Access Barriers, Trusted Channels, and Misconceptions About the COVID-19 Vaccine Among Rural Immigrant Farmworkers.

Background: Although COVID-19 has disproportionately impacted immigrant agricultural workers, vaccination efforts have been challenging. Barriers to immunization include language, visa status, and access to medical care. Additionally, vaccine hesitancy, mistrust, and misinformation contributed to low uptake. Methods: A community needs assessment was conducted with immigrant agricultural workers (n = 9) and community stakeholders (n = 15) in rural areas of Maryland and Delaware. In-depth interviews were recorded, transcribed verbatim, and analyzed using template analysis. Results: The participants named trusted and untrusted sources, sources of misinformation, and barriers to accessing information and physical locations to receive the vaccine as reasons for not getting the vaccine. Trusted sources included known community leaders and television programs. Some barriers mentioned were fear of deportation, lack of paid time off, language barriers, and difficulty navigating the U.S. healthcare system. Discussion: There is a need for culturally-tailored programs that address misinformation and barriers and use community-based programming.

Resilient Infant Feeding Among Young Women With Histories of Maltreatment and Poor Support.

OBJECTIVE: To explore how young women with histories of maltreatment describe their experiences and decisions around infant feeding. DESIGN: Secondary qualitative analysis using supplementary analysis. SETTING: Washington, DC; Baltimore, MD; and their respective suburbs. PARTICIPANTS: Young women with histories of being abused or neglected as children or adolescents and who gave birth to one child before age 19 years (N = 9). METHODS: We collected data through in-depth semistructured interviews and analyzed them using reflexive thematic analysis. RESULTS: The analysis resulted in three themes: Infant Feeding Intention, Identifying Challenges and Persistence, and Pivoting to What Is Feasible. Participants felt that breastfeeding was valuable and wanted to be able to breastfeed their children. They continued to provide human milk through painful latches and a lack of support and guidance, but formula became the only viable option for many of them. CONCLUSION: Despite wanting to breastfeed and continuing through barriers, many participants could not continue to breastfeed as long as they wanted because of a systemic lack of support. These findings indicate a need to support young women with histories of maltreatment through increased and consistent access to lactation support providers and trauma-informed care. Nurses and other clinicians are uniquely positioned to support young women with histories of maltreatment to overcome barriers related to breastfeeding.

Rosie, a Health Education Question-and-Answer Chatbot for New Mothers: Randomized Pilot Study.

BACKGROUND: Stark disparities exist in maternal and child outcomes and there is a need to provide timely and accurate health information. OBJECTIVE: In this pilot study, we assessed the feasibility and acceptability of a health chatbot for new mothers of color. METHODS: Rosie, a question-and-answer chatbot, was developed as a mobile app and is available to answer questions about pregnancy, parenting, and child development. From January 9, 2023, to February 9, 2023, participants were recruited using social media posts and through engagement with community organizations. Inclusion criteria included being aged ≥14 years, being a woman of color, and either being currently pregnant or having given birth within the past 6 months. Participants were randomly assigned to the Rosie treatment group (15/29, 52% received the Rosie app) or control group (14/29, 48% received a children's book each month) for 3 months. Those assigned to the treatment group could ask Rosie questions and receive an immediate response generated from Rosie's knowledgebase. Upon detection of a possible health emergency, Rosie sends emergency resources and relevant hotline information. In addition, a study staff member, who is a clinical social worker, reaches out to the participant within 24 hours to follow up. Preintervention and postintervention tests were completed to qualitatively and quantitatively evaluate Rosie and describe changes across key health outcomes, including postpartum depression and the frequency of emergency room visits. These measurements were used to inform the clinical trial's sample size calculations. RESULTS: Of 41 individuals who were screened and eligible, 31 (76%) enrolled and 29 (71%) were retained in the study. More than 87% (13/15) of Rosie treatment group members reported using Rosie daily (5/15, 33%) or weekly (8/15, 53%) across the 3-month study period. Most users reported that Rosie was easy to use (14/15, 93%) and provided responses quickly (13/15, 87%). The remaining issues identified included crashing of the app (8/15, 53%), and users were not satisfied with some of Rosie's answers (12/15, 80%). Mothers in both the Rosie treatment group and control group experienced a decline in depression scores from pretest to posttest periods, but the decline was statistically significant only among treatment group mothers (P=.008). In addition, a low proportion of treatment group infants had emergency room visits (1/11, 9%) compared with control group members (3/13, 23%). Nonetheless, no between-group differences reached statistical significance at P<.05. CONCLUSIONS: Rosie was found to be an acceptable, feasible, and appropriate intervention for ethnic and racial minority pregnant women and mothers of infants owing to the chatbot's ability to provide a personalized, flexible tool to increase the timeliness and accessibility of high-quality health information to individuals during a period of elevated health risks for the mother and child. TRIAL REGISTRATION: ClinicalTrials.gov NCT06053515; https://clinicaltrials.gov/study/NCT06053515.

