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In recent years, maternal and child health professionals have been seeking approaches to integrating the Life Course Perspective and social determinants of health into their work. In this article, we describe how community input, staff feedback, and evidence from the field that the connection between wealth and health should be addressed compelled the Contra Costa Family, Maternal and Child Health (FMCH) Programs Life Course Initiative to launch Building Economic Security Today (BEST). BEST utilizes innovative strategies to reduce inequities in health outcomes for low-income Contra Costa families by improving their financial security and stability. FMCH Programs' Women, Infants, and Children Program (WIC) conducted BEST financial education classes, and its Medically Vulnerable Infant Program (MVIP) instituted BEST financial assessments during public health nurse home visits. Educational and referral resources were also developed and distributed to all clients. The classes at WIC increased clients' awareness of financial issues and confidence that they could improve their financial situations. WIC clients and staff also gained knowledge about financial resources in the community. MVIP's financial assessments offered clients a new and needed perspective on their financial situations, as well as support around the financial and psychological stresses of caring for a child with special health care needs. BEST offered FMCH Programs staff opportunities to engage in non-traditional, cross-sector partnerships, and gain new knowledge and skills to address a pressing social determinant of health. We learned the value of flexible timelines, maintaining a long view for creating change, and challenging the traditional paradigm of maternal and child health.

Background While breast milk is considered the gold standard of infant feeding, a majority of African American mothers are not exclusively breastfeeding their newborn infants. Objective The overall goal of this critical ethnographic research study was to describe infant feeding perceptions and experiences of African American mothers and their support persons. Methods Twenty-two participants (14 pregnant women and eight support persons) were recruited from public health programs and community based organizations in northern California. Data were collected through field observations, demographic questionnaires, and multiple in-person interviews. Thematic analysis was used to identify key themes. Results Half of the mothers noted an intention to exclusively breastfeed during the antepartum period. However, few mothers exclusively breastfed during the postpartum period. Many participants expressed guilt and shame for not being able to accomplish their antepartum goals. Life experiences and stressors, lack of breastfeeding role models, limited experiences with breastfeeding and lactation, and changes to the family dynamic played a major role in the infant feeding decision making process and breastfeeding duration. Conclusions for Practice Our observations suggest that while exclusivity goals were not being met, a considerable proportion of African American women were breastfeeding. Future interventions geared towards this population should include social media interventions, messaging around combination feeding, and increased education for identified social support persons. Public health measures aimed at reducing the current infant feeding inequities would benefit by also incorporating more culturally inclusive messaging around breastfeeding and lactation.

Objectives: To describe depressive symptomatology and examine the relationship between social stressors and depressive symptoms in pregnant African American women. Design and Sample: Cross‐sectional study of 119 women receiving care at 2 prenatal clinics in Northern California. Measures: Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES‐D). Social stress variables included discrimination, trauma exposure, social conflict, and economic stress. Results: In this sample, mean CES‐D score was 15.88. Forty‐two percent of the women had CES‐D scores ≥16 (possible risk), and 23% had CES‐D scores ≥23 (probable risk). There were significantly positive relationships between the social stress variables (discrimination, trauma exposure, social conflict, economic stress) and CES‐D scores. Stepwise multiple regression analysis indicated that together discrimination and social conflict accounted for 36% of the variance in antepartum depressive symptoms. Conclusions: Discrimination and social conflict are considerable sources of stress that contribute to levels of antepartum depressive symptoms in African American women. While the results reinforce the importance of universal prenatal screening, comprehensive strategies are also needed to help ameliorate the impact that social stressors such as discrimination and social conflict have on the mental health of pregnant African American women.

