Where Is Women's Health in Maternal and Child Health?

Maternal and Child Health Journal -     

The Influence of Maternal Health Literacy and Child’s Age on Participation in Social Welfare Programs

The objective of this study is to determine the influence of maternal health literacy and child’s age on participation in social welfare programs benefiting children. In a longitudinal prospective cohort study of 560 Medicaid-eligible mother-infant dyads recruited in Philadelphia, maternal health literacy was assessed using the test of functional health literacy in adults (short version). Participation in social welfare programs [Temporary Assistance to Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), child care subsidy, and public housing] was self-reported at child’s birth, and at the 6, 12, 18, 24 month follow-up interviews. Generalized estimating equations quantified the strength of maternal health literacy as an estimator of program participation. The mothers were primarily African-Americans (83 %), single (87 %), with multiple children (62 %). Nearly 24 % of the mothers had inadequate or marginal health literacy. Children whose mothers had inadequate health literacy were less likely to receive child care subsidy (adjusted OR = 0.54, 95 % CI 0.34–0.85) than children whose mothers had adequate health literacy. Health literacy was not a significant predictor for TANF, SNAP, WIC or housing assistance. The predicted probability for participation in all programs decreased from birth to 24 months. Most notably, predicted WIC participation declined rapidly after age one. During the first 24 months, mothers with inadequate health literacy could benefit from simplified or facilitated child care subsidy application processes. Targeted outreach and enrollment efforts conducted by social welfare programs need to take into account the changing needs of families as children age.     

In Appreciation of the Maternal and Child Health Journal’s Peer Reviewers, 2018

Maternal and Child Health Journal -     

Do Positive Parenting Practices Moderate Parental Mental Health and Child Behavior Among Homeless Families?

The social interaction learning framework was used to explore whether positive parenting practices (noncoercive discipline, clear expectations, and praise and incentives) mitigated any effects of parent mental health (psychological distress and parenting stress) on child externalizing behaviors in a predominantly African American sample of homeless parents residing in transitional housing (N = 52, 79.6% female). The results showed that the positive relationship between psychological distress and child behavior was attenuated when parents provided high levels of praise and incentives. In addition, a positive relationship between parenting stress and child behavior existed only when parents transmitted low levels of praise and incentives. No significant findings existed for noncoercive discipline and clear expectations. The results suggest the need to further understand the positive aspects of parenting in the context of homelessness that can promote child adjustment even if parental mental health is compromised.     

Building Economic Security Today: Making the Health–Wealth Connection in Contra Costa County’s Maternal and Child Health Programs

In recent years, maternal and child health professionals have been seeking approaches to integrating the Life Course Perspective and social determinants of health into their work. In this article, we describe how community input, staff feedback, and evidence from the field that the connection between wealth and health should be addressed compelled the Contra Costa Family, Maternal and Child Health (FMCH) Programs Life Course Initiative to launch Building Economic Security Today (BEST). BEST utilizes innovative strategies to reduce inequities in health outcomes for low-income Contra Costa families by improving their financial security and stability. FMCH Programs’ Women, Infants, and Children Program (WIC) conducted BEST financial education classes, and its Medically Vulnerable Infant Program (MVIP) instituted BEST financial assessments during public health nurse home visits. Educational and referral resources were also developed and distributed to all clients. The classes at WIC increased clients’ awareness of financial issues and confidence that they could improve their financial situations. WIC clients and staff also gained knowledge about financial resources in the community. MVIP’s financial assessments offered clients a new and needed perspective on their financial situations, as well as support around the financial and psychological stresses of caring for a child with special health care needs. BEST offered FMCH Programs staff opportunities to engage in non-traditional, cross-sector partnerships, and gain new knowledge and skills to address a pressing social determinant of health. We learned the value of flexible timelines, maintaining a long view for creating change, and challenging the traditional paradigm of maternal and child health.     

Women's Health in Maternal and Child Health: Time for a New Tradition?

Objectives. The status quo in maternal and child health (MCH) focuses on obstetric health. An emerging alternative is to broaden the notion to reproductive health. An inclusive perspective encompasses women's health issues in MCH. The purpose of this paper is to further the debate on the relationship of women's health to MCH. Specific aims are (1) to describe activities promoting women's health in MCH and (2) to examine consequences of alternative perspectives for MCH research, services, and training. Method. To achieve the first objective, I discuss developments in a state health agency and pertinent documents from the MCH Section of the American Public Health Association. To address the second aim, I follow the Bush Policy Analysis Model of weighing the three paradigms against the following evaluative criteria: equity, efficiency, satisfaction, stigma, indirect effects, feasibility, sensitivity to class and race, and social responsibility. Results. The obstetric approach meets most criteria in a positive fashion; reproductive health satisfies criteria more positively and less equivocally. A women's health perspective bears the most potential for improving reproductive outcomes at this time, since no area of women's general health has been definitively shown to be irrelevant to reproduction (or vice versa). Conclusions: This analysis suggests that women's health should be incorporated more fully into the MCH field, as well as other areas of public health and medicine. Once research deficits have been addressed and the scope of reproductive health delineated more clearly, the alignment of women's health with MCH may be reevaluated.     

