations between victimization and health risk behaviors identified by the Centers for Disease Control and Prevention as leading causes of adolescent morbidity and mortality. METHODS Participants (n = 1233) were predominantly Latina (58%) and non-Latina Black (34%) pregnant adolescents (aged 14-21 years) enrolled in a randomized controlled trial of group prenatal care in 14 clinical sites in New York City (2008-2012). They completed surveys to assess interpersonal victimization and risk behaviors: substance use, risky sexual behaviors, injuries or violence, unhealthy dietary behavior, and inadequate physical activity. RESULTS Fifty-two percent reported intimate partner victimization, which was associated with nearly all health risk behaviors. CONCLUSIONS Pregnant adolescents who experienced intimate partner victimization were significantly more likely to engage in health risk behaviors, which can have adverse health consequences. Expanded prevention programs tailored to specific needs of pregnant adolescents are needed. Health care providers and others who work with pregnant adolescents should consistently screen for and intervene in intimate partner victimization.
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Affiliation(s)
- Ifeyinwa E Udo
- Ifeyinwa E. Udo, Jessica B. Lewis, and Jeannette R. Ickovics are with Yale School of Public Health and Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT. Jonathan N. Tobin is with the Clinical Directors Network, New York, NY
| | - Jessica B Lewis Lmft
- Ifeyinwa E. Udo, Jessica B. Lewis, and Jeannette R. Ickovics are with Yale School of Public Health and Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT. Jonathan N. Tobin is with the Clinical Directors Network, New York, NY
| | - Jonathan N Tobin
- Ifeyinwa E. Udo, Jessica B. Lewis, and Jeannette R. Ickovics are with Yale School of Public Health and Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT. Jonathan N. Tobin is with the Clinical Directors Network, New York, NY
| | - Jeannette R Ickovics
- Ifeyinwa E. Udo, Jessica B. Lewis, and Jeannette R. Ickovics are with Yale School of Public Health and Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT. Jonathan N. Tobin is with the Clinical Directors Network, New York, NY
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Santilli A, Carroll-Scott A, Ickovics JR. Applying Community Organizing Principles to Assess Health Needs in New Haven, Connecticut. Am J Public Health 2016; 106:841-7. [PMID: 26985599 PMCID: PMC4985100 DOI: 10.2105/ajph.2016.303050] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2015] [Indexed: 11/04/2022]
Abstract
The Affordable Care Act added requirements for nonprofit hospitals to conduct community health needs assessments. Guidelines are minimal; however, they require input and representation from the broader community. This call echoes 2 decades of literature on the importance of including community members in all aspects of research design, a tenet of community organizing. We describe a community-engaged research approach to a community health needs assessment in New Haven, Connecticut. We demonstrate that a robust community organizing approach provided unique research benefits: access to residents for data collection, reliable data, leverage for community-driven interventions, and modest improvements in behavioral risk. We make recommendations for future community-engaged efforts and workforce development, which are important for responding to increasing calls for community health needs assessments.
