Maternal and Child Health Commons^™

Understanding The U.S. Maternal Healthcare System At The Intersection Of Asian American Birth Outcomes And The Model Minority Stereotype: A Literature Review, Sophia Hevel

University Honors Theses

This thesis aims to explore the maternal healthcare system in the United States as it pertains to Asian American birthing people, the ways in which their racial, ethnic, and cultural identities are interacted with within the U.S. Healthcare system, and subsequently the detrimental effects of the medical system's devaluation of culturally specific birthing and postpartum practices have on Asian American birthing experiences. This will be accomplished through an exploration of the United States' maternal healthcare system, or rather, its crisis; how Asian Americans navigate a system that has not been structured to support their specific needs; and lastly, a discussion …

Exploring Muslim American Attitudes Toward Genetic Testing: Perceptions, Barriers, And Ethical Considerations, Hannah Mahmoud

University Honors Theses

This thesis explores perceptions and attitudes toward genetic testing within the Muslim American community, a group often underrepresented in genomic research and public health discourse. Using a community-distributed digital survey, data was collected from 50 self-identified Muslim Americans on their familiarity with genetic testing, reproductive and ethical considerations, and the influence of religious factors. While only 18% had undergone genetic testing themselves, many were familiar through family or friends, and most expressed cautious interest—especially when results could influence future family planning. Education level, age, and religious values shaped both comfort and understanding.

A key theme was the desire for culturally …

"Our Vision Is That Black Mothers And Birthing People, Fathers, And Partners Are Safe, Honored, And Respected Throughout Pregnancy And Parenthood": Black Birth Workers' Agenda For Black Maternal Health In Oregon, Sarah Marguerite Applin

University Honors Theses

Black women and Birthing People (BWBP) face disproportionate rates of mortality within the United States healthcare system. BWBP are three times more likely to suffer a pregnancy-related death than White women. Therefore, addressing and consulting with BWBP about the birthing experience that BWBP sustains when they are bearing children is imperative. The inclusion and application of this key knowledge and understanding should be emphasized and at the root of further development toward reproductive justice. This participatory story was led by Dr. Roberta Hunte. Interviews and focus groups with Black birth workers, birthing people, and public health professionals were conducted in …

Increasing Access To Doulas In Oregon: A Delphi Study, Courtney Elizabeth Crane

Dissertations and Theses

Doulas are trained, nonmedical support professionals that provide continuous emotional, informational, physical, and practical support before, during, and after childbirth. Doula care has been shown to reduce the cost of birth-related healthcare, reduce adverse birth outcomes, and increase patient satisfaction and positive birth experience. In 2011 Oregon became the first state to authorize payment expenditures of doula care through Medicaid as a strategy to reduce birth-related health disparities and increase culturally and linguistically appropriate healthcare delivery. The intention of the set of policies and administrative rules was to mandate access to doulas and other types of Traditional Health Workers (THWs) …

Determinants Of Modern Contraceptive Use Among Young Women In Ghana: A Mixed-Methods Study Design, Adjoa N. Manu

OHSU-PSU School of Public Health Annual Conference

Background: Only 20% of sexually active women aged 15-24 in Ghana used contraception during their last sexual intercourse. Young women are highly exposed to the risks associated with having unprotected sexual intercourse, such as unintended pregnancy and sexually transmitted infections.

Objective: To use an explanatory sequential mixed-methods design to examine the determinants of modern contraceptive use among young women in Ghana using population-based data and identify the types of contraceptive methods the population know and use.

QUAN Design: Analysis of the 2017 Ghana Maternal Health Survey data, a nationally representative cross-sectional survey.

QUAN Findings: The male …

Maternal Socioeconomic Status And Infant Low Birth Weight: Interactions Across Generations, Kira M. Anderson

University Honors Theses

This article examines the interplay between low birth weight (LBW) and socioeconomic status (SES) across generations. Transgenerational research of LBW and SES is limited and poses certain challenges and nuances. A literature review was conducted which gathered studies that analyze both LBW and SES for two or more generations. Results of these studies are mixed, but the body of research is suggestive of patterns in which LBW and low SES may mutually exacerbate each other across generations. Furthermore, the research suggests that these patterns may be more severe among Black women. This paper calls into question the consequences that these …

The Impact Of Maternal Nutrition On The Development And Severity Of Generalized Anxiety Disorders In Rodent And Non-Human Primate Studies, Esmeralda H. Cardoso

University Honors Theses

Generalized anxiety has become more prevalent among children and adolescents in the United States which impacts their health and livelihood. Maternal nutrition during pregnancy is purported to play a role in cognitive development and mental health during childhood, adolescence, and into adulthood. The Developmental Origins of Health and Disease theory suggests maternal nutrition before and during pregnancy influences transgenerational susceptibility, onset, and severity of disease through epigenetic mechanisms that then impact the child’s overall health, including cognitive development and mental health later in life. A literature review of rodents and non-human primate studies was conducted to explore the association between …

The Relationship Between Regulation And Care Access In The Doula Industry, Charissa Billings

