low-SES Mothers Research Articles

Inequalities at birth: stable socioeconomic differences in birth outcomes in three British cohorts

In this article, I investigate the association between maternal socioeconomic status (SES) and children’s birth outcomes (birth weight) across three different birth cohorts. I also perform mediation analysis to assess the degree to which maternal smoking habits during pregnancy account for this relationship. I draw from three UK cohort studies: the 1958 National Child Developmental Study (NCDS); the 1970 British Cohort (B70); and the 2001 Millennium Cohort study (MCS). There are two main results. First, low-SES mothers are more likely to have children with poor birth outcomes and this association has remained persistent throughout the last 50 years. Second, smoking explains a large part of this association, but only in the two most recent cohorts.

Understanding health inequalities through a practice-oriented 'capabilities' perspective. Motherhood and leisure time physical activity.

In this article, we explore how a capabilities perspective can advance practice theoretic conceptualisations of persistent health inequalities. Specifically, we seek to understand the capabilities necessary for recruitment to leisure time physical activity (LTPA) practices by low SES mothers, a group traditionally excluded from LTPA. Our study illuminates that mothers living a life of social disadvantage face difficulties in becoming recruited to LTPA practices despite, in many cases, the availability of elements required for performance. We identify that temporal, support and energy capabilities are necessary for low SES mothers to become recruitable to LTPA. The dispossession of these capabilities signals inequalities in the constellation of practices that configure this group's lived experiences, in turn giving rise to practice absence and further consolidating patterns of inequality. We offer a framework of practice capabilities and health inequalities to guide future practice-oriented scholarship in the sociology of illness and health, which signals how capabilities may enable or constrain recruitment to health-promoting practices, give rise to inequalities and condition the possibility of practice absence.

Maternal Functioning and Psychological Distress During the COVID-19 Pandemic.

Background: Our objective was to understand maternal functioning and psychological distress among mothers of young children in the United States during April/May 2020, early in the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: Participants were 862 moms of children aged 0-3 years old who completed an online survey. We examined maternal functioning (maternal competency and self-care subscales from the Barkin Index of Maternal Functioning) and psychological distress (depression, anxiety, and stress subscales of the DASS-21), and then examined interaction effects of COVID-19 impact and socioeconomic status (SES; represented by income and education). Results: Mothers' reports of higher maternal functioning correlated with lower psychological distress and both sets of factors varied substantially by SES and COVID-19 Impact. Higher COVID-19 Impact was associated with lower functioning and greater distress. Higher income and education were associated with better maternal self-care, but not maternal competency. Although we expected high SES to buffer mothers from a higher impact of COVID-19, we found that mothers with high SES reported a lower level of maternal competence and more stress than low-SES mothers. Interactions between COVID-19 impact and SES predicting maternal functioning and psychological distress revealed that when COVID-19 impact was low, high SES was associated with high functioning scores and less distress. Conclusions: This work challenges the assumptions that a stressful event will be uniformly experienced by mothers of young children as well as the stress-buffering role of higher SES. This study highlights the importance of considering SES when characterizing maternal functioning and psychological distress during times of high stress. Further research is needed to examine the processes contributing to these discrepancies.

Increases in Language Input are Sustained among Mothers of Low SES: Evidence from a Randomized Controlled Trial

SYNOPSIS Objective. This randomized controlled trial examined whether the quantity and quality of maternal language input were increased through the 3Ts Home Visiting (3Ts-HV) intervention early in toddlerhood and whether increases in maternal language input were sustained over time among families of low SES, controlling for maternal education level, language skill, depressive symptoms, family adversity, child age, child language skills, and the length of recording. Design. 149 mother-toddler dyads of low SES were randomized to receive either the 3Ts-HV intervention (n = 76) or Healthy Lifestyle control (n = 73) curriculum from 14 to 20 months. Both quantity (tokens) and quality (lexical diversity, syntactic complexity, and use of complex sentences and wh-questions) of maternal language input were assessed at 14, 20, 26, 32, and 38 months. Hierarchical linear models were estimated to compare maternal language input between groups over time. Growth trajectories were modeled during the post-curriculum period alone, controlling for baseline maternal language input. Results. Intervention mothers had significantly larger increases in both quantity and quality of language input than Control mothers at 20 months. Intervention mothers’ increases in both quantity and quality of language input were sustained at 26, 32, and 38 months. Conclusions. Language input can be promoted early in toddlerhood and sustained over time among families facing socioeconomic disadvantages. Fostering sustainable increases in maternal language behaviors with very young children among families of low SES is a critical first step in addressing early language input disparities.

