Pediatric obesity is a significant clinical and public health issue for African American girls in which low physical activity (PA) is a contributor. The mother-daughter relationship (MDR) has rarely been examined in the context of improving health behaviors such as PA and mental health outcomes (MHO) within this population. PURPOSE: To examine if change in PA following a 12-week culturally-tailored mother-daughter PA intervention predicts change in MHO variables (self-esteem, depressive symptoms, body image dissatisfaction) and MDR in pre-adolescent African American girls. METHODS: Mothers (n=27; age=36.0±17.0 years; body mass index (BMI)=34.0±7.4 kg/m2) and daughters (n=27; age=9.0±1.4 years; BMI=20.3±5.7 kg/m2, BMI percentile=73%) randomized to the mother-daughter dance group were examined in this analysis. Physical activity levels were assessed with Actigraph GT3X+ accelerometers for seven days and validated questionnaires. Mental health outcome variables and MDR were assessed using validated questionnaires. Spearman correlations were used to examine associations between variables. MANOVA was used to assess differences in PA levels across three time points. Paired t-tests and ANOVA were used for MHO variables and MDR across two and three time points, respectively. Simple regression was used to assess if PA self-efficacy and MDR mediated changes in PA. Hierarchical linear modeling (HLM) assessed if changes in PA variables predicted changes in MHO variables. RESULTS: Several significant correlations were observed at baseline and post-intervention such as the negative relationships between daughters’ light PA (% time) and depressive symptoms as well as a daughters’ BMI percentile and body image dissatisfaction. Significant reduction was observed in daughters’ self-reported PA (p=0.04) pre- to post-intervention. No other significant changes were observed. Change in PA did not predict change in MHO variables, but there was a negative effect of average BMI percentile on self-esteem (p=0.017) and body image dissatisfaction (p=0.002). CONCLUSION: In this sample of pre-adolescent African American girls, change in objectively measured PA did not predict change in MHO. The lack of significant findings could be attributed to low attendance of the intervention. Future studies should examine these relationships in a larger sample and explore the use of technology to combat low attendance.

Legal induced abortion is a safe option for terminating a pregnancy for women of reproductive age in the United States (U.S.), though access has varied since the Roe v. Wade and Doe v. Bolton cases in 1973. Information is lacking on women’s attitudes toward and perceptions of abortion as well as on related constructs such as pregnancy attitudes and contraceptive use. Exploring these constructs is important in that it can provide much needed context to women’s reproductive life planning. This research aimed to explore perceptions of abortion access and safety and examine the potential associations between attitudes toward abortion access and pregnancy avoidance and contraceptive use, respectively, among women living in Alabama and South Carolina. Secondary data were from two representative, statewide surveys of reproductive-aged women (18-44 years) living in Alabama and South Carolina. This mixed-methods research used thematic analysis to categorize open-ended responses regarding perceptions of abortion access and safety and bivariate (χ2 tests) and multivariate analyses to assess the relationships between abortion attitudes and pregnancy avoidance and contraceptive use, respectively. In Study 1, half of women (50.0%) thought that an abortion was very or somewhat easy to obtain and less than half women (41.2%) perceived abortion as very or somewhat safe in their state. The most common open-ended response themes were abortion legality and restrictions and abortion as similar to any medical procedure. In Study 2, women who were ambivalent about pregnancy avoidance or who found it unimportant to avoid pregnancy were less likely to agree that safe, effective, and affordable methods of abortion care should be available to women in their community compared to those who found it important to avoid pregnancy (adjusted Odds Ratio (aOR), 0.53 and 0.55, respectively). In Study 3, contraceptive users were more likely to agree that safe, effective, and affordable methods of abortion should be available to women in their community than contraceptive non-users (aOR, 1.43). There are clear opportunities for key stakeholders in reproductive health and health policy to unite in efforts to create woman-centered practices, programs, and policies to meet the reproductive health needs of the women they serve.

