Category 6
Family, Child, Adolescent Health (Includes Maternal and Child Health)

Background: The extant link between depression and contraceptive behaviors is based on quantitative data, but there is a dearth of evidence to explain this relationship.

Goal: To explain the underlying mechanisms of association between depression and contraceptive behaviors.

Objectives: To investigate whether, how, and why depression affects contraceptive behaviors through a qualitative lens.

Approach/Methods:We conducted qualitative in-depth interviews with a diverse group of women (N=49) visiting low-cost family planning or mental health clinics in the Washington, D.C. area. Interviews focused on women’s mental health histories and experiences, current depressive symptoms (PHQ, BDI-II), feelings about parenthood and having children, and contraceptive behaviors. We used grounded theory techniques to code the data in three waves using Dedoose software.

Results: Overall, depressed and non-depressed women shared many attitudes on having children, including the importance of mental preparedness, financial stability, and partner support. However, women with depression (moderate to severe symptoms or a depression diagnosis) overwhelmingly wanted to delay childbearing or were ambivalent about having children. They cited concerns regarding not being a good parent, not being worthy of parenthood, passing mental health issues to their offspring, and taking medication while pregnant. Women with depression also cited more instances of unprotected sex, compared to non-depressed women.

Importance to Public Health:Our results indicate that women with depression think deeply about how their mental health might impact their potential children and parenting role, and this shapes their fertility desires accordingly. However, their fertility desires frequently appear to be misaligned with their contraceptive behaviors. Implications for how family planning and mental health services can be better integrated to serve women with depression will be discussed.

Background: Dental caries is a preventable, yet it remains the most common chronic disease found among children. Educating soon-to-deliver mothers could decrease transmission of caries-causing bacteria between mothers and their children. However, labor and delivery (L&D) nurses may not educate patients about oral health.

Goal: The goal of our pilot study was two-fold: 1) to investigate whether labor and delivery nurses at the University of Maryland Hospital provide oral health education to their patients and 2) to measure their oral health knowledge.

Objectives: The goal of our pilot study was two-fold: 1) to investigate whether labor and delivery nurses at the University of Maryland Hospital provide oral health education to their patients and 2) to measure their oral health knowledge.

Approach/Methods:We developed a six-question survey through Qualtrix to measure oral health knowledge and education practices among labor and delivery nurses at the University of Maryland Medical Center (UMMC). A convenience sample of labor and delivery nurses at UMMC received a link to the survey via text. The UMB IRB determined this project to be a Non-Human Subjects Research.

Results: Fifteen labor and delivery nurses voluntarily responded to the survey. The results indicated that the majority (86%) of respondents never provide oral health education to their patients. In addition, less than half (40%) of respondents indicates that babies do not need their mouth clean prior to tooth eruption which indicates a lack of oral health knowledge. A large-scale study in Maryland hospitals is needed to measure oral health knowledge and education practices among L&D nurses.

Importance to Public Health:Integrating oral health into the labor and delivery nurse care protocol could help address the public health concern of dental caries being the most common chronic disease of children. Continuing education courses for labor and delivery nurses and integrating oral health in nursing school curricula could help address this need.

Background: The 2018 HIV infection rate among African American youth aged 15-19 years was four times higher than the national average. Among African American families, parent-to-child sexual health communication is a known protective factor against several sexual risk behaviors, however, father-daughter sexual health communication is largely understudied when compared to father-son or mother-child communication.

Goal: The current study investigated which sexual health topics are the easiest and most challenging for African American fathers and daughters to discuss, and which topics have the largest perceived impact on daughters’ sexual risk behaviors.

Objectives: This study aims to expand current knowledge surrounding the (1) content and (2) impact of African American father-daughter sexual health communication.

Approach/Methods:Nineteen (N=19) semi-structured interviews were conducted among 12 daughters aged 19 to 21 years (M=20.3) and 7 fathers aged 52 to 60 years (M=56.7). Daughters were recruited through academic courses, student-led and community-based organizations, and GED programs. Participating daughters subsequently recruited their fathers. Interviews were 32 to 149 minutes in length (M=79). Interviews were analyzed using thematic analysis.

Results: Analysis revealed that among African American father-daughter dyads, ease of communication varied both by topic and relationship within each dyad. Easy topics to discuss include relationships, dating, prevention of motherhood, abstinence, waiting until marriage, how to carry oneself, and influences of social networks. Topics varying in ease of communication include sex, porn, solo sexual activity, mental health, HIV and STDs, sexuality and gender, topics discussed on impulse, and female development. For several participants, discussing topics vulnerable to criticism and discussing sexual health irrespective of the topic was challenging. Daughters expressed a desire to discuss healthy relationships, dating, casual sexual encounters, STDs, personal sexual health challenges, and their fathers’ perspectives. Topics with the greatest perceived impact on daughters’ behavior include pregnancy prevention, healthy relationships, marriage, dating, and messages rooted in the father’s lived experiences.

