Trace Kershaw

University of Illinois at Chicago, Chicago, IL, United States

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Publications (138)364.93 Total impact

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    ABSTRACT: Background: We examined the association between financial life events stressors during pregnancy and low birth weight (LBW) among African Americans and Whites, while systematically controlling for potential confounders including individual characteristics and city-level variations and clustering. Methods: We analyzed data from 4970 women with singleton births from the 2007 and 2010 Los Angeles Mommy and Baby Surveys. Having experienced financial stressors was defined as having experienced at least one of the following life events during pregnancy: lost job, husband lost job, and had a lot of bills she could not pay. Multilevel logistic regression was used to assess the association between financial stressors and LBW among African Americans and Whites. Potential confounders included were: city-level economic hardship index, maternal demographics, pre-pregnancy conditions, insurance, behavioral risk factors and social support. Results: Significantly higher proportion of African Americans experienced one or more financial stressors during their pregnancy, compared to Whites (p<0.001). The association between financial stressors and LBW was significantly different between African Americans and Whites (P for interaction=0.033). Experience of financial stressors during pregnancy was significantly associated with LBW among African Americans (adjusted Odds Ratio=1.49; 95% Confident Interval=1.01, 2.20) but not whites. Conclusions: The three financial life event stressors examined in this study were more likely to impact African Americans than Whites. Differential impact of financial stressors during pregnancy may contribute to racial disparities in LBW among African Americans and Whites. Financial stress during pregnancy is an important area for public health to address to improve birth outcomes among African Americans.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: The need for parenting and relationship strengthening programs is important among low-income minority parents where the burden of relational and parental stressors contributes to relationship dissolution. We examine these stressors among young parents. Data were collected from four focus groups (N = 35) with young parents. Data were audio-recorded and transcribed. Inductive coding was used to generate themes and codes, and analysis was completed using NVivo. Relationship and parenting challenges, values, and areas of need were the three major themes that emerged. Women's relationship challenges were family interference and unbalanced parenting, and men reported feeling disrespected and having limited finances. Common relationship challenges for women and men were family interference and unbalanced parenting. Both genders valued trust, communication, and honesty in relationships. Areas of need for women and men included: improving communication and understanding the impact of negative relationships on current relationships. Parenting challenges for women were unbalanced parenting, child safety, and feeling unprepared to parent; men reported limited finances. Both genders valued quality time with child to instill family morals. Areas of need for women and men included learning child discipline techniques and increasing knowledge about child development. Finally, women and men have relationship and parenting similarities and differences. Young parents are interested in learning how to improve relationships and co-parent to reduce relationship distress, which could reduce risk behaviors and improve child outcomes.
    Family Process 07/2014; · 1.73 Impact Factor
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    ABSTRACT: Depression is known to mediate the association between low social support and parenting competence in adult mothers, but this relationship is rarely assessed in adolescent mothers and fathers. The primary aim of this study was to identify the association between social support, family functioning and social capital on parenting competence, including self-efficacy and satisfaction in adolescent mothers and their partners. Secondary aims included identifying potential partner effects (e.g. whether a partner's social support influenced the respondent's parenting efficacy). Data was obtained from a subset of participants from a longitudinal study of pregnant adolescent females and their partners. Couples completed individual structured interviews via audio computer-assisted self-interview during pregnancy and at 6 months postpartum. To measure the influence of support on parenting outcomes, multi-level modeling was used to assess the Actor-Partner Interdependence model, which examines responses from both members of a dyad in a single analysis. Greater social support was associated with increased parenting self-efficacy (B = 0.062, p = 0.006) and parenting satisfaction (B = 0.111, p < 0.001). Higher family functioning was also associated with greater parenting satisfaction (B = 0.05, p = 0.035). Greater partner family functioning was associated with higher parenting satisfaction (B = 0.047, p = 0.026). This study found the importance of a strong support structure during pregnancy on perceived parenting competence in the early postpartum period for young mothers and fathers. Both social support and family functioning during pregnancy were associated with a greater sense of parenting competence, and these associations were mediated by parental depression. The results of this study underscore the importance of providing social support for young expectant fathers as well as mothers.
