Objectives To examine: (1) the prevalence and characteristics of bed-sharing among non-Hispanic B... more Objectives To examine: (1) the prevalence and characteristics of bed-sharing among non-Hispanic Black and White infants in Georgia, and (2) differences in bed-sharing and sleep position behaviors prior to and after the American Academy of Pediatrics' 2005 recommendations against bed-sharing. Methods Georgia Pregnancy Risk Assessment Monitoring System (PRAMS) data were obtained from the Georgia Department of Public Health. Analysis was guided by the socioecological model levels of: Infant, Maternal, Family, and Community/Society within the context of race. Data from 2004 to 2011 were analyzed to address the first objective and from 2000 to 2004 and 2006 to 2011 to address the second objective. Rao-Scott Chi square tests and backward selection unconditional logistic regression models for weighted data were built separately by race; odds ratios (OR) and 95 % Confidence Intervals (CIs) were calculated. Results A total of 6595 (3528 Black and 3067 White) cases were analyzed between 2004 and 2011. Significantly more Black mothers (81.9 %) reported "ever" bed-sharing compared to White mothers (56 %), p < 0.001. Logistic regression results indicated that the most parsimonious model included variables from all socioecological levels. For Blacks, the final model included infant age, pregnancy intention, number of dependents, and use of Women, Infant and Children (WIC) Services. For Whites, the final model included infant age, maternal age, financial stress, partner-related stress, and WIC. When comparing the period 2000-2004 to 2006-2011, a total of 10,015 (5373 Black and 4642 White cases) were analyzed. A significant decrease in bedsharing was found for both Blacks and Whites; rates of non-supine sleep position decreased significantly for Blacks but not Whites. Conclusions for Practice Continued high rates of bed-sharing and non-supine sleep position for both Blacks and Whites demonstrate an ongoing need for safe infant sleep messaging. Risk profiles for Black and White mothers differed, suggesting the importance of tailored messaging. Specific research and practice implications are identified and described.
Background. Although the American Academy of Pediatrics has recommended a separate but proximate ... more Background. Although the American Academy of Pediatrics has recommended a separate but proximate sleep surface for infants since 2005, maternal-infant bed-sharing remains a common practice, especially among African-Americans. Bed-sharing has been associated with a higher risk of Sudden Infant Death Syndrome, which affects African-Americans at a disproportionately higher rate. This study examined factors associated with bed-sharing (main outcome) among African-American and White mothers. Methods. Analysis of the 2007-2010 Wisconsin Pregnancy Risk Assessment and Monitoring System (PRAMS) using separate logistic regression models for African-Americans and Whites. Results. The sample consisted of 806 African-Americans and 1,680 Whites (N = 2,486). A significantly larger proportion of African-Americans (70.6%) reported bed-sharing than Whites (53.4%). For both races, partner-related stress was significantly associated with bed-sharing; no significant differences were found between the tw...
Health education & behavior : the official publication of the Society for Public Health Education, 2014
Mother-infant bed-sharing has been associated with an increased risk of sleep-related infant deat... more Mother-infant bed-sharing has been associated with an increased risk of sleep-related infant deaths, and thus, health messaging has aimed to discourage this behavior. Despite this messaging, bed-sharing remains a common practice in the United States, especially among minority families. Moreover, rates of accidental suffocation and strangulation in bed (often related to bed-sharing) are on the rise, with Black infants at two to three times greater risk than Whites. Multiple studies have identified risk factors for bed-sharing, but a gap remains between findings and translation into interventions. The socio-ecological model (SEM) has been suggested as a way to study and design interventions addressing complex public health issues. This article reconceptualizes the literature on mother-infant bed-sharing using the SEM. PubMed, POPLINE, ERIC, and Psych Info were searched for articles that (a) included bed-sharing as the outcome variable, (b) were published between 2000 and 2013, (c) wer...