University Honors Theses

Birth doulas are unregulated service providers in the United States, who provide informational, emotional, and physical support before, during, and after birth. Currently, the United States has the highest maternal mortality rate amongst the most developed nations, as well as a serious racial gap, with Black women being twice as likely to die due to pregnancy-related complications when compared to White women. Birth doulas can help close the gaps with trained support and advocacy. Since over 40% of the births in the US are covered by Medicaid, providing birth doula services to Medicaid recipients could result in improved birth outcomes. …

A Hidden Crisis During Covid-19: How Have Intimate Partner Violence Screening Guidelines For Pregnant Patients Changed Since The Start Of The Global Covid-19 Pandemic?, Zayba Afshar

University Honors Theses

Introduction: Due to the risks of pregnancy outcomes in relation to IPV and the increased rates of IPV as a result of COVID-19 precautions, health care screening for IPV in the prenatal process is even more imperative for preventing negative healthcare outcomes for both the pregnant patient and children.

Background: Intimate partner violence (IPV) is a significant public health issue that puts both baby and pregnant patients at risk for severe negative healthcare outcomes. Healthcare screening is a tool to find a condition or to learn more about a patient before symptoms become severe.

Methods: Screening for …

Iron-Deficiency Anaemia (Ida): Socio-Cultural Misconceptions Intersect The Health Of Vulnerable Populations In Developing Countries, Samantha G. Alarcon Basurto

University Honors Theses

Iron is a mineral that the human body uses to make hemoglobin, a protein that red blood cells need to carry oxygen from the lungs to all parts of the body. The lack of adequate iron in the blood is known as iron deficiency, which if experienced in greater proportions, can lead to anaemia. Iron-deficiency anaemia is generally understood as a nutritional deficiency that can be treated by diets of food rich in iron content or the ingestion of iron supplements; yet lack of information, restricted access to bioavailable iron-rich foods, minimal awareness of anaemia’s detrimental effects on children’s cognitive …

Ethnic Enclaves And Pregnancy And Behavior Outcomes Among Asian/Pacific Islanders In The Usa, Andrew D. Williams, Lynne C. Messer, Jenna Kanner, Sandie Ha, Katherine L. Grantz, Pauline Mendola

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objectives—Ethnic enclaves are ethnically, spatially, and socially distinct communities that may promote health through access to culturally appropriate resources and reduced exposure to discrimination. This study examined ethnic enclave residence and pregnancy outcomes among Asian/Pacific Islander (API) women in the USA.

Design—We examined 9206 API births in the Consortium on Safe Labor (2002–2008). Ethnic enclaves were defined as hospital regions with high percentage of API residents (> 4%), high dissimilarity index (> 0.41; distribution of API and white residents within a geographic area), and high isolation index (> 0.03; interaction between API and white residents in an area). …

Dohad And The Latina Paradox, Chelsea Peterson, Kellie Pertl, Lulu Gonzalez, Molly Sax

OHSU-PSU School of Public Health Annual Conference

The Latina Paradox is the observation that Latina mothers in the United States have better than expected birth outcomes despite lower socioeconomic status and higher prevalence of risk factors. The Latina Paradox is particularly prominent among women born in Mexico that immigrate to the U.S. prior to having children. Mexican-born women who give birth in the U. S. experience fewer incidences of low birth weight than White women born in the U. S. Various factors are responsible for the Latina Paradox, including social and cultural support in maternity, traditional diet, and immigration of healthier than average women to the U.S. …

Growing Healthy Together: Protocol For A Randomized Clinical Trial Using Parent Mentors For Early Childhood Obesity Intervention In A Latino Community, Byron A. Foster, Kelsey Weinstein, Jackilen Shannon

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Latino children in the US experience high rates of obesity, increasing their risk of subsequent diabetes. There are few clinical trials among low-income, Latino families to test interventions that account for and address their unique situation.

Methods/design: This trial, conducted in a Head Start (early childhood education) setting, randomly assigns children 2–5 years of age who have obesity by CDC (Centers for Disease Control and Prevention) guidelines (at least 95th percentile body mass index) and their parents to one of three conditions: (1) control, (2) parent mentor with an experimental curriculum, or (3) parent mentor with a …

Associations Between Environmental Quality And Infant Mortality In The United States, 2000–2005, Achal P. Patel, Jyotsna S. Jagai, Lynne C. Messer, Christine L. Gray, Kristen M. Rappazzo

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: The United States (U.S.) suffers from high infant mortality (IM) rates and there are significant racial/ethnic differences in these rates. Prior studies on the environment and infant mortality are generally limited to singular exposures. We utilize the Environmental Quality Index (EQI), a measure of cumulative environmental exposure (across air, water, land, sociodemographic, and land domains) for U.S. counties from 2000 to 2005, to investigate associations between ambient environment and IM across maternal race/ethnicity.

