Carol A. Hickey

Medical, psychosocial, and behavioral risk factors do not explain the increased risk for low birth weight among black women☆☆☆★★★

OBJECTIVE Our purpose was to determine whether various demographic, behavioral, housing, psychosocial, or medical characteristics explain the difference in pregnancy outcome between black and white women. STUDY DESIGN A sample of 1491 multiparous women with singleton pregnancies, 69% of whom were black and 31% of whom were white and who enrolled for care between Oct. 1, 1985, and March 30, 1988, participated in the study. The frequencies of various demographic, medical environmental, and psychosocial risk factors among black and white women were determined. The outcome measures were birth weight, gestational age, fetal growth restriction, preterm delivery and low birth weight. RESULTS White infants were heavier and born later than black infants. The white women in this sample smoked more cigarettes, moved more frequently, and had worse psychosocial scores. The black women had lower incomes, were less likely to be married, and had more hypertension, anemia, and diabetes. Besides race, only maternal height, weight, blood pressure, diabetes, and smoking had a consistent impact on outcome and did not explain the difference in outcome between the two groups. CONCLUSION In this low-income population, many of the risk factors for low birth weight were more common among white women than black women. Nevertheless, black women had more infants born preterm, with growth restriction, and with low birth weight than did white women. The various maternal characteristics studied did not explain these differences.

Social Cognitive Model of Fruit and Vegetable Consumption in Elementary School Children

Fruit and vegetable consumption is related to reduced risk for certain forms of cancer. Health organizations recommend the increased consumption of fruit and vegetables. Despite these recommendations, few U.S. children eat the recommended number of at least five servings of fruit and vegetables per day. Understanding the determinants of consumption might improve our ability to increase consumption. Few theory-based models have been developed to explain and predict the consumption of various foods by children. This study proposed a model to explain fruit and vegetable consumption in children based on Social Cognitive Theory and on the literature in nutrition education. The model was tested using structural equation modeling techniques. Data from 414 third-graders were gathered on five predictors including availability, modeling, nutrition education, motivation (i.e., self-efficacy, outcome expectancies, food preferences), and knowledge. The proposed model was tested with two random splits of the data and also separately for males and females. Results indicate adequate fit of the models for each of the four data sets (split 1, split 2, males, females). The pattern of significant paths was similar across the data sets. Availability and motivation (i.e., self-efficacy, outcome expectancies, food preference) were most consistently related to consumption and to other constructs in the model.

Sociocultural and behavioral influences on weight gain during pregnancy

Studies have consistently identified a positive association between prenatal weight gain and birth weight. Much less, however, is known about factors that may influence women to gain weight within currently recommended ranges. The importance of this issue is suggested by recent reports indicating that only 30-40% of women actually gain weight within these ranges. This paper examines demographic, sociocultural, and behavioral factors that are associated with, and may influence risk of, low prenatal weight gain among adult women with low and normal body mass indexes. Available data suggest that these factors include ethnicity, socioeconomic status, age, education, pregnancy intendedness or wantedness, prenatal advice, and psychosocial characteristics such as attitude toward weight gain, social support, depression, stress, anxiety, and self-efficacy. Potential theoretical models for these associations include biological, behavioral, and mixed pathways. The design of targeted intervention studies will depend on further identification and characterization of sociocultural and behavioral risk factors that, along with reproductive and nutritional characteristics, may predict which women are most likely to have inadequate prenatal weight gain.

Relationship of psychosocial status to low prenatal weight gain among nonobese black and white women delivering at term

Objective To examine the association of six indices of psychosocial well-being with low prenatal weight gain. Methods Scales assessing depression, trait anxiety, stress, mastery, self-esteem, and social support were self-administered at mid-pregnancy to 536 black and 270 white low-income, nonobese, multiparous women who subsequently delivered at term. All women had one or more risk factors for fetal growth restriction. The association of individual scale scores with prenatal weight gain values below current Institute of Medicine guidelines was examined while controlling for sociodemographic and reproductive variables, and for time between last weight observation and delivery. Results None of the scales were associated with low gain among black women. Among white women, poor scores (worst quartile) on four of the scales were associated with increased adjusted odds ratios for low gain, including 2.5 for high trait anxiety, 3.0 for increased levels of depression, 3.9 for low mastery, and 7.2 for low self-esteem. When scale scores and weight gain were examined as continuous variables, poor scores on five of the six scales were associated with lower weight gain values among white women (scores on the stress scale were the exception). Conclusion These data suggest an important role for psychosocial factors in the etiology of low prenatal weight gain among white women but show no such role for black women. Along with reports of wide inter-individual variability in the energy costs of pregnancy, these data also suggest that attempts to manipulate pregnancy weight gain through dietary means will meet with variable success until psychosocial and other factors affecting prenatal energy intake and/or utilization are further delineated.