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Affiliation(s)
- Alycia Santilli
- At the time of the study, Alycia Santilli, Jeannette R. Ickovics, and Amy Carroll-Scott were with the Community Alliance for Research and Engagement, Yale School of Public Health, New Haven, CT
| | - Amy Carroll-Scott
- At the time of the study, Alycia Santilli, Jeannette R. Ickovics, and Amy Carroll-Scott were with the Community Alliance for Research and Engagement, Yale School of Public Health, New Haven, CT
| | - Jeannette R Ickovics
- At the time of the study, Alycia Santilli, Jeannette R. Ickovics, and Amy Carroll-Scott were with the Community Alliance for Research and Engagement, Yale School of Public Health, New Haven, CT
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Reid AE, Rosenthal L, Earnshaw VA, Lewis TT, Lewis JB, Stasko EC, Tobin JN, Ickovics JR. Discrimination and excessive weight gain during pregnancy among Black and Latina young women. Soc Sci Med 2016; 156:134-41. [PMID: 27038321 DOI: 10.1016/j.socscimed.2016.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 02/26/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
Abstract
RATIONALE Excessive weight gain during pregnancy is a major determinant of later life obesity among both Black and Latina women and their offspring. However, psychosocial determinants of this risk, including everyday discrimination, and potential moderators of such effects remain unexplored. OBJECTIVE We examined the influence of discrimination, a culturally relevant stressor, on odds of gaining weight beyond Institute of Medicine recommendations during pregnancy. Whether the effect was moderated by race/ethnicity, age, or depressive symptoms was also examined. METHOD Participants were 413 Black and Latina pregnant young women, ages 14-21 years. Experience with discrimination and all moderators were assessed in the second trimester. Last weight recorded in the third trimester was abstracted from medical records and used to determine excessive weight gain. RESULTS Ever experiencing discrimination was associated with a 71% increase in the odds of excessive weight gain. The effect of discrimination was primarily present among women who attributed this treatment to membership in a historically oppressed group (e.g., ethnic minority, female) or to membership in other stigmatized groups (e.g., overweight). The effect of ever experiencing discrimination was not moderated by race/ethnicity or age but was moderated by depressive symptoms. Supporting the perspective of the environmental affordances model, discrimination strongly predicted excessive weight gain when women were low in depressive symptoms but had no effect when women were high in depressive symptoms. The moderating role of depressive symptoms was equivalent for Black and Latina women. CONCLUSION Results highlight the role of discrimination in perpetuating weight-related health disparities and suggest opportunities for improving health outcomes among young pregnant women.
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Affiliation(s)
- Allecia E Reid
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States; Colby College, Psychology Department, United States.
| | - Lisa Rosenthal
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States; Pace University, Psychology Department, United States
| | - Valerie A Earnshaw
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States; Harvard Medical School, Department of Pediatrics, United States; Boston Children's Hospital, Department of Medicine, United States
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, United States
| | - Jessica B Lewis
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States
| | - Emily C Stasko
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States
| | | | - Jeannette R Ickovics
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States
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Cunningham SD, Smith A, Kershaw T, Lewis JB, Cassells A, Tobin JN, Ickovics JR. Prenatal Depressive Symptoms and Postpartum Sexual Risk Among Young Urban Women of Color. J Pediatr Adolesc Gynecol 2016; 29:11-7. [PMID: 26165914 PMCID: PMC5536107 DOI: 10.1016/j.jpag.2015.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 04/15/2015] [Accepted: 04/17/2015] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To determine whether prenatal depressive symptoms are associated with postpartum sexual risk among young, urban women of color. DESIGN Participants completed surveys during their second trimester of pregnancy and at 1 year postpartum. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression Scale, excluding somatic items because women were pregnant. Logistic and linear regression models adjusted for known predictors of sexual risk and baseline outcome variables were used to assess whether prenatal depressive symptoms make an independent contribution to sexual risk over time. SETTING Fourteen community health centers and hospitals in New York City. PARTICIPANTS The participants included 757 predominantly black and Latina (91%, n = 692) pregnant teens and young women aged 14-21 years. INTERVENTIONS AND MAIN OUTCOME MEASURES The main outcome measures were number of sex partners, condom use, exposure to high-risk sex partners, diagnosis of a sexually transmitted disease, and repeat pregnancy. RESULTS High levels of prenatal depressive symptoms were significantly associated with increased number of sex partners (β = 0.17; standard error, 0.08), decreased condom use (β = -7.16; standard error, 3.08), and greater likelihood of having had sex with a high-risk partner (odds ratio = 1.84; 95% confidence interval, 1.26-2.70), and repeat pregnancy (odds ratio = 1.72; 95% confidence interval, 1.09-2.72), among participants who were sexually active (all P < .05). Prenatal depressive symptoms were not associated with whether participants engaged in postpartum sexual activity or sexually transmitted disease incidence. CONCLUSION Screening and treatment for depression should be available routinely to women at risk for antenatal depression.
