Saundra H. Glover

Person and Place: The Compounding Effects of Race/Ethnicity and Rurality on Health

Rural racial/ethnic minorities constitute a forgotten population. The limited research addressing rural Black, Hispanic, and American Indian/Alaska Native populations suggests that disparities in health and in health care access found among rural racial/ethnic minority populations are generally more severe than those among urban racial/ethnic minorities. We suggest that disparities must be understood as both collective and contextual phenomena. Rural racial/ethnic minority disparities in part stem from the aggregation of disadvantaged individuals in rural areas. Disparities also emerge from a context of limited educational and economic opportunity. Linking public health planning to the education and economic development sectors will reduce racial/ethnic minority disparities while increasing overall well-being in rural communities.

The Effect of Maternity Leave Length and Time of Return to Work on Breastfeeding

OBJECTIVE: We investigated the effect of maternity leave length and time of first return to work on breastfeeding. METHODS: Data were from the Early Childhood Longitudinal Study–Birth Cohort. Restricting our sample to singletons whose biological mothers were the respondents at the 9-month interview and worked in the 12 months before delivery (N = 6150), we classified the length of total maternity leave (weeks) as 1 to 6, 7 to 12, ≥13, and did not take; paid maternity leave (weeks) as 0, 1 to 6, ≥7, and did not take; and time of return to work postpartum (weeks) as 1 to 6, 7 to 12, ≥13, and not yet returned. Analyses included χ2 tests and multiple logistic regressions. RESULTS: In our study population, 69.4% initiated breastfeeding with positive variation by both total and paid maternity leave length, and time of return to work. In adjusted analyses, neither total nor paid maternity leave length had any impact on breastfeeding initiation or duration. Compared with those returning to work within 1 to 6 weeks, women who had not yet returned to work had a greater odds of initiating breastfeeding (odds ratio [OR]: 1.46 [1.08–1.97]; risk ratios [RR]: 1.13 [1.03–1.22]), continuing any breastfeeding beyond 6 months (OR: 1.41 [0.87–2.27]; RR: 1.25 [0.91–1.61]), and predominant breastfeeding beyond 3 months (OR: 2.01 [1.06–3.80]; RR: 1.70 [1.05–2.53]). Women who returned to work at or after 13 weeks postpartum had higher odds of predominantly breastfeeding beyond 3 months (OR: 2.54 [1.51–4.27]; RR: 1.99 [1.38–2.69]). CONCLUSION: If new mothers delay their time of return to work, then duration of breastfeeding among US mothers may lengthen.

Gender differences in ethical decision making

Most of the research on fostering ethical climates by making ethical decision choices in organisations has taken place in the last 20 years. Research has moved from specific studies evaluating either individual or situational variables as factors in ethical decision behaviour to more complex models that encompass the interaction of individual and situational factors. This study revisits the influence of the individual variable of gender on ethical decision making. Using a laboratory format and decision exercises that attempted to create realistic business conflict situations through decision scenarios, the influence of demographic factors, specifically gender, and the moral intensity of the conflict situation on ethical decision making are examined in the light of workplace values.

II. Utilization of Mental Health Services in a Tri-Ethnic Sample of Adolescents

In our study of a tri-ethnic sample of 2528junior and high school students, we examined utilizationof outpatient mental health services in relation to anumber of variables cited in the literature as leading to potential biases and barriers tocare. These include: age, gender, ethnicity,socioeconomic status, family size and composition, andlinguistic fluency in Hispanic youth. The impact ofservice availability was examined through differencesbetween the two regions studied: a well-served region ofcoastal southeast Texas and the markedly under servedlower Rio Grande Valley. The impact of symptomatology was evaluated using the total problem score onthe Youth Self Report by Achenbach. Hispanic youth hadsignificantly lower mean service utilization thannon-Hispanic whites. Multiple regression analyses demonstrated that socioeconomic status andfamily composition had a greater relative impact onutilization than all other non-clinical factors, bothfor the total sample as well as for the Hispanic sample. Ethnicity may play a significant role in childmental health services utilization through its closeassociation to socioeconomic status.

Anxiety Symptomatology in Mexican-American Adolescents

Mexican-American adults and adolescents in general have been reported to have high levels of anxiety symptomatology. In our study of a tri-ethnic sample of 2528 junior and senior high school students, the Youth Self Report (YSR) version of the Child Behavior Checklist (CBCL) and a sociodemographic questionnaire was used to assess the anxiety symptoms of Hispanic youth. We compared the ratings on anxiety symptoms, using Achenbachs anxiety subscale on the YSR, between two populations. The anxiety levels of youth in coastal southeast Texas (Galveston County) were compared to the anxiety levels of youth in the lower Rio Grande Valley. We found that Mexican-Americans of the Lower Rio Grande Valley scored higher on anxiety symptoms than the tri-ethnic population of Galveston County. Other factors associated with higher anxiety scores for Mexican-American youths included being born outside the US, linguistic fluency, father absent from the home, mothers education, and household size. Multiple regression analyses showed that socio-economic status (SES), family composition, and linguistic fluency had a greater relative impact on anxiety symptomatology than all other factors, both for the total sample as well as for the Mexican-American sample. These results parallel previous findings, with Mexican-American adults, which suggest either higher risk for anxiety symptomatology or a culturally related bias in the reporting of such symptoms.

