Family Science Research Works

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Different perceptual worlds: Parent and youth perspectives on parenting outcome trajectories from a Latino family-based program
(Wiley, 2024-01-24) Hurtado Choque, Ghaffar Ali; Kim, HaeDong; Epstein, Norman B.; Garcia-Huidobro, Diego; Svetaz, Maria Veronica; Allen, Michele L.
Discrepancies between parent and youth perceptions of their relationship are a common aspect of generational acculturation gaps influencing immigrant families. Programs designed to strengthen parenting practices among immigrant Latino families commonly address immigration stresses, including differences between parent and youth perceptions, but little is known about discrepancies in their appraisals of program effects on parenting behavior. A randomized trial was conducted examining effects on parent behavior of a program for immigrant families with youth aged 10–14, developed through community-based participatory research principles. Families (346 parents and youth) were recruited by organizations serving Latino families in a Midwestern metropolitan area and randomly assigned to the eight-session psychoeducation and skill-building program or a waitlist control. Parents and youth completed self-report measures at pre-intervention, post-intervention (4 months), and a 6-month follow-up regarding parents' expression of acceptance, efforts to solicit information about the child's experiences, and consistency of discipline, key foci of the program. Based on social cognition theory, the study focused on possible differences in parents' and youths' perceptions of change in parenting behavior. Parents in the treatment group reported pre-post improved acceptance, consistent discipline, and solicitation, whereas youth reported improvement only in parental solicitation, a pattern maintained at follow-up. In the control group, the only change was youth-reported reduction in parental acceptance. Parents' perceptions of improvement are encouraging, but overall lack of improvements from the youth perspective poses a potential problem for impact on parent–child relations. Interventions may need to target both parent and youth cognitions about behavior changes directly.
Technical Assistance: An Overview of a Product from the Sexual & Gender Diversity Learning Community Program
(2024) Aparicio, Elizabeth M.; Gazit-Rosenthal, Shachar; Lare, Sean; Vigorito, Michael; Thomas, Shanéa; King-Marshall, Evelyn; Fish, Jessica N.; Boekeloo, Bradley O.; UMD-PRC Community Advisory Board
Reflecting on your mental health organization’s structure and integrating LGBTQ+ affirming policies and procedures can be helpful in increasing your organization’s competency in supporting LGBTQ+ people. This guide includes statements and questions to help you individually or in a group setting to reflect upon, discuss, and apply key concepts to your practice.
Clinical Consultations: An Overview of a Product from the Sexual & Gender Diversity Learning Community Program
(2024) Aparicio, Elizabeth M.; Gazit-Rosenthal, Shachar; Lare, Sean; Vigorito, Michael; Thomas, Shanéa; King-Marshall, Evelyn; Boekeloo, Bradley O.; Fish, Jessica N.; UMD-PRC Community Advisory Board
Reflecting on your practice in consultation with other clinicians can improve your comfort and confidence in providing mental health care to LGBTQ+ clients. This guide includes self-reflection questions to consider on your own or bring to clinical consultation meetings.
Sexual and Gender Diversity Learning Community (SGDLC) Workshop Study Guide
(2024) Aparicio, Elizabeth M.; Gazit-Rosenthal, Shachar; Lare, Sean; Vigorito, Michael; Thomas, Shanéa; King-Marshall, Evelyn; Fish, Jessica N.; Boekleoo, Bradley O.; UMD-PRC Community Advisory Board
This guide introduces concepts from the Sexual and Gender Diversity Learning Community (SGDLC) workshop: a 7-hour training for mental health providers and administrators on LGBTQ+ affirming mental health care. The objective of this guide is to provide ways to improve mental health providers’ and administrators’ comfort, knowledge, and skill with LGBTQ+ affirmative mental health care.
