Correlates of Unintended Birth Among Low-Income Hispanic Immigrants at High Risk for Depression

Hispanic women, a large and growing ethnic minority group in the U.S., have an unintended birth rate over twice the national average. However, little is known about unintended birth among Hispanic immigrants. The purpose of this study is to determine the sociodemographic, including immigration-related, correlates of unintended birth in this population. Data were collected as part of a preventive intervention among pregnant Hispanic immigrants at increased risk for depression (n = 215). The correlates of women’s self-reported pregnancy intention (intended, mistimed, unwanted) were examined using multinomial logistic regression. Similar to nationally representative findings, unintended birth was more common among younger women, single women and women not cohabiting with their partners, and women with more children. Additionally, women who had immigrated to the U.S. less than 1 year ago had almost a 4 times greater risk of a mistimed birth (RRR = 3.82, P < 0.05) compared to women who immigrated 1–4 years ago. Women with greater social support scores had a reduced chance of mistimed (RRR = 0.98, P < 0.10) and unwanted (RRR = 0.97, P < 0.05) birth. The findings have implications for development of effective and culturally appropriate family planning programs. They suggest that interventions should target young women, women who have achieved their desired family size, and very recent immigrants.     

Coping Styles and Depression Among Undocumented Hispanic Immigrants

This cross-sectional study examined coping strategies and their relationship with depression among undocumented Hispanic immigrants. A community sample of 122 self-identified undocumented Hispanics filled out questionnaires measuring coping and depression. The authors categorized coping strategies as problem-focused, active-emotional, or avoidant-emotional. Findings indicated that coping through “prayer and meditation” (problem-focused), “get comfort from someone” (active-emotional), and “see bad things positively” (active-emotional) were more frequently used by undocumented Hispanics. Contrary to past research and predictions, problem-focused and active-emotional coping were both positively related to depression. What is more, problem-focused coping accounted for additional variance of depression above and beyond active-emotional coping. The insoluble nature of many of the problems faced by undocumented immigrants may explain the counterintuitive finding that as problem-focused and active-emotional coping increased, so too did depression.     

Experiences of Discrimination and Depression Trajectories over Pregnancy

IntroductionResearch on risk factors for prenatal depression is critical to improve the understanding, prevention, and treatment of women's psychopathology. The current study examines the relation between experiences of racial discrimination and trajectories of depression symptoms over the course of pregnancy.MethodParticipants completed standardized measures regarding symptoms of depression at four timepoints during pregnancy and reported on experiences of racial discrimination at one timepoint. Latent growth curve modeling was used to examine the relation between discrimination and initial levels (intercept) and trajectories (slope) of depression symptoms over pregnancy.ResultsParticipants were 129 pregnant individuals recruited from obstetric clinics and oversampled for elevated depression symptoms. Thirty-six percent of the participants were living at or below 200% of the federal poverty line. Fifty-four percent of the sample identified as non-Latinx White, 26% as Latinx, and 13% as non-Latinx Black. An unconditional latent growth curve modeling revealed a negative quadratic trajectory of depression symptoms during pregnancy. When women's report of discrimination was added as a predictor of depression trajectories, discrimination predicted the initial value (intercept) of depression symptoms, but not change over the course of pregnancy (slope). Specifically, higher levels of experiences of discrimination were associated with higher levels of depression symptoms. When sociodemographic and contextual covariates were included in the model, a low family income-to-needs ratio was also related to higher levels of depression symptoms.ConclusionsThese findings provide evidence that women's experiences of racial discrimination and family financial strain are risk factors for prenatal depression, with implications for screening, treatment, and policy.     

