Prevalence and correlates of vaccine attitudes and behaviors in a cohort of low-income mothers.

The US is facing a rise in vaccine hesitancy, delay, and refusal, though little is known about these outcomes in socio-economically disadvantaged populations. This study examines the prevalence and correlates of vaccine attitudes and behaviors in a diverse cohort of low-income mothers receiving home visiting services. Survey data were collected from 813 recipients of evidence-based home visiting services in Wisconsin from 2013 to 2018. Analyses were performed to describe outcome measures of vaccine attitudes and self-reported completion, and multivariate regressions were used to test associations between vaccine-related outcomes and hypothesized correlates. Most women (94%) reported their children were up to date on vaccines; 14.3% reported having ever delayed vaccination. A small minority disagreed that vaccines are important (5.0%), effective (5.4%), and safe (6.2%), though a larger proportion responded ambivalently (10.9%-21.9%). Participants with greater trust in health care providers reported more positive overall vaccine attitudes (B = 0.24; 95% CI = 0.17, 0.31), a lower likelihood of vaccine delay (OR = 0.57; 95% CI = 0.46, 0.73), and a greater likelihood of being up to date on vaccines (OR = 1.79, 95% CI = 1.30, 2.44). Women with greater trust in a home visitor also rated vaccines more positively (B = 0.09; 95% CI = 0.02, 0.15), and women who reported better mental health were more likely to report their children were up to date (OR = 1.05; 95% CI = 1.02, 1.09). Compared to non-Hispanic whites, American Indians and non-Hispanic blacks had poorer vaccine-related outcomes. More research on vaccine attitudes and behaviors among higher-risk populations is needed to develop tailored strategies aimed at addressing vaccine hesitancy and underimmunization.

Home Visiting Effects on Breastfeeding and Bedsharing in a Low-Income Sample.

BACKGROUND: Research suggests that home visiting interventions can promote breastfeeding initiation, though their effects on breastfeeding continuation are unclear. No known studies have assessed the impact of home visiting on bedsharing. AIMS: To test the effects of home visiting on breastfeeding and bedsharing in a low-income, urban sample in the United States. METHODS: During a field trial conducted in Milwaukee, Wisconsin, from April 2014 to March 2017, referrals to a public health department were randomized to a Healthy Families America (HFA) program or a prenatal care and coordination (PNCC) program. Of the 204 women who accepted services, 139 consented to the study and were allocated to the two treatment groups, which were compared with each other and a third quasi-experimental group of 100 women who did not accept services. Data were collected at four time points up to 12 months postpartum. RESULTS: Breastfeeding initiation was higher among 72 HFA participants (88.4%; odds ratio [OR] = 2.7) and 67 PNCC participants (88.5%; OR = 2.2) than 100 comparison participants (76.5%). Similar results emerged for breastfeeding duration, though group differences were not statistically significant. Unexpectedly, bedsharing prevalence was higher among HFA participants (56.5%) than PNCC participants (31.1%; OR = 2.9) and comparison group participants (38.8%; OR = 2.0). DISCUSSION: Home visiting was linked to increased breastfeeding, while effects on bedsharing varied by program. Progress toward precision home visiting will be advanced by identifying program components that promote breastfeeding and safe sleep. CONCLUSION: Further research is needed to examine whether home visiting reduces disparities in breastfeeding and safe sleep practices.

Prevalence and Correlates of Maternal and Infant Sleep Problems in a Low-Income US Sample.

OBJECTIVES: This study examined the prevalence and correlates of maternal and infant sleep problems among low-income families receiving home visiting services. METHODS: The study sample includes 1142 mother-infant dyads in Wisconsin, United States. Women completed a survey when their infants were between two weeks and one year old. Outcome data were collected using the PROMIS® sleep disturbance short form-4a and the Brief Infant Sleep Questionnaire. Correlates of sleep problems were assessed in two domains: maternal health and home environment quality. Descriptive analyses produced prevalence estimates, and multivariate regressions were performed to test hypothesized correlates of maternal and infant sleep problems. Subgroup analyses were conducted to examine the prevalence and correlates of sleep problems across different infant age groups. RESULTS: Approximately 24.5% of women reported poor or very poor sleep in the past week; 13% reported an infant sleep problem and 11% reported more than three infant wakings per night. Reported night wakings were more prevalent among younger infants but maternal and infant sleep problems were not. Multivariate results showed that poor maternal physical and mental health and low social support were associated with maternal sleep disturbance but not infant sleep problems. Bed sharing and smoking were associated with infant sleep outcomes but not maternal sleep. There was limited evidence that the correlates of maternal and infant sleep varied by infant age. CONCLUSIONS FOR PRACTICE: The findings point to alterable factors that home visiting programs and other interventions may target to enhance maternal and infant sleep.

Client and Provider Discomfort With an Adverse Childhood Experiences Survey.

INTRODUCTION: Many service providers report concerns that questions about adverse events may upset clients. Studies indicate that most survey respondents answer sensitive questions without experiencing distress, although little is known about the prevalence or correlates of clients' discomfort when they are asked similar questions by direct care providers, such as home visitors. METHODS: This study used data collected between 2013 and 2018 from 1,678 clients and 161 providers in a network of home visiting programs in Wisconsin. Clients and home visitors completed an adverse childhood experience questionnaire that concludes by asking about discomfort with the questions. Analyses conducted in 2018 examined overall client discomfort and associations between discomfort and the endorsement of 10 distinct adverse childhood experiences. Multilevel regressions were performed to test whether client and provider factors were associated with client discomfort. RESULTS: More than 80% of clients were not at all or slightly uncomfortable with the adverse childhood experience questionnaire, and 3% reported extreme discomfort. Bivariate results showed that each adverse childhood experience, except parental divorce, was associated with greater discomfort; sexual abuse was the only adverse childhood experience associated with discomfort in a multivariate analysis. Multiple client variables were linked to increased discomfort, including higher adverse childhood experience scores (b=0.06, 95% CI=0.04, 0.08) and depression scores (b=0.01, 95% CI=0.00, 0.02). Home visitor discomfort was positively associated with client discomfort (b=0.16, 95% CI=0.01, 0.31). CONCLUSIONS: Results indicated that most clients in home visiting programs tolerated an adverse childhood experience questionnaire well. The findings point to clients who may be more likely to report discomfort and highlight an important association between client and provider discomfort.