Low-income African American Women Research Articles

Computer-delivered screening and brief intervention (e-SBI) for postpartum drug use: A randomized trial

Electronic screening and brief intervention (e-SBI) approaches for substance use have shown early promise. This trial was designed to replicate previous findings from a single 20-minute e-SBI for drug use among postpartum women. A total of 143 postpartum, primarily low-income African-American women meeting criteria for drug use, were randomly assigned to either a tailored e-SBI or a time-matched control condition. Blinded follow-up evaluation 3- and 6-months following childbirth revealed strong effects for confirmed illicit drug use abstinence at the 3-month observation (OR=3.3, p=.01), as did hair analysis at 6months (OR=4.8, p=.018). Additional primary outcomes suggested small to moderate effect sizes in favor of the e-SBI, but did not reach significance. This result replicates previous findings but fails to show durable effects. Assessment reactivity, e-SBI design, and possible extension of e-SBI via tailored messaging all merit careful consideration.

Understanding the Link Between Multiple Oppressions and Depression Among African American Women

The purpose of our study was to examine the multiple oppression experiences of sexual objectification, racism, and gendered racism as predictors of depressive symptoms among a clinical sample of low-income African American women. In addition, we examined coping with oppression via internalization (i.e., the tendency to attribute responsibility or the cause of an oppressive event to oneself) as a mediator between these three intersecting forms of oppression and depressive symptoms. Participants included 144 African American women who sought some type of mental health treatment at a U.S. southeastern, public, urban, university-affiliated hospital that attends to a primarily indigent and underserved population. The results of our mediational analysis using bootstrapping provided support for a theorized model in which coping with oppressive events via internalization mediated the links between sexual objectification and depression and between racist events and depression but not between gendered racism and depression. In addition, a unique and direct effect of racist events on depression was found. Finally, the four variables in the model accounted for 42% of variance in depression scores. The study includes implications for future research and clinical work such as exploration of other mediators and the importance of comprehensive intake assessments and multicultural/feminist coping interventions.

What is the effect of a self-administered Reproductive Life Plan (RLP) on preconception and contraceptive counseling?

The Centers for Disease Control and Prevention recommends incorporating reproductive life plans (RLPs) into each clinical encounter for women of reproductive age. However, there have been no studies examining the effect of a self-administered RLP designed as a patient-empowerment tool in the primary care setting. This study used a qualitative design in a clinic serving low-income African-American women to examine patient and provider perceptions of the effect of a novel format of RLP on reproductive health counseling, as well as factors that influence reproductive health counseling in primary care.

Motherhood, reasons for living, and suicidality among African American women.

This report examines the protective role of motherhood against suicidal ideation among low-income African American women with a history of suicide attempts. Findings from previous studies examining the relations between family factors and suicide risks are inconsistent in this population, indicating that family could both exacerbate and reduce risks. Research on the link between motherhood-status specifically and suicide risk is rare, but family and child-related concerns have been identified as unique reasons for living associated with reduced risk of suicide attempt. Self-identified African American women (N = 146), ages 18-64, who attempted suicide within the previous 12 months were recruited from a large urban public hospital. A bootstrapping mediation model was tested using motherhood status from the demographics measure as the predictor, the Reasons for Living (RFL) scales as the mediator, and the Beck Suicidal Ideation Scale as the outcome. The model accounted for 41% of the variance in suicidal ideation and the indirect effect of RFL was statistically significant. These findings provide empirical support for the hypothesis that motherhood is protective against suicidal ideation among African American women with a history of suicide attempts. Future research should seek to determine how incorporating the protective function of motherhood status in clinical interventions with this high-risk population might help to improve treatment effectiveness.

Cumulative Poor Psychosocial and Behavioral Health Among Low-Income Women at 6 Weeks Postpartum