    Maternal and Child Health Journal 05/2014; · 2.24 Impact Factor
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    ABSTRACT: Intimate partner violence (IPV) victimization and perpetration and power imbalances in parenting partners may result in poor outcomes for parents and children. Previous work in this area has focused on the maternal experiences, neglecting to examine paternal effects. The present study aimed to elucidate the role of IPV, power, and equity in parenting and child outcomes in an urban sample of adolescent parents. 159 male and 182 female parents in a relationship were recruited through university-affiliated hospitals. Power, equity, and IPV were measured at 6 months post-partum and were used as predictors for parenting and child outcomes 12 months post-partum using general estimating equations. Gender interactions and mediation effects of depression were also assessed. Higher perceived relationship equity was related to better infant temperament (B = 0.052, SE = 0.023, p = 0.02) whereas higher partner power was related to poorer social development (B = -0.201, SE = 0.088, p = 0.02) and fine motor development (B = -0.195, SE = 0.078, p = 0.01). IPV victimization was associated with poor infant temperament (B = -2.925, SE = 1.083, p = 0.007) and lower parenting competence (B = -3.508, SE = 1.142, p = 0.002). Depression mediated the relationship between IPV and parenting and IPV and infant temperament. No gender effects were found. IPV, inequities, and power imbalances were disadvantageous for parenting and child outcomes. Our results suggest that these dynamics may negatively affect both males and females. Interventions to reduce violence in both partners and promote equity in relationships could benefit couples and their children.
    Maternal and Child Health Journal 04/2014; · 2.24 Impact Factor
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    ABSTRACT: The study assessed the relationship between postpartum intimate partner violence (IPV) and postpartum health risks among young mothers over time. Data were collected from 2001 to 2005 on young women aged 14-25 attending obstetrics and gynecology clinics in two US cities. Postpartum IPV (i.e., emotional, physical, sexual) was assessed at 6 and 12 months after childbirth (n = 734). Four types of postpartum IPV patterns were examined: emerged IPV, dissipated IPV, repeated IPV, and no IPV. Emerged IPV occurred at 12 months postpartum, not 6 months postpartum. Dissipated IPV occurred at 6 months postpartum, not 12 months postpartum. Repeated IPV was reported at 6 months and 12 months postpartum. Postpartum health risks studied at both time points were perceived stress, depression, fear of condom negotiation, condom use, infant sleeping problems, and parental stress. Repeated measures analysis of covariance was used. The proportion of young mothers reporting IPV after childbirth increased from 17.9 % at 6 months postpartum to 25.3 % at 12 months postpartum (P < 0.001). Emerged and/or repeated postpartum IPV were associated with increased perceived stress, depression, fear of condom negotiation, and infant sleeping problems as well as decreased condom use (P < 0.05). Dissipated postpartum IPV was associated with decreased depression (P < 0.05). IPV screening and prevention programs for young mothers may reduce health risks observed in this group during the postpartum period.