A Rural Perspective on Perinatal Depression: Prevalence, Correlates, and Implications for Help-Seeking Among Low-Income Women

ABSTRACT:  Context/Purpose: To examine a low-income sample of women in the rural Midwest (N = 1,086) who were screened for perinatal depression through the outreach and education activities within a Healthy Start Initiative project. Specifically, we describe the frequency and severity of depressive symptoms, explore social and demographic correlates of depression, and examine help-seeking through patterns of self-referral to a Healthy Start perinatal depression project in a rural, medically underserved community. Methods: Depression screening data using the Primary Care Evaluation of Mental Disorders (PRIME-MD) as well as intake records from the project were analyzed in a retrospective analysis to identify important demographic and psychosocial characteristics associated with elevated levels of depressive symptoms and help-seeking patterns. Findings: Thirty-six percent of screened women met criteria for major, minor, or subthreshold depression, with 13% meeting diagnostic criteria for major depression alone. Less than 8% were currently receiving any type of mental health services or treatment at screening. The most significant correlate of self-referral to the Healthy Start project was meeting symptom criteria for major depression, although minor depression, subthreshold depression, and status as low-income /Temporary Aid to Needy Families ( TANF)-eligible were all significantly associated with self-referral. Conclusions: The findings from this study highlight the potential significance of identifying and addressing the unmet mental health needs of low-income rural women during and around pregnancy. In addition, the study illustrates that low income, in addition to depressive symptoms, impacts mental health service delivery in this rural community with a fragmented mental health service infrastructure .     

High-Risk Nutrient Intakes Among Low-Income Mexican Women in Chicago, Illinois

Objectives The Cross-sectional Cooking, Eating, Nutrition, and Shopping (CENAS) Survey was used to obtain data on food consumption patterns of low-income Mexicans living in Chicago, Ill.

Design As part of the CENAS Survey, 186 Mexican women provided 24-hour dietary recall data.

Outcome measures Distributions of macronutrient and micronutrient intakes were determined. The proportions of CENAS Survey participants achieving the National Heart Association and National Cancer Institute dietary guidelines were calculated. Intakes of Mexican women in Chicago were compared with intakes of Mexican women of similar socioeconomic status in Texas, Mexican-American women participating in phase 1 of the third National Health and Nutrition Examination Survey (1988-1991), and Mexican-American women participating in the Hispanic Health and Nutrition Examination Survey (1982-1984).

Statistical analysis t Tests were used to compare the nutrient intakes of CENAS Survey respondents with published results from other studies.

Results The proportion of respondents reporting intakes less than two thirds of Recommended Dietary Allowances for nine micronutrients ranged from 11% (thiamin and riboflavin) to 82% (folacin). Respondents also reported median fat (34% of energy) and fiber (16.9 g/day) intakes that departed from recommendations to reduce the risk of heart disease and cancer.

Applications and conclusions Half or more of the Mexican women interviewed in Chicago reported inadequate consumption of calcium, folate, zinc, and iron; higher than recommended intakes of fats; and lower than recommended intakes of fiber, indicating the need for nutrition education and intervention. Their nutrient consumptions differed significantly from those of Mexican-American women in the United States, suggesting possible regional or temporal variation in dietary patterns and underscoring the need for population-specific interventions. J Am Diet Assoc, 1995; 95:1409-1413.     

Six-Month Outcomes from a Randomized Controlled Trial to Prevent Perinatal Depression in Low-Income Home Visiting Clients

Perinatal depression (PD) has negative consequences for mothers and children and is more prevalent among women of low socioeconomic status. Home visitation programs serve low-income pregnant women at risk for PD. This study tested the efficacy of a group-based cognitive behavioral intervention (Mothers and Babies Course; MB) in reducing depressive symptoms and preventing the onset of perinatal depression among low-income women enrolled in home visitation. A randomized controlled trial was conducted. Seventy-eight women who were pregnant or had a child less than 6 months of age and who were assessed as at risk for PD were randomized to the MB intervention or usual home visiting services. Depressive symptoms were assessed at baseline and 1-week, 3- and 6-months post-intervention; depressive episodes were assessed with a clinical interview at the 6-month follow-up. Depressive symptoms declined at a significantly greater rate for intervention participants than usual care participants between baseline and 1-week, 3 and 6 months post-intervention. At the 6-month follow-up, 15 % of women who received the MB intervention had experienced a major depressive episode as compared with 32 % of women receiving usual care. Integrating mental health interventions into home visitation appears to be a promising approach for preventing PD. Cognitive behavioral techniques can be effective in preventing depression in perinatal populations and treating it.     

