Postpartum mothers' napping and improved cognitive growth fostering of infants: results from a pilot study.

Little is known about how maternal sleep disturbances in the postpartum period affect mother-infant interaction. The study was designed to assess if less maternal sleep disturbance and less fatigue were associated with more positive mother-child interaction, independent of maternal depression symptoms. Twenty-three mothers completed 1 week of actigraphy and self-report measures of fatigue and depression symptoms. To determine the quality of mother-infant interaction, mothers and infants were then observed in a structured, video-recorded teaching episode. Greater maternal napping frequency was associated with better cognitive growth fostering of the infant (r s = .44, p < .05), a subscale of the interaction assessment. Maternal napping, not the quality or quantity of nocturnal sleep, appears to be associated with improvements in mother-infant interactions.

Violence and other stressful life events as triggers of depression and anxiety: what psychosocial resources protect African American mothers?

Understanding the risk and protective factors related to maternal mental health problems is important for improving the well-being of mothers and children, particularly in African American populations which may be at greater risk for maternal depression and resulting child behavior problems. This study explored whether three psychosocial resources--emotional resilience, social support, and ethnic identity--serve as protective factors in the face of specific stressful events that may trigger African American mothers' depression and anxiety symptoms. Standard self-report measures of depression, anxiety, negative life events, community violence, abuse, emotional resilience, social support, and ethnic identity were administered to African American mothers (N=209) of 2-18 month-old children. Linear regression models revealed main effects of negative life events and abuse on increased depression and anxiety symptoms, while emotional resilience and social support predicted decreased symptoms. There was also a significant interaction revealing a protective-reactive effect of ethnic identity on the associations of witnessed community violence with depression and anxiety symptoms. It is important for primary care providers to screen African American mothers for negative life events and abuse to identify those at increased risk for maternal depression and anxiety symptoms. Treatment programs should target emotional resilience, enhanced social support, and stronger ethnic group affiliation, which may be most effective at preventing mental health problems among mothers exposed to relative lower levels of community violence.

Disparity in location of urban mental service providers.

This article investigates geographic disparities in the location of mental health providers in relation to population demographics. Associations between provider-to-population ratios and demographics were examined with density calculations and map algebra. This disparity in geospatial availability of specialists may constitute an important barrier for persons seeking mental health care.

Disparities in early childhood caries.

Despite remarkable reduction in the prevalence of dental caries in the United States, dental caries is still a highly prevalent disease among children who are socially disadvantaged (racial/ethnic minority, poor, rural, immigrants). Consequently, caries sequelae such as dental pain, need for dental treatment under general anesthesia, and future orthodontic treatment, are also concentrated among the most socially disadvantaged children. To make the situation more appalling, those children who need treatment the most are the ones least likely to visit the dentist. Low income children are less likely to visit the dentist in part because of family's competing needs for limited resources, shortage of pediatric dentists, and dentists not taking uninsured or publicly insured patients. In the same vein, if these children do not have access to dental care, they are deprived from effective caries preventive measures that are dentist-dependent such as sealants and professionally applied fluoride. Dentistry has done well at devising caries preventive and treatment strategies; but these strategies have missed the most needed segment of society: disadvantaged children. The challenge now is to develop innovative strategies to reach these children.

Urban premature mortality in the U.S. between 1980 and 1990: changing roles of income inequality and social spending.

Measuring the effects of policy and social inequality is complicated because inequalities and policies may have delayed or accumulative effects on health. The objective of this study is to build on the body of work on population mortality and income inequality by investigating the association between income inequality and mortality at the city level at two points in time (1980 and 1990) as well as to determine whether indicators of 1980 social policies of cities are associated with 1990 mortality rates due to delayed or accumulative effects. We found that 1980 income inequality and police spending is associated with increased premature mortality for 1990. In conclusion, there appear to be long-term consequences of city levels of income inequality on population health, although this relationship is incompletely understood. While a lack of information on how inequality operates on health should not preclude us from making policy decisions aimed at creating greater social equality, for example, through improvements in education, we would benefit from longitudinal research on specific macroeconomic and environmental factors, inequality, and health. Establishing such causal relationships is critical in creating social policies that optimally promote health and well-being.

Oral health status of children and adolescents by rural residence, United States.

CONTEXT: The limited information available on the oral health status of rural children in the United States makes it difficult to devise policy strategies to address perceived problems. PURPOSE: To document the oral health status and dental care utilization of US children by place of residence, METHODS: Data from National Health Interview Surveys for 1995, 1997, and 1998, and from the third National Health and Nutrition Examination Survey (1988-1994) were analyzed. FINDINGS: Children residing in rural areas were more likely to be uninsured for dental care than were children from urban areas (41.1% versus 34.7%). A greater percentage of rural than urban children reported unmet dental needs (7.5% versus 5.6%); there was no difference in self-reported poor dental status. Urban children were more likely than rural children to have visited the dentist in the past year (73.6% versus 69.9%) and were also more likely to be regular users of dental care (61.7% versus 51.4%). Differences in percentage of rural and urban children with caries lesions and caries experience were not significant. CONCLUSIONS: Children residing in rural areas have less access to and utilization of dental care compared to children residing in urban areas. Moreover, poor rural children display less utilization of dental services than poor urban children. Differences in the sum of decayed and filled primary teeth and the sum of decayed, missing, and filled permanent teeth were not significant.