    Maternal and Child Health Journal 02/2014; · 2.24 Impact Factor
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    ABSTRACT: Objective: There is evidence that pregnancy-specific stress is associated with preterm birth. The purpose of this study is to examine the association between change in pregnancy-specific stress over the course of pregnancy and birth outcomes (i.e., preterm birth and gestational age) in an understudied but vulnerable group using a theoretically derived model. Methods: Multivariate linear and logistic regression techniques were used to examine the association between pregnancy-specific stress (measured in second and third trimester) and length of gestation (i.e., preterm birth and gestational age) among a sample of 920 Black and/or Latina adolescent and young women. Results: Second trimester pregnancy-specific stress was not associated with preterm birth or gestational age. Third trimester pregnancy-specific stress was associated with preterm birth but not with gestational age. Change in pregnancy-specific stress between second and third trimester was significantly associated with increased likelihood of preterm delivery and shortened gestational age, even after controlling for important biological, behavioral, psychological, interpersonal, and sociocultural risk factors. Conclusions: Findings emphasize the importance of measuring pregnancy-specific stress across pregnancy, as the longitudinal change from second to third trimester was significantly associated with length of gestation measured both as a dichotomous variable (preterm birth) and a continuous variable (gestational age). Furthermore, this is the first study to observe the association of pregnancy-specific stress with length of gestation in this understudied population-unique in age, race, and ethnicity. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Health Psychology 01/2014; · 3.95 Impact Factor
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    ABSTRACT: Rates of STIs, HIV, and pregnancy remain high among adolescents in the US, and recent approaches to reducing sexual risk have shown limited success. Future expectations, or the extent to which one expects an event to actually occur, may influence sexual risk behavior. This prospective study uses longitudinal data from the National Longitudinal Survey of Youth 1997 (n = 3,205 adolescents; 49.8 % female) to examine the impact of previously derived latent classes of future expectations on sexual risk behavior. Cox regression and latent growth models were used to determine the effect of future expectations on age at first biological child, number of sexual partners, and inconsistent contraception use. The results indicate that classes of future expectations were uniquely associated with each outcome. The latent class reporting expectations of drinking and being arrested was consistently associated with the greatest risks of engaging in sexual risk behavior compared with the referent class, which reported expectations of attending school and little engagement in delinquent behaviors. The class reporting expectations of attending school and drinking was associated with having greater numbers of sexual partners and inconsistent contraception use but not with age at first biological child. The third class, defined by expectations of victimization, was not associated with any outcome in adjusted models, despite being associated with being younger at the birth of their first child in the unadjusted analysis. Gender moderated specific associations between latent classes and sexual risk outcomes. Future expectations, conceptualized as a multidimensional construct, may have a unique ability to explain sexual risk behaviors over time. Future strategies should target multiple expectations and use multiple levels of influence to improve individual future expectations prior to high school and throughout the adolescent period.
    Journal of Youth and Adolescence 12/2013; · 2.72 Impact Factor
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    ABSTRACT: The purpose of this report was to examine the course of smoking among pregnant women with concurrent substance use, and to assess the impact of depression on smoking. Data were gathered as part of a randomized controlled trial assessing the efficacy of substance abuse treatment in pregnant women. Women (n=176) were recruited before 28 completed weeks of pregnancy, and followed until 3months postpartum. Depression was assessed using the Inventory of Depressive Symptomatology and the MINI Neuropsychiatric Interview. Our outcome was the average number of cigarettes smoked per day. Linear mixed effects regression was used to measure differential changes in smoking. 66% of women smoked in the three months before pregnancy, 42% of pre-pregnancy smokers achieved abstinence before delivery and 60% of the baseline cohort smoked postpartum. Smoking did not differ significantly between depressed and non-depressed groups. After delivery both groups increased smoking at similar rates. Smoking was common among our cohort of pregnant women with a history of substance use. Women were able to discontinue or decrease smoking during pregnancy, but were likely to resume or increase smoking postpartum. Having clinically significant depressive symptoms or a diagnosis of depression did not have an obvious effect on smoking behaviors.
    Addictive behaviors 12/2013; 39(4):749-756. · 2.25 Impact Factor
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    ABSTRACT: Background: Power imbalances in intimate relationships affect decision making regarding health, and may result in intimate partner violence (IPV) and poor psychological health outcomes. Children of individuals with low power may also be vulnerable to adverse health outcomes. The present study aimed to elucidate the role of power, equity, and IPV in outcomes for their children in an urban sample of adolescent parents. Methods: 159 male and 182 female parents in a relationship were recruited through university-affiliated hospitals. Power, equity, and IPV were measured 6 months post-partum and were used as predictors for parenting and child outcomes 12 months post-partum using general estimating equations. Gender interactions and mediation effects of depression were also assessed. Results: Higher perceived relationship equity was related to better infant temperament, (B=.052, SE=.023, p=.02) whereas higher partner power was related to poorer social (B= -.201, SE=.088, p=.02) and fine motor development (B= -.195, SE=.078, p=.01). IPV was associated with poor infant temperament (B= -2.925, SE=1.083, p=.007) and lower parenting competence (B= -3.508, SE=1.142, p=.002). Depression mediated the relationship between IPV and parenting as well as IPV and infant temperament. No gender effects were found. Conclusions: Power imbalances were disadvantageous for child outcomes. Previous work suggests that women may be particularly vulnerable to adverse effects of power imbalances. However, our results indicate that perceived power imbalances may negatively affect both males and females, which is disadvantageous for parenting and child outcomes. Interventions promoting equity and power in relationships could benefit couples and their children.