The Effects of Race, Ethnicity, and Maternal Education on Infant Mortality.

BACKGROUND: The state of New Jersey has a large Black/African American (AA) versus White racial disparity in infant mortality and educational level at childbirth. This disparity, measured by rate ratio, increases with greater maternal education among varied racial-ethnic groups. The nature of this disparity measured by rate differences has not been explored. OBJECTIVES: Infant birth and mortality data were used to examine whether racial or ethnic disparities in infant mortality increased with greater maternal education, comparing rate differences and rate ratios. Racial and ethnic variations in the association between maternal education and infant mortality were examined. METHODS: Data were from the New Jersey State Health Assessment Data for all New Jersey births between 2014 and 2018 stratified by race and ethnicity, maternal education, and infant mortality ( n = 481,333). R software was used to create a data set and estimate additive and multiplicative interactions, rate differences, and rate ratios for infant mortality by maternal race/ethnicity and educational levels among four racial-ethnic groups. RESULTS: Infant mortality was significantly greater for Black/AA and Hispanic mothers than for White mothers. At all educational levels, Black/AA mothers had the highest prevalence of infant mortality compared to other racial or ethnic groups. Rate differences in infant mortality showed a decrease in Black/AA-White differences for mothers with a high school education or less compared to mothers with a college degree. However, rate ratios showed an increase in Black/AA-White ratio with increasing education levels for mothers with high school education or less than mothers with a college degree. Risk ratios comparing infant mortality for Black/AA versus Hispanic or Asian mothers showed more than a twofold greater risk at all education levels for Black/AA infants. Finally, college-educated Black/AA mothers had significantly higher rates of infant mortality than White or Hispanic mothers with a high school education or less. DISCUSSION/IMPLICATIONS: Black/AA mothers with a college degree had a higher infant mortality rate than White, Hispanic, or Asian mothers with a high school education or less. Future research should address contextual/systemic contributors to this disparity.

School readiness and social determinants of health: A collaboration with community teachers and parents.

PURPOSE: To explore perceptions of community dwelling caregivers of preschool-aged children regarding the influence of social determinants of health (SDOH) on children's school readiness. Parents' perspectives regarding solutions to enhance school readiness in preschool-aged children are also explored. METHODS: This study employed a qualitative, descriptive design and a community based participatory research (CBPR) approach. An academic institution collaborated with parents, teachers, and administrators at a community-based preschool learning center. Ten young-adult to middle-aged mothers and caregivers attended two separate focus groups and completed open-ended questionnaires. Inductive and deductive thematic analysis of text were employed. FINDINGS: Three themes emerged 1) Families described the vast lack of appropriate community resources and inability to access those resources that are available to prepare their children for school 2). Family members need help processing information about social resources 3) Community, individual and systemic level solutions to enhance school readiness. CONCLUSIONS: Academic-Community partnerships provide an opportunity to (1) identify solutions to remove systemic barriers that impede children's readiness for school, and (2) design interventions to support families through that process. Interventions to enhance school readiness should be family-focused and can be informed by understanding the influence of SDOH during the planning stages. SDOH create barriers and prevent parents from prioritizing their children's school, health-care, and developmental needs. PRACTICE IMPLICATIONS: Interventions to enhance school readiness should be family-based and can be informed by understanding the influence of SDOH during the planning stages. Social advocacy is also needed to enhance the ability of parents to enhance their children's school readiness.

Service learning: Nursing students' civic engagement with diverse populations of children with special needs.

PURPOSE: There is limited knowledge of nursing students' perspectives about engagement with special needs populations. The purpose of this study was to identify the advantages/benefits and disadvantages/challenges of nursing students' engagement experience with children with special mental and physical disabilities. Recommendations to enhance student engagement experiences were also provided. METHODS: A descriptive, qualitative design was employed. Undergraduate nursing students (N = 28) responded to open-ended questions about their civic engagement experiences at a community-based, respite care program for children with special needs. Student accounts underwent directed content analysis, with coding, category and theme development according to the Theory of Planned Behavior. The Atlas.Ti computer program was used to manage the data. RESULTS: Advantages/Benefits: Filling cognitive and experiential learning gaps, rewarding connections/relationships, positive emotions, perceptions and interactions, and fun and stress relief. Disadvantage/challenges: Managing negative/uncomfortable emotions and uncertainty, witnessing and managing disruptive behaviors, negative perceptions of program operations/expectations. CONCLUSIONS: Students experienced cognitive, emotional, interpersonal and educational advantages and/or disadvantages while engaging with this defined population. PRACTICE IMPLICATIONS: To enhance engagement faculty can provide education and anticipatory guidance, detail responsibilities and expectations, and/or utilize simulation for student preparation. Nurses and researchers can utilize community based participatory methods to guide discussions with community-based organizations to collaboratively develop strategies to institute, evaluate and enhance student engagement during service learning experiences with children who have special needs.