WMJ : official publication of the State Medical Society of Wisconsin, 2010
A national study found that infants born in low socioeconomic areas had the worst infant mortalit... more A national study found that infants born in low socioeconomic areas had the worst infant mortality rates (IMRs) and the highest racial disparity. Racial disparities in birth outcomes are also evident in the city of Milwaukee, with African American infants at 3 times greater the risk than white infants. This study was conducted to examine the influence of socioeconomic status (SES) and race on birth outcomes in the city of Milwaukee. Milwaukee ZIP codes were stratified into lower, middle, and upper SES groups. IMR, low birth weight, and preterm birth rates by race were analyzed by SES group for the years 2003 to 2007. The overall IMR for the lower, middle, and upper SES groups were 12.4, 10.7, and 7.7, respectively. The largest racial disparity in IMR (3.1) was in the middle SES group, versus lower (1.6) and upper (1.8) SES groups. The overall percent of low birth weight infants for the lower, middle, and upper SES groups was 10.9%, 9.5%, and 7.5%, respectively. Racial disparity rati...
Objectives: The aims of this pilot study were to evaluate treatment effects, ascertain safety and... more Objectives: The aims of this pilot study were to evaluate treatment effects, ascertain safety and formulate best practice Chinese medicine protocols relevant for London women suffering from menopausal symptoms. Study design: This clinical pilot study employed a case series design within a wider action-based research project. 117 perimenopausal women between 45 and 55 years of age recruited from the general population were treated for menopausal symptoms by six experienced practitioners of Chinese medicine at the Polyclinic of the University of Westminster. Practitioners were instructed to treat as near to their usual practice style as possible. This involved using Chinese herbal medicine and/or acupuncture along with dietary and lifestyle advice. A maximum of 12 treatments over 6 months was allowed per patient. Outcome measures: The menopause specific quality of life questionnaire (MenQoL), the Greene climacteric scale, and flushing diaries were used to evaluate treatment outcomes. Liver and kidney function tests were carried out at intake and after 1, 6 and 12 treatments to evaluate the safety particularly in relation to the use of herbal medicines. Results: Patients showed significant improvement across all domains measured by the MenQoL and Greene climacteric scales. Reduction on the MenQoL scale between first and last visit was from 4.31 to 3.27 (p < 0.001) and on the Green climacteric scale from 21.01 to 13.00 (p < 0.001). Study participants did not reliably complete their flushing diaries. No adverse events or abnormal liver or kidney function values were observed during the course of the study. Conclusions: Further research that seeks to investigate the effects observed in more detail and to evaluate them against other forms of treatment and/or no-treatment controls is warranted. This could be achieved by way of a pragmatic randomized controlled trial that evaluated Chinese medicine against orthodox medical care.
Mother-infant bed-sharing has been associated with a higher risk of sleep-related infant deaths, ... more Mother-infant bed-sharing has been associated with a higher risk of sleep-related infant deaths, which affects African Americans at a disproportionately higher rate. Although &amp;amp;amp;amp;quot;separate but proximate sleep surfaces&amp;amp;amp;amp;quot; for infants has been recommended since 2005, bed-sharing remains a common practice, especially among African Americans. This study examined factors associated with bed-sharing among African American and White mothers. Separate logistic regression models were constructed for African American and White respondents to the 2007-2010 Wisconsin Pregnancy Risk Assessment and Monitoring System. The sample consisted of 806 African Americans and 1,680 Whites (N = 2,486). A significantly larger proportion of African Americans (70.6 %) reported bed-sharing than Whites (53.4 %). For both races, partner-related stress was significantly associated with bed-sharing; no significant differences were found between the two racial groups. For African Americans, partner stress (OR 1.8: 1.2-2.6) and maternal education of 13-15 years (OR 2.0: 1.2-3.4) or ≥16 years (OR 2.7: 1.1-6.3) was associated with increased odds of bed-sharing. For Whites, partner stress (OR 1.3: 1-1.8), breastfeeding (OR 2.5: 1.9-3.1), income of $35,000-$49,999 (OR 1.6: 1.2-2.3), being unmarried (OR 1.5: 1.1-2.2), needing money for food (OR 1.6: 1.1-2.3), and non-supine sleep (OR 1.8: 1.2-2.6) were associated with increased odds of bed-sharing. Differences were found in bed-sharing factors between racial groups which suggests a need for culturally-relevant, tailored safe infant sleep interventions. Providers should ask families about their infant&amp;amp;amp;amp;#39;s sleeping environment and address safety issues within that environment. More research is needed on the context and reasons for bed-sharing.
