Jane S. Norbeck

Psychosocial Predictors of Pregnancy Outcomes in Low-Income Black, Hispanic, and White Women

This study focused on psychosocial risk factors in a population of 208 low-income medically normal women. The total sample had nearly equal numbers of black, Hispanic, and white women. Life stress, social support, anxiety state, and substance use were measured at mid- and late pregnacy. Outcome variables included various pregnacny complications, birth weights, and qestational ages. The predictor variables were usally not significant for the full sample. For black women, social support from the womans partner or mother accounted for 33% of the variance in gestation complications and 14% of the variance in prologed labor or cesarean section complications. For white women, high rather than low social support was significant in accounting for pregnancy outcomes and substance use, indicating that the social network might reinforce negative health practices for this group. None of the predictor variables were found to be statistically significant for the group of Hispanic women, who had very low complication rates.

A randomized trial of an empirically-derived social support intervention to prevent low birthweight among African American women

Previous clinical trials of social support interventions to reduce low birthweight (LBW) have not fully capitalized on findings from social science research, and therefore have not used empirically-derived criteria to define a low social support population or to develop the intervention. To overcome limitations of previous studies, this randomized clinical trial tested the hypothesis that an empirically-derived social support intervention would reduce LBW among African American women. Based on prior work, African American women were identified as at-risk for LBW due to inadequate social support if they lacked support from their mothers or male partners. Focus groups were used in this study to develop a culturally-relevant intervention. Adult low-income African American pregnant women (n = 319) were tested for inadequate social support in mid-pregnancy. Of these, 114 (36%) low-support women were identified and randomly assigned to the intervention group (n = 56) or control group (n = 58). The intervention was designed to provide the support usually provided by the pregnant womans mother or male partner. It consisted of four standardized face-to-face sessions at two week intervals and telephone contact in the intervening weeks. Birthweight was obtained blinded from charts or birth certificates, with 99% follow-up. The rate of LBW (below 2500 grams) was 9.1% in the intervention group compared to 22.4% in the control group (P < 0.05). Contrary to previous studies, this social support intervention was effective in reducing the rate of LBW. It is promising that this intervention was successful for African Americans because the rate of LBW is twice as high among African Americans than among Caucasians.

Stress, satisfaction, and coping: A study of women clerical workers

Increasing numbers of women in the work force have prompted researchers to study the health impact of their work satisfactions and stressors. In this study, we examined the quality of the work role as perceived by women who hold clerical jobs. Qualitative data were collected through structured interviews with 87 female clerical workers employed in four organizational settings. All were mothers with one or more children living at home. Work satisfaction, work stressors, coping strategies, and resources were discussed in the interviews. Categories were developed for each of these areas. The Ethnograph computer program was used after content analysis to code and retrieve the responses for each category.

HOSPITALIZED CHILDREN WITH HISTORY OF SEXUAL ABUSE: Incidence and Care Issues

This study used a questionnaire to identify the incidence of sexual abuse history and behavioral characteristics of prepubertal children in 110 psychiatric inpatient settings. Suggestions of clinical care issues that arise for staff working with this population were generated. Implications of the findings are considered and the need for development of special staff training programs and milieu treatment planning is highlighted.

The Development of a Social Support Intervention among African American Women

The purpose of this feminist qualitative study was the development of a psychosocial intervention to reduce the number of low birthweight babies among lower income, socially isolated, pregnant, African American women. Using data from both group and individual interviews, we constructed a series of interactive sessions. The focus of these sessions was skill building, both to develop self-esteem and to access social support; and acknowledgment of the pregnant womens lives and experiences.

The Personal Experience of Pregnancy for African-American Women

This study describes the personal experiences of pregnancy for African-American women. Data were obtained from two group interviews with four African-American nurse-midwives who had experienced pregnancy and had extensive professional experience in the provision of health care services to pregnant African Americans. Three major themes were constructed from the interview narratives. The first concerned the experience of pregnancy as a transition experience from childhood to adulthood and from womanhood to motherhood, involving heightened senses of maturity, self-esteem, and intimacy. The second identified stresses experienced by African-American women, including the lack of material resources and emotional support. The last theme concerned the provision of effective support in pregnancy. The significance of interpersonal relationships with the pregnant women’s mothers, other significant women, and their partners was described. Implications for practice included suggestions for the provision of effective emotional support from health care professionals such as attentive listening and the elimination of environmental factors that communicate lowered personal value.

