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BACKGROUND: Due to high rates of unintended pregnancies in Delaware, the state launched a public health initiative in 2014 to increase access to contraceptive services. OBJECTIVES: This study was designed to assess the practice-level barriers and facilitators to providing contraceptive care, particularly long-acting reversible contraceptives (LARCs), to adolescents in primary care settings. DESIGN: This qualitative study was part of a larger process evaluation of the Delaware Contraceptive Access Now (DelCAN) initiative. METHODS: In-depth, semi-structured qualitative interviews were conducted with 16 practice administrators at 13 adolescent-serving primary care sites across the state of Delaware. A process of open, axial, and selective coding was used to analyze the data. RESULTS: Despite the interest in LARC among their adolescent patients, administrators described numerous barriers to providing LARC for adolescents including confidentiality in patient visits and billing, preceptorship, and provider discomfort and assumptions about the need for contraception among adolescent patients. CONCLUSION: Findings from this study reveal substantial barriers to providing contraception to adolescents, even in primary care practices that were committed to comprehensive contraceptive access for their adolescent patients. This study supports the need for contraceptive care to be integrated into training of pediatricians at every stage of their education. Such training must go beyond education about contraceptive options and the clinical skills necessary for LARC insertion and removal, to include counseling skills based in a reproductive justice framework. Additional changes in policies and practices for adolescent patients would further increase access to contraceptive care.
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Serviços de Planejamento Familiar , Acessibilidade aos Serviços de Saúde , Atenção Primária à Saúde , Pesquisa Qualitativa , Humanos , Adolescente , Feminino , Delaware , Anticoncepção/métodos , Gravidez , Gravidez na Adolescência/prevenção & controle , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Entrevistas como Assunto , MasculinoRESUMO
Objective: Post-migration stress and trauma impact the way Latino/a immigrants in the USA experience everyday life. Mindfulness-based interventions (MBIs) reduce stress and strengthen mental health by improving the response to stressors and promoting physical and psychological well-being; however, they have not been tested extensively with Latino/a immigrants in the USA, particularly MBIs implemented online. Thus, more information is needed about the feasibility of online MBIs adapted for Latino/a immigrants. Method: This study focuses on the feasibility of an online MBI for Latina mothers and community staff members working with them (n = 41). Qualitative (three focus groups) data were collected to assess feasibility, appropriateness, acceptability, and quantitative (questionnaires) data asking about self-reported changes on stress, mindfulness, mind-body connection, subjective well-being, and perceived physical and mental health after the program. Results: Participants in the three groups indicated the program was appropriate, feasible, and acceptable for Latina immigrant mothers and the staff serving them. Mothers' and Promotoras' (community health workers) mean scores for subjective well-being and perceived physical and mental health increased significantly from baseline to post-test. No significant changes were observed in surveys completed by the staff, even though focus group participants reported meaningful improvement. Conclusion: Overall, the feasibility study was well received and relevant for the organization and the population they serve. The study's findings provide guidance to others who are implementing online mindfulness practices with Latina immigrants and the staff that work with them. Preregistration: This study is not preregistered. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-023-02123-6.
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INTRODUCTION: Flourishing reflects a child's ability to cope with stress and have positive relationships, which are critical to health and well-being. Pediatricians may increase flourishing in children through family-centered care, which is perceived as sensitive and responsive to specific child needs and family circumstances. The purpose of this study was to examine the relationship between family-centered care and flourishing in young children. METHODS: Data from the 2019-2020 National Survey of Children's Health were used to examine the relationship among children aged 1-5 years (n=17,826). The relationship was explored using chi-square tests and sequential logistic regression modeling, controlling for family socioeconomics and adversity, race/ethnicity, child health, and other measures of healthcare quality. Analyses were conducted in January 2022. RESULTS: Approximately 82% of young children were flourishing. After adjusting for all variables, receipt of family-centered care was the only measure of quality health care associated with an increased likelihood of flourishing in young children (adjusted prevalence rate ratio=1.14; 95% CI=1.01, 1.29; p=0.02). Disparities in flourishing by child sex, race/ethnicity, parental education, income, and insurance type were mitigated after adjustment. However, a decreased likelihood of flourishing continued to be associated with having a special healthcare need (adjusted prevalence rate ratio=0.74; 95% CI=0.68, 0.82) and experiencing multiple adverse childhood experiences (adjusted prevalence rate ratio=0.78; 95% CI=0.66, 0.92). CONCLUSIONS: Expanding receipt of family-centered care may support flourishing and help to reduce disparities in flourishing during early childhood. Future research should evaluate the strategies to overcome barriers to delivering and receiving family-centered care, especially among children with special healthcare needs and children who experienced multiple adverse childhood experiences.
