Persistence of maternal concerns surrounding neonatal jaundice: an exploratory study.

OBJECTIVES: To explore whether mothers currently express concerns about neonatal jaundice and perceive it as a serious condition; if so, to identify factors influencing these perceptions; and to elicit maternal recommendations for improved health care interactions. DESIGN: Ethnographic interviews using grounded theory methods. Audiotaped data were transcribed and analyzed for themes using a qualitative data analysis software program. SETTING: University and community hospitals. PARTICIPANTS: Forty-seven Spanish- and English-speaking breastfeeding mothers of otherwise healthy infants with a diagnosis of neonatal jaundice and treated in inpatient and/or outpatient settings. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Qualitative descriptions of maternal experiences with neonatal jaundice. RESULTS: Mothers continued to voice concerns about jaundice and perceive it as serious. They expressed misconceptions, wished to have jaundice explained further, and offered suggestions to improve communications with medical staff. Guilt was common, with mothers believing that they had caused the jaundice. Mothers voiced alarm about the yellow skin and discomfort about jaundice management and worried about perceived short- and long-term effects. Maternal perceptions were exacerbated by cultural differences, language barriers, and subtlety of language and its meaning. Key factors in creating perceptions of jaundice as serious included unexpectedness of and lack of knowledge about jaundice, quality of information received, levels of intervention, and prolonged duration of illness and yellow color. Interactions with health care professionals and other mothers with personal experience with jaundice were important mediators in the way mothers reacted to information. CONCLUSION: Practitioners need to address these persisting misconceptions and concerns about neonatal jaundice with mothers.

The changing ethnic makeup of America's adolescents: implications for health.

As the percentage of minority adolescents in society increases, behaviors that affect the health of these adolescents will become increasingly important. Both mental and physical health as well as substance abuse and violence need to be addressed, and the ethnicity and culture of the adolescent patient may guide specific approaches and considerations. Many of the health problems affecting adolescents are preventable, and health care providers should aim significant resources at these issues. Gaps in adolescent health care, and especially barriers to entry for some ethnic groups, deserve greater attention to ensure that all groups can enjoy access to quality health care. Options available to health care practitioners for reducing these barriers are offered in the final portion of the article.

Motor-vehicle occupant injury: strategies for increasing use of child safety seats, increasing use of safety belts, and reducing alcohol-impaired driving.

The Task Force on Community Preventive Services has conducted systematic reviews of interventions designed to increase use of child safety seats, increase use of safety belts, and reduce alcohol-impaired driving. The Task Force strongly recommends the following interventions: laws requiring use of child safety seats, distribution and education programs for child safety seats, laws requiring use of safety belts, both primary and enhanced enforcement of safety belt use laws, laws that lower the legal blood alcohol concentration (BAC) limit for adult drivers to 0.08%, laws that maintain the minimum legal drinking age at 21 years, and use of sobriety checkpoints. The Task Force recommends communitywide information and enforcement campaigns for use of child safety seats, incentive and education programs for use of child safety seats, and a lower legal BAC for young drivers (in the United States, those under the minimum legal drinking age). This report provides additional information regarding these recommendations, briefly describes how the reviews were conducted, and provides information to help apply the interventions locally.

African-American and Latina adolescent mothers' infant feeding decisions and breastfeeding practices: a qualitative study.

PURPOSE: To explore minority teen mothers' perceptions of breastfeeding and the influences on infant feeding choices. METHODS: A qualitative study using semistructured ethnographic interviews and focus groups involving 35 Latina and African-American girls in Chicago between the ages of 12 and 19 years who were primiparous and were currently pregnant or had delivered within the past 3 months. RESULTS: Adolescents identified three main influences on infant feeding decisions and practices: (a) their perceptions of the benefits of breastfeeding, (b) their perceptions of the problems with breastfeeding, and (c) influential people. In this study, teens reported no single influence which determined infant feeding choices. The decision to breastfeed was a dynamic process. Teens recognized that breastfeeding offered many benefits including facilitating maternal-child bonding and promoting the baby's health, but concern was raised regarding a potential for excessive attachment between teen mother and baby. Fear of pain, embarrassment with public exposure, and unease with the act of breastfeeding acted as barriers for teenagers who were considering breastfeeding. Teenagers discussed the breast pump as a strategy in dealing with these barriers. The adolescents' mothers continued to be an important influence. CONCLUSIONS: The ranges of perceptions and influences that minority adolescent mothers have identified as affecting their infant feeding choices, illustrated and explained in the teens' own words, are helpful to health care providers as they counsel teen mothers about infant feeding options.