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Affiliation(s)
| | - A Smith
- Yale School of Public Health, New Haven, Connecticut
| | - T Kershaw
- Yale School of Public Health, New Haven, Connecticut
| | - J B Lewis
- Yale School of Public Health, New Haven, Connecticut
| | - A Cassells
- Clinical Directors Network (CDN), New York, New York
| | - J N Tobin
- Clinical Directors Network (CDN), New York, New York
| | - J R Ickovics
- Yale School of Public Health, New Haven, Connecticut
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Duffany KO, McVeigh KH, Kershaw TS, Lipkind HS, Ickovics JR. Maternal Obesity: Risks for Developmental Delays in Early Childhood. Matern Child Health J 2015; 20:219-30. [DOI: 10.1007/s10995-015-1821-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ickovics JR, Earnshaw V, Lewis JB, Kershaw TS, Magriples U, Stasko E, Rising SS, Cassells A, Cunningham S, Bernstein P, Tobin JN. Cluster Randomized Controlled Trial of Group Prenatal Care: Perinatal Outcomes Among Adolescents in New York City Health Centers. Am J Public Health 2015; 106:359-65. [PMID: 26691105 DOI: 10.2105/ajph.2015.302960] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We compared an evidence-based model of group prenatal care to traditional individual prenatal care on birth, neonatal, and reproductive health outcomes. METHODS We performed a multisite cluster randomized controlled trial in 14 health centers in New York City (2008-2012). We analyzed 1148 pregnant women aged 14 to 21 years, at less than 24 weeks of gestation, and not at high obstetrical risk. We assessed outcomes via medical records and surveys. RESULTS In intention-to-treat analyses, women at intervention sites were significantly less likely to have infants small for gestational age (< 10th percentile; 11.0% vs 15.8%; odds ratio = 0.66; 95% confidence interval = 0.44, 0.99). In as-treated analyses, women with more group visits had better outcomes, including small for gestational age, gestational age, birth weight, days in neonatal intensive care unit, rapid repeat pregnancy, condom use, and unprotected sex (P = .030 to < .001). There were no associated risks. CONCLUSIONS CenteringPregnancy Plus group prenatal care resulted in more favorable birth, neonatal, and reproductive outcomes. Successful translation of clinical innovations to enhance care, improve outcomes, and reduce cost requires strategies that facilitate patient adherence and support organizational change.
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Affiliation(s)
- Jeannette R Ickovics
- Jeannette R. Ickovics, Valerie Earnshaw, Jessica B. Lewis, Trace S. Kershaw, Emily Stasko, and Shayna Cunningham are with the Yale School of Public Health, New Haven, CT. Urania Magriples is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven. Sharon Schindler Rising is with the Centering Healthcare Institute, Boston, MA. Andrea Cassells and Jonathan N. Tobin are with the Clinical Directors' Network, New York, NY. Peter Bernstein is with the Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Valerie Earnshaw
- Jeannette R. Ickovics, Valerie Earnshaw, Jessica B. Lewis, Trace S. Kershaw, Emily Stasko, and Shayna Cunningham are with the Yale School of Public Health, New Haven, CT. Urania Magriples is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven. Sharon Schindler Rising is with the Centering Healthcare Institute, Boston, MA. Andrea Cassells and Jonathan N. Tobin are with the Clinical Directors' Network, New York, NY. Peter Bernstein is with the Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Jessica B Lewis
- Jeannette R. Ickovics, Valerie Earnshaw, Jessica B. Lewis, Trace S. Kershaw, Emily Stasko, and Shayna Cunningham are with the Yale School of Public Health, New Haven, CT. Urania Magriples is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven. Sharon Schindler Rising is with the Centering Healthcare Institute, Boston, MA. Andrea Cassells and Jonathan N. Tobin are with the Clinical Directors' Network, New York, NY. Peter Bernstein is with the Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Trace S Kershaw
- Jeannette R. Ickovics, Valerie Earnshaw, Jessica B. Lewis, Trace S. Kershaw, Emily Stasko, and Shayna Cunningham are with the Yale School of Public Health, New Haven, CT. Urania Magriples is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven. Sharon Schindler Rising is with the Centering Healthcare Institute, Boston, MA. Andrea Cassells and Jonathan N. Tobin are with the Clinical Directors' Network, New York, NY. Peter Bernstein is with the Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Urania Magriples
- Jeannette R. Ickovics, Valerie Earnshaw, Jessica B. Lewis, Trace S. Kershaw, Emily Stasko, and Shayna Cunningham are with the Yale School of Public Health, New Haven, CT. Urania Magriples is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven. Sharon Schindler Rising is with the Centering Healthcare Institute, Boston, MA. Andrea Cassells and Jonathan N. Tobin are with the Clinical Directors' Network, New York, NY. Peter Bernstein is with the Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Emily Stasko