Importance to Public Health:Study findings can be used to inform future intervention that seeks to increase the overall frequency and effectiveness of African American father-daughter sexual health communication with the ultimate goal of reducing adolescent sexual risk-taking behaviors and mitigating racial disparities in sexual health outcomes.

Background: Healthy school environments (e.g., nutritious lunches, active free time, functioning water fountains) can reduce health inequities among minoritized or low-income students, who may have less access to health-promoting environments outside of school. Students can play a role in reducing inequities by advocating for improvements to their schools’ health-promoting environment.

Goal: To qualitatively explore how adolescent students attending rural, low/middle-income elementary and middle schools perceive leadership, in order to inform training programs that build student leadership and public health advocacy skills.

Objectives: To describe the extent to which students perceive themselves as leaders, and understand how students’ perceive their leadership qualities compared to qualities they observe in others they consider leaders.

Approach/Methods:Students (n=76; 65.8% female-identifying and 57.9% in elementary school) in 12 rural, low/middle-income schools participating in a randomized controlled obesity prevention trial completed brief semi-structured interviews. Of the 76 students interviewed, 68 reported race/ethnicity: Black/African American (29.4%), non-Hispanic white (29.4%), more than one race (26.5%), Hispanic/Latino (13.2%), non-Hispanic Asian (1.5%). Interviews averaged 9.3 minutes (SD=3.2; range=4.3-17.6). Two coders independently coded data to identify themes related to students’ own leadership qualities and qualities of other people that students considered leaders. Coders met to reach consensus until a stable thematic structure was reached. Comparative analysis explored consistent and discrepant themes between students’ perceptions of their own leadership qualities and those of others.

Results: When asked if they considered themselves leaders, 38% of students agreed, 45% replied “sometimes,” and 14% disagreed. Students most frequently referenced parents, peers, or teachers to describe other people they considered leaders. Consistent themes for leadership qualities included: (1) actions, such as providing emotional and tangible support to others; (2) characteristics, such as being a good example for others to follow. As discrepant themes, having authority/power and being hard-working were often attributed to others, and rarely attributed to students themselves.

Importance to Public Health:Most students viewed themselves as leaders and identified leadership qualities in themselves and in others. While future quantitative/mixed methods research is needed to further contextualize these findings, this study can inform interventions that train underserved adolescents as advocates for more accessible health-promoting environments.

Background: Youth homelessness remains a major public health issue in the United States and youth experiencing homelessness (YEH) are still one of the more understudied and underserved Groups. Each year, approximately 3.5 million unaccompanied youth between 18 and 25 years of age experience homelessness.

Goal: This study aimed to understand the facilitators and challenges to linking youth experiencing homelessness (YEH) to housing services through an understudied avenue -- holistic sexual and reproductive health (SRH) programs for YEH.

Objectives: Holistic SRH programs for YEH are rare yet, potentially, effective settings through which to link YEH with housing services. Wahine (“woman”) Talk (WT) is one such holistic program, and is a multilevel intervention delivered out of a youth drop-in center in Honolulu, Hawai‘i. One of WT’s core components is addressing basic needs, including providing linkage to housing services. Little research exists on SRH programs’ facilitators and barriers to providing linkage to housing for YEH. The current study explores, “What are facilitators and challenges to linking young women experiencing homelessness to housing services through a holistic sexual and reproductive health program?”

Approach/Methods:The study team collected in-depth qualitative data through seven focus groups and 25 individual interviews with WT staff and youth participants aged 14-22 years. Multiple team members analyzed the data using template analysis.

Results: The analysis revealed that while SRH programs may have some facilitators and challenges to linking YEH to housing services that are consistent with other programs such as shelters and drop-in centers, SRH programs also have unique considerations. In particular, SRH programs should consider employing a housing-specific staff person and bolster staff-youth meetings and communication. SRH programs should also determine how to navigate the potential conflict between its goal to reduce pregnancies, the youth participants’ motivation to be housed because she is a mother already or pregnant, and housing programs’ preference to house families.

Importance to Public Health:Given approximately one in 10 youth between the ages of 18-25 experience homelessness every year, it is imperative to find more and better ways to connect YEH to housing services. The study suggests ways SRH programs for YEH can improve their access to housing services for YEH.

Background: Teen parenthood is associated with various challenges, including difficulties in educational and economic attainment, and young mothers with a history of maltreatment experience increased psychological and parenting burden. Social support is one of the key factors that can help young mothers cope with these challenges.

