Cynthia R. Ronzio

Disparities in Early Childhood Caries

Despite remarkable reduction in the prevalence of dental caries in the United States, dental caries is still a highly prevalent disease among children who are socially disadvantaged (racial/ethnic minority, poor, rural, immigrants). Consequently, caries sequelae such as dental pain, need for dental treatment under general anesthesia, and future orthodontic treatment, are also concentrated among the most socially disadvantaged children. To make the situation more appalling, those children who need treatment the most are the ones least likely to visit the dentist. Low income children are less likely to visit the dentist in part because of familys competing needs for limited resources, shortage of pediatric dentists, and dentists not taking uninsured or publicly insured patients. In the same vein, if these children do not have access to dental care, they are deprived from effective caries preventive measures that are dentist-dependent such as sealants and professionally applied fluoride. Dentistry has done well at devising caries preventive and treatment strategies; but these strategies have missed the most needed segment of society: disadvantaged children. The challenge now is to develop innovative strategies to reach these children.

Depressive symptomatology and mental health help-seeking patterns of U.S.- and foreign-born mothers.

Objectives: This report presents the national estimates of maternal depressive symptomatology prevalence and its socio-demographic correlates among major racial/ethnic-nativity groups in the United States. We also examined the relationship of mental health-seeking patterns by race/ethnicity and nativity. Methods: Using the Early Childhood Longitudinal Survey-Birth Cohort Nine-month data, we present the distribution of Center for Epidemiological Study-Depression (CES-D) score by new mothers’ nativity and race/ethnicity. The mental health-seeking pattern study was limited to mothers with moderate to severe symptoms. Weighted prevalence and 95% confidence intervals for depression score categories were presented by race/ethnic groups and nativity. Multi-variable logistic regression was used to obtain the adjusted odds ratios of help-seeking patterns by race/ethnicity and nativity in mothers with moderate to severe symptoms. Results: Compared to foreign-born mothers, mothers born in the U.S. were more likely to have moderate to severe depressive symptoms in every racial/ethnic group except for Asian/Pacific Islanders. These US-born mothers were also more likely to be teenagers, lack a partner at home, and live in rural areas. Among Asians, Filipina mothers had the highest rate of severe depressive symptoms (9.6%), similar to those of US-born black mothers (10.2%). Racial/ethnic minorities and foreign-born mothers were less likely to consult doctors (OR: 2.2 to 2.5) or think they needed consultation (OR: 1.9 to 2.2) for their emotional problems compare to non-Hispanic White mothers. Conclusion: Our research suggests that previous “global estimates” on Asian American mental health underestimated sub-ethnic group differences. More efforts are needed to overcome the barriers in mental health services access and utilizations, especially in minority and foreign-born populations.

Relationship Between Children’s Dental Needs and Dental Care Utilization: United States, 1988–1994

OBJECTIVES This study describes the relationship between dental needs and dental care utilization among children. METHODS Data from the third National Health and Nutrition Examination Survey (1988-1994) were used to analyze dental care needs and dental care utilization. RESULTS Younger children with perceived needs (needs perceived by the child or responsible adult) were more likely to be episodic users of dental care than children without perceived needs. Younger children with normative needs (defined by the presence of untreated caries diagnosed by a dentist) were less likely to be regular users. Older children with perceived or normative needs were more likely to be episodic users and less likely to have had a previous-year visit than children with no needs. CONCLUSIONS Despite their presence, dental needs do not drive dental care use among children, and childrens dental care utilization is inadequate.

Developmental Differences in Parenting Behavior: Comparing Adolescent, Emerging Adult, and Adult Mothers

The nationally representative Early Childhood Longitudinal Study-Birth cohort data set was used to compare parenting behaviors of adolescent mothers (<19 years old), emerging adult mothers (19-25 years old), and adult mothers (>25 years old) when their children were 2 years old. Regression models controlling for socioeconomic differences indicate that adolescent mothers exhibited less supportiveness, sensitivity, and positive regard than emerging adult mothers, who exhibited less than adults. Adolescent and emerging adult mothers reported comparable frequencies of spanking and use of time out but significantly more than adults. Age differences in coparenting were largely accounted for by different rates of father coresidence. These finding suggest that age differences in parenting behaviors are not solely explained by sociodemographic factors, and that mothers who gave birth during the emerging adult period are a developmentally distinct group; overall, they are not as prepared for optimal parenting as older mothers but are better equipped than adolescent mothers.