Background: Perinatal depression affects 1 in 7 childbearing individuals and remains underdiagnosed and undertreated. Individuals with a psychiatric history are at increased risk of perinatal depression, and little is known about how experiences with the mental health care pathway may differ between these individuals and those without a psychiatric history. Methods: This was a secondary analysis of data from the PRISM (PRogram in Support of Moms) study, a cluster randomized controlled trial of two interventions for perinatal depression. Care access and barriers to care were evaluated in perinatal individuals who screened positive for depression using the EPDS (N=280). Results: Individuals with no psychiatric history prior to pregnancy (N=113), compared to those with such history (N=267), were less likely to be screened for perinatal depression, and less likely to be offered a therapy referral, though equally likely to attend when referred. In adjusted models, those without a psychiatric history had 0.59 times the odds of attending therapy (95% CI 0.28-1.25), 0.23 times the odds of utilizing medication (95% CI 0.11-0.47), and overall, 0.22 times the odds of receiving any depression care (95% CI 0.11-0.43). Participants reported on average 3 barriers as preventing them from receiving care “a lot” or “quite a lot”. The proportion of individuals endorsing each barrier was similar between groups, excepting “concerns about treatments available” and “thinking the problem would get better by itself”, which were more prevalent in those without a prior psychiatric history. Conclusions: There exist meaningful differences in the way perinatal individuals access care for depression based on psychiatric history. An understanding of these differences is crucial in addressing gaps between mental health care need and care receipt.

The purpose of this study was to measure and evaluate the clinical presentation, outcome and longterm effects of tuberculosis in children admitted to the paediatric intensive care unit at Tygerberg Hospital. A retrospective, descriptive study was conducted among 57 children admitted to the paediatric intensive care unit between January 1991 to December 1994. The sample comprised all the children with tuberculosis aged one month to twelve years who were admitted to the paediatric intensive care unit. Audit measures were taken to ensure that all the children with tuberculosis were identified. Data was collected by means of a structured working sheet and questionnaire that was sent to the clinics. Respondents completed the questionnaire in the clinics. There was an increase in the incidence of children suffering from pulmonary or disseminated tuberculosis who required admission to the PICU, although the incidence of HIV was low. None of the index cases had MDR-TB. Fifty-one percent of children were admitted to the PICU because of primary tuberculosis or complications of the disease. Of these children 69 % had respiratory failure who required ventilation. Thirty percent were admitted to the PICU for respiratory failure and were subsequently diagnosed as having tuberculosis. Tuberculosis was incidently found amongst 4 children when they were routinely examined in the PICU. Due to the difficulty in confirming the diagnosis of tuberculosis in children, a large proportion of cases go unrecognised. The chest radiographs demonstrated that hilar ( 40 % ) and paratracheal (32 % ) adenopathy was the most common findings. Bronchial compressions was present in 12 % of cases. A significantly positive Mantoux skin test was reported in 35 % of cases and 53 % had a positive Tine skin test. Gastric aspirates positive for M. tuberculosis were obtained in 42 % of cases and of cultures other than gastric aspirates, 44 % were positive. Other special investigations to confirm the diagnosis of tuberculosis included CT scan and bronchoscopies. Bronchoscopies were performed on 13 children and found to be abnormal in 12 cases. The most common finding was nodal compression of the airways. Overall the diagnosis of confirmed tuberculosis was made in 47% and of probable tuberculosis in 53 % of cases. The length of stay in the PICU was 10.2 + 22.4 days. The PICU mortality was 23%, with a total hospital mortality of 26%. The mortality for the TBM subgroup was 75 % . Although a good compliance (82 % ) was recorded by the clinics in the follow-up study, they experienced problems with the notifications. The follow-up study pointed out that communication was a problem between the referring hospital and the clinics. Thirty-one percent of the clinics made suggestions for improving the communication. The findings demonstrates that in an area with a high incidence of TB, children do develop severe disease requiring admission to the PICU. This places a considerable clinical and financial burden on the already limited health system. Early diagnosis of TB should prevent severe disease and subsequent admission to the PICU. The increasing incidence of HIV and MDR-TB will undoubtedly pose a major risk to ICU staff and the prevention of infection is of primary concern for those who may be exposed in this area. Due to this, certain recommendations regarding guidelines for admission to the PICU, investigations of patients exposed of having TB in the PICU, prevention of infection and detection of disease in staff in the PICU, the need for increase beds in the PICU and recommendations post discharge from the PICU were made.