Methods: We linked 2000–2005 infant data from the U.S. Centers for Disease Control and Prevention to the EQI (n = 22,702,529; 144,741 deaths). We utilized multi-level …

Vitamin C To Decrease The Effects Of Smoking In Pregnancy On Infant Lung Function (Vcsip): Rationale, Design, And Methods Of A Randomized, Controlled Trial Of Vitamin C Supplementation In Pregnancy For The Primary Prevention Of Effects Of In Utero Tobacco Smoke Exposure On Infant Lung Function And Respiratory Health, Cindy T. Mcevoy, Kristin F. Milner, Ashley J. Scherman, Diane G. Schilling, Christina J. Tiller, Brittany Vuylsteke, Lyndsey E. Shorey-Kendrick, Eliot R. Spindel, Robert Schuff, Julie Mitchell, Dawn Peters, Jill Metz, David Haas, Keith Jackson, Robert S. Tepper, Cynthia D. Morris

OHSU-PSU School of Public Health Faculty Publications and Presentations

Despite strong anti-smoking efforts, at least 12% of American women cannot quit smoking when pregnant resulting in > 450,000 smoke-exposed infants born yearly. Smoking during pregnancy is the largest preventable cause of childhood respiratory illness including wheezing and asthma. Recent studies have shown a protective effect of vitamin C supplementation on the lung function of offspring exposed to in utero smoke in a non-human primate model and an initial human trial. Vitamin C to Decrease the Effects of Smoking in Pregnancy on Infant Lung Function (VCSIP) is a randomized, double-blind, placebo-controlled trial to evaluate pulmonary function at 3 months of age …

The Associations Between Environmental Quality And Preterm Birth In The United States, 2000–2005: A Cross-Sectional Analysis, Kristen M. Rappazzo, Lynne C. Messer, Jyotsna S. Jagai, Christine L. Gray, Shannon C. Grabich, Danelle T. Lobdell

Community Health Faculty Publications and Presentations

Background: Many environmental factors have been independently associated with preterm birth (PTB). However, exposure is not isolated to a single environmental factor, but rather to many positive and negative factors that co-occur. The environmental quality index (EQI), a measure of cumulative environmental exposure across all US counties from 2000—2005, was used to investigate associations between ambient environment and PTB.

Methods: With 2000–2005 birth data from the National Center for Health Statistics for the United States (n = 24,483,348), we estimated the association between increasing quintiles of the EQI and county-level and individual-level PTB; we also considered environmental domain-specific (air, …

Exposure To Fine Particulate Matter During Pregnancy And Risk Of Preterm Birth Among Women In New Jersey, Ohio, And Pennsylvania, 2000–2005, Kristen M. Rappazzo, Julie L. Daniels, Lynne C. Messer, Charles Poole, Danelle T. Lobdell

Community Health Faculty Publications and Presentations

Background: Particulate matter < 2.5 micrometers in aerodynamic diameter (PM2.5) has been variably associated with preterm birth (PTB).

Objective: We classified preterm births into four categories (20–27, 28–31, 32–34, and 35–36 weeks completed gestation) and estimated risk differences (RD) for each category in association with a 1-µg/m3 increase in PM2.5 exposure during each week of gestation.

Methods: We assembled a cohort of singleton pregnancies that completed at least 20 weeks of gestation during 2000-2005 using live birth certificate data from three states (Pennsylvania, Ohio, and New Jersey) (n = 1,940,213; 8% PTB). We estimated mean PM2.5 exposures for each week of gestation from monitor-corrected Community Multi-Scale Air Quality modeling data. RDs were …

An Analysis Of The Changing Forces Behind Health Insurance Coverage Of Homebirth, Christina Anne Gasbarro

Dissertations and Theses

The expansion of managed care, which is premised on containing costs while maintaining market share, represents a radical transformation of the U.S. health care system. A central question for medical sociologists is to determine how the changes brought by managed care influence health insurance and health care options. In evaluating the impacts of managed care, obstetrics is a particularly important site of study. Part of this agenda involves gathering baseline data on a specific transformation in obstetrics practice new to the managed care scene: the emergence of health insurance coverage for the option of home birth. The research project detailed …

Pregnancy Outcomes: A Study Testing A Model For Predicting Health Outcomes In Pregnancy, Tamera Ann Hart-Johnson

Dissertations and Theses

There is a persistent relationship between socioeconomic status and physical health outcomes found in the literature; however the variables mediating this relationship are many, and ways that they interact with each other are complex. The goal of understanding this relationship is to decrease the disparity in health by socioeconomic status.

This study tested a biopsychosocial model proposed by David Williams (1990) to explain the relationship between socioeconomic status and physical health outcomes. The model included the following latent factors: demographics, socioeconomic status, biomedical risk, medical care, psychosocial variables, and health outcomes. The model was tested through a secondary data analysis. …

An Exploratory Study Of Children’S Mental Health Needs In The Pact Target Area Of Southeast Portland, Richard L. Bossardt, Clifford G. Larsen

Dissertations and Theses

The original, and still primary, purpose of this study was to provide a statistical data base for a grant proposal to fund a children's mental health service agency in the PACT target area of Southeast Portland. Since the conception, the plan has been subsumed under the planning auspices of a group whose aim is to work toward expanding and consolidating mental health services in all dimensions for the Southeast Portland area. The geographical focus of this study is on that section of Southeast Portland which has been designated by the Office of Economic Opportunity as a poverty pocket because of …