Non-Hispanic White Women’s Exposure to Decreased Neighborhood Income and Small for Gestational Age Births: A Population-Based Study

Maternal and Child Health Journal - The relationship between non-Hispanic White (NHW) women’s decreased neighborhood income between early-life and adulthood, individual risk-status at...     

Women’s Lifelong Exposure to Neighborhood Poverty and Low Birth Weight: A Population-Based Study

Objective To determine whether women’s lifelong residential environment is associated with infant low birth weight. Methods We performed race-specific stratified and multivariate binomial regression analyses on an Illinois vital record dataset of non-Latino White and African-American infants (1989–1991) and their mothers (1956–1975) with appended United States census income information. Results Non-Latino White women (N = 267) with a lifelong residence in low-income neighborhoods had a low birth weight (<2,500 g) incidence of 10.1% vs. 5.1% for White women (N = 10,647) with a lifelong residence in high-income neighborhoods; RR = 2.0 (1.4–2.9). African-American women (N = 18,297) with a lifelong residence in low-income neighborhoods had a low birth weight incidence of 17% vs. 11.7% for African-American women (N = 546) with a lifelong residence in high-income areas; RR = 1.5 (1.2–1.8). The adjusted population attributable risk (PAR) percent of LBW for lifelong residence in low-income neighborhoods was 1.6% for non-Latino White and 23.6% for African-American women. Conclusions Non-Latino White and African-American women’s lifelong residence in low-income neighborhoods is a risk factor for LBW; however, African-Americans experience a greater public health burden from this phenomenon.     

African-American women’s Upward Economic Mobility and Small for Gestational Age Births: A Population-Based Study

Background The relationship between African-American women’s upward economic mobility and small for gestational age (weight for gestational?<?10th percentile, SGA) rates is incompletely understood. Objective To ascertain the extent to which African-American women’s upward economic mobility from early-life impoverishment is coupled with reduced SGA rates. Methods Stratified and multilevel logistic regression analyses were completed on the Illinois transgenerational dataset of African-American infants (1989–1991) and their Chicago-born mothers (1956–1976) with linked U.S. census income information. Results Impoverished-born (defined as lowest quartile of neighborhood income distribution) African-American women (n?=?4891) who remained impoverished by the time of delivery had a SGA rate of 19.7%. Individuals who achieved low (n?=?5827), modest (n?=?2254), or high (n?=?732) upward economic mobility by adulthood had lower SGA rates of 17.2, 14.8, and 13.7%, respectively; RR?=?0.9 (0.8–0.9), 0.8 (0.7–0.8), and 0.7 (0.6–0.8), respectively. In adjusted (controlling for traditional individual-level risk factors) multilevel regression models, there was a decreasing linear trend in SGA rates with increasing levels of upward economic mobility; the adjusted RR of SGA birth for impoverished-born African-American women who experienced low, modest, of high (compared to no) upward mobility equaled 0.95 (0.91, 0.99), 0.90 (0.83, 0.98), and 0.86 (0.75, 0.98), respectively, p?<?0.05. Conclusions African-American women’s upward economic mobility from early-life residence in poor urban communities is associated with lower SGA rates independent of adulthood risk status.     

It’s Alive: Microbes and Cells in Human Milk and Their Potential Benefits to Mother and Infant

Human milk is the optimal source of nutrition for the nursing infant. Classically, the nutrients (water, protein, lipid, carbohydrate, vitamins, and minerals) were studied as the critical components of milk serving the growth needs of the infant for optimum growth. However, human milk contains factors other than the classically defined nutrients for which researchers are investigating potential roles in infant and maternal health, development, and well-being. The symposium addressed some of the exciting factors being studied, including microbes and maternal cells found within milk. Drs. Michelle McGuire and Juan M. Rodríguez addressed the presence of a bacterial community in human milk produced by healthy and mastitic mothers, potential sources of those bacteria, and the impact of milk-derived bacteria on the nursing infant. Drs. Donna Geddes, Peter Hartmann, and Foteini Hassiotou discussed the potential importance of maternal cells. For years, immune cells were known to be present in human milk, but recent evidence suggests that their impact is as much on the infant as on the health of the lactating mammary gland. Finally, the existence of highly plastic stem cells in human milk opens doors for previously unforeseen developmental “training” of the nursing infant.     

Women’s Autonomy in Infant Feeding Decision-Making: A Qualitative Study in Nairobi,Kenya

Maternal and Child Health Journal - Exclusive breastfeeding (EBF) is the optimal way to feed young infants. Guidelines recommend that women living with HIV on antiretroviral therapy should EBF for...     

