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Background: Research exploring associations between exposure to social determinants of health and breastfeeding is needed to identify breastfeeding barriers. Housing insecurity and household conditions (chaos and crowding) may affect breastfeeding by increasing maternal stress and discomfort and decreasing time available to breastfeed. Research Aim: We aimed to examine the relationships between housing insecurity, breastfeeding exclusivity intention during the early postnatal period, and breastfeeding exclusivity at 6 months postpartum among a sample "at risk" for suboptimal breastfeeding rates. Methods: This study is a secondary data analysis of a longitudinal study at two time periods. Data were collected from English- and Spanish-speaking, Medicaid-eligible mother-infant dyads (N = 361) at near-birth and child aged 6 months, in New York City and Pittsburgh. Structural equation modeling was used to examine direct and indirect effects of housing insecurity on breastfeeding exclusivity at child aged 6 months. Results: The path model showed that experiencing more markers of housing insecurity (i.e., foreclosure/eviction threat, history of homelessness, late rent) was predictive of significantly lower breastfeeding exclusivity at 6 months. This was partially mediated through less exclusive breastfeeding intention during the early postnatal period. Greater household crowding was associated with 6-month breastfeeding exclusivity when mediated by intention. Household crowding had differential effects by study site and participant race/ethnicity. Conclusion: Refinement of housing insecurity as a multi-dimensional construct can lead to the development of standardized data collection instruments, inform future methodological decisions in research addressing social determinants of health, and can inform the development of responsive individual- and structural-level interventions. The data used in this study were collected as part of the SMART Beginnings Randomized Controlled Trial (NCT02459327 registered at ClinicalTrials.gov). [ABSTRACT FROM AUTHOR]

The Sustainable Development Goals (SDGs) enlist a triple-bottom-line approach of environment, social, and economic wellbeing that mirrors social work's environmental, social, and economic justice commitments. Additionally, the networked systems design of the SDGs resonates with the ecological systems approach central to social work practice. Systems science is vital for addressing the SDGs, and systems dynamics has been used to model the interactions between them. However, to date, social work education has used systems frameworks largely as a sensitizing tool rather than an operational one. This paper advocates for using systems science to teach SDGs in social work education, and provides an example of how to accomplish this in the classroom. Accessible texts on systems dynamics support the practical implementation of these tools in social work classrooms. This paper extends that work by outlining a classroom activity that incorporates the networked structures of the SDG's and introductory systems dynamics concepts. This activity can be implemented in service of re-examining the micro and macro practice gap in social work education, and to prepare the next generation of social workers to engage with the SDGs. [ABSTRACT FROM AUTHOR]

Preterm birth (PTB; <37 weeks gestation), is a leading cause of infant mortality and morbidity. Among those born preterm, risk increases as gestational age at birth decreases. Psychosocial factors such as depression symptoms and social determinants of health (SDH) may increase risk for PTB. Research is needed to understand these risk factors and identify effective interventions. This retrospective cohort study recruited English- and Spanish-speaking women presenting symptoms of preterm labor or admitted for PTB from an urban county hospital in the San Francisco Bay Area (n = 47). We used an iterative analytic approach by which qualitative data informed an exploratory quantitative analysis. Key exposures were presence of self-reported depression symptoms during pregnancy, SDH along eight domains, and receipt of behavioral health services. The outcome was gestational age at birth. T-tests, Wilcoxon rank sum tests, and linear regression models were used to test associations between the exposures and gestational age. Most participants were Black (25.5%) or Latina (59.6%). After adjusting for covariates, participants with depression symptoms had an average gestational age 3.1 weeks shorter (95% CI: -5.02, -1.20) than women reporting no symptoms. After adjusting for covariates, high number of adverse social determinants (≥ 4) suggested an association with shorter gestational age (p = 0.07, 1.65 weeks, 95% CI: -3.44, 0.14). Receipt of behavioral health services was associated with a significantly later gestational age; the median difference was 5.5 weeks longer for depression symptoms, 3.5 weeks longer for high social determinants, and 6 weeks longer for depression symptoms and high social determinants. Among a cohort of high-risk pregnant women, both depression symptoms during pregnancy and co-occurring with exposure to high adverse SDH are associated with shorter gestational age at birth, after controlling for psychosocial factors. Receipt of behavioral health services may be an effective intervention to address disparities in PTB. [ABSTRACT FROM AUTHOR]

The majority of sex workers are mothers. Although participation in sex work is primarily driven by the prioritization of their children's needs over their own, mothers are stigmatized, subject to poorer health, and lack access to quality health care and social services. Interviews with 25 mothers in Mumbai, India, were analyzed using theory-driven coding to reexamine participation in sex work in context of Gilligan's three-stage ethic of care, a feminist theory of moral reasoning. Stage 1 (decision making focused on self) themes were (a) sex work served as a means to survival and (b) exploitative and unfulfilling relationships required a focus on self. The transition from Stage 1 to 2 theme was language of selfishness versus responsibility. Stage 2 (selflessness is goodness) themes characterizing the majority of narratives were (a) sex work is justified, (b) duty to prioritize care of others, and (c) self-sacrifice to achieve aspirations for children. The transition from Stage 2 to 3 had one theme: consideration of self. While Stage 3 represents women taking holistic care of themselves and others, the data did not reflect this. Reframing mothers' participation in sex work using the ethic of care framework may support destigmatization, decriminalization, and security of human rights. [ABSTRACT FROM AUTHOR]