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Saúde da Criança , Saúde da Família , Criança , Pré-Escolar , Humanos , Família , Pais , Assistência Centrada no Paciente , Fatores SocioeconômicosRESUMO
In recognition of the family as central to health, the concept of family, rather than individual, health has been an important area of research and, increasingly, clinical practice. There is a need to leverage existing theories of family health to align with our evolving understanding of Life Course Health Development, including the opportunities and constraints of the family context for promoting lifelong individual and population health. The purpose of this article is to propose an integrative model of family health development within a Life Course Health Development lens to facilitate conceptualization, research, and clinical practice. This model provides an organizing heuristic model for understanding the dynamic interactions between family structures, processes, cognitions, and behaviors across development. Potential applications of this model are discussed.
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Saúde da Família , Relações Familiares , Formação de Conceito , Família , Humanos , Acontecimentos que Mudam a VidaRESUMO
OBJECTIVE: Despite the well-established relationship between Adverse Childhood Experiences (ACEs) and health and well-being across the life course, there is a limited understanding of ACEs among diverse populations. The purpose of this study was to develop a new measure, the ACE-I, which consists of adversities that may be more relevant among immigrant populations, and to compare these rates to those of traditionally studied ACEs. METHOD: Data for this study comes from a community sample of 338 Latino immigrant adolescents who completed an 11-item measure of traditional ACEs and a novel 13-item measure of immigrant-specific ACEs (ACE-I) as part of the intake process for a positive youth development program. RESULTS: While the scores of the two ACEs measure were correlated (r = .16), immigrant youth, on average, reported more adversities on the ACE-I measure than the traditional ACEs measure (3.6 vs. 1.6). Overall, individual ACE-I items were more likely to be endorsed than traditional ACE items. Fit indexes from a confirmatory factor analysis suggested that the ACE-I hypothesized three-factor structure (experiences of violence/unrest in one's home country, danger encountered on the migration journey, and instability of life as an immigrant) represents a satisfactory solution. CONCLUSIONS: These findings suggest that there are essential early adverse experiences for immigrants that have not previously been considered in ACEs research. Broadening our conceptualization and measurement of ACEs among immigrant populations could provide valuable insight into social determinants of health and avenues for intervention for immigrant youth and families. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Experiências Adversas da Infância , Emigrantes e Imigrantes , Adolescente , Humanos , Psicometria , Hispânico ou Latino , Acontecimentos que Mudam a VidaRESUMO
OBJECTIVES: In 2014, Delaware launched a statewide initiative to reduce the rate of unintended pregnancies and increase access to contraception services. Our study objective was to understand the implementation experiences, barriers, and successes across health care practice settings and to provide recommendations for future, similar initiatives. STUDY DESIGN: As part of a larger multicomponent process evaluation, we conducted semistructured interviews with 32 leaders from 26 practice settings implementing the initiative across the state. We analyzed the qualitative data through iterative open, axial, and selective coding using grounded theory methods, employing thematic analysis to identify common themes in implementation experiences. RESULTS: Most practices perceived that patient demand for methods of long-acting reversible contraception (LARC) increased. Many practices had to adapt the intervention to fit the needs and constraints of their settings and patient populations. Primary care practices, smaller practices, and practices that served large numbers of adolescents experienced more barriers compared to obstetrics and gynecology or women's health practices. For current and future iterations of the initiative, leaders emphasized: (1) the need for greater implementation flexibility, (2) the importance of inclusive communication at multiple levels, and (3) attending to logistical challenges, particularly around billing. CONCLUSION: Varied practice settings required significant flexibility and responsiveness to context in order to implement the initiative. Organizations with greater pre-existing capacity were able to offer the full range of contraceptive care, as the initiative intended, in contrast to practices with less pre-existing capacity for providing methods of LARC and other types of contraception. IMPLICATIONS: To meet the specific but heterogenous needs of various practices, it is crucial for future contraceptive access initiatives to conduct a comprehensive pre-implementation assessment. Preceding any training, this assessment should gather input from participants across all roles in a medical practice (e.g., providers, medical assistants, office staff, billing department).