Mother’s Self-Efficacy Mediates the Relationship Between Household Food Insecurity and Maternal Infant Feeding Styles

Objectives This study was performed to examine the association between household food insecurity, self-efficacy and infant feeding styles in mothers with children under 2 years old in Varamin, Iran. Methods In this cross-sectional study, 423 mothers aged 17–40 years from different areas of Varamin were selected by a multistage sampling methods from October 2013 to February 2014. The questionnaires consisted of three valid instruments, including: Household Food Insecurity Access Scale, Comprehensive Feeding Practices Questionnaire and Mother’s Self-Efficacy Questionnaire. Data were analyzed using Chi-square, t tests, ANOVA, Pearson correlations and multiple linear regressions. Structural equation modeling was also used. Results Mild and moderate–severe food insecurity was observed in 39.5 and 12.8 % of the households respectively. Mean score of mother’s self-efficacy in food secure households was 32.5 ± 3.7; while in mild food insecure and moderate–severe food insecure households were 31.9 ± 3.1 and 28.4 ± 4.0, respectively (P = 0.001). There was a significant negative correlation between household food insecurity and mother’s self-efficacy (r = ?0.297, P < 0.01). Significant correlation was seen between mother’s self-efficacy and the maternal infant feeding styles. Household food insecurity and mother’s self-efficacy had significant relationship with mother-infant feeding styles: control of home food access [β (SE)] = [?0.015(0.004), P = 0.001]; restriction for weight control [β = 0.038(0.013), P = 0.003]; restriction for health [β = 0.019(0.008), P = 0.027] and encouragement [=0.018(0.006), P = 0.001]. The model had sufficient fitness with data of the research (CFI = 0.927, RMSEA = 0.076). Conclusions Our findings suggest that performing interventions in order to enhance mother’s self-efficacy in food insecure households can lead to improve positive maternal feeding behaviors.     

Interpregnancy Intervals and the Risk for Infant Mortality: A Case Control Study of Arizona Infants 2003–2007

There is well-documented evidence on how interpregnancy interval (IPI) is associated with adverse perinatal outcomes and how short and long IPIs are associated with increased risk for preterm birth, low birth weight, and intra-uterine growth restriction. However, the extremes of IPI on infant mortality are less well documented. The current study builds on the existing evidence on IPI to examine if extremes of IPI are associated with infant mortality, and also examines if IPI is associated with both neonatal and post-neonatal mortality after adjusting for several known confounders. Matched birth and death certificate data for Arizona resident infants was drawn for 2003–2007 cohorts. The analysis was restricted to singleton births among resident mothers with a previous live birth (n = 1,466) and a randomly selected cohort of surviving infants during the same time-frame was used as a comparison group (n = 2,000). Logistic regression models were utilized to assess the odds for infant mortality at monthly interpregnancy intervals (<6, 6–11, 12–17, 18–23, 24–59, ≥60), while adjusting for established predictors of infant mortality (i.e., preterm birth, low birth weight, and small for gestational age), and other potential confounders. Unadjusted analysis showed greater clustering at extreme IPIs of <6 months and ≥60 months for infants that died (32 %) compared to infants that survived (24.7 %). Shorter IPI (i.e., <6 months, 6–11 months, and 12–17 months) compared to ‘ideal’ IPI (i.e., 18–23 months), were associated with infant mortality even after adjusting for confounders. Short intervals were significantly associated with neonatal, but not post-neonatal deaths. IPI above 23 months were not associated with infant mortality in our analyses. Shorter IPIs (18 months or less) significantly increases the risk for neonatal infant mortality even after controlling for known confounders, and our study adds to the existing evidence on adverse perinatal outcomes. Counseling women of reproductive age on the benefits of spacing pregnancies to at least 18 months addresses one preventable risk for early infant mortality.     

Does Air Pollution Trigger Infant Mortality in Western Europe? A Case-Crossover Study

