Influence of social determinants of health barriers to family management of type 1 diabetes in Black single parent families: A mixed methods study.

OBJECTIVE: US disparities in pediatric type 1 diabetes treatment and outcomes are increasing disproportionately among Black youth and compounded for youth from single parent homes. Despite worsened outcomes, Black youth from single parent homes and their caregivers are underrepresented in pediatric type 1 diabetes research. The purpose of this study was to understand the social determinants of health (SDOH) barriers that may contribute to health disparities and family management in Black youth with type 1 diabetes from single parent homes. RESEARCH DESIGN AND METHODS: A three-phase mixed methods study with self-identified Black single parents of youth with type 1 diabetes from an urban US pediatric diabetes center was conducted. Focus groups and interviews informed development of a parent-generated survey of SDOH barriers to diabetes management. Survey results are presented. RESULTS: A resulting 71 item parent-generated survey was administered to 105 parents. Among all items, most problematic SDOH barriers included lack of social support, managing parent/child diabetes-related stress, difficulties accessing diabetes supplies, pain management, cost of food and diabetes camp, need to take time off from work, lack of skilled school staff, school absences and unsafe neighborhoods. Structural racism related to child welfare reporting, and police targeting were also notable concerns. CONCLUSIONS: There is a critical need for clinical, community, and policy-related research and interventions, designed to reduce type 1 diabetes racial health disparities by addressing the impacts of SDOH as drivers of family management outcomes among Black youth from single parent families.

Children of single-parent households are at a higher risk of obesity: A systematic review.

The goal of this systematic review was to evaluate whether children living in single-parent households have a higher risk of obesity. Of the 539 studies identified using keywords, a total of 10 original studies met the inclusion criteria for this review. The outcome measures included objective assessment of adiposity (weight or body mass index (BMI)), dietary consumption, physical activity, and/or obesogenic behaviors (bedroom television, elevated television viewing time, insufficient physical activity, and infrequent family meals). Overall, the studies found higher BMIs and obesogenic behaviors in children of single-parent households. Characteristics identified with this association is comprised of being most prevalent among girls and Black children. Possible explanations for this association include single-parent households having higher time demands due to the lack of shared household responsibilities. Subsequently, a reduction of homemade meals, shared family meals, and physical activity can occur. Also, lower incomes and higher instability related to living transitions may be other possible challenges experienced in single-parent households. Based on the limited number of studies found, further research of the obesity risk in children from single-parent families is recommended. The findings can help provide clinicians and public health programs with a better understanding of how to effectively target family-based interventions for this population.

The Sibsize Revolution and Social Disparities in Children's Family Contexts in the United States, 1940-2012.

This article points to a sharp decline in children's sibling numbers (sibsize) that occurred in the United States since the 1970s and was large enough among children with lower socioeconomic status (SES) (particularly black children) to amount to a revolution in their family circumstances. It interprets sibsize decline as a source of social convergence in children's family contexts that ran counter to trends toward social divergence caused by the rise of lone parenthood. The article is based on new estimates of differences in children's sibsize and lone parenthood by race and maternal education generated from public-use samples from the Census of Population and Current Population Survey (CPS), focusing especially on the period 1940-2012. I discuss some methodological and substantive challenges for existing scholarship arising from the findings and point to questions for future research.

African-American Solo Grandparents Raising Grandchildren: A Representative Profile of Their Health Status.

The objective of this study is to document the health profile of 252 African-American grandparents raising their grandchildren solo, compared with 1552 African-American single parents. The 2012 Behavior Risk Factor Surveillance System is used to compare the specific physical and mental health profiles of these two family groups. The findings suggest solo grandparents have prevalence of many health conditions, including arthritis (50.3 %), diabetes (20.1 %), heart attack (16.6 %) and coronary heart disease (16.6 %). Logistic regression analyses suggest that solo grandparents have much higher odds of several chronic health disorders in comparison with single parents, but this difference is largely explained by age. Although solo grandparents have good access to health care insurance and primary care providers, a substantial percentage (44 %) rate their health as fair or poor. Practice interventions to address African American solo grandparents' health needs are discussed.

Attitudes towards family formation in cohabiting and single childless women in their mid- to late thirties.

