Coates, Erica (UMD SPH Family Science)
Tran, Quynh (USF CAS Psychology)
Phares, Vicky (USF CAS Psychology)
Background: The majority of Black youth live in a single-mother household (SMH) at some point during childhood (The Annie E. Casey Foundation, 2015). Children who spend part of their childhood living in SMHs are at greater risk for adverse psychosocial outcomes compared to those who live continuously in two-parent households (Langton & Berger, 2011). Although the majority of resilience studies have investigated the protective roles of maternal positive parenting, maternal well-being, mother-child relationships, and coparent relationship quality, a burgeoning literature suggests the positive influence that noncustodial father attributes and father-child relationships have on children’s psychosocial outcomes (e.g., Harper & Fine, 2006).
Goal: Guided by the Coparenting Framework for African American Single-Mother Families (Jones et al., 2007), we examined the protective role of nonresidential fathers in the psychosocial adjustment of Black adolescents from SMHs.
Objectives: We expected 1) higher paternal warmth, lower depressive symptoms, and better father-child relationship quality would be uniquely related to adolescents’ lower externalizing and internalizing behaviors above and beyond maternal warmth, depressive symptoms, and mother-child relationship quality, and 2) coparenting relationship quality would mediate the relation between father factors and adolescent psychosocial functioning in that fathers who have lower depressive symptoms, higher warmth, and better father-child relationships would in turn have better coparenting relationships that would be related to more favorable youth outcomes.
Approach: Participants included 107 noncohabiting Black parental dyads aged 27 to 68 years with children aged 12 to 18 years. Participants completed a telephone survey including demographic questions and measures of positive parenting, parent-child relationship quality, depressive symptoms, coparenting relationship quality, and adolescents’ emotional and behavioral functioning.
Results: Results of hierarchical multiple regressions controlling for father-child contact, economic hardships, and maternal factors, found that father factors contributed unique variance to father-reported adolescent internalizing problems, Fchange(3, 98)=7.28, p<.001, ∆R2=.17 and father-reported adolescent externalizing problems, Fchange(3, 98)=5.63, p=.001, ∆R2=.13. Path analysis showed that coparenting relationship quality mediated the relation between father-child relationship quality and mother-reported adolescent externalizing behaviors (β=-.30, p=.009; 95% CI [0.129–0.595]).
Importance to public health: This study highlights the unique contributions of nonresidential Black father factors to adolescent mental health outcomes.
McClure, Erin (SPH)
Stephanie, Cork (SPH)
Background: Lactation/feeding spaces on university campuses are a necessary facility to support the health and wellness of the community. To assess the accessibility of current facilities as well as need and usage patterns at the University of Maryland we have created a survey that will be disseminated Spring 2018. The findings of this survey will direct a current project that looks to assess and improve current facilities at on campus and promote the three pillars of public health: preventing disease and injury, promoting health and wellness, with the goal of prolonging life with the highest of qualities.
Goal: Using data collection via survey to assess need/awareness, obtain feedback on existing facilities that support nursing parents, and increase awareness so that current designated lactation/feeding spaces can be improved and opportunities for new facilities and educational programming can be identified and implemented via supported by a grant to the President’s Commission on Women’s Issues (PCWI) in collaboration with the UMD School of Public Health (SPH).
Objectives: 1). Assessing Facilities to assess need/awareness of lactation feeding spaces. 2). Improving Facilities to promote healthy feeding behaviors on campus (this includes accessibility to disabled and LGBTQ+ populations) 3). Educating Campus & Increasing Awareness about the current facilities and working with parent(s) to offer spaces conducive to comfortable and safe feeding practices and lactation facilities.
Approach: -Survey to entire campus disseminated through the University’s Human Resource Office (UHR) to assess the current need/awareness of lactation/feeding space. -Assessment of current physical spaces in collaboration with the PCWI and SPH and in partnership with the University Health Center, the Business School and Facilities Management. -Improvement of current UMD lactation/feeding spaces. Construction of new lactation/feeding spaces, so there are more “lactation friendly” facilities for all community members across campus.