Background: Numerous studies show associations between fine particulate air pollutants [particulate matter with an aerodynamic diameter ≤ 10 μm (PM₁₀)] and mortality in adults.Objectives: We investigated short-term effects of elevated PM₁₀ levels on infant mortality in Flanders, Belgium, and studied whether the European Union (EU) limit value protects infants from the air pollution trigger.Methods: In a case-crossover analysis, we estimated the risk of dying from nontraumatic causes before 1 year of age in relation to outdoor PM₁₀ concentrations on the day of death. We matched control days on temperature to exclude confounding by variations in daily temperature.Results: During the study period (1998–2006), PM₁₀ concentration averaged 31.9 ± 13.8 μg/m³. In the entire study population (n = 2,382), the risk of death increased by 4% [95% confidence interval (CI), 0–8%; p = 0.045] for a 10-μg/m³ increase in daily mean PM₁₀. However, this association was significant only for late neonates (2–4 weeks of age; n = 372), in whom the risk of death increased by 11% (95% CI, 1–22%; p = 0.028) per 10-μg/m³ increase in PM₁₀. In this age class, infants were 1.74 (95% CI, 1.18–2.58; p = 0.006) times more likely to die on days with a mean PM₁₀ above the EU limit value of 50 μg/m³ than on days below this cutoff.Conclusions: Even in an affluent region in Western Europe, where infant mortality is low, days with higher PM air pollution are associated with an increased risk of infant mortality. Assuming causality, the current EU limit value for PM₁₀, which may be exceeded on 35 days/year, does not prevent PM₁₀ from triggering mortality in late neonates.     

Traffic-Related Air Pollution and Perinatal Mortality: A Case–Control Study

Background

Ambient levels of air pollution may affect the health of children, as indicated by studies of infant and perinatal mortality. Scientific evidence has also correlated low birth weight and preterm birth, which are important determinants of perinatal death, with air pollution. However, most of these studies used ambient concentrations measured at monitoring sites, which may not consider differential exposure to pollutants found at elevated concentrations near heavy-traffic roadways.

Objectives

Our goal was to examine the association between traffic-related pollution and perinatal mortality.

Methods

We used the information collected for a case–control study conducted in 14 districts in the City of São Paulo, Brazil, regarding risk factors for perinatal deaths. We geocoded the residential addresses of cases (fetal and early neonatal deaths) and controls (children who survived the 28th day of life) and calculated a distance-weighted traffic density (DWTD) measure considering all roads contained in a buffer surrounding these homes.

Results

Logistic regression revealed a gradient of increasing risk of early neonatal death with higher exposure to traffic-related air pollution. Mothers exposed to the highest quartile of the DWTD compared with those less exposed exhibited approximately 50% increased risk (adjusted odds ratio = 1.47; 95% confidence interval, 0.67–3.19). Associations for fetal mortality were less consistent.

Conclusions

These results suggest that motor vehicle exhaust exposures may be a risk factor for perinatal mortality.     

A Child’s View: Social and Physical Environmental Features Differentially Predict Parent and Child Perceived Neighborhood Safety

Parent and child perceived neighborhood safety predicts child health outcomes such as sleep quality, asthma, physical activity, and psychological distress. Although previous studies identify environmental predictors of parent perceived safety, little is known about predictors of child perceived safety. This study aims to identify the social and physical environmental neighborhood features that predict child and parent perceived neighborhood safety and, simultaneously, to assess the association between child and parent perceptions. Data were from the QUebec Adipose and Lifestyle InvesTigation in Youth (QUALITY) cohort, an ongoing study of Caucasian children (aged 8–10 years) with a parental history of obesity, and their biological parents from Québec, Canada. Measures of social and physical neighborhood features were collected using a spatial data infrastructure and in-person audits. Structural equation modeling was used to test direct and indirect associations between neighborhood features, child and parent perceived safety. Results suggest that among children (N = 494), trees and lighting were positively associated with perceived neighborhood safety, whereas a high proportion of visible minorities was associated with poorer perceived safety. Parents’ perceptions of safety were more strongly tied to indicators of disorder and a lack of community involvement, and to traffic. Child perceived safety was partly explained by parent perceived safety, suggesting moderate concordance between perceptions. Although associated with each other, parent and child perceived safety seemed to be determined by distinct environmental features. Though this study focused on determinants of child and parent perceived safety, future research investigating the impact of neighborhood safety on child health should consider both child and parent perspectives.     

Occupational Exposure to Benzene and Non-Hodgkin Lymphoma in a Population-Based Cohort: The Shanghai Women’s Health Study

Background

The association between benzene exposure and non-Hodgkin lymphoma (NHL) has been the subject of debate as a result of inconsistent epidemiologic evidence. An International Agency for Research on Cancer (IARC) working group evaluated benzene in 2009 and noted evidence for a positive association between benzene exposure and NHL risk.

Objective

We evaluated the association between occupational benzene exposure and NHL among 73,087 women enrolled in the prospective population-based Shanghai Women’s Health Study.

Methods

Benzene exposure estimates were derived using a previously developed exposure assessment framework that combined ordinal job-exposure matrix intensity ratings with quantitative benzene exposure measurements from an inspection database of Shanghai factories collected between 1954 and 2000. Associations between benzene exposure metrics and NHL (n = 102 cases) were assessed using Cox proportional hazard models, with study follow-up occurring from December 1996 through December 2009.