The role of teachers’ practices in low-SES mothers’ motivation and involvement in education

Parental involvement impacts their children’s academic achievement. Teachers can promote parental involvement in education by their actions. Thus, the study’s purpose is to examine the associations between teacher-mother relations and teachers’ invitations for involvement with mother's motivation (autonomous or controlling) and involvement in their children's education. The sample included 521 female (Mage = 13.1 years, SD = 1.2) and 463 male (Mage = 14.5 years, SD = 2.3) rural low-SES tele-secondary students and their mothers (Mage = 38.8 years, SD = 6.6). The structural model showed that both positive teacher-mother relationships and the teacher’s invitation to mothers’ involvement positively related to home and school-based mother involvement. Moreover, mothers’ autonomous motivation was positively related to home and school-based involvement, while controlling motivation was negatively associated with home-based involvement. Results also indicate that mothers’ motivation for involvement mediates the relationship between teachers’ practices and mothers’ involvement. Overall, findings suggest that teachers’ practices were related to mothers’ motivation and involvement in education.

Stakeholders' Views on Mobile Applications to Deliver Infant and Toddler Feeding Education to Latina Mothers of Low Socioeconomic Status.

Infant- and toddler-feeding (ITF) practices are critical to long-term health and chronic disease prevention. Using mobile applications (apps) to promote desirable ITF practices shows promise for overcoming challenges of in-person education. However, the viability of ITF apps for Latina mothers of low-socioeconomic status (SES) remains unclear. The objective of this study was to characterize stakeholders’ views on Latina mothers’ capability, motivation, and barriers to using ITF apps. New York City-based health professionals who frequently engage with Latina mothers of low SES completed in-depth interviews. Directed content analysis was used to identify themes through theoretical and inductive codes. Participants included dietitians, nutrition educators, and physicians (n = 17). The following themes were identified: (1) Most Latina mothers of low-SES are tech-savvy (i.e., high capability and experience using smartphones and apps); (2) Apps are an appealing way to deliver ITF education; (3) There are challenges to using apps that must be carefully considered for ITF education development. Overall, ITF apps are a viable option as skills and use appear high among Latina mothers. Key considerations for app development include targeted app promotion; detailed instructions for obtaining and using app; more visuals, less text for low literacy and multiple dialects; making key features available offline.

Daily stressors and food choices: A lab experiment with low-SES mothers

We investigate experimentally the effects of daily-like stressors on immediate and planned food choices, in a sample of low socioeconomic status (SES) mothers. We design a novel stress protocol that aims to mimic everyday stressors experienced by low socioeconomic status individuals. The protocol consists of budget and time allocation tasks to be performed under time and financial pressure. Immediate consumption is measured with in-laboratory consumption of low calorie and high calorie snacks; planned consumption is measured with an incentivized food shopping task. We find no evidence of a significant effect of the stressor on planned food consumption. We do find a notable increase in high-calorie snacking following the stress protocol but it is not precisely estimated. Overall, we find little support for the hypothesis that daily-life stressors induce unhealthy food choices.

Outcomes of Equity-Oriented, Web-Based Parenting Information in Mothers of Low Socioeconomic Status Compared to Other Mothers: Participatory Mixed Methods Study.

