Kristine Siefert

Maternal bisphenol-A levels at delivery: a looming problem?

Objective:The objective was to determine whether bisphenol-A (BPA) is found in maternal circulation of pregnant women in the US population and is related to gestational length and birth weight.Method:Circulating levels of BPA were quantified by high performance liquid chromatography-tandem mass spectrometry at delivery in 40 southeastern Michigan mothers and correlated with gestational length and birth weight of offspring.Result:Maternal levels of unconjugated BPA ranged between 0.5 and 22.3 ng ml−1 in southeastern Michigan mothers. There was no correlation between BPA concentrations and gestational length or birth weight of offspring.Conclusion:This is the first study to document measurable levels of BPA in maternal blood of the US population. Long-term follow-up studies of offspring are needed to validate or refute concerns over human fetal exposure to synthetic exogenous steroids.

Food Insufficiency and Physical and Mental Health in a Longitudinal Survey of Welfare Recipients

Food insufficiency is a significant problem in the United States, and poor African American women with children are at especially high risk. An inadequate household food supply can potentially affect the well-being of household members, but it is difficult to distinguish the effects of food insufficiency from risk factors for poor health that are also common among the food insufficient, such as poverty. We examined food insufficiency and physical and mental health among African American and white women (n = 676) who were welfare recipients in 1997. Controlling for common risk factors, women who reported food insufficiency in both 1997 and 1998 were more likely to report fair or poor health at the later date. Food insufficiency in 1998 was significantly associated with meeting the diagnostic screening criteria for recent major depression. Food insufficiency at both times and in 1998 only was related to womens sense of mastery. These findings add to growing evidence that household food insufficiency is associated with poor physical and mental health.

Modifiable Risk and Protective Factors for Depressive Symptoms in Low-Income African American Mothers

Low-income African American mothers of young children experience high rates of depression, but many of the risk factors that have been identified provide little direction for intervention. The authors examined modifiable risk and protective factors for probable depression (Center for Epidemiological Studies Depression Scale >or= 23) in 824 African American mothers living in the 39 poorest census tracts in Detroit. Household food insufficiency and deteriorated housing significantly increased the odds of likely depression, whereas availability of a loan in a crisis, help with childcare, and transportation were protective. However, more frequent experiences of everyday discrimination greatly increased the odds of elevated depressive symptoms. These findings support the need for interventions that operate across individual and societal levels to address the fundamental causes of poor mental health.

Work Trajectories, Income Changes, and Food Insufficiency in a Michigan Welfare Population

This article examines determinants of changes in food insufficiency status over time in a Michigan welfare sample. The studied determinants include individual constraints on coping abilities, work‐related demands, and resources of households. Analyses use logistic regressions based on data from four waves of the Women’s Employment Study. Findings suggest that, without controlling for unobserved heterogeneity, hours worked, transportation expenses, and measures of coping ability are associated with food insufficiency. However, conditional fixed‐effect logistic regression models suggest that having one or more mental health problems and a low level of financial resources are associated with reported food insufficiency.

Bisphenol-A and disparities in birth outcomes: a review and directions for future research

Racial disparities in pregnancy outcome in the United States are significant, persistent and costly, but the causes are poorly understood. We propose that disproportionate exposure of African-American women to environmental endocrine disrupting compounds (EDCs) may contribute to birth outcome disparities. Marked racial segregation, as well as health behaviors associated with poverty could result in differences in exposure to particular EDCs. One EDC that has aroused concern in recent years is bisphenol-A (BPA), a widely used industrial plasticizer with known estrogenic properties. Published studies indicate that excessive BPA exposure is associated with reduced fetal survival, as well as reductions in maternal weight and fetal body weight. Related findings include adverse effects of BPA exposure on ovarian function, mammary gland development, earlier age of puberty onset and some metabolic parameters. However, these findings are largely limited to experimental animal studies, and need to be validated in human populations. Our review supports the need to move beyond the currently dominant toxicological approach to examining the effects of BPA exposure, and rely more on observational human studies and epidemiological methods. Many of the risk factors for racial disparities in pregnancy outcome are global or difficult to modify, but exposure to BPA is a potentially malleable risk factor. If BPA contributes to racial disparities in pregnancy outcome, there are important implications for prevention. It is our hope that this review will stimulate further research in this important and neglected area.

Discrimination, Mastery, and Depressive Symptoms among African American Men.

Purpose: This study examines the influence of discrimination and mastery on depressive symptoms for African American men at young (18—34), middle (35—54), and late (55+) adulthood. Method: Analyses are based on responses from 1,271 African American men from the National Survey of American Life (NSAL). Results: Discrimination was significantly related to depressive symptoms for men ages 35 to 54 and mastery was found to be protective against depressive symptoms for all men. Compared to African American men in the young and late adult groups, discrimination remained a statistically significant predictor of depressive symptoms for men in the middle group once mastery was included. Implications: Findings demonstrate the distinct differences in the influence of discrimination on depressive symptoms among adult African American males and the need for future research that explores the correlates of mental health across age groups. Implications for social work research and practice with African American men are discussed.