Mediators of ethnic-associated differences in infant birth weight.

PURPOSE: To examine whether ethnic differences in low birth weight babies of low-income women may be explained in part by group differences in prenatal health behaviors and psychosocial factors. METHODS: A prospective, survey of 1,071 low-income, primiparous African-American and Mexican-origin women was conducted in Los Angeles County, California. In face-to-face interviews, data were obtained on substance use, prenatal stress, social support, attitudes toward pregnancy, initiation of prenatal care, and medical risk. Medical chart data were abstracted regarding medical risk factors and labor, delivery, and neonatal data. Interview data were linked with birth outcome data retrieved from maternal medical records. Structural equation modeling was used to test a hypothesized model in which differences in birth weight were expected to be mediated by ethnic differences in substance use, psychosocial factors, and medical risk. RESULTS: As expected, African-American women delivered babies of earlier gestational age and lower birth weight than did women of Mexican origin. Direct predictors of low birth weight were use of drugs and cigarettes, prenatal stress, and positive attitudes toward pregnancy; together, these factors accounted for the observed ethnic differences in birth weight. CONCLUSION: These data contribute to our understanding of the factors that may account for ethnic-associated differences in low birth weight.

Prenatal health behaviors and psychosocial risk factors in pregnant women of Mexican origin: the role of acculturation.

OBJECTIVES: This study examined the association between acculturation of Mexican-origin women and factors in low birthweight and preterm delivery. METHODS: Interviews were conducted with 911 Mexican-origin respondents in Los Angeles prenatal care clinics. Infant outcome data were retrieved from delivery records. RESULTS: Mexican-American women had generally more undesirable prenatal behaviors and risk factors than Mexican-immigrant women. Although higher acculturation was significantly associated with behavioral risk factors, there were no direct effects of acculturation on infant gestational age or birthweight. CONCLUSIONS: Future research needs to measure multiple factors to assess their effects on culture-specific protective factors.

Maternal psychosocial factors associated with substance use in Mexican-origin and African American low-income pregnant women.

PURPOSE: To describe ethnic-specific patterns of substance use before and during pregnancy in low-income pregnant women, examine the associations between psychosocial factors and patterns of substance use within ethnic groups, and assess maternal sociodemographic, prenatal, and psychosocial factors of women who continue to use substances during pregnancy and those who do not. METHOD: A prospective study of low-income, primiparous African American (n = 255), Mexican American (n = 525), and Mexican immigrant (n = 764) women was conducted in 22 prenatal care clinics in Los Angeles, CA. Data were collected in face-to-face interviews in both English and Spanish on prenatal life events, anxiety, sources of support, and substance use behaviors three months before and during pregnancy. FINDINGS: Significant ethnic differences were found in use of alcohol, cigarettes, and illicit drugs. African American women were more likely than Mexican-origin women to report use of substances before and during pregnancy. Mexican American women were more likely than Mexican immigrant women to report use of substances before and during pregnancy. Women who continued to use substances during pregnancy were less likely to be living with the baby's father, to have planned the pregnancy, to report having been able to go for prenatal care as soon as they wanted, and more likely to be identified at medical risk. CONCLUSIONS: Providers must increase the assessment and monitoring of substance use behaviors of low-income women in prenatal care settings. The role of health care providers must encompass advocacy and public health education.

Determinants of adherence among health department patients referred for a mammogram.