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Anticoncepção , Contracepção Reversível de Longo Prazo , Adolescente , Delaware , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Gravidez , Gravidez não PlanejadaRESUMO
Background: Intimate partner violence and differential power dynamics are associated with contraceptive behaviors. This study examines the role of reproductive coercion (RC) by an intimate partner in women's decisions about contraceptive use. Materials and Methods: A self-report survey was administered to a probability sample of a diverse group of women of reproductive age in Delaware's Title X health care facilities. Currently used contraceptive methods were categorized into three effectiveness levels based on typical use failure rates: no method or low effectiveness (>10% failure), moderate effectiveness (>1% and <10% failure), and high effectiveness (<1% failure). The short-form RC scale was used to categorize RC experiences: no RC, verbal only, or behavioral. We conducted multinomial logistic regression to examine the association between types of RC and effectiveness level of current contraceptive method, taking our sampling design into account and adjusting for covariates. Results: Among 240 women (weighted n = 6529) included in the sample, 13.9% reported experiencing only verbal RC, and 16.1% reported behavioral RC. Women who reported behavioral RC were more likely to currently be using highly versus moderately (adjusted relative risk ratio [aRRR]: 26.71, 95% confidence interval [CI]: 4.59-156.0) and low effective methods (aRRR: 3.08, 95% CI: 0.97-9.82), but less likely to be using moderately (aRRR: 0.12, 95% CI: 0.02-0.77) than low effective methods. Conclusions: Using highly and low effective methods may indicate two opposing ways of managing behavioral RC experiences: controlling fertility by choosing less detectable but highly effective methods or feeling disempowered and using no or low effective partner-dependent methods.
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Coerção , Violência por Parceiro Íntimo , Anticoncepção , Comportamento Contraceptivo , Anticoncepcionais , Feminino , HumanosRESUMO
This study examines the effect of inconsistent Medicaid coverage on parenting stress, maternal depression, and child behavior in a sample of teen mothers and their children. The majority (54%) of mothers experienced inconsistent coverage. After 24 months, mothers experiencing inconsistent coverage had significantly higher parenting stress and depressive symptoms, and their children had more internalizing behaviors than families with consistent Medicaid. These differences existed despite no initial differences and controlling for numerous covariates. Policies and practices that stabilize Medicaid coverage for teen parent families may reduce unnecessary stress, depressive symptoms, and early childhood behavior problems.
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Medicaid/normas , Saúde Mental/normas , Poder Familiar/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Estados Unidos , Adulto JovemRESUMO
Objective: The current study examined the role of family influences on the vaccine behavior of emerging adults. Participants: In Spring 2017, we conducted anonymous online surveys of undergraduate students (n = 608) at a large, public university in the mid-Atlantic. Methods: Logistic regression was used to examine associations between family factors and students' awareness of the HPV vaccine, vaccine receipt, and vaccine intentions. Family factors included sex communication, religiosity, parental monitoring, family structure, and parents' birthplace. Results: More comprehensive family sex communication is associated with less uncertainty regarding HPV vaccine receipt and greater likelihood of being already vaccinated. More frequent family religiosity and more parental monitoring are associated with greater likelihood of having decided against vaccination rather than already being vaccinated. Significant gender and racial disparities exist. Conclusion: Further research, policy, and programmatic intervention are needed to reduce disparities and to improve emerging adults' compliance with HPV vaccine recommendations.