Prenatal weight gain within upper and lower recommended ranges: Effect on birth weight of black and white infants**

Objective To that end examine differences in birth weight among the term infants of black and white women with weight gains in the upper or lower half of recommended ranges. Methods Birth weight (mean, low [at or below 2500 g], and suboptimal [2501–2999 g]) among term infants of 2219 black and 3966 white low-income women was compared with maternal prenatal weight gain classified according to four categories: below, within the lower or upper halves, and above the recommended ranges for pregravid body mass index (BMI) category (low, normal, high). Results Adjusted mean birth weights among the infants of women with prenatal weight gain in the upper versus lower half of the recommended ranges were higher among white women with normal BMI (3307 g upper half, 3199 g lower half, P = .0001) but not among black women with normal BMI (3180 g upper half, 3105 g lower half, not significant). Logistic regression analyses revealed that prenatal weight gain in the upper compared with the lower half of the recommended ranges was associated with a decreased adjusted odds ratio (OR) for low (but not suboptimal) birth weight among the infants of white women (OR 0.4, 95% confidence intervals [CI] 0.2,0.9) but not of black women (OR 1.2; 95% CI 0.4,3.3). Conclusion These preliminary observations do not provide support for the presence of ethnic group-specific recommendations within guidelines for prenatal weight gain.

Low Prenatal Weight Gain Among Adult WIC Participants Delivering Term Singleton Infants: Variation by Maternal and Program Participation Characteristics

Objective: To determine the association of maternal and prenatal WIC program participation characteristics with low prenatal weight gain among adult women delivering liveborn, singleton infants at term. Methods: WIC program data for 19,017 Black and White Alabama women delivering in 1994 were linked with birth certificate files to examine the association of anthropometric, demographic, reproductive, hematologic, behavioral and program participation characteristics with low prenatal weight gain. Results: One third (31.0%) had low prenatal weight gain as defined by the Institute of Medicine. The incidence of low weight gain was increased among women who had < 12 years of education, were single, Black, anemic, had low or normal pre-pregnancy body mass index (BMI), increased parity, interpregnancy intervals ≤ 24 months, used tobacco or alcohol, or entered prenatal care or WIC programs after the first trimester. After adjusting for selected maternal characteristics, the adjusted odds ratios (AOR) for low weight gain were increased with short interpregnancy intervals (AOR 1.21 to 2.20); tobacco use (AOR 1.16 to 1.40), anemia (AOR 1.20 to 1.25), and second trimester entry into prenatal care (AOR 1.14 to 1.20); the size of the AORs and 95% confidence intervals varied by BMI and racial subgroup. Conclusions: The results of this study suggest that WIC interventions targeting low prenatal weight gain be focused on risk factors present not only during pregnancy, but during the pre- and interconceptional periods as well. Interventions should target low BMI, tobacco use, and anemia, and include attention to nutrition screening and risk reduction among women in postpartum and family planning clinic settings.

Maternal weight status and term birth weight in first and second adolescent pregnancies

The relationship of maternal weight status to birth weight was evaluated retrospectively for the first and second pregnancies of 72 younger (age 12-15 years at first conception) and 80 older (age 16-19 years at first conception) low-income adolescents (76% black, 24% white). Mean birth weight increased during the second pregnancies of both groups (277 g and 132 g, respectively). Multiple regression analysis (controlling for potentially confounding variables) indicated a positive relationship between second and third trimester rate of maternal weight gain (kg/week) and birth weight for younger adolescents during their second pregnancy (p = 0.014), and for older adolescents during their first pregnancy (p = 0.047). Mean birth weight increased with each increase in maternal weight-for-height (W/H) category near term from the lowest (< 100% of standard) to the highest (> or = 140% of standard), for both age groups during both pregnancies. Multiple regression analysis indicated that among older adolescents birth weight increased 4.2 +/- 2.0 g (X +/- SE) for each 1% increase in maternal W/H near term in their first pregnancy (p = 0.038) and 7.1 +/- 1.8 g for each 1% increase in maternal W/H near term in their second pregnancy (p = 0.0003). Among younger adolescents these relationships, while in the same direction, were not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Anemia as a Nutrition Status Indicator Among A Head Start Cohort

