Innovations and Opportunities in Care for Black Mothers and Birthing People.

In recent years, there has been increased attention given to how racism fuels health inequities, including the inadequacy of prenatal care (PNC) that Black women and Black birthing people receive. This increase of attention has brought notable advancements in research, practice, and policy that intend to better understand and address these systemic inequities within the health care system. This review aims to provide an overview of promising developments in the study of Black mothers' and birthing people's experiences in PNC and delivery, to detail current research surrounding interventions to improve quality and mitigate bias in obstetric care, and to offer ways in which legislation can support such strategies targeting the root causes of inequities in care.

The promotive and protective effects of parents' perceived changes during the COVID-19 pandemic on emotional well-being among U.S. households with young children: an investigation of family resilience processes.

Introduction: The COVID-19 pandemic may constitute a traumatic event for families with young children due to its acute onset, the unpredictable and ubiquitous nature, and the highly distressing disruptions it caused in family lives. Despite the prevalent challenges such as material hardships, child care disruptions, and social isolation, some families evinced remarkable resilience in the face of this potentially traumatic event. This study examined domains of changes perceived by parents of young children that were consistent with the post-traumatic growth (PTG) model as factors that facilitate family resilience processes. Methods: This study drew data from the RAPID project, a large ongoing national study that used frequent online surveys to examine the pandemic impact on U.S. households with young children. A subsample of 669 families was leveraged for the current investigation, including 8.07% Black, 9.57% Latino(a), 74.44% non-Latino(a) White families, and 7.92% households of other racial/ethnic backgrounds. In this subsample, 26.36% were below 200% federal poverty level. Results: Approximately half of the parents reported moderate-to-large degrees of changes during the pandemic, and the most prevalent domain of change was appreciation of life, followed by personal strengths, new possibilities, improved relationships, and spiritual growth. Black and Latino(a) parents reported more changes in all five domains than White parents and more spiritual growth than parents of the other racial/ethnic groups. Moreover, parent-reported improved relationships were found to indirectly reduce young children's overall fussiness/defiance and fear/anxiety symptoms through reducing parents' emotional distress. Perceived changes in the new possibilities, personal strengths, and appreciation of life domains were found to serve as protective factors that buffered the indirect impacts of material hardship mean levels on child behavioral symptoms via mitigating parents' emotional distress. Discussion: These findings shed light on resilience processes of a family system in a large-scale, disruptive, and stressful socio-historical event such as the COVID-19 pandemic. The five PTG domains could inform therapeutic and intervention practices in the face of future similar events. Importantly, these findings and the evinced family resilience should not negate the urgent needs of policy and program efforts to address material hardships, financial instabilities, and race/ethnicity-based structural inequalities for families of young children.

Antiracism defined as equitable sociocultural interactions in prekindergarten: Classroom racial composition makes a difference.

This study used secondary data from the My Teaching Partner-Math/Science 2013-2016 randomized control trial to explore whether equitable sociocultural classroom interactions (see Curenton et al., 2019) were associated with the skills of 105 four- and five-year-olds (52% boys; drawn from 20 unique video recordings of preschool teachers/classrooms; 43% were Black, Latine, Asian, or other racially marginalized learners). Equitable interactions predicted children's skills with effect sizes ranging from small (0.01-0.44) to large (1.00). Moderation analyses revealed that when classrooms had more racially marginalized learners, teachers' use of equitable disciplinary and personalized learning practices were associated with higher executive functioning gains across prekindergarten. Findings illustrate how classroom composition can be a key indicator between equitable classroom interactions and young children's early skills.

Examining Economic Risks in Adolescents' Families, Neighborhoods, and Schools: Implications for Mental and Behavioral Health in Early Adulthood.

