RESUMO
PURPOSE: To examine whether ethnic differences in low birth weight babies of low-income women may be explained in part by group differences in prenatal health behaviors and psychosocial factors. METHODS: A prospective, survey of 1,071 low-income, primiparous African-American and Mexican-origin women was conducted in Los Angeles County, California. In face-to-face interviews, data were obtained on substance use, prenatal stress, social support, attitudes toward pregnancy, initiation of prenatal care, and medical risk. Medical chart data were abstracted regarding medical risk factors and labor, delivery, and neonatal data. Interview data were linked with birth outcome data retrieved from maternal medical records. Structural equation modeling was used to test a hypothesized model in which differences in birth weight were expected to be mediated by ethnic differences in substance use, psychosocial factors, and medical risk. RESULTS: As expected, African-American women delivered babies of earlier gestational age and lower birth weight than did women of Mexican origin. Direct predictors of low birth weight were use of drugs and cigarettes, prenatal stress, and positive attitudes toward pregnancy; together, these factors accounted for the observed ethnic differences in birth weight. CONCLUSION: These data contribute to our understanding of the factors that may account for ethnic-associated differences in low birth weight.
Assuntos
Peso ao Nascer , Etnicidade , Adolescente , Adulto , Negro ou Afro-Americano , Atitude Frente a Saúde , Parto Obstétrico , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Entrevistas como Assunto , Trabalho de Parto , Los Angeles , Americanos Mexicanos , México/etnologia , Pobreza , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal , Efeitos Tardios da Exposição Pré-Natal , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Apoio Social , Transtornos Relacionados ao Uso de Substâncias/etiologiaRESUMO
OBJECTIVES: This study examined the association between acculturation of Mexican-origin women and factors in low birthweight and preterm delivery. METHODS: Interviews were conducted with 911 Mexican-origin respondents in Los Angeles prenatal care clinics. Infant outcome data were retrieved from delivery records. RESULTS: Mexican-American women had generally more undesirable prenatal behaviors and risk factors than Mexican-immigrant women. Although higher acculturation was significantly associated with behavioral risk factors, there were no direct effects of acculturation on infant gestational age or birthweight. CONCLUSIONS: Future research needs to measure multiple factors to assess their effects on culture-specific protective factors.
Assuntos
Aculturação , Comportamentos Relacionados com a Saúde , Americanos Mexicanos/psicologia , Gravidez , Apoio Social , Adulto , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Americanos Mexicanos/estatística & dados numéricos , Gravidez/psicologia , Fatores de RiscoRESUMO
PURPOSE: To describe ethnic-specific patterns of substance use before and during pregnancy in low-income pregnant women, examine the associations between psychosocial factors and patterns of substance use within ethnic groups, and assess maternal sociodemographic, prenatal, and psychosocial factors of women who continue to use substances during pregnancy and those who do not. METHOD: A prospective study of low-income, primiparous African American (n = 255), Mexican American (n = 525), and Mexican immigrant (n = 764) women was conducted in 22 prenatal care clinics in Los Angeles, CA. Data were collected in face-to-face interviews in both English and Spanish on prenatal life events, anxiety, sources of support, and substance use behaviors three months before and during pregnancy. FINDINGS: Significant ethnic differences were found in use of alcohol, cigarettes, and illicit drugs. African American women were more likely than Mexican-origin women to report use of substances before and during pregnancy. Mexican American women were more likely than Mexican immigrant women to report use of substances before and during pregnancy. Women who continued to use substances during pregnancy were less likely to be living with the baby's father, to have planned the pregnancy, to report having been able to go for prenatal care as soon as they wanted, and more likely to be identified at medical risk. CONCLUSIONS: Providers must increase the assessment and monitoring of substance use behaviors of low-income women in prenatal care settings. The role of health care providers must encompass advocacy and public health education.
Assuntos
Negro ou Afro-Americano/psicologia , Americanos Mexicanos/psicologia , Mães/psicologia , Pobreza , Transtornos Relacionados ao Uso de Substâncias/etnologia , Adolescente , Adulto , California , Comparação Transcultural , Emigração e Imigração , Feminino , Humanos , México/etnologia , Gravidez , Estudos Prospectivos , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
Communication theories and research data were used to design cross-cultural health education messages. A University of California Los Angeles-Universidad Autonoma in Tijuana, Mexico, research team used the methods of ethnographic and survey research to study behaviors, attitudes, and knowledge concerning prenatal care of a sample of pregnant low-income women living in Tijuana. This audience provided information that served as a framework for a series of messages to increase awareness and change prenatal care behaviors. The message design process was guided by persuasion theories that included Petty and Caccioppo's elaboration likelihood model, McGuire's persuasion matrix, and Bandura's social learning theory. The results from the research showed that poor women in Tijuana tend to delay or not seek prenatal care. They were not aware of symptoms that could warn of pregnancy complications. Their responses also revealed pregnant women's culturally specific beliefs and behaviors regarding pregnancy. After examination of these and other results from the study, prenatal care messages about four topics were identified as the most relevant to communicate to this audience: health services use, the mother's weight gain, nutrition and anemia, and symptoms of high-risk complications during pregnancy. A poster, a calendar, a brochure, and two radio songs were produced and pretested in focus groups with low-income women in Tijuana. Each medium included one or more messages addressing informational, attitudinal, or behavioral needs, or all three, of the target population.