This study aimed to explore attitudes towards family formation in single or cohabiting childless women of advanced age. The design comprised semi-structured qualitative interviews of 20 women aged 34-39 years attending the Fertility Assessment and Counselling Clinic, Rigshospitalet, Copenhagen. A sample of 10 single women and 10 cohabiting women was chosen with equal distribution of postgraduate education length. Data were analysed using content analysis following the method of Graneheim and Lundman and consolidated criteria for reporting qualitative research (COREQ). The general attitude towards family formation was characterized by a fear of the consequences of choosing motherhood on one hand, and a 'ticking biological clock' and a wish to establish a nuclear family on the other. The women idealized the perception of perfect mothering in terms of uncompromising expectations of child rearing and showed an increasing awareness of solo motherhood as a possible solution to advanced age, the wish of a child and single status compared to earlier studies. Our study contributes to knowledge and understanding of personal considerations related to childbearing in nullipara women in their mid- to late 30s and may be useful in a fertility assessment and counselling setting.

Better for Baby? The Retreat From Mid-Pregnancy Marriage and Implications for Parenting and Child Well-being.

Recent decades have seen a significant decline in mid-pregnancy ("shotgun") marriage, particularly among disadvantaged groups, which has contributed to increasing nonmarital birth rates. Despite public and political concern about this shift, the implications for parenting and child well-being are not known. Drawing on a sample of U.S. black and white mothers with nonmarital conceptions from the NLSY79, our study fills this gap. Using propensity score techniques to address concerns about selection bias, we found that mid-pregnancy marriages were associated with slightly better parenting quality relative to remaining single, although effect sizes were small and limited to marriages that remained intact at the time of child assessment. Mid-pregnancy marriages were not associated with improved children's behavior or cognitive ability. These findings suggest that the retreat from mid-pregnancy marriage may contribute to increasing inequality in parenting resources for children.

Socioeconomic status, parenting, and externalizing problems in African American single-mother homes: A person-oriented approach.

African American youth, particularly those from single-mother homes, are overrepresented in statistics on externalizing problems. The family is a central context in which to understand externalizing problems; however, reliance on variable-oriented approaches to the study of parenting, which originate from work with intact, middle-income, European American families, may obscure important information regarding variability in parenting styles among African American single mothers, and in turn, variability in youth outcomes as well. The current study demonstrated that within African American single-mother families: (a) a person-, rather than variable-, oriented approach to measuring parenting style may further elucidate variability; (b) socioeconomic status may provide 1 context within which to understanding variability in parenting style; and (c) 1 marker of socioeconomic status, income, and parenting style may each explain variability in youth externalizing problems; however, the interaction between income and parenting style was not significant. Findings have potential implications for better understanding the specific contexts in which externalizing problems may be most likely to occur within this at-risk and underserved group.

The Determinants of young Adult Social well-being and Health (DASH) study: diversity, psychosocial determinants and health.

PURPOSE: The Determinants of young Adult Social well-being and Health longitudinal study draws on life-course models to understand ethnic differences in health. A key hypothesis relates to the role of psychosocial factors in nurturing the health and well-being of ethnic minorities growing up in the UK. We report the effects of culturally patterned exposures in childhood. METHODS: In 2002/2003, 6643 11-13 year olds in London, ~80 % ethnic minorities, participated in the baseline survey. In 2005/2006, 4782 were followed-up. In 2012-2014, 665 took part in a pilot follow-up aged 21-23 years, including 42 qualitative interviews. Measures of socioeconomic and psychosocial factors and health were collected. RESULTS: Ethnic minority adolescents reported better mental health than White British, despite more adversity (e.g. economic disadvantage, racism). It is unclear what explains this resilience but findings support a role for cultural factors. Racism was an adverse influence on mental health, while family care and connectedness, religious involvement and ethnic diversity of friendships were protective. While mental health resilience was a feature throughout adolescence, a less positive picture emerged for cardio-respiratory health. Both, mental health and cultural factors played a role. These patterns largely endured in early 20s with family support reducing stressful transitions to adulthood. Education levels, however, signal potential for socio-economic parity across ethnic groups.

A systematic review of risk factors for neonatal mortality in adolescent mother's in Sub Saharan Africa.