PURPOSE: This study assessed long-term links among adolescent family, neighborhood, and school economic contexts and mental and behavioral health in early adulthood, irrespective of adult economic contexts. METHODS: Data were drawn from Add Health, following 10,180 participants from adolescence through early adulthood in the United States. Early adults self-reported on their depressive symptoms, perceived psychological stress, and alcohol use disorder. Income at family and school levels was drawn from youth and parent report; neighborhood income was derived from US Census Data. Multilevel models assessed associations between income in adolescence and early adult outcomes 13 years later while accounting for adolescent outcomes and income in early adulthood. Links with depressive symptoms and stress were assessed utilizing ordinary least squares regression; alcohol use disorder was assessed using ordered logistic regression. Nonlinearities in income effects were assessed with quadratic income variables in adolescence and early adulthood. RESULTS: Family income emerged as the most consistent predictor of depressive symptoms (p < .01) and stress (p < .01), showing negative curvilinear associations. In contrast, exposure to higher income schools (p < .01) and neighborhoods (p < .01) during adolescence was associated with heightened risks for alcohol use disorder in early adulthood. These links emerged over and above concurrent negative connections between early adult family and neighborhood economic contexts and depressive symptoms and stress. DISCUSSION: Findings call attention to persistent health-related risks across the income spectrum-not only at the lower end-and also highlight the long-term importance of broader economic contexts beyond the family context.

Development of a multi-component intervention to promote participation of Black and Latinx individuals in biomedical research.

INTRODUCTION: Barriers to research participation by racial and ethnic minority group members are multi-factorial, stem from historical social injustices and occur at participant, research team, and research process levels. The informed consent procedure is a key component of the research process and represents an opportunity to address these barriers. This manuscript describes the development of the Strengthening Translational Research in Diverse Enrollment (STRIDE) intervention, which aims to improve research participation by individuals from underrepresented groups. METHODS: We used a community-engaged approach to develop an integrated, culturally, and literacy-sensitive, multi-component intervention that addresses barriers to research participation during the informed consent process. This approach involved having Community Investigators participate in intervention development activities and using community engagement studios and other methods to get feedback from community members on intervention components. RESULTS: The STRIDE intervention has three components: a simulation-based training program directed toward clinical study research assistants that emphasizes cultural competency and communication skills for assisting in the informed consent process, an electronic consent (eConsent) framework designed to improve health-related research material comprehension and relevance, and a "storytelling" intervention in which prior research participants from diverse backgrounds share their experiences delivered via video vignettes during the consent process. CONCLUSIONS: The community engaged development approach resulted in a multi-component intervention that addresses known barriers to research participation and can be integrated into the consent process of research studies. Results of an ongoing study will determine its effectiveness at increasing diversity among research participants.

Variations in links between educational success and health: Implications for enduring health disparities.

OBJECTIVES: Educational achievement and attainment have been posited to narrow health disparities seen across the socioeconomic spectrum and among racial and ethnic groups. Yet emerging evidence suggests that striving for educational success in contexts of marginalization may actually dysregulate physiological stress processes, thereby exacerbating rather than narrowing health disparities. Utilizing an allostatic load perspective and data drawn from a nationally representative sample, this study sought to clarify these links by attending to potential variation across the socioeconomic spectrum and among racial and ethnic groups. METHOD: Drawing on data from the National Longitudinal Study of Adolescent Health, multilevel regression analyses considered prospective associations between educational achievement and attainment and allostatic load among 12,672 young adults followed from ages 16 to 29 years. Interaction terms considered the potential for variation across the socioeconomic spectrum and among racial/ethnic groups. RESULTS: Findings revealed promotive links between educational attainment and physiological health but also suggested that benefits were not shared by all youth. Although links were consistent across the socioeconomic spectrum, non-Hispanic Black and Mexican American youth experienced reversed links-with educational attainment presaging higher rather than lower levels of allostatic load. CONCLUSION: These results extend this arena of work by highlighting the role that racial and ethnic-rather than socioeconomic-marginality plays in differential links between educational success and physiological health. Additional longitudinal research is necessary to discern the processes and contexts that may link educational success with differential later health among racial and ethnic groups. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Are the Benefits of Economic Resources for Socioemotional Functioning Shared across Racial/Ethnic Groups?