During the postpartum period, women may experience unfavorable psychosocial and behavioral health in multiple domains with adverse effects on parenting and maternal and infant health. Yet, little is known about the accumulation of poor health across the domains of depressive symptoms; body image; diet and physical activity; substance use including smoking and alcohol; and general self-care at 6 weeks postpartum, the usual end of maternity care. The aims of this study were to evaluate relationships among the domains comprising psychosocial and behavioral health and to examine the distribution and risk factors associated with cumulative poor psychosocial and behavioral health at 6 weeks postpartum. This study was a secondary analysis of cumulative poor health assessed by self-report scales for depressive symptoms, body image dissatisfaction, diet and exercise, substance use, and general self-care among 419 low-income White, African American, and Hispanic women at 6 weeks postpartum. Multivariable Poisson and logistic regression were used in key analyses. The correlation among psychosocial and behavioral domains had a range of r = .50-.00. In this sample of women, 45% had two or more domains in which they had poor health. The model testing risk factors for cumulative poor health was significant (likelihood ratio chi-square = 39.26, df = 11, p < 0.05), with two significant factors: not exclusively breastfeeding (odds ratio [OR] = 1.459, 95% confidence interval [CI] [1.119, 1.901]) and Hispanic ethnicity (OR = 0.707, 95% CI [0.582, 0.858], psuedo-R = .029). Within individual domains, significant risk factors (body mass index, not exclusively breastfeeding, ethnicity, education level, and parity) varied by domain. Many low-income women postpartum have poor psychosocial and behavioral health in multiple domains, which constitute areas for health promotion and early disease prevention.

Motivations for Sex Among Low-Income African American Young Women

African American young women exhibit higher risk for sexually transmitted infections, including HIV/AIDS, compared with European American women, and this is particularly true for African American women living in low-income contexts. We used rigorous qualitative methods, that is, domain analysis, including free listing (n = 20), similarity assessment (n = 25), and focus groups (four groups), to elicit self-described motivations for sex among low-income African American young women (19-22 years). Analyses revealed six clusters: Love/Feelings, For Fun, Curiosity, Pressured, For Money, and For Material Things. Focus groups explored how African American women interpreted the clusters in light of condom use expectations. Participants expressed the importance of using condoms in risky situations, yet endorsed condom use during casual sexual encounters less than half the time. This study highlights the need for more effective intervention strategies to increase condom use expectations among low-income African American women, particularly in casual relationships where perceived risk is already high.

Pregnant African American women's attitudes toward perinatal depression prevention.

Depression during the perinatal period is common, debilitating, and consequential for women and their children, particularly among low income African American women. Viable approaches to prevention of depression have emerged. Yet little is known about women's preferences for approaches to preventing depression. A sample of 60 pregnant, low-income African American women seeking routine prenatal care was presented with standardized descriptions of three approaches to depression prevention (pharmacotherapy and two psychosocial approaches) and measures of preferences, perceived credibility, and personal reactions to each approach. Women also completed measures of perceived barriers and facilitators and current depression. Consistent with expectations, both of the psychosocial approaches were rated as more strongly preferred, more credible, and associated with more positive personal reactions relative to the pharmacotherapy approach. Depression did not alter women's preferences among the approaches. Contrary to prediction, women with clinically significant levels of depression did not find the pharmacotherapy approach to be more credible or to have more favorable personal reactions to it than women with low depression symptom levels. Exploration of women's perceptions of barriers revealed the importance of logistics, beliefs, and stigma barriers whereas women reported that concern about depression being impairing and ease of pragmatics would both facilitate engagement with preventive interventions. The findings suggest the need to examine the role of preferences in tests of the effectiveness of approaches to the prevention of perinatal depression in order to enhance service delivery among low income African American women.

Are Nutrition Knowledge, Attitudes, and Beliefs Associated with Obesity among Low-Income Hispanic and African American Women Caretakers?

The purposes of this descriptive study were to (1) describe nutrition knowledge, attitudes, beliefs (KAB), and self-efficacy among low-income African American and Hispanic women; (2) identify the associations these variables have on diet quality and weight status; (3) identify barriers to healthy eating. Data from three separate studies were combined and analyzed. The total sample included African Americans (N = 92) and Hispanics (N = 272). Descriptive statistics and bivariate analyses were used to identify associations between KAB and body mass index (BMI) and diet quality. The majority of African Americans had good knowledge in nutrition while Hispanics had fair knowledge. Attitudes toward eating a healthy diet were significantly associated with high fiber intake among African Americans and low fat consumption among Hispanics. A computed KAB score showed no significant relation to individuals' weight status or diet quality. However, attitudes and beliefs about healthy foods strongly correlated with participants' weight or diet consumption among Hispanics. The most common barrier to consuming a healthy diet reported by both groups was the cost of healthy foods. It is therefore recommended to address these variables when addressing obesity and poor dietary intake among low-income minority groups.