Importance to public health: Providing a “lactation friendly” campus with designated environmentally friendly lactation/feeding spaces for students, staff, faculty, alumni and visitors and providing designated healthy lactation/feeding spaces decreases barriers to expressing milk/breastfeeding and increases health benefits, both short and long-term, to infants and feeding parent(s). The American Public Health Association recognizes breastfeeding as a public health issue and an important preventive health measure.
Covington, Lauren (UMB SON)
Rogers, Valerie (UMB SON)
Background: Sleep plays an important role in children’s physical growth, behavior and emotional development. The National Sleep Foundation recommends that toddlers get between 11-14 hours of sleep per 24 hours, and go to bed no later than 9 pm. Given the important role sleep plays in toddler development, it is imperative that sleep assessment is accurate.
Goal: The purpose of this study was to explore toddler sleep in an urban, low-income, minority population using sleep diaries and actigraphy (watch size device that measures movement and light), and to compare these measures.
Objectives: We hypothesized that this sample would not meet the National Sleep Foundation Recommendations and that there would be limited agreement between sleep diaries and actigraphy.
Approach: A convenience sample of mother-toddler dyads were recruited and an actigraph was placed on the toddler’s ankle and worn consecutively for 3 days. A sleep diary was completed simultaneously. Bedtime, nighttime sleep duration, number of naps, nap duration and 24-hour sleep duration were collected.
Results: Twenty toddlers were included in sleep analyses. Nearly all (95%) mothers/toddlers identified as African American, and 95% had public or no health insurance. Mothers were a mean age of 25.8 years (SD=5.0), 89.5% were not married and over half (52%) had a high school education or less. Per actigraphy data, only one toddler went to bed before 9 pm on all 3 nights. Six participants received at least 11 hours of sleep in a 24-hour period, for one of the 3 study days, but when sleep was averaged across the study, none achieved this goal. Compared to actigraphy, toddler bedtimes recorded in sleep diaries underestimated bedtime by an hour, overestimated nighttime sleep duration by 2.5 hours, and overestimated 24-hour sleep duration by 2.25 hours, on average for all 3 nights.
Importance to public health: The majority of toddlers had inconsistent bed times and inadequate sleep duration. These findings are concerning given the important role that sleep plays in child health and development.
Drew, Laura (UMD SPH Family Science)
Grantz, Katherine (National Institute of Child Health and Human Development)
Thoma, Marie (UMD SPH Family Science)
Background: Little research has considered the association between macrosomia and neonatal morbidities at the national level and how maternal diabetes may alter this relationship. Using revised U.S. birth certificate data, we examined the association between macrosomia and neonatal morbidities overall and by diabetes status.
Goal: To identify the association between macrosomia and neonatal morbidities overall and by mother's diabetes status using near national level data.
Objectives: Identify the relationship between macrosomia (birthweight of 4000 grams or more) and the following neonatal morbidities: Apgar score < 7, NICU admission, and immediate assisted ventilation, using US birth certificate data. Assess whether or not these relationships vary by mother's diabetes status (none, pre-pregnancy, or gestational).
Approach: We used 2014-2016 U.S. birth certificate data restricted to singleton, first-born, full/post-term (> 39 weeks gestation) infants with birthweights >= 2500g. We compared macrosomia (4000-4499g; 4500-4999g; and >= 5000g) to normosomic (2500-3999g) birthweight categories by the following outcomes: Apgar <7, NICU admission, and immediate assisted ventilation following delivery. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusted for gestational age, infant sex, as well as maternal demographic and health characteristics. Models were then stratified by diabetes status during pregnancy (none, pre-pregnancy, and gestational).
Results: After adjustment, increasing categories of macrosomia were significantly associated with increased odds of Apgar <7, NICU admission, and immediate assisted ventilation compared to normosomic births. Odds ratios for infants >= 5000g were 1.53 (CI: 1.21-1.94), 2.56 (CI: 2.28-2.88), and 1.33 (CI: 1.10-1.60), respectively. The magnitude of the association between birthweight >= 5000g and NICU admission differed for mothers with pre-pregnancy (OR: 4.96) or gestational diabetes (OR: 2.77) compared to without (OR: 2.40).
Importance to public health: The odds of neonatal morbidities increased with increasing levels of macrosomia and among women with pre- or gestational diabetes, suggesting diabetes may alter this relationship. Future research should explore potentially modifiable risk factors for excessive birthweight to prevent these related neonatal morbidities.
