Purpose/Aim

This study aims to identify patient and neighborhood characteristics associated with the use of evidence-based clinical practice to prevent recurrent preterm birth.

Significance/Background

Scientific research prompted widespread recommendation of 17a-hydroxyprogesterone caproate (17P) to prevent recurrent preterm birth. However, the diffusion of 17P is both inadequate and inequitable, with limited knowledge about patterns of use by patient neighborhood.

Methods

In this retrospective cohort study, I analyze the use of 17P in pregnancies from 4,125 New York Medicaid beneficiaries who had single, live births in 2017-2018 complicated by previous preterm birth. I estimate the conditional probability of receiving 17P by patient race and ethnicity, and residential neighborhood factors of poverty and racial residential composition using multilevel logistic regression.

Findings

Women living in neighborhoods with concentrated poverty where 83-99% of the residents identify as Black or Hispanic, were 76% less likely to receive 17P than those living in high-poverty areas with 0-21% Black or Hispanic residents (aOR 0.24, 95% CI = 0.11-0.55), adjusting for limited prenatal care, age and maternal race and ethnicity. Women classified as non-Hispanic Black (adjusted odds ratio (aOR) = 0.64, 95% Confidence Interval (CI) = 0.49-0.83) and Hispanic (aOR = 0.58, 95% CI = 0.43-0.78) were 36% and 42%, less likely to receive 17P than White women, respectively.

Discussion

Lower use of evidence-based practice disadvantages families along neighborhood lines and by maternal race/ethnicity. Resources should be directed to prenatal care sites that serve patient populations from predominantly Black or Hispanic high-poverty neighborhoods to increase the use of recommended practices.

Background: Children exposed to domestic violence have an increased risk of adolescent dating violence involvement. We aimed to investigate the potential moderating role of supportive family, school, and neighborhood environments.

Methods: Using data from the Fragile Families and Child Wellbeing Study (FFCWS), we examined the association between exposure to maternal physical intimate partner violence (IPV) from birth through age 9 (e.g., mother slapped, kicked, or hit by partner) and physical dating violence at age 15 (e.g., pushed or hit partner, or pushed or hit by partner). We evaluated youth’s perceptions of their relationship with their parents, school climate, and neighborhood collective efficacy as potential moderators of this association.

Results: Of 2,576 adolescents, 29.8% were exposed to maternal physical IPV by her partner during childhood. At age 15, 36.1% of youth reported being in a dating relationship, with 9.2% of those reporting physical relationship violence. Adjusting for maternal education and poverty level at birth, childhood exposure to maternal IPV significantly elevated the risk of being in a relationship with physical violence (aOR=2.30;95% CI=1.48-3.57). This association was attenuated among youth reporting closer relationships with their parents (aOR=1.64;95% CI=0.60-4.46 for close vs. aOR=2.32;95% CI=1.41-3.84 for less close relationships); attending schools with more positive climates (aOR=1.95;95% CI=0.67-5.72 for positive vs. aOR=2.31;95% CI=1.41-3.78 for less positive climate); and living in neighborhoods with higher collective efficacy (aOR=1.67;95% CI=0.80-3.49 for high vs. aOR=2.85;95% CI=1.63-4.99 for low efficacy).

Conclusions: Supportive family, school, and neighborhood environments may help break the link between childhood family violence and adolescent dating violence.

Background: Nigeria continues to record one of the highest maternal mortality rates (between 496 and 560 deaths per 100,000 live births) over the past decade. At national level, Nigeria has seen a 40% decline in maternal mortality rate from about 1,200 deaths to 814 deaths between the years 1990 and 2015. Despite this decline, approximately, 58,000 Nigeria women die from pregnancy related complications yearly. The United Nations calls for an approach to maternal healthcare that increases availability and accessibility especially among pregnant women.

Objectives: To identify prominent social factors that are prevalent among pregnant Nigerian women. To explain the association between these social factors and access to skilled healthcare services during delivery among pregnant Nigerian women.

Methods: The DHS’s 2018 (Nigeria) dataset was analyzed with IBM SPSS V.26. Holding a priori confounders constant, Skilled healthcare access (dependent) and Socio factors (education, household number, residence, wealth, religion) were analyzed using univariate, bivariate and multivariate analyses. Weighted data increased generalizability.

Results: Compared to women with no education, those with secondary (OR=2.88, 95% CI=2.60-3.19) and higher education (OR=8.82, 95% CI=7.44-10.45) had higher skilled healthcare access during delivery; rich women had more skilled healthcare access during delivery (OR=3.05, 95% CI=2.75-3.38) compared to the poor, while rural dwellers had 16% less skilled healthcare access during delivery than urban dwellers (OR=0.84, 95% CI=0.77-0.91). Igbo women and Christians accessed skilled healthcare during delivery more than other ethnic groups and other religions, respectively.

Conclusion: Certain social factors are significantly associated with skilled healthcare access among pregnant Nigerian women.

Background: Afghans comprise one of the largest refugee populations in the world. Due to forced migration stressors, Afghans are at risk of worse health outcomes than the general U.S. population. Afghan women, especially, face sociocultural barriers and minimal access to sexual and reproductive health education.

Methods: We conducted a needs assessment about Afghan women’s knowledge about pregnancy and abortions to inform a future health education intervention. We developed project materials collaboratively with community members to ensure questions were culturally sensitive. Participants were recruited via purposive sampling in collaboration with community organizations until data saturation was met. We conducted one-on-one interviews and demographic surveys via phone. Two members of the study team transcribed, validated, and analyzed the interviews.

Results: We conducted 36 individual interviews,14 with healthcare professionals who serve the Afghan community and 22 with Afghan women themselves. Most of our Afghan participants explained that they did not receive formal education about pregnancy and received incomplete information through their family/community or physicians. Most participants had limited knowledge about abortions. When asked about options to address unwanted pregnancies in Afghanistan, many participants did not know what of any or explained that it was inaccessible, illegal, and persecutory. No women knew how unwanted pregnancies could be addressed in America. All participants supported the creation of our health education intervention.

Conclusion: Afghan refugee women have unique experiences or knowledge about pregnancy and abortion. They support the creation of culturally relevant health education to improve their knowledge of maternal and child health.

Most qualitative research studies systematically exclude participants with Limited English Proficiency (LEP), by failing to address their specific language needs. One in four children has at least one LEP parent/caregiver, a growing population in the United States, whose experiences are unique and merit inclusion in qualitative research. Cross-language qualitative research studies, which use a translator or interpreter, can reduce linguistic inequities and systemic disparities in qualitative research participation, and in the knowledge that qualitative research can generate about an individual’s lived experiences. This systematic narrative review aims to develop best practices for performing cross-language qualitative research that includes LEP parents/caregivers in pediatric settings. We performed a critical synthesis of existing guidelines including the Consolidated Criteria for Reporting Qualitative Studies (COREQ), Standards for Reporting Qualitative Research (SRQR), and prior recommendations about how translators and interpreters should be used [Squires, 2008]. We then conducted a systematic review that examined the research practices in 20 cross-language pediatric research studies from 2010 - 2020. Our findings demonstrate that few studies address cultural and linguistic barriers during each phase of the qualitative research process, including, who comprises the research team, development of interview guides, interpretation and translation for study participants, data analysis, and dissemination of findings. Using results of our review, we developed guidelines for conducting cross-language pediatric qualitative research through an iterative process with the consultation of qualitative experts. Our guidelines encourage cultural humility and include LEP parents/caregiver population in each phase of the research process.