- Jeannette R. Ickovics, Valerie Earnshaw, Jessica B. Lewis, Trace S. Kershaw, Emily Stasko, and Shayna Cunningham are with the Yale School of Public Health, New Haven, CT. Urania Magriples is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven. Sharon Schindler Rising is with the Centering Healthcare Institute, Boston, MA. Andrea Cassells and Jonathan N. Tobin are with the Clinical Directors' Network, New York, NY. Peter Bernstein is with the Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Sharon Schindler Rising
- Jeannette R. Ickovics, Valerie Earnshaw, Jessica B. Lewis, Trace S. Kershaw, Emily Stasko, and Shayna Cunningham are with the Yale School of Public Health, New Haven, CT. Urania Magriples is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven. Sharon Schindler Rising is with the Centering Healthcare Institute, Boston, MA. Andrea Cassells and Jonathan N. Tobin are with the Clinical Directors' Network, New York, NY. Peter Bernstein is with the Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Andrea Cassells
- Jeannette R. Ickovics, Valerie Earnshaw, Jessica B. Lewis, Trace S. Kershaw, Emily Stasko, and Shayna Cunningham are with the Yale School of Public Health, New Haven, CT. Urania Magriples is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven. Sharon Schindler Rising is with the Centering Healthcare Institute, Boston, MA. Andrea Cassells and Jonathan N. Tobin are with the Clinical Directors' Network, New York, NY. Peter Bernstein is with the Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Shayna Cunningham
- Jeannette R. Ickovics, Valerie Earnshaw, Jessica B. Lewis, Trace S. Kershaw, Emily Stasko, and Shayna Cunningham are with the Yale School of Public Health, New Haven, CT. Urania Magriples is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven. Sharon Schindler Rising is with the Centering Healthcare Institute, Boston, MA. Andrea Cassells and Jonathan N. Tobin are with the Clinical Directors' Network, New York, NY. Peter Bernstein is with the Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Peter Bernstein
- Jeannette R. Ickovics, Valerie Earnshaw, Jessica B. Lewis, Trace S. Kershaw, Emily Stasko, and Shayna Cunningham are with the Yale School of Public Health, New Haven, CT. Urania Magriples is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven. Sharon Schindler Rising is with the Centering Healthcare Institute, Boston, MA. Andrea Cassells and Jonathan N. Tobin are with the Clinical Directors' Network, New York, NY. Peter Bernstein is with the Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Jonathan N Tobin
- Jeannette R. Ickovics, Valerie Earnshaw, Jessica B. Lewis, Trace S. Kershaw, Emily Stasko, and Shayna Cunningham are with the Yale School of Public Health, New Haven, CT. Urania Magriples is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven. Sharon Schindler Rising is with the Centering Healthcare Institute, Boston, MA. Andrea Cassells and Jonathan N. Tobin are with the Clinical Directors' Network, New York, NY. Peter Bernstein is with the Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
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Earnshaw VA, Rosenthal L, Cunningham SD, Kershaw T, Lewis J, Rising SS, Stasko E, Tobin J, Ickovics JR. Exploring Group Composition among Young, Urban Women of Color in Prenatal Care: Implications for Satisfaction, Engagement, and Group Attendance. Womens Health Issues 2015; 26:110-5. [PMID: 26542382 DOI: 10.1016/j.whi.2015.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE Group models of prenatal care continue to grow in popularity. However, little is known about how group composition (similarity or diversity between members of groups) relates to care-related outcomes. The current investigation aimed to explore associations between prenatal care group composition with patient satisfaction, engagement, and group attendance among young, urban women of color. METHODS Data were drawn from two studies conducted in New Haven and Atlanta (2001-2004; n = 557) and New York City (2008-2011; n = 375) designed to evaluate group prenatal care among young, urban women of color. Women aged 14 to 25 were assigned to group prenatal care and completed surveys during their second and third trimesters of pregnancy. Group attendance was recorded. Data were merged and analyzed guided by the Group Actor-Partner Interdependence Model using multilevel regression. Analyses explored composition in terms of age, race, ethnicity, and language. MAIN FINDINGS Women in groups with others more diverse in age reported greater patient engagement and, in turn, attended more group sessions, b(se) = -0.01(0.01); p = .04. CONCLUSION The composition of prenatal care groups seems to be associated with young women's engagement in care, ultimately relating to the number of group prenatal care sessions they attend. Creating groups diverse in age may be particularly beneficial for young, urban women of color, who have unique pregnancy needs and experiences. Future research is needed to test the generalizability of these exploratory findings.