Disparity in location of urban mental service providers

This article investigates geographic disparities in the location of mental health providers in relation to population demographics. Associations between provider-to-population ratios and demographics were examined with density calculations and map algebra. This disparity in geospatial availability of specialists may constitute an important barrier for persons seeking mental health care.

The Structure of Witnessed Community Violence amongst Urban African American Mothers: Latent Class Analysis of a Community Sample

The prevalence of witnessed community violence (WCV) amongst urban populations in the USA is striking. WCV can be harmful to ones psychological health, and for mothers, the consequences may be more far-reaching as their mental health affects parenting and child development. This study used telephone interviews (n = 209) to explore the patterns and covariates of WCV amongst a sample of urban, African American mothers of infants. Mothers reported whether they had witnessed 11 different forms of violence in their current neighborhoods. A latent class analysis revealed two distinct groups of mothers, those with higher versus lower-exposure to WCV. Mothers in the higher-exposure group were more likely to be low-income, to have a high school education or less, and to have higher anxiety scores than those in the lower-exposure group. Depression was not associated with higher exposure to WCV. Distinguishing between higher- and lower-exposure samples can inform the development of targeted prevention and intervention strategies for metropolitan areas.

The Highs and Lows of Maternal Depression: Cluster Analysis of Depression Symptoms in a Sample of African American Women

Background Maternal depression affects between 10% and 15% of US mothers. Emerging evidence suggests that variability in symptoms is linked to different risk factors and different pathological subtypes. Building on this research, this study examines manifestations of depression symptoms and risk factors associated with different manifestations among a socioeconomically heterogeneous sample of African American mothers. Methods Data were collected via telephone interviews with a community sample of 208 self-identified African American women with children 2 to 18 months old. Mothers were screened for depression symptoms using the Center for Epidemiological Studies Depression scale and reported on several psychosocial factors including social support, history of depression, and demographic characteristics. Cluster analysis was used to determine whether there were distinct subtypes of depression symptoms in this sample. Results A k-means cluster analysis of the 57 women with a positive depression symptom screen revealed 2 distinct groups characterized by higher versus lower symptom severity. A logistic regression indicated that mothers were more likely to fall into the high severity cluster if they were employed and reported lower levels of social support. Limitations Because of its cross-sectional design, this study could not explore the timing and the course of depression symptoms, which may be more closely related to risk and functional impairment than the severity distinction found in this research. Conclusions Researchers, pediatricians, and obstetricians working with African American mothers should screen for social support, with the understanding that those with low levels may be at increased risk for severe depression symptoms. Finally, the heterogeneity in symptoms suggests that clinicians should be aware of all depression symptoms among their patients rather than looking for specific, potentially stereotypical symptoms as cues.

Postpartum Mothers' Napping and Improved Cognitive Growth Fostering of Infants: Results From a Pilot Study

Little is known about how maternal sleep disturbances in the postpartum period affect mother–infant interaction. The study was designed to assess if less maternal sleep disturbance and less fatigue were associated with more positive mother–child interaction, independent of maternal depression symptoms. Twenty-three mothers completed 1 week of actigraphy and self-report measures of fatigue and depression symptoms. To determine the quality of mother–infant interaction, mothers and infants were then observed in a structured, video-recorded teaching episode. Greater maternal napping frequency was associated with better cognitive growth fostering of the infant (r s = .44, p < .05), a subscale of the interaction assessment. Maternal napping, not the quality or quantity of nocturnal sleep, appears to be associated with improvements in mother–infant interactions.