Prevalence of Child Welfare Services Involvement among Homeless and Low-Income Mothers: A Five-year Birth Cohort Study

This paper investigates the five-year prevalence of child welfare services involvement and foster care placement among a population-based cohort of births in a large US city, by housing status of the mothers (mothers who have been homeless at least once, other low-income neighborhood residents, and all others), and by number of children. Children of mothers with at least one homeless episode have the greatest rate of involvement with child welfare services (37%),followed by other low-income residents (9.2%), and all others (4.0%). Involvement rates increase with number of children for all housing categories, with rates highest among women with four or more births (33 %), particularlyf or those mothers who have been homeless at least once (54%). Among families involved with child welfare services, the rate of placement in foster care is highest for the index children of women with at least one episode of homelessness (62%), followed by other low-income mothers (39%) and all others (39%). Half of the birth cohort eventually involved with child welfare services was among the group of women who have ever used the shelter system, as were 60% of the cohort placed in foster care. Multivariate logistic regression analyses reveal that mothers with one or more homeless episodes and mothers living in low-income neighborhoods have significantly greater risk of child welfare service involvement (OR = 5.67 and OR = 1.51, respectively) and foster care placement (OR = 8.82 and OR = 1.59, respectively). The implications forfurther research, and for child welfare risk assessment and prevention are discussed. Specifically, the salience of housing instability/homelessness to risk of child welfare service involvement is highlighted

Eliciting Maternal Subjective Expectations about the Technology of Cognitive Skill Formation

In this paper, we formulate a model of early childhood development in which mothers have subjective expectations about the technology of skill formation. The model is useful for understanding how maternal knowledge about child development affects the maternal choices of investments in the human capital of children. Unfortunately, the model is not identified from data that are usually available to econometricians. To solve this problem, we conduct a study where mothers were interviewed to elicit maternal expectations about the technology of skill formation. We interviewed a sample of socioeconomically disadvantaged African‐American women. We find that the median subjective expectation about the elasticity of child development with respect to investments is between 4% and 19%. In comparison, when we estimate the technology of skill formation from the CNLSY/79 data, we find that the elasticity is between 18% and 26%. We use the model and our unique data to answer a simple but important question: What would happen to investments and child development if we implemented a policy that moved expectations from the median to the objective estimates that we obtain from the CNLSY/79 data? According to our estimates, maternal investments would go up by between 4% and 24% and the stocks of cognitive skills at age 24 months would subsequently increase between 1% and 5%. Needless to say, the impacts of such a policy would be even higher for mothers whose expectations were below the median

Barriers to women's participation in inter-conceptional care: a cross-sectional analysis

<p>Abstract</p> <p>Background</p> <p>We describe participation rates in a special interconceptional care program that addressed all commonly known barriers to care, and identify predictors of the observed levels of participation in this preventive care service.</p> <p>Methods</p> <p>A secondary analysis of data from women in the intervention arm of an interconceptional care clinical trial in Philadelphia (n = 442). Gelberg-Andersen Behavioral Model for Vulnerable Populations to Health Services (herein called Andersen model) was used as a theoretical base. We used a multinomial logit model to analyze the factors influencing women's level of participation in this enhanced interconceptional care program.</p> <p>Results</p> <p>Although common barriers were addressed, there was variable participation in the interconceptional interventions. The Andersen model did not explain the variation in interconceptional care participation (Wald ch sq = 49, <it>p = </it>0.45). <it>Enabling </it>factors <it>(p </it>= 0.058), <it>older maternal age (p = 0.03) </it>and <it>smoking (p = < 0.0001) </it>were independently associated with participation.</p> <p>Conclusions</p> <p>Actively removing common barriers to care does not guarantee the long-term and consistent participation of vulnerable women in preventive care. There are unknown factors beyond known barriers that affect participation in interconceptional care. New paradigms are needed to identify the additional factors that serve as barriers to participation in preventive care for vulnerable women.</p

Perceived Discrimination and Depressive Symptoms, Smoking, and Recent Alcohol Use in Pregnancy

Perceived discrimination is associated with poor mental health and health-compromising behaviors in a range of vulnerable populations, but this link has not been assessed among pregnant women. We aimed to determine whether perceived discrimination was associated with these important targets of maternal health care among low-income pregnant women

Recruitment and retention of women in a large randomized control trial to reduce repeat preterm births: the Philadelphia Collaborative Preterm Prevention Project