Results

Women ever exposed to benzene had a significantly higher risk of NHL [hazard ratio (HR) = 1.87, 95% CI: 1.19, 2.96]. Compared with unexposed women, significant trends in NHL risk were observed for increasing years of benzene exposure (p_trend = 0.006) and increasing cumulative exposure levels (p_trend = 0.005), with the highest duration and cumulative exposure tertiles having a significantly higher association with NHL (HR = 2.07, 95% CI: 1.07, 4.01 and HR = 2.16, 95% CI: 1.17, 3.98, respectively).

Conclusions

Our findings, using a population-based prospective cohort of women with diverse occupational histories, provide additional evidence that occupational exposure to benzene is associated with NHL risk.

Citation

Bassig BA, Friesen MC, Vermeulen R, Shu XO, Purdue MP, Stewart PA, Xiang YB, Chow WH, Zheng T, Ji BT, Yang G, Linet MS, Hu W, Zhang H, Zheng W, Gao YT, Rothman N, Lan Q. 2015. Occupational exposure to benzene and non-Hodgkin lymphoma in a population-based cohort: the Shanghai Women’s Health Study. Environ Health Perspect 123:971–977; http://dx.doi.org/10.1289/ehp.1408307     

Children’s Exposure to Metals: A Community-Initiated Study

In 2007, it was shown that the shipping of lead (Pb) through Esperance Port in Western Australia resulted in contamination and increased Pb concentrations in children. A clean-up strategy was implemented; however, little attention was given to other metals. In consultation with the community, a cross-sectional exposure study was designed. Thirty-nine children aged 1 to 12 years provided samples of hair, urine, drinking water, residential soil and dust. Concentrations of nickel (Ni) and Pb were low in biological and environmental samples. Hair aluminium (Al) (lower than the detection limit [DL] to 251 μg/g) and copper (Cu) (7 to 415 μg/g), as well as urinary Al (<DL to 210 μg/L), manganese (Mn) (<DL to 550 μg/L), and Cu (<DL to 87 μg/L), were increased for a small number of participants. Concentrations of nickel (Ni) in urine, soil, and dust decreased with increasing distance from the port, as did soil Pb concentrations. The results suggest exposure to Ni and Pb was limited in children at the time of sampling in 2009. Further investigation is required to determine the source(s) and significance of other increased metals concentrations.     

Evaluating Latino WIC Mothers’ Perceptions of Infant’s Healthy Growth: A Formative Assessment

Objectives This article reports on a formative assessment with Latino mothers in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) evaluating knowledge, attitudes and behaviors regarding healthy growth for infants and their understanding of infant growth monitoring. Further, we explored the acceptability and feasibility of mothers’ monitoring their infants’ growth. This assessment includes healthy growth perceptions from mothers, caregivers and from WIC staff. Methods Utilizing a mixed method approach, this assessment included qualitative focus groups with WIC mothers that included a growth chart plotting exercise and a quantitative survey. In-depth interviews with clinic staff discussing protocols used in assessing children’s growth were also conducted in one WIC clinic. Results Focus group participants included 34 mothers and 19 caregivers with a mean age of 32 years; 90 % identified as Latino. Themes included concern for underweight status, and reports of limited conversations between mothers and healthcare providers regarding overweight status, and infant feeding practices/beliefs that may contribute to feeding behaviors associated with risk for excess weight gain during infancy. Growth charts were well received, mothers were able to plot with modest accuracy; but effectiveness of growth plotting might be limited without refinement for health literacy and the provision of culturally-sensitive education in relation to feeding behaviors to support healthy infant growth. Conclusions This represents a first effort in evaluating Latino mothers’ perceptions of infants’ healthy growth and use growth charts as a potential tool that can help prevent excess weight gain in early infancy.     

Maternal Pre-Gravid Obesity and Early Childhood Respiratory Hospitalization: A Population-Based Case–Control Study