UMD PRC Mental Health Therapist LGBTQ+ Competency Self-Assessment
(2023-06) Boekeloo, Bradley O.; Fish, Jessica N.; Aparicio, Elizabeth M.; Shin, Richard; Smith-Bynum, Mia; Vigorito, Michael; Lare, Sean; University of Maryland Prevention Research Center
The Mental Health Therapist LGBTQ+ Competency Self-Assessment was created by the University of Maryland Prevention Research Center for mental and behavioral health professionals to self-reflect and assess their own competencies related to providing LGBTQ+ affirmative care in the following areas: knowledge, attitudes, self-efficacy, and practice. This self-assessment takes 15-20 minutes to complete. Each section includes scoring information and interpretations to assist professionals in understanding their current levels of LGBTQ+ competencies. For additional training resources and information, please visit the UMD-PRC Resources Page and consider participating in the UMD-PRC Sexual and Gender Diversity Learning Community Certificate Program.
UMD PRC Organizational LGBTQ+ Climate Assessment
(2023-06) Boekeloo, Bradley O.; Fish, Jessica N.; Aparicio, Elizabeth M.; Shin, Richard; Smith-Bynum, Mia; Vigorito, Michael; Lare, Sean; University of Maryland Prevention Research Center
The Organizational LGBTQ+ Climate Assessment was created by the University of Maryland Prevention Research Center for administrators of mental and behavioral health organizations to assess the performance of their mental and behavioral health primary organization/practice in serving LGBTQ people. This assessment works best when administrators identify a specific "primary organization/practice" that is the focus for change and growth. This may be a group of service providers who share one organizational administrative system or a solo practitioner. Throughout this assessment, "organization" refers to one administrative system or solo private practice. This assessment takes 15-20 minutes to complete. To calculate domain total scores, add the score for all items under each domain. The higher the scores, the more welcoming and inclusive your organization is for LGBTQ+ and other diverse people. For additional training resources and information, please visit the UMD-PRC Resources Page and consider participating in the UMD-PRC Sexual and Gender Diversity Learning Community Certificate Program.
Against the Odds: A Structural Equation Analysis of Family Resilience Processes during Paternal Incarceration
(MDPI, 2021-11-04) Morgan, Amy A.; Arditti, Joyce A.; Dennison, Susan; Frederiksen, Signe
On any given day, approximately 2.1 million children in Europe have an incarcerated parent. Although research indicates that material hardship is associated with parental incarceration, and particularly paternal incarceration, little is known about family processes that may mitigate the harmful effects of such hardship on children with an incarcerated parent. Guided by a resilience framework, this study examined how family processes mediate the effects of material hardship on youth academic adjustment within the context of paternal incarceration. Using Danish data that assessed key family constructs, structural equation modeling was used to perform a mediational within-group analysis of primary caregivers (n = 727) to children with an incarcerated father. Results indicate that although social support and parenting skills did not yield mediating effects, caregiver mental health strongly mediated the effects of material hardship on youth academic adjustment during paternal incarceration. Findings suggest that economic conditions, as well as caregiver mental health symptoms, are important areas of intervention that may promote family-level resilience for youth of an imprisoned father. We conclude with research and practice recommendations to advance our understanding of resilience among families with an incarcerated parent.
Spousal Violence and Contraceptive Use among Married Afghan Women in a Nationally Representative Sample
(MDPI, 2022-08-09) Ibrahimi, Sahra; Steinberg, Julia R.
Objective: Afghanistan is one of the countries with the highest prevalence of spousal violence (56%) and a low prevalence of contraceptive use (23%), yet there is no study assessing how spousal violence is related to contraceptive use, and what methods are most used by women. Therefore, this study examined the association between the number of types of spousal violence and contraceptive use. Method: Using data from 18,985 Afghan married women, aged 15 to 49, who responded to the 2015 Afghanistan Demographic and Health Survey, the current contraceptive method was grouped into five categories: male-involved methods, pills, injectables, long-acting reversible contraception, female sterilization, and Lactation Amenorrhea Method. The number of types of spousal violence in the past 12 months was categorized as none, one type, or two or more types, based on women’s experiences with verbal, physical, and sexual violence. For analysis, binary and multinomial logistic regression were used. Results: After adjusting for the covariates, the experience of any spousal violence was associated with contraception use (adjusted odds ratio (aOR) = 1.93, 95% CI: 1.64–2.27, p = 0.0001). Among those using contraception, experiencing two or three types of spousal violence was associated with using pills (adjusted risk ratio (aRRR) = 2.12, 95% CI: 1.63–2.77, p = 0.0001), injections (aRRR = 1.75, 95% CI: 1.26–2.41, p = 0.001), and LAM (aRRR = 3.27, 95% CI: 2.05–5.20, p = 0.0001), compared to male-involved methods. Conclusions: The findings of this study may inform policymakers and program implementers in designing interventions to address the pervasive problem of violence against women, and make pills and injectables more accessible to Afghan women, since these methods are under women’s control and more often used in Afghanistan.