The Food Stamp Program and Low-Income Legal Immigrants

Editors' note: In 1996, the U.S. Congress passed the Personal Responsibility and Work Opportunity Reconciliation Act, which had as one of its effects the withdrawal of food stamp eligibility for many legal immigrants. The following analysis from the Tufts University Center on Hunger, Poverty, and Nutrition Policy examines the nutritional impact of this legislation on legal immigrants and discusses the arguments for restoration of these nutritional benefits. At press time, the U.S. Congress had just passed legislation to restore food stamp benefits to many legal immigrants.     

Food Hardship and Obesity in a Sample of Low-Income Immigrants

Very little work has examined the relationship between food hardship (having inconsistent financial resources to buy food) and obesity among immigrant groups. A cross-sectional study was conducted in a low-income, multi-racial/ethnic adult sample in greater Boston, MA (n = 828). Modified Poisson regression models estimated the association between food hardship obesity (BMI ≥ 30) among adults reporting food hardship; interactions were tested by place of birth. Body mass index (BMI) was based on anthropometric height and weight. In adjusted models, those experiencing food hardship were more likely to be obese (RR 1.17, CI 1.07, 1.29) than those not experiencing food hardship. Participants from Haiti reporting food hardship were more likely to be obese than those not reporting hardship (RR 1.58, CI 1.23, 2.04); this was not the case among other groups (US born, Puerto Rican, Latin American, Other). The relationship between food hardship and weight may vary among immigrant subgroups.     

Neighborhood and Individual-Level Violence and Unintended Pregnancy

As many as half of all pregnancies are unintended, and unintended pregnancy has been linked to a variety of adverse pregnancy and infant health outcomes. Our aim was to determine if urban women who experience high levels of neighborhood and/or individual-level violence are at an increased risk of reporting an unintended pregnancy. One thousand five hundred thirty-six pregnant women seeking care in an emergency department in Philadelphia, Pennsylvania were recruited in their first or second trimester and completed in-person interviews. Information on demographic characteristics, social support, substance abuse, current experience and history of interpersonal violence, perceptions of current neighborhood-level violence, and the intendedness of their current pregnancy were gathered. Multiple logistic regression analyses were conducted to assess the relationship between violence indicators and pregnancy intendedness. Six hundred twenty-seven women (41%) reported an unintended pregnancy. Not feeling safe in one's neighborhood was significantly associated with reporting an unintended pregnancy (odds ratio (OR), 1.28; 95% confidence interval (CI), 1.02–1.61) when demographic, other neighborhood, and individual-level violence indicators were accounted for. Furthermore, history of sexual abuse (OR, 1.5; 95% CI, 1.11–2.04), violence in previous pregnancy (OR = 1.7, 95% CI, 1.15–2.51), and a high index of spousal abuse score (OR = 1.6; 95% CI, 1.32–2.04) were also associated with unintended pregnancy in multiple logistic regression models. These findings indicate that neighborhood-level violence and other individual-level violence indicators may be important when examining factors related to unintended pregnancy among young, urban women.     