Teaching, research, and service: Striking the balance in doctoral education*

The concept of balance across the multiple role expectations of faculty is a relative term that should be understood in the context of the mission of a particular institution and as it relates to the external environment. Various metaphors or visual images of balance carry symbolic meanings. During this dynamic period in higher education, images of balance that suggest that creativity and the capacity for change are preferable to static forms. Models for defining balance are presented that include two levels of analysis (the individual faculty member and the institutional level) and two temporal variations (continuous balance versus balance over a period of time). Strategies identified by faculty that enhance faculty productivity included both individual and institutional characteristics. Formal faculty development activities are also described. Those aimed at the individual level include orientation, mentoring, peer expertise, and use of sabbaticals or leaves. Institutional approaches to faculty development relate to the reward structure and recognition systems and use workshops and centers for providing faculty development. Based on changes occurring in the health care system and in higher education, implications for changes in faculty roles in the future are discussed.

Social support as road map and vehicle: an analysis of data from focus group interviews with a group of African American women.

As part of a larger study of the impact of a social support intervention on pregnancy outcome for lower-income African American women, 6 African American women (a medical social worker, a physicians assistant, 2 community outreach workers, a lactation consultant, and a health project representative) participated in focus group discussions concerning the unique social support needs of lower-income African American women during pregnancy. Transcripts of focus group interviews were analyzed using qualitative content analysis. Emergent themes included strengths of African American communities, deficiencies in social support for many lower-income African American women, the meaning of pregnancy for African American women, the ability of many pregnant women to “make it” without visible means of support, young womens locations “inside” and “outside” of “mainstream” life, and the importance of social support as a mechanism for guiding and transporting “lost souls” back into the mainstream.

Dimensions of health in young people in foster care.

UNLABELLED To describe the dimensions of health and illness from the perspective of adolescents in foster care. METHODS Descriptive analyses of dimensions of health were conducted on N = 105 adolescents in foster care. Differences among demographic (age, gender, race/ethnicity) and foster care placement (age at first placement, reason(s) for foster care placement, length of time in care, number, and types of placement) variables and the dimensions and subdimensions of health (Child Health and Illness Profile- Adolescent Edition) were determined using T-tests and ANOVA. RESULTS Most were placed in long-term foster care (x = 6.46 years; SD = 4.86) during adolescence (38%), with multiple placements (x = 3.99; SD = 3.8). All domains of health were self-reported to be average to low average, with poorer findings in specific risk and resilience subdomains. There were no significant differences by age or race/ethnicity. Girls had lower satisfaction with health and self esteem and more physical and emotional discomfort. Pre-placement adverse experiences were associated with increased risks. CONCLUSIONS Adolescent self-report of the domains of health for those in foster care was better than expected, based on literature review and qualitative data for the larger study. Potential explanations for this inflation of status and functioning include the need for self-protection in foster care, the familiarity of testing regimes by children in foster care with some social desirability effect, and their paradoxical responses to pre-placement problems. Data including qualitative and significant other-reported data may be necessary to gain an accurate portrayal of the health status of adolescents in foster care.

Health Profiles of Adolescents in Foster Care

The purpose of this paper is to describe health profiles of adolescents in foster care. The Child Health and Illness Profile-Adolescent Edition clustered adolescents in foster care into 13 mutually exclusive health profiles using dimensions of satisfaction with health, risks, resilience, and discomfort. Health profiles were further characterized into four health status rankings from best to worst health status. Many reported best health status (39%); nearly equal numbers (30.6%) had profiles indicating poor or worst health status, particularly girls and those with high risk behaviors, aggression, sexual abuse, or suicidality. It is valuable to identify health characteristics of the most vulnerable subgroups of foster youth to tailor specific interventions.