Self-Advocacy Among Black Women During the Perinatal Period: Prevalence and Relationship to Patient Experiences.

INTRODUCTION: Black women experience many barriers to receiving high-quality maternal healthcare. The ability of Black women to self-advocate may mitigate these threats to their health. Limited research describes Black women's self-advocacy during the perinatal period and how self-advocacy related to other relevant concepts. The aim of this study was to describe the relationship between self-advocacy, patient-provider relationships, and mental health outcomes among Black women in the perinatal period. METHODS: This cross-sectional descriptive pilot study recruited Black women who were either in their 3rd trimester of pregnancy or within a year postpartum to complete surveys describing their self-advocacy (Female Self-Advocacy in Cancer Survivorship Scale adapted for perinatal period) and maternal health outcomes (trust and comfort with maternal healthcare providers-Patient-Provider Relationship Scale; abuse and disrespect during childbirth-Mothers of Respect Index; experiences of discrimination-Experiences of Discrimination scale; depression-Edinburgh Postnatal Depression Scale; and postpartum posttraumatic stress-City Birth Trauma Scale). RESULTS: N = 40 participants were recruited between January and September 2022. Participants reported moderate levels of self-advocacy which were associated with trust and comfort with healthcare providers (r = 0.57-0.76, p < 0.001). Feeling respected by healthcare providers was positively associated with two self-advocacy subscales (r = 0.42-0.44, p < 0.01). Depression was inversely related to all self-advocacy subscales (r = -0.47-0.62, p < 0.001). CONCLUSION: Black women's self-advocacy during the perinatal period is associated with trust and comfort with healthcare providers, perceptions of respect from their providers, and perinatal depression. Future research should focus on promoting trusting, respectful relationships between Black women and their maternal health providers.

Autonomy and Respect in Pregnancy Care for LGBTQIA+ Families: Evaluation of a Home Visiting Program.

The purpose of this program evaluation was to gather information on proportions of LGBTQIA+ individuals and families, their needs, and care experiences in a county health department's home visiting programs for perinatal clients and to make recommendations for improving culturally competent care for LGBTQIA+ individuals and families. In this engaged scholarship partnership, home visiting nurses administered a questionnaire to perinatal clients including demographic information on sexual orientation and gender identity. Differences between LBGTQIA+ identifying individuals' perception of the perinatal care received and those of heterosexual, cisgender individuals were assessed. On the basis of these data, 10% of the 52 respondents identified as LGBTQIA+ and 4% identified with a gender other than "woman." Clients who identified as straight had similar mean scores to those who listed an LGBTQIA+ sexual orientation. Clients who chose a gender identity other than "woman" had scores that fell within the 50th to 75th percentile of the overall mean. Qualitative interviews with 2 respondents provided additional in-depth information on their experiences. Overall, clients served by these perinatal programs reported similar diversity in terms of gender identity and sexual orientation as compared with national averages. This project provided evidence of the diversity among the clientele served by this agency and the importance of expanding the focus on inclusionary language and practices.

Pregnancy weight gain in twin gestations and maternal and child health outcomes at 5 years.

OBJECTIVE: Current guidelines for maternal weight gain in twin pregnancy were established in the absence of evidence on its longer-term consequences for maternal and child health. We evaluated the association between weight gain in twin pregnancies and the risk of excess maternal postpartum weight increase, childhood obesity, and child cognitive ability. METHODS: We used 5-year follow-up data from 1000 twins born to 450 mothers in the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative U.S. cohort of births in 2001. Pregnancy weight gain was standardized into gestational age- and prepregnancy body mass index (BMI)-specific z-scores. Excess postpartum weight increase was defined as ≥10 kg increase from prepregnancy weight. We defined child overweight/obesity as BMI ≥ 85th percentile, and low reading and math achievement as scores one standard deviation below the mean. We used survey-weighted multivariable modified Poisson models with a log link to relate gestational weight gain z-score with each outcome. RESULTS: Excess postpartum weight increase occurred in 40% of mothers. Approximately 28% of twins were affected by overweight/obesity, and 16 and 14% had low reading and low math scores. There was a positive linear relationship between pregnancy weight gain and both excess postpartum weight increase and childhood overweight/obesity. Compared with a gestational weight gain z-score 0 SD (equivalent to 20 kg at 37 weeks gestation), a weight gain z-score of +1 SD (27 kg) was associated with 6.3 (0.71, 12) cases of excess weight increase per 1000 women and 4.5 (0.81, 8.2) excess cases of child overweight/obesity per 100 twins. Gestational weight gain was not related to kindergarten academic readiness. CONCLUSIONS: The high prevalence of excess postpartum weight increase and childhood overweight/obesity within the recommended ranges of gestational weight gain for twin pregnancies suggests that these guidelines could be inadvertently contributing to longer-term maternal and child obesity.