Socioeconomic Inequalities in Unintended Pregnancy and Abortion Decision

Pregnancy planning allows women to better control their life trajectory and contributes to the future child’s health and development. Many studies that have analyzed socioeconomic inequalities in unintended pregnancy only took into account those pregnancies ending in births. Few of them that analyzed unintended pregnancy, including both induced abortion and births, and its socioeconomic determinants, concluded that unintended pregnancy is more frequent in young, poor, or unmarried women. These inequalities have been poorly studied in Europe, especially in the southern European context. The aim of the present study is to describe socioeconomic inequalities in unintended pregnancy and in abortion decision in Barcelona, Spain. The major findings are that unintended pregnancies accounted for 41% of total pregnancy and of these, 60% ended in abortion. From all pregnancies, the proportion of induced abortion reached 25.6%. Compared to women with university studies, those with primary education uncompleted had more unintended pregnancies (OR = 7.22). When facing an unintended pregnancy, women of lower socioeconomic position are more likely to choose induced abortion, although this is not the case among young or single women. This study reveals deep socioeconomic inequalities in unintended pregnancies and abortion decision in Barcelona, Spain, where the birth rate is very low and the abortion rate is rising. Women in low socioeconomic positions have many more unintended pregnancies than better educated women. Except for young or single women, the lower the socioeconomic position, the higher the proportion of women who choose an induced abortion when facing an unintended pregnancy. Font-Ribera, Pérez, Salvador, and Borrell are with the Health Information Service, Agency of Public Health of Barcelona, Barcelona, Spain; Pérez and Borrell are with the University Pompeu Fabra, Barcelona, Spain; Pérez and Borrell are with the CIBER in Epìdemiology and Public Health (CIBERESP), Barcelona, Spain; Pérez is with the Agency of Public Health of Barcelona, Barcelona, Spain.     

Unintended Pregnancy in a Commercially Insured Population

Objectives: While much attention has been focused on unintended pregnancy in disadvantaged populations, few studies have focused on women in lower risk groups. This study, conducted in a national managed care organization, reports the prevalence of unintended pregnancy resulting in live births and examines associated factors. Methods: Women ages 18–49 who delivered a live infant during a 6-month interval were eligible for the study. Telephone surveys were conducted after delivery. We report the rate of unintended pregnancy resulting in a live birth, and describe its association with sociodemographic and pregnancy-related factors, partner's intention status, and contraceptive use. Results: Of 1173 births, 29% were unintended. Women who reported that the partner did not want the pregnancy were 7.4 times more likely than women whose partner wanted the pregnancy to regard the pregnancy as unintended. Only 40% of the women with an unintended birth used birth control and 64% of those used less effective methods such as condoms and diaphragms. Conclusions: In a population where the majority of women were married, educated, and with incomes over $40,000, almost 1/3 of the births resulted from unintended pregnancies. Future research is needed to help us better understand contradictions in pregnancy intention and contraceptive behavior. Comprehensive efforts are needed to promote consistent and correct use of contraception by women at risk for unintended pregnancy, and to involve male partners in family planning.     

Correlates of Prenatal Diet Quality in Low-Income Hispanic Women

BackgroundLow-income Hispanic women are at-risk of poor prenatal diet quality. Correlates associated with prenatal diet quality in this group of women are understudied.ObjectiveThe objective of this study was to examine the associations between financial, cultural, psychosocial, and lifestyle correlates and prenatal diet quality in low-income Hispanic women.DesignThis cross-sectional analysis used data from pregnant women enrolled in the Starting Early Trial, a randomized-controlled trial of a primary-care based child obesity prevention program beginning in pregnancy. The trial enrolled women from clinics affiliated with a large urban medical center in New York City from 2012 to 2014. Financial, cultural, psychosocial, and lifestyle variables were collected using a comprehensive baseline questionnaire. Usual dietary intakes over the past year were assessed using the Block Food Frequency Questionnaire 2005 bilingual version.ParticipantsThe study enrolled low-income Hispanic women between 28 and 32 gestational weeks (N=519).Main outcome measuresPrenatal diet quality was measured by the Healthy Eating Index 2015.Statistical analyses performedUnadjusted and adjusted multivariable linear regression analyses were performed to determine independent associations between financial, cultural, psychosocial, and lifestyle correlates and Healthy Eating Index 2015 total score.ResultsOverall prenatal diet quality was poor (mean Healthy Eating Index 2015 total score=69.0±9.4). Most women did not meet the maximum score for total vegetables (65.3%), whole grains (97.1%), dairy (74.8%), fatty acids (84.4%), refined grains (79.8%), sodium (97.5%), saturated fats (92.9%), and added sugars (66.5%). Women who reported screen time ≤2 hours/day, physical activity before and/or during pregnancy, and being born outside the United States had higher mean Healthy Eating Index 2015 total score than women with screen time >2 hours/day, no physical activity, and those born in the United States.ConclusionsPrenatal diet quality of low-income pregnant Hispanic women was suboptimal. This cross-sectional study revealed associations between cultural and lifestyle factors and prenatal diet quality in low-income Hispanic women. Longitudinal studies are needed to determine long-term influences and specific behaviors to target for effective intervention studies.     

