Bisphenol-A and disparities in birth outcomes: a review and directions for future research.

Racial disparities in pregnancy outcome in the United States are significant, persistent and costly, but the causes are poorly understood. We propose that disproportionate exposure of African-American women to environmental endocrine disrupting compounds (EDCs) may contribute to birth outcome disparities. Marked racial segregation, as well as health behaviors associated with poverty could result in differences in exposure to particular EDCs. One EDC that has aroused concern in recent years is bisphenol-A (BPA), a widely used industrial plasticizer with known estrogenic properties. Published studies indicate that excessive BPA exposure is associated with reduced fetal survival, as well as reductions in maternal weight and fetal body weight. Related findings include adverse effects of BPA exposure on ovarian function, mammary gland development, earlier age of puberty onset and some metabolic parameters. However, these findings are largely limited to experimental animal studies, and need to be validated in human populations. Our review supports the need to move beyond the currently dominant toxicological approach to examining the effects of BPA exposure, and rely more on observational human studies and epidemiological methods. Many of the risk factors for racial disparities in pregnancy outcome are global or difficult to modify, but exposure to BPA is a potentially malleable risk factor. If BPA contributes to racial disparities in pregnancy outcome, there are important implications for prevention. It is our hope that this review will stimulate further research in this important and neglected area.

Maternal bisphenol-A levels at delivery: a looming problem?

OBJECTIVE: The objective was to determine whether bisphenol-A (BPA) is found in maternal circulation of pregnant women in the US population and is related to gestational length and birth weight. METHOD: Circulating levels of BPA were quantified by high performance liquid chromatography-tandem mass spectrometry at delivery in 40 southeastern Michigan mothers and correlated with gestational length and birth weight of offspring. RESULT: Maternal levels of unconjugated BPA ranged between 0.5 and 22.3 ng ml(-1) in southeastern Michigan mothers. There was no correlation between BPA concentrations and gestational length or birth weight of offspring. CONCLUSION: This is the first study to document measurable levels of BPA in maternal blood of the US population. Long-term follow-up studies of offspring are needed to validate or refute concerns over human fetal exposure to synthetic exogenous steroids.

What accounts for vertigo one year after neuritis vestibularis - anxiety or a dysfunctional vestibular organ?

One year after neuritis vestibularis, 29% from a sample of 75 patients still complained of vertigo. The objective of this investigation was to study why patients suffer from persisting vertigo. The alternative hypotheses were that the vertigo experienced could be explained either by a persisting vestibular dysfunction or by psychopathological changes. To elucidate this question, patients were examined with dynamic posturography, the symptom check list (SCL 90 R), the state-trait anxiety inventory (STAI), the agoraphobic cognitions questionnaire (ALQ) and the body sensations questionnaire (BSQ). After one year, only two patients had overall pathological results in the posturography. Following the assumption that sub-clinical dysfunction of the organs of balance can also lead to an altered body perception in combination with anxiety, the pathological results of posturographic sub-tests were related to experiences of vertigo. Here also there were no significant associations. However, vertigo correlated highly significantly with body-related anxiety and anxiety-related apprehension. In conclusion, chronic vertigo after an acute vestibular disorder could be regarded as a somatopsychic process. Persisting experience of vertigo is not explained by sub-clinical organic changes. Anxiety seems to be the crucial factor in persisting vertigo.

Food insufficiency and the physical and mental health of low-income women.

Poor women with children are disproportionately represented among the food insufficient. Recent research has linked food insufficiency with dietary deficiencies, but further research linking this problem to health and mental health problems is needed to inform health and social policy. We analyzed the relationship between food insufficiency and physical and mental health in a random sample of 724 single women who were welfare recipients in February, 1997. Food insufficiency was significantly associated with poor or fair self-rated health and physical limitations, and with respondents' meeting DSM-III-R criteria for recent major depression. Although the cross-sectional design of this study precludes causal inference, these findings add to a growing body of evidence that food insufficiency is associated with serious adverse physical and mental health consequences.

Improving pregnancy outcome during imprisonment: a model residential care program.

The female prison population has increased dramatically in recent years. Most women prisoners are involved with drugs, and as many as 25 percent are pregnant or have delivered within the past year. Reproductive health and drug treatment services for women in prison are inadequate, if they are available at all, and although illicit drugs are readily available in prison, drug-involved pregnant women often are incarcerated to protect fetal health. Studies of pregnancy outcome among women prisoners have demonstrated high rates of perinatal mortality and morbidity. This article examines issues related to pregnancy among women prisoners and describes an innovative residential program designed for pregnant, drug-dependent women in a state adult corrections system. Social workers can play an important role in promoting policy reform and improved services for this underserved population.

Social and environmental predictors of maternal depression in current and recent welfare recipients.

Depression is highly prevalent in welfare recipients, and is associated with failure to move from welfare to work. This paper examines the relationship between social and environmental factors in a large, community-based sample of mothers who currently or recently received welfare benefits. Specific and modifiable risk factors related to poverty, gender, and race were found to predict major depression beyond traditional risk factors. Research and practice implications are discussed.

Nonfamilial roles of alcoholic women in treatment.

This study compared the educational achievement and employment-related experiences of a sample of 301 alcoholic women in treatment with 137 non-alcoholic matched controls. Alcoholic women were significantly more likely than controls to marry at a younger age and have their first child earlier, had less education, and were more likely to be employed in blue collar settings than non-alcoholic women. Alcoholic women were significantly less likely to be working outside the home, and employed alcoholic women were more likely to report boredom in the workplace than employed non-alcoholic women. The lives of alcoholic women include more than their familial roles. More attention to issues of education, employment, and occupational status on the part of health care providers is needed.