Randomized data from SWOG 8794 and EORTC 22911 confirm the benefit of post-operative radiation th... more Randomized data from SWOG 8794 and EORTC 22911 confirm the benefit of post-operative radiation therapy (RT) for selected patients with pT3 prostate cancer (CaP) after radical prostatectomy (RP). However, data regarding the potential benefit of RT for patients post-RP with positive lymph node ( þ LN) involvement are limited. We analyzed the Surveillance Epidemiology End Results (SEER) registry for population-based data on efficacy of postoperative RT for þ LN patients after RP. As LN data have only been captured by SEER since 1988, we analyzed data for 1988-1992, with specific attention to 10-year relative survival (defined as observed survival divided by the survival of a gender-, age-and race-matched population cohort without disease). Specifically analyzed were data for 1921 patients with nonmetastatic prostate cancer who underwent surgery alone, or surgery followed by RT, and who had þ LNs documented. SEER does not code the interval between surgery and RT, so the ratio of patients receiving salvage versus adjuvant therapy is unknown. Using follow-up data through 2002, post-diagnosis survival was examined by number of þ LNs. There was no significant relative survival benefit for þ LN patients receiving post-operative RT (v 2 P ¼ 0.270). These data do not support routine use of postoperative RT for patients with þ LNs in the surgical specimen.
African American infants die at higher rates and are at greater risk of adverse birth outcomes th... more African American infants die at higher rates and are at greater risk of adverse birth outcomes than White infants in Milwaukee. Though self-reported experiences of racism have been linked to adverse health outcomes, limited research exists on the impact of racism on women&amp;amp;amp;amp;#39;s prenatal care experiences. The purpose of this study was to examine the experiences of racial discrimination during prenatal care from the perspectives of African American women in a low income Milwaukee neighborhood. Transcripts from six focus groups with twenty-nine women and two individual interviews were analyzed to identify important emergent themes. Validity was maintained using an audit trail, peer debriefing, and two individual member validation sessions. Participants identified three areas of perceived discrimination based on: (1) insurance or income status, (2) race, and (3) lifetime experiences of racial discrimination. Women described being treated differently by support staff and providers based on type of insurance (public versus private), including perceiving a lower quality of care at clinics that accepted public insurance. While some described personally-mediated racism, the majority of women described experiences that fit within a definition of institutionalized racism-in which the system was designed in a way that worked against their attempts to get quality prenatal care. Women also described lifetime experiences of racial discrimination. Our findings suggest that African American women with limited incomes perceive many provider practices and personal interactions during prenatal care as discriminatory. Future studies could explore the relationship between perceptions of discrimination and utilization of prenatal care.
Journal of Social Work Practice in the Addictions, 2011
This article explores the importance of incorporating past attempts at changing one's drinking du... more This article explores the importance of incorporating past attempts at changing one's drinking during current assessment and treatment processes, as well as when interpreting research outcomes. It is hypothesized that the current change efforts might be influenced by the change attempts that individuals have experienced over the lifecourse or "career" of their alcohol use disorders. In addition to formal treatment efforts, previous attempts might include other
Background: There is a significant need for research on treatments that provide pain relief durin... more Background: There is a significant need for research on treatments that provide pain relief during intrauterine device (IUD) insertion. Misoprostol is frequently used before IUD insertion but is not always necessary and its use may increase pain and side effects. This survey evaluated how providers who perform IUD insertion in nulliparous women report using misoprostol to facilitate the procedure. Study Design: An anonymous Internet-based survey was distributed to members of three professional organizations with family planning providers. Results: Of 2211 survey respondents, 1905 (86%) reported providing IUDs to nulliparous women. Of those providing IUDs to nulliparous women, 947/1905 (49.7%) reported using misoprostol, and 380 (40%) of 947 of misoprostol users reported using the treatment empirically with all nulliparous IUD insertions. There was wide variation reported in dose, route and timing of misoprostol administration. Providers most commonly reported learning of misoprostol use for IUD insertion by word of mouth rather than through the literature. Conclusions: Despite conflicting published data, nearly half of survey respondents use misoprostol before IUD insertion. Considerable variation in the timing of misoprostol use may explain differences in perception of its effectiveness. Evidence-based information about misoprostol for IUD insertion in nulliparous women, including pharmacokinetics, efficacy and optimal dosing, is needed.