Latina Mothers' Infant Feeding Experiences During the 2022 Formula Shortage.

BACKGROUND: Mothers report feeling immense pressure to breastfeed their infants, and not doing so can be associated with stigma, shame, and judgment. Many Latina mothers struggle to meet their breastfeeding goals and substitute formula earlier than planned. During 2022, an infant formula recall caused a shortage and made acquiring formula difficult or impossible in many areas of the United States. This study explores Latina mothers' experiences with infant feeding during the time of the formula shortage. METHODS: In-depth interviews (N = 7) were conducted with Latina mothers who formula-fed during the shortage. Interviews were analyzed using reflexive thematic analysis. Mean maternal age was 29.7 years, and mean infant age was 10.3 months. Three mothers were born in the United States, and 4 were immigrants. RESULTS: Thematic analysis generated 3 themes: (1) Fighting to breastfeed; (2) Breastfeeding is not the only way to be a "good" mother; and (3) No formula on the shelves. Participants described their determination to continue breastfeeding despite challenges before realizing that it limited their ability to care for their children. They discussed the emotional toll of the formula shortage and strategies for finding formula. CONCLUSIONS: The findings emphasize the need for additional structural support for infant feeding in the United States to prevent future formula shortages and for better lactation care and mental health support for mothers who want to breastfeed.

Practical Guidance for the Development of Rosie, a Health Education Question-and-Answer Chatbot for New Mothers.

Communities of color experience higher maternal and infant mortality, as well as a host of other adverse outcomes, during pregnancy and postpartum. To address this, our team is developing a free, user-friendly, question-answering chatbot called Rosie. Chatbots have gained significant popularity due to their scalability and success in individualizing resources. In recent years, scientific communities and researchers have started recognizing this technology's potential to inform communities, promote health outcomes, and address health disparities. The development of Rosie is an interdisciplinary project, with teams focused on the technical build of the application (app), the development of machine learning models, and community outreach, making Rosie a chatbot built with the input from the communities it aims to serve. From June to October 2022, more than 20 demonstration sessions were conducted in Washington, District of Columbia, Maryland, and Virginia, where a total of 109 pregnant women and new mothers of color could interact with Rosie. Results from the live demonstrations showed that 75% of mothers searched for maternity and baby-related information at least once a week and more than 90% of participants expressed the likelihood to use the app. Most of the participants inquired about their baby's development, nutrition for babies, and identifying and addressing the causes of certain symptoms and conditions, accounting for about 80% of the total questions asked. Mother-related questions in the community demonstrations were mainly about pregnancy. The high level of interest in the chatbot is a clear indication of the need for more resources. Rosie aims to help close the racial gap in maternal and infant health disparities by providing new mothers with easy access to reliable health information.

Familial sources of encouragement and breast-feeding practices among women participating in the US Special Supplemental Nutrition Programme for Women, Infants and Children.

OBJECTIVE: To explore how sources of familial encouragement are associated with breast-feeding initiation and duration among a national sample participating in the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). DESIGN: This study uses the 2013-2015 WIC Infant and Toddler Feeding Practices Study 2 (WIC ITFPS-2) data. Breast-feeding initiation was measured at the first month, while duration was derived from a composite of the first 13 months. The analysis used logistic and linear regression to explore the association between encouragement sources and breast-feeding outcomes. SETTING: A nationally representative sample of WIC participants in the USA. PARTICIPANTS: WIC participants who completed the 13-month interview of the WIC ITFPS-2 (n 2807). RESULTS: Encouragement was significantly associated with both initiation and duration. Each source of encouragement was associated with a 3·2 (95 % CI 2·8, 3·8) increase in odds of initiating breast-feeding in the unadjusted model and 3·0 (95 % CI 2·5, 3·6) increased odds, controlling for age, education, nativity, poverty status, race and ethnicity (<0·0001). When predicting log duration, each percent increase in source of encouragement was associated with an increasing duration on average by 0·003 d (95 % CI 0·2, 0·3, <0·0001). When controls were added, it was associated with an increase of an average of 0·002 d (95 % CI 0·2, 0·3) per percent increase in encouragement source (<0·0001). CONCLUSIONS: Women who receive encouragement appear to be more likely to breastfeed. Additional work is needed to explore sources of encouragement and how to include them in intervention work.