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Família , Conhecimentos, Atitudes e Prática em Saúde , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Comunicação , Estudos Transversais , Feminino , Humanos , Intenção , Masculino , Grupos Raciais , Fatores Sexuais , Fatores Socioeconômicos , Estudantes/estatística & dados numéricos , Incerteza , Universidades , Adulto JovemRESUMO
INTRODUCTION: The purpose of this study is to determine the effectiveness of a patient-centered medical home intervention for teen parent families in reducing rates of unintended repeat pregnancy in the first 2 years postpartum. METHODS: A prospective quasi-experimental evaluation was conducted with 98 African American, low-income, teen mother (aged <20 years) participants who received either the intervention or standard pediatric primary care. All participants completed structured interviews at baseline (child aged 2 months) and at follow-ups 12 and 24 months later. Data were collected from 2011 to 2015. Participants reported number of pregnancies, contraception used at last intercourse, depressive symptoms, and romantic status of the relationship with the baby's father. Analyses were conducted from 2015 to 2017. RESULTS: Logistic regression showed that mothers in the intervention group were half as likely as mothers who received standard pediatric primary care to have a repeat pregnancy within 2 years (OR=0.55, p=0.16). The main effect of the intervention on lower rates of repeat pregnancy was mediated by higher rates of contraceptive use. Depression was associated with higher odds of repeat pregnancy, but did not appear to mediate the intervention effect. CONCLUSIONS: This comprehensive and integrated model of care for teen parents may be an effective method to prevent rapid repeat pregnancies in this vulnerable population.
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Negro ou Afro-Americano , Anticoncepção/métodos , Serviços de Saúde Mental/organização & administração , Gravidez na Adolescência/prevenção & controle , Atenção Primária à Saúde/organização & administração , Serviço Social/organização & administração , Adolescente , Continuidade da Assistência ao Paciente , Depressão/etnologia , Depressão/terapia , Feminino , Humanos , Modelos Logísticos , Assistência Centrada no Paciente/organização & administração , Pobreza , Gravidez , Gravidez na Adolescência/etnologia , Gravidez não Planejada , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Parceiros Sexuais/psicologia , Fatores SocioeconômicosRESUMO
Poverty is a common experience for many children and families in the United States. Children <18 years old are disproportionately affected by poverty, making up 33% of all people in poverty. Living in a poor or low-income household has been linked to poor health and increased risk for mental health problems in both children and adults that can persist across the life span. Despite their high need for mental health services, children and families living in poverty are least likely to be connected with high-quality mental health care. Pediatric primary care providers are in a unique position to take a leading role in addressing disparities in access to mental health care, because many low-income families come to them first to address mental health concerns. In this report, we discuss the impact of poverty on mental health, barriers to care, and integrated behavioral health care models that show promise in improving access and outcomes for children and families residing in the contexts of poverty. We also offer practice recommendations, relevant to providers in the primary care setting, that can help improve access to mental health care in this population.
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Acessibilidade aos Serviços de Saúde/organização & administração , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Pobreza/psicologia , Pobreza/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Adulto , Criança , Estudos Transversais , Seguimentos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Serviços de Saúde Mental/provisão & distribuição , Fatores de RiscoRESUMO
STUDY OBJECTIVE: To explore interpersonal factors associated with maintaining contraceptive use over time among urban, African American teen mothers. DESIGN: Longitudinal study, 2011-2015. SETTING: Six pediatric primary care sites in the same city, all of which primarily serve urban, low-income, African American families. PARTICIPANTS: Teen mothers accessing health services for their child at one of the six study sites. INTERVENTIONS: The current study was a secondary data analysis of data that were collected as part of a patient-centered medical home model intervention, that compared a group of teen mothers and their children who were participants in the intervention with mother-child dyads who were enrolled in standard community-based pediatric primary care. Structured interviews were conducted with teen mothers at baseline/enrollment, when their children were, on average, 3 months old, and again 12 months later. MAIN OUTCOME MEASURES: Maintenance of contraceptive use over time. RESULTS: Teen mothers who perceived any tangible support from their own mothers were significantly less likely to maintain contraceptive use over time (adjusted odds ratio [AOR] = .27). However, teens who perceived any emotional support from their own mothers were nearly four times more likely to maintain contraceptive use (AOR = 3.74). Teens who lived with their own mothers were more than 5 times more likely to maintain contraceptive use over time (AOR = 5.49). CONCLUSION: To better understand contraceptive discontinuation and thus to prevent repeat pregnancies among teen mothers, it might be necessary to further examine the role of support relationships in teen mothers' contraceptive decision-making. Secondary pregnancy prevention programs should include key support persons.