The Development and Pilot Evaluation of a Family-Based Education to Strengthen Latinx Adolescent Mental Health in the United States: The Familias Activas Experience
(MDPI, 2022-12-23) Hurtado Choque, Ghaffar Ali; Garcia Cosavalente, Hilda Patricia; Chan, Alexander E.; Rodriguez, Matthew R.; Sumano, Eva
Adolescent years are a time of joy and can represent a challenge for parents and youth, especially for immigrants to the US who are adjusting to their host country. Programs focusing on family skills and positive youth development (PYD) can contribute to youth wellbeing especially, however, few exist for low-income immigrant families. (1) Background: The major goals of this project are to strengthen both PYD and healthy parenting practices by implementing an evidence-informed program, Familias Activas. A theory of change guided the development of Familias Activas in which three factors: parent training, positive youth development, and youth physical activity sessions (soccer) aimed to improve Latinx youth mental health. Youth participated in weekly soccer practices led by trained soccer coaches while parents/caregivers attended parent education. Both sessions lasted eight weeks. (2) Method: We describe the formative stage of the research project as well as the pilot implementation of the Familias Activas program, which provides critical insights for the development of a PYD program. (3) Results: Evaluation surveys were administered to youth and their parents. Thirty youths and sixteen parents completed the survey. The Kidscreen scale had a mean for most items ranging from 3.6 to 4.2. Participating youth were 11 years old and most affirmed they were Latinx. The feasibility program quality mean was 4.2 indicating an overall positive result for the pilot program.. Implications of PYD programs for Latinx youth are discussed. (4) Conclusions: The current paper presents a model for positively influencing the physical and mental wellbeing of Latinx youth and their parents. The model is culturally responsive in its involvement of both parents and youth in programming.
Household savings and present bias among Chinese couples: A household bargaining approach
(Wiley, 2023-02-16) Chawla, Isha; Svec, Joseph
Family savings is crucial to long-term wellbeing for all members in a household, particularly in a Chinese context where costs of living increasingly shift from government to individuals. Savings are typically examined as a balance of financial behaviors and spending preferences; however, this study highlights how savings in a family context is also a function of relationship status. Drawing on intra-household bargaining models, we analyze data from the 2014 China Family Panel Studies to examine the extent to which men's and women's relative power in the household explain variation in savings levels across families. Our findings indicate that women's greater bargaining positions (e.g., income and assets) correspond with greater savings for the family. However, such bargaining power constitutes a net negative for family savings when women have both greater relational power and higher spending preferences. We suggest that family savings can and should be understood as an outcome of dynamic bargaining conditions in addition to income factors.
The role of doulas in respectful care for communities of color and Medicaid recipients
(Wiley, 2022-06-02) Mallick, Lindsay M.; Thoma, Marie E.; Shenassa, Edmond D.