Growth in economic disparities, economic segregation, and racial/ethnic diversity have occurred in tandem in the U.S., leading to essential questions concerning whether the benefits of economic resources are shared across diverse groups. Analyzing a sample of eighth grade early adolescents (age 14 years) drawn from the nationally representative Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999 (N = 7625; 59% White, 12% Black, 19% Hispanic, 7% Asian, 2% Native American, and 2% multiracial; 47% female), lagged regression models assessed links between family, neighborhood, and school income and adolescent emotional and behavioral functioning. The results found that family income was associated with heightened emotional and behavioral functioning, and school income with improved behavioral functioning for White adolescents, whereas no benefits emerged for Black or Hispanic youth. In contrast, mixed associations emerged between income and early adolescent functioning for Asian and American Indian youth, with predominantly negative links appearing for multiracial youth. These patterns highlight diversity in the potential benefits and costs of economic resources, and suggest the need to better specify mechanisms through which economic disparities affect youth from varied backgrounds.

Locating Economic Risks for Adolescent Mental and Behavioral Health: Poverty and Affluence in Families, Neighborhoods, and Schools.

Research has identified risks of both poverty and affluence for adolescents. This study sought to clarify associations between income and youth mental and behavioral health by delineating economic risks derived from family, neighborhood, and school contexts within a nationally representative sample of high school students (N = 13,179, average age 16). Attending schools with more affluent schoolmates was associated with heightened likelihoods of intoxication, drug use, and property crime, but youth at poorer schools reported greater depressive and anxiety symptoms, engagement in violence, and for male adolescents, more frequent violence and intoxication. Neighborhood and family income were far less predictive. Results suggest that adolescent health risks derive from both ends of the economic spectrum, and may be largely driven by school contexts.

Environmental risks outweigh dopaminergic genetic risks for alcohol use and abuse from adolescence through early adulthood.

BACKGROUND: Alcohol use is a primary public health concern, particularly among adolescents and young adults. Based on the rapidly growing field of gene-environment models, this study assessed the combined role of environmental and dopamine-related genetic correlates of early alcohol use and abuse. METHODS: Multilevel growth models assessed trajectories of alcohol use and intoxication and ordered logistic regressions assessed alcohol use disorder among a sample of 12,437 youth from the nationally representative Add Health study who were followed from mid-adolescence through early adulthood. RESULTS: Endogenous and exogenous stressful life events and social norms supportive of alcohol use from parents and peers were significant predictors of alcohol use, intoxication, and alcohol use disorder, with consistent patterns across males and females. In contrast, a dopamine-system genetic risk score (GRS) was not associated with alcohol use trajectories nor alcohol use disorder in early adulthood, although weak connections emerged between the GRS and growth trajectories of intoxication, indicating that higher GRS predicted more frequent episodes of intoxication during the transition to adulthood but not during adolescence or later 20s. No evidence of gene-environment interactions emerged. CONCLUSIONS: Results extend a substantial body of prior research primarily assessing single genetic polymorphisms in the dopamine system, suggesting that dopaminergic GRSs may be associated with more problematic alcohol behaviors at some developmental periods, but further, that social norms and stressful life experiences are more consistent correlates of early and problematic alcohol use among youth. These environmental factors present potential targets for research manipulating contexts to identify causal pathways.

Gender, male-typicality, and social norms predicting adolescent alcohol intoxication and marijuana use.

OBJECTIVE: This study examined the direct and interactive effects of gender, male-typicality, and social norms in predicting the initiation and longitudinal patterns of alcohol intoxication and marijuana use in U.S. youth. METHOD: Data were drawn from a longitudinal survey of 10,588 youth who participated in the in-home survey of the National Longitudinal Study of Adolescent Health (Add Health). Multilevel growth modeling used data from three time points to assess trajectories of substance use from adolescence to young adulthood. RESULTS: Analyses indicated that gender, male-typicality, as well as home availability, friend social norms, and schoolmate social norms predicted initial levels of intoxication and marijuana use, with gender, friend norms, and schoolmate norms also predicting differential rates of growth over time in intoxication and marijuana use. Interaction results indicated that gender moderated male-typicality's relationship to both substance use variables, and home availability's relationship to alcohol intoxication. CONCLUSIONS: These findings extend the literatures regarding interrelations among gender, gender roles, social norms, and health risk behaviors by (a) locating the genesis of those effects in adolescence, (b) identifying gender and social norms to be salient in terms of both initiation and growth of substance use over time, (c) suggesting that gender differences should be understood as moderated by other social-contextual variables, and (d) arguing that prevention efforts should address gender and gender roles more explicitly in programming.

