Partner Influence on Women’s Perceptions of Pregnancy Charlan Kroelinger, MA, PhD c Department of...
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Transcript of Partner Influence on Women’s Perceptions of Pregnancy Charlan Kroelinger, MA, PhD c Department of...
Partner Influence on Women’s Perceptions of Pregnancy
Charlan Kroelinger, MA, PhDc
Department of Epidemiology and BiostatisticsCollege of Public Health
University of South Florida
Co-authors: Heather Stockwell, Sc.D.
Department of Epidemiology and Biostatistics University of South Florida
Kathryn Oths, Ph.D. Department of Anthropology, The University of Alabama
John Bolland, Ph.D. Institute for Social Science Research, The University of Alabama
Thomas Mason, Ph.D. Department of Epidemiology and Biostatistics
University of South Florida
Research Question
• Does the support of a woman’s current partner impact her reaction to stressors occurring during pregnancy?– If so, does partner social support buffer the
impact of specific stressors (e.g., pregnancy wantedness and physical and/or verbal abuse)?
Definitions of Partner Social Support
• Partner support– Has the partner provided support (emotional or
material) during the pregnancy? Yes or No– When he provided support, what was the magnitude?
Norbeck social support scale (score 0 – 6)• Please name all of the people you are close to in your
life who make you feel liked or loved.• …you are close to who make you feel important.• …you know for certain you could go to for comfort if you
were upset about something• Who would help you if you needed a ride somewhere.• …you needed to borrow some money.• …you were sick for a long time and couldn’t get out of
bed.
Definitions of Pregnancy Stressors
• Pregnancy stressors– Pregnancy Wantedness: When you first
found out you were pregnant, did you really feel like you wanted to have a baby? Yes or No
– Abuse: • Is there anyone who often says things to you
that hurt you? Yes or No
• Have you ever been hit, slapped, kicked, or hurt by someone? Yes or No
Study Population – Basic Demographic Characteristics*
Characteristic Alabama Tuscaloosa County
Mobile County
Population** 4,447,100 164,875 399,843
Ethnicity
Black 29.9% 31.9% 36.9%
White 71.1% 68.1% 63.1%
Median income $34,135 $34,436 $17,178
Below poverty level
16.1% 17.0% 18.5%
At least a high school education**
75.3% 78.8% 76.7%
Total # Live births 62,061 2,296 6,216
*All data are from the 1999 census unless otherwise specified **2000 census
Study Population
• Prospective Cohort– Pregnant women in the first trimester of
pregnancy at their initial prenatal visit– All participants had to be between 13 and
34 years of age, either black or white, and receiving Medicaid waiver services
• Each participant was followed forward through childbirth
• Each participant was interviewed twice during the pregnancy– First trimester and third trimester
Methodology
• Sampling (N = 506)– Consecutive random (at participating clinics)• Possible participants’ charts were reviewed to
assess inclusion/exclusion criteria• Upon inclusion, participants were approached
during the prenatal visit• Informed consent received• Initial interview conducted (1-14 weeks gestation)• Final interview conducted (28-40 weeks gestation)
– Approximately 4 years of data collection with each participant followed for the duration of one pregnancy
Research Model
EthnicityBlackWhite
Partner Social Support
Physical and/orVerbal Abuse
PregnancyWantedness
Buffers
Buffers
Interacts
Results – Descriptive Characteristics
Characteristic Frequency Proportion (%)
Ethnicity
Black 227 44.9
White 170 33.6
Missing 109 21.5
Educational Level
<9th grade (middle school) 53 10.5
<High school, >middle school 267 52.8
<College, >high school/GED 160 31.6
College or greater 26 5.1
Marital Status
Single 296 58.5
Single, ever-married 45 8.9
Married/Living with partner 165 32.6
Results – Descriptive Characteristics
Characteristic Range Mean Standard Deviation
Missing
Age 14-35 22.5 4.39 0
Pre-pregnant weight (lbs.) 82.0-411.0 151.5 46.07 0
Height (inches) 57-78 64.5 2.82 2
Body Mass Index 14.0-60.7 25.5 7.03 2
Results – Descriptive Statistics: Measures of Partner Support
Characteristic Frequency Proportion (%)
Partner Support
No 116 22.9
Yes 390 77.1
Characteristic Range Mean Standard Deviation
Missing
Partner Support Scale 0-6 3.7 2.41 0
Categorical Measure of Partner Social Support
Partner Support Scale (0-6)
Results – Descriptive Statistics: Pregnancy Wantedness and Abuse
Characteristic Frequency Proportion (%)
Pregnancy Wantedness
No 210 41.5%
Yes 225 44.5%
Missing 71 14.0%
Abuse
Yes 176 34.8
No 330 65.2
Results – Analysis of Pregnancy Wantedness
Partner social support (present or absent) and pregnancy wantedness (N = 433)
Characteristica Odds Ratio
P-value
95% Confidence Interval
Social support 2.23 0.004 1.28-3.87
• Women who lack their partner’s social support are over 2 times more likely to say their pregnancy is unwanted compared with women who have their partner’s social support.
a Logistic regression adjusting for age, educational attainment, marital status, pre-pregnant weight, BMI
Results – Analysis of Pregnancy Wantedness
• Subgroup analysis of partner social support and ethnicity (Full Model) N = 349
Characteristica Odds Ratio
P-value 95% Confidence Interval
Social support 2.19 0.050 1.00-4.82
Ethnicity 0.49 0.018 0.28-0.89
Social support*ethnicity 1.77 0.383 0.49-6.34a Logistic regression adjusting for age, educational attainment, marital status, pre-pregnant weight, BMI
• No significant interaction
Results – Analysis of