In Tennessee (TN), the rate of unintended pregnancies remains higher than the national rate (32.4% vs. 30.3%). Although long-acting reversible contraceptives (LARCs) are 99% effective in preventing undesired pregnancies; uptake remains low in rural and underserved communities. Previous research has provided some insight into women’s perceptions of LARCs; however, those guided by conceptual frameworks to understand the multiple influences that impact perceptions towards LARCs, especially among rural regions, are scarce. This multimethod qualitative study explored multiple influences that impact northeast Tennessee women’s perceptions and attitudes toward LARCs using the Socio-ecological Model (SEM) as a guiding framework. The study comprised six focus groups and seven individual interviews of women aged 18-44, not pregnant, and current residents of five counties in Northeast TN. Participants’ demographics were administered through REDCap, while qualitative data from focus groups and interviews were recorded via Zoom. Focus groups and interview data were combined, and an a priori list of codes identified from the constructs of the SEM was initially used to deductively code the data. Subsequently, the data were analyzed inductively for new codes and themes that did not apply to the a priori categories. Seventeen themes and 23 sub-themes were identified using the SEM; On the intrapersonal level of the SEM, participants’ contraception utilization history, attitudes towards a method, perception of method features, and perceived side effects were identified as themes that delineate influences on their LARC utilization. Perception of partner support, perceived support from peer/social networks, and provider trust themes were identified on the interpersonal level. On the community level, the cost of the method, access to information, perceived accessibility to a method, social services, and cultural norms themes were identified. The availability of preferred methods in a clinic, the need for multiple clinic visits to use a method, and provider counseling practices were identified as organizational-level themes. On the policy level, insurance, and billing policies, sex education policies were identified as impacting LARC utilization. Study findings highlight the areas of influence that can be addressed to increase LARC uptake and enable women in rural and underserved regions to achieve their personal reproductive goals.

Vitamin D deficiency is of particular concern among women in many south Asian countries due to low availability of vitamin D-rich foods, dark skin pigmentation, and cultural and religious practices that promote the wearing of concealing clothing. However, information regarding the vitamin D status of many subpopulations in south Asian countries is limited. The current study was conducted to assess the vitamin D status of 147 Bangladeshi women of reproductive age and determine whether vitamin D status influences susceptibility to arsenic-associated skin lesions (75 cases, 72 controls). Serum 25(OH)D3 levels were measured using a radioimmunoassay. The mean serum vitamin D level among the women in the current study was 60.1 nmol/L, which is well below the cut-off value of 75 nmol/L defining optimal vitamin D status. Over 81% of the women were below this cut-off value. Vitamin D status was not influenced by the presence of arsenic-associated skin lesions. Sun exposure and very low egg consumption were factors identified as significant predictors of vitamin D status (p<0.05, p<0.04, respectively). Every additional hour of sun exposure per week during work was associated with a 0.32 nmol/L, on average, increase in serum vitamin D levels. Very low egg consumption corresponded to a 10.85 nmol/L lower serum vitamin D level compared to frequent egg consumption. Public health efforts in Bangladesh should promote increased consumption of food sources rich in vitamin D. Vitamin D fortification or supplementation may also be viable options to improve the vitamin D status of the population.

Access to early childhood education not only leads to improved social, academic, and health outcomes for children, but can also carry the same benefits into adulthood. Early education and care programs can work against some of the negative effects of social factors such as socioeconomic status, discrimination, social support, and work demands which have been linked to physical and mental health outcomes. Early education programs could intervene not only in the life of a child, but also impact parents, families, and populations. This thesis will review the research showing early childhood education leads to better social and health outcomes and that there is a lack of adequate access to early childhood education for low-income families in Massachusetts. This thesis presents three state-level policy options for making early childhood education more accessible to low-income families in Massachusetts: lengthen the certification period of child care vouchers; reduce the administrative burden on families including eliminating the need for double documentation; dissolve the child care subsidy waiting list by making child care services an entitlement for families at or below 50% State Median Income. These policy options are evaluated based on the criteria of political feasibility, equity and fairness, administrative ease, effectiveness, and cost. Based on this policy analysis, a recommendation is made for Massachusetts to lengthen the certification period of child care vouchers, as well as reduce the administrative burden on families including eliminating the need for double documentation.

