Effects of Nurse Staffing on Missed Breastfeeding Support in Maternity Units With Different Nurse Work Environments.

PURPOSE: To examine the effect of nurse staffing in varying work environments on missed breastfeeding teaching and support in inpatient maternity units in the United States. BACKGROUND: Breast milk is the optimal food for newborns. Teaching and supporting women in breastfeeding are primarily a nurse's responsibility. Better maternity nurse staffing (fewer patients per nurse) is associated with less missed breastfeeding teaching and support and increased rates of breastfeeding. We examined the extent to which the nursing work environment, staffing, and nurse education were associated with missed breastfeeding care and how the work environment and staffing interacted to impact missed breastfeeding care. METHODS: In this cross-sectional study using the 2015 National Database of Nursing Quality Indicator survey, maternity nurses in hospitals in 48 states and the District of Columbia responded about their workplace and breastfeeding care. Clustered logistic regression models with interactions were used to estimate the effects of the nursing work environment and staffing on missed breastfeeding care. RESULTS: There were 19 486 registered nurses in 444 hospitals. Nearly 3 in 10 (28.2%) nurses reported missing breastfeeding care. In adjusted models, an additional patient per nurse was associated with a 39% increased odds of missed breastfeeding care. Furthermore, 1 standard deviation decrease in the work environment was associated with a 65% increased odds of missed breastfeeding care. In an interaction model, staffing only had a significant impact on missed breastfeeding care in poor work environments. CONCLUSIONS: We found that the work environment is more fundamental than staffing for ensuring that not only breastfeeding care is not missed but also breastfeeding care is sensitive to nurse staffing. Improvements to the work environment support the provision of breastfeeding care. IMPLICATIONS FOR RESEARCH AND PRACTICE: Both nurse staffing and the work environment are important for improving breastfeeding rates, but the work environment is foundational.

Racial disparities in low-risk cesarean birth rates across hospitals.

BACKGROUND: We compared low-risk cesarean birth rates for Black and White women across hospitals serving increasing proportions of Black women and identified hospitals where Black women had low-risk cesarean rates less than or equal to White women. METHODS: In this cross-sectional analysis of secondary data from four states, we categorized hospitals by their proportion of Black women giving birth from "low" to "high". We analyzed the odds of low-risk cesarean for Black and White women across hospital categories. RESULTS: Our sample comprised 493 hospitals and the 65,524 Black and 251,426 White women at low risk for cesarean who birthed in them. The mean low-risk cesarean rate was significantly higher for Black, compared with White, women in the low (20.1% vs. 15.9%) and medium (18.1% vs. 16.9%) hospital categories. In regression models, no hospital structural characteristics were significantly associated with the odds of a Black woman having a low-risk cesarean. For White women, birthing in a hospital serving the highest proportion of Black women was associated with a 21% (95% CI: 1.01-1.44) increase in the odds of having a low-risk cesarean. DISCUSSION: Black women had higher odds of a low-risk cesarean than White women and were more likely to access care in hospitals with higher low-risk cesarean rates. The existence of hospitals where low-risk cesarean rates for Black women were less than or equal to those of White women was notable, given a predominant focus on hospitals where Black women have poorer outcomes. Efforts to decrease the low-risk cesarean rate should focus on (1) improving intrapartum care for Black women and (2) identifying differentiating organizational factors in hospitals where cesarean birth rates are optimally low and equivalent among racial groups as a basis for system-level policy efforts to improve equity and reduce cesarean birth rates.

Teacher depressive symptoms and children's school readiness in Ghana.

This study investigated associations between kindergarten teachers' (N = 208) depressive symptoms and students' (Ghanaian nationals, N = 1490, Mage  = 5.8) school-readiness skills (early literacy, early numeracy, social-emotional skills, and executive function) across 208 schools in Ghana over one school year. Teachers' depressive symptoms in the fall negatively predicted students' overall school-readiness skills in the spring, controlling for school-readiness skills in the fall. These results were primarily driven by social-emotional skills (r = .1-.3). There was evidence of heterogeneity by students' fall skill levels; teacher depressive symptoms predicted more negative spring overall school readiness for children who had higher fall school-readiness skills. Findings underscore the importance of teachers' mental health in early childhood education globally, with implications for policy and practice.

Nursing Resources by Type of Maternity Unit Across Regions of the United States.

