Using Positive Deviance to Understand the Uptake of Optimal Infant and Young Child Feeding Practices by Mothers in an Urban Slum of Mumbai

Objectives Positive deviance research seeks out well-nourished children living in disadvantaged contexts to understand local growth-promoting behaviors. This study explored the factors that influence the uptake of infant and young child feeding behaviors among mothers. Methods Children with a height-for-age z-score (HAZ) > 0 (n = 10) or a HAZ < ?2.0 (n = 12) were purposefully selected from households enrolled in a community management of acute malnutrition (CMAM) program in an urban slum of Mumbai, India. Qualitative methods were employed by means of semi-structured key informant interviews with positive and non-positive deviant mothers. Eligibility was restricted to households with limited resources and more than one child. A 24-h dietary recall and anthropometric measurements were taken for the index child. An observation checklist assessed household hygiene. Data analysis was based on the Grounded Theory of qualitative research. Results Positive deviant mothers (those with children with a HAZ > 0) largely exhibited optimal infant and young child feeding practices explained by maternal information seeking behaviors; mothers acknowledging the importance of maternal health; and social support. The relationship between mother and health worker seemed to influence how well they listened to the health workers’ recommendations. Across all households, the daily consumption of high-energy, processed foods was apparent. Conclusions Practical considerations include exploring how to tailor CMAM programs to include social support and counseling training for health workers to engage more closely with mothers; exploring the feasibility of a women’s social group for mothers to share information on child rearing; and teaching mothers about healthy eating and the link between nutrition and health.     

The effect of preconception counselling on health locus of control and stress in Iranian women: a randomized control trial

ABSTRACT

Preconception counseling can improve women’s health and pregnancy outcomes. Internal health locus of control and belief in the benefits of health-promoting behaviors improve people’s engagement in health-promoting behaviors. This study examined whether preconception counseling was related to stress and health locus of control. This randomized controlled trial was conducted from March to November 2016 on 152 healthy 18–35-year-old women intending to become pregnant within the next year in Iran. The intervention group received six sessions of group counseling, and the control group received only usual care. The Perceived Stress Scale, Multidimensional Health Locus of Control Scales and checklist for preconception control were completed before and after the intervention. Repeated measures ANOVA showed a significant post-intervention increase in the mean internal health locus of control (P < .001) and preconception control scores (P = .034) in the intervention group and the mean perceived stress score (P = .001), and chance health locus of control (P = .013) decreased significantly. Preconception counseling was associated with increased internal locus of control and reduced perceived stress. Preconception counselors should consider reinforcing women’s internal beliefs with an emphasis on the effect of the couple’s own behaviors and exposures on pregnancy and fetal outcomes.     

Exploring the self-compassion of health-care social workers: How do they fare?

ABSTRACT

Indubitably, the challenges facing health-care social workers are becoming increasingly complex. Whilst these problematic professional circumstances compound the need for self-compassion among health-care social workers, few studies, if any, have explicitly examined self-compassion among this practitioner group. This cross-sectional study explored self-compassion among a sample of practitioners (N = 138) in one southeastern state. Results indicate that health-care social workers in this sample engage in self-compassion only moderately. Further, occupational and demographic/life characteristics (e.g., age, years practicing social work, average hours worked per week, health status, and relationship status, among others) are able to predict self-compassion scores. After a terse review of relevant literature, this paper will explicate findings from this study, discuss relevant points derived from said findings, and identify salient implication for health-care social work praxis.     

