Preterm Birth And The Perception Of Risk Among African Americans

Background: African American women deliver preterm at a rate that is two to three times that of their white counterparts, and after decades of research, this disparity in birth outcomes still remains unexplained. While factors including income, education, neighborhood conditions, infection and stress have all been associated with prematurity, no combination of these factors has explained why the disparity persists. Recently, however, racism-specific stress has emerged as a possible factor contributing to this disparity. This study was designed to learn how preterm birth was explained by African Americans directly impacted by prematurity. Methods: Interviews were conducted with African American women with a history of preterm birth hospitalized for complications with their current pregnancy; the mothers of these women; the fathers of their unborn children; and African American physicians, nurses and medical assistants. A total of 25 recorded interviews were transcribed and analyzed for risk perception, and for explanatory models of risk. Results: With one exception, racism, racism-specific stress and the structural inequalities that impact the incidence of preterm birth for African American families were not acknowledged. All respondents shared a perception that the pregnant woman\u27s behavior was the primary explanation for her continuing experience with prematurity. The informants also agreed that stress and lack of support were strongly implicated in preterm birth. There were, however, differences between the groups. Notably, the competing priorities women faced in their roles as mothers, wives and homemakers, and their moral hierarchies for deciding how to fulfill these cultural roles, were often not recognized by providers. The emphasis by health care providers on gestational age at delivery often obscured the other important concerns that families faced. Additionally, this study found that patients and providers assigned significantly different meanings to risk and harm, and that these differences impacted health behaviors. Conclusions from this study offer a direction for constructing culturally appropriate interventions, including the co-negotiation of risk, and inform best practices for the health care community

Slavery to Liberation: The African American Experience (Second Edition)

Slavery to Liberation: The African American Experience (Second Edition) gives instructors, students, and general readers a comprehensive and up-to-date account of African Americans’ cultural and political history, economic development, artistic expressiveness, and religious and philosophical worldviews in a critical framework. It offers sound interdisciplinary analysis of selected historical and contemporary issues surrounding the origins and manifestations of White supremacy in the United States. By placing race at the center of the work, the book offers significant lessons for understanding the institutional marginalization of Blacks in contemporary America and their historical resistance and perseverance.https://encompass.eku.edu/ekuopen/1002/thumbnail.jp

Slavery to Liberation: The African American Experience

Slavery to Liberation: The African American Experience gives instructors, students, and general readers a comprehensive and up-to-date account of African Americans’ cultural and political history, economic development, artistic expressiveness, and religious and philosophical worldviews in a critical framework. It offers sound interdisciplinary analysis of selected historical and contemporary issues surrounding the origins and manifestations of White supremacy in the United States. By placing race at the center of the work, the book offers significant lessons for understanding the institutional marginalization of Blacks in contemporary America and their historical resistance and perseverance.https://encompass.eku.edu/ekuopen/1000/thumbnail.jp

Sleep and Diet in Urban Pregnant African American Women

ABSTRACT Objective: Sleep disturbances during pregnancy are associated with gestational diabetes and excessive weight gain. Diet could potentially play a role in these relationships, yet examinations of sleep and diet in African American pregnant populations are scarce. Methods: The study population includes pregnant African American women from Detroit, MI (n=53). At the baseline study visit during late pregnancy, women were surveyed about typical bed and wake times, as well as usual food intake via a dietary screener. Sleep measures examined included time in bed and sleep midpoint (median of going to bed and wake time). Composite dietary measures included estimated fruit and vegetable (FV), dairy, and added sugar intake. Linear regression models were used to evaluate associations between sleep and dietary measures, adjusting for potential confounders. Results: On average, women with shorter time in bed (\u3c8 hours compared to ≥8 hours) had one cup/day higher intake of fruits and vegetables (95% CI 0.10 to 1.83), driven by the individual items tomato sauce, salsa, and fruit juice. Delayed sleep timing (a midpoint\u3e2:45 AM compared to midpoint≤2:45 AM) was associated with 0.78 cup/day lower fruit and vegetable intake (95% CI -1.67 to 0.12), mostly driven by whole fruit and vegetables (e.g. string beans, peas, corn rather than salad or cooked dried beans). Later midpoint was also associated with lower dairy intake (0.41 fewer servings/day; 95% CI -0.78 to -0.04), particularly milk. Shorter time in bed was associated with higher pastry intake, and delayed sleep timing was associated with lower pastry intake. Conclusions: Sleep characteristics were uniquely associated with diet in pregnant women

The National Childrens Study: Recruitment Outcomes Using the Provider-Based Recruitment Approach