Limited clinical evidence exists regarding whether the single private room Neonatal Intensive Care Unit (NICU) environment of care delivery has a positive, negative, or neutral impact on health outcomes for the high risk neonate and on maternal stress as compared to the open room design. The study purpose was to examine whether a difference exists in health outcomes in the open room versus single private room NICU environment. The factors considered were weight gain, ventilator days, hospital length of stay, incidence and grade of intraventricular hemorrhage (IVH), the number of parental visits, and perceptions of maternal stress. Infants hospitalized in an open room environment (n=52) were matched by gestational age to infants in a single private room NICU (n=52). Mothers of the infants from the open room (n=26) and the single private room (n=20) groups completed the Parental Stress Scale: Neonatal Intensive Care Unit (PSS:NICU) survey instrument. The t-test for independent groups demonstrated a difference for the number of parent visits (t=6.672, df=60.13, p<.001) with a significant increase in visitation frequency for infants in the single private room NICU. Maternal perceptions of stress were not different (t=.154, df=44, p=.878), and high stress scores were reported for both groups regardless of the infant's environment of hospitalization. This study demonstrates that the single private room environment promotes increased parental access to their infants. The finding of high levels of maternal perception of stress in both the open room and single private room NICU's demonstrates that the environment did not impact the perception of maternal stress. This finding supports the implication that mothers of hospitalized infants need nursing support regardless of the type of NICU environment.

Child mortality in sub-Saharan Africa is reducing but the levels remain high with subnational within-country variations. Birth weight is a key predictor of child survival and monitoring birth weight outcomes, in particular, prevalence of low birth weights, is important for resource allocation to improve child survival outcomes. Past research in sub-Saharan Africa has found that different individual-level factors are associated with birth weight including BMI of mother, sex of baby, educational level of mother, and wealth index of household. Some environmental factors are found to be associated with birth outcomes. However, past findings regarding the association of birth weight with household air pollution (HAP) resulting from cooking fuels are non-conclusive. In this study, we analyze variability in birth weights subnationally for Ghana and assess its association with household air pollution resulting from cooking fuels, accounting for variation due to other factors including maternal and household predictors, as well as geographical location. The analysis was based on birth weights for 1310 births, obtained from data collected in 2014 in the Demographic and Health Survey (DHS). We use Bayesian spatial regression models to estimate associations and capture spatial variation. Spatial variation was captured with a conditional autoregressive (CAR) model. Based on various models, we do not find evidence to suggest that cooking fuel is associated with birth weight. After accounting for covariates, the average birth weights per district ranged from 2823g (95% CI: 2613g, 3171g) in Ketu district to 3243g (95% CI: 3083g, 3358g) in Ashanti Akim North district. Across Ghana, difference in birth weight attributable to district spatial effects range from -33g in Lawra district in Upper West region of Ghana to 11g in Ho in the Volta region.

Background Postpartum depression (PPD) is a major public health challenge and associated with poor maternal and infant health outcomes. Quality prenatal care decreases adverse outcomes in pregnancy and may reduce PPD risk factors. This study critically reviews the evidence about the role of prenatal care practices in reducing PPD prevalence across population groups and examines the association between prenatal care timing and counseling content with PPD prevalence. Methods A scoping review was completed across eight databases to synthesize evidence about prenatal care and PPD across different contextual settings. National data from the Pregnancy Risk Assessment Monitoring System (PRAMS) was used to examine the research questions. The key outcome was PPD symptoms as self-reported by postpartum women. Key independent variables were timing and content of prenatal care. Bivariate analyses used chi-square and t-tests, as appropriate, and a logistic regression analysis examined associations at the multivariable level while accounting sociodemographic characteristics, history of depression, and interaction effects. An issue brief was developed, triangulating findings from the scoping review and quantitative analysis. Results Forty-five studies were analyzed as a part of the scoping review and identified a strong association between robust prenatal care that included education about depression and increased awareness of PPD prevention among pregnant women. In the PRAMS analysis, women with a history of depression (aOR: 2.87; 95% CI: 2.74, 2.99) and those who initiated prenatal care in the third trimester or had no prenatal care (aOR: 1.54; 95% CI: 1.21, 1.85) had higher odds of PPD. Women who were not asked about depression during prenatal care had higher odds of PPD (aOR: 1.26; 95% CI: 1.21, 1.32). Women who were Asian, Black, and asked less than five questions on health-related topics during prenatal care were more likely to report PPD symptoms. Conclusion Blending education and counseling into routine prenatal care for pregnant women will increase awareness of depression, thereby preventing PPD. Prenatal care should, therefore, be accompanied by evidence-based systems for counseling, education, diagnosing, treatment, and referral of perinatal depression. To optimize the health of women, prenatal care should provide services and support tailored to each woman's needs.