HIV Risk Behaviors among African American Women with at-Risk Male Partners

BackgroundHIV continues to impact African American women at alarming rates. Yet, few researchers have examined the relationship factors promoting unprotected sex within African American communities, especially instances in which women are aware that their male partners are engaging in high risk behaviors. This qualitative study explored the sexual behaviors, relationship characteristics, and HIV prevention strategies utilized by African American women in relationships with African American men at-risk for HIV.MethodTo understand the issues that should be addressed in a sexual risk-reduction intervention, data were collected from three, two-hour focus group discussions (n=24) comprised primarily of low-income African American women with histories of at-risk male sex partners. At-risk partners included specifically men who had sex with other men or with transgender individuals, used crack cocaine or injection drugs, had lengthy incarceration periods, or an unknown sexual history. Discussion questions examined external factors affecting sexual risk behaviors such as societal pressures, peer norms, and financial vulnerability. Discussions were audiotaped, transcribed, and analyzed using a consensual qualitative research approach.ResultsFive themes, including self-esteem, social influences on behavior, relationship fidelity, sexual risk behavior, and partners' sexual behaviors, were identified as placing women at increased risk for HIV. Reasons for inconsistent condom use included concern for maintaining the relationship and substance use before and during sex. African American women also believed that men who have sex with men and women (MSMW) were dishonest about their sexuality due to stigma towards homosexuality/bisexuality. Despite these challenges, participants indicated that African American women have a strong sense of pride that can positively impact behaviors in relationships.ConclusionThe findings of this study support that social and contextual factor such as emotional and financial issues, culture, history, and relationship dynamics need to be considered when developing tailored sexual health interventions for this population.

Acceptability and Potential Impact of Brief Preconception Health Risk Assessment and Counseling in the WIC Setting

To determine the reproductive risks of women using the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the acceptability of delivering preconception screening and counseling with the WIC encounter. A mixed methods approach to include quantitative analysis of reproductive risks and qualitative analysis of post-counseling interviews. A WIC clinic in Clayton County, Georgia. A quota sample of 150 African-American women 18 to 44 years of age recruited from the attendees of WIC nutrition classes for postpartum and breastfeeding women and mothers of children under 5. Intervention. A brief individual counseling based upon identified risks. Participants were administered a risk assessment questionnaire by a member of the study team to determine topics for brief counseling. Following standardized brief counseling, participants completed an individual semistructured interview. The risk assessment questionnaire was analyzed quantitatively; transcripts from the post-counseling interviews were analyzed thematically. Reproductive risks were prevalent among women of reproductive age seeking WIC services: unintended pregnancy (27%), history of sexually transmitted infection (49%), inadequate folic acid supplementation (66%), intimate partner violence (47%), tobacco use (21%), binge drinking (10%), and illicit drug use (5%). The vast majority of WIC clients found the preconception risk assessment and brief counseling to be acceptable and important. WIC constitutes a suitable location for identifying low-income African-American women in need of preconception and reproductive health services and at risk for poor reproductive health outcomes.

Race of Interviewer Effect on Disclosures of Suicidal Low-Income African American Women

Few studies have investigated the impact of interviewer race on the results gleaned through psychological assessment. African American and European American clinical evaluators conducted face-to-face interviews with 161 low-income African American women seeking services at an inner-city hospital following a suicide attempt. Participants were administered measures related to various current life stressors, including the Survey for Recent Life Events, which assesses various forms of daily hassles, and the Index of Spouse Abuse, which taps both physical and nonphysical intimate partner violence (IPV). Multivariate analyses of variance revealed a significant difference on the participants’ reports of daily hassles and IPV to African Americanand European American evaluators. With regard to overall life stress, African American women reported higher levels of total life stress, time pressure stress, social acceptability stress, and social victimization to African American than in European American–led interviews. They also endorsed higher levels of both physical and nonphysical IPV to interviewers of the same race as themselves as compared with interviewers from a different racial background. There were no group differences in terms of work stress, sociocultural differences, and finances. The findings underscore the saliency of interviewer race as a source of nonrandom measurement error capable of influencing statistical results. Implications of ignoring race of interviewer effects in analysis are explored and suggestions are offered in terms of culturally responsive assessment processes.

The Moderating Effects of Skin Color and Ethnic Identity Affirmation on Suicide Risk among Low-SES African American Women

This study examined the influence of concurrent racism and sexism experiences (i.e. gendered racism) on African American women's suicidal ideation and behavior in the context of disadvantaged socioeconomic status. Drawing on a stress process framework, the moderating effects of ethnic identity and skin color were explored using multiple regression analyses. Data were from 204 low-income African American women in the B-WISE (Black Women in a Study of Epidemics) project. Findings suggested that experiencing gendered racism significantly increased these women's risk for suicidal ideation or behavior, though only among women with medium or dark skin color. Also, having strong ethnic identity buffered the harmful effects of gendered racism. The moderating properties of skin color and ethnic identity affirmation likely operate through psychosocial pathways, blocking internalization of negative stereotypes and reducing the level of distress experienced in response to gendered racism.