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Affiliation(s)
- Valerie A Earnshaw
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - Lisa Rosenthal
- Department of Psychology, Pace University, New York, New York
| | - Shayna D Cunningham
- Division of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, Connecticut
| | - Trace Kershaw
- Division of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, Connecticut
| | - Jessica Lewis
- Division of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, Connecticut
| | | | - Emily Stasko
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | - Jonathan Tobin
- Clinical Directors Network, New York, New York; Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York
| | - Jeannette R Ickovics
- Division of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, Connecticut
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Carroll-Scott A, Gilstad-Hayden K, Rosenthal L, Eldahan A, McCaslin C, Peters SM, Ickovics JR. Associations of Neighborhood and School Socioeconomic and Social Contexts With Body Mass Index Among Urban Preadolescent Students. Am J Public Health 2015; 105:2496-502. [PMID: 26469652 DOI: 10.2105/ajph.2015.302882] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES We examined independent and synergistic effects of school and neighborhood environments on preadolescent body mass index (BMI) to determine why obesity rates nearly double during preadolescence. METHODS Physical measures and health surveys from fifth and sixth graders in 12 randomly selected schools in New Haven, Connecticut, in 2009 were matched to student sociodemographics and school- and residential census tract-level data, for a total of 811 urban preadolescents. Key independent variables included school connectedness, neighborhood social ties, and school and neighborhood socioeconomic status. We estimated cross-classified random-effects hierarchical linear models to examine associations between key school and neighborhood characteristics with student BMI. RESULTS Greater average connectedness felt by students to their school was significantly associated with lower BMI. This association was stronger among students living in neighborhoods with higher concentrations of affluent neighbors. CONCLUSIONS How schools engage and support students may affect obesity rates preferentially in higher-income neighborhoods. Further research should explore the associations between multiple environments to which children are exposed and obesity-related behaviors and outcomes. This understanding of the multiple social-spatial contexts that children occupy has potential to inform comprehensive and sustainable child obesity prevention efforts.
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Affiliation(s)
- Amy Carroll-Scott
- At the time of this study, Amy Carroll-Scott, Kathryn Gilstad-Hayden, Lisa Rosenthal, Susan M. Peters, and Jeannette R. Ickovics were with CARE (Community Alliance for Research and Engagement) at Yale School of Public Health, New Haven, CT. Adam Eldahan was with the Yale School of Public Health. Catherine McCaslin is with the New Haven Public School District, New Haven, CT
| | - Kathryn Gilstad-Hayden
- At the time of this study, Amy Carroll-Scott, Kathryn Gilstad-Hayden, Lisa Rosenthal, Susan M. Peters, and Jeannette R. Ickovics were with CARE (Community Alliance for Research and Engagement) at Yale School of Public Health, New Haven, CT. Adam Eldahan was with the Yale School of Public Health. Catherine McCaslin is with the New Haven Public School District, New Haven, CT
| | - Lisa Rosenthal
- At the time of this study, Amy Carroll-Scott, Kathryn Gilstad-Hayden, Lisa Rosenthal, Susan M. Peters, and Jeannette R. Ickovics were with CARE (Community Alliance for Research and Engagement) at Yale School of Public Health, New Haven, CT. Adam Eldahan was with the Yale School of Public Health. Catherine McCaslin is with the New Haven Public School District, New Haven, CT