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Negro ou Afro-Americano/psicologia , Comportamento Contraceptivo/psicologia , Relações Mãe-Filho , Mães/psicologia , Gravidez na Adolescência/prevenção & controle , Apoio Social , Adolescente , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Razão de Chances , Pobreza/psicologia , Gravidez , Gravidez na Adolescência/psicologia , Fatores de TempoRESUMO
PURPOSE: The Generations program, a patient-centered medical home, providing primary medical care, social work, and mental health services to teen mothers and their children, offers a promising approach to pregnancy prevention for teen mothers. This study tested whether the Generations intervention was associated with improved rates of contraceptive and condom use among participants 12 months after program entry. METHODS: This study compared teen mothers enrolled in Generations to those receiving standard community-based pediatric primary care over 12 months. Participants included African-American mothers ages 19 and younger, with infants under 6 months, living in Washington DC. A total of 83% of the baseline sample (150 mother-child dyads) was retained at follow-up. RESULTS: Generations participants had over three times the odds of contraceptive use, with an odds ratio (OR) of 3.35, and twice the odds of condom use (OR = 2.29) after 12 months, compared to participants receiving standard pediatric care. The odds remained comparable and significant when adjusting for differences in baseline use. Once additional covariates were entered into the model, the association was reduced to OR = 2.59 because being in a relationship with the baby's father was significantly associated with reduced contraceptive use. The same pattern was evident for condom use. Mothers in Generations had steady use of contraceptives over time, but there was a decline in use among comparison mothers, indicating that Generations prevented contraceptive discontinuation. CONCLUSIONS: Findings from this study suggest that the Generations program is an effective intervention for improving contraceptive use among teen mothers, a group at especially high risk for pregnancy.
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Comportamento Contraceptivo/estatística & dados numéricos , Mães/estatística & dados numéricos , Gravidez na Adolescência/estatística & dados numéricos , Adolescente , Negro ou Afro-Americano , District of Columbia , Pai/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Razão de Chances , Assistência Centrada no Paciente , Gravidez , Gravidez na Adolescência/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Apoio Social , Adulto JovemRESUMO
Teen childbearing is associated with a range of adverse outcomes for both mothers and children, and perpetuates an intergenerational cycle of socioeconomic disadvantage. Fathers may be an underappreciated source of support to teen mothers and their children. The strongest and most consistent predictor of positive father involvement is a positive coparenting relationship between the mother and father. Thus, strengthening the coparenting relationship of teen parents may be protective for both parents and children. This paper describes the rationale, the intervention model, and the cultural adaptation of Strong Foundations, an intervention designed to facilitate and enhance positive coparenting in teen parents. Adapted from an evidence-based coparenting program for adult, cohabiting parents, this intervention was modified to be developmentally and culturally appropriate, acceptable, and feasible for use with urban, low-income, minority expectant teen mothers and their male partners. The authors present lessons learned from the cultural adaptation of this innovative intervention. Pilot testing has shown that this model is both acceptable and feasible in this traditionally hard to reach population. Although recruitment and engagement in this population present specific challenges, young, urban minority parents are deeply interested in being effective coparents, and were open to learning skills to support this goal.