An Evaluation of Racial and Ethnic Health Differences in State Mental Health Inpatient Services: 2002–2005 Versus 2010–2011

This study analyzed racial-ethnic differences previously documented in the Connecticut Department of Mental Health and Addiction Services mental health inpatient system across two time periods (2002–2005 and 2010–2011). Comparisons of logistic regression analyses from the two time periods showed that, at time 1, significant racial-ethnic differences were found for referral by other sources (e.g., outpatient), length of stay, discharge against medical advice, and some diagnostic differences (e.g., schizophrenia, other psychotic disorders, cluster B discharge diagnosis), but these differences were not significant at time 2. Other diagnostic differences remained significant at time 2 (e.g., mood disorders, substance use disorders, other axis I disorders, mental retardation) as well as racial-ethnic differences in self-referral. These results suggest that the multiple national and state cultural competence initiatives between time 1 and time 2 could have resulted in decreases in racial-ethnic differences. Targeted interventions to alleviate the remaining differences are needed.     

Parental Nativity Affects Children’s Health and Access to Care

Objective To examine the effect of parental nativity on child health and access to health care. Data Source The 2002 National Survey of America’s Families. Results Among US children, 14% have foreign-born parents; 5% have one foreign- and one native-born parent (“mixed-nativity”). In multivariate logistic regression analyses, children with foreign-born parents were less likely than children with US-born parents to be perceived in “very good” or “excellent health” [OR = 0.68; 95% CI (0.56–0.82)] and to have a usual health care site [OR = 0.52 (0.38–0.69)]; having mixed-nativity parents is associated with better perceived child health. These effects persisted for minority, but not white, children. Regardless of race and ethnicity, non-citizen children have worse access to care. Conclusion Efforts to improve children of immigrants’ health and access to care should focus on families in which both parents are immigrants, particularly those who are ethnic or racial minorities. Efforts to increase use of health services should focus on non-citizen children.     

Weight and Mental Health Status in Massachusetts,National Survey of Children’s Health, 2007

This study explores how weight status is related to mental health status among Massachusetts children, aged 10–17 years. We used data from the 2007 National Survey of Children’s Health to examine the association between weight status (body mass index-for-age) and parent-reported mental health status among Massachusetts children (N = 827). Multivariable log binomial regression was performed to calculate the adjusted prevalence ratios (aPR) of three mental health outcomes (behavioral, emotional, and social) as related to weight status, after controlling for covariates including physical activity, sex, race/ethnicity, maternal education, poverty status, special health needs, and neighborhood safety. Almost one-third (32.5 %) of Massachusetts children were either overweight or obese. Sex was a significant effect modifier of the association between weight status and negative emotions. After stratifying by sex and controlling for covariates, the relationship between weight status and negative emotions remained significant among girls (aPR = 1.8, 95 % CI 1.3–2.6). Children who did not exercise at all were significantly more likely to exhibit negative behaviors (aPR = 1.3, 95 % CI 1.0–1.6), negative emotions (boys’ aPR = 3.3, 95 % CI 1.6–6.9; girls’ aPR = 2.6, 95 % CI 1.5–4.5), and fewer social skills (aPR = 1.9, 95 % CI 1.3–2.9) than those who exercised at least 20 min every day of the week. Overweight/obese children, especially girls, were more likely than children of normal weight to have parent-reported negative emotions, suggesting an association between weight status and mental health. Lower levels of physical activity were associated with negative mental health outcomes, supporting the benefits of physical activity for all children.     

Public Health Consequences of Terrorism on Maternal–Child Health in New York City and Madrid

Past research provides evidence for trajectories of health and wellness among individuals following disasters that follow specific pathways of resilience, resistance, recovery, or continued dysfunction. These individual responses are influenced by event type and pre-event capacities. This study was designed to utilize the trajectories of health model to determine if it translates to population health. We identified terrorist attacks that could potentially impact population health rather than only selected individuals within the areas of the attacks. We chose to examine a time series of population birth outcomes before and after the terrorist events of the New York City (NYC) World Trade Center (WTC) attacks of 2001 and the Madrid, Spain train bombings of 2004 to determine if the events affected maternal–child health of those cities and, if so, for how long. For percentages of low birth weight (LBW) and preterm births, we found no significant effects from the WTC attacks in NYC and transient but significant effects on rates of LBW and preterm births following the bombings in Madrid. We did find a significant positive and sustained effect on infant mortality rate in NYC following the WTC attacks but no similar effect in Madrid. There were no effects on any of the indicator variables in the comparison regions of New York state and the remainder of Spain. Thus, population maternal–health in New York and Madrid showed unique adverse effects after the terrorist attacks in those cities. Short-term effects on LBW and preterm birth rates in Madrid and long-term effects on infant mortality rates in NYC were found when quarterly data were analyzed from 1990 through 2008/2009. These findings raise questions about chronic changes in the population’s quality of life following catastrophic terrorist attacks. Public health should be monitored and interventions designed to address chronic stress, environmental, and socioeconomic threats beyond the acute aftermath of events.     