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Few studies have looked at how partners influence each other's mental health, the influence of relationships on mental health, and the influence of mental health on relationships. This may be particularly important across pregnancy and early parenthood, when stress is heightened. Data are from a longitudinal cohort of adolescent females (ages 14-21) and their male partners followed from pregnancy through 1 year postpartum. Structural equation modeling assessed lagged effects across time for depression, stress, and relationship satisfaction. Results showed that males' and females' depression did not significantly relate to their partner's subsequent depression. However, for stress, more female stress during pregnancy predicted increased stress of their male partner at 6-months postpartum (β=.127. p<.05). In addition, higher male relationship satisfaction at 6-months postpartum predicted higher relationship satisfaction of their female partner at 12-months postpartum (β=.122. p<.05). Among males, higher relationship satisfaction predicted subsequent lower depression at 6-months postpartum (β=-.164. p<.05) and 12-months postpartum (β=-.138. p<.05). Whereas for females the opposite effect was found; more depression predicted lower relationship satisfaction 6-months postpartum (β=-.118. p<.05), and 12-months postpartum(β=-.184. p<.05). Results suggest mental health and relationship satisfaction of one member of a couple can influence the other member of the couple. Further, we showed the complicated association between relationship satisfaction and mental health and how it differed by gender. For males, poor relationships influenced mental health; whereas for women mental health influenced relationship satisfaction. There is a need of couple based interventions during pregnancy and parenthood that improve mental health and strengthen relationships.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Poor mental health during the postpartum period can have a significant impact on parents and their new baby. Young parents may be more vulnerable to poor mental health than older parents; however, research to understand their mental health and use of mental health services is limited. Accordingly, we aimed to examine depressive symptoms and use of mental health care among young parents. Data were derived from a longitudinal cohort of pregnant adolescent females (ages 14-21; N=296) and their male partners followed through 1 year postpartum. Multilevel regression models stratified by gender identified trends over time and factors associated with elevated depressive symptoms (top quartile; >13 on modified CES-D). Depressive symptoms significantly decreased from pregnancy through 1 year postpartum among females (B=-0.91, p<0.001), but increased among males, although this trend was non-significant (B=0.35, p=0.145). Mental health care use was stable for females (approximately 5.0%), but increased significantly for males (OR=1.70, p=0.014) from 1.4% during pregnancy to 4.0% at 1 year. Among females, healthy eating (OR=0.50) and greater social support (OR=0.94) were associated with lower odds of having elevated depressive symptoms, while experiencing intimate partner violence (OR=6.61) was associated with higher odds (all p<0.05). Among males, greater social support (OR=0.97) and higher relationship satisfaction (OR=0.98) were associated with lower odds of having elevated depressive symptoms (both p<0.05). Results suggest postpartum mental health, particularly among young males, requires additional attention. Improving relationships between young parents, their use of mental health services, and social support may help improve the overall health of young families.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Assess the influence of relationship and family factors during pregnancy on parenting behavior 6 months postpartum among low-income young parents. Some 434 young expectant couples were recruited from obstetrics clinics during pregnancy and followed 6 months postpartum. Using a series of general estimating equations to control for the correlated nature of the data, we assessed the influence of relationship factors (e.g., relationship satisfaction, attachment) and family factors (e.g., family functioning, family history) during pregnancy on parenting (e.g., parenting involvement, time spent caregiving, parenting experiences, and parenting sense of competence) 6 months postpartum controlling for covariates. Relationship functioning related to parenting involvement, caregiving, parenting experiences, and parenting sense of competence. In addition, several family factors related to parenting. Mother involvement during childhood was related to more parenting involvement, parenting positive experiences, and parenting sense of competence. History of being spanked as a child related to less time spent caregiving and less positive life change from being a parent. Further, gender significantly moderated the associations between relationship and family factors and parenting behavior. Male parenting behavior was more influenced by relationship and family factors than female parenting. This study suggests the importance of relationship and family contexts for parenting behaviors of young mothers and fathers, highlighting the potential utility of involving both young mothers and fathers in parenting programs, and developing interventions that focus on strengthening young parents' romantic relationships and that address negative parenting experienced during childhood.