Latinas and sexually transmitted diseases: implications of recent research for prevention.

Latinas are among the poorest members of this society, and are not only exposed to greater health risks, but are less likely to have access to health care services. Both HIV infection and cervical cancer are associated with low socioeconomic status, and both have also been linked with sexual transmission. Because of their overrepresentation among the poor, Latinas are at greater risk of cervical cancer, and have also been identified as being at higher risk of HIV/AIDS. Since neither the economic status of Latinas nor the health services available to them are likely to improve within the near future, Latinas are a critical target for health promotion and prevention. This paper documents the urgent need for prevention of cervical cancer and AIDS in the Latina community and makes recommendations for gender-sensitive and culturally competent public health social work practice at the individual, community, and policy-making levels.

Infant mortality in Michigan's child welfare system.

This article reports findings from a study on infant mortality in Michigan's child welfare system. The findings indicate that postneonatal death rates for infants in foster care placement from 1980 to 1989 are substantially higher than those in the general population. Although infants in the child welfare system are likely to be at greater risk, this article suggests that some of these deaths were preventable. Recommendations are made to address this problem as well as other policy issues raised by the data.

Implementing the Public Health Social Work Forward Plan: a research-based prevention curriculum for schools of social work.

In 1985, the Division of Maternal and Child Health of the U.S. Public Health Service funded a major working conference entitled "Public Health Social Work in Maternal and Child Health: A Forward Plan." Curriculum recommendations for schools of social work were made, including a recommendation for the integration of health and mental health content in the education of social workers within a public health conceptual framework. In 1986, the National Institute of Mental Health funded a three-year program to develop and evaluate a research-based prevention training curriculum for dissemination to schools of social work and other primary care professional schools. This article examines the Michigan Prevention Training and Curriculum Development Project from the perspective of the recommendations of the Public Health Social Work Forward Plan.

Similarities and differences between children with asthma wnd children with cancer: Implications for preventive intervention.

A substantial increase in the prevalence of chronic health conditions among children in the U.S. has led to growing concern with preventing the psychosocial and economic problems engendered by such illness. This exploratory study examined the validity of the recently proposed non-categorical approach to physical illness versus the traditional disease-specific perspective as the basis for the content and organization of preventive services for children with chronic illness. No significant disease-specific differences were found in measures of psychological and social adaptation between children with asthma and children with cancer, lending support to a non-categorical approach to the provision of preventive services.

Job satisfaction, burnout, and turnover in health care social workers.

The findings of two consecutive surveys of job satisfaction and burnout in national samples of health care social workers are presented. Between 1979 and 1989, there were significant increases in the proportion of social workers employed in private versus public agencies, in quantitative workload, and in social workers' perceptions of the challenges presented by their jobs. Role conflict and role ambiguity, lack of comfort, and dissatisfaction with financial rewards emerged as significant predictors of depersonalization and burnout. However, a significant increase in social workers' feelings of personal accomplishment also occurred, and high challenge emerged as a significant predictor of sense of effectiveness.

Preventing black maternal mortality: A challenge for the 90's.

The authors studied maternal mortality in Chicago and Detroit from 1979 through 1984. The death rates for black women were more than four times the national rate for white women. Many of the conditions causing death were preventable. Since the general condition of the mother prior to pregnancy is a major influence on pregnancy outcome, accessible and high-quality prenatal care is a necessary but not sufficient preventive measure. If black maternal mortality is to be prevented, attention must be directed to the protection and promotion of black women's physical, mental and social well-being, and not just to their reproductive health.

Perinatal stress: a study of factors linked to the risk of parenting problems.

Infants who are born preterm are at high risk for subsequent maltreatment. This study examines the relationship between family functioning, infant morbidity, parents' experience following their infant's admission to a neonatal intensive care unit, and postdischarge risk of parenting problems. For the sample as a whole, family factors emerged as the best predictors of outcome.

An exemplar of primary prevention in social work: the Sheppard-Towner Act of 1921.

Sixty years ago, the excessively high rates of maternal and infant mortality in this country posed a major social problem. A series of prospective surveys designed and carried out by the U.S. Children's Bureau established that many of these deaths were related to the poor condition of the mother and could be prevented. Overcoming opposition from a conservative federal government, the American Medical Association, and a coalition of ultraconservative groups, social workers lead a campaign which resulted in passage of the Sheppard-Towner Act in 1921. The work accomplished under this act contributed substantially to the reduction of infant mortality in the United States, demonstrated the effectiveness of such preventive health services, and established the principle of shared federal-state responsibility in matters of health and social welfare.

A study of maternal participation in preschool programs for handicapped children and their families.

This study investigates the effects on maternal attitudes toward child-rearing of preschool programs for handicapped children and their families. Two types of programs were studied: programs emphasizing maternal participation and those minimizing maternal involvement. It was hypothesized that programs which stress mothers' involvement would result in more positive attitude changes than programs de-emphasizing maternal participation. The findings indicate that maternal involvement and program support are critical variables in promoting positive attitudes toward child-rearing. The authors recommend that a multi-regional study be undertaken to determine the applicability of this study's findings. Such information would be useful in future program development and in the training of program personnel.

Origins of sulfur in coal: importance of the ester sulfate content of peat.

The sulfur found in coal stems in large part from sulfur incorporation at the peat-forming stage. Ester sulfate (a carbon-oxygen-sulfur linkage) is a major contributor to the sulfur in peat and thus is an important determiner of the quantity and forms of sulfur eventually found in coal.