<p>Abstract</p> <p>Background</p> <p>Recruitment and retention of patients for randomized control trial (RCT) studies can provide formidable challenges, particularly with minority and underserved populations. Data are reported for the Philadelphia Collaborative Preterm Prevention Project (PCPPP), a large RCT targeting risk factors for repeat preterm births among women who previously delivered premature (< 35 weeks gestation) infants.</p> <p>Methods</p> <p>Design of the PCPPP incorporated strategies to maximize recruitment and retention. These included an advanced database system tracking follow-up status and assessment completion rates; cultural sensitivity training for staff; communication to the community and eligible women of the benefits of participation; financial incentives; assistance with transportation and supervised childcare services; and reminder calls for convenient, flexibly scheduled appointments. Analyses reported here: 1) compare recruitment projections to actual enrollment 2) explore recruitment bias; 3) validate the randomization process 4) document the extent to which contact was maintained and complete assessments achieved 5) determine if follow-up was conditioned upon socio-economic status, race/ethnicity, or other factors.</p> <p>Results</p> <p>Of eligible women approached, 1,126 (77.7%) agreed to participate fully. Of the 324 not agreeing, 118 (36.4%) completed a short survey. Consenting women were disproportionately from minority and low SES backgrounds: 71.5% consenting were African American, versus 38.8% not consenting. Consenting women were also more likely to report homelessness during their lifetime (14.6% vs. 0.87%) and to be unmarried at the time of delivery (81.6% versus 47.9%). First one-month postpartum assessment was completed for 83.5% (n = 472) of the intervention group (n = 565) and 76% (426) of the control group. Higher assessment completion rates were observed for the intervention group throughout the follow-up. Second, third, fourth and fifth postpartum assessments were 67.6% vs. 57.5%, 60.0% vs. 48.9%, 54.2% vs. 46.3% and 47.3% vs. 40.8%, for the intervention and control group women, respectively. There were no differences in follow-up rates according to race/ethnicity, SES or other factors. Greater retention of the intervention group may reflect the highly-valued nature of the medical and behavior services constituting the intervention arms of the Project.</p> <p>Conclusion</p> <p>Findings challenge beliefs that low income and minority women are averse to enrolling and continuing in clinical trials or community studies.</p

Neighbourhood deprivation and small-for-gestational-age term births in the United States

Residential context has received increased attention as a possible contributing factor to race/ethnic and socioeconomic disparities in birth outcomes in the United States. Utilizing vital statistics birth record data, this study examined the association between neighbourhood deprivation and the risk of a term small-for-gestational-age (SGA) birth among non-Hispanic whites and non-Hispanic blacks in eight geographic areas: Baltimore City, Baltimore County, Montgomery County and Prince Georges County in Maryland, 16 pooled cities in Michigan, Durham County and Wake County in North Carolina, and Philadelphia, Pennsylvania. Multilevel random intercept logistic regression models were employed and statistical tests were performed to examine if the association between neighbourhood deprivation and SGA varied by race/ethnicity and study site. The risk of term SGA was higher among non-Hispanic blacks (range: 10.8%–17.5%) than non-Hispanic whites (range: 5.1%–9.2%) in all areas and it was higher in cities than in suburban locations. In all areas, non-Hispanic blacks lived in more deprived neighbourhoods than non-Hispanic whites. However, the adjusted associations between neighbourhood deprivation and term SGA did not vary significantly by race/ethnicity or study site. The summary fully-adjusted pooled odds ratios, indicating the effect of one standard deviation increase in the deprivation score, were 1.15 [95% CI: 1.08–1.22] for non-Hispanic whites and 1.09 [95% CI: 1.05–1.14] for non-Hispanic blacks. Thus, neighbourhood deprivation was weakly associated with term SGA among both non-Hispanic whites and non-Hispanic blacks

Changes in Prenatal Testing During the COVID-19 Pandemic

Objective: The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare delivery, including prenatal care. The study objective was to assess if timing of routine prenatal testing changed during the COVID-19 pandemic. Methods: Retrospective observational cohort study using claims data from a regional insurer (Highmark) and electronic health record data from two academic health systems (Penn Medicine and Yale New Haven) to compare prenatal testing timing in the pre-pandemic (03/10/2018-12/31/2018 and 03/10/2019-12/31/2019) and early COVID-19 pandemic (03/10/2020-12/31/2020) periods. Primary outcomes were second trimester fetal anatomy ultrasounds and gestational diabetes (GDM) testing. A secondary analysis examined first trimester ultrasounds. Results: The three datasets included 31,474 pregnant patients. Mean gestational age for second trimester anatomy ultrasounds increased from the pre-pandemic to COVID-19 period (Highmark 19.4 vs. 19.6 weeks; Penn: 20.1 vs. 20.4 weeks; Yale: 18.8 vs. 19.2 weeks, all p \u3c 0.001). There was a detectable decrease in the proportion of patients who completed the anatomy survey \u3c20 weeks\u27 gestation across datasets, which did not persist at \u3c23 weeks\u27 gestation. There were no consistent changes in timing of GDM screening. There were significant reductions in the proportion of patients with first trimester ultrasounds in the academic institutions (Penn: 57.7% vs. 40.6% and Yale: 78.7% vs. 65.5%, both p \u3c 0.001) but not Highmark. Findings were similar with multivariable adjustment. Conclusion: While some prenatal testing happened later in pregnancy during the pandemic, pregnant patients continued to receive appropriately timed testing. Despite disruptions in care delivery, prenatal screening remained a priority for patients and providers during the COVID-19 pandemic