Abstract Iron deficiency anemia is the most common nutrition-related developmental risk factor among Head Start children. National Head Start anemia rates reflect the incidence of anemia as high as 20%. The Head Start Program provides comprehensive health services to each child enrolled including general health screening, hearing and vision screening, nutrition intervention, dental services, and mental health services. In a southeastern Head Start program with 1110 children, 554 girls (49.9%) and 556 boys (50.1%), 68 (7.5%) of the children were identified as anemic as defined by a hemoglobin level of 11.0g/dL or less or hemato-crit level of 32% or less. Upon follow-up, improvements in iron status were noted among all of the subjects with the exception of those with medical anemias (i.e. sickle cell disease, etc.) as determined by past medical history. This retrospective analysis has implications for future data collection techniques and for nutrition and health intervention criteria used by Head Start programs. This study also provides the framework for additional examinations of health and nutrition outcomes in Head Start programs by examining assessment and intervention criteria within the context of Head Start regulations.

Compliance, Knowledge, and Health Beliefs of Children With Phenylketonuria and their Parents

Abstract LEARNING OUTCOME: To examine the association of dietary knowledge and health beliefs of clients with Phenylketonuria (PKU) and their parents with indicators of compliance in PKU management. Previous studies have found knowledge of PKU to be associated with compliance, but no other studies have researched health beliefs and PKU. Individuals with PKU must limit their intake of phenylalanine, maintain an adequate intake of protein, and kilocalories for life. Because the prescribed regimen of an individual with PKU is complex, it is difficult to maintain. The Health Belief Model has been used to predict behavior according to beliefs about health. Fifteen clients, with PKU, 9-18 years of age, and their parents participated in the retrospective study. The clients had a history of poor compliance. Indicators of compliance were compiled from three years of client records. Indicators included: collection of blood levels at specified intervals, blood level being in the appropriate range, regular clinic attendance at clinic appointments, consistent formula intake, and provision of a dietary record. Demographic variables were also measured. A picture page knowledge of foods test and a questionnaire on health beliefs were completed by each client and parent. Results indicated that several of the health belief model questions were correlated to clinical indicators of compliance such as clinic attendance and frequency of blood checks. Knowledge of appropriate foods was very high among subjects. Phenylalanine blood level control was influenced by the distance clients had to travel to clinic. The significant decrease in clinic attendance and blood level control over time indicates a need for more client contact with health professionals. Distance traveled to clinic may be outweighing the benefits to health care perceived in the clinic visit. The possibility of further home health care and incorporating local health care providers is evident in the care of this population.

Leadership Profiles of Public Health Nutritionists

Abstract Public health nutritionists (PHN) practice in dynamic and complex organizations. Providing leadership in these types of organizations requires diverse skills. One leadership theory differentiates transactional from transformational leadership. Transactional leaders achieve results by providing and maintaining structure while transformational leaders raise awareness of others and facilitate goal achievement The purpose of this study was to evaluate transactional and transformational leadership roles of PHN. The Competing Values Leadership Profile was completed by 342 PHN in an 8 state region in the southeastern US. This profile included 32 items that assessed frequency of performance of transactional leadership roles (monitor, coordinator, director, producer) and transformational leadership roles (facilitator, mentor, innovator, broker) using a 7-point hedonic scale (7=high) for each item. Differences between role performance was determined by repeated measures analysis of variance. Median experience of PHN was 12 years in nutrition, 7 of that in public health nutrition. Most (74%) had administrative responsibilities. Mean performance scores for transactional roles were: monitor (4.8 ± 1.4), coordinator (5.3 ± 1.4), director (5.0 ± 1.5), and producer (5.1 ± 1). Mean performance scores for transformational roles were: facilitator (5.3 ± 1.4), mentor (5.7 ± 1.3), innovator (4.9 ± 1.1) and broker (4.5 ± 1.3). PHN performed the innovator and broker roles significantly less often than the other 6 roles (p Results suggest that PHN may benefit from professional continuing education and career development opportunities that foster development of innovator and broker roles.