Subjective Social Status and Psychological Distress in Mothers of Young Children

Introduction Perceptions of social standing have increasingly well-documented relationships with health. Higher subjective social status (SSS) is associated with better psychological well-being among women, and mothers of newborns. The relationship between SSS and psychological distress among mothers of young children, however, is largely unknown. SSS may provide insight into aspects of maternal functioning that are relevant to parenting capacity, as well as insight into future health; in addition, SSS is brief, and may be perceived as less intrusive than other measures of socioeconomic status or mental health. We evaluated the relationship between SSS and psychological distress among mothers of 5-year-old children from diverse socioeconomic backgrounds. Methods One hundred and sixty-two mothers of 5-year old children, who participated in a study of child self-regulation, completed surveys that assessed sociodemographics, mental health, and perceived social support. The MacArthur Scale of SSS used pictures of ten-rung ladders to assess respondents’ social position in relation to the US (SES ladder) and their community (community ladder). Quantile regression models were used to assess the relationship between maternal psychological distress (perceived social support, depressive symptoms, anxiety) and the ladders (individually and together), adjusting for maternal age, race, education, and number of children. To examine whether the SSS–health relationships differed by race, the models were also stratified by race. Results Community ladder ranking was positively associated with social support (β = 1.34, SE = 0.33, p < .001), and negatively associated with depressive symptoms (β = ?1.34, SE = 0.52, p < .05). SES ladder ranking was positively associated with social support (β = 1.17, SE = 0.52, p < .05). Findings in the full sample were driven by more robust relationships between psychological distress and community SSS among Black/African-American mothers. Discussion The findings suggest that perceived social standing in one’s community is associated with maternal psychological well-being. Community SSS may be particularly influential for Black/African-American mothers’ well-being.     

Childbearing and Economic Work: The Health Balance of Women in Accra,Ghana

Objectives This study aims to investigate (1) whether the health of working women with young children differs from that of working women without young children, and (2) which social factors mediate the relationship between economic and maternal role performance and health among mothers with young children. Methods The analyses uses panel data from 697 women present in both waves of the Women’s Health Study for Accra (WHSA-I and WHSA-II); a community based study of women aged 18 years and older in the Accra Metropolitan Area of Ghana conducted in 2003 and 2008–2009. Change in physical and mental health between the survey waves is compared between women with a biological child alive at WHSA-II and born since WHSA-I and women without a living biological child at WHSA-II born in the interval. To account for attrition between the two survey waves selection models were used with unconditional change score models being used as the outcome model. Results We found in our sample of working women that those who had a child born between WHSA-I and WHSA-II who was still alive at WHSA-II did not experience a change in mental or physical health different from other women. Among working women with young children, educational status, relationship to the household head and household demography were associated with change in mental health at the 5 % level, whilst migration status and household demography was associated with change in physical health scores. Conclusion The results suggest there are no health penalties of combining work and childbearing among women with young children in Accra, Ghana.     

Influential Factors of Puerto Rican Mother–Child Communication About Sexual Health Topics

Introduction Latina mothers play a central role in raising and socializing their children; however, few studies have examined the cultural, socio-cognitive and neighborhood-related variables influencing the level of communication between Puerto Rican mothers and their children about sexuality and sexual health. This cross-sectional study sought to examine these influences. Methods Puerto Rican mothers with children aged 10–19 years (n = 193) were selected randomly for an ethnographic interview as part of a community participatory action research project in a U.S. urban northeastern community. Results Bivariate analyses found statistically significant associations between the child’s age (p = 0.002), the mother’s past communication about traditional gender role norms of women (marianismo) (p < 0.001), her positive outcome expectations for communications with her child (p < 0.025), and her perceptions of the physical condition (p < 0.001) and sexual health problems (p = 0.047) in the neighborhood. In a multivariate model, all of these variables remained significant except sexual health problems, and mother’s attitudes toward the obligations of children to parents (familismo) emerged as a factor associated with a decrease in the number of sexual health topics that mothers raised with their children. No significant effects were found for mother’s spiritual and religious experience (religiosidad). Discussion Our study highlights the importance of marianismo as a framework within which Puerto Rican mothers communicate sexual health information as well as the need to improve mothers’ confidence discussing sexual health issues with their children. Future public health interventions to promote communication about sexuality and sexual health among Puerto Rican mothers should consider addressing this issue as a part of comprehensive neighborhood improvement projects.     

Predictors of paternal and maternal controlling feeding practices with 2- to 5-year-old children

ObjectiveThis study aimed to identify predictors of controlling feeding practices in both mothers and fathers of young children.DesignCross-sectional, questionnaire design.SettingNursery schools within the United Kingdom recruited participants.ParticipantsNinety-six mothers and fathers comprising 48 mother-father pairs of male and female children aged 2 to 5 years.Main Outcome MeasuresParents' child feeding practices, eating psychopathology, general mental health symptomology, and their children's eating behaviors and temperament.AnalysisPreliminary correlations; stepwise regressions.ResultsMaternal controlling feeding was predicted by children's eating behaviors (emotional over- and undereating), child temperament (sociability), and maternal general mental health symptoms. Paternal reports of children's eating behaviors (slow eating and emotional undereating) were the only significant predictors of fathers' controlling feeding practices.Conclusions and ImplicationsMothers' and fathers' feeding practices seem to be better linked to child characteristics than to the presence of eating psychopathology symptoms. Children's emotional eating predicted all 3 controlling feeding practices in mothers and warrants further study to elucidate the causal nature of this relationship.     