Assuntos
Educação em Saúde , Cuidado Pré-Natal , Adolescente , Adulto , Comunicação , Cultura , Feminino , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Humanos , México , Pessoa de Meia-Idade , Gravidez , Fatores SocioeconômicosRESUMO
There is very limited information on ethnic differences in use of prenatal care services. The purpose of this study was to examine the effect of sociodemographic, health behaviors, medical risk, and psychosocial risk factors on the timing of prenatal care among Black-American, Mexican-American, and recent Mexican immigrant women in Los Angeles. A sample of 107 primiparous women were interviewed using a structured questionnaire. Information obtained included socioeconomic indicators, relationship with baby's father, timing of prenatal care, psychosocial factors, and substance use before pregnancy. Ethnic patterns of timing of prenatal care revealed no significant differences. The relationship with the baby's father was associated with early timing of prenatal care and more prenatal care visits. Substance use before pregnancy was significantly related to total number of visits for this pregnancy.
Assuntos
Atitude Frente a Saúde/etnologia , Negro ou Afro-Americano , Emigração e Imigração , Americanos Mexicanos , Cuidado Pré-Natal , Adulto , África/etnologia , Consumo de Bebidas Alcoólicas/etnologia , População Negra , Feminino , Comportamentos Relacionados com a Saúde/etnologia , Humanos , Renda , Acontecimentos que Mudam a Vida , Los Angeles , México/etnologia , Análise Multivariada , Gravidez , Fatores de Risco , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/etnologiaRESUMO
Examined psychosocial factors related to prenatal and postnatal anxiety in 291 primiparous Mexican women giving birth in Los Angeles. Characteristics of health care providers preferred by more anxious and less anxious women were also assessed. Higher prenatal anxiety was associated with less desire for an active role during labor, lower assertiveness, higher pain expectation at delivery, lack of support from family members other than the husband, and preferences for health care providers who are female and Latino. All groups of women preferred health care providers who provided good medical explanations and who were knowledgeable, friendly, and sympathetic. Postnatal anxiety was significantly lower than prenatal anxiety. Negative attitudes toward the baby and number of complications during labor and delivery, however, were related to postnatal anxiety adjusted for prenatal anxiety.
Assuntos
Ansiedade/psicologia , Hispânico ou Latino/psicologia , Trabalho de Parto/psicologia , Gravidez/psicologia , Cuidado Pré-Natal/psicologia , Aculturação , Adulto , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Los Angeles , México/etnologia , Educação de Pacientes como Assunto , Testes de Personalidade , Relações Médico-PacienteAssuntos
Atitude , Cesárea , Hispânico ou Latino/psicologia , California , Cultura , Parto Obstétrico/métodos , Feminino , Humanos , Satisfação Pessoal , GravidezRESUMO
The process of conducting applied anthropological work leading to health program development and evaluation is seldom described in the literature. This paper discusses the combination of factors which led to the involvement of anthropologists in the Central American Child Survival Project and how anthropological approaches are being used in the project. Ethnoclassification was used to illustrate the discrepancy between the proposed approach to treatment for dehydration produced by diarrheal disease and the actual beliefs and practices in 4 Central American communities. Techniques such as rapid, focused assessment using anthropological methods of data collection and presentation are discussed, as are strategies for presenting this information to health program planners and administrators.
Assuntos
Antropologia Cultural , Países em Desenvolvimento , Diarreia/prevenção & controle , Medicina Tradicional , América Central , Criança , Pré-Escolar , Diarreia Infantil/prevenção & controle , Educação em Saúde , Humanos , LactenteRESUMO
Data on breastfeeding intentions and behavior were collected in prenatal and postpartum interviews as part of a study on first birth among 518 women of Mexican origin or descent in two Los Angeles hospitals. The prenatal intentions of 82 per cent of the women to breastfeed were maintained postpartum in one hospital but dropped sharply in the other. A greater number of hours a day with the baby in the hospital and earlier initiation of breastfeeding were associated with the hospital where prenatal breastfeeding intentions were more likely to be carried out. The intention to work postpartum was associated both with the decision not to breastfeed at all and with shorter intended duration of breastfeeding.