BackgroundTypically, web-based consumer health information is considered more beneficial for people with high levels of education and income. No evidence shows that equity-oriented information offers equal benefits to all. This is important for parents of low socioeconomic status (SES; low levels of education and income and usually a low level of literacy).ObjectiveThis study is based on a conceptual framework of information outcomes. In light of this, it aims to compare the perception of the outcomes of web-based parenting information in low-SES mothers with that of other mothers and explore the perspective of low-SES mothers on contextual factors and information needs and behavior associated with these outcomes.MethodsA participatory mixed methods research was conducted in partnership with academic researchers and Naître et grandir (N&G) editors. N&G is a magazine, website, and newsletter that offers trustworthy parenting information on child development, education, health, and well-being in a format that is easy to read, listen, or watch. Quantitative component (QUAN) included a 3-year longitudinal observational web survey; participants were mothers of 0- to 8-year-old children. For each N&G newsletter, the participants’ perception regarding the outcomes of specific N&G webpages was gathered using a content-validated Information Assessment Method (IAM) questionnaire. Differences between participants of low SES versus others were estimated. Qualitative component (QUAL) was interpretive; participants were low-SES mothers. The thematic analysis of interview transcripts identified participants’ characteristics and different sources of information depending on information needs. Findings from the two components were integrated (QUAN+QUAL integration) through the conceptual framework and assimilated into the description of an ideal-typical mother of low SES (Kate). A narrative describes Kate’s perception of the outcomes of web-based parenting information and her perspective on contextual factors, information needs, and behavior associated with these outcomes.ResultsQUAN—a total of 1889 participants completed 2447 IAM responses (50 from mothers of low SES and 2397 from other mothers). N&G information was more likely to help low-SES participants to better understand something, decrease worries, and increase self-confidence in decision making. QUAL—the 40 participants (21 N&G users and 19 nonusers) used 4 information sources in an iterative manner: websites, forums, relatives, and professionals. The integration of QUAN and QUAL findings provides a short narrative, Kate, which summarizes the main findings.ConclusionsThis is the first study comparing perceptions of information outcomes in low-SES mothers with those of other mothers. Findings suggest that equity-oriented, web-based parenting information can offer equal benefits to all, including low-SES mothers. The short narrative, Kate, can be quickly read by decision policy makers, for example, web editors, and might encourage them to reach the underserved and provide and assess trustworthy web-based consumer health information in a format that is easy to read, listen, or watch.

Enhancing food habits via sensitivity in rural low-SES mothers of children aged 1–3 living in Colombia: a randomized controlled trial using video-feedback intervention

ABSTRACT In a randomized controlled trial with 25 Colombian rural low-SES mothers and their children (aged 1–3 years), the effectiveness of the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) in enhancing maternal sensitivity and food habits was tested pre-intervention, post-intervention, and at a 6-month follow-up. The study further verified whether maternal sensitivity represented a mechanism of change for food habits. Mixed models indicated that the VIPP-SD did promote higher maternal sensitivity and better food habits. Moreover, increased maternal sensitivity following the VIPP-SD predicted improved maternal food habits, both post-intervention and at the follow-up. The findings suggest that interventions aimed at preventing early inadequate parental food habits in low-SES communities should promote sensitive parenting during daily mother–child interactions, in addition to offering nutritional advice.

Stress and Food Preferences: A Lab Experiment with Low-Ses Mothers

We investigate whether short-term everyday stressors leads to unhealthier dietary choices among low socioeconomic status mothers. We propose a novel stress protocol that aims to mimic everyday stressors experienced by this population, involving time and financial pressure. We evaluate the impact of stress on immediate and planned food choices, comparing a group exposed to our stress protocol relative to a control group. Immediate consumption is measured with in-laboratory consumption of low calorie and high calorie snacks; planned consumption is measured with an incentivized food shopping task. The stressfulness of the stress protocol is evaluated using subjective assessments, as well as physiological measurements (heart rate and salivary cortisol levels). We find no evidence of an effect of stress on the nutritional content of immediate or planned food consumption, thus no support for the hypothesis that everyday stressors are a likely explanation for unhealthy food choices.

