Race, Age, and Neighborhood Socioeconomic Status in Low Birth Weight Disparities Among Adolescent Mothers: An Intersectional Inquiry

Introduction: Few studies examined socioeconomic contributors to racial disparities in low birth weight outcomes between African-American and Caucasian adolescent mothers. This cross-sectional study examined the intersections of maternal racial status, age, and neighborhood socioeconomic status in explaining these disparities in low birth weight outcomes across a statewide sample of adolescent mothers. Methods: Using data from the North Carolina State Center of Health Statistics for 2010-2011, birth cases for 16,472 adolescents were geocoded by street address and linked to census-tract information from the 2010 United States Census. Multilevel models with interaction terms were used to identify significant associations between maternal racial status, age, and neighborhood socioeconomic status (as defined by census-tract median household income) and low birth weight outcomes across census tracts. Results: Significant racial differences were identified in which African-American adolescents had greater odds of low birth weight outcomes than Caucasian adolescents (OR=1.88, 95% CI 1.64, 2.15). Although racial disparities in low birth weight outcomes remained significant in context of maternal age and neighborhood socioeconomic status, the greatest disparities were found between African-American and Caucasian adolescents that lived in areas of higher socioeconomic status (p Conclusion: These findings indicate that racial disparities in low birth weight outcomes among adolescent mothers can vary by neighborhood socioeconomic status. Further investigations using intersectional frameworks are needed for examining the relationships between neighborhood socioeconomic status and birth outcome disparities among infants born to adolescent mothers

Race, place, and age: an intersectional multilevel investigation of birth outcome disparities among North Carolina teen mothers

Previous research illustrates the persistence of racial disparities in adverse birth outcomes across all age groups, including teen mothers. However, limited literature exists that examined contributors of these disparities specifically between racial groups of teen mothers. This study extended previous research with the examination and comparison of individual and structural factors between non-Hispanic African-American and white teen mothers as potential contributors to racial disparities in adverse birth outcomes. Birth record data for a cross-sectional sample of North Carolina teen mothers (n=16,472) were examined through multilevel models, and an intersectional conceptual framework served as a theoretical foundation for this examination to determine how race, socioeconomic status as defined by neighborhood factors, and age intersect in impacting birth outcomes and explaining racial disparities. This study focused on infant birth weight in grams, gestational age in weeks, low birth weight and preterm birth as birth outcome variables, whereas secondary focus was placed on pregnancy health status and health behaviors (prenatal care use and smoking). Neighborhood socioeconomic status was operationalized by neighborhood risk and census-tract median household income. The two papers included in this dissertation address the following questions: 1) Are there racial differences in birth weight outcomes between African-American and White teen mothers after controlling for neighborhood risk? 2) Does neighborhood income moderate racial differences in gestational age and preterm birth outcomes of infants born to teen mothers? 3) Does neighborhood income moderate racial differences in gestational age & preterm birth outcomes differently between younger and older teen mothers? In this sample, African-American teens gave birth to infants of significantly lower birth weights and gestational ages and had higher odds of low birth weight and preterm birth outcomes in comparison to White teens across all census-tracts. Neighborhood risk had a significant negative association with infant birth weight; however racial differences remained significant after controlling for neighborhood risk. Racial differences in gestational age and preterm birth outcomes varied significantly by neighborhood income. With birth weight and gestational age, the greatest disparities were identified between African-American and White teens living in neighborhoods of lower neighborhood risk and higher income levels. Significant differences were not found in birth weight and gestational age outcomes based on maternal age. Overall, findings from this study suggest that racial factors intersect with socioeconomic circumstances to subsequently impact birth weight outcomes and racial disparities for teen populations. Future examinations need to explore these intersectional influences in context of other individual and interpersonal factors, community and social context to enhance understanding on birth outcome disparities among teen mothers

Early breastfeeding experiences of adolescent mothers: a qualitative prospective study

Abstract Background Teen mothers face many challenges to successful breastfeeding and are less likely to breastfeed than any other population group in the U.S. Few studies have investigated this population; all prior studies are cross-sectional and collect breastfeeding data retrospectively. The purpose of our qualitative prospective study was to understand the factors that contribute to the breastfeeding decisions and practices of teen mothers. Methods This prospective study took place from January through December 2009 in Greensboro, North Carolina in the U.S. We followed the cohort from pregnancy until two weeks after they ceased all breastfeeding and milk expression. We conducted semi-structured interviews at baseline and follow-up, and tracked infant feeding weekly by phone. We analyzed the data to create individual life and breastfeeding journeys and then identified themes that cut across the individual journeys. Results Four of the five teenagers breastfed at the breast for nine days: in contrast, one teen breastfed exclusively for five months. Milk expression by pumping was associated with significantly longer provision of human milk. Breastfeeding practices and cessation were closely connected with their experiences as new mothers in the context of ongoing multiple roles, complex living situations, youth and dependency, and poor knowledge of the fundamentals of breastfeeding and infant development. Breastfeeding cessation was influenced by inadequate breastfeeding skill, physically unpleasant and painful early experiences they were unprepared to manage, and inadequate health care response to real problems. Conclusions Continued breastfeeding depends on a complex interplay of multiple factors, including having made an informed choice and having the skills, support and experiences needed to sustain the belief that breastfeeding is the best choice for them and their baby given their life situation. Teenagers in the US context need to have a positive early breastfeeding experience, be able to identify and claim a reliable support system supportive of breastfeeding, and gain through their experience, a belief in their own agency and competency as mothers

Early breastfeeding experiences of adolescent mothers: a qualitative prospective study

Abstract Background Teen mothers face many challenges to successful breastfeeding and are less likely to breastfeed than any other population group in the U.S. Few studies have investigated this population; all prior studies are cross-sectional and collect breastfeeding data retrospectively. The purpose of our qualitative prospective study was to understand the factors that contribute to the breastfeeding decisions and practices of teen mothers. Methods This prospective study took place from January through December 2009 in Greensboro, North Carolina in the U.S. We followed the cohort from pregnancy until two weeks after they ceased all breastfeeding and milk expression. We conducted semi-structured interviews at baseline and follow-up, and tracked infant feeding weekly by phone. We analyzed the data to create individual life and breastfeeding journeys and then identified themes that cut across the individual journeys. Results Four of the five teenagers breastfed at the breast for nine days: in contrast, one teen breastfed exclusively for five months. Milk expression by pumping was associated with significantly longer provision of human milk. Breastfeeding practices and cessation were closely connected with their experiences as new mothers in the context of ongoing multiple roles, complex living situations, youth and dependency, and poor knowledge of the fundamentals of breastfeeding and infant development. Breastfeeding cessation was influenced by inadequate breastfeeding skill, physically unpleasant and painful early experiences they were unprepared to manage, and inadequate health care response to real problems. Conclusions Continued breastfeeding depends on a complex interplay of multiple factors, including having made an informed choice and having the skills, support and experiences needed to sustain the belief that breastfeeding is the best choice for them and their baby given their life situation. Teenagers in the US context need to have a positive early breastfeeding experience, be able to identify and claim a reliable support system supportive of breastfeeding, and gain through their experience, a belief in their own agency and competency as mothers.</p

Early breastfeeding experiences of adolescent mothers: a qualitative prospective study International Breastfeeding Journal Early breastfeeding experiences of adolescent mothers: a qualitative prospective study

Abstract Backgroun