OBJECTIVE: To examine variation in nursing resources across three different types of maternity units in five regions of the United States. DESIGN: Cross-sectional descriptive. SETTING: Maternity units in hospitals in 48 states and the District of Columbia that participated in the 2016 National Database of Nursing Quality Indicator survey. PARTICIPANTS: Staff nurses (N = 19,486) who worked in 707 maternity units. METHODS: We conducted a secondary analysis of survey data examining nursing resources (work environment, staffing, education, specialty certification) by type of maternity unit, including labor and delivery, labor/delivery/recovery/postpartum, and postpartum. We used descriptive statistics and analysis of variance. RESULTS: Participants worked in 707 units (269 labor and delivery units, 164 labor/delivery/recovery/postpartum units, and 274 postpartum units) in 444 hospitals. The work environment was not significantly different across unit types (mean = 2.89-2.94, p = .27). Staffing, education, and specialty certification varied significantly across the unit types (p ≤ .001). In terms of staffing, postpartum units had, on average, almost twice the number of patients per nurse as labor and delivery units (7.51 patients/nurse vs. 4.01 patients/nurse, p ≤ .001) and 1.5 times more patients than labor/delivery/recovery/postpartum units (5.04 patients/nurse vs. 4.01 patients/nurse, p ≤ .001). CONCLUSION: Nursing resources varied significantly across types of maternity units and regions of the United States. This variation suggests that improving nursing resources may be a system-level target for improving maternity care in the United States.

Self-reported COVID-19 infection and implications for mental health and food insecurity among American college students.

While the COVID-19 pandemic affected mental health and increased food insecurity across the general population, less is known about the virus's impact on college students. A fall 2020 survey of more than 100,000 students at 202 colleges and universities in 42 states reveals sociodemographic variation in self-reported infections, as well as associations between self-reported infection and food insecurity and mental health. We find that 7% of students self-reported a COVID-19 infection, with sizable differences by race/ethnicity, socioeconomic status, parenting status, and student athlete status. Students who self-reported COVID-19 infections were more likely to experience food insecurity, anxiety, and depression. Implications for higher education institutions, policy makers, and students are discussed.

Policy Evaluation Of The Affordable Care Act Graduate Nurse Education Demonstration.

The US is experiencing a shortage of primary care providers, which could be reduced by the addition of nurse practitioners. However, the ability to increase the supply of nurse practitioners is limited by a shortage of clinical preceptors. The Affordable Care Act's Graduate Nurse Education Demonstration provided federal funding to offset the clinical training costs of advanced practice nurses. We used data from the American Association of Colleges of Nursing from academic years 2005-06 through 2017-18 to determine whether the demonstration was associated with increased nurse practitioner enrollment and graduation growth. The demonstration was associated with a significant increase in nurse practitioner enrollments and graduations. A promising model of organizing and implementing funding for graduate nursing education nationally was identified. Findings suggest that modernizing Medicare payments for nursing education to support nurse practitioner clinical training costs is a promising option for increasing primary care providers.

The Nexus of Physical and Psychological Pain: Consequences for Mortality and Implications for Medical Sociology.

Although physical pain lies at the intersection of biology and social conditions, a sociology of pain is still in its infancy. We seek to show how physical and psychological pain are jointly parts of a common expression of despair, particularly in relation to mortality. Using the 2002-2014 National Health Interview Survey Linked Mortality Files (N = 228,098), we explore sociodemographic differences in the intersection of physical and psychological pain (referred to as the "pain-distress nexus") and its relationship to mortality among adults ages 25 to 64. Results from regression and event history models reveal that differences are large for the combination of the two, pointing to an overlooked aspect of health disparities. The combination of both high distress and high pain is most prevalent and most strongly predictive of mortality among socioeconomically disadvantaged, non-Hispanic whites. These patterns have several implications that medical sociology is well positioned to address.

The Affordable Care Act's young adult mandate was associated with a reduction in pain prevalence.

ABSTRACT: Pain is a major health problem among U.S. young adults. The passage of the Affordable Care Act's young adult mandate in 2010 allowed individuals to remain on their parents' health insurance until age 26. Although studies have documented the positive effects of this mandate on various health outcomes, less is known about its association with self-reported pain among young adults. Using the 2002 to 2018 National Health Interview Survey (N = 48,053) and a difference-in-differences approach, we compared the probabilities of reporting pain at 5 sites (low back, joint, neck, headache/migraine, and facial/jaw) and the number of pain sites between mandate eligible (ages 20-25) and ineligible (ages 26-30) adults before and after the mandate. In fully adjusted models, the mandate was associated with a decline of 2 percentage points in the probability of reporting pain at any site (marginal effect, -0.02; 95% confidence interval [CI], -0.05 to -0.002; weighted sample proportion, 0.37) and in the number of pain sites (coefficient, -0.07; 95% CI, -0.11 to -0.01; weighted sample average, 0.62). These results were primarily driven by the association between the mandate and the probability of reporting low back pain (marginal effect, -0.03; 95% CI, -0.05 to -0.01; weighted sample proportion, 0.20). Additional analyses revealed that the mandate was associated with improvements in access to care and reductions in risk factors for pain-including chronic conditions and risky health behaviors. To the extent that the results are generalizable to other health insurance programs, removing financial barriers to medical care may help reduce pain prevalence.