Objectives To examine: (1) the prevalence and characteristics of bed-sharing among non-Hispanic B... more Objectives To examine: (1) the prevalence and characteristics of bed-sharing among non-Hispanic Black and White infants in Georgia, and (2) differences in bed-sharing and sleep position behaviors prior to and after the American Academy of Pediatrics&#39; 2005 recommendations against bed-sharing. Methods Georgia Pregnancy Risk Assessment Monitoring System (PRAMS) data were obtained from the Georgia Department of Public Health. Analysis was guided by the socioecological model levels of: Infant, Maternal, Family, and Community/Society within the context of race. Data from 2004 to 2011 were analyzed to address the first objective and from 2000 to 2004 and 2006 to 2011 to address the second objective. Rao-Scott Chi square tests and backward selection unconditional logistic regression models for weighted data were built separately by race; odds ratios (OR) and 95 % Confidence Intervals (CIs) were calculated. Results A total of 6595 (3528 Black and 3067 White) cases were analyzed between 2004 and 2011. Significantly more Black mothers (81.9 %) reported &quot;ever&quot; bed-sharing compared to White mothers (56 %), p &lt; 0.001. Logistic regression results indicated that the most parsimonious model included variables from all socioecological levels. For Blacks, the final model included infant age, pregnancy intention, number of dependents, and use of Women, Infant and Children (WIC) Services. For Whites, the final model included infant age, maternal age, financial stress, partner-related stress, and WIC. When comparing the period 2000-2004 to 2006-2011, a total of 10,015 (5373 Black and 4642 White cases) were analyzed. A significant decrease in bedsharing was found for both Blacks and Whites; rates of non-supine sleep position decreased significantly for Blacks but not Whites. Conclusions for Practice Continued high rates of bed-sharing and non-supine sleep position for both Blacks and Whites demonstrate an ongoing need for safe infant sleep messaging. Risk profiles for Black and White mothers differed, suggesting the importance of tailored messaging. Specific research and practice implications are identified and described.
Background. Although the American Academy of Pediatrics has recommended a separate but proximate ... more Background. Although the American Academy of Pediatrics has recommended a separate but proximate sleep surface for infants since 2005, maternal-infant bed-sharing remains a common practice, especially among African-Americans. Bed-sharing has been associated with a higher risk of Sudden Infant Death Syndrome, which affects African-Americans at a disproportionately higher rate. This study examined factors associated with bed-sharing (main outcome) among African-American and White mothers. Methods. Analysis of the 2007-2010 Wisconsin Pregnancy Risk Assessment and Monitoring System (PRAMS) using separate logistic regression models for African-Americans and Whites. Results. The sample consisted of 806 African-Americans and 1,680 Whites (N = 2,486). A significantly larger proportion of African-Americans (70.6%) reported bed-sharing than Whites (53.4%). For both races, partner-related stress was significantly associated with bed-sharing; no significant differences were found between the tw...
Health education & behavior : the official publication of the Society for Public Health Education, 2014
Mother-infant bed-sharing has been associated with an increased risk of sleep-related infant deat... more Mother-infant bed-sharing has been associated with an increased risk of sleep-related infant deaths, and thus, health messaging has aimed to discourage this behavior. Despite this messaging, bed-sharing remains a common practice in the United States, especially among minority families. Moreover, rates of accidental suffocation and strangulation in bed (often related to bed-sharing) are on the rise, with Black infants at two to three times greater risk than Whites. Multiple studies have identified risk factors for bed-sharing, but a gap remains between findings and translation into interventions. The socio-ecological model (SEM) has been suggested as a way to study and design interventions addressing complex public health issues. This article reconceptualizes the literature on mother-infant bed-sharing using the SEM. PubMed, POPLINE, ERIC, and Psych Info were searched for articles that (a) included bed-sharing as the outcome variable, (b) were published between 2000 and 2013, (c) wer...