“We were on our own”: Mothers' experiences navigating the fragmented system of professional care for autism

Autism is a developmental disorder that emerges in early childhood. Treatments for autism span a wide variety of professionals and paraprofessionals in the medical and educational realms. This article draws on data from a survey of 620 parents of autistic children, including 385 written narratives, to examine the experiences of mothers as they engage with this fragmented system of professional care for children with autism. Findings suggest that engagement with treatments sent families into a complex and confusing universe of diagnosis and treatment. The fragmentation of autism's professional jurisdiction between the medical and educational systems meant that mothers struggled to find comprehensive professional care that met the standards recommended by leading medical research organizations. Many mothers found it necessary to reduce their workforce participation in order to obtain and maintain their children's treatment regimes, a phenomenon that transcended social class. However, the consequences of reducing work had differential impacts on families. While married and high socioeconomic status mothers were more insulated from the potential negative effects of losing one partner's income, single and low SES mothers experienced greater precarity. These findings connect the structure and arrangement of professional jurisdictions to the experiences of parents, suggesting ways that the fragmentation of professional care for autism can have negative impacts for women, single mothers, and low SES families.

Correlates of child abuse potential among African American and latina mothers: A developmental-ecological perspective

The child victimization rate in the US has rapidly grown over the past five years. Today, nine out of every 1000 children are victims of some type of child maltreatment, and lifetime costs of child victimization exceed $100 billion per year. Effective policies promoting fairness and child safety must target the most salient indicators of child maltreatment. In this study, we examined three groups of risk factors for child abuse potential with the goal of identifying the most prominent indicators in a sample of 170 African-American and Latina mothers. Specifically, we analyzed the effect of socio-demographic variables (e.g., SES), child-specific behaviors, maternal trauma and corresponding psychological sequelae on child abuse potential. Variables from all three groups were significantly associated with child abuse potential with maternal SES, alexithymia, depression, and child self-control as well as internalizing behaviors having the largest effects. All factors combined captured over 50% of the variation in child abuse potential. The results highlight the need for programs that not only address the financial needs of low SES mothers, but also the mental health outcomes correlated with low SES. Particular emphasis should also be placed on interventions that address children’s social needs, specifically their socio-emotional functioning.

Table talk: How mothers and adolescents across socioeconomic status discuss food

This article reports findings from a qualitative study of food practices among families of differing socioeconomic circumstances. Using in-depth interviews from sixty-two families in the San Francisco Bay Area in 2015–2016, we find socioeconomic differences in how mothers and adolescents talk about food. Across SES, mothers and adolescents engage in discussions about healthy eating. However, these conversations are more commonplace and embedded within high-SES family life than among low-SES families. Beyond conversations about 1) healthy eating, the topics of 2) food quality and 3) price are discussed to varying degrees across SES. Within high-SES families, frequent discussions of healthy eating are paired with dialogue highlighting the importance of consuming higher quality food. Price is largely absent as a topic of conversation among high-SES families. On the other end of the socioeconomic spectrum, low-SES mothers and adolescents frequently engage in conversations about price when discussing food. Mentions of food quality are rare, but when they do occur, they underscore important trade-offs between food's healthiness, quality and price. Given prior research showing the impact of dialogue between parents and adolescents on adolescents' dietary behaviors, these findings help us understand how family discussions contribute to shaping adolescents' approaches to food. An important implication is that high-SES families' discussions of food quality may strengthen messages about healthy eating, while conversations about affordability within low-SES families may highlight financial barriers to healthy eating.

Distinct Influences of Mothers and Fathers on Kindergartners’ Numeracy Performance: The Role of Math Anxiety, Home Numeracy Practices, and Numeracy Expectations

ABSTRACT The current study analyzed maternal and paternal differential influences on numeracy performance in kindergarten children. Participants were 180 Chilean children from backgrounds of low and high socioeconomic status (SES), their mothers, and their fathers. A path analysis was used to explore the influences of both maternal and paternal numeracy practices on children’s numeracy performance and the influences of maternal and paternal expectations and anxiety on those activities. Research Findings: Results showed that mothers and fathers who endorse higher numeracy expectations for their children and who report lower levels of math anxiety also report engaging more frequently in advanced numeracy practices with their children. Mothers’—but not fathers’—engagement in numeracy practices at home predicted children’s numeracy performance. Also, low-SES mothers engaged more frequently in numeracy practices with their children, and mothers in general engaged more often in numeracy activities with girls than with boys. Practice or Policy: These findings improve understanding of how maternal and paternal processes relate differently to numeracy performance in kindergarten children. Moreover, these results highlight the need to take into account parents’ numeracy attitudes and practices, as well as their SES, when designing interventions directed at increasing family support for math achievement.