Experiences of the COVID-19 pandemic among young parents with foster care backgrounds: A participatory action PhotoVoice study.

The COVID-19 pandemic has had a disproportionate impact on many vulnerable populations, including youth in foster care and parents of young children. In this study, we worked with nine parenting current and former foster youth to share their experiences of the COVID-19 pandemic through photography. Data were collected between January and March 2021 during a series of three virtual PhotoVoice sessions, then transcripts of PhotoVoice sessions and participant-selected captioned photographs were analyzed using thematic analysis. Themes in participants' photographs included 1) Pandemic Parenting and 2) Making the Best of It. Findings indicate the need to expand mental health services, protect essential workers, and ensure young parents receive support navigating medical and social welfare systems and the process of receiving pandemic relief-related benefits.

COVID-19 Vaccination Perspectives Among Young Parents with Foster Care Backgrounds.

The COVID-19 pandemic has brought unique stressors for youth in foster care and recent foster care alumni, particularly those who are also parenting young children. One way the pandemic can be mitigated is through vaccination of the general population. Yet, some young adults have been slow to choose to be vaccinated. As has been demonstrated, simple availability of the COVID-19 vaccine will not guarantee its uptake, especially among marginalized populations. In order to better understand the nuances of vaccination among youth in foster care and recent foster care alumni, we conducted in-depth, semi-structured focus groups and interviews with 23 parenting youth with foster care histories aged 18-26 years. Data regarding vaccine attitudes were analyzed using thematic analysis. Participating youth, who were majority Black, Indigenous, and people of color (BIPOC) and often lived in multigenerational households, had significant concerns about the COVID-19 vaccine. They expressed varying degrees of intention to get vaccinated. Young people, especially those who belong to marginalized populations, need opportunities to openly discuss their vaccination-related questions without judgment. Science communicators should consider these questions and address youths' concerns through diverse voices and channels to ensure youth have the information they need to make an informed decision regarding COVID-19 vaccination.

Experiences of young parents with foster care backgrounds during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has brought unique challenges to parents of young children, due to the closure of schools and childcare centers, and increased caregiver burden. These challenges may be especially pronounced for youth with foster care backgrounds, as they lack critical support and resources to rely on during emergency situations. OBJECTIVE: The purpose of the present study was to examine the experiences of these vulnerable young parents since the beginning of the pandemic. PARTICIPANTS AND SETTING: Our study included 17 young parents ages 18-26, who had recently aged out of foster care or were currently in extended care. Participants were predominantly female, and Black, Indigenous, or people of color (BIPOC). METHODS: Youth participated in virtual focus groups or individual interviews and described their experiences and challenges during the COVID-19 pandemic. A structured thematic analysis approach was employed to examine key themes in youths` accounts. RESULTS: Analysis resulted in five major themes: (a) employment disruptions and economic hardships, (b) educational challenges for parents and children, (c) parental and child mental health concerns, (d) insufficient resources and barriers to service receipt, and (e) "silver linings". CONCLUSIONS: Young parents with foster care backgrounds faced numerous challenges due to COVID-19 and struggled to access critical resources and supports. Implications for policy, practice, and research are discussed.

Breastfeeding Among Mothers Who Have Experienced Childhood Maltreatment: A Review.

BACKGROUND: Current breastfeeding recommendations focus on the physical benefits of breastfeeding but do not take into account the influence of a history of childhood maltreatment on mothers' experiences breastfeeding. A better understanding of this relationship is important to be able to better support mothers during this critical time. RESEARCH AIM: To review current research that examined how women's personal experiences of childhood maltreatment has affected their breastfeeding outcomes and experiences. METHODS: A scoping review was conducted to evaluate current literature on breastfeeding and childhood maltreatment. We screened 275 articles, of which eight met the sample selection criteria and were included in this review. These articles were analyzed based on common themes that emerged: Breastfeeding intention, initiation, duration, and exclusivity; medical conditions associated with breastfeeding; and participants' experiences related to breastfeeding. RESULTS: History of childhood maltreatment was associated with decreased and shorter duration of breastfeeding. Participants' experiences of breastfeeding varied: Some found it empowering, and others experienced great distress while breastfeeding. Challenges during this period included managing touch, struggling with the power differential between providers and participants, and coping with trauma symptoms (e.g., dissociation). CONCLUSIONS: For some participants, it was possible to breastfeed successfully after childhood maltreatment, but others found the experience extremely difficult, even traumatizing. There is a need for a trauma-informed approach to lactation care for women with a childhood maltreatment history.