WMJ : official publication of the State Medical Society of Wisconsin, 2010
A national study found that infants born in low socioeconomic areas had the worst infant mortalit... more A national study found that infants born in low socioeconomic areas had the worst infant mortality rates (IMRs) and the highest racial disparity. Racial disparities in birth outcomes are also evident in the city of Milwaukee, with African American infants at 3 times greater the risk than white infants. This study was conducted to examine the influence of socioeconomic status (SES) and race on birth outcomes in the city of Milwaukee. Milwaukee ZIP codes were stratified into lower, middle, and upper SES groups. IMR, low birth weight, and preterm birth rates by race were analyzed by SES group for the years 2003 to 2007. The overall IMR for the lower, middle, and upper SES groups were 12.4, 10.7, and 7.7, respectively. The largest racial disparity in IMR (3.1) was in the middle SES group, versus lower (1.6) and upper (1.8) SES groups. The overall percent of low birth weight infants for the lower, middle, and upper SES groups was 10.9%, 9.5%, and 7.5%, respectively. Racial disparity rati...
Objectives: The aims of this pilot study were to evaluate treatment effects, ascertain safety and... more Objectives: The aims of this pilot study were to evaluate treatment effects, ascertain safety and formulate best practice Chinese medicine protocols relevant for London women suffering from menopausal symptoms. Study design: This clinical pilot study employed a case series design within a wider action-based research project. 117 perimenopausal women between 45 and 55 years of age recruited from the general population were treated for menopausal symptoms by six experienced practitioners of Chinese medicine at the Polyclinic of the University of Westminster. Practitioners were instructed to treat as near to their usual practice style as possible. This involved using Chinese herbal medicine and/or acupuncture along with dietary and lifestyle advice. A maximum of 12 treatments over 6 months was allowed per patient. Outcome measures: The menopause specific quality of life questionnaire (MenQoL), the Greene climacteric scale, and flushing diaries were used to evaluate treatment outcomes. Liver and kidney function tests were carried out at intake and after 1, 6 and 12 treatments to evaluate the safety particularly in relation to the use of herbal medicines. Results: Patients showed significant improvement across all domains measured by the MenQoL and Greene climacteric scales. Reduction on the MenQoL scale between first and last visit was from 4.31 to 3.27 (p < 0.001) and on the Green climacteric scale from 21.01 to 13.00 (p < 0.001). Study participants did not reliably complete their flushing diaries. No adverse events or abnormal liver or kidney function values were observed during the course of the study. Conclusions: Further research that seeks to investigate the effects observed in more detail and to evaluate them against other forms of treatment and/or no-treatment controls is warranted. This could be achieved by way of a pragmatic randomized controlled trial that evaluated Chinese medicine against orthodox medical care.
Mother-infant bed-sharing has been associated with a higher risk of sleep-related infant deaths, ... more Mother-infant bed-sharing has been associated with a higher risk of sleep-related infant deaths, which affects African Americans at a disproportionately higher rate. Although &amp;amp;amp;amp;quot;separate but proximate sleep surfaces&amp;amp;amp;amp;quot; for infants has been recommended since 2005, bed-sharing remains a common practice, especially among African Americans. This study examined factors associated with bed-sharing among African American and White mothers. Separate logistic regression models were constructed for African American and White respondents to the 2007-2010 Wisconsin Pregnancy Risk Assessment and Monitoring System. The sample consisted of 806 African Americans and 1,680 Whites (N = 2,486). A significantly larger proportion of African Americans (70.6 %) reported bed-sharing than Whites (53.4 %). For both races, partner-related stress was significantly associated with bed-sharing; no significant differences were found between the two racial groups. For African Americans, partner stress (OR 1.8: 1.2-2.6) and maternal education of 13-15 years (OR 2.0: 1.2-3.4) or ≥16 years (OR 2.7: 1.1-6.3) was associated with increased odds of bed-sharing. For Whites, partner stress (OR 1.3: 1-1.8), breastfeeding (OR 2.5: 1.9-3.1), income of $35,000-$49,999 (OR 1.6: 1.2-2.3), being unmarried (OR 1.5: 1.1-2.2), needing money for food (OR 1.6: 1.1-2.3), and non-supine sleep (OR 1.8: 1.2-2.6) were associated with increased odds of bed-sharing. Differences were found in bed-sharing factors between racial groups which suggests a need for culturally-relevant, tailored safe infant sleep interventions. Providers should ask families about their infant&amp;amp;amp;amp;#39;s sleeping environment and address safety issues within that environment. More research is needed on the context and reasons for bed-sharing.