Inflammation in utero is linked to childhood respiratory and infectious complications. Obesity is an increasingly common chronic inflammatory state, yet little is known about its role in childhood respiratory illness. We sought to examine the association between maternal pre-gravid BMI and early childhood respiratory hospitalization. We conducted a population-based case–control study using the Washington State Comprehensive Hospital Abstract Reporting System and linked birth certificate data. Cases were children age 0–5 years, born in Washington state, with a respiratory hospitalization between 2003 and 2008. We identified 15,318 cases, frequency matching each case to two controls by birth year (total 31,060 controls). We used logistic regression to estimate the risk (approximated by odds ratios) of early childhood respiratory hospitalization according to maternal pre-gravid body mass index (BMI) category (underweight, normal, overweight, obese), after adjustment for maternal and infant characteristics. An elevated maternal pre-gravid BMI was associated with increased risk of childhood respiratory hospitalization, with an adjusted odds ratio OR [95 % CI] = 1.08 [1.03–1.14] for overweight mothers (BMI 25–29.9 kg/m²), and OR = 1.29 [1.22–1.36] for obese mothers (BMI ≥ 30 kg/m²). An elevated maternal pre-gravid BMI was associated with higher risk of early childhood respiratory hospitalization. Childhood respiratory illness may be an important complication of excess maternal weight that should be shared with expectant mothers.     

Women’s Private Conversations about Abortion: A Qualitative Study

Abortion is a relatively frequent experience, yet public discourse about abortion is contentious and stigmatizing. Little literature is available on private conversations about abortion, which may be distinct from public discourse. We explored private discourse by documenting the nature of women’s discussions about abortion with peers in a book club. We recruited thirteen women’s book clubs in nine states. Participants (n = 119) read the book Choice: True Stories of Birth, Contraception, Infertility, Adoption, Single Parenthood, & Abortion, and participated in a book club meeting, which we audio-recorded and transcribed. Data collection occurred between April 2012 and April 2013. In contrast to public discourse of abortion, private discourse was nuanced and included disclosures of multiple kinds of experiences with abortion. Participants disclosed having abortions, considering abortion as an option for past or future pregnancies, and supporting others through an abortion. Distinguishing between public and private discourse enabled us to identify that an “abortion experience” could include personal decisions, hypothetical decisions, or connection with someone having an abortion. The book club atmosphere provided a rare opportunity for participants to explore their relationship to abortion. More research is needed to understand the role of private discourse in reducing abortion stigma.     

Low-Income Women’s Feeding Practices and Perceptions of Dietary Guidance: A Qualitative Study

Objectives Describe themes characterizing feeding behaviors of low-income women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and identify the attitudes, beliefs, and sources of information that inform these practices. Methods Formative research was conducted including focus groups and semi-structured individual phone interviews with a total of 68 low-income women participating in WIC. Qualitative data were recorded, transcribed, imported into NVivo 8.0, and analyzed for common themes. Results Mothers reported feeding behaviors inconsistent with guidance from WIC and the American Academy of Pediatrics. Three main themes were identified. First, mothers reported receiving conflicting messaging/advice from medical professionals, WIC nutritionists, and family members, which was confusing. Mothers also reported dissatisfaction with the “one size fits most” approach. Lastly, mothers reported relying on their “instincts” and that “all babies are different” when deciding and rationalizing what feeding guidance to follow. Conclusions Future interventions targeting this high-risk population should consider developing personalized (individualized) messaging, tailored to the needs of each mother–child dyad. Focused efforts are needed to build partnerships between WIC providers and other health care providers to provide more consistent messages about responsive feeding to prevent early obesity.     

Changing Mother’s Hygiene and Sanitation Practices in Resource Constrained Communities: Case Study of Turkana District, Kenya

Lack of adequate sanitation, hygiene and safe portable water are serious global health problems that contribute to deaths of many children under the age of 5?years annually, mainly due to diarrhoeal diseases. This study was set out to determine the extent to which sanitation and hygiene promotion influenced mothers’ and children’s health in Turkana District; one of the arid Northern frontier Districts of Kenya. A repeat cross-sectional study design with multi-stage sampling method was used. A total of 300 mothers were randomly sampled for interviews in a baseline survey carried out in 2007 and in a post-intervention survey carried out in 2008. Data were collected using questionnaires and analyzed using SPSS for frequencies, cross tabulations and regression amongst other tests. Significant improvements were observed in hand washing practice, presence of hand washing soap at household and refuse pit ownership. In Kakuma Division the proportion of those who washed hands regularly increased from 48.8 to 91.3?% (χ²?=?7.28, P?=?0.122), in Lodwar Central, those who wash hands regularly increased from 85.5 to 89.9?% (χ2?=?10.85, P?=?0.028) while in Lokichogio, the proportions increased from 77.5 to 93.8?% (χ2?=?15.56, P?=?0.004). For hand washing soap at household, there was an increase in proportion of those who wash hands with soap from 65 to 78?% (χ2?=?3.87, P?=?0.049) within the group with no formal education. There was significant reduction of diarrhoea prevalence in children aged less than 5?years. Sanitation and hygiene promotion based on community participatory approaches can lead to significant reduction of diarrhoea in children.