How Pregnant African American Women View Pregnancy Weight Gain

To gain insight into how low-income, pregnant African American women viewed their weight gain while pregnant and how they managed their weight during pregnancy. Descriptive study using three focus groups. Women were recruited from urban prenatal care sites and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) services in a medium-sized urban northeastern city. Twenty-six adult, low-income, pregnant African American women, age 18 to 39; the majority were within the first 20 weeks of pregnancy. Three focus groups were conducted utilizing open-ended questions related to pregnancy weight gain. Content analysis was used to analyze the verbatim transcripts. Analysis focused on meaning, intention, and context. Groups were compared and contrasted at the within and between group levels to identify themes. Four themes were identified that provided insight into how women viewed their pregnancy weight gain and managed weight gain during pregnancy: (a) pregnancy weight gain: no matter how much means a healthy baby; (b) weight retention: it happens; (c) there is a limit: weight gain impact on appearance; and (d) watching and waiting: plans for controlling weight. Low-income African American women, though cognizant of the likelihood of retention of weight following pregnancy, are not focused on limiting their gestational weight gain. The cultural acceptance of a larger body size along with the belief that gaining more weight is indicative of a healthy infant present challenges for interventions to limit excessive gestational weight gain.

The African American Women and Mass Media campaign: a CDC breast cancer screening project.

For decades, black radio has reached African American communities with relevant, culturally appropriate information, and it continues to be an ideal communication channel to use for contemporary health promotion. In an effort to combat excess breast cancer mortality rates and help eliminate cancer disparities among low-income African American women, the Centers for Disease Control and Prevention's (CDC) Division of Cancer Prevention and Control designed, implemented, and evaluated the African American Women and Mass Media (AAMM) pilot campaign. The AAMM campaign uses black radio, radio stations with broad African American listenership, as a platform for targeted, culturally competent health promotion and outreach to low-income, African American women. The AAMM campaign uses radio advertisements and print materials disseminated in predominantly African American neighborhoods to promote awareness of breast cancer, early detection, and the CDC's National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Evaluation of the AAMM campaign found that the campaign successfully reached its target audience of low-income, African American women and increased women's awareness of breast cancer screening services through the Breast and Cervical Cancer Program in Savannah and Macon, Georgia.

Racial identity and reasons for living in African American female suicide attempters.

The current study investigated the association between racial identity and reasons for living in African American women who have attempted suicide. Particular attention was paid to the relation between two elements of racial identity (private regard, racial centrality) and reasons for living, an alternative assessment of suicidal risk. While private regard refers to an individual's beliefs about the African American race, racial centrality describes the importance an individual places on his or her racial identity. The sample included 82 low-income African American women, ages 18-64, who reported a suicide attempt in the past 12 months. Participants, recruited from a large, urban public hospital located in the Southeast, completed the Reasons for Living Inventory and the Multidimensional Inventory of Black Identity, which included the private regard and racial centrality subscales. Results indicated that, as predicted, higher private regard was associated with more reasons for living. Contrary to expectations, racial centrality was not correlated with reasons for living nor was there an interaction between private regard and racial centrality indicating that racial centrality did not function as a moderator in predicting participants' reasons for living scores. Implications for culturally competent clinical interventions that target bolstering private regard are discussed.

Benefits of a self-management program in low-income African-American women with systemic lupus erythematosus: results of a pilot test

Minorities with systemic lupus erythematosus (SLE) are at high risk of poor disease outcomes and may face challenges in effectively self-managing multiple health problems. The Chronic Disease Self-Management Program (CDSMP) is an evidence-based intervention that improves the health of people with chronic illnesses. Although the CDSMP is offered by organizations throughout the United States and many countries around the world, it has not been tested among SLE patients. We pilot tested the benefits of the CDSMP in low-income African American patients with SLE. CDSMP workshops were delivered to 49 African American women with SLE who received medical care at a public lupus clinic in Atlanta, Georgia, US. We compared pre-post CDSMP changes (from baseline to 4 months after the start of the intervention) in health status, self-efficacy and self-management behaviors using self-reported measures. Additionally, we assessed health care utilization changes using electronic administrative records in the 6-month periods before and after the intervention. We observed significant improvements post-intervention in the SF-36 physical health component summary (mean change = 2.4, p = 0.032); self-efficacy (mean change = 0.5, p = 0.035); and several self-management behaviors: cognitive symptoms management (mean change = 0.3, p = 0.036); communication with physicians (mean change = 0.4, p = 0.01); and treatment adherence (mean change = 0.4, p = 0.01). The median number of outpatient visits decreased from 3 to 1 (p < .0001). The CDSMP is a promising intervention for low-income African Americans with SLE. It is an inexpensive program with growing availability around the world that should be further evaluated as a resource to improve patient-centered outcomes and decrease health service utilization among SLE patients.

