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Research suggests that breastfeeding may reduce child maltreatment risk. Alaska has high rates of both breastfeeding initiation and maltreatment reports to Child Protective Services (CPS). The present study assessed any and exclusive breastfeeding duration and child maltreatment reports to CPS among Alaskan mother-infant dyads, controlling for demographics and shared risk factors. We used a prospective, population-representative dataset linking 2009-2011 Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) data with 2009-2016 Alaska CPS and administrative state data (n = 3,459). Breastfeeding duration was derived from PRAMS breastfeeding questions and categorized as never, < 1 weeks, 1-9 weeks, and [greater than or equal to] 10 weeks. Age at first report of maltreatment to Alaska CPS included physical or sexual abuse, neglect, or mental injury. Hazard ratios and 95% confidence intervals (CI) were calculated using Cox proportional hazard models, adjusting for confounders. There was no increase in risk of maltreatment report among children never breastfed compared to those breastfed for [greater than or equal to] 10 weeks. Risk of maltreatment report during the observation period was 1.7 times as high among children breastfed for < 1 week (CI: 1.06, 2.73), and 1.5 times as high among those breastfed for 1-9 weeks (CI: 1.17, 1.80), compared to those breastfed for [greater than or equal to] 10 weeks. Estimates were attenuated for exclusive breastfeeding. Feeding method did not predict maltreatment reports in this population. Among mothers who initiated breastfeeding, shorter duration was associated with elevated risk of maltreatment reports. Addressing factors that facilitate or prohibit sustained breastfeeding may reduce risk of child maltreatment reports., Author(s): Helena J. Hutchins [sup.1] , Kim G. Harley [sup.1] , Jordyn T. Wallenborn [sup.1] , Barbara Abrams [sup.1] [sup.2] , Rebecca Reno [sup.1] , Jared W. Parrish [sup.3] Author [...]

Author(s): Rebecca Reno [sup.1] , Emily Warming [sup.1] , Claudia Zaugg [sup.1] , Kate Marx [sup.1] , Cheri Pies [sup.1] Author Affiliations: (1) grid.47840.3f, 0000 0001 2181 7878, School of [...], 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&apos;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.

Author(s): Patricia Temple Gabbe [sup.1] , Rebecca Reno [sup.1] , Carmen Clutter [sup.1] , T. F. Schottke [sup.1] , Tanikka Price [sup.1] , Katherine Calhoun [sup.1] , Jamie Sager [sup.1] [...], Objectives To describe temporal changes in maternal and child health outcomes in an impoverished urban community after the implementation of an innovative community-based pregnancy support program, named Moms2B. Methods Beginning in 2011, pregnant women in an urban impoverished community were recruited for participation in a community-based pregnancy support program focused on improving nutrition coupled with increasing social and medical support. The comprehensive program targeting pregnancy through the infants&apos; first year of life was developed and staffed by a multidisciplinary team from an academic health system. As a preliminary effort to assess the effectiveness of Moms2B, we examined maternal and infant health characteristics in the community before and after implementation of the program. Results From 2011 to 2014, 195 pregnant women attended one or more Moms2B sessions at the Weinland Park (WP) location. Most (75%) were African American (AA) with incomes below $800 per month and significant medical and social stressors. Outcomes from the two WP census tracts before and after implementation of the Moms2B program were studied. From 2007 to 2010, there were 442 births in WP and 6 infant deaths for an infant mortality rate of 14.2/1000. In 2011-2014, the first four years of the Moms2B program there were 339 births and one infant death giving an IMR of 2.9/1000, nearly a five-fold reduction in the rate of an infant death. Among pregnant women in WP who were covered by Medicaid, the breastfeeding initiation rate improved from 37.9 to 75.5% (p < .01) after the introduction of Moms2B. There were no infant deaths among Moms2B participants at the WP location in the first four years of the program. Conclusions Implementation of an innovative community-based pregnancy support program was associated with important improvements in maternal and infant health in an impoverished neighborhood.

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]

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]

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]

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]

Background: Female entertainment workers (FEWs) in Cambodia experience high levels of stress due to economic hardship, exposure to violence, and harassment by law enforcement due to their employment. This study aims to gather qualitative data on stressors, coping strategies, and preferences for chatline functions to inform the development of a WhatsApp hotline (chatline) for FEWs in Cambodia., Methods: This qualitative study includes data from 5 focus groups and 10 in-depth interviews (IDIs), at which point data collectors felt we approached saturation. Participants were asked to respond to open-ended questions, a comic strip showing how the hotline might work and an audio recording of a hypothetical hotline conversation. Primary structural coding was used to identify the preferred functions and type of support participants want to receive from hotline staff. As more secondary themes arose during codebook development, an inductive thematic analytical approach was selected to categorize these data., Results: Participants identified several stressors associated with female entertainment work, including concerns about physical and mental health, fear related to experiences with the police or threat of arrest, and exposure to violence. Passive/avoidance and active coping strategies were also identified. Participants preferred a 24 h chatline that provides emotional support from a kind and comforting female staff person. The types of support participants were looking for were advice about personal problems, encouragement to achieve their goals and address depression, and immediate help for violence. Most participants felt that the hotline could bring them a sense of relief and safety and improve their mood. Some stated that the hotline alone would not alleviate the stressors they were exposed to, particularly related to violence and called for more transformational change., Conclusions: This study offers textured evidence to inform the WhatsApp hotline development and staff training tailored to meet the needs of this specific population. Linking this hotline with crisis response, legal support, and longer-term in-depth counseling and using information gathered from this project to inform more extensive structural and policy-level changes should also be part a foundational part of this project., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/mhealth-21-12). Dr. Carinne Brody serves as an unpaid editorial board member of mHealth from March 2021 to February 2023. The other authors have no conflicts of interest to declare., (2022 mHealth. All rights reserved.)