Goal: The overall goal of this study is to understand how young mothers with a history of child maltreatment experience social support during pregnancy and in the early stages of motherhood.

Objectives: This research study was part of a needs assessment for designing a support program for young mothers with a history of maltreatment.

Approach/Methods: We conducted in-depth phenomenological semi-structured interviews with young maltreated mothers (N=9) aged 18-25. We transcribed the interviews and used the iterative six-step interpretative phenomenological analysis (IPA) approach to examine themes in young mothers' lived experiences of seeking and receiving various forms of social support.

Results: Three major themes emerged from the study: (1) need for informational and emotional support as a young mother, (2) varying levels of social support and self-help strategies, and (3) support groups with other young moms. These themes will be discussed, and salient quotes from the interviews with young moms will be presented.

Importance to Public Health: Results of this study extend our knowledge of how social support is critically important in providing mothers with guidance on parenting, and avenues for sharing and learning from each other are needed. Study findings have meaningful implications for prevention efforts aimed at addressing young mothers' parenting and psychological needs.

Background: There is a rich literature about children’s developmental abilities, but the published papers mostly reflect populations drawn from middle- and upper-income countries. Very little published work describes children’s skills and abilities in low-income countries.

Goal: As part of a larger intervention study examining the impact of an educational television show, we were able to collect baseline data on a large sample of preschool children in northern Nigeria.

Objectives: The objective of this work is to offer important information on children’s abilities in terms of a variety of educational and developmental constructs.

Approach/Methods:Researchers conducted one-on-one 25-minute interviews with 396 boys and girls (mean age=5.25, SD=0.86, range 4-6 years) from Nigeria’s Jigawa State in Fall 2020.

Results: From among 8 different letters, children could correctly identify 2.7 and name 1.0 letters. Among 8 different numbers, they could identify 2.2 and name 1.4 numbers. When presented with typical scenarios, children could correctly describe 3.6 emotions (out of 6) and provide 2.9 correct strategies (out of 5) to handle difficult situations. On a scale from 0 to 11, children had an average score of 5.11 (SD=1.88) on health hygiene knowledge. In an exercise with 8 foods, children could appropriately sort 4.8 foods.

Boys and girls differed in their ability to identify letters (p< 0.05), name letters (p< 0.01), and speak in English (p< 0.01), with girls performing better than boys. Younger children scored significantly less than the older children for identifying and naming letters (p< 0.001), speaking English (p< 0.05), all the numeracy variables (p<0.001), health hygiene knowledge (p< 0.05), and sorting foods (p< 0.01). There were no significant differences in the socio-emotional variables for either child’s sex or age.

Importance to Public Health:This study provides valuable data on preschool children’s skills, in terms of literacy, numeracy, socio-emotional development, and health knowledge. Information about developmental abilities of northern Nigerian children provides educational and public health practitioners critical insight to create more targeted and effective interventions.

Background: Stigmas toward menstruation exist in many cultures around the world. Internalized negative attitudes towards menstruation can cause women to be less likely to seek healthcare, recognize what is healthy and unhealthy, and communicate with their healthcare providers. Improved confidence and feelings towards menstruation are linked with improved knowledge on the topic, hygiene, and preparedness for menarche.

Goal: The purpose of this study was to better understand how having a multicultural background in the United States can affect the menstruation experience as most studies group the American identity as homologous when in fact it can involve many cultures and perspectives.

Objectives: The objective of this project was to create a questionnaire to gather qualitative data on differing menstrual taboos the participants have been exposed to. Additionally, the survey was done to better understand how different ethnicities may affect the menstruation experience and if having a culture outside of the American culture alters perceptions. The hypothesis was that those who associate with outside cultures along with the American one would experience more taboos as they are exposed to more perspectives and ideas.

Approach/Methods:This project consisted in creating a questionnaire about cultural identity as well as feelings and experiences with menstruation. The survey was done anonymously and made through google forms. It was shared to different University of Maryland Organizations such as the Latino Student Union, Public Health Beyond Borders, ethnic based sororities, and more.

Results: This survey indicated a variety of taboos dealt with within the American identity whether or not one has other cultures along with this one. Some more common ideas that young women were taught were food restrictions such as no eating eggs, cold or spicy food, lemon, watermelon, and fatty foods. Another very common misconception that appeared most across identities was that tampons take one’s virginity and should be avoided. Religious restrictions such as no praying, fasting, touching holy objects, or entering places of worship were also prevalent. Additionally, it was found that 17.54% of monocultural white individuals reported learning menstrual taboos in their life while 49.46% of multicultural individuals did.

Importance to Public Health:This study is important to public health because recognizing stigmas can potentially assist in minimizing them. Addressing and decreasing these taboos can improve self esteem, communication, knowledge, and overall health outcomes for menstruating individuals.