    Journal of Adolescent Health 10/2013; · 2.97 Impact Factor
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    ABSTRACT: The study objective was to describe relationship adjustment and its association with mental and physical quality of life for young couples expecting a baby. 296 young pregnant couples recruited from urban obstetric clinics reported on relationship strengths (e.g., equity, romantic love, and attractiveness), relationship risks (e.g., attachment, intimate partner violence), external family support, relationship adjustment, and mental and physical quality of life. Using the Actor Partner Interdependence Model we assessed both actor and partner effects of relationship variables on relationship adjustment and quality of life. Sixty-one percent of couples had at least one member with moderate or severe relationship distress. Lower attachment avoidance, lower attachment anxiety, higher relationship equity, lack of intimate partner violence, feelings of love, perceived partner attractiveness, and family support of the relationship related to better relationship adjustment. Associations were fairly consistent across gender. Better relationship adjustment related to more positive mental and physical quality of life for both young women and men. Our results highlight the potential importance of strong relationships on the well-being of expecting parents. Our results suggest that secure attachments, equitable relationships, feelings of love, and a lack of violence may be particularly important in having strong relationships and improved mental and physical health during pregnancy.
    American Journal of Community Psychology 10/2013; · 1.74 Impact Factor
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    ABSTRACT: Hypertension is a major global public health risk and significant precursor to cardiovascular disease, stroke, diabetes and maternal mortality. A possible strategy to reduce chronic disease in resource-poor areas is social intervention. Research into the possible relationship of social determinants and disease is needed to determine appropriate social interventions. This study aims to determine the association between social capital and hypertension in rural Haitian women. From June to August 2005, 306 women, ages 18-49, who attended one of Hôpital Albert Schweitzer's five rural dispensaries as patients or accompanying patients, were interviewed. Individual interviews on social capital, demographics and anthropometrics were conducted. SAS statistical package was used to analyze the data. Groups/networks, personal empowerment, collective action/cooperation and trust components significantly decreased the likelihood of hypertension in multivariate analysis. In an additive model, the ranked index of social capital indicated that each social capital component score above the conceptual midpoint showed a 41 % reduction in the likelihood of hypertension. The findings suggest that interventions aimed to increase components of social capital may significantly lower hypertension.
    Maternal and Child Health Journal 09/2013; · 2.24 Impact Factor
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    ABSTRACT: The aim was to examine gender differences in sexual risk communication among young couples and factors influencing communication. Sample consisted of 296 young pregnant couples. We assessed individual, interpersonal, and community factors on sexual risk communication. The Actor-Partner Independence Model was used to assess actor and partner effects on sexual risk communication. For actor effects, being female, older, not being Hispanic, and higher condom use self-efficacy was associated with sexual risk communication. The significant partner effect was avoidant romantic attachment. Gender interactions were significant for high risk behaviors and family functioning. High risk behaviors and family functioning were associated with sexual risk communication for females but not for males. The study emphasizes the need to promote sexual risk communication among young high risk couples, particularly for males. Family support could serve as a catalyst for sexual risk communication and other sexual protective behaviors among young couples.
    Journal of Behavioral Medicine 09/2013; · 3.10 Impact Factor
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    ABSTRACT: The current study investigates the relationship between romantic attachment style and depressive symptoms between both members of pregnant adolescent and young adult couples. Participants were 296 pregnant young females (mean age = 18.7) and their male partners (mean age = 21.3; 592 total participants) who were recruited from obstetrics and gynecology clinics in Connecticut. The dimensions of avoidant and anxious romantic attachment were assessed using the Experiences in Close Relationships Inventory. Depressive symptoms were measured using the Center for Epidemiological Studies-Depression Scale. Results showed that avoidant attachment and anxious attachment were significantly positively related to depressive symptoms. Multilevel modeling for partner effects revealed that anxious attachment and depressive symptoms in partners were significantly positively associated with depressive symptoms CONCLUSION: Findings underscore the importance of considering couples-based approaches to supporting the transition to parenthood and developing the necessary self and relationship skills to manage attachment needs and relationship challenges.