Physician accessibility: an urban case study of pediatric providers.

Social disparity in the spatial distribution of healthcare providers in urban areas is a recognized problem. However, efforts to quantify the problem have been hampered by a lack of satisfactory measurements and methods. We revive and enhance a strategy based on provider density, proposed nearly three decades ago. The method avoids the border-crossing problem associated with provider-population ratios, yet reports spatial accessibility in intuitive units that are easily compared across diverse populations and geographies. We find racial and socioeconomic disparities in our case city, Washington, DC, despite a citywide overabundance of primary care providers for children.

The highs and lows of maternal depression: cluster analysis of depression symptoms in a sample of African American women.

BACKGROUND: Maternal depression affects between 10% and 15% of US mothers. Emerging evidence suggests that variability in symptoms is linked to different risk factors and different pathological subtypes. Building on this research, this study examines manifestations of depression symptoms and risk factors associated with different manifestations among a socioeconomically heterogeneous sample of African American mothers. METHODS: Data were collected via telephone interviews with a community sample of 208 self-identified African American women with children 2 to 18 months old. Mothers were screened for depression symptoms using the Center for Epidemiological Studies Depression scale and reported on several psychosocial factors including social support, history of depression, and demographic characteristics. Cluster analysis was used to determine whether there were distinct subtypes of depression symptoms in this sample. RESULTS: A k-means cluster analysis of the 57 women with a positive depression symptom screen revealed 2 distinct groups characterized by higher versus lower symptom severity. A logistic regression indicated that mothers were more likely to fall into the high severity cluster if they were employed and reported lower levels of social support. LIMITATIONS: Because of its cross-sectional design, this study could not explore the timing and the course of depression symptoms, which may be more closely related to risk and functional impairment than the severity distinction found in this research. CONCLUSIONS: Researchers, pediatricians, and obstetricians working with African American mothers should screen for social support, with the understanding that those with low levels may be at increased risk for severe depression symptoms. Finally, the heterogeneity in symptoms suggests that clinicians should be aware of all depression symptoms among their patients rather than looking for specific, potentially stereotypical symptoms as cues.

Depressive symptomatology and mental health help-seeking patterns of U.S.- and foreign-born mothers.

OBJECTIVES: This report presents the national estimates of maternal depressive symptomatology prevalence and its socio-demographic correlates among major racial/ethnic-nativity groups in the United States. We also examined the relationship of mental health-seeking patterns by race/ethnicity and nativity. METHODS: Using the Early Childhood Longitudinal Survey-Birth Cohort Nine-month data, we present the distribution of Center for Epidemiological Study-Depression (CES-D) score by new mothers' nativity and race/ethnicity. The mental health-seeking pattern study was limited to mothers with moderate to severe symptoms. Weighted prevalence and 95% confidence intervals for depression score categories were presented by race/ethnic groups and nativity. Multi-variable logistic regression was used to obtain the adjusted odds ratios of help-seeking patterns by race/ethnicity and nativity in mothers with moderate to severe symptoms. RESULTS: Compared to foreign-born mothers, mothers born in the U.S. were more likely to have moderate to severe depressive symptoms in every racial/ethnic group except for Asian/Pacific Islanders. These US-born mothers were also more likely to be teenagers, lack a partner at home, and live in rural areas. Among Asians, Filipina mothers had the highest rate of severe depressive symptoms (9.6%), similar to those of US-born black mothers (10.2%). Racial/ethnic minorities and foreign-born mothers were less likely to consult doctors (OR: 2.2 to 2.5) or think they needed consultation (OR: 1.9 to 2.2) for their emotional problems compare to non-Hispanic White mothers. CONCLUSION: Our research suggests that previous "global estimates" on Asian American mental health underestimated sub-ethnic group differences. More efforts are needed to overcome the barriers in mental health services access and utilizations, especially in minority and foreign-born populations.

Relationship between children's dental needs and dental care utilization: United States, 1988-1994.

OBJECTIVES: This study describes the relationship between dental needs and dental care utilization among children. METHODS: Data from the third National Health and Nutrition Examination Survey (1988-1994) were used to analyze dental care needs and dental care utilization. RESULTS: Younger children with perceived needs (needs perceived by the child or responsible adult) were more likely to be episodic users of dental care than children without perceived needs. Younger children with normative needs (defined by the presence of untreated caries diagnosed by a dentist) were less likely to be regular users. Older children with perceived or normative needs were more likely to be episodic users and less likely to have had a previous-year visit than children with no needs. CONCLUSIONS: Despite their presence, dental needs do not drive dental care use among children, and children's dental care utilization is inadequate.