Post on 14-Oct-2020
Iowa WIC Mothers Experience
More Traumatic Stress
BROOKE MEHNER, MPH IOWA DEPARTMENT OF PUBLIC HEALTH
Stress
“A reaction to a situation where a person feels threatened or anxious. Stress can be positive (e.g., preparing for a wedding) or negative (e.g., dealing with a natural disaster). The symptoms may be physical or emotional.” (CDC, 2018)
Common side effects:Sleeping too much or too little
Feeing sad, frustrated, and helpless
Wanting to be alone
Loss of appetite
Headaches, back pains and stomach problems
Increased heart rate, difficulty breathing
Smoking or use of alcohol or drugs
SOURCE: CDC, 2018
Stress One of the Top 10 Social Determinants of Health Inequities
Associated with low-income populations
Continued anxiety, insecurity, low self-esteem, social isolation and lack of control over work and home lifePowerful impacts on mental and physical health Increased chances of poor mental health and premature death;
Feeling tense too often or for too long increases the risk for many serious health conditions, including infections, diabetes, high blood pressure, heart attack, stroke, depression and aggression
Long periods of anxiety and insecurity and lack of supportive friendships are damaging
The lower people are in the social hierarchy of industrialized countries, the more common these problems
Stressful events before and/or during pregnancy can impact the health across generations
SOURCE: WHO, 2003
Stress
SOURCE: CDC, 2018
HEALTHY WAYS TO COPE SOCIAL DETERMINANTS OF HEALTH
Eat healthy, well-balanced meals Food security
Exercise regularly Neighborhood safety
Sleep Finances
Talk to others Social network
Give yourself a break And others
Time for Some
Audience
Participation!
STUDY QUESTION
Comparing Iowa WIC and non-WIC mothers, what are the differences in the amount and types of stress experienced in the 12
months before infant birth and the association with poor mood?
Methods
Iowa 2013-2015 PRAMS data
Iowa WIC population most reliable
Poor mood:Selecting “Always” or “Often” to P7 Core Questions 54 & 55 :
Q54: Since your baby was born, how often have you felt down, depressed or hopeless?
Q55: Since your new baby was born, how often have you had little interest or little pleasure in doing things?
Methods
14 stressors experienced in the 12 months before infant birth (P7 Core Question 36) Continuous count (0-14)
4 Categories
EMOTIONAL(1) Family ill;(2) Someone close died
FINANCIAL(1) Moved; (2) Husband/partner lost job; (3) Mom lost job; (4) Husband/partner reduced pay/work; (5) Couldn’t pay bills
PARTNER-ASSOCIATED(1) Divorced; (2) Arguing with husband/partner;(3) Husband/partner didn’t want to be pregnant;(4) A part from husband/partner (work related)
TRAUMATIC(1) Husband/partner/self went to jail;(2) Someone close had problem with drinking or drugs
Results – DescriptivesWIC NON-WIC
% [CI] MEAN [CI] % [CI] MEAN [CI]
ALL 36.6 [34.2-39.0] 63.5 [61.0-65.8]
RACE/ETHNICITY
NH White/Other/Unknown 72.3 [70.3-74.3] 93.8 [93.3-94.2]
NH Black 10.7 [9.9-11.5] 2.47 [2.2-2.7]
Hispanic 17.0 [15.8-18.3] 3.8 [3.5-4.1]
AGE
14-19 12.7 [10.2-15.7] 1.55 [0.9-2.6]
20-24 33.9 [30.0-38.0] 11.93 [9.9-14.3]
25-29 29.61 [25.9-33.6] 37.6 [34.5-40.8]
30-34 16.03 [13.3-19.1] 34.6 [31.6-37.8]
35+ 7.8 [6.0-10.1] 14.3 [12.1-16.7]
EDUCATION
Less Than HS 18.8 [16.3-21.7] 4.5 [3.3-6.1]
HS 40.2 [36.1-44.4] 10.7 [8.7-13.1]
Some college 35.8 [31.8-39.9] 33.2 [30.8-36.4]
College+ 5.2 [3.7-7.4] 51.59 [48.3-54.9]
*All values are statistically significant
Results – DescriptivesWIC NON-WIC
% [CI] MEAN [CI] % [CI] MEAN [CI]
GEOGRAPHY
Urban 56.5 [52.3-60.5] 65.2 [62.0-68.3]
Rural 43.6 [39.5-47.7] 34.8 [31.7-38.0]
FEDERAL POVERTY LEVEL (FPL)
0-49% 38.8 [34.6-43.2] 5.9 [4.5-7.6]
50-184% 50.6 [46.2-55.1] 19.5 [17.0-22.4]
185-374% 9.0 [6.6-12.2] 33.4 [30.3-36.6]
375% + -- 41.3 [38.1-44.6]
INSURANCE (During Pregnancy)
Public 64.1 [59.9-68.0] 10.8 [9.0-13.0]
Private 31.2 [27.3-35.3] 87.0 [84.6-89.1]
None 4.8 [3.8-6.0] 2.2 [1.4-3.5]
*All values are statistically significant value--Suppressed values (<25 respondents)
Results – Stress (Rates)
7 IN 10 2 IN 10
FINANCIAL PARTNER TRAUMATIC
2 IN 5
1 IN 54 IN 10 1 IN 10
WIC
Non-WIC
STRESSORS
3.0
1.7
EMOTIONAL
3 IN 10
3 IN 10
Results – Poor Mood (RATES)
1.5 IN 10WIC
<1 IN 10Non-WIC
More than DOUBLE the rate of WIC postpartum moms are considered to have poor mood.