Health Versus Appearance Versus Body Competence: A Content Analysis Investigating Frames of Health Advice in Women’s Health Magazines

The present study investigated the extent to which women’s health magazines advise readers to adopt healthy behaviors in order to look good (appearance frame), in order to feel good (health frame), or in order to perform better (body competence frame). A content analysis of 5 years of the 6 highest circulating U.S. women’s health magazines revealed a higher frequency of health frames (32.6%) than appearance frames (24.8%) overall, but when beauty/health hybrid magazines (i.e., Shape and Self) were examined separately, appearance frames (32.8%) outnumbered health frames (26.5%). Compared to appearance and health frames, body competence frames were underrepresented (13.3% in the full sample). The visual sexual objectification of female models in women’s health magazines was also investigated. Appearance-framed articles (43.2%) were significantly more likely to visually depict women with a high degree of skin exposure than health-framed articles (17.4%), and appearance-framed articles (34.8%) were more likely to focus on individual body parts than health-framed articles (21.3%). In addition, despite the magazines’ editorial focus on health, the most frequent category of products advertised was appearance-enhancing products. Results are discussed in light of self-determination theory (Deci & Ryan, 1985) and objectification theory (Fredrickson & Roberts, 1997).     

Racial and Ethnic Disparities in the Continuation of Community-Based Children’s Mental Health Services

This paper examines racial and ethnic disparities in continuation of mental health services for children and youth in California and how English language proficiency moderates the effect of race/ethnicity on the continuation of service. While previous research indicated racial/ethnic or geographic disparities in accessing mental health services among children and youth, few studies specifically focused on the continuation of mental health care. The authors used administrative data from California county mental health services users under age 25. Applying logistic regression, English language proficiency was found to be the major determinant of continuation of mental health services in this age group. With the exception of children of Asian descent, non-English speaking children and youth of diverse racial/ethnic background were significantly less likely to continue receiving mental health services compared with White English-speaking peers, even after controlling for sociodemographic, clinical and county characteristics.     

Correlates of Overweight and Obesity Among American Indian/Alaska Native and Non-Hispanic White Children and Adolescents: National Survey of Children’s Health, 2007

Risk factors for overweight and obesity may be different for American Indian and Alaska Native (AI/AN) children compared to children of other racial/ethnic backgrounds, as obesity prevalence among AI/AN children remains much higher. Using data from the 2007 National Survey of Children’s Health, behavioral (child’s sport team participation, vigorous physical activity, television viewing, and computer use), household (parental physical activity, frequency of family meals, rules limiting television viewing, and television in the child’s bedroom), neighborhood (neighborhood support, perceived community and school safety, and presence of parks, sidewalks, and recreation centers in the neighborhood), and sociodemographic (child’s age and sex, household structure, and poverty status) correlates of overweight/obesity (body mass index ≥85th percentile for age and sex) were assessed among 10–17 year-old non-Hispanic white (NHW) and AI/AN children residing in Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, and South Dakota (n = 5,372). Prevalence of overweight/obesity was 29.0 % among NHW children and 48.3 % among AI/AN children in this sample. Viewing more than 2 h of television per day (adjusted odds ratio [aOR] = 2.0; 95 % confidence interval [CI] = 1.5–2.8), a lack of neighborhood support (aOR = 1.9; 95 % CI = 1.1–3.5), and demographic characteristics were significantly associated with overweight/obesity in the pooled sample. Lack of sport team participation was significantly associated with overweight/obesity only among AI/AN children (aOR = 2.7; 95 % CI = 1.3–5.2). Culturally sensitive interventions targeting individual predictors, such as sports team participation and television viewing, in conjunction with neighborhood-level factors, may be effective in addressing childhood overweight/obesity among AI/AN children. Longitudinal studies are needed to confirm these findings.     

A Tale of Two Countries—the United States and Japan: Are Differences in Health Due to Differences in Overweight?

Background

Despite similar standards of living and health care systems for older persons, there are marked differences in the relative health of the elderly populations in the United States (US) and Japan. We explore the association of overweight and obesity with these health disparities.

Methods

Data on older adults from the US National Health Interview Survey (1994) and the Longitudinal Study of Aging II (1994) were compared to similar data from the 1999-2001 Nihon University Japanese Longitudinal Study of Aging. Regression analyses for the 2 countries were conducted to examine the correlates of being overweight and obese, and the relationships of overweight and obesity with activities of daily living functioning, heart disease, arthritis, and diabetes.

Results

The prevalence of overweight and obesity is higher in the US than in Japan, as is the prevalence of heart disease, diabetes, arthritis, and functioning problems. Education level and marital status are predictors of overweight for older Americans but not for older Japanese people. Health behaviors affect weight in all groups. The prevalence of functioning problems and disease are more likely to be associated with being overweight in US men and women than in Japanese women, and are not associated with being overweight in Japanese men.

Conclusion

Despite similar standards of living and health care systems for older persons, the conditions associated with poor health differ in the US and Japan. Being overweight or obese appears to be related to more functioning problems and arthritis in the US than in Japan.Key words: cross-national studies, obesity, disease, chronic conditions