Oral Health Disparities and Psychosocial Correlates of Self-Rated Oral Health in the National Survey of American Life

OBJECTIVES We sought to better understand the determinants of oral health disparities by examining individual-level psychosocial stressors and resources and self-rated oral health in nationally representative samples of Black American, Caribbean Black, and non-Hispanic White adults. METHODS We conducted logistic regression analyses on fair or poor versus better oral health using data from the National Survey of American Life (n = 6082). RESULTS There were no significant racial differences. Overall, 28% of adults reported having fair or poor oral health. Adults with lower income and less than a high school education were each about 1.5 times as likely as other adults to report fair or poor oral health. Higher levels of chronic stress, depressive symptoms, and material hardship were associated with fair or poor oral health. Adults living near more neighborhood resources were less likely to report fair or poor oral health. Higher levels of self-esteem and mastery were protective, and more-religious adults were also less likely to report fair or poor oral health. CONCLUSIONS Social gradients in self-rated oral health were found, and they have implications for developing interventions to address oral health disparities.

The Health of Poor Women Under Welfare Reform

OBJECTIVES We compared the health of single mothers affected by welfare reform with the health of a nationally representative sample of women to document the prevalence of poor health as single mothers experience the effects of welfare reform. METHODS We compared risk factors and measures of health among women randomly sampled from the welfare rolls with similar data from a nationally representative sample of women. RESULTS Women in our welfare recipient sample had higher rates of elevated glycosylated hemoglobin (> or = 6%; prevalence ratio [PR]=4.87; 95% confidence interval [CI]=2.69, 7.04), hypertension (systole > or = 140 or diastole > or = 90; PR=2.36; 95% CI = 1.47, 3.24), high body mass index ( > or = 30; PR = 1.78; 95% CI = 1.49, 2.08), and high-density lipoprotein cholesterol (< or = 35 mg/dL; PR=1.91; 95% CI=1.17, 2.65); lower peak expiratory flow; and less physical functioning. Current smoking rates were higher (PR = 1.85; 95% CI = 1.50, 2.19) and smoking cessation rates were lower (PR=0.62; 95% CI=0.37, 0.86) than in the national sample. CONCLUSIONS Current and former welfare recipients bear a substantial burden of illness. Further studies are necessary to interpret our findings of worsened health in the wake of welfare reform.

Household food insufficiency and mental health in South Africa

Background Both mental illness and food insufficiency are common in low and middle income countries. However, there are limited data on the relation between food insufficiency and mental disorders, despite the potential relevance of such data for the development of policy-level interventions. The relationship between food insufficiency and mental disorders within a nationally representative sample of South African adults was examined. Methods A national survey of 4185 South African adults was conducted using the WHO Composite International Diagnostic Interview to generate psychiatric diagnoses. The survey included a widely used single-item measure of household food insufficiency. The independent effects of food insufficiency and demographic characteristics on 12-month and lifetime DSM-IV diagnosis were assessed using logistic regression. Results 29% of respondents reported that their household ‘sometimes’ did not have enough to eat while 9% reported that they ‘often’ did not have enough to eat. After controlling for conventional socioeconomic and sociodemographic variables, food insufficiency was associated with having any 12-month (OR 1.44, 95% CI 1.1 to 1.9) and lifetime (OR 1.35, 95% CI 1.1 to 1.7) DSM-IV disorder. Conclusions In South Africa the prevalence of household food insufficiency is very high compared with studies conducted in the developed world, and is independently associated with having a 12-month and lifetime DSM-IV diagnosis. The relationship between food insufficiency and mental health has implications for reducing the burden of common mental disorders in South Africa since, unlike a number of major risk factors for mental illness, food insufficiency may be relatively amenable to intervention.

A Systematic Review of Mammography Educational Interventions for Low-income Women

Objective. We conducted a systematic review to examine the effectiveness of educational interventions in increasing mammography screening among low-income women. Data Sources. Bibliographic databases, including MEDLINE, The Cochrane Central Register of Controlled Trials, The Cochrane Database of Systematic Reviews, and the ISI Web of Science, were searched for relevant articles. Study Inclusion and Exclusion Criteria. Randomized, community-based trials targeting low-income women and published between January 1980 and March 2003 were included. Data Extraction. The search yielded 242 studies; 24 met all inclusion criteria. Data Synthesis. Three studies used mammography vans, three used low-cost vouchers or provided free mammograms, three used home visits, one used community education alone, one provided referrals, five incorporated multiple intervention strategies, two used phone calls, one used videos and print material, and five used primarily print material. Results. Of nine studies that reduced barriers to care via mammography vans, cost vouchers, or home visits, eight showed statistically significant increases in mammography screening. Seven of the eight studies that used peer educators had significant increases in screening, as did four of the five studies that used multiple (intervention) components. Conclusions. Interventions that used peer educators, incorporated multiple intervention strategies, or provided easy access via vans, cost vouchers, or home visits were effective in increasing screenings. Mailed letter or telephone reminders were not effective in trials involving low-income women, which is contrary to findings from middle/upper-income studies.