Beliefs and willingness towards participating in genetic testing for depression in low-income and racial/ethnic minority mothers at-risk.

PURPOSE: To identify mothers' salient normative, behavioral and control beliefs and willingness towards participating in genetic salivary testing for depression. DESIGN: A qualitative, descriptive design was employed. 41 multi-ethnic mothers completed surveys that underwent directed content analysis according to The Theory of Planned Behavior. Percentages and frequency counts were used to categorize responses and calculate willingness. FINDINGS: Salient beliefs included: Behavioral: Finding a cure/treatment for depression (29.3 %), Normative: Family would approve (46.3 %), and Church associates would disapprove (19.5 %). CONTROL: Lacking information/explanations (34.1 %) as barriers, convenient locations (24.4 %) as facilitators. Most mothers indicated a willingness to participate (90.2 %). CONCLUSIONS: Interventions should target families, emphasize benefits, explain purposes and procedures, and use community based participatory methods.

Using Mindfulness-Informed Photovoice to Explore Stress and Coping in Women Residing in Public Housing in a Low-Resourced Community.

The setting of the current study was an urban city where the majority of public housing residents are single females living in poverty. An adapted women's mindfulness program, including a Photovoice exercise, was offered to this vulnerable population. Stress contributes to poor mental/physical health. A Photovoice research method was used to elucidate the stressors and coping facilitators used by participants. Eleven participants took a digital photography workshop and then photographed stressors and coping facilitators. All 275 photographic submissions were analyzed thematically. Coping themes were: Aesthetics: Man-Made and Natural; Relationships: Pets and People; Self-Esteem and Cultural Identity; and Inspiration Through Religion and Social Media Messaging. Stress themes were: Urban Disarray and Existential Threat/Danger. Results showed that social connectedness, spirituality, improving neighborhood aesthetics, use of social media, and access to nature could support coping. [Journal of Psychosocial Nursing and Mental Health Services, 60(7), 23-31.].

Contributors to Depressed Mood in Black Single Mothers.

Participants: A convenience sample of 210 community dwelling Black single mothers ages 18 to 45, who reside in U.S. urban communities.Methods: A descriptive, cross-sectional design was employed. Participants responded to an open-ended question that asked about reasons for depressed mood. A directed approach to content analysis was used to categorize the responses based on existing theoretical formulations and empirical findings about the causes of depression in women. Percentages and frequencies were used to describe the results of the analysis.Findings: A total of 319 usable responses were provided. Collectively and individually the most frequent responses were consistent with Social/Environmental factors such as lack of financial resources (n = 115; 36.05%), followed by Psychological factors such as general cognitive/emotional feelings of stress (n = 60; 18.81%), and parenting stressors or daily hassles (n = 40; 12.54%). Physiologic factors such as a having physiologic or medical conditions were reported less often (n = 14; 4.39%).Conclusions/Implications: Social/Environmental and Psychological factors contribute to depressed mood more often than Physiological factors in Black single mothers. Depression prevention efforts should target the social determinants of mental health in Black single mothers who should be connected with appropriate financial, psychological, educational and social service resources in the community.

Partnerships to Evaluate the Social Impact of Dance for Health: A Qualitative Inquiry.

Objectives: The purpose of this study is to determine the social impact and meaning of "Dance for Health" for participants who attended this community driven, intergenerational, physical activity dance program. Methods:This study employed a descriptive, qualitative design and utilized a participatory action research approach to obtain pilot data on fourteen participants between the ages 18 to 75. One focus group discussion with 13 participants and an individual interview with a female participant was conducted. Data collection took place in the community where intervention sessions were held. Audiotapes from one focus group discussion and one in depth individual interview were transcribed by a professional transcription service. The NVIVO computer program was used to organize the data. Directed content analysis of the data took place utilizing primary and secondary coding, category and theme development. Results: Three broad themes emerged representing the social impact of Dance for Health and included: (1) Enhancing the Well-being of the Individual, (2) Fostering Interpersonal Relationships and Connections, (3) Fostering Connections with the Community. Conclusion: A participatory action research approach facilitates successful collaborations between community organizations and academic institutions and can be used to evaluate the impact of physical activity programs on urban community residents. Participants experienced interpersonal and social benefits from regular attendance at the "Dance for Health" program, subsequently contributing to program sustainability. Focused attention to social determinants of physical activity participation can improve physical activity maintenance in residents who reside in under-resourced communities.