Citizenship and health insurance status predict glycemic management: NHANES data 2007-2016.

The prevalence of diabetes in United States (US) immigrants is higher than the general population. Non-citizenship and lack of health insurance have been associated with increased health risks including diabetes, but previous US studies were done in non-representative samples and did not examine the effect on glycemic management. The purpose of this study was to compare demographic, metabolic, and behavioral risk factors for increased blood glucose including citizenship and health insurance status, and determine predictors of poor glycemic management (A1C ≥ 8.0%). Logistic regression was used to analyze data from the 2007-2016 National Health and Nutrition Examination Surveys (NHANES) of persons with diabetes and available citizenship data ages 30 to 70 years (N = 2702), excluding persons with A1C < 5% and pregnant women. Results represent the weighted sample. Among participants, 92% indicated citizenship by birth (81%) or naturalization (11%). Insured rates increased from 83% to 91% between 2007 and 2008 and 2015-2016 (p < .001). Citizenship was positively associated with insurance status, higher income and education, better diet, increased smoking, and more sedentary hours (ps < .05). Non- citizens (OR: 1.74, 95% CI: 1.20-2.51) and uninsured persons (OR: 1.99, 95% CI: 1.53-2.59) were nearly twice as likely to have poor glycemic management than US citizens by naturalization and insured individuals respectively. We conclude that citizenship and absence of health insurance negatively impacts diabetes management. Policy decisions are needed that address primary and secondary prevention strategies for individuals without citizenship and health insurance to reduce diabetes burden in the US.

Pregnancy Weight Gain by Gestational Age in Women with Uncomplicated Dichorionic Twin Pregnancies.

BACKGROUND: Twin pregnancies are at increased risk for adverse outcomes and are associated with greater gestational weight gain compared to singleton pregnancies. Studies that disentangle the relationship between gestational duration, weight gain and adverse outcomes are needed to inform weight gain guidelines. We created charts of the mean, standard deviation and select percentiles of maternal weight gain-for-gestational age in twin pregnancies and compared them to singleton curves. METHODS: We abstracted serial prenatal weight measurements of women delivering uncomplicated twin pregnancies at Magee-Womens Hospital (Pittsburgh, PA, 1998-2013) and merged them with the hospital's perinatal database. Hierarchical linear regression was used to express pregnancy weight gain as a smoothed function of gestational age according to pre-pregnancy BMI category. Charts of week- and day-specific values for the mean, standard deviation, and percentiles of maternal weight gain were created. RESULTS: Prenatal weight measurements (median: 11 [interquartile range: 9, 13] per woman) were available for 1109 women (573 normal weight, 287 overweight, and 249 obese). The slope of weight gain was most pronounced in normal weight women and flattened with increasing pre-pregnancy BMI (e.g. 50th percentiles of 6.8, 5.7, and 3.6 kg at 20 weeks and 19.8, 18.1, and 14.4 at 37 weeks in normal weight, overweight, and obese women, respectively). Weight gain patterns in twins diverged from singletons after 17-19 weeks. CONCLUSIONS: Our charts provide a tool for the classification of maternal weight gain in twin pregnancies. Future work is needed to identify the range of weight gain associated with optimal pregnancy health outcomes.

Promoting Healthy Eating Among African-American School-Aged Girls in a Community Setting.

The prevention of obesity is vital to the health of American children. In the urban African-American community, the health of school-aged children is in particular jeopardy due to the high prevalence of obesity, type 2 diabetes, and poor dietary choices such as the purchase of sugary drinks, salty snacks, low consumption of fresh fruits and vegetables, and reliance on fast food meals. African-American girls are at a higher risk for obesity and early puberty before age 10, placing them at a greater risk for diabetes and cardiovascular disease in adulthood. Our current "Cooking with Kids" program in a local grocery store has allowed us to promote healthy eating behavior in a unique way; teaching 6 through 11-year-olds how to prepare easy healthy breakfasts, lunches, and snack food recipes at a local grocery store while their mothers shopped.

Exploring the need for interventions to manage weight and stress during interconception.