Pathways to adolescent childbearing among Kaqchikel women in Guatemala

Abstract

One-in-five children in Guatemala is born to a mother aged 15–19 years, which poses social, economic and health risks to both mother and child. In Guatemala, adolescent childbearing is directly associated with education, ethnicity and poverty, which increases vulnerability among Indigenous young women living in poverty. This study examines the context and experiences of adolescent childbearing from the perspectives of young mothers in the Kaqchikel Indigenous ethnic group of Sololá, Guatemala. Data were collected in 19 qualitative in-depth interviews with women who had given birth to one or more children when aged 15 to 19 years. Grounded theory and narrative analysis were used to develop a conceptual framework of the process and influences on childbearing. Four distinct pathways were identified, which were influenced by gender expectations, limited communication about sex and stigma around sex. The study identifies key sociocultural influences that lead to adolescent childbearing and reveals variability within these. Identifying distinct pathways to early childbearing and their influences enables a clearer understanding of potential opportunities to interrupt these pathways with culturally relevant policies and programmes, in particular those that promote gender equality and intergenerational communication about sex.     

Mothers Who Smoke: Confessions and Justifications

Interviews with mothers who smoke were analyzed to examine the influence of social discourses. Women presented themselves as knowledgeable about the health risks of tobacco, confessed guilt and shame, attempted to deflect accusations of neglect for smoking or exposing their children to tobacco, provided rationalization that they smoked for the sake of their children, and, although they were all smokers, demonstrated an antismoking stance. The findings indicate that mothers are in a “bind” when it comes to smoking and fulfilling societal expectations of a good mother. Health professionals must be cognizant of how discourses constrain women's choices in relation to tobacco.

     

Moms and Media: Exploring the Effects of Online Communication on Infant Feeding Practices

Using a survey of mothers with young children (N = 455), this study applies Fishbein and Ajzen’s reasoned action approach (RAA) to examine the relationship between online communication and infant feeding practices. Contrary to expectations, attitudes, perceived normative pressure, and perceived behavioral control (PBC) did not fully mediate the relationship between time spent online and behavioral intentions. Our findings indicate a significant, direct, negative association between time spent online and breastfeeding intentions In this article, theoretical and practical implications for health communication are discussed.     

Maternal-Child Dyads of Functioning: the Intergenerational Impact of Violence Against Women on Children

Violence against women is a global epidemic with potential consequences of injury, illness, and death. Children exposed to the violence may also be impacted with functional impairments. Little is known of the inter-generational impact of violence experienced by the mother from an intimate partner on functioning of her children. No dyad analysis was found in the literature. To examine the inter-generational impact of violence against women on the behavioral functioning of children, 300 mothers reporting intimate partner abuse and one randomly chosen child, age 18 months to 16 years of age; were evaluated for borderline and clinical diagnostic levels of problem behaviors. Linear, Logistic, and Ordinal regression models were applied. Mothers’ problem behavior scores were significantly related to children’s problem behavior scores (internalizing r = 0.611, externalizing r = 0.494, total problems r = 0.662, all ps < 0.001). Mothers who reported clinical and borderline clinical internalized problems (i.e., depression, anxiety) were 7 times more likely to have children with the same problems and mothers with borderline clinical and clinical external problems (i.e., aggression, hostility) were 4.5 times more likely to have children with the same external problems. These dyadic analyses provide evidence of a direct relationship of maternal functioning on child behavioral functioning. Intervention strategies to decrease internalizing maternal behavioral problems, such as depression, anxiety, and post traumatic stress disorder, and/or externalizing problems, such as hostility and aggression, can be expected to have a pass through, secondary impact on the behavioral functioning of children. Awareness of the relationship between intimate partner violence against mothers and child behavioral function can support interventions that decrease the distress experienced by mothers and their children, interrupt intergenerational transmission of abusive behaviors, and promote better maternal child functioning.     