Background Despite the tenets of rights-based, person-centered maternity care, racialized groups, low-income people, and people who receive Medicaid insurance in the United States experience mistreatment, discrimination, and disrespectful care more often than people with higher income or who identify as white. This study aimed to explore the relationship between the presence of a doula (a person who provides continuous support during childbirth) and respectful care during birth, especially for groups made vulnerable by systemic inequality. Methods We used data from 1977 women interviewed in the Listening to Mothers in California survey (2018). Respondents who reported high levels of decision making, support, and communication during childbirth were classified as having “high” respectful care. To examine associations between respectful care and self-reported doula support, we conducted multivariable logistic regressions. Interactions by race/ethnicity and private or Medi-Cal (Medicaid) insurance status were assessed. Results Overall, we found higher odds of respectful care among women supported by a doula than those without such support (odds ratios [OR]: 1.4, 95% CI: 1.0–1.8). By race/ethnicity, the association was largest for non-Hispanic Black women (2.7 [1.1–6.7]) and Asian/Pacific Islander women (2.3 [0.9–5.6]). Doula support predicts higher odds of respectful care among women with Medi-Cal (1.8 [1.3–2.5]), but not private insurance. Conclusions Doula support was associated with high respectful care, particularly for low-income and certain racial/ethnic groups in California. Policies supporting the expansion of doulas for low-income and marginalized groups are consistent with the right to respectful care and may address disparities in maternal experiences.
All-Cause Maternal Mortality in the US Before vs During the COVID-19 Pandemic
(JAMA Network, 2022-06-28) Thoma, Marie E.; Declercq, Eugene R.
The National Center for Health Statistics (NCHS) reported an 18.4% increase in US maternal mortality (ie, death during pregnancy or within 42 days of pregnancy) between 2019 and 2020. The relative increase was 44.4% among Hispanic, 25.7% among non-Hispanic Black, and 6.1% among non-Hispanic White women.1 Given a 16.8% increase in overall US mortality in 2020, largely attributed to the COVID-19 pandemic,2 we examined the pandemic’s role in 2020 maternal death rates.
Spousal Violence and Contraceptive Use among Married Afghan Women in a Nationally Representative Sample
(MDPI, 2022-08-09) Ibrahimi, Sahra; Steinberg, Julia R.
Objective: Afghanistan is one of the countries with the highest prevalence of spousal violence (56%) and a low prevalence of contraceptive use (23%), yet there is no study assessing how spousal violence is related to contraceptive use, and what methods are most used by women. Therefore, this study examined the association between the number of types of spousal violence and contraceptive use. Method: Using data from 18,985 Afghan married women, aged 15 to 49, who responded to the 2015 Afghanistan Demographic and Health Survey, the current contraceptive method was grouped into five categories: male-involved methods, pills, injectables, long-acting reversible contraception, female sterilization, and Lactation Amenorrhea Method. The number of types of spousal violence in the past 12 months was categorized as none, one type, or two or more types, based on women’s experiences with verbal, physical, and sexual violence. For analysis, binary and multinomial logistic regression were used. Results: After adjusting for the covariates, the experience of any spousal violence was associated with contraception use (adjusted odds ratio (aOR) = 1.93, 95% CI: 1.64–2.27, p = 0.0001). Among those using contraception, experiencing two or three types of spousal violence was associated with using pills (adjusted risk ratio (aRRR) = 2.12, 95% CI: 1.63–2.77, p = 0.0001), injections (aRRR = 1.75, 95% CI: 1.26–2.41, p = 0.001), and LAM (aRRR = 3.27, 95% CI: 2.05–5.20, p = 0.0001), compared to male-involved methods. Conclusions: The findings of this study may inform policymakers and program implementers in designing interventions to address the pervasive problem of violence against women, and make pills and injectables more accessible to Afghan women, since these methods are under women’s control and more often used in Afghanistan.
Padres Preparados, Jóvenes Saludables: intervention impact of a randomized controlled trial on Latino father and adolescent energy balance-related behaviors
(Springer Nature, 2022-10-18) Baltaci, A.; Hurtado Choque, G. A.; Davey, C.; Reyes Peralta, A.; Alvarez de Davila, S.; Zhang, Y.; Gold, A.; Larson, N.; Reicks, M.