Purpose: As theories about the causes of racial inequities in infant mortality evolve, they are becoming increasingly complex. Interventions to address these inequities must be similarly complex, incorporating both upstream and downstream approaches. Description: The Best Babies Zone Initiative (BBZ) has been in operation since 2012 with an aim of reducing racial inequities in infant mortality. BBZ is designed to be flexible and responsive to the conditions creating toxic stress in communities of color. After seven years of operation in nine sites across the United States, and interventions implemented in housing, economic, and environmental justice, the Initiative has identified strategies to support the development and advancement of aligned programs. Assessment: Lessons learned and opportunities were identified across the Initiative's theoretical foundation (the life course perspective) and each of the four foundational strategies: place-based, community-driven, multi-sector work that contributes to broader social movements. Overarching lessons learned about advancing equity in MCH were identified including: the need to focus explicitly on racial equity, the imperative of shifting the time horizon for change, and the importance of identifying sustainable funding mechanisms. Conclusion: A complex initiative such as BBZ is relatively nascent in the field of Maternal and Child Health. However it represents an innovative approach to building community power and fostering strategic organizational partnerships in service of addressing root causes of racial inequities in birth outcomes. The lessons learned and opportunities identified by BBZ can serve as a foundation from which to build other programs and initiatives to advance racial justice. [ABSTRACT FROM AUTHOR]

Breastfeeding has numerous health, environmental, and economic benefits, and the promotion and support of breastfeeding has been at the centre of efforts from many global organizations such as WHO and UNICEF to promote maternal and child health. Interventions developed from such policies tend to be inaccessible to those who are economically marginalized, however, and thus may further inequities. Understanding the lived experiences of women occupying this segment of society, such as sex workers, illuminates the social and structural determinants of breastfeeding and how they constitute structural vulnerability that renders breastfeeding difficult. This qualitative study explores breastfeeding practices and decisions among sex workers in Mumbai and the factors shaping their experiences. We look at proximal factors—those that women directly indicate as influencing their breastfeeding decision‐making or behaviour, and distal factors—macrolevel forces identified by the women, as indication of their structural vulnerability, particularly in relationship to the decision to initiate and sustain breastfeeding. We conclude with discussing the need to promote appropriate infant feeding practices through culturally responsive interventions and mechanisms, taking both proximal and distal factors into account, to work towards equity in health outcomes. [ABSTRACT FROM AUTHOR]

Postpartum Depression (PPD) affects approximately 9 - 20% of women. Many women with PPD go undiagnosed and/ or do not follow through on referrals for treatment. Although the most routinely prescribed treatments for PPD are antidepressant medication and psychotherapy, a significant number of women desire non-traditional options. This article provides a systematic review of ten recently published, randomized clinical trials in the examination of the effectiveness of complementary health approaches—the use of non-mainstream products and interventions—on PPD. A search of nine databases of the English language literature from the years 2006 to 2018 was performed. Review criteria included published work, utilization of randomized-controlled trials, and the use of a reliable and valid measurement tool to identify cases of PPD and monitor changes in symptom severity. The studies reviewed focused on the following interventions: aromatherapy, bright light therapy, electroacupuncture, infant massage, iron supplementation, mindfulness training, omega-3 fatty acids, saffron, and yoga. Outcomes demonstrate the feasibility and safety of these approaches, as well as varying degrees of effectiveness. While many were pilot studies using small sample sizes, the results are encouraging and substantiate the need for additional trials. Studies are summarized and limitations and implications for social work and future research are described. [ABSTRACT FROM AUTHOR]

Integrating physical and behavioral health services has the potential to reduce health disparities and service inequities among persons most at risk. However, clinical social workers in integrated health settings must possess relevant knowledge and skills to provide quality care to diverse populations. The Social Worker Integrated Care Competency Scale (SWICCS), developed to complement the Integrated and Culturally Relevant Care (ICRC) field education curriculum, measures students' self-perceptions of knowledge and skills associated with providing behavioral health care. Three student cohorts (n = 38) completed the SWICCS three times during an integrated care field practicum. Results indicated a statistically significant increase in student knowledge and skills at each time point, with a large effect size (r = −.87). The SWICCS demonstrated utility in measuring and tracking social work student acquisition of knowledge and skills required for practice in integrated care environments. [ABSTRACT FROM AUTHOR]

Integrated care is a promising practice to promote health equity and improve population health across the life course, but the mechanisms needed to integrate services remain nebulous. This study aimed to identify the components required to achieve a fully integrated health care system as articulated by social work trainees. The authors conducted five focus groups (N = 20). Transcripts were analyzed using structural and pattern coding. Three primary themes emerged: Organizational Structure and Support, Personal and Interpersonal Dynamics, and Practitioner Knowledge. Results from this study can inform the process of integration and has implications for social work education. [ABSTRACT FROM AUTHOR]