Gayfield, Asiah (UMD)
Cohen, Philip (UMD)
Background: Although, the overall rate of infant mortality in the United States has declined for all races in the past ten years, Black mothers are still more likely than White mothers to experience the death of an infant. Past research has found that Black mothers initiate and continue prenatal care at lower rates than their White counterparts, however there exists very little research examining how prenatal care usage varies by socioeconomic status within racial groups and how this variation effects the relationship between maternal race and infant mortality.
Goal: This paper investigates variation in prenatal care utilization within racial groups and across socioeconomic statuses, and the effect that prenatal care has on the relationship between race, SES, and infant mortality.
Objectives: This study has three specific aims: 1. Determining if there is a difference between the prenatal care initiation and continuation rates of black women of different socioeconomic statuses. 2. Comparing the prenatal care initiation and continuation behavior of black women to white and Hispanic women of similar socioeconomic statuses. 3. Examining the moderating effect that receiving prenatal care may have on the relationship between race, socioeconomic status, and birth outcomes.
Approach: This study used the Linked Birth/Infant Death Public Use File from the Centers for Disease Control and Prevention (CDC), to model the effect that maternal education and prenatal care has on the relationship between maternal race and infant mortality.
Results: Results indicate that the probability of infant death decreases as maternal education and prenatal care increases, but the effect is not as strong for Black mothers as it is for White and Hispanic mothers.
Importance to public health: This study fills a necessary gap in knowledge regarding prenatal care utilization habits of women who exist at different intersections of race and socioeconomic status.
Gleason, Jessica (University of Maryland School of Public Health)
Shenassa, Edmond (University of Maryland School of Public Health)
Thoma, Marie (University of Maryland School of Public Health)
Background: Infertility is increasingly a public health issue, with emerging links to health conditions including cancer, diabetes, and cardiovascular disease. Existing literature on infertility primarily focuses on known causes, such as polycystic ovarian syndrome and endometriosis, which likely excludes a substantial number of women, for whom there is no known cause or formal diagnosis.
Goal: The goal of this project was to explore potential associations between infertility and both cardiovascular dysfunction and metabolic syndrome, a long-term predictor of cardiovascular disease.
Objectives: Using a nationally-representative sample, compare the prevalence of metabolic syndrome and cardiovascular dysfunction between women who report ever experiencing infertility, and those who do not.
Approach: We examined the association between self-reported infertility (i.e., ever experiencing inability to conceive after 12 months of trying to become pregnant) and metabolic syndrome and cardiovascular events among US women, aged 20-59, (National Health and Nutrition Examination Survey 2013-2014). Odds ratios were calculated using multivariate logistic regression, adjusting for demographic, behavioral, and lifestyle factors in separate models.
Results: Compared to women who have never experienced infertility, women who reported infertility were 1.52 (99% CI 1.52, 1.52) times more likely to report symptoms of metabolic syndrome and 1.69 (99% CI 1.68, 1.70) times more likely to have experienced a cardiovascular event (i.e., congestive heart failure, coronary heart disease, heart attack, or stroke). Furthermore, women with self-reported infertility were 50% more likely to report a cardiovascular event after controlling for metabolic syndrome (99% CI 1.49, 1.50).
Importance to public health: Our results indicate that the experience of infertility at any point in a woman’s reproductive window is associated with subclinical and clinical cardiovascular dysfunction in the general population.
Horowitz, Alice (UMD)
Maybury, Catherine (UMD)
Wang, Min Qi (UMD)
Battani, Katy (MDH)
Background: Women, infant and Children (WIC) personnel see the majority of pregnant women in the US. Low-income women have poorer oral health compared with privately insured counterparts and they do not know that poor oral health affects their overall health, the health of their baby and they can transmit dental caries causing bacteria (tooth decay) to their child.
Goal: Improve the oral health of low-income pregnant women and their children
Objectives: 1. Understand Maryland WIC personnel's perspectives on factors that support or prevent low income pregnant women receiving prenatal dental care. 2. Assess WIC personnel's knowledge and understanding of preventing dental caries.
