WIC Staff Views and Perceptions on the Relationship between Food Insecurity and Perinatal Depression.

Food insecurity and perinatal depression are significant public health concerns for perinatal services, however descriptive research examining their association is limited. The purpose of this study was to examine the views and perspectives of staff from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program on the relationship between food insecurity and perinatal depression among their WIC clients. Four, semi-structured focus groups with WIC staff (n = 24) were conducted across four diverse nonmetropolitan public health districts in Midwestern counties in the United States. WIC staff included social workers, nurses, nutritionists and ancillary staff. All interviews were audio-recorded, transcribed, and verified, and data were organized using NVivo 11.4.2. Thematic networking analysis was employed as the qualitative analysis to identify organizing themes. Three themes emerged including (1) depression experienced by clients; (2) food insecurity experienced by clients; and (3) barriers preventing clients from accessing services for themselves and their children. Research on food insecurity and perinatal depression is sparse, with fewer studies having included health staff of low-income women. Our findings suggest that the association between food insecurity and mental health needs among WIC clients is a significant public health issue to which policy change and interventions are required.

Patients' Perceptions Of Perinatal Depression Screening: A Qualitative Study.

Screening for perinatal depression is a clinical approach to identifying women in need of mental health diagnoses, referral, and treatment. Many states mandate screening for perinatal depression, but it remains unclear whether screening leads to increased access to treatment and better health outcomes. The aim of this qualitative study was to identify how women from diverse backgrounds perceive the quality of perinatal depression screening and whether the perceived quality affected their decisions about mental health care. During 2019 a sample of twenty-nine participants who had been screened for perinatal depression completed semistructured in-depth interviews in which they were asked for their impressions of the screening process. Common themes were that the screening was ineffective because providers didn't explain the purpose or uses of the screening tool, didn't tell patients anything about the results, and failed to provide any follow-up relating to patient depression scores. The results suggest the need for health care facilities to engage patients in a dialogue about screening results and for health care delivery systems to refine the screening process. These findings offer a foundation to design more comprehensive, patient-centered screening protocols that might result in improved mental health outcomes.

Prevalence and Correlates of Tobacco Smoking During the Perinatal Period Among Women Enrolled in a Midwestern WIC Program.

BACKGROUND: Perinatal tobacco smoking remains a public health concern and is associated with smoking related morbidity and mortality. This study aims to report the prevalence and correlates of smoking during pregnancy among low-income women. METHODS: The study sample comprised 729 pregnant women who were enrolled in a perinatal depression registry in a public health WIC program between 2013 and 2015. Smoking risks were obtained from the clinical USDA Risk Assessment. STATA 14.2 was used for analyses. RESULTS: 15.1% of women reported smoking during pregnancy. Compared to White women, Black women were less likely to smoke odds ratio (OR 0.45 [95% CI 0.25-0.81]). Foreign-born women and women living in non-smoking homes remained at a lower risk for smoking during pregnancy. IMPLICATIONS: Smoking during pregnancy is prevalent among low-income women. In addition to prenatal education on smoking cessation, supportive measures to help deliver smoking cessation interventions should be provided to household members.

Prevalence of antenatal suicidal ideation among racially and ethnically diverse WIC enrolled women receiving care in a Midwestern public health clinic.

BACKGROUND: Suicidal ideation (SI) during pregnancy is a major maternal health concern, however few examinations report findings on the burden of SI among low-income women. The aim of this study is to estimate the prevalence and correlates of suicidal ideation among a sample of low-income women. METHODS: A cross-sectional analysis of 736 low-income pregnant women enrolled in a Women Infant and Children supplemental nutrition program and a perinatal depression registry between 2013 and 2015. All participants provided informed consent. SI was captured from Edinburgh Postnatal Depression Scale (EPDS) screens administered during standard clinic visits. RESULTS: The prevalence of suicidal ideation was 4.6%. After adjusting for smoking, women with depression were 13 times as likely to report SI. LIMITATIONS: SI was measured using a single item from the EPDS during pregnancy. CONCLUSIONS: This study indicates that most, but not all, women with SI reported elevated depressive symptoms.

Racial Differences in Breastfeeding Initiation Among Participants in a Midwestern Public Health District.

Purpose: Although variations in breastfeeding initiation are well documented, the contributing role of maternal race remains poorly understood, especially among the multiracial-two or more races-population. The purpose of this study is to examine differences in breastfeeding initiation among a racially and ethnically diverse population of low-income women. Methods: Participants for this study (n=1010) were enrolled in the supplemental nutrition program for women, infant, and children and concurrently enrolled in a perinatal depression registry at a public health clinic in the Midwest. Race was obtained from medical records. Breastfeeding initiation was gathered through a clinical interview during the first postpartum visit. Logistic regression was conducted using STATA 14.2. Results: Sixty-eight percent of study participants reported breastfeeding initiation. The bivariate analysis demonstrated that there were significant differences in rates of breastfeeding initiation by race/ethnicity. The logistic regression models showed that after adjusting for maternal education, age, income, nativity, parity, body mass index, and antenatal smoking, Black (odds ratio [OR] 0.47; confidence interval [95% CI] 0.34-0.66), multiracial (OR 0.21; 95% CI 0.07-0.65), and Latina women (OR 0.48; 95% CI 0.26-0.86) were significantly less likely to initiate breastfeeding compared with White women. Conclusion: These findings highlight the need for further understanding of the underlying barriers to the initiation of breastfeeding among low-income Black, multiracial, and Latina women. Moreover, breastfeeding should remain a priority for intervention and policy development, particularly among racially and ethnically diverse low-income women.