Randomized Trial of a Children's Book Versus Brochures for Safe Sleep Knowledge and Adherence in a High-Risk Population

ObjectiveSleep-related infant deaths have plateaued in the past decade, disproportionately affecting low socioeconomic status (SES) families. Printed materials are widely used for anticipatory guidance, yet none for safe sleep has been studied. We tested the efficacy of a specially designed children's book compared to brochures for safe sleep knowledge and adherence, which we hypothesized would be greater due to superior readability and engagement. MethodsThis randomized controlled trial involved low-SES mothers (n = 282) enrolled in a home visiting program. Home visitors (n = 56) were randomly assigned to perform safe sleep teaching and assessments during 3 visits: third trimester, 1 week old, and 2 months old, exclusively utilizing a specially designed children's book or brochures, and surveys incorporating the American Academy of Pediatrics' safe sleep recommendations. Outcomes were safe sleep knowledge, adherence, and usefulness of materials, controlling for maternal health literacy. ResultsSafe sleep knowledge increased across all time points with no overall group difference, though gains for sleep-evocative and general health items varied. Odds of bed sharing were higher and exclusive crib use lower for the brochure group (P < .05). Mothers and home visitors reported similar usefulness, though home visitors reported greater dialogue via the book and mothers in the book group reported more book sharing with their baby. ConclusionsWhile a specially designed children's book and brochures were equally effective conveying aggregate safe sleep knowledge in low-SES mothers, adherence to exclusive crib use and avoiding bed sharing were greater in the book group, attributable to enhanced dialogue, readability and emotional engagement. Children's books are a promising mode of anticipatory guidance, warranting further investigation.

Lifecourse socioeconomic status and cancer-related risk factors: Analysis of the WHO study on global ageing and adult health (SAGE).

Few studies have examined cancer-related risk factors in relation to SES across the lifecourse in low to middle income countries. This analysis focuses on adult women in India, China, Mexico, Russia and South Africa, and examines the association between individual, parental and lifecourse SES with smoking, alcohol, BMI, nutrition and physical activity. Data on 22,283 women aged 18 years and older were obtained from the 2007 WHO Study on Global Aging and Adult Health (SAGE). Overall, 34% of women had no formal education, 73% had mothers with no formal education and 73% of women had low lifecourse SES. Low SES women were almost four times more likely to exceed alcohol use guidelines (OR: 3.86, 95% CI: 1.23-12.10), and 68% more likely to smoke (OR: 1.68, 95% CI: 1.01-2.80) compared with higher SES. Women with low SES mothers and fathers were more likely to have poor nutrition (Mothers OR: 1.59, 95% CI: 1.17-2.16; Fathers OR: 1.33, 95% CI: 1.11-1.59) and more likely to smoke (Mothers OR: 1.46, 95% CI: 1.15-1.87; Fathers OR: 2.17, 95% CI: 1.80-2.63) compared with those with high SES parents. Women with stable low lifecourse SES were more likely to smoke (OR: 2.55, 95% CI: 1.47-4.43), while those with declining lifecourse SES were more likely to exceed alcohol use guidelines (OR: 3.63, 95% CI: 1.07-12.34). Cancer-related risk factors varied significantly by lifecourse SES, suggesting that cancer prevention strategies will need to be tailored to specific sub-groups in order to be most effective.