Studies have shown associations among food and activity behaviors and body weight of Latino fathers and adolescents. However, few Latino father-focused interventions have been designed to improve energy balance-related behaviors (EBRBs) and weight status among early adolescents. Thus, this efficacy study aims to evaluate the Padres Preparados, Jóvenes Saludables (Padres) youth obesity prevention program for positive changes in EBRBs (fruit, vegetable, sugar-sweetened beverage (SSB), sweet/salty snack, and fast-food consumption, physical activity, and screen time) and weight status among low-income Latino fathers and adolescents (10-14 years). A two-arm (treatment versus delayed-treatment control group) randomized controlled trial was conducted to evaluate the efficacy of 8 weekly experiential learning sessions (2.5 hours each) based on social cognitive theory. The sessions included food preparation, parenting skills, nutrition, and physical activity. The program was delivered to father-adolescent dyads (mothers were encouraged to attend) in trusted community-based settings in a Midwest metropolitan area between 2017 and 2019. In March 2020, in-person implementation was discontinued due to COVID-19 pandemic restrictions, which limited the sample size. Father/adolescent dyads were randomized to treatment or control group within each site. Surveys and measurements were completed by fathers and adolescents to assess changes in food and activity behaviors from baseline to post-intervention. Adolescents also completed 24-hour dietary recall interviews at baseline and post-intervention. Intervention effects were assessed using linear regression mixed models adjusted for covariates and accounting for clustering of participants within sites. Data from 147 father/adolescent dyads who completed at least the baseline data collection were used. No significant differences were observed for baseline to post-intervention changes in adolescents’ and fathers’ EBRBs or weight status between treatment and control groups. Fathers’ SSB and fast food intakes were not statistically significant (p = 0.067 and p = 0.090, respectively). The Padres program resulted in no significant improvements in adolescent and father EBRBs and weight status. Additional Latino father-focused interventions are needed to examine intervention effects on EBRBs among Latino adolescents.
Against the Odds: A Structural Equation Analysis of Family Resilience Processes during Paternal Incarceration
(MDPI, 2021-11-04) Morgan, Amy A.; Arditti, Joyce A.; Dennison, Susan; Frederiksen, Signe
On any given day, approximately 2.1 million children in Europe have an incarcerated parent. Although research indicates that material hardship is associated with parental incarceration, and particularly paternal incarceration, little is known about family processes that may mitigate the harmful effects of such hardship on children with an incarcerated parent. Guided by a resilience framework, this study examined how family processes mediate the effects of material hardship on youth academic adjustment within the context of paternal incarceration. Using Danish data that assessed key family constructs, structural equation modeling was used to perform a mediational within-group analysis of primary caregivers (n = 727) to children with an incarcerated father. Results indicate that although social support and parenting skills did not yield mediating effects, caregiver mental health strongly mediated the effects of material hardship on youth academic adjustment during paternal incarceration. Findings suggest that economic conditions, as well as caregiver mental health symptoms, are important areas of intervention that may promote family-level resilience for youth of an imprisoned father. We conclude with research and practice recommendations to advance our understanding of resilience among families with an incarcerated parent.
Joint effects of ethnic enclave residence and ambient volatile organic compounds exposure on risk of gestational diabetes mellitus among Asian/Pacific Islander women in the United States
(Springer Nature, 2021-05-08) Williams, Andrew D.; Ha, Sandie; Shenassa, Edmond; Messer, Lynne C.; Kanner, Jenna; Mendola, Pauline
Asian/Pacific Islander (API) communities in the United States often reside in metropolitan areas with distinct social and environmental attributes. Residence in an ethnic enclave, a socially distinct area, is associated with lower gestational diabetes mellitus (GDM) risk, yet exposure to high levels of air pollution, including volatile organic compounds (VOCS), is associated with increased GDM risk. We examined the joint effects of ethnic enclaves and VOCs to better understand GDM risk among API women, the group with the highest prevalence of GDM. We examined 9069 API births in the Consortium on Safe Labor (19 hospitals, 2002–2008). API ethnic enclaves were defined as areas ≥66th percentile for percent API residents, dissimilarity (geographic dispersal of API and White residents), and isolation (degree that API individuals interact with another API individual). High levels of 14 volatile organic compounds (VOC) were defined as ≥75th percentile. Four joint categories were created for each VOC: Low VOC/Enclave (reference group), Low VOC/No Enclave, High VOC/Enclave, High VOC/No Enclave. GDM was reported in medical records. Hierarchical logistic regression estimated odds ratios (OR) and 95% confidence intervals (95%CI) between joint exposures and GDM, adjusted for maternal factors and area-level poverty. Risk was estimated for 3-months preconception and first trimester exposures. Enclave residence was associated with lower GDM risk regardless of VOC exposure. Preconception benzene exposure was associated with increased risk when women resided outside enclaves [High VOC/No Enclave (OR:3.45, 95%CI:1.77,6.72)], and the effect was somewhat mitigated within enclaves, [High VOC/Enclave (OR:2.07, 95%:1.09,3.94)]. Risks were similar for 12 of 14 VOCs during preconception and 10 of 14 during the first trimester. API residence in non-enclave areas is associated with higher GDM risk, regardless of VOC level. Ethnic enclave residence may mitigate effects of VOC exposure, perhaps due to lower stress levels. The potential benefit of ethnic enclaves warrants further study.