This paper examines adherence to a referral for a screening mammogram among an ethnically diverse sample of 576 female county health department patients age 50 and over. Data were obtained by interview approximately one year after the referral for a screening mammogram. Overall, approximately 80% of the sample were adherent to the referral. Medical record validation of self-reports of mammography receipt verified receipt of a mammogram for 82% of those reporting one. In logistic regression analysis, determinants of adherence included: transportation barriers, fear of immigration authorities, perceived control over getting breast cancer, self-rated health status, age, and perceived quality of provider-patient communication. The most prevalent concerns about mammography were concern over finding cancer, treatment for breast cancer, and removal of a breast. Reporting of these concerns was not significantly related to adherence. Also reported are barriers to health care experienced by this population over the past 12 months. The high adherence rate found in this study emphasizes the importance of provider referral in the delivery of screening mammography, and invalidates assumptions that women of lower education and lower income are less likely to adhere to provider recommendations.

Social support in pregnancy: psychosocial correlates of birth outcomes and postpartum depression.

This prospective study examined the effects of prenatal social support on maternal and infant health and well-being in a sample of low-income pregnant women (N = 129). Three aspects of support (amount received, quality of support received, and network resources) and four outcomes (birth weight, Apgar scores, labor progress, and postpartum depression) were studied. Results indicated that women who received more support had better labor progress and babies with higher Apgar scores. Women with higher quality support had babies with higher Apgar scores and experienced less postpartum depression. Also, women with larger networks had babies of higher birth weight. Further analyses indicated that the outcomes as a whole were more consistently predicted by instrumental rather than emotional forms of support. Finally, although there was some evidence for stress-buffering effects of support, the overall findings were more consistent with a main effect model.

Prenatal maternal stress and prematurity: a prospective study of socioeconomically disadvantaged women.

Developed and tested a biopsychosocial model of birthweight and gestational age at delivery using structural equation modeling procedures. The model tested the effects of medical risk and prenatal stress on these indicators of prematurity after controlling for whether a woman had ever given birth (parity). Subjects were 130 women of low socioeconomic status interviewed throughout pregnancy in conjunction with prenatal care visits to a public clinic. The majority of women were Latino or African-American. Half were interviewed in Spanish. Lower birthweight was predicted by earlier delivery and by prenatal stress. Earlier delivery was predicted by medical risk and by prenatal stress. Parity was not related to time of delivery or to birthweight. Implications of results for the development of biopsychosocial research on pregnancy and on stress are discussed.

The AIDS Rapid Anthropological Assessment Procedures: a tool for health education planning and evaluation.

Health education is an essential part of efforts to limit and manage the current AIDS pandemic. The information needed to develop meaningful and culturally appropriate educational interventions is often difficult to obtain because topics related to the prevention and treatment of AIDS are invariably culturally and/or personally sensitive. This article describes the data collection guidelines of the HIV/AIDS Rapid Anthropological Assessment Procedures developed by the Social and Behavioural Research Unit of the World Health Organization's Global Programme on AIDS. The guidelines apply anthropological methods of observation, participant observation, informal and formal interviews, and focus group interviews to the collection of information on AIDS-related beliefs and behaviors. When researchers focus on specific issues in countries, cultures, and languages with which they are already familiar, relatively rapid assessments can be made with a high degree of validity. This article briefly discusses these methods and their application to AIDS-related topics, together with the validity and reliability of the various methodological tools available to social and behavioral scientists.

Prenatal and postnatal anxiety in Mexican women giving birth in Los Angeles.

Examined psychosocial factors related to prenatal and postnatal anxiety in 291 primiparous Mexican women giving birth in Los Angeles. Characteristics of health care providers preferred by more anxious and less anxious women were also assessed. Higher prenatal anxiety was associated with less desire for an active role during labor, lower assertiveness, higher pain expectation at delivery, lack of support from family members other than the husband, and preferences for health care providers who are female and Latino. All groups of women preferred health care providers who provided good medical explanations and who were knowledgeable, friendly, and sympathetic. Postnatal anxiety was significantly lower than prenatal anxiety. Negative attitudes toward the baby and number of complications during labor and delivery, however, were related to postnatal anxiety adjusted for prenatal anxiety.