    Journal of Clinical Psychology 06/2013; · 2.12 Impact Factor
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    ABSTRACT: PURPOSE: Despite a substantial amount of evidence on breastfeeding among non-adolescent mothers, research and strategies uniquely designed to target adolescent mothers are critical because their rates of breastfeeding are disproportionately low and their transition to parenthood is often unlike that of older mothers. Literature to date, however, offers limited evidence for designing effective interventions. Therefore, we aimed to fill this gap in the literature by examining breastfeeding behaviors among a cohort of female adolescents as they transition to parenthood. METHODS: Data were derived from a longitudinal cohort of pregnant adolescent females (ages 14-21 years) and their male partners, observed from pregnancy through 6 months postpartum. Means and frequencies were used to describe breastfeeding experiences, breastfeeding behaviors, and sociodemographic characteristics. We used multivariate logistic regression and Cox proportional hazards models to identify factors independently associated with breastfeeding initiation, exclusive breastfeeding, and breastfeeding duration. RESULTS: Approximately 71% initiated breastfeeding. Intending to breastfeed, having had complications in labor and delivery, and lower social support were associated with greater odds of breastfeeding initiation. Of the adolescent mothers who initiated breastfeeding, 84% had stopped by 6 months postpartum; among those, average breastfeeding duration was 5 weeks. Participants who exclusively breastfed had longer breastfeeding duration, and participants who had experienced intimate partner violence had shorter breastfeeding duration. Obese women and women who had more difficulty breastfeeding had lower odds of exclusive breastfeeding. CONCLUSIONS: Enhanced clinical support and the promotion of exclusive breastfeeding should be considered when designing interventions to improve breastfeeding rates among adolescent mothers.
    Journal of Adolescent Health 05/2013; · 2.97 Impact Factor
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    ABSTRACT: The aims of this study were to identify partner attributes associated with sexually transmitted infections (STIs) among adolescents and to summarize implications for research and prevention. The design of this study was systematic review. We identified peer-reviewed studies published in 1990 through 2010 that assessed 1 or more partner attributes in relation to a biologically confirmed STI among adolescents (15-24 years) by searching MEDLINE and included articles. Studies that included adolescents but more than 50% of the sample or with mean or median age of 25 years or greater were excluded. Sixty-four studies met the eligibility criteria; 61% were conducted in high-income countries; 80% were cross sectional; and 91% enrolled females and 42% enrolled males. There was no standard "partner" definition. Partner attributes assessed most frequently included the following: age, race/ethnicity, multiple sex partners, and STI symptoms. Older partners were associated with prevalent STIs but largely unrelated to incidence. Black race was associated with STIs but not uniformly. Partners with multiple partners and STI symptoms seem to be associated with STIs predominantly among females. Although significant associations were reported, weaker evidence exists for the following: other partner sociodemographics, sexual and other behaviors (sexual concurrency, intimate partner violence, substance use, travel), and STI history. There were no apparent differences by STI. Partner attributes are independently associated with STIs among male and female adolescents worldwide. These findings reinforce the importance of assessing partner attributes when determining STI risk. Prevention efforts should continue to promote and address barriers to condom use. Increased efforts are needed to screen and treat STIs and reduce risky behavior among men. A standard partner definition would facilitate the interpretation of findings in future studies.