Low-income African American women have disproportionately low rates of breastfeeding, which is indicative of individual, social, and structural barriers to breastfeeding. The WIC Infant Feeding Practices Scale was administered to 32 low-income, African American women. Participants reported favorable attitudes toward breastfeeding and identified with breastfeeding benefits, however not with breastfeeding barriers. Participants also completed a postpartum breastfeeding experiences survey that showed low levels of engagement with lactation professionals. Using critical feminist theory and quantitative criticalist approach to interpret these findings, this study highlights the need for more culturally responsive research and interventions. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To identify barriers and supporting factors for breastfeeding, and the dynamic interactions between them, as identified by low‐income African American women and lactation peer helpers. Background: Stark breastfeeding disparities exist between African American mothers and their White counterparts in the USA. This pattern is often replicated across the globe, with marginalised populations demonstrating decreased breastfeeding rates. While breastfeeding research focused on sociocultural factors for different populations has been conducted, a more dynamic model of the factors impacting breastfeeding may help identify effective leverage points for change. Design: Group model building was used as a grounded theoretical approach, to build and validate a model representing factors impacting breastfeeding and the relationships between them. Methods: Low‐income African American women (n = 21) and lactation peer helpers (n = 3) were engaged in model building sessions to identify factors impacting breastfeeding. A two‐cycle process was used for analysis, in vivo and axial coding. The final factors and model were validated with a subgroup of participants. Results: The participants generated 82 factors that make breastfeeding easier, and 86 factors that make breastfeeding more challenging. These were grouped into 10 and 14 themes, respectively. A final model was constructed identifying three domains impacting breastfeeding: a mother's return to work or school, her knowledge, support and persistence, and the social acceptance of breastfeeding. Conclusions: This study documented the sociocultural context within which low‐income African American women are situated by identifying factors impacting breastfeeding, and the dynamic interactions between them. The model also provided various leverage points from which breastfeeding women can be supported. Relevance to Clinical Practice: Postpartum nurses are critical in supporting breastfeeding practices. To be most effective, they must be aware of the factors impacting breastfeeding, some of which may be unique to women based on their culture. [ABSTRACT FROM AUTHOR]

Background: Increasing breastfeeding rates among low-income African American women may work toward the achievement of health equity. The dynamic breastfeeding assessment process (D-BAP) is a community-grounded, equity-focused intervention designed to increase prenatal breastfeeding self-efficacy. Research aim: The aims of the pilot study were (a) to determine the effect of the D-BAP on breastfeeding self-efficacy among pregnant, low-income African American women, (b) to examine the findings among women with no previous breastfeeding experience, and (c) to compare the findings between women with prior breastfeeding experience and those without it. Methods: A pre/post, paired-samples design was utilized. Convenience sampling was used to recruit pregnant, low-income African American women (N = 25). Participants completed the Breastfeeding Self-Efficacy Scale–Short Form prior to and following the D-BAP. Results: The Wilcoxon signed rank test indicated that participation in the D-BAP had a statistically significant influence on breastfeeding self-efficacy (z = −2.01, p = .04). Among a subsample of participants with no previous breastfeeding experience (n = 12), completion of the D-BAP resulted in a statistically significant increase in breastfeeding self-efficacy (z = −2.36, p = .02). There was no statistically significant difference between those with prior breastfeeding experience and those without it. Conclusion: Breastfeeding among low-income African American women is a health equity issue for which culturally responsive, effective breastfeeding interventions are needed. This research demonstrates an association between completion of the D-BAP and an increase in prenatal breastfeeding self-efficacy. [ABSTRACT FROM AUTHOR]

Policymakers and researchers emphasize needs for an integrated, effective, and efficient health care system to address well-documented disparities and inequities in care experienced by diverse populations. The Affordable Care Act, through its support of integrated health care, addresses social determinants of health with a goal of increasing access to care. Social work is poised to assume a central position in health care reform and integrated behavioral health, but must prepare practitioners to work alongside medical providers in health care settings. This article describes a social work field education model developed in partnership with community mental health and health care providers. The model, Integrated and Culturally Relevant Care, prepares social work students to provide behavioral health services in integrated primary care environments. [ABSTRACT FROM PUBLISHER]

The purpose of this exploratory case study was to understand the academic disengagement and reengagement process from the perspective of students enrolled in a dropout recovery charter school. Specifically, this study focused on students' perceptions of the factors that influenced their lack of success in the traditional school setting, the motivational factors that led them to enroll in a dropout recovery charter school, and the factors currently promoting their success in this new school setting. Thirteen students participated in semi-structured focus groups. Behavioral and discipline challenges and lack of teacher support were mentioned most frequently as barriers to success in the traditional school setting. Referrals by family, friends, or school staff and self-determined motivation were the most commonly reported motivators to enroll in the dropout recovery charter school. Students reported individualization of learning, school structure, and school climate as factors promoting their current success. The findings of this study have important implications for social work practice, particularly around social worker's engagement in multilevel systemic change, collaborative work with teachers, and the design of dropout prevention programs. [ABSTRACT FROM AUTHOR]