In 2009, the National Children’s Study (NCS) Vanguard Study tested the feasibility of household-based recruitment and participant enrollment using a birth-rate probability sample. In 2010, the NCS Program Office launched 3 additional recruitment approaches. We tested whether provider-based recruitment could improve recruitment outcomes compared with household-based recruitment

Pregnancy Recruitment for Population Research: the National Children's Study Vanguard Experience in W ayne C ounty, M ichigan

Background To obtain a probability sample of pregnancies, the N ational C hildren's S tudy conducted door‐to‐door recruitment in randomly selected neighbourhoods in randomly selected counties in 2009–10. In 2011, an experiment was conducted in 10 US counties, in which the two‐stage geographic sample was maintained, but participants were recruited in prenatal care provider offices. We describe our experience recruiting pregnant women this way in W ayne C ounty, M ichigan, a county where geographically eligible women attended 147 prenatal care settings, and comprised just 2% of total county pregnancies. Methods After screening for address eligibility in prenatal care offices, we used a three‐part recruitment process: (1) providers obtained permission for us to contact eligible patients, (2) clinical research staff described the study to women in clinical settings, and (3) survey research staff visited the home to consent and interview eligible women. Results We screened 34 065 addresses in 67 provider settings to find 215 eligible women. Providers obtained permission for research contact from 81.4% of eligible women, of whom 92.5% agreed to a home visit. All home‐visited women consented, giving a net enrolment of 75%. From birth certificates, we estimate that 30% of eligible county pregnancies were enrolled, reaching 40–50% in the final recruitment months. Conclusions We recruited a high fraction of pregnancies identified in a broad cross‐section of provider offices. Nonetheless, because of time and resource constraints, we could enrol only a fraction of geographically eligible pregnancies. Our experience suggests that the probability sampling of pregnancies for research could be more efficiently achieved through sampling of providers rather than households.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97525/1/ppe12047.pd

Associations of Neighborhood Opportunity and Social Vulnerability With Trajectories of Childhood Body Mass Index and Obesity Among US Children

IMPORTANCE: Physical and social neighborhood attributes may have implications for children\u27s growth and development patterns. The extent to which these attributes are associated with body mass index (BMI) trajectories and obesity risk from childhood to adolescence remains understudied. OBJECTIVE: To examine associations of neighborhood-level measures of opportunity and social vulnerability with trajectories of BMI and obesity risk from birth to adolescence. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from 54 cohorts (20 677 children) participating in the Environmental Influences on Child Health Outcomes (ECHO) program from January 1, 1995, to January 1, 2022. Participant inclusion required at least 1 geocoded residential address and anthropometric measure (taken at the same time or after the address date) from birth through adolescence. Data were analyzed from February 1 to June 30, 2022. EXPOSURES: Census tract-level Child Opportunity Index (COI) and Social Vulnerability Index (SVI) linked to geocoded residential addresses at birth and in infancy (age range, 0.5-1.5 years), early childhood (age range, 2.0-4.8 years), and mid-childhood (age range, 5.0-9.8 years). MAIN OUTCOMES AND MEASURES: BMI (calculated as weight in kilograms divided by length [if aged \u3c2 \u3eyears] or height in meters squared) and obesity (age- and sex-specific BMI ≥95th percentile). Based on nationwide distributions of the COI and SVI, Census tract rankings were grouped into 5 categories: very low (\u3c20th \u3epercentile), low (20th percentile to \u3c40th \u3epercentile), moderate (40th percentile to \u3c60th \u3epercentile), high (60th percentile to \u3c80th \u3epercentile), or very high (≥80th percentile) opportunity (COI) or vulnerability (SVI). RESULTS: Among 20 677 children, 10 747 (52.0%) were male; 12 463 of 20 105 (62.0%) were White, and 16 036 of 20 333 (78.9%) were non-Hispanic. (Some data for race and ethnicity were missing.) Overall, 29.9% of children in the ECHO program resided in areas with the most advantageous characteristics. For example, at birth, 26.7% of children lived in areas with very high COI, and 25.3% lived in areas with very low SVI; in mid-childhood, 30.6% lived in areas with very high COI and 28.4% lived in areas with very low SVI. Linear mixed-effects models revealed that at every life stage, children who resided in areas with higher COI (vs very low COI) had lower mean BMI trajectories and lower risk of obesity from childhood to adolescence, independent of family sociodemographic and prenatal characteristics. For example, among children with obesity at age 10 years, the risk ratio was 0.21 (95% CI, 0.12-0.34) for very high COI at birth, 0.31 (95% CI, 0.20-0.51) for high COI at birth, 0.46 (95% CI, 0.28-0.74) for moderate COI at birth, and 0.53 (95% CI, 0.32-0.86) for low COI at birth. Similar patterns of findings were observed for children who resided in areas with lower SVI (vs very high SVI). For example, among children with obesity at age 10 years, the risk ratio was 0.17 (95% CI, 0.10-0.30) for very low SVI at birth, 0.20 (95% CI, 0.11-0.35) for low SVI at birth, 0.42 (95% CI, 0.24-0.75) for moderate SVI at birth, and 0.43 (95% CI, 0.24-0.76) for high SVI at birth. For both indices, effect estimates for mean BMI difference and obesity risk were larger at an older age of outcome measurement. In addition, exposure to COI or SVI at birth was associated with the most substantial difference in subsequent mean BMI and risk of obesity compared with exposure at later life stages. CONCLUSIONS AND RELEVANCE: In this cohort study, residing in higher-opportunity and lower-vulnerability neighborhoods in early life, especially at birth, was associated with a lower mean BMI trajectory and a lower risk of obesity from childhood to adolescence. Future research should clarify whether initiatives or policies that alter specific components of neighborhood environment would be beneficial in preventing excess weight in children