Perceptions of Body Size in Mothers and Their Young Children in the Galapagos Islands

Introduction Little specific information has been published about the health of people who live in the Galapagos Islands. As part of determining the status of the nutrition transition that may be occurring in the islands mothers of young children in the Galapagos perceptions of their child’s body size and therefore health status was evaluated along with actual body size. Methods This paper presents data collected as part of a pilot study that used a mixed methods approach to identify and describe health and nutrition issues for mother–child pairs on Isla Isabela in Galapagos, Ecuador. It includes participant anthropometric assessment and self-perception of body size using silhouettes for themselves and one of their children along with open-ended questions to elicit further understanding of body size perceptions. Twenty mothers of children greater than 6 months of age but less than 6 years of age were interviewed. Results The women preferred a smaller body size for themselves but a larger body size for their children. Findings of different body size combinations between mothers and children in the same household demonstrated that the island is undergoing or may be post the nutrition transition. Discussion This dual burden of body weights (especially overweight or obese mothers) in the same household with underweight, normal and overweight or obese children and the potential nutrition related chronic disease burden in the future will require more educational resources and innovative health services than are currently available for the people of the Galapagos.     

The Association of Acculturation and Health Literacy, Numeracy and Health-Related Skills in Spanish-speaking Caregivers of Young Children

Little is known about the relationship among acculturation, literacy, and health skills in Latino caregivers of young children. Latino caregivers of children < 30 months seeking primary care at four medical centers were administered measures of acculturation (SASH), functional health literacy (STOFHLA), numeracy (WRAT-3) and health-related skills (PHLAT Spanish). Child anthropomorphics and immunization status were ascertained by chart review. Caregivers (N = 184) with a median age of 27 years (IQR: 23–32) participated; 89.1 % were mothers, and 97.1 % had low acculturation. Lower SASH scores were significantly correlated (P < 0.01) with lower STOFHLA (ρ = 0.21), WRAT-3 (ρ = 0.25), and PHLAT Spanish scores (ρ = 0.34). SASH scores predicted PHLAT Spanish scores in a multivariable linear regression model that adjusted for the age of child, the age and gender of the caregiver, number of children in the family, the type of health insurance of the caregiver, and study site (adjusted β: 0.84, 95 % CI 0.26–1.42, P = 0.005). This association was attenuated by the addition of literacy (adjusted β: 0.66, 95 % CI 0.11–1.21, P = 0.02) or numeracy (adjusted β: 0.50, 95 % CI ?0.04–1.04, P = 0.07) into the model. There was no significant association between acculturation and up-to-date child immunizations or a weight status of overweight/obese. Lower acculturation was associated with worse health literacy and diminished ability to perform child health-related skills. Literacy and numeracy skills attenuated the association between acculturation and child health skills. These associations may help to explain some child health disparities in Latino communities.     

Examining the roles of self-compassion and resilience on health-related quality of life for individuals with Multiple Sclerosis

Background

There are over 400,000 individuals living with Multiple Sclerosis (MS) in the U.S. These individuals experience unpredictable relapses of disabling conditions and poorer quality of life than the general population. Recent literature suggests self-compassion and resilience may improve wellness in this population.

Internalizing symptoms mediate the relationship between sleep disordered breathing and pain symptoms in a pediatric hematology/oncology sample

Objective: To examine caregiver ratings of children’s internalizing symptoms as a potential mediator between sleep disordered breathing and pain symptoms. Caregiver depression/anxiety symptoms were further examined as a potential moderator of the mediation model. Methods: Participants were 96 caregivers (82% mothers) of children with cancer, sickle cell disease, or other hematological conditions (M age = 10.45 years; 46.9% female, 78.1% African American). Caregivers completed questionnaires on child patient symptoms during regular clinic visits. Results: As hypothesized, the effect of sleep on pain (β = 0.31) was reduced (β = 0.15) after accounting for child internalizing symptoms (β = 0.17, 95% confidence interval = 0.03 to 0.42). The indirect effect accounted for 54.8% of the total effect. However, caregiver depression/anxiety symptoms were not a significant moderator of this mediation model. Conclusions: Sleep may play an important role in the experience of pain in children with hematology/oncology conditions. A child’s mood may mediate this relationship.     