Interventions to manage weight and stress during the interconception period (i.e., time immediately following childbirth to subsequent pregnancy) are needed to promote optimal maternal and infant health outcomes. To address this gap, we summarize the current state of knowledge, critically evaluate the research focused on weight and stress management during the interconception period, and provide future recommendations for research in this area. Evidence supports the importance of weight and stress management during the reproductive years and the impact of weight on maternal and child health outcomes. However, evidence-based treatment models that address postpartum weight loss and manage maternal stress during the interconception period are lacking. This problem is further compounded by inconsistent definitions and measurements of stress. Recommendations for future research include interventions that address weight and stress tailored for women in the interconception period, interventions that address healthcare providers' understanding of the significance of weight and stress management during interconception, and long-term follow-up studies that focus on the public health implications of weight and stress management during interconception. Addressing obesity and stress during the interconception period via a reproductive lens will be a starting point for women and their families to live long and healthy lives.

Understanding How Overweight and Obese Emerging Adults Make Lifestyle Choices.

To better understand health-related decision making among overweight and obese emerging adults. DESIGN AND METHODS: A cross-sectional design was used in the parent study involving overweight and obese emerging adults, ages 18-29 years. The goal of the parent study was to screen participants' diabetes risk and identify characteristics of emerging adults with prediabetes (N=107). A sub-sample of respondents (n=34) from the parent study were invited to participate in focus group interviews depending on whether they had prediabetes (three groups) or they did not have prediabetes (four groups). Each focus group interview lasted 90-120 minutes following a semi-structured interview guide. Conventional content analysis was used in the data analysis. Because of the similarities between participants with and without prediabetes, the findings were synthesized and reported in the aggregate. Moreover, during the analysis, the authors decided that rational choice theory provided a useful organizing structure for presenting the data. RESULTS: Emerging adults' behavioral decisions were rational reactions to their personal competence, perception of health, environment, and availability of resources to handle problems. Calculation of trade-offs and estimations of resource availability were often used when making decisions. CONCLUSIONS: Emerging adults choose unhealthy behaviors due to inaccurate information and insufficient competence to practice healthy lifestyles rather than because of laziness or being irrational. PRACTICE IMPLICATIONS: Behavioral interventions for emerging adults need to help them develop skills to enhance health literacy and problem solving, thereby enhancing their awareness of available resources and decreasing the perceived cost of making healthy choices.

Temperament disturbances measured in infancy progress to substance use disorder 20 years later.

OBJECTIVE: This prospective study determined whether temperament before two years of age predicts transmissible risk for substance use disorder (SUD) up to a decade later and SUD outcome in adulthood. METHOD: Boys between 10 and 12 years of age (N = 482) were tracked to age 22. The previously validated transmissible liability index (TLI) was administered at baseline, and temperament prior to two years of age was retrospectively rated. The Structured Clinical Interview for DSM-III-R (SCID) was administered to document presence/absence of SUD for parents at baseline and sons at age 22. RESULTS: Path analysis revealed that number of parents with SUD predicted severity of temperament disturbance in their sons which in turn predicted TLI score at age 10-12, presaging SUD. Temperament before age two did not predict SUD at age 22. The association between number of SUD parents and transmissible risk was mediated by severity of temperament disturbance. CONCLUSION: Temperament disturbance in early childhood, reflecting quality of behavioral and emotion regulation, comprise psychological antecedents of transmissible risk for SUD.

Preventive strategies to reduce depressive symptoms in overweight and obese young adults.

This study examined the relationships among problem-solving, physical activity self-efficacy, leisure-time physical activity, and depressive symptoms in overweight/obese young adults vulnerable to many health risks. Data from 96 young adults were used. The mean age and body mass index were 24.0±3.3 years old, and 36.9±7.9, respectively. There was a positive association between physical activity self-efficacy and leisure-time physical activity in African Americans, but not in non-African Americans. Better problem solving was associated with fewer depressive symptoms regardless of gender and race.

Comparing Online with Face-to-Face HELPP Intervention in Women Experiencing Intimate Partner Violence.

Intimate partner violence (IPV) is a public health problem. The purpose of this study was to compare the effectiveness of the HELPP (Health, Education on Safety, and Legal Support and Resources in IPV Participant Preferred) intervention among IPV survivors. A sequential, transformative mixed-methods design was used. Participants were randomly assigned to one of three study groups: Online (ONL), Face-to-Face (FTF), and Waitlist Control (WLC). The HELPP intervention was offered to 32 adult female participants who were 45.2% Asian, 32.3% White, and 22.5% Black. Outcome measures were anxiety, depression, anger, personal, and social support. In total, 64% (n  =  20) of the participants reported having experienced IPV before the age of 18. The anger mean score pre-test to post-test difference was significant for ONL (p < 0.001) and WLC (p  =  0.01). The personal and social support pre-test to post-test mean score differences were significant for ONL (p < 0.001; p < 0.001) and WLC (p  =  0.01; p  =  0.006), respectively. The HELPP intervention (1) decreased anxiety, depression, anger, and (2) increased personal and social support in the ONL group. The HELPP information and intervention was shown to be feasible, acceptable, and effective among IPV survivors compared with participants in the WLC group. The WLC participants displayed (1) increased levels of anxiety, depression, and anger and (2) decreased levels of personal and social support, post-intervention. Further research could be conducted to determine if e-mail alone or e-mail plus mobile devices are more useful modes of delivering interventions.