Direct and interactive effects of parent, friend and schoolmate drinking on alcohol use trajectories.

OBJECTIVE: This study considered the unique and interactive roles of social norms from parents, friends and schools in predicting developmental trajectories of adolescent drinking and intoxication. DESIGN AND OUTCOME MEASURES: Using data from the National Longitudinal Study of Adolescent Health, which followed adolescents (N = 18,921) for 13 years, we used discrete mixture modelling to identify unique developmental trajectories of drinking and of intoxication. Next, multilevel multinomial regression models examined the role of alcohol-related social norms from parents, friends and schoolmates in the prediction of youths' trajectory group membership. RESULTS: Results demonstrated that social norms from parents, friends and schoolmates that were favourable towards alcohol use uniquely predicted drinking and intoxication trajectory group membership. Interactions between social norms revealed that schoolmate drinking played an important moderating role, frequently augmenting social norms from parents and friends. The current findings suggest that social norms from multiple sources (parents, friends and schools) work both independently and interactively to predict longitudinal trajectories of adolescent alcohol use. CONCLUSIONS: Results highlight the need to identify and understand social messages from multiple developmental contexts in efforts to reduce adolescent alcohol consumption and alcohol-related risk-taking.

Sexual partner accumulation from adolescence through early adulthood: the role of family, peer, and school social norms.

PURPOSE: An early age of sexual initiation and sexual activity with multiple partners are risk factors for an array of detrimental outcomes. Drawing on social norms theory, this study assessed the role of subjective and descriptive social norms from parents, peers, and schoolmates on trajectories of sexual partner accumulation from early adolescence through early adulthood. METHODS: Data were drawn from the in-home survey sample of Add Health, following 14,797 youth from adolescence through early adulthood. Social norms data were drawn from youth, parent, schoolmate, and school administrator reports. Multi-level growth models assess how parent, peer, and school social norms predicted initial levels and growth in sexual partner accumulation. RESULTS: Parent and peer approval of youth sexual behavior, as well as lower perceived negative repercussions of pregnancy, predicted greater initial levels and greater growth over time in the accumulation of sexual partners. Similarly, youth attending schools with a greater proportion of sexually experienced schoolmates reported higher initial levels of sexual partners. In contrast, greater parental warnings regarding negative consequences of sex predicted heightened sexual partner accumulation. Some moderation by youth gender and age emerged as well. CONCLUSIONS: Results highlight the role of both subjective and descriptive social norms, suggesting the importance of understanding and seeking to influence the social beliefs and expectations of youth and their families.

Low-dose radiotherapy as a chemopotentiator of gemcitabine in tumors of the pancreas or small bowel: a phase I study exploring a new treatment paradigm.

PURPOSE: To determine the maximum tolerated dose of upper abdominal low-dose fractionated radiotherapy (<1.0 Gy per fraction) given in combination with, and as a chemopotentiator for, gemcitabine. METHODS AND MATERIALS: Gemcitabine was given at 1,250 mg/m(2) at 10 mg/m(2)/min on Days 1 and 8 of a 3-week cycle. Low-dose fractionated radiotherapy was tested at two dose levels: 60 cGy per fraction and 70 cGy per fraction. Radiotherapy was given b.i.d. on Days 1, 2, 8, and 9. Four cycles were planned. RESULTS: Twenty-seven patients have been put on study. Ten patients have been entered in Phase I: 6 with metastatic/recurrent pancreatic carcinoma and 4 with unresectable pancreatic/small bowel carcinoma. Two of four patients at Dose Level 2 experienced dose-limiting toxicity. The overall radiographic response was 30%, and median survival was 11 months (range, 4-37 months). CONCLUSION: Low-dose fractionated radiotherapy to the upper abdomen is well tolerated at 60 cGy per fraction when combined with gemcitabine. Phase II evaluation is ongoing.