Depressive and anxiety symptoms in early childhood education teachers: Relations to professional well-being and absenteeism.

This study investigated how early childhood education teachers' (N = 444) depressive and anxiety symptoms predicted their professional well-being outcomes and absenteeism over the course of one school year in Ghana. Higher anxiety and depressive symptoms predicted lower job motivation and job satisfaction and higher levels of emotional exhaustion at the end of the school year. Increased depressive symptoms were further associated with more days absent over the course of the school year. Findings point to the importance of considering teachers' mental health for early educational quality. Implications for policy and practice are discussed.

Ecological factors associated with suicide mortality among non-Hispanic whites.

BACKGROUND: In this paper, we examine the ecological factors associated with death rates from suicide in the United States in 1999 and 2017, a period when suicide mortality increased in the United States. We focus on Non-Hispanic Whites, who experienced the largest increase in suicide mortality. We ask whether variation in suicide mortality among commuting zones can be explained by measures of the social and economic environment and access to lethal means used to kill oneself in one's area of residence. METHODS: We use vital statistics data on deaths and Census Bureau population estimates and define area of residence as one of 704 commuting zones. We estimate separate models for men and women at ages 20-64 and 65 and above. We measure economic environment by percent of the workforce in manufacturing and the unemployment rate and social environment by marital status, educational attainment, and religious participation. We use gun sellers and opioid prescriptions as measures of access to lethal means. RESULTS: We find that the strongest contextual predictors of higher suicide mortality are lower rates of manufacturing employment and higher rates of opiate prescriptions for all age/sex groups, increased gun accessibility for men, and religious participation for older people. CONCLUSIONS: Socioeconomic characteristic and access to lethal means explain much of the variation in suicide mortality rates across commuting zones, but do not account for the pervasive national-level increase in suicide mortality between 1999 and 2017.

Predictors of anxiety and depressive symptoms among teachers in Ghana: Evidence from a randomized controlled trial.

RATIONALE: While teachers are heralded as key drivers of student learning outcomes, little attention has been paid to teachers' mental health, especially in less-developed countries such as Ghana. Professional background, workplace environment, and personal life stressors may threaten teachers' mental health and subsequent effectiveness in the classroom. OBJECTIVES: The objectives of this study were to investigate 1) whether and how professional background, workplace environment, and personal life stressors predicted teachers' anxiety and depressive symptoms, and 2) whether participation in a professional development intervention predicted change in teachers' symptoms over the course of one school year in Ghana. METHOD: We used multilevel models to examine predictors of depressive and anxiety symptoms among 444 kindergarten teachers (98% female; age range: 18-69) who participated in the Quality Preschool for Ghana (QP4G) Study. QP4G was a school-randomized control trial (n = 108 public schools; n = 132 private schools) evaluating a one-year teacher professional development intervention program implemented with and without parental-awareness meetings. Teacher depressive and anxiety symptoms were assessed at baseline before the intervention and at the end of the school year. RESULTS: Poor workplace environment was associated with increased anxiety and depressive symptoms. Social support also predicted symptoms, with lack of support from students' parents and being new to the local community associated with more anxiety symptoms. Within teachers' personal lives, household food insecurity predicted more depressive symptoms. Finally, anxiety and depressive symptoms increased for all teachers over the school year. However, randomization to either intervention was linked to a significantly smaller increase in symptoms over the school year. CONCLUSIONS: Results suggest that teachers' personal and professional lives are consequential for their mental health, and that professional development interventions that provide training and in-class coaching and parent engagement may benefit teachers' mental health.

Domains of Childhood Disadvantage and Functional Limitation Trajectories Among Midlife Men and Women in China.