A Qualitative Exploration of Self-Advocacy Experiences of Black Women in the Perinatal Period: Who Is Listening?

INTRODUCTION: Black women face poor maternal health outcomes including being over 3 times more likely to die from pregnancy complications than White women. Yet the lived experience of how these women self-advocate has not been clearly explored. The goal of this cross-sectional qualitative study was to describe the lived experiences of Black women advocating for their needs and priorities during the perinatal period. METHODS: Between January and October of 2022, we recruited Black women from obstetric clinics, research registries, and community advocacy groups who were either in their third trimester of pregnancy or within a year postpartum. Participants completed one-on-one interviews describing their experiences of self-advocacy. These data were analyzed using descriptive content analysis approaches that summarized women's experiences by iteratively creating major themes and subthemes that encapsulate their self-advocacy descriptions. RESULTS: Fifteen Black women completed interviews. Major themes and subthemes describing women's experience of self-advocacy were the following: (1) carrying a burden with subthemes of having to be good and easy, not trusting health care information and providers, and being dismissed; (2) building comfort with health care providers with subthemes of trusting I have a good provider, comfort in knowing they understand, and wanting low-touch, high-concern care; and (3) advocating for my child and myself when I need to with subthemes of going with the flow, becoming informed, pushing to ask questions, and balancing being proactive and pushy. DISCUSSION: Women reported self-advocating mainly due to experiences related to the burdens associated with not trusting providers and health care information. These findings provide clarity to how women carefully balance between ensuring their health is taken seriously while not jeopardizing their health or that of their newborn. This study offers promising directions to support Black women in advocating for their perinatal health care needs and values.

Confirming the factor structure of the alcohol and alcohol problems questionnaire (AAPPQ) in a sample of baccalaureate nursing students.

The Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ) is a multi-dimensional measure of clinicians' attitudes toward working with patients with alcohol problems. In the past 35 years, five- and six-subscale versions and a short version of the AAPPQ have been published. While the reliability of the AAPPQ subscales has remained acceptable, the factor structure has not been verified using confirmatory techniques. In the current study, we split a sample of 299 baccalaureate nursing students to use exploratory (EFA) and confirmatory factor analyses (CFA). When compared to the original six-factor solution and an imposed six-factor structure in CFA, the EFA seven-factor solution with three original items (19, 20, and 25) removed had the best model fit.

Effects of Screening, Brief Intervention, and Referral to Treatment (SBIRT) education and training on nursing students' attitudes toward working with patients who use alcohol and drugs.

BACKGROUND: Screening, Brief Intervention, and Referral to Treatment (SBIRT) can reduce alcohol use and negative health outcomes in patients with risky substance use. However, negative attitudes that some health care professionals have toward patients who use substances are a barrier to implementing SBIRT. METHODS: The University of Pittsburgh School of Nursing, in partnership with the Institute for Research, Education, and Training in Addictions (IRETA), developed a curriculum to train baccalaureate student nurses to deliver SBIRT. RESULTS: Following SBIRT education and training, students' perceived attitudes toward patients who use alcohol became more positive. Less robust changes were found for attitudes related to patients who use drugs. CONCLUSIONS: Nurses composing the largest group of healthcare workers are in key positions to screen, intervene, and provide education about substance use.

Stakeholders Inform an LGBTQIA+ Health Best Practices Learning Module for Nursing Students.

INTRODUCTION: The American Association of Colleges of Nursing (AACN) summons nurse educators to address health care inequities by preparing leaders who advocate for vulnerable groups. A lack of academic guidelines promoting cultural competence in nursing with lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, and asexual and/or aromantic (LGBTQIA+) individuals exist. The purpose of this study was to develop a learning module for health care providers about best practices in LGBTQIA+ health informed by key stakeholders. METHODS: Exploratory qualitative design utilized focus group methodology obtaining stakeholder's views on LGBTQIA+ health, with a convenience sample recruited from a large public university. Focus group thematic analysis informed development of the learning module. RESULTS: Three overarching themes emerged from focus group discussions (n = 31): appropriate terminology, health disparities, and respectful communication. DISCUSSION: This project addresses an educational gap in nursing curriculum using an interactive online module, introducing key concepts about LGBTQIA+ health. Future research focused on the development of standards of care for LGBTQIA+ individuals can support inclusion and reduce discrimination in health care settings.