Differences in reporting food insecurity and factors associated with differences among Latino fathers and mothers
(Springer Nature, 2021-05-13) Nagao-Sato, Sayaka; Druziako, Stephanie; Baltaci, Aysegul; Peralta Reyes, Alejandro Omar; Zhang, Youjie; Hurtado Choque, Ghaffar Ali; Reicks, Marla
Food security status has been assessed as a representative score for households; however, different members in the same household may perceive and report food insecurity differently. A high prevalence of food insecurity has been reported among Latino households, therefore understanding differences in reporting food insecurity by Latino father-mother dyads may improve accuracy of assessment and plans to address food insecurity. This study aimed to 1) determine demographic characteristics and/or food-related factors associated with perceptions of food security status among Latino father-mother dyads, and 2) identify factors associated with discordance in perceptions of food insecurity between dyads. Baseline data were used from a community-based, youth obesity prevention program among Latino families (n = 106 father-mother dyads). Food security was assessed with a 2-item food insecurity screen. Logistic regression models were used to evaluate associations between reporting food security status and predictor variables for fathers, mothers, and dyad-discordant responses. Food insecurity was reported by 39% of fathers and 55% of mothers. Adjusted odds of reporting food insecurity were significantly higher for fathers perceiving their neighborhood was unsafe vs. safe (OR: 3.7, p < 0.05) and reporting lower vs. higher household income (OR: 3.2, p < 0.05). Adjusted odds of reporting food insecurity were significantly higher for mothers perceiving their neighborhood was unsafe vs. safe (OR: 4.1, p < 0.01) and reporting lower vs. higher home availability of fruit and vegetable (OR: 5.5, p < 0.01). Dyad discordance in reporting food security status occurred in 24% of the dyads. Adjusted odds of dyad discordant reports of food insecurity status were significantly higher for dyads reporting discordant responses regarding previous nutrition education (OR: 3.4, p < 0.05) and higher home fruit and vegetable accessibility (OR: 3.1, p < 0.05) compared to dyads reporting concordant responses. Among the 28 dyads who reported discordant nutrition education participation, 21 reported that fathers had never participated but mothers had participated more than once. Differential factors were associated with reporting food security among Latino father-mother dyads. Nutrition education for fathers that improves awareness of home food supplies and a better understanding of how food accessibility influences maternal perceptions may improve dyad discordance in reporting household food security.