Feeding Behaviors and Other Motor Development in Healthy Children (2–24 Months)

Objectives: To monitor infant’s gross, fine and oral motor development patterns related to feeding.

Design: An incomplete block design was used with 57 to 60 (sample=98) mothers interviewed when their children were 2, 3, 4, 6, 8, 10, 12, 16 and 24 months (within ± 5 days of birth date). Each mother had 5 to 6 interviews.

Setting: Selected developmental feeding behaviors were monitored using in-home interviews conducted by trained interviewers (n=2). At each interview, mothers reported the child’s age when behaviors first occurred, and anthropometric measurements were performed.

Subjects: Subjects were healthy white children who lived mostly in homes with educated two-parent families of upper socioeconomic status.

Results: Mean behavioral ages were within normal ranges reported in the literature, whereas individuals exhibited a wide diversity in reported ages. Examples of gross motor skills (age in months, ± SD) included sitting without help (5.50 ± 2.08) and crawling (8.00 ± 1.55). Mean ages for self-feeding fine motor skills showed children reaching for a spoon when hungry (5.47 ± 1.44), using fingers to rake food toward self (8.87 ± 2.58) and using fingers to self-feed soft foods (13.52 ± 2.83). Oral behaviors included children opening their mouth when food approached (4.46 ± 1.37), eating food with tiny lumps (8.70 ± 2.03) and chewing and swallowing firmer foods without choking (12.17 ± 2.28).

Conclusions: Mean ages for feeding behaviors occurred within expected age ranges associated with normal development. However, mothers reported that individual children exhibited a wide age range for achieving these behaviors. Our results should be considered in counseling mothers about infant feeding practices.     

Mother–daughter communication and health: A cross-cultural comparison

Abstract

Mother–daughter communication about health is one of the most important experiences that young women can have to promote a healthy lifestyle, but the success of that communication depends on a variety of factors. Three factors that influence health motivation and behavior were examined in this study: (1) the frequency mothers and daughters communicate about health, (2) the quality of those interactions, and (3) their country. Participants were 168 female college students (74 from Jamaica and 92 from the United States) who completed online surveys regarding the relationship with their mothers, how often they talked with their mother about a variety of health topics, how they were motivated, and how often they engaged in healthy and unhealthy behaviors. Both the frequency and quality of interactions about health were important, but this effect was stronger for Jamaican women than for Americans. Implications for health research regarding culture and relationships are discussed.     

母亲孕期被动吸烟和补充叶酸与其子女孤独症行为的交互作用

目的 探讨母亲孕期被动吸烟和补充叶酸与儿童孤独症行为的交互作用。方法 以2014年深圳市龙华新区新入园的小班（3岁）儿童为研究对象,由家长填写问卷,询问儿童年龄、性别、早产、低出生体重、父母学历、父母生育年龄、家庭收入等,用孤独症行为量表评估儿童孤独症行为,按筛检界值31分和诊断界值62分将儿童分为正常组（<31分）、亚临床组（31～61分）和疑似临床组（≥62分）。控制混杂因素后,采用多分类logistic回归模型,分析孕期母亲被动吸烟和补充叶酸对儿童孤独症行为的主效应和交互作用。结果 孕期母亲被动吸烟与儿童孤独症行为呈正相关（亚临床组：OR=1.48,P<0.05;疑似临床组：OR=2.85,P<0.05）,孕期母亲补充叶酸与儿童孤独症行为的关联无统计学意义（亚临床组：OR=1.04,P>0.05;疑似临床组：OR=0.75,P>0.05）。分层分析显示,孕期母亲未被动吸烟的儿童中,孕期母亲补充叶酸与儿童孤独症行为呈负关联（疑似临床组：OR=0.30,P<0.05）;孕期母亲补充叶酸的儿童中,孕期母亲被动吸烟与儿童孤独症行为显著正关联（亚临床组：OR=1.52,P<0.05;疑似临床组：OR=4.45,P<0.05）。进一步交互作用分析显示,孕期母亲被动吸烟和补充叶酸对儿童孤独症行为疑似临床组的交互作用明显（OR=5.30,P<0.05）。结论 孕期母亲被动吸烟和补充叶酸与儿童孤独症行为关联,且存在交互作用。