Depression and Its Correlates Among Brazilian Immigrants in Massachusetts,USA

The goal of this paper is to assess the frequency of depression symptoms among Brazilian immigrants living in Massachusetts, the second largest Brazilian immigrant population in the United States, and to identify correlates of depression. A convenience sample of Brazilian immigrants aged 18 or older residing in Massachusetts was used. Data were collected from December 2013 to March 2014, in the Consulate General of Brazil in Boston and in three religious events, using a structure questionnaire and the Center for Epidemiological Studies Depression Scale (CES-D). Depression symptoms were observed in 35.3% of the respondents, with equal distribution by sex. Correlates of depression were low income, being single, poor English proficiency, and poor self-perception of health. These results suggest a need for community outreach, sensitization, and counseling, in Portuguese and adapted to the culture of Brazilian immigrants.     

Gender Distrust and Intimate Unions among Low-Income Hispanic and African-American Women

We investigate levels of generalized distrust of men among low-income African American, Mexican, Puerto Rican, Dominican, and non-Hispanic white women in a three-city survey. The results reveal substantial variation. We find Hispanics' overall levels of distrust to be higher than levels for either African Americans or whites. Among Hispanics, however, Dominicans are the most distrusting group followed by Puerto Ricans; whereas Mexicans report levels of distrust that are comparable to African Americans and non-Hispanic whites. Married women are less distrusting than cohabiting women who, in turn, are less distrusting than non-cohabiting women. Nevertheless, distrust is not a significant predictor of a woman's total number of lifetime marital and cohabiting relationships; and distrust only marginally predicts a woman's desire to be in a steady relationship. We suggest that studies of trust in this population should focus more on attitudes displayed in specific encounters than on overall, generalized attitudes about gender distrust.     

Knowledge of Depression and Depression Related Stigma in Immigrants from Former Yugoslavia

The aim of the current research was to assess and compare level of depression literacy and level of depression related stigma in first generation immigrants from former Yugoslavia (FY) with a same aged Anglo Australian (AA) sample. The community sample comprised of 54 immigrants born in the FY and 54 AA born participants living in Melbourne. Participants were recruited through various social and recreational clubs. All participants completed questionnaires assessing depression literacy, self and perceived stigma and level of acculturation for the immigrants from FY in an interview format. After controlling for level of education, immigrants from the FY demonstrated lower depression literacy and higher personal and perceived depression stigma scores compared to the AA participants. The findings provide further insight to potential barriers impeding access to mental health care in immigrant populations living in Australia. Implications for mental health professionals working with immigrant populations in Australia are discussed.     

Pilot of a Diabetes Primary Prevention Program in a Hard-to-Reach,Low-Income,Immigrant Hispanic Population

An immigrant Hispanic population in the Texas-Mexico border region urgently requested assistance with diabetes. The project team implemented an exploratory pilot intervention to prevent type 2 diabetes in the general population through enhanced nutrition and physical activity. Social networks in low-income rural areas (colonias) participated in an adaptation of the Diabetes Empowerment Education Program. The program had a pre-post-test design with a comparison group. The intervention had a small but significant effect in lowering body mass index, the biological outcome variable. The process evaluation shows that the participants valued the pilot project and found it culturally and economically appropriate. This program was the first primary prevention program in diabetes to address a general population successfully. The study shows that low-income, rural Mexican American families will take ownership of a program that is participatory and tailored to their culture and economic situation.     

Legal Status,Worries About Deportation,and Depression Among Asian Immigrants

Journal of Immigrant and Minority Health - Although legal status and worries of deportation have been identified as key factors in immigrant health inequities for Latinx immigrants, how they impact...