BACKGROUND: Worldwide, approximately 14 million mothers aged 15 - 19 years give birth annually. The number of teenage births in Sub Saharan Africa (SSA) is particularly high with an estimated 50% of mothers under the age of 20. Adolescent mothers have a significantly higher risk of neonatal mortality in comparison to adults. The objective of this review was to compare perinatal/neonatal mortality in Sub Saharan Africa and it's associated risk factors between adolescents and adults. RESULTS: We systematically searched six databases to determine risk factors for perinatal/neonatal mortality, and pregnancy outcomes, between adolescent and adults in SSA. Article's quality was assessed and synthesized as a narrative. Being single and having a single parent household is more prevalent amongst adolescents than adults. Nearly all the adolescent mothers (97%) were raised in single parent households. These single life factors could be interconnected and catalyze other risky behaviors. Accordingly, having co-morbidities such as Sexually Transmitted Infections, or not going to school was more prevalent in younger mothers. CONCLUSIONS: Inter-generational support for single mothers in SSA communities appears essential in preventing both early pregnancies and ensuring healthy outcomes when they occur during adolescence. Future studies should test related hypothesis and seek to unpack the processes that underpin the relationships between being single and other risk indicators for neonatal mortality in young mothers. Current policy initiatives should account for the context of single African women's lives, low opportunity, status and little access to supportive relationships, or practical help.

Impact of a federal healthy start program on feto-infant morbidity associated with absent fathers: a quasi-experimental study.

The absence of fathers during pregnancy increases the risk of feto-infant morbidities, including low birth weight (LBW), preterm birth (PTB), and small-for-gestational age. Previous research has shown that the Central Hillsborough Healthy Start project (CHHS)-a federally funded initiative in Tampa, Florida-has improved birth outcomes. This study explores the effectiveness of the CHHS project in ameliorating the adverse effects of fathers' absence during pregnancy. This retrospective cohort study used CHHS records linked to vital statistics and hospital discharge data (1998-2007). The study population consisted of women who had a singleton birth with an absent father during pregnancy. Women were categorized based on residence in the CHHS service area. Propensity score matching was used to match cases (CHHS) to controls (rest of Florida). Conditional logistic regression was employed to generate odds ratios (OR) and 95 % confidence intervals (CI) for matched observations. Women residing in the CHHS service area were more likely to be high school graduates, black, younger (<35 years), and to have adequate prenatal care compared to controls (p < 0.01). These differences disappeared after propensity score matching. Mothers with absent fathers in the CHHS service area had a reduced likelihood of LBW (OR 0.76, 95 % CI 0.65-0.89), PTB (OR 0.72, 95 % CI 0.62-0.84), very low birth weight (OR 0.50, 95 % CI 0.35-0.72) and very preterm birth (OR 0.48, 95 % CI 0.34-0.69) compared to their counterparts in the rest of the state. This study demonstrates that a Federal Healthy Start project contributed to a significant reduction in adverse fetal birth outcomes in families with absent fathers.

The lived experiences of single Taiwanese mothers being resilient after divorce.

The lived experiences of being resilient as described by 13 single Taiwanese mothers after divorce was the focus of this study. A descriptive phenomenological approach to inquiry was the theoretical framework underpinning the study. Information was gathered through two in-depth face-to-face digitally recorded interviews with each participant. Each of the participants had suffered from depression. For the analysis of the participants' transcripts of interview the authors used Colaizzi's method. Four themes emerged from the analysis process: having faith in God, bending with the ebb and flow of daily life, finding strength in the support and friendship of others, and new found freedom and hope for the future. Findings of this study have the potential to enhance understanding of the mental health needs of single mothers and their children in the provision of holistic health care delivery.

Early community contexts, race/ethnicity and young adult CVD risk factors: the protective role of education.

Using a sample of 13,500 adolescents (53% female and 47% male) who participated in all four waves of the National Longitudinal Study of Adolescent Health, this study used multilevel regression to examine the influence of early structural community adversity (as measured by rates of community poverty, single-parent headed families, and two indicators of employment) and racial/ethnic status on cardiovascular disease (CVD) risk factors of young adults (systolic blood pressure, diastolic blood pressure, and mean arterial pressure). The moderating role of youth's socioeconomic attainment was also examined. Results indicate that early community adversity and African American racial status place young adults at risk for CVD. Youth's socioeconomic attainment does not erase the persistent influences of early community adversity and African American racial status on CVD risk. However, the level of education attained can protect African American young adults and those experiencing early community adversity from CVD risk factors.

"Let us help them to raise their children into good citizens": the Lone-Parent Families Act and the wages of care-giving in Israel.