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Negro ou Afro-Americano , Relações Interpessoais , Grupos Minoritários , Poder Familiar/etnologia , Pais/educação , Pais/psicologia , Adolescente , Fatores Etários , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Populações Vulneráveis , Adulto JovemRESUMO
The purpose of this study is to examine the role of father involvement on infant distress among children born to teen mothers, particularly those who are depressed. 119 teen mothers (<20 years) and their infants (<6 months) enrolled in a quasi-experimental trial of a comprehensive pediatric primary care program. Data were drawn from mother-reported questionnaires administered at baseline, before participation in the intervention or comparison conditions. 29 % of teen mothers screened positive for depression. Mothers reported that 78 % of fathers were engaged with their children, typically seeing them a few times per month, and 71 % took financial responsibility for their children. In a multiple linear regression, father responsibility predicted lower infant distress, maternal depression predicted higher infant distress, and there was a significant interaction in which father engagement buffered the effect of maternal depression on infant distress. Fathers may be a protective resource for children born to teen mothers, even as early as the first 6 months of life, potentially mitigating the heightened risk associated with maternal depression in the postpartum period.
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Depressão Pós-Parto/psicologia , Relações Pai-Filho , Pai/psicologia , Poder Familiar/psicologia , Adolescente , Adulto , Negro ou Afro-Americano , Maus-Tratos Infantis/prevenção & controle , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Lineares , Masculino , Relações Mãe-Filho , Pediatria , Pobreza , Gravidez , Gravidez na Adolescência , Atenção Primária à Saúde , Inquéritos e Questionários , Adulto JovemAssuntos
Abuso Sexual na Infância/ética , Confidencialidade/ética , Feminino , Humanos , Masculino , GravidezRESUMO
STUDY OBJECTIVE: To examine the self-reported pregnancy intentions of the male partners of expectant adolescent mothers, the accuracy of adolescent mothers' perceptions of their partner's pregnancy intentions, and the concordance between young mothers' and fathers' pregnancy intentions. DESIGN: This cross-sectional pilot study collected interview data from expectant adolescent mothers and their male partners. SETTING: Data were collected in participants' homes. PARTICIPANTS: 35 expectant couples were interviewed separately. Most participants were African American (89% of mothers, 74% of fathers). 69% of mothers were 17-18 years old, and half of the fathers were ≥19. MAIN OUTCOME MEASURES: Parents responded to survey questions adapted from the Center for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System Questionnaire. RESULTS: 44% of fathers reported wanting their partner to get pregnant. Another 15% were ambivalent. A kappa statistic of 0.12 (P = .33) indicated very little "accuracy" of mothers' perceptions of their partners' pregnancy intentions. Further, there was low concordance between the pregnancy intentions of mothers and fathers. Young fathers who wanted or were ambivalent about pregnancy were significantly more likely to use no contraception or withdrawal. CONCLUSION: For a notable number of minority couples, adolescent mothers do not have an accurate perception of their partners' pregnancy intentions and use contraceptive methods that are not within their control. These findings indicate that teen pregnancy prevention interventions must target young males in addition to females and sexually active adolescents should be encouraged to discuss pregnancy intentions with each other.
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Intenção , Gravidez na Adolescência/psicologia , Parceiros Sexuais/psicologia , Adolescente , Anticoncepção/estatística & dados numéricos , Comportamento Contraceptivo , Estudos Transversais , Feminino , Humanos , Masculino , Projetos Piloto , Gravidez , Gravidez não Desejada , Autorrelato , Inquéritos e Questionários , Adulto JovemRESUMO
Adolescent parenthood is associated with a range of adverse outcomes for young mothers, including mental health problems such as depression, substance abuse, and posttraumatic stress disorder. Teen mothers are also more likely to be impoverished and reside in communities and families that are socially and economically disadvantaged. These circumstances can adversely affect maternal mental health, parenting, and behavior outcomes for their children. In this report, we provide an overview of the mental health challenges associated with teen parenthood, barriers that often prevent teen mothers from seeking mental health services, and interventions for this vulnerable population that can be integrated into primary care services. Pediatricians in the primary care setting are in a unique position to address the mental health needs of adolescent parents because teens often turn to them first for assistance with emotional and behavioral concerns. Consequently, pediatricians can play a pivotal role in facilitating and encouraging teen parents' engagement in mental health treatment.