Approach: We sent an email to all Maryland WIC program directors (n=18) requesting they forward it to their staff members. The email described the purpose of the survey and contained an anonymous link to the survey. Fourteen program directors responded and 13 forwarded the survey to their staff (n=173). Of the 187 potential respondents, 130 completed the survey.
Results: The response rate was 69.5%. A majority of respondents had either a college degree (56.7%) or a graduate degree (12.7%). Almost three-quarters (73.9%) had been in their position for more than 3 years. The primary barriers to prenatal dental care were: cost (81.8%); transportation (61.4%); client didn't think their problem was serious enough (58.6%); and lack of dentists who are available/accept Medicaid (51.5%). Ninety-nine percent of respondents reported they had heard of fluoride and 82% knew fluoride prevents caries. Although 71.6% reported teaching clients about drinking fluoridated tap water, only 2.3% recognized the best way to prevent tooth decay is consuming fluoridated tap water. Almost all responded they were very (64.3%) or somewhat concerned (33.3%) about pregnant women in their program getting dental treatment.
Importance to public health: WIC personnel see the majority of pregnant women in the US; they can be extremely influential in educating their clients about the importance and safety of dental care during pregnancy and how to rear cavity free children. Thus, WIC personnel must have accurate knowledge and understanding about caries prevention.
Lama, Yuki (UMD SPH Family Science)
Thoma, Marie (UMD SPH Family Science)
Background: Interconception care is a critical opportunity for health promotion efforts to reduce maternal health risks. Short interpregnancy intervals (IPI) have been associated with adverse infant health outcomes in several studies.
Goal: Our goal was to expand on the limited research on IPI's relationship to maternal health outcomes, including health-promoting behaviors such as early initiation of prenatal care (PNC).
Objectives: Therefore, the objective of this study was to examine the association between IPI and delayed PNC initiation.
Approach: Data are based on births from reporting areas that implemented the 2003 revised U.S. birth certificate in 2015 (97% of all resident births). Our sample consisted of singleton, second-born or higher births (n=2,180,755). Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) of IPI and delayed PNC initiation (i.e., 2nd or 3rd trimester or no prenatal care), adjusting for relevant sociodemographic and health characteristics.
Results: Shorter IPIs were associated with delayed PNC initiation, which decreased monotonically with increasing IPI length. Approximately 28% of singleton, second-born or higher births were conceived < 18 months from the previous live birth. Our adjusted model showed a decrease in the odds of delayed PNC with increasing time between pregnancies: < 6 months [OR: 1.92, 95% CI: 1.89-1.95]; 6-11 months [OR: 1.51, 95% CI: 1.49-1.52]; 12-17 months [OR: 1.25, 95% CI: 1.23-1.26] compared 18-59 months.
Importance to public health: Further research is needed to address whether interconception health promotion to optimize birth spacing, such as postpartum contraception and counseling, could translate to earlier PNC initiation and other maternal health-promoting behaviors for subsequent births.
Pantaleao, Ashley (UMD SPH Family Science)
Young, Jennifer (UMD SPH Family Science)
Background: Li-Fraumeni Syndrome (LFS) is a hereditary cancer predisposition syndrome mostly caused by germline TP53 mutations. Individuals with LFS have a 90% lifetime risk of developing cancer and a 50% chance of a second, independent primary cancer. Onset of cancer risk is in childhood, creating unique psychosocial challenges for parents and their affected children compared with adult-onset inherited cancer syndromes.
Goal: This work sought to explore how families create and communicate meaning about living with and managing LFS-related cancer risk.
Objectives: How do family members seek methods to cope with cancer and their mutation status based on the meaning and threat they associate with it?
Approach: Semi-structured interviews were conducted with 26 families enrolled in the National Cancer Institute’s LFS Study. Families consisted of parents and their children with at least one family member being a TP53 mutation carrier. Using grounded theory methods, three independent investigators completed independent coding of the transcribed interview data.
Results: The sample consisted primarily of mothers interviewed with one child. Family members discussed shared experiences, and characteristics of self and family that were shaped by their history and risk of LFS-associated cancer. Parents and children discussed daily practices used to cope with LFS, and emphasized family networks as a major emotional support system. They reported that illness-related family coping styles may be prioritized over individual wishes. Parents described the importance of maintaining typical day-to-day routines while also addressing LFS screening and management.