| | - Adam Eldahan
- At the time of this study, Amy Carroll-Scott, Kathryn Gilstad-Hayden, Lisa Rosenthal, Susan M. Peters, and Jeannette R. Ickovics were with CARE (Community Alliance for Research and Engagement) at Yale School of Public Health, New Haven, CT. Adam Eldahan was with the Yale School of Public Health. Catherine McCaslin is with the New Haven Public School District, New Haven, CT
| | - Catherine McCaslin
- At the time of this study, Amy Carroll-Scott, Kathryn Gilstad-Hayden, Lisa Rosenthal, Susan M. Peters, and Jeannette R. Ickovics were with CARE (Community Alliance for Research and Engagement) at Yale School of Public Health, New Haven, CT. Adam Eldahan was with the Yale School of Public Health. Catherine McCaslin is with the New Haven Public School District, New Haven, CT
| | - Susan M Peters
- At the time of this study, Amy Carroll-Scott, Kathryn Gilstad-Hayden, Lisa Rosenthal, Susan M. Peters, and Jeannette R. Ickovics were with CARE (Community Alliance for Research and Engagement) at Yale School of Public Health, New Haven, CT. Adam Eldahan was with the Yale School of Public Health. Catherine McCaslin is with the New Haven Public School District, New Haven, CT
| | - Jeannette R Ickovics
- At the time of this study, Amy Carroll-Scott, Kathryn Gilstad-Hayden, Lisa Rosenthal, Susan M. Peters, and Jeannette R. Ickovics were with CARE (Community Alliance for Research and Engagement) at Yale School of Public Health, New Haven, CT. Adam Eldahan was with the Yale School of Public Health. Catherine McCaslin is with the New Haven Public School District, New Haven, CT
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Schwartz MB, Gilstad-Hayden K, Henderson KE, Luedicke J, Carroll-Scott A, Peters SM, McCaslin C, Ickovics JR. The Relationship between Parental Behaviors and Children's Sugary Drink Consumption Is Moderated by a Television in the Child's Bedroom. Child Obes 2015; 11:560-8. [PMID: 26317365 PMCID: PMC4808288 DOI: 10.1089/chi.2014.0041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The aim of this longitudinal study was to examine the link between perceived authoritative parenting behaviors and sugary drink consumption among children from low-income families who do or do not have televisions (TVs) in their bedrooms. METHODS Middle school students (N = 480) completed a baseline survey in sixth grade and a follow-up survey in seventh grade. The students were recruited from 12 schools in a low-income, predominantly black (33%) and Latino (48%), urban school district. The survey assessed the children's perception of their parents' controlling and nurturing behaviors, the presence of a TV in their bedrooms, and their level of sugary drink consumption on the previous school day. Children's report of specific controlling and nurturing parental behaviors were used to create an "authoritative parenting" score. Regression analyses were used to test the main and interactive effects of authoritative parenting behaviors and having a TV in the bedroom with sugary drink consumption in seventh grade, controlling for age, race/ethnicity, gender, BMI, and sugary drink consumption in sixth grade. RESULTS A significant interaction emerged: The authoritative parenting score predicted lower levels of sugary drink consumption in seventh grade, but this relationship was moderated by whether or not there was a TV in the child's bedroom. CONCLUSION A TV in the child's bedroom may weaken the positive influence of authoritative parenting behaviors on limiting sugary drink consumption among middle school children from low-income families. Stronger initiatives are recommended to educate parents and help them refrain from placing TVs in their children's bedrooms.