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Transtornos Mentais , Serviços de Saúde Mental , Mães/psicologia , Gravidez na Adolescência/psicologia , Populações Vulneráveis/psicologia , Adolescente , Feminino , Acessibilidade aos Serviços de Saúde , Visita Domiciliar , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/estatística & dados numéricos , Relações Mãe-Filho/psicologia , Poder Familiar/psicologia , Pediatria , Papel do Médico , Gravidez , Prevalência , Atenção Primária à Saúde , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Asian-American children are considered to be at low risk of obesity, but previous estimates have not distinguished between children from different Asian countries. We estimate the prevalence of obesity among Asian-American children by mother's country of origin, generational status, and family socioeconomic factors using a secondary analysis of the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) wave III (children â¼4 years old) dataset. METHODS: The ECLS-B is a nationally representative study of children born in 2001 that oversampled births to Asian mothers. Asian ethnic categories included Chinese, Japanese, Filipino, Asian Indian, Korean, Vietnamese, and Other Asian/Pacific Islander. The primary outcome variable was weight status; overweight = BMI ≥85(th) and obese = BMI ≥95(th) percentile for age and gender. RESULTS: Twenty-six percent [95% confidence interval (CI) 23.6-29.1] of Asian-American 4 year olds were overweight or obese, and 13% (95% CI 10.2-15.2) were obese. Chinese-American children were at lower risk of overweight or obesity (23.5%, 95% CI 18.4-29.5 ) compared to whites (36%, 95% CI 34.3-37.7); Asian-Indian 4 year olds had the lowest rates of overweight or obesity (15.6%, 95% CI 8.0-28.2) and were most likely to be underweight (10%, 95% CI 4.9-19.4). Among Asians,Vietnamese-American children had the highest rate of overweight or obesity (34.7%, 95% CI 0.6-52.3). CONCLUSIONS: Vietnamese-American children are at elevated risk of obesity and overweight, whereas Chinese and Asian-Indian children are at low risk. After controlling for Asian ethnicity, maternal education, and household poverty status, Asian-American children whose mothers were born outside the United States were less likely to be obese [odds ratio = 0.55 (0.32-0.95), p = 0.03].
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Asiático , Obesidade/epidemiologia , Índice de Massa Corporal , Pré-Escolar , China/etnologia , Escolaridade , Feminino , Humanos , Índia/etnologia , Japão/etnologia , Coreia (Geográfico)/etnologia , Masculino , Havaiano Nativo ou Outro Ilhéu do Pacífico , Sobrepeso/epidemiologia , Filipinas/etnologia , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Vietnã/etnologia , População BrancaRESUMO
OBJECTIVE: (1) To describe coparenting among adolescent mothers and the biological fathers of their children. (2) To examine the effects of coparenting on young children's social-emotional development and whether these effects vary by father's residence status, parental education, and child characteristics. METHODS: Secondary analysis was conducted with the Early Childhood Longitudinal Study-Birth Cohort, which is a nationally representative sample of U.S. children born in 2001. The subsample used in this study includes 400 children whose biological mothers, aged 15-19, participated when their children were 2 years and 4 years old and whose biological fathers (residential and nonresidential) participated at 4 years. Cooperative coparenting and coparenting conflict were measured at child age 2 years. Children's social skills and problem behavior were measured at child age 4 years. RESULTS: Mother- and father-reported coparenting conflict were associated with child behavior problems, more strongly among boys (b = 1.31, P < .01) than girls (b = -0.13, P > .05). Mother-reported coparenting conflict also predicted lower child social skills (b = -1.28, P < .05); the association of father-reported coparenting conflict with social skills was moderated by child race and father education. CONCLUSIONS: Coparenting conflict between adolescent parents influences child adjustment. Practitioners working with teen mothers should encourage father participation at medical visits and other clinical contacts and should address the relationship between the parents, whether or not they are living together, as part of routine care.