Importance to public health: These findings provide insight into the coping processes families utilize collectively or individually to manage their varying levels of LFS-related distress. Healthcare providers attuned to family dynamics and coping strategies may be better able to meet their patients’ needs based on how LFS can impact the whole family’s psychosocial functioning.
Shenassa, Edmond (University of Maryland)
Paradis, Angela (Brown University)
Rogrers, Michelle (Brown University)
Buka, Stephen (Brown University)
Background: Prior studies investigating the association between maternal smoking during pregnancy (MSP) and risk of major depressive disorders (MDD) among adult offspring have produced conflicting results. These studies have differed in their control for potential familial confounding factors and have not accounted for the possibility of confounding by offspring’s history of regular smoking.
Goal: We report findings from a longitudinal study of MSP, MDD, and regular smoking utilizing a family design.
Objectives: Our primary aim was to conduct the first study utilizing a family design to examine the association between MSP and offspring’s lifetime risk of major depressive disorder (MDD) using a biologically-validated, prospectively collected measure of MSP. Our secondary aim was to examine the role of the offspring’s smoking history in the association between MSP and MDD.
Approach: Study participants were adult offspring of members of the Providence and Boston cohorts of the Collaborative Perinatal Project (1959–1966). Approximately 10% of these adult offspring were enrolled in the New England Family Study (n = 1,783), a follow-up study that oversampled families with multiple siblings. Logistic regression models were fit using models that allowed between-mother effects (ORB) of MSP to differ from within-mother effects (ORw).
Results: In models including gender and gravida MSP predicted risk of MDD among the offspring (ORw=2.35, CI=1.05, 5.26 and ORB=1.15, CI=0.96, 1.37). Inclusion of smoking history yielded a slightly larger within-mother effect (ORw=2.48, CI=1.11, 5.52) and had no practical effect on between-mother effect (ORB=1.13, CI=0.95, 1.35). Current regular smoking was an independent risk factor for lifetime MDD (OR=1.80, CI=1.37, 2.35).
Importance to public health: This study explores the lifecourse perspective and provides a clear overview of overlapping pathways linking maternal smoking during pregnancy with risk of depression among the offspring.
Trivedi, Neha (UMD SPH Behavioral and Community Health)
Beck, Kenneth (UMD SPH Behavioral and Community Health)
Background: Texting while driving is prevalent among college-aged students despite distracted driving laws. Social Norms Theory suggests that individual behaviors are influenced often times by perceptions of how their social groups act. Proximal sources of social influence, such as significant others (S.O.) may be more likely to effect college-aged students.
Goal: The purpose of this study was to examine whether different social normative relationships (proximal or distal) mediate the pathway between perceptions of risk associated with texting while driving and reported texting and driving, among a sample of college drivers.
Objectives: We hypothesized that individuals who saw their S.O. (proximal sources) texting while driving would be more likely to mediate this relationship than their friends (distal sources). We were also interested in understanding whether mediational differences occurred across driver status as well as gender.
Approach: Our analysis included 835 undergraduates, who were licensed drivers and usually drove a car or other motor vehicle. We examined the influence of perceived risk of texting while driving on texting while driving in the past month, and whether seeing ones S.O. texting while driving mediated this effect. The sample was analyzed in two groups: low-risk drivers and high-risk drivers. Low-risk drivers never received a traffic citation nor got into a crash. High-risk drivers had ever received traffic citation or got into a crash. A series of logistic regressions were conducted to test the mediation effect, adjusting for gender and race/ethnicity. Sobel Tests were conducted to evaluate the indirect effect.
Results: Results showed that the influence of S.O. partially mediated the effect of perceived risk of texting while driving on past month texting while driving. Sobel tests for participants who were low-risk drivers showed that the effect of texting while driving in the past month was mediated by the influence of S.O. (t=2.24, p<0.05). Participants who were high-risk drivers were also partially mediated by perceived influence of their S.O. (t=2.03, p<0.05).
Importance to public health: These findings bolster the limited research on the importance of proximal sources of social influence. These findings suggest prevention efforts focus on proximal social networks of college-aged students as opposed to distal social influences when targeting young adults distracted driving behaviors, and intervention strategies be tailored towards texting while driving.