Perinatal depression screening in a Women, Infants, and Children (WIC) program: perception of feasibility and acceptability among a multidisciplinary staff.

OBJECTIVE: Best practices for addressing women's mental health and screening for depression in public health clinics are not available. Clinic staff are often responsible for screening for depression; however, few studies examine staff perceptions on feasibility and acceptability of using perinatal screening for mood disorders in ethnically diverse public health clinics. METHODS: During December 2012, we conducted four focus groups using a semistructured interview guide with public health clinic staff of varying disciplines (n=25) in a Special Supplemental Nutrition Program for Women, Infants, and Children. All interviews were audio recorded and analyzed using thematic analysis. RESULTS: We found five descriptive themes related to acceptability and feasibility of screening for perinatal depression in a public health clinic. The main themes include (1) literacy barriers, (2) need for referrals and follow-up with outside services, (3) training and capacity needs, (4) stigma of depression, and (5) location and privacy of screening. Although multiple barriers to universal depression screening in a public health clinic were identified, participants found value in practice of screening low-income women for depression. CONCLUSION: Factors for facilitating implementation of systematic depression screening in a public health clinic have been identified. Implications discuss how policy makers and public health clinic administrators can improve the universal depression screening process.

Clinic staff attitudes towards the use of mHealth technology to conduct perinatal depression screenings: a qualitative study.

BACKGROUND: The use of mHealth technology is an innovative approach for screening low-income mothers for depression. Past studies show that the use of technology removes barriers such as literacy issues, language challenges, concerns about privacy and lack of transportation and can also increase reliability. However, little is known about staff attitudes and perceptions towards using mHealth technology for screening low-income women for depression in clinics. METHODS: Four focus groups were conducted with staff members in a supplemental nutrition program for women, infants and children located in a public health clinic. A semi-structured focus group interview guide was used to examine staff perceptions related to depression screening with tablet technology. All interviews were audio recorded and transcribed verbatim. Thematic analysis was used to analyse all focus group data. RESULTS: Three major benefits and two major barriers were found. The benefits of using technology for perinatal depression screenings were reduction of literacy and language barriers, reduction of redundancy and errors and increased privacy for clients. The barriers were increased network issues and responsibility for technology, which included fear of the devices being lost, stolen or broken. IMPLICATIONS: Before implementing mHealth tablet technology for depression screening in a public health clinic, it is important to address the concerns of staff members to make the transition more effective. This study provides timely information on staff-perceived benefits and barriers when implementing mHealth technology in a public health setting.

Comparative analysis of salivary bacterial microbiome diversity in edentulous infants and their mothers or primary care givers using pyrosequencing.

Bacterial contribution to oral disease has been studied in young children, but there is a lack of data addressing the developmental perspective in edentulous infants. Our primary objectives were to use pyrosequencing to phylogenetically characterize the salivary bacterial microbiome of edentulous infants and to make comparisons against their mothers. Saliva samples were collected from 5 edentulous infants (mean age = 4.6±1.2 mo old) and their mothers or primary care givers (mean age = 30.8±9.5 y old). Salivary DNA was extracted, used to generate DNA amplicons of the V4-V6 hypervariable region of the bacterial 16S rDNA gene, and subjected to 454-pyrosequencing. On average, over 80,000 sequences per sample were generated. High bacterial diversity was noted in the saliva of adults [1012 operational taxonomical units (OTU) at 3% divergence] and infants (578 OTU at 3% divergence). Firmicutes, Proteobacteria, Actinobacteria, and Fusobacteria were predominant bacterial phyla present in all samples. A total of 397 bacterial genera were present in our dataset. Of the 28 genera different (P<0.05) between infants and adults, 27 had a greater prevalence in adults. The exception was Streptococcus, which was the predominant genera in infant saliva (62.2% in infants vs. 20.4% in adults; P<0.05). Veillonella, Neisseria, Rothia, Haemophilus, Gemella, Granulicatella, Leptotrichia, and Fusobacterium were also predominant genera in infant samples, while Haemophilus, Neisseria, Veillonella, Fusobacterium, Oribacterium, Rothia, Treponema, and Actinomyces were predominant in adults. Our data demonstrate that although the adult saliva bacterial microbiome had a greater OTU count than infants, a rich bacterial community exists in the infant oral cavity prior to tooth eruption. Streptococcus, Veillonella, and Neisseria are the predominant bacterial genera present in infants. Further research is required to characterize the development of oral microbiota early in life and identify environmental factors that impact colonization and oral and gastrointestinal disease risk.