Exploring Expressions of Depression in Black Single Mothers.

PROBLEM: This study investigates the experience of depression from the perspective of Black single mothers, an understudied diverse-sub-group who consistently report high levels of depressive symptoms that go undetected and untreated. PARTICIPANTS: The sample consisted of 210 Black single mothers aged 18-45 who reside in urban communities. METHODS: A descriptive, cross-sectional design was used to categorize the responses of Black single mothers to an open-ended question that asks about feelings of depression according to the four domains of the Centers for Epidemiologic Studies Depression Scale. Percentages and frequencies were used to describe the results of the analysis. FINDINGS: The 303 usable responses were most consistent with the depressed affect domain (N = 172), followed by somatic activity (N = 108), interpersonal symptoms (N = 21), and lack of positive affect (N = 2). The most prevalent raw responses included sadness (N = 59), forms of anger (N = 48), depressed (N = 24), cry (N = 23), do not want to be around people (N = 21), lonely (N = 17), tired (N = 16), and stressed (N = 12). CONCLUSIONS/IMPLICATIONS: Consider culture and individualized assessments to explore feelings of anger and sadness when screening for depressive symptoms in specific sub-groups of Black single mothers. Consider the use of appropriate screening tools.

Coping with Depression in Single Black Mothers.

Very little information exists in the literature about what black women do when they experience symptoms of depression. The purpose of this descriptive study was to analyze the responses of 208 community-residing black single mothers, aged 18 to 45, to an open-ended question asking, "What do you do to feel better when you are feeling down in the dumps?" The theoretical bases of the Ways of Coping Checklist, were used to facilitate categorizing their responses into a coping scale and then a particular coping profile. Percentages were used to categorize the frequency of the responses into the respective coping scale and to categorize the frequency of the combined responses of each woman into a respective coping profile. Of the 333 responses that the women provided, 327 were useable. Findings indicated that a majority of responses fell into the Escape-Avoidance category (n = 206; 63%), followed by the Seeking Social Support (n = 60, 18.3%), Positive Reappraisal (n = 40; 12.2%), Planful Problem Solving (n = 12; 3.7%), Distancing (n = 3; 1%), and Self-Controlling (n = 6; 1.8%) categories. No responses fit the Confrontive Coping or Accepting Responsibility categories and none of the responses indicated that the women sought professional help. Of the 176 women who provided answers to the study question, more than half (64.2%; n = 113) gave only emotion-focused responses, 2.8% (n = 5) gave only problem-focused responses, 2.8% (n = 5) gave mixed responses, and 30.2% (n = 53) reported social support seeking. Implications for future research, cultural theory, and nursing practice are addressed.

Instruments measuring perceived racism/racial discrimination: review and critique of factor analytic techniques.

Several compendiums of instruments that measure perceived racism and/or discrimination are present in the literature. Other works have reviewed the psychometric properties of these instruments in terms of validity and reliability and have indicated if the instrument was factor analyzed. However, little attention has been given to the quality of the factor analysis performed. The aim of this study was to evaluate the exploratory factor analyses done on instruments measuring perceived racism/racial discrimination using guidelines from experts in psychometric theory. The techniques used for factor analysis were reviewed and critiqued and the adequacy of reporting was evaluated. Internet search engines and four electronic abstract databases were used to identify 16 relevant instruments that met the inclusion/exclusion criteria. Principal component analysis was the most frequent method of extraction (81%). Sample sizes were adequate for factor analysis in 81 percent of studies. The majority of studies reported appropriate criteria for the acceptance of un-rotated factors (81%) and justified the rotation method (75%). Exactly 94 percent of studies reported partially acceptable criteria for the acceptance of rotated factors. The majority of articles (69%) reported adequate coefficient alphas for the resultant subscales. In 81 percent of the studies, the conceptualized dimensions were supported by factor analysis.

Validation of the Center for Epidemiologic Studies Depression Scale in black single mothers.

BACKGROUND AND PURPOSE: The purpose of this study was to investigate the factor structure of the Center for Epidemiologic Studies Depression (CES-D) scale in a community sample of Black single mothers and to evaluate the scale's construct validity. METHODS: Principal components and exploratory factor analysis were used. The participants responded to the CES-D scale and Spielberger's State-Trait Anger Expression Inventory. RESULTS: The final sample consisted of 208 Black single mothers aged 18-45 years. A 2-factor structure was accepted. Construct validity was confirmed via significant correlations with the anger scales. A method artifact for the 2-factor solution was ruled out. CONCLUSION: The CES-D scale is valid for use with Black single mothers. Additional psychometric evidence for the CES-D for Black single mothers is warranted.