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Affiliation(s)
- Marlene B. Schwartz
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT
| | - Kathryn Gilstad-Hayden
- Community Alliance for Research and Engagement, Yale School of Public Health, New Haven, CT
| | | | | | - Amy Carroll-Scott
- Department of Community Health and Prevention, Drexel School of Public Health, Philadelphia, PA
| | | | | | - Jeannette R. Ickovics
- Community Alliance for Research and Engagement, Yale School of Public Health, New Haven, CT
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Novick G, Womack JA, Lewis J, Stasko EC, Rising SS, Sadler LS, Cunningham SC, Tobin JN, Ickovics JR. Perceptions of Barriers and Facilitators During Implementation of a Complex Model of Group Prenatal Care in Six Urban Sites. Res Nurs Health 2015; 38:462-74. [PMID: 26340483 DOI: 10.1002/nur.21681] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 11/06/2022]
Abstract
Group prenatal care improves perinatal outcomes, but implementing this complex model places substantial demands on settings designed for individual care. To describe perceived barriers and facilitators to implementing and sustaining CenteringPregnancy Plus (CP+) group prenatal care, 24 in-depth interviews were conducted with 22 clinicians, staff, administrators, and study personnel in six of the 14 sites of a randomized trial of the model. All sites served low-income, minority women. Sites for the present evaluation were selected for variation in location, study arm, and initial implementation response. Implementing CP+ was challenging in all sites, requiring substantial adaptations of clinical systems. All sites had barriers to meeting the model's demands, but how sites responded to these barriers affected whether implementation thrived or struggled. Thriving sites had organizational cultures that supported innovation, champions who advocated for CP+, and staff who viewed logistical demands as manageable hurdles. Struggling sites had bureaucratic organizational structures and lacked buy-in and financial resources, and staff were overwhelmed by the model's challenges. Findings suggested that implementing and sustaining health care innovation requires new practices and different ways of thinking, and health systems may not fully recognize the magnitude of change required. Consequently, evidence-based practices are modified or discontinued, and outcomes may differ from those in the original controlled studies. Before implementing new models of care, clinical settings should anticipate model demands and assess capacity for adapting to the disruptions of innovation.
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Affiliation(s)
- Gina Novick
- Assistant Professor, School of Nursing, Yale University West Campus, P.O. Box 27399, West Haven, CT, 06516
| | - Julie A Womack
- Assistant Professor, Yale University School of Nursing, VA Connecticut Healthcare System, West Haven, CT
| | - Jessica Lewis
- Research Associate, Yale School of Public Health, New Haven, CT
| | - Emily C Stasko
- Doctoral Student, Department of Psychology, Drexel University, Philadelphia, PA
| | - Sharon S Rising
- Founder and President Emeritus, Centering Healthcare Institute, Silver Spring, MD
| | - Lois S Sadler
- Professor, Yale University School of Nursing, Yale Child Study Center, West Haven, CT
| | | | - Jonathan N Tobin
- President/CEO, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, Clinical Directors Network, Bronx, NY
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49
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Affiliation(s)
- Billy Bromage
- Billy Bromage is with Program for Recovery and Community Health, Yale Department of Psychiatry, New Haven, CT. Alycia Santilli and Jeannette R. Ickovics are with Community Alliance for Research and Engagement, Yale School of Public Health, New Haven, CT
| | - Alycia Santilli
- Billy Bromage is with Program for Recovery and Community Health, Yale Department of Psychiatry, New Haven, CT. Alycia Santilli and Jeannette R. Ickovics are with Community Alliance for Research and Engagement, Yale School of Public Health, New Haven, CT
| | - Jeannette R Ickovics
- Billy Bromage is with Program for Recovery and Community Health, Yale Department of Psychiatry, New Haven, CT. Alycia Santilli and Jeannette R. Ickovics are with Community Alliance for Research and Engagement, Yale School of Public Health, New Haven, CT
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50
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Chandler I, Rosenthal L, Carroll-Scott A, Peters SM, McCaslin C, Ickovics JR. Adolescents Who Visit the Emergency Department Are More Likely to Make Unhealthy Dietary Choices: An Opportunity for Behavioral Intervention. J Health Care Poor Underserved 2015; 26:701-11. [PMID: 26320906 PMCID: PMC4753571 DOI: 10.1353/hpu.2015.0086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To identify health behaviors that may be amenable to brief screening and intervention among children in the emergency department (ED), we described the prevalence of health behaviors known to contribute to childhood obesity among middle school students who used the ED recently. Participants included 1590 5th, 7th, and 8th grade students who completed health surveys in 2011. Multivariate logistic regression was used to examine the association between health behaviors and ED use. Children who used the ED reported more unhealthy dietary behaviors, including greater consumption of energy-dense foods such as fried chicken, french fries, and ice cream (OR 1.20, 95% CI 1.06-1.37), fast food (OR 1.07, 95% CI 1.00-1.14) and sugar-sweetened beverages (OR 1.24, 95% CI 1.14-1.35). There was no association with fruit and vegetable consumption, physical activity, or screen time. Unhealthy dietary behaviors are associated with ED use in a low-resource urban population of middle school students.
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