The context of violent disagreements between parents: a qualitative analysis from parents’ reports
(Springer Nature, 2014-12-24) Bair-Merritt, Megan H; Mandal, Mahua; Epstein, Norman B; Werlinich, Carol A; Kerrigan, Deanna
Intimate partner violence (IPV) is a prevalent public health problem that affects millions of families. Much of what is known about IPV comes from quantitative studies that often "count" acts of IPV without exploring in depth the circumstances surrounding the violence, thereby leaving critical questions unanswered; existing qualitative studies tend to focus solely on women’s perspectives. There is a dearth of dyadic qualitative research exploring the context of IPV in families with children, thus hindering the development of effective interventions for families experiencing IPV. Seven heterosexual couples were recruited from a University-based family therapy clinic to participate in qualitative interviews. Couples were eligible if they had experienced severe verbal or any physical aggression during the past 4 months; had ≥ one child living in the household; were English-speaking; and were ≥ 18. Each individual was interviewed separately. Key topics explored included specific types of violence used by men and women; primary triggers and the context surrounding aggressive disagreements; degree to which the child(ren) were exposed; and perceived consequences for adults and children. All couples listed household responsibilities and parenting as key IPV triggers. Couples with infants reported that parenting disagreements were particularly heated, with women using aggression due to frustration about their partners’ lack of support. Couples also described substance use, wanting to be heard, and prior violence histories as triggers or as the background context for IPV episodes. Children were present during IPV and often intervened in conflicts involving severe violence. Parents’ perceptions of the effects of IPV on their children ranged from minimal to major emotional distress, with men describing more significant impact than women. When describing acute triggers, parents most commonly mentioned that arguments were instigated by concerns about the division of household labor and parenting, a finding that may have significant implications for intervention development; this was particularly notable for parents of infants. Our findings emphasize the need for innovative programs that help parents cope with the stresses of raising a family as well as programs that directly address the consequences of IPV for children.
Predictors of maternal health services utilization by poor, rural women: a comparative study in Indian States of Gujarat and Tamil Nadu
(Springer Nature, 2015-07-31) Vora, Kranti Suresh; Koblinsky, Sally A.; Koblinsky, Marge A.
India leads all nations in numbers of maternal deaths, with poor, rural women contributing disproportionately to the high maternal mortality ratio. In 2005, India launched the world’s largest conditional cash transfer scheme, Janani Suraksha Yojana (JSY), to increase poor women’s access to institutional delivery, anticipating that facility-based birthing would decrease deaths. Indian states have taken different approaches to implementing JSY. Tamil Nadu adopted JSY with a reorganization of its public health system, and Gujarat augmented JSY with the state-funded Chiranjeevi Yojana (CY) scheme, contracting with private physicians for delivery services. Given scarce evidence of the outcomes of these approaches, especially in states with more optimal health indicators, this cross-sectional study examined the role of JSY/CY and other healthcare system and social factors in predicting poor, rural women’s use of maternal health services in Gujarat and Tamil Nadu. Using the District Level Household Survey (DLHS)-3, the sample included 1584 Gujarati and 601 Tamil rural women in the lowest two wealth quintiles. Multivariate logistic regression analyses examined associations between JSY/CY and other salient health system, socio-demographic, and obstetric factors with three outcomes: adequate antenatal care, institutional delivery, and Cesarean-section. Tamil women reported greater use of maternal healthcare services than Gujarati women. JSY/CY participation predicted institutional delivery in Gujarat (AOR = 3.9), but JSY assistance failed to predict institutional delivery in Tamil Nadu, where mothers received some cash for home births under another scheme. JSY/CY assistance failed to predict adequate antenatal care, which was not incentivized. All-weather road access predicted institutional delivery in both Tamil Nadu (AOR = 3.4) and Gujarat (AOR = 1.4). Women’s education predicted institutional delivery and Cesarean-section in Tamil Nadu, while husbands’ education predicted institutional delivery in Gujarat. Overall, assistance from health financing schemes, good road access to health facilities, and socio-demographic and obstetric factors were associated with differential use of maternity health services by poor, rural women in the two states. Policymakers and practitioners should promote financing schemes to increase access, including consideration of incentives for antenatal care, and address health system and social factors in designing state-level interventions to promote safe motherhood.
Latino adolescent-father discrepancies in reporting activity parenting practices and associations with adolescents’ physical activity and screen time
(Springer Nature, 2020-01-21) Zhang, Youjie; Baltaci, Aysegul; Overcash, Francine; Druziako, Stephanie; Peralta, Alejandro; Hurtado, Ghaffar Ali; Reicks, Marla
Latino fathers may play important roles in adolescents’ physical activity and screen time. However, informant discrepancies regarding paternal activity parenting practices may challenge studies supporting evidence-based applications. This study examined Latino adolescent-father discrepancies in reporting paternal activity parenting practices, types of discrepancies by participant characteristics, and associations between discrepancy types and adolescents’ physical activity and screen time.

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