    Sexually transmitted diseases 05/2013; 40(5):372-8. · 2.58 Impact Factor
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    ABSTRACT: Abstract Background: Rates of breastfeeding remain disproportionately low among young mothers in the United States. Although breastfeeding behavior may be most directly related to breastfeeding intention, little is known about breastfeeding intentions among young women who are expecting a baby. Subjects and Methods: Pregnant adolescents and young adults (14-21 years old) and their male partners were recruited for participation. Females were asked if they intended to breastfeed, and their partners were asked if they wanted their partners to breastfeed; participants indicated reasons for their responses. Logistic regression modeling was used to determine the associations between breastfeeding intentions and sociodemographic characteristics, relationship characteristics, and partner's intention to breastfeed. Results: Approximately 73% of females reported intending to breastfeed, and 80% of males reported wanting his partner to breastfeed, most commonly because it is "healthier for the baby" and "a more natural way to feed the baby." Sociodemographic and relationship characteristics explained a small amount of variance of breastfeeding intention (15% and 4% among females, respectively, and 8% and 4% among males, respectively). Partner intention explained an additional 23% and 24% of the variance in individual intention for females and males, respectively. Females who had experienced intimate partner violence (IPV) from their current partner had lower odds of intending to breastfeed (odds ratio=0.37; 95% confidence interval=0.16, 0.84). Race/ethnicity modified associations among both genders. Conclusions: These findings emphasize the importance of dyadic approaches and suggest strategies for improving breastfeeding intentions and behavior among young couples expecting a baby. These results are also among the first to document the relationship between IPV and breastfeeding intentions among young women.
    Breastfeeding Medicine 04/2013; · 1.65 Impact Factor
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    ABSTRACT: OBJECTIVE: CenteringPregnancy group prenatal care has been demonstrated to improve pregnancy outcomes. However, there is likely variation in how the model is implemented in clinical practice, which may be associated with efficacy, and therefore variation, in outcomes. We examined the association of fidelity to process and content of the CenteringPregnancy group prenatal care model with outcomes previously shown to be affected in a clinical trial: preterm birth, adequacy of prenatal care and breastfeeding initiation. STUDY DESIGN: Participants were 519 women who received CenteringPregnancy group prenatal care. Process fidelity reflected how facilitative leaders were and how involved participants were in each session. Content fidelity reflected whether recommended content was discussed in each session. Fidelity was rated at each session by a trained researcher. Preterm birth and adequacy of care were abstracted from medical records. Participants self-reported breastfeeding initiation at 6-months postpartum. RESULTS: Controlling for important clinical predictors, greater process fidelity was associated with significantly lower odds of both preterm birth (B=-0.43, Wald χ(2)=8.65, P=.001) and intensive utilization of care (B=-0.29, Wald χ(2)=3.91, P=.05). Greater content fidelity was associated with lower odds of intensive utilization of care (B=-0.03, Wald χ(2)=9.31, P=.001). CONCLUSION: Maintaining fidelity to facilitative group processes in CenteringPregnancy was associated with significant reductions in preterm birth and intensive care utilization of care. Content fidelity also was associated with reductions in intensive utilization of care. Clinicians learning to facilitate group care should receive training in facilitative leadership, emphasizing the critical role that creating a participatory atmosphere can play in improving outcomes.
    American journal of obstetrics and gynecology 03/2013; · 3.28 Impact Factor

Publication Stats

2k Citations
364.93 Total Impact Points

Institutions

  • 2013
    • University of Illinois at Chicago
      • Department of Women, Children and Family Health Science
      Chicago, IL, United States
  • 2012–2013
    • University of New Haven
      New Haven, Connecticut, United States
    • Johns Hopkins Bloomberg School of Public Health
      • Department of Population, Family and Reproductive Health
      Baltimore, MD, United States
  • 2004–2013
    • Yale University
      • • Center for Interdisciplinary Research on AIDS (CIRA)
      • • School of Public Health
      New Haven, CT, United States
  • 2003–2013
    • Yale-New Haven Hospital
      New Haven, Connecticut, United States
  • 2007–2012
    • University of Michigan
      • • School of Nursing
      • • Department of Urology
      Ann Arbor, MI, United States
    • University of North Carolina at Chapel Hill
      • Department of Health Behavior and Health Education
      Chapel Hill, NC, United States
    • Emory University
      • Department of Gynecology and Obstetrics
      Atlanta, GA, United States
  • 2008
    • Duke University Medical Center
      • Department of Psychiatry and Behavioral Science
      Durham, NC, United States
  • 2000–2008
    • Wayne State University
      • • College of Nursing
      • • Department of Pediatrics
      Detroit, MI, United States
  • 2006
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
    • Centers for Disease Control and Prevention
      Atlanta, Michigan, United States