Exploring Cultural Factors of Human Papillomavirus Vaccination Acceptance in African Americans: An Integrative Review.

INTRODUCTION: Human papillomavirus (HPV) vaccine can prevent HPV-related cancers. However, African Americans (AA) have a 30% higher incidence of HPV-related cervical cancer than Whites. The purpose of this integrative review is to explore cultural factors and beliefs impacting HPV vaccine decisions in AA adults. METHODOLOGY: The Whittemore & Knafl model guided this review. Databases searched were PubMed, CINAHL, and Embase. Key terms included "human papillomavirus," "vaccine," "cultural values," "African American," and "adult." Inclusion criteria were AAs aged 18 years and over living in the United States. RESULTS: A total of 634 articles were identified, and 20 studies published from 2010 to 2020 were used. Common factors influencing HPV vaccine decisions included religion, knowledge, physician recommendation, social network, attitudes, mistrust, benefits, and safety. DISCUSSION: Limitations included omission of articles lacking AA representation, limited databases searched, and one-author-evaluated studies. Future studies to discover additional cultural factors influencing HPV vaccine acceptance are critical.

Testing the theory of reasoned action in explaining sexual behavior among African American young teen girls.

This study tested the Theory of Reasoned Action to examine the prediction of early sexual behavior among African American young teen girls. Baseline data from a longitudinal randomized clinical trial were used. Between 2001 and 2005, 198 middle-school girls aged 11 to 14 years were recruited. As girls aged, they held more permissive attitudes toward engaging in early sexual behavior and had a higher intention to engage in early sexual behavior. Intention was a significant predictor to explain sexual behavior among the girls. There is a need to develop strategies that promote intention related to delay and prevention of early sexual behavior.

Preconception Care to Reduce the Risks of Overweight and Obesity in Women of Reproductive Age: An Integrative Review.

Despite adverse pregnancy outcomes for women with overweight or obesity, preconception guidelines for achieving optimal wellness for women contemplating pregnancy regarding the risks of overweight or obesity are varied based upon national affiliation. The aim of this study was to synthesize the best evidence related to preconception counseling and care focused on overweight or obesity provided to women of reproductive age. An integrative review of original studies was conducted. PubMed, Cumulative Index in Nursing and Allied Health Literature, Ovid, Scopus, Web of Science, and Embase were included. Full-text, data-based articles were searched from 2009 to 2018, with reviews and synthesis completed in 2019 and 2020. Of 8703 initial articles, 31 articles remained in the review. Quality assessment and level of evidence were evaluated based upon criteria from the Joanna Briggs Institute and the Johns Hopkins Nursing Evidence-Based Practice Quality Guide. The level of evidence for the majority of studies was non-experimental but they were of good quality with appropriate methods, samples and relevant results. Limited attention and interest in preconception counseling regarding risks of overweight or obesity by health care professionals were noted, which may contribute to women's unawareness of these risks on preconception health.

Client-Centered Breastfeeding-Promotion Strategies: Q Methodology.

Fewer Korean women are choosing the 6 months of exclusive breastfeeding that are recommended for obtaining its maximal benefits despite an increasing effort to promote breastfeeding. Successful breastfeeding education and counseling need to be segmentally designed on the basis of client characteristics. This study explored the perceptions of breastfeeding in pregnant and 6 month postpartum Korean women using the Q methodology, a useful research approach to examine personal perceptions, feelings, and values about a concept or phenomenon of interest and identify typologies of perspectives. The Q sample consisted of 38 statements representing the universe of viewpoints on breastfeeding. The P sample (N = 49) included women who shared their perceptions of breastfeeding and filled each grid with a statement in the Q sorting table. Data were analyzed using the PC-QUANL program. Varimax (orthogonal) rotation revealed four factors that explained 53.0% of variance: maternal privilege (Factor 1), option based on emotion (Factor 2), option if efficient (Factor 3), and option if I have sufficient problem-solving skills (Factor 4). Korean women have changed their attitudes toward breastfeeding, with all participants viewing breastfeeding as optional. Breastfeeding-promotion campaigns and education need to consider societal norms and changes in women's beliefs and perceptions.