Development of Telemedicine Simulations Addressing Social Determinants of Health.

BACKGROUND: Five telemedicine simulations were created during the coronavirus disease 2019 (COVID-19) pandemic to elucidate implicit biases and enhance awareness of social determinants of health among nursing students. Social determinants affect overall health, functioning, and quality-of-life outcomes and risks. Implicit biases are related to patient-provider interactions, treatment decisions and adherence, and ultimately patient health outcomes. PURPOSE: This article explains the simulation development and content, describes the student learning outcomes, and presents faculty insights that highlight the necessity of simulation experiences in nursing education. METHOD: Five telemedicine simulations that presented different social determinants of health and implicit biases were created for undergraduate nursing students. RESULTS: Nursing students increased knowledge related to social determinants and their own implicit biases. CONCLUSION: Telemedicine simulations were effective in assisting nursing students recognize their own implicit biases and the economic challenges of individuals living in poverty, as well as the potential influence of social determinants of health. [J Nurs Educ. 2023;62(1):58-61.].

Socio-Demographic and Coping Correlates and Predictors of Depressive Symptoms Among Low-Income and Ethnic Minority Mothers At-Risk.

This study identified coping and sociodemographic correlates and predictors of depressive symptoms in mothers at risk for clinical depression. A descriptive, cross-sectional design was employed. A convenience sample of 88 low-income or ethnic-minority mothers aged 21 to 45 completed a depression scale, demographic data sheet, and responded to an open-ended question. Content analysis, descriptive, and inferential statistics was used for data analysis. Exactly 42.5% of mothers reported high depressive symptoms (>16). Lower income levels (r = .342, p = .01) and head-of-household status (r = .220, p = .04) were significantly associated with higher depressive symptoms. Those who used social support coping had lower depressive symptoms than those who did not (t = 2.50, p = .014). Those using emotion-focused coping only had higher depressive symptoms than those using a mix of coping strategies (t = 2.60, p = .011). Healthcare providers can employ vigilant depression screening and encourage utilization of a mix of problem and emotion-focused coping strategies to reduce depressive symptoms and prevent clinical depression.

The Effects of a Community-Based, Multicomponent, Depression Prevention Intervention in Mothers At-Risk.

The purpose of this study was to develop a 12-week multicomponent, depression prevention pilot intervention and evaluate its feasibility and preliminary effects on improving levels and correlates of depressive symptoms, including anger, self-esteem perceived stress, social support, and racism. A quasi-experimental, mixed-methods design and a community-based participatory research (CBPR) approach was employed. University faculty, students and community residents collaborated at a low-income housing complex in a low-resourced, urban community. Fifteen low-income, ethnic minority mothers ages 23-46 years completed the intervention and evaluation surveys. Eight mothers participated in a focus group. The intervention included social group-dance, health education, and socialization. t-Tests, sign-tests, and thematic analysis was employed. Mothers identified barriers and facilitators of program engagement. Depressive symptoms were significantly reduced (t(14) = 2.41, p = .030). Self-esteem (t(14) = 2.28, p = .039) and social support levels (M = 4.5, p = .035) were significantly increased. This multicomponent intervention is feasible. Preliminary efficacy evidence was mixed.

Eliciting Willingness and Beliefs towards Participation in Genetic Psychiatric Testing in Black/African American Mothers at Risk for Depression.

Black/African American women are at high risk for depression, yet are underrepresented in psychiatric genetic research for depression prevention and treatment. Little is known about the factors that influence participation in genetic testing for Black/African American women at risk. The purpose of this study was to elicit the beliefs that underlie participation in genetic testing for depression in Black/African American mothers, a subgroup at high risk. Willingness to participate in genetic testing procedures was also determined. A qualitative, descriptive design was employed. Exactly 19 mothers aged 21-42 completed open-ended questionnaires. Directed content and descriptive analyses of the text were conducted based on the Theory of Planned Behavior. Salient beliefs included: behavioral advantages-diagnosing/detecting depression (31.6%), finding cure/treatment (21.1%); disadvantages-not finding follow-up treatment/help (21.1%); salient referents, who approves-family members (47.4%), agencies/organizations (26.3%); who disapproves-church associates (21.1%). Control beliefs included: barriers-unpleasant/difficult testing procedures (42.1%), limited knowledge about the purpose of testing (26.3%); facilitator-a convenient location (21.1%). Most mothers (89.5%) indicated willingness to participate in testing. Interventions can target families, address barriers, emphasize future benefits, and use convenient locations and community-based participatory research methods. Policies can address social determinants of participation to increase inclusion of these mothers in psychiatric genetic research.