Objective: To examine the impacts of four childhood disadvantage domains-parental behavior, hunger, health, and socioeconomic status (SES)-on functional limitation trajectories among midlife adults in China. Method: Data (2011-2015) from the China Health and Retirement Longitudinal Study (N = 8,646) were used to examine the associations between different domains of childhood disadvantage and functional limitation trajectories among adults aged 45 to 64. Results: Adverse parental behavior was not associated with baseline functional limitation but was associated with steeper trajectories for men. Health, hunger, and SES were associated with more functional limitations at baseline, and SES with steeper trajectories for men and women. Adulthood SES largely accounted for the associations between childhood SES and functional limitations for men. Discussion: It is important to examine multiple domains of childhood conditions because the type and magnitude of disadvantage may influence functional limitations in different ways among men and women in China.

Changing trajectories of learning and development: experimental evidence from the Quality Preschool for Ghana interventions.

We examined how exposure to two intervention programmes designed to improve the quality of pre-primary education in Ghana-the Quality Preschool for Ghana project-impacted children's rate of growth in academic (literacy and numeracy) and non-academic skills (social-emotional and executive function) across two school years. This cluster-randomised trial included 240 schools (N = 3,345 children, M age = 5.2 at baseline) randomly assigned to one of three conditions: teacher training (TT), teacher training plus parental-awareness meetings (TTPA), and control. We found some evidence that the interventions altered children's rate of growth in academic and non-academic skills for the full sample, and one unexpected finding: TTPA had negative impacts on growth in numeracy skills. When examined by grade level and gender, TT improved trajectories of younger children, and the negative effects of TTPA on numeracy were driven by boys. Implications are discussed in the context of global early childhood education policy, and teacher professional development and parental engagement programmes.

Longitudinal causal impacts of preschool teacher training on Ghanaian children's school readiness: Evidence for persistence and fade-out.

Preschool programs have expanded rapidly in low- and middle-income countries, but there are widespread concerns about whether they are of sufficient quality to promote children's learning and development. We conducted a large school-randomized control trial ('Quality Preschool for Ghana' - QP4G) of a one-year teacher training and coaching program, with and without parental-awareness meetings, designed to improve preschool quality and child development. We followed 3,435 children in 240 schools in the Greater Accra Region of Ghana, a country with universal pre-primary education. A previous study reported positive impacts of teacher training (but not teacher training plus parental-awareness meetings) at the end of the implementation year on some dimensions of classroom quality, teacher well-being, and children's school readiness (Wolf et al., [2019] Journal of Research on Educational Effectiveness, 12, 10-37). The present study analyzed a new round of data collected 1 year after the end of implementation to assess (a) the extent of persistence in impacts on child development and (b) whether such impacts vary by select child, household, and school characteristics. We found impacts of the teacher training intervention on children's overall school readiness were sustained (d = 0.13), but were only marginally statistically significant. When broken down by domain, impacts on social-emotional skills specifically persisted. Persistent negative effects of teacher training plus parental-awareness meetings varied by the literacy status of the male parent such that negative impacts were concentrated in children in households with non-literate male heads.

Examining sustained impacts of two teacher professional development programs on professional well-being and classroom practices.

We examine second-year impacts of a 1-year pre-primary teacher training and coaching program, delivered with and without parental-awareness meetings, evaluated with a school-level randomized trial. Outcomes included teachers' professional well-being and classroom practices. Most gains observed during the program year faded out. However, there were small sustained impacts on the implementation of training activities. Counteracting effects of the parental-awareness meetings were evident, with suggestive evidence that teachers in this treatment group displayed lower scores on one dimension of classroom quality-Supporting Student Expression-compared to controls. Implications for professional development and educational quality are discussed.

Childhood Conditions Predict Chronic Diseases and Functional Limitations Among Older Adults: The Case of Indonesia.

Objective: Limited knowledge exists about whether childhood health and socioeconomic status (SES) conditions influence health among older adults in Indonesia. Method: Data from Wave 5 (2014/2015) of the Indonesian Family Life Survey (N = 6,530) was used to examine associations between childhood health and SES and hypertension, lung conditions, diabetes, lower body functional limitations (LBFL), and instrumental activities of daily living limitations (IADL). Results: Poor childhood health was associated with 34% higher odds of hypertension (odds ratio [OR] = 1.34, p < .05), 37% higher odds of diabetes (OR = 1.37, p < .05), and 32% higher odds of lung conditions (OR = 1.32, p < .05). Household overcrowding was associated with 22% higher odds of a LBFL (OR = 1.22, p < .05) and 24% higher odds of an IADL (OR = 1.24, p < .01). Lacking a household toilet was associated with 18% higher odds of a LBFL (OR = 1.18, p < .05). Adjusting for adult SES and current health did not account for these relationships. Discussion: Childhood conditions appear to shape older adult health in Indonesia.