Dual diagnosis : HIV and mental illness, a population-based study

This is a cross-sectional, population-based (n = 378,710) study using hospital discharge abstract data to determine the relative risk associated with having a dual diagnosis of mental illness and HIV/AIDS. The analysis addresses issues of gender, race, and age, as well as types of mental illness. Persons with a mental illness are 1.44 times more likely to have HIV/AIDS. Women are at increased risk of being dually diagnosed. There are no risk differences by race. Those with a specific diagnosis of substance abuse or a depressive disorder are more likely to have a diagnosis of HIV/AIDS.

Reasons Why Women Do Not Initiate Breastfeeding: A Southeastern State Study

PURPOSE Despite the increase in breastfeeding initiation and duration in the United States, only five states have met the three Healthy People 2010 breastfeeding objectives. Our objectives are to study womens self-reported reasons for not initiating breastfeeding and to determine whether these reasons vary by race/ethnicity, and other maternal and hospital support characteristics. METHODS Data are from the 2000-2003 Arkansas Pregnancy Risk Assessment Monitoring System, restricting the sample to women who did not initiate breastfeeding (unweighted n=2,917). Reasons for not initiating breastfeeding are characterized as individual reasons, household responsibilities, and circumstances. Analyses include the chi(2) test and multiple logistic regression. RESULTS About 38% of Arkansas mothers of live singletons did not initiate breastfeeding. There was a greater representation of non-Hispanic Blacks among those who did not initiate breastfeeding (32%) than among those who initiated breastfeeding (9.9%). Among those who never breastfed, individual reasons were most frequently cited for noninitiation (63.0%). After adjusting for covariates, Hispanics had three times the odds of citing circumstances than Whites (odds ratio [OR], 3.07; 95% confidence interval [CI], 1.31-7.18). Women who indicated that the hospital staff did not teach them how to breastfeed had more than two times greater odds of citing individual reasons (OR, 2.25; 95% CI, 1.30-3.91) or reasons related to household responsibilities (OR, 2.27; 95% CI, 1.19-4.36) as compared with women who indicated they were taught. CONCLUSIONS Findings suggest the need for targeting breastfeeding interventions to different subgroups of women. In addition, there are implications for policy particularly regarding breastfeeding support in hospitals.

Balancing work and family: effect of employment characteristics on breastfeeding.

This article describes an investigation of the effect of postpartum employment and occupational type on breastfeeding initiation and duration. Data were from the Early Childhood Longitudinal Study-Birth Cohort. Postpartum employment status was classified as full-time, part-time, and not employed. Among postpartum workers, occupational type was classified as management, professional, service, sales, administrative, and “other.” In adjusted analysis, professional women had a 20% greater likelihood of initiating breastfeeding than administrative workers (risk ratio [RR] 1.20; 95% confidence interval [CI], 1.06-1.30). Full-time workers had a 10% lower likelihood of initiating breastfeeding than those not employed (RR 0.90; 95% CI, 0.82-0.97). Among breastfeeding initiators, full-time workers had a 19% lower likelihood of any breastfeeding beyond 6 months than those not employed (RR 0.81; 95% CI, 0.65-0.99). To improve breastfeeding initiation and duration in the United States, part-time options may be an effective solution for working mothers.

Higher Risk Of Death In Rural Blacks And Whites Than Urbanites Is Related To Lower Incomes, Education, And Health Coverage

Health outcomes among rural minority populations are seldom examined. Our research studied mortality among urban and rural white, black, and Hispanic adults ages 45-64, comparing outcomes for each group. We found the mortality risk to be higher among both rural white and rural minority populations compared to urban whites; rural blacks were at higher risk of death than urban blacks. When personal characteristics and circumstances of these populations-such as level of education, presence of health insurance, and income above or below the poverty line-were held statistically equal, disparities were reduced or eliminated. Our study suggests that policies directed toward reducing differences related to education, poverty, and health insurance would go a long way toward eliminating the disparities in health status between urban and rural populations.

The impact of disasters on populations with health and health care disparities.

CONTEXT A disaster is indiscriminate in whom it affects. Limited research has shown that the poor and medically underserved, especially in rural areas, bear an inequitable amount of the burden. OBJECTIVE To review the literature on the combined effects of a disaster and living in an area with existing health or health care disparities on a communitys health, access to health resources, and quality of life. METHODS We performed a systematic literature review using the following search terms: disaster, health disparities, health care disparities, medically underserved, and rural. Our inclusion criteria were peer-reviewed, US studies that discussed the delayed or persistent health effects of disasters in medically underserved areas. RESULTS There has been extensive research published on disasters, health disparities, health care disparities, and medically underserved populations individually, but not collectively. CONCLUSIONS The current literature does not capture the strain of health and health care disparities before and after a disaster in medically underserved communities. Future disaster studies and policies should account for differences in health profiles and access to care before and after a disaster.