Results – Poor mood (Odds)
2.4 WIC
1 Non-WIC
WIC mothers have more than 2x higher odds of experiencing poor mood.
Results – Stressors
3.0 OR WIC
1.66 OR Non-WIC
WIC mothers experience 1.35 more stressors in the 12 months before delivery than non-WIC mothers.
Results – Poor mood
The total number of stressors experienced before delivery has a slightly lesser impact on postpartum poor mood in the WIC population than in the non-WIC population.
1.21 OR WIC
1.39 OR Non-WIC
Results – Stress (Odds)
WIC mothers have a 17% increased odds of experiencing emotional stress (not statistically significant).
17%
WIC moms are also 3x more likely to experience financial stress than non-WIC moms.
Results – Stress (Odds)
WIC Non-WIC
PARTNER-ASSOCIATED
TRAUMATIC
WIC mothers have a 3x greater odds of experiencing partner-associated stress
and more than 2x greater odds of experiencing traumatic stress.
Results Summary
Before delivery, WIC mothers have: WIC NON-WIC
1.2x greater odds of experiencing emotional stress
3x greater odds of experiencing partner-associated stress
More than 2x the odds of experiencing traumatic stress
Postpartum, WIC mothers have: WIC NON-WIC
2x greater odds to experience poor mood
Limitations
Mixed data sourcesBirth Certificate
PRAMS self-report
Dose of stress is not equally processed by every individual
Unaware of positive versus negative stressi.e. moving
Conclusions &
Public Health Implications
Iowa WIC mothers experience higher rates and greater odds of emotional,
partner-associated, and
traumatic stress, potentially leading to adverse health outcomes.
Poor mood rate differences may demonstrate a need for postnatal care and mental health care accessibility.
WIC, Title V clinics, and other organizations interacting with pregnant women may consider new activities or available resources to aide in traumatic and partner-associated stress prevention and treatment.
Mental health is crucial to a long, happy and fulfilling life; now and for future generations.
Future analysis – if/what is the effect on health
Thank you!QUESTIONS?
Also, Thank you to:
The Iowa PRAMS mothers,
Jennifer Pham, the PRAMS Project Coordinator and
all others who assisted in the making of this presentation.
ResourcesBrondolo, Elizabeth, et al. “Stress and Health Disparities: Contexts, Mechanisms and Interventions Among
Racial/Ethnic Minority and Low Socioeconomic Status Populations.” American Psychological Association, 2017.
Burns, Elizabeth R., et al. “Stressful Life Events Experienced by Women in the Year Before Their Infant's Birth - United States, 2000-2010.” Morbidity and Mortality Weekly Report, vol. 64, no. 9, 13 Mar. 2015.
Center for Disease Control and Prevention. (2018, January 09). Violence Prevention: Coping with Stress. Retrieved from https://www.cdc.gov/ViolencePrevention/pub/coping_with_stress_tips.html
Hanley J., “Listening Visits in Perinatal Mental Health: A Guide for Health Professionals and Support Workers.” Abingdon, Oxon: Routledge; 2015.
Thorn, Betsy, et al. WIC Participant and Program Characteristics Final Report. 2015, United States Department of Agriculture. Retrieved from https://fns-prod.azureedge.net/sites/default/files/ops/WICPC2014.pdf.
World Health Organization Europe. (2003). The Solid Facts: Second Edition (R. Wilkinson & M. Marmot, Eds.). Social Determinants of Health. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf
Contact Information
Brooke Mehner, MPHPRAMS Data AnalystBureau of Family HealthIowa Department of Public HealthP: (515) 601-5329 | F: (515) 242-6384
brooke.mehner@idph.iowa.gov
Jennifer Pham, MPHPRAMS Project DirectorBureau of Family HealthIowa Department of Public HealthP: (515) 725-2833 | F: (515) 725-1760jennifer.pham@idph.iowa.gov