Randomized data from SWOG 8794 and EORTC 22911 confirm the benefit of post-operative radiation th... more Randomized data from SWOG 8794 and EORTC 22911 confirm the benefit of post-operative radiation therapy (RT) for selected patients with pT3 prostate cancer (CaP) after radical prostatectomy (RP). However, data regarding the potential benefit of RT for patients post-RP with positive lymph node ( þ LN) involvement are limited. We analyzed the Surveillance Epidemiology End Results (SEER) registry for population-based data on efficacy of postoperative RT for þ LN patients after RP. As LN data have only been captured by SEER since 1988, we analyzed data for 1988-1992, with specific attention to 10-year relative survival (defined as observed survival divided by the survival of a gender-, age-and race-matched population cohort without disease). Specifically analyzed were data for 1921 patients with nonmetastatic prostate cancer who underwent surgery alone, or surgery followed by RT, and who had þ LNs documented. SEER does not code the interval between surgery and RT, so the ratio of patients receiving salvage versus adjuvant therapy is unknown. Using follow-up data through 2002, post-diagnosis survival was examined by number of þ LNs. There was no significant relative survival benefit for þ LN patients receiving post-operative RT (v 2 P ¼ 0.270). These data do not support routine use of postoperative RT for patients with þ LNs in the surgical specimen.
African American infants die at higher rates and are at greater risk of adverse birth outcomes th... more African American infants die at higher rates and are at greater risk of adverse birth outcomes than White infants in Milwaukee. Though self-reported experiences of racism have been linked to adverse health outcomes, limited research exists on the impact of racism on women&amp;amp;amp;amp;#39;s prenatal care experiences. The purpose of this study was to examine the experiences of racial discrimination during prenatal care from the perspectives of African American women in a low income Milwaukee neighborhood. Transcripts from six focus groups with twenty-nine women and two individual interviews were analyzed to identify important emergent themes. Validity was maintained using an audit trail, peer debriefing, and two individual member validation sessions. Participants identified three areas of perceived discrimination based on: (1) insurance or income status, (2) race, and (3) lifetime experiences of racial discrimination. Women described being treated differently by support staff and providers based on type of insurance (public versus private), including perceiving a lower quality of care at clinics that accepted public insurance. While some described personally-mediated racism, the majority of women described experiences that fit within a definition of institutionalized racism-in which the system was designed in a way that worked against their attempts to get quality prenatal care. Women also described lifetime experiences of racial discrimination. Our findings suggest that African American women with limited incomes perceive many provider practices and personal interactions during prenatal care as discriminatory. Future studies could explore the relationship between perceptions of discrimination and utilization of prenatal care.
Journal of Social Work Practice in the Addictions, 2011
This article explores the importance of incorporating past attempts at changing one's drinking du... more This article explores the importance of incorporating past attempts at changing one's drinking during current assessment and treatment processes, as well as when interpreting research outcomes. It is hypothesized that the current change efforts might be influenced by the change attempts that individuals have experienced over the lifecourse or "career" of their alcohol use disorders. In addition to formal treatment efforts, previous attempts might include other
Background: There is a significant need for research on treatments that provide pain relief durin... more Background: There is a significant need for research on treatments that provide pain relief during intrauterine device (IUD) insertion. Misoprostol is frequently used before IUD insertion but is not always necessary and its use may increase pain and side effects. This survey evaluated how providers who perform IUD insertion in nulliparous women report using misoprostol to facilitate the procedure. Study Design: An anonymous Internet-based survey was distributed to members of three professional organizations with family planning providers. Results: Of 2211 survey respondents, 1905 (86%) reported providing IUDs to nulliparous women. Of those providing IUDs to nulliparous women, 947/1905 (49.7%) reported using misoprostol, and 380 (40%) of 947 of misoprostol users reported using the treatment empirically with all nulliparous IUD insertions. There was wide variation reported in dose, route and timing of misoprostol administration. Providers most commonly reported learning of misoprostol use for IUD insertion by word of mouth rather than through the literature. Conclusions: Despite conflicting published data, nearly half of survey respondents use misoprostol before IUD insertion. Considerable variation in the timing of misoprostol use may explain differences in perception of its effectiveness. Evidence-based information about misoprostol for IUD insertion in nulliparous women, including pharmacokinetics, efficacy and optimal dosing, is needed.
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Papers by Trina Ward