Based on the assumption that the construction of meaning in the process of policy-making is crucial if we wish to understand the gender outcomes of social policy, this article analyzes the parliamentary debates that preceded and accompanied the legislation of the Israeli Mono-Parental Families Act, 1992. It focuses on the enunciation of gender roles and relations in the discourses that framed and justified the Act as well as on how the capacity to establish and maintain autonomous households was constructed and legitimized. Two sets of discourses emerged during the deliberations over the Act, each of which endeavored to interpret the needs, identities, and capacities for action among lone-parent families. The article shows how a specific version of the capacity to establish and maintain autonomous households­that of caregivers who happen to be workers­was privileged in the policy paradigm underlying the Act. The alternative vision­that of workers with caregiving responsibilities­was marginalized and eventually disregarded in the final wording and implementation of the Act. The article concludes with an analysis of the socio-political processes that underlie the prioritization of the version, which was ultimately expressed in the implementation of the Act. It is suggested that a state-level collective identity project shaped by demographic concerns and geo-political factors and changes in the political economy combined to define the needs, identities, and capacities for action of lone-parent families in terms of a model of motherhood in which care-giving trumped paid work.

Empowerment or endurance? War wives' experiences of independence during and after the Second World War in Germany, 1939-1948.

As German men were conscripted into the armed forces during the Second World War, more and more wives were left to manage their families alone. At the same time more women than ever entered paid employment to fill the gaps in the market left by their soldier husbands. Scholars working in the field have made much of the dislocation to gender roles prompted by the Second World War. This article questions whether women's wartime experiences changed their views on being confined to the home. Ultimately, this article argues, women wanted to return to a sense of normality at the end of the war. In the aftermath of defeat, in which mere survival rather than speculation about potentially improved models of the family set-up were paramount, "normality" was most obviously represented by prewar gender roles. Women were hoping for normalization, not only in the public sphere in the sense of a flourishing economy, but also in the private sphere with the return of the men and a resumption of the old role divisions. It was therefore not only conservative politicians who wished to preserve prewar structures within the home - so too did women themselves. The re-emergence of the traditional family model in the wake of the Second World War was thus as much the result of popular aspirations "from below" as of government policies imposed "from above".

Father absence, body mass index, and pubertal timing in girls: differential effects by family income and ethnicity.

PURPOSE: Numerous studies show associations between father absence and girls' early puberty. However, most research has been retrospective, focused on menarche, and failed to consider body mass index (BMI), ethnicity, and income in the analyses. This study resolves these scientific gaps. METHODS: This was a prospective study of 444 girls aged 6-8 years and their caregivers (96% mothers). Data were collected annually in clinic, including weight, height, and Tanner stage for breast and pubic hair. Caregivers reported on father absence and demographics. This report focuses on the assessment of father absence at baseline and 2 years of follow-up for pubertal outcomes. Cox proportional hazards regression models were used to test whether father absence at baseline predicted pubertal onset by follow-up visit 2. BMI was assumed to be in the causal pathway. Differences by ethnicity and income were examined. RESULTS: Income and ethnicity moderated associations between father absence and pubertal onset when adjusting for BMI. Father absence predicted earlier onset of breast development only in higher-income families and onset of pubic hair development only in higher-income African Americans families. BMI was not related to father absence and therefore was not in the causal pathway. CONCLUSION: Among girls from higher-income families, father absence was linked to earlier puberty. This was particularly true for African Americans in terms of pubic hair development. These effects are not explained by body weight. Future research is needed to identify social and biophysiological mechanisms through which father absence, ethnicity, and income affect the pubertal onset.

Unmarried motherhood in twentieth-century England.

This article explores the experiences of unmarried mothers who kept and tried to raise their children between World War One and the end of the twentieth century. It argues that there has not been a simple progression from their experiencing social stigma and ostracism to more enlightened attitudes since the 1970s. Rather there is a great deal that has hitherto been unknown about what the evidence suggests were very diverse experiences and attitudes throughout the period. A major change since the 1970s has been from pervasive secrecy about unmarried motherhood, cohabitation, adultery and similar 'irregular' practices, especially among the middle classes, to greater openness. The article uses a variety of sources, including the records of the National Council for the Unmarried Mother and Her Child (founded in 1918, now One Parent Families), oral histories, contemporary interviews and official and unofficial investigations.