Discussion: Systemic Diseases

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Understanding Factors Influencing Breastfeeding Outcomes in a Sample of African American Women

OBJECTIVES: Persistent disparities in breastfeeding rates among African American (AA) women compared to other population groups have motivated researchers to understand factors influencing breastfeeding choices using a variety of methods. Quantitative surveys are more commonly reported, however, qualitative work that amplifies voices of AA women is limited. METHODS: Participants were recruited from a randomized controlled feasibility trial focused on breastfeeding support for AA women in Detroit, MI. Thirteen women were enrolled in the qualitative portion of the study described here. Using the Socioecological model (SEM) as the theoretical foundation, semi-structured qualitative interviews were conducted to explore perceived facilitators and barriers to breastfeeding. Interviews were digitally recorded, transcribed, and analyzed using Theoretical thematic analysis. RESULTS: Women reported factors ranging from micro to macro SEM levels that discouraged or reinforced breastfeeding. Key challenges included breastfeeding-related discouragement issues, including factors that decreased confidence and led women to terminate breastfeeding (e.g., problems with latching, pumping, lack of comfort with breastfeeding in public, and work constraints). Facilitators included perceived mother and infant benefits, perseverance/commitment/self-motivation, pumping ability, and social support. Participant suggestions for expanding breastfeeding promotion and support included: (1) tangible, immediate, and proactive support; (2) positive non-judgmental support; (3) milk supply and use of pump education; and (4) self-motivation/willpower/perseverance. CONCLUSIONS FOR PRACTICE: Despite the identification of common facilitators, findings reveal AA women face many obstacles to meeting breastfeeding recommendations. Collaborative discussions between women and healthcare providers focused on suggestions provided by AA women should be encouraged

Breastfeeding Self-Efficacy as a Predictor of Breastfeeding Intensity Among African American Women in the Mama Bear Feasibility Trial

Background: Improving breastfeeding rates among African American (AA) families is an important public health goal. Breastfeeding self-efficacy, a known predictor of breastfeeding behavior, has seldom been assessed among AAs, in relation to breastfeeding intensity (% breastfeeding relative to total feeding) or as a protective factor in combating the historical breastfeeding challenges faced by people of color. We aimed to test the association between breastfeeding self-efficacy assessed during pregnancy and breastfeeding intensity assessed in the early postpartum period. Methods: This was a secondary data analysis of a randomized controlled feasibility trial of breastfeeding support and postpartum weight management. AA women were recruited during pregnancy from a prenatal clinic in Detroit, MI. Data presented, in this study, were collected at enrollment (n = 50) and ∼6 weeks postpartum (n = 31). Linear regression models were used, adjusting for potential confounders. Results: There were no differences in breastfeeding intensity by study arm; data are from all women with complete data on targeted variables. Age ranged from 18 to 43 years, 52% were Women, Infant\u27s, and Children program enrollees, and 62% had ≥ some college. Breastfeeding self-efficacy during pregnancy was a significant predictor of breastfeeding intensity in the early postpartum period (β = 0.125, p \u3c 0.05) with only slight attenuation in the fully adjusted model (β = 0.123, p \u3c 0.05). Implications for Practice: Our results confirm that self-efficacy is an important predictor of breastfeeding practice. Furthermore, the simple act of assessing breastfeeding self-efficacy permits an opportunity for women to reflect on breastfeeding possibilities, and can inform individualized confidence-building interventions to improve the disproportionately low breastfeeding rates among AAs. Clinical Trial Registration number NCT03480048