Why Errors in Alibis Are Not Necessarily Evidence of Guilt

Laypeople, police, and prosecutors tend to believe that a suspect's alibi, if truthful, should remain consistent over time (see Burke, Turtle, &amp; Olson, 2007; Culhane &amp; Hosch 2012; Dysart &amp; Strange, 2012). However, there is no empirical evidence to support this assumption. We investigated (a) whether some features of an alibi-such as what was happening, who with, where, and for how long-are more likely to produce errors than others; and (b) whether consistency in alibi stories is correlated with particular phenomenological characteristics of the alibi such as a person's confidence and sense of reliving the event. We asked participants to imagine they were suspected of a crime and to provide their truthful alibi for an afternoon 3 weeks prior and to complete questions regarding the phenomenological characteristics of their memory. We also asked participants to locate evidence of their actual whereabouts for the critical period. Participants returned a week later, presented their evidence, re-told their alibi, and re-rated the phenomenological characteristics of the alibi. Our results revealed that participants were largely inconsistent across all aspects of their alibi, but there was variability across the different features. In addition, those who were inconsistent were less confident, recollected the time period in less detail and less vividly, and were less likely to claim to remember the time period. We conclude that inconsistencies are a normal byproduct of an imperfect memory system and thus should not necessarily arouse suspicion that a suspect is lying. © 2014 Hogrefe Publishing

Estimating prevalence of overweight and obesity at the neighborhood level: the value of maternal height and weight data available on birth certificate records

<p>Abstract</p> <p>Objective</p> <p>To determine the value of maternal height and weight data on birth certificate records when estimating prevalence of overweight and obese adults at the neighborhood level.</p> <p>Research Design and Methods</p> <p>Regression analysis was used to determine how much variation in the percentage of the adult population with a body mass index (BMI) of ≥ 25 (based on survey data) could be accounted for by the percentage of mothers with BMI ≥ 25 (based on birth certificate data) -- alone and in combination with other sociodemographic characteristics of census tracts.</p> <p>Results</p> <p>Alone, the percentage of mothers with BMI ≥ 25 explained more than half (R²= .52) of the variation in the percentage of all residents in census tracts with BMI ≥ 25; in combination with several measures of the sociodemographic characteristics of the census tracts, 75% ( R²= 75.2) of the variation is explained.</p> <p>Conclusions</p> <p>Maternal height and weight data available from birth certificate records may be useful for identifying neighborhoods with relatively high or low prevalence of adult residents who are overweight or obese. This is especially true if used in combination with readily available census data.</p

Preconception Care Between Pregnancies: The Content of Internatal Care

For more than two decades, prenatal care has been a cornerstone of our nation’s strategy for improving pregnancy outcomes. In recent years, however, a growing recognition of the limits of prenatal care and the importance of maternal health before pregnancy has drawn increasing attention to preconception and internatal care. Internatal care refers to a package of healthcare and ancillary services provided to a woman and her family from the birth of one child to the birth of her next child. For healthy mothers, internatal care offers an opportunity for wellness promotion between pregnancies. For high-risk mothers, internatal care provides strategies for risk reduction before their next pregnancy. In this paper we begin to define the contents of internatal care. The core components of internatal care consist of risk assessment, health promotion, clinical and psychosocial interventions. We identified several priority areas, such as FINDS (family violence, infections, nutrition, depression, and stress) for risk assessment or BBEEFF (breastfeeding, back-to-sleep, exercise, exposures, family planning and folate) for health promotion. Women with chronic health conditions such as hypertension, diabetes, or weight problems should receive on-going care per clinical guidelines for their evaluation, treatment, and follow-up during the internatal period. For women with prior adverse outcomes such as preterm delivery, we propose an internatal care model based on known etiologic pathways, with the goal of preventing recurrence by addressing these biobehavioral pathways prior to the next pregnancy. We suggest enhancing service integration for women and families, including possibly care coordination and home visitation for selected high-risk women. The primary aim of this paper is to start a dialogue on the content of internatal care