African American Mothers: Bringing the Case for Breastfeeding Home

Breastfeeding MedicineVol. 7, No. 5 Empowering Mothers to make a DifferenceAfrican American Mothers: Bringing the Case for Breastfeeding HomeKuae Kelch MattoxKuae Kelch MattoxSearch for more papers by this authorPublished Online:27 Sep 2012https://doi.org/10.1089/bfm.2012.0070AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byHistorical Antecedents of Breastfeeding for African American Women: from the Pre-Colonial Period to the Mid-Twentieth Century2 March 2020 | Journal of Racial and Ethnic Health Disparities, Vol. 7, No. 5Hormonal contraception, breastfeeding and bedside advocacy: the case for patient-centered careContraception, Vol. 99, No. 2A Critical Inquiry of Breastfeeding Attitudes, Barriers, and Experiences of African American Women living in Poverty13 July 2018 | Journal of Poverty, Vol. 22, No. 6Using group model building to develop a culturally grounded model of breastfeeding for low-income African American women in the USA29 May 2017 | Journal of Clinical Nursing, Vol. 27, No. 17-18A Qualitative Study of Social, Cultural, and Historical Influences on African American Women’s Infant-Feeding Practices1 January 2018 | The Journal of Perinatal Education, Vol. 27, No. 2Infant-Feeding Practices Among African American Women8 May 2014 | Journal of Transcultural Nursing, Vol. 26, No. 3Overcoming Clinical Barriers to Exclusive BreastfeedingPediatric Clinics of North America, Vol. 60, No. 1 Volume 7Issue 5Oct 2012 InformationCopyright 2012, Mary Ann Liebert, Inc.To cite this article:Kuae Kelch Mattox.African American Mothers: Bringing the Case for Breastfeeding Home.Breastfeeding Medicine.Oct 2012.343-345.http://doi.org/10.1089/bfm.2012.0070Published in Volume: 7 Issue 5: September 27, 2012Online Ahead of Print:August 27, 2012PDF download

Examining the Validity of Low-Income African American Women's Responses to Items from the Compulsive Sexual Behavior Inventory (CSBI)

The CSBI assesses problems associated with compulsive sexual behavior in male samples. Three hundred and six low income women were administered a 13-item CSBI prior to a sexual health seminar. CFA was used to confirm the previously-established two factor model. The two factor model showed acceptable fit. Women's scores appeared lower than men's. CSBI-13 total and subscale scores were higher in women who reported having engaged in sex exchange. Results support continued use of CSBI Total and Control scores in studying women's sexual behavior. It is unclear whether women's lower scores indicate less CSB or whether women's symptoms are inadequately measured by the CSBI.

From Policy to Practice Change: Nursing Partnerships in Practice to Change Low-Income African American and Hispanic Initiation of Breastfeeding Rates

It has been well documented in previous research that a low-income African American pregnant women are less likely to initiate and continue breastfeeding for the recommended first year of the infant's life. According to National Health and Nutritional data, breastfeeding rates include the following: non-Hispanic White (61%), Spanish-speaking Mexican American (63%), and African American (26%). Mothers with higher levels of education and income have greater breastfeeding initiation and continuation rates than mothers with low-income and low levels of education.

Assessment of a Diversity Assignment in a PR Principles Course

This study assesses an assignment for incorporating diversity into the principles of public relations course. The assignment is tailored to the challenges of using an active learning approach in a large lecture class. For the assignment, students write a goal, objectives, strategies, an identification of tactics, and evaluation plans for either low-income African-American women or low-income Hispanic women living in an urban food desert. Based on focus group data, this assignment appears to help students focus on lectures and retain the material a year after the assignment. With rare exception, the participants who completed the assignment had a better level of cultural understanding than participants who did not have the assignment, as measured by performances on a similar case study one year after the assignment.