Assuntos
Atitude , Aleitamento Materno , Hispânico ou Latino , Adulto , California , Emprego , Feminino , Humanos , Casamento , México/etnologia , Período Pós-Parto , Gravidez , Estados UnidosRESUMO
PIP: This paper analyzes a data set on women of Mexican origin delivering in Los Angeles hospitals, in order to examine whether Mexican women's attitudes toward their 1st-born infants are influenced by the sex of the child, either alone or in combination with other factors, such as the difficulty of labor and delivery or the woman's social support system. The authors' hypothesize that the mother's attitude toward the 1st child will be determined primarily by factors other than the child's sex, since there is evidence to suggest equal sex preference among women in Latin culture. They predict that the most negative attitudes would be expressed in the case of an unplanned pregnancy, of a child being born into an unstable family or with physical abnormalities. The women described in this paper are all from the Mestizo, or Hispanicized peoples from Mexico. The analyses are based on interviews with a sample of 518 low risk women. Data on the medical course of their labor and delivery was also collected from their medical charts. The operationalization and measurement of each predictive variable are explained. Sex differences in women's evaluations of their children were examined with Chi-Square analyses. As expected, almost no differences on any attitude measure were found. In general the mothers were very pleased with their infants, whether male or female, although there is a suggestion that if they were disappointed, they were more likely to be displeased with a female infant than with a male. Regression analyses, more sensitive for picking up sex differences than the simple Chi-Square, were performed to determine which of the predictive variables were most related to the mother's attitude. Results show that sex was not a predictive variable. Contrary to what was predicted, whether or not the baby was planned, appeared to be relatively unimportant in the mother's attitude toward her child. A 2nd surprising finding was that the woman's experience of birth was unrelated to her evaluation of her child. The social support system had a significant impact on the mother's evaluation of her child. For both boys and girls, social support from the baby's father was associated with a positive attitude toward infants. Women were significantly more negative toward their infants if they had a poor relationship with the baby's father. Finally, the more acculturated women expressed less positive attitudes toward their newborns; this relationship was slightly stronger for girls than boys.^ieng
Assuntos
Atitude , Hispânico ou Latino/psicologia , Recém-Nascido , Fatores Sexuais , California , Cultura , Feminino , Humanos , Masculino , México/etnologia , Relações Mãe-FilhoRESUMO
PIP: Blake hypothesized in 1955 that the instability of reproductive unions may affect fertility in 2 opposite ways - it may reduce the rate of reproduction by decreasing the total time of exposure to pregnancy, and it may increase the rate of reproduction because there is often a desire to have children born of each new union or simply because coitus is more frequent at the start of each new union. Independent measurements of the effects on fertility of these 2 components are presented in order to test a modified form of Blake's hypothesis. The source of data for this analysis is the Urban In-Migration and Fertility Survey conducted in Guayaquil, Ecuador, in 1971. When the number of unions was controlled for, a negative correlation between fertility and years of reproductive time loss was found among men, but the evidence among the female population was not conclusive. Women with less than 1 year of loss had .7 fewer children than women with 1-3 years of loss. This is a significant difference which cannot be explained by sampling error. When years spent in union was controlled for, individuals who had 2 unions had a 14% higher fertility rate than those who had been in only 1 union. Similar results were found for both the male and female populations. These findings support the hypothesis that multiplicity of sexual unions has a positive effect on fertility. The desire for children in the current union seems to be stronger among the Ecuadorian men. It can be concluded that in societies where people enter new unions soon after dissolution of a previous union, instability will have a positive effect upon fertility. Instability will tend to reduce fertility in societies where people spend a long time in interunion or postunion celibacy.^ieng
Assuntos
Coleta de Dados , Características da Família , Homens , Pobreza , Fatores Socioeconômicos , Estatística como Assunto , População Urbana , Mulheres , Fatores Etários , América , Demografia , Países em Desenvolvimento , Economia , Equador , América Latina , Paridade , População , Características da População , Dinâmica Populacional , Pesquisa , Estudos de Amostragem , Classe Social , América do SulRESUMO
Summary Intervals between births to 1934 women from poor areas of Guayaquil, Ecuador, were subjected to analysis to determine what effect on survival chances of their children, if any, was exerted by differences in these intervals. The analysis showed that risks of miscarriage and stillbirth were increased when the interval between last termination of pregnancy and conception was either very short or very long. Post-neo-natal mortality was strongly influenced by the length of the interval, reaching a minimum where the interval was around three years. The influence of interval length diminished as the level of mortality fell (with improving health standards over time). The possibility could not be discarded that for neo-natal mortality and mortality in the second year of life, extremely short intervals (under three months) carried significant additional risks. For both periods, intervals longer than three years increased the risk of infant mortality. Evidence was found that the survival chances of the first child of a pair were seriously impaired during the first year of life where a fresh conception supervened during that period (the earlier this happened the more serious the impairment). An analysis of'double intervals' (not presented here) showed that the effects of short intervals were exaggerated when two such intervals succeeded one another. The principle conclusions remained valid when competing sources of association between short intervals and mortality were excluded, thus lending plausibility to the view that the two are connected by a causal chain. While no great precision can be claimed, it seems likely that if effective measures were taken to prevent the occurrence of pregnancy intervals shorter than 27 months (corresponding to birth intervals of less than three years) spontaneous abortions might be reduced by one-third and infant mortality by one-half in populations similar to that studied here. These results justify a recommendation that the prescription of contraception for a limited period post-partum in areas of moderate or high neo-natal mortality should become a routine of responsible obstetric or maternity and child welfare care.