Anthropological involvement in the Central American diarrheal disease control project.

The process of conducting applied anthropological work leading to health program development and evaluation is seldom described in the literature. This paper discusses the combination of factors which led to the involvement of anthropologists in the Central American Child Survival Project and how anthropological approaches are being used in the project. Ethnoclassification was used to illustrate the discrepancy between the proposed approach to treatment for dehydration produced by diarrheal disease and the actual beliefs and practices in 4 Central American communities. Techniques such as rapid, focused assessment using anthropological methods of data collection and presentation are discussed, as are strategies for presenting this information to health program planners and administrators.

Factors affecting breastfeeding among women of Mexican origin or descent in Los Angeles.

Data on breastfeeding intentions and behavior were collected in prenatal and postpartum interviews as part of a study on first birth among 518 women of Mexican origin or descent in two Los Angeles hospitals. The prenatal intentions of 82 per cent of the women to breastfeed were maintained postpartum in one hospital but dropped sharply in the other. A greater number of hours a day with the baby in the hospital and earlier initiation of breastfeeding were associated with the hospital where prenatal breastfeeding intentions were more likely to be carried out. The intention to work postpartum was associated both with the decision not to breastfeed at all and with shorter intended duration of breastfeeding.

Gender and level of training differences in obstetricians' attitudes towards patients in childbirth.

This paper explores male and female obstetricians' attitudes towards their patients in childbirth. Individual interviews were conducted with 50 obstetricians using a semistructured questionnaire. Across gender and level-of-training there were few differences in descriptions of easy patients. The few differences that did emerge reveal that attending physicians see patients as less difficult to handle than do residents and that female residents place more emphasis on compliance and control than do male residents. The results of the study are discussed in terms of sex-role stereotypes, the medical school socialization process and the medical model of health care.

Sex differences in attitudes towards newborn infants among women of Mexican origin.

PIP: This paper analyzes a data set on women of Mexican origin delivering in Los Angeles hospitals, in order to examine whether Mexican women's attitudes toward their 1st-born infants are influenced by the sex of the child, either alone or in combination with other factors, such as the difficulty of labor and delivery or the woman's social support system. The authors' hypothesize that the mother's attitude toward the 1st child will be determined primarily by factors other than the child's sex, since there is evidence to suggest equal sex preference among women in Latin culture. They predict that the most negative attitudes would be expressed in the case of an unplanned pregnancy, of a child being born into an unstable family or with physical abnormalities. The women described in this paper are all from the Mestizo, or Hispanicized peoples from Mexico. The analyses are based on interviews with a sample of 518 low risk women. Data on the medical course of their labor and delivery was also collected from their medical charts. The operationalization and measurement of each predictive variable are explained. Sex differences in women's evaluations of their children were examined with Chi-Square analyses. As expected, almost no differences on any attitude measure were found. In general the mothers were very pleased with their infants, whether male or female, although there is a suggestion that if they were disappointed, they were more likely to be displeased with a female infant than with a male. Regression analyses, more sensitive for picking up sex differences than the simple Chi-Square, were performed to determine which of the predictive variables were most related to the mother's attitude. Results show that sex was not a predictive variable. Contrary to what was predicted, whether or not the baby was planned, appeared to be relatively unimportant in the mother's attitude toward her child. A 2nd surprising finding was that the woman's experience of birth was unrelated to her evaluation of her child. The social support system had a significant impact on the mother's evaluation of her child. For both boys and girls, social support from the baby's father was associated with a positive attitude toward infants. Women were significantly more negative toward their infants if they had a poor relationship with the baby's father. Finally, the more acculturated women expressed less positive attitudes toward their newborns; this relationship was slightly stronger for girls than boys.^ieng