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Purpose.: To understand how social and structural contexts shape individual risk, vulnerability, and interconception health-related behaviors of African-American women. Approach or Design.: A longitudinal ethnographic study was conducted. Setting.: The study was conducted in Philadelphia, Pennsylvania. Participants.: The sample included 19 African-American women who were participants in the intervention group of a randomized clinical trial of interconceptional care. Method.: Data were collected through interaction with participants over a period of 6 to 12 months. Participant observation, structured and unstructured interviews, and Photovoice were used to obtain data; grounded theory was used for analysis. The analysis was guided by intersectional theory. Results.: Social disadvantage influenced health and health care–seeking behaviors of African-American women, and the disadvantage centered on the experience of racism. The authors identify seven experiences grounded in the interactions among the forces of racism, class, gender, and history that may influence women's participation in and the effectiveness of preconception and interconception health care. Conclusion.: African-American women's health and wellness behaviors are influenced by an experience of racism structurally embedded and made more virulent by its intersection with class, gender, and history. These intersecting forces create what may be a unique exposure that contributes significantly to the proximal determinants of health inequities for African-American women. Health promotion approaches that focus on the individual as the locus of intervention must concomitantly unravel and address the intertwining structural forces that shape individual circumstance in order to improve women's interconceptional health and to reduce disparities. [ABSTRACT FROM AUTHOR]

Objectives. We compared health behaviors and health outcomes among US-born, African-born, and Caribbean-born pregnant Black women and examined whether sociodemographic and psychosocial characteristics explained differences among these population subgroups. Methods. We analyzed data from a prospective cohort study conducted in Philadelphia, Pennsylvania, with a series of nested logistic regression models predicting tobacco, alcohol, and marijuana use and measures of physical and mental health. Results. Foreign-born Black women were significantly less likely to engage in substance use and had better self-rated physical and mental health than did native-born Black women. These findings were largely unchanged by adjustment for sociodemographic and psychosocial characteristics. The foreign-born advantage varied by place of birth: it was somewhat stronger for African-born women than for Caribbean-born women. Conclusions. Further studies are needed to gain a better understanding of the role of immigrant selectivity and other characteristics that contribute to more favorable health behaviors and health outcomes among foreign-born Blacks than among native-born Blacks in the United States. [ABSTRACT FROM AUTHOR]

Objectives. Despite the promotion of breastfeeding as the “ideal” infant feeding method by health experts, breastfeeding continues to be less common among low-income and minority mothers than among other women. This article investigates how maternal sociodemographic and infant characteristics, household environment, and health behaviors are related to breastfeeding initiation and duration among low-income, inner-city mothers, with a specific focus on differences in breastfeeding behavior by race/ethnicity and nativity status. Methods. Using data from a community-based, longitudinal study of women in Philadelphia, PA ( N=1,140), we estimate logistic regression and Cox proportional hazard models to predict breastfeeding initiation and duration. Results. Both foreign-born black mothers and Hispanic mothers (most of whom were foreign born) were significantly more likely to breastfeed their infants than non-Hispanic white women, findings that were partly explained by foreign-born and Hispanic mothers' prenatal intention to breastfeed. In contrast to previous studies, we also found that native-born black women were more likely to breastfeed than non-Hispanic white women. Conclusion. Our findings suggest that when poor whites and African Americans are similarly situated in an inner-city context, the disparity in their behavior with respect to infant feeding is not as distinct as documented in national surveys. Breastfeeding was much more common among low-income immigrant black women than among white or native-born black mothers. [ABSTRACT FROM AUTHOR]

Objectives. The study of neighborhood effects on health and well-being has regained prominence in recent years. Most authors have relied on Census data and other administrative data sources to assess neighborhood characteristics. Less commonly employed, but gaining in popularity, are measures from surveys that ask neighborhood residents about various aspects of their neighborhood environment. Such surveys are a potentially attractive alternative or augmentation to administrative data sources. Methods. Using data from a study of neighborhood effects on pregnancy outcomes among low-income, inner-city women in Philadelphia, PA ( N=3,988), we examined psychometric and ecometric properties of scales used to assess perceptions of crime and safety, physical disorder and social disorder, and estimated effects of individual- and neighborhood-level predictors on perceptions. Results. The three perceived neighborhood disorder scales had high internal consistency and good neighborhood-level reliability. Several individual attributes of the women predicted perceptions of neighborhood disorder, controlling for neighborhood-level characteristics (within Census tract, fixed-effect estimates). In addition, our objective indicators of neighborhood crime and physical and social disorder were highly significant predictors of women's perceptions, explaining over 70 percent of the between-neighborhood variation in perceptions. Conclusions. When data on objective neighborhood characteristics are unavailable, the inclusion of questions about residents' perceptions of neighborhood conditions in surveys of inner-city residents provides a useful alternative to characterize neighborhood conditions. [ABSTRACT FROM AUTHOR]

Objective This study measures the relative performance of three methods for diagnosing bacterial vaginosis (BV) during pregnancy and assesses the implications of measurement for clinical practice and surveillance. Methods A sample ( n = 1,780) of English or Spanish speaking women, with a singleton intrauterine pregnancy and receiving prenatal care at a consortium of public health centers in Philadelphia were consecutively enrolled. Gram stain, clinician’s diagnosis, and a commercial test were the three diagnostic methods used to assess BV. Sensitivity, specificity, and the positive and negative predictive values of clinical diagnosis and the commercial test were assessed using the gram stain/Nugent score as a gold standard. Results The prevalence of BV, measured on the same population, differed considerably depending on the diagnostic test used. The measured prevalences were 55% (Gram stain), 28.5% (clinician’s diagnosis), and 12.6% (commercial test). The prevalence of BV (diagnosed by gram stain) was twice as high among African American women compared to White women. Only 69% BV-positive high-risk women were treated for BV. Conclusions Inaccurate diagnosis of BV leads to missed cases. The identification of true cases is critical for assigning treatment and for assessing treatment effectiveness. Clinician’s routine diagnosis fell short of recommended procedures and performed poorly compared to gold standard in case ascertainment. This inability to ascertain cases may have an impact on our ability to prevent preterm birth. [ABSTRACT FROM AUTHOR]

Objective. To assess the effect of maternal length of stay (Los) legislation on LOS and hospital charges associated with Philadelphia resident live births from 1994 through 1997. Data Source/Study Setting. This was a descriptive epidemiological study involving secondary data analyses of linked birth record and hospital discharge data pertaining to all Philadelphia resident live births occurring between January 1, 1994 and December 31, 1997. Study Design. Using these linked data, trends in median and mean maternal and infant LOS and hospital charges were described for three distinct time periods: (1) a "prelegislative" period (January 1, 1994 through June 30, 1995); (2) a on&year period during which LOS legislation was introduced, debated, modified, and eventually passed by Pennsylvania lawmakers (July 1, 1995 through June 30, 1996); and (3) a "post-LOS law" period immediately following enactment of Act 85 mandating minimum LOS for mothers and their newborns (July 1, 1996 through December 31, 1997). LOS variables for both mothers and infants were calculated based on the actual number of hours elapsing between birth and discharge; hospital charges were obtained directly from information available in the Hospital Discharge Survey data. Principal Findings. Maternal median charges arid LOS per delivery for vaginal births rose from $5,270 to $6,333 and from 35 to 47 hours following the enactment of Pennsylvania maternal minimum LOS legislation. Median infant cost and LOS pet delivery mirrored these trends. Conclusion. Pennsylvania LOS legislation had a profound effect on maternal and infant discharge practices in Philadelphia. As much as $20 million may have been added to annual health care costs associated with Philadelphia resident births. [ABSTRACT FROM AUTHOR]

Objectives. This report measured the effect of births at 22 weeks' gestation or earlier on infant mortality in Philadelphia, Pa. Methods. The proportion of live-born deliveries at 22 weeks or earlier was calculated. Overall and race-specific infant mortality was calculated after excluding live-born deliveries at 22 weeks' gestation or earlier. Results. Of all deliveries, 1.5% were at 22 weeks or earlier. Of these, 68% were stillborn and 32% were live-born. Large hospital-to-hospital variation in the proportion of live-born deliveries at 22 weeks' gestation or earlier was noted. When nonviable births were excluded, overall infant mortality decreased 40%. Conclusions. The development of a standardized birth certificate policy is needed and will facilitate comparisons of infant mortality across spatial boundaries and racial/ethnic groups. (Am J Public Health. 2000;90:1303-1306) [ABSTRACT FROM AUTHOR]

Presents a study that assessed the prevalence of homelessness among adult childbearing women in Philadelphia, Pennsylvania. Methodology; Relation between ethnicity and the prevalence of homelessness; Prevalence rates of African American women.