Engaging With the Community to Promote Physical Activity in Urban Neighborhoods.

PURPOSE: To describe perceptions of physical activity, opinions, on intergenerational approaches to physical activity and a vision for increasing physical activity in an underresourced urban community. APPROACH: Focus groups embedded in a large Community-Based Participatory Research Project. SETTING: West and Southwest Philadelphia. PARTICIPANTS: 15 parents, 16 youth, and 14 athletic coaches; youth were 13 to 18 years old and attended West Philadelphia schools; parents' children attended West Philadelphia schools; and coaches worked in West Philadelphia schools. METHODS: Six focus groups (2 youth, 2 parent, and 2 coach) were conducted guided by the Socio-Ecological Model; transcriptions were analyzed using a rigorous process of directed content analysis. RESULTS: Factors on all levels of the Socio-Ecological Model influence the perception of and engagement in physical activity for youth and their families. Future strategies to increase engagement in physical activity need to be collaborative and multifaceted. CONCLUSION: When physical activity is reframed as a broad goal that is normative and gender-neutral, a potential exists to engage youth and their families over their lifetimes; with attention to cross-sector collaboration and resource sharing, engaging and sustainable intergenerational physical activity interventions can be developed to promote health in underresourced urban communities.

University⁻Community Partnerships Using a Participatory Action Research Model to Evaluate the Impact of Dance for Health.

Little is known about fostering sustainable, collaborative community-academic partnerships that effectively improve physical activity and health in residents of under resourced communities using Participatory Action Research (PAR) driven models. The purpose of this PAR study was to evaluate the impact of an urban, intergenerational, and physical activity dance program by identifying community preferred measurable outcomes that promote program participation and sustainability. A descriptive, qualitative design was employed using semi-structured interview guides to facilitate discussions for two adult focus groups and one youth focus group. Exactly 19 community-residing adults and six youth who lived in urban neighborhoods in West Philadelphia participated in the discussions. The audiotapes were transcribed and analyzed using directed content analysis. Five outcome themes emerged and included: (1). Enhancing the psychological and emotional well-being of the individual, (2). Enhancement of social well-being and management of interpersonal relationships and responsibilities (3). Enhancing and promoting physiologic well-being (4). Changes in health promoting behaviors and skill acquisition, and (5). Concerns about accessibility of dance for health and other physical activity programs in the community. Focused attention to measuring community preferred outcomes can promote sustainability of Dance for Health and possibly other urban-based physical activity dance programs.

Outcomes of Depression in Black Single Mothers.

Despite suggestions in the literature that depression has serious consequences, few studies have examined specific health and psychosocial outcomes of depression in Black single mothers. The purpose of this study was to estimate paths in a just-identified theoretical model of outcomes of depression for Black single mothers based on theoretical propositions and empirical findings. The model included the variables, depressive cognitions, depressive symptomatology, perceived social support, and positive health practices. Five direct and two indirect hypothesized relationships were estimated using structural equation modeling. A nonprobability sample of convenience of 159 Black single mothers aged 18 to 45 years was recruited for the study. This study used a cross-sectional correlational design. The participants responded in person or via the U.S. mail to the Center for Epidemiologic Studies-Depression scale, the Depressive Cognition Scale, the Personal Resource Questionnaire 85-Part 2, and the Personal Lifestyle Questionnaire. Beta and Gamma path coefficients were statistically significant for four out of five hypothesized direct relationships within the model ( p < .01). The direct path between depressive cognitions and positive health practices was not supported (Gamma = -.11, p > .05). The two indirect paths were weak but statistically significant ( p < .01). Depressive symptoms and perceived social support were outcomes of depressive cognitions. Positive health practices was not a direct outcome of depressive cognitions. Perceived social support and positive health practices were outcomes of depressive symptoms.

Depression in Black Single Mothers: A Test of a Theoretical Model.

The aim of this study was to test a theoretical model of depression for Black single mothers. Participants were 208 Black single mothers, aged 18 to 45, recruited from community settings. The a priori over-identified recursive theoretical model was tested via the LISREL 9.1 program using a maximum likelihood estimation for structural equation modeling. The chi-square indicated that there was an excellent fit of the model with the data, χ(2)(1, N = 208) = .05, p = .82. The fit indices for the model were excellent. Path coefficients were statistically significant for seven out of eight of the direct paths within the model (p < .05). The two indirect paths were also statistically significant. The theory was supported and can be applied by health care professionals when working with depressed Black single mothers.