The influence of socio-economic status on mothers’ volubility and responsiveness in a monolingual Dutch-speaking sample

This article investigates the amount of input and the quality of mother–child interactions in mothers who differ in socio-economic status (SES): mid-to-high SES (mhSES) and low SES. The amount of input was measured as the number of utterances per hour, the total duration of speech per hour and the number of turns per hour. The quality of the mother–child interactions was analysed using a simple coding scheme: (1) response or not?, (2) incorporation or not? and (3) exact repetition or expansion? Main results showed that mothers of lowSES have fewer utterances per hour, shorter durations of speech and fewer turns per hour than mothers of mhSES. Also, lowSES mothers respond significantly less to their children’s utterances and use more exact repetitions than expansions.

Determinants of suboptimal breastfeeding practices in Nigeria: evidence from the 2008 demographic and health survey.

BackgroundIn Nigeria, suboptimal breastfeeding practices are contributing to the burden of childhood diseases and mortality. This study identified the determinants of key suboptimal breastfeeding practices among children 0–23 months in Nigeria.MethodData on 10,225 children under-24 months were obtained from the 2008 Nigeria Demographic and Health Survey (NDHS). Socio-economic, health service and individual factors associated with key breastfeeding indicators (early initiation of breastfeeding, exclusive breastfeeding, predominant breastfeeding and bottle feeding) were investigated using multiple logistic regression analyses.ResultsAmong infants 0–5 months of age, 14% [95% confidence Interval (CI): 13%, 15%] were exclusively breastfed and 48% [95% CI: 46, 50%] were predominantly breastfed. Among children aged 0–23 months, 38% [95% CI 36, 39%] were breastfed within the first hour of birth, and 15% [95% CI: 14, 17%] were bottle-fed. Early initiation of breastfeeding was associated with higher maternal education, frequent antenatal care (ANC) visits and birth interval but deliveries at a health facility with caesarean section was associated with delayed initiation of breastfeeding. Educated mothers, older mothers and mothers from wealthier households exclusively breastfeed their babies. The risk for bottle feeding was higher among educated mothers and fathers, and women from wealthier households including mothers who made frequent ANC visits.ConclusionSocio-economic and health service factors were associated with suboptimal breastfeeding practices in Nigeria. To improve the current breastfeeding practices, breastfeeding initiatives should target all mothers – particularly low SES mothers – including, national and sub-national health policies that ensure improved access to maternal health services, and improvements to baby friendly hospital and community initiatives for mothers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1595-7) contains supplementary material, which is available to authorized users.

The effects of SES on infant and maternal diurnal salivary cortisol output

The present study directly compared diurnal salivary cortisol output and maternal-infant synchrony in low and high socio-economic status (SES) mother–infant dyads. Saliva cortisol samples were collected from 32 6–12-month-old infants and their mothers on the same day in the morning, afternoon and evening, and assayed for free cortisol concentration. Low-SES infants and mothers exhibited higher average salivary cortisol output, without dysregulation, compared to high-SES infants. Low-SES infants and mothers also showed reduced synchrony in cortisol output compared to high-SES infants and mothers. Results are discussed with respect to maternal sensitivity and early stress reduction interventions.

Development of the Oxford Hills Healthy Moms Project Using a Social Marketing Process: A Community-Based Physical Activity and Nutrition Intervention for Low-Socioeconomic-Status Mothers in a Rural Area in Maine

A physical activity and nutrition community intervention called the Oxford Hills Healthy Moms (OHHM) Project was developed using a multifaceted social marketing process, including review of state surveillance results, key informant interviews, and a survey and focus group discussions with low-socioeconomic-status (low-SES) mothers. This formative work was used to make key decisions on the selection of the intervention region, segmentation of the audience, and design of intervention strategies addressing multiple levels of the socioecological model. The OHHM Project aims to increase fruit and vegetable consumption and physical activity levels among low-SES mothers in the Oxford Hills region of Maine. The OHHM Project includes five components: (a) physical activity buddy program, (b) cooking club with education, (c) fruit and vegetable discount buying club with education, (d) increased access to produce vendors, and (e) increased access to places for physical activity.