In health disparities research, studying the vulnerabilities of African Americans should be balanced by research on resources and strengths that influence health. One resource is spirituality, yet few tools have been developed and tested in diverse populations. This study evaluated the psychometric characteristics of the Spiritual Perspective Scale (SPS) in 102 pregnant African American women. Internal consistency reliability was high and evidence of construct validity was provided. The SPS correlated as hypothesized with church attendance, religiosity, and self-reported spirituality. In addition, the SPS correlated negatively with depression, anxiety, and stress. Factor analysis revealed a two-factor solution. The SPS performed well suggesting that it is an appropriate tool to use as a measure of spirituality in pregnant African American women.

BACKGROUND: Perinatal racial disparities remain an elusive problem in the United States. African American women experience the highest rate of low-birth-weight deliveries. Understanding the factors contributing to infant birth weight is crucial to unraveling existing perinatal racial disparities. OBJECTIVE: The aim of this study was to broaden knowledge of predictors of infant birth weight in African American people by examining stress and resource factors not explored routinely in perinatal research along with other known correlates of birth weight. METHODS: A total of 119 pregnant African American women participated in this prospective study. Social stressors included discrimination and trauma exposure. Personal resources included spirituality and social support. Data on socioeconomic status, health behaviors, and medical conditions were collected. RESULTS: On average, the infants weighed 3,194 +/- 660 g at birth. Overall, 14% were born with birth weights less than 2,500 g. Tobacco use, number of prenatal visits, and discrimination due to age and physical disability were significant predictors of infant birth weight (R2 = .25; p >or= .001). Factors such as spirituality and social support were not associated with birth weight. Other variables traditionally associated with birth weight did not contribute to the model in this sample. CONCLUSION: These findings provide further evidence that tobacco use, number of prenatal visits, and discrimination adversely affects birth outcomes. By continuing to explore the social and personal experiences of African American women, important insights can be gained on factors that contribute to the pervasive racial disparities in perinatal health and contribute to interventions to improve the quality of healthcare for all women.

The focus on racial health inequities has resurged. Although the reasons are complex, the consequences of racism are potentially contributing factors. This article aims to advance the concept of perceived racism as an area of focus for health inequity research by describing a framework within which to examine health outcomes that are associated with perceived racism. Perceived racism is defined as the subjective interpretation by the effected individual of an event, situation, or experience as negative, unjust, or undignified and one that solely occurs due to one's racial background. The framework establishes race as a determinant in health outcomes and it depicts the multidimensional contexts of racism. The model identifies physical, psychological, and behavioral pathways affecting health outcomes and personal, cultural, and social resources as mediating factors. Perceived racism can potentially permeate the lives of African-Americans and can profoundly impact their health and well being. The principles of concept clarification were applied to explore the association between perceived racism and health.

Objectives The objective of this study was to describe the occurrence of lifetime trauma exposure in relation to perinatal health outcomes in low-income African American women. Methods One hundred and sixteen pregnant African American women recruited from two public prenatal clinics participated in this exploratory study. Information was obtained about psychological symptoms, medical conditions, prenatal care utilization, and health behaviors. To measure lifetime trauma exposure, women completed the Trauma History Questionnaire. Maternal and infant outcome data were obtained from the medical records following delivery. Results The occurrence of trauma exposure was high, with 87% of the women reporting at least one traumatic event. Their mean age was 25 years, 21% were primiparas, and they reported a mean of 4.3 ± 3.5 (median = 3) traumatic events during their lifetime. Crime-related experiences were common and included incidents of family or friends being murdered or killed (40%), robberies (23%), home burglaries (14%), attacks with weapons (13%), and muggings (12%). Lifetime trauma exposure was significantly associated with depressive symptoms, anxiety, and generalized stress. Women with greater lifetime trauma exposure had a higher rate of tobacco use, higher rate of premature rupture of membranes, and longer maternal hospital stay. Conclusion Low-income African American women in this sample experienced a variety of traumatic events. Lifetime trauma exposure was associated with adverse perinatal health. Findings suggest the need to further investigate trauma across the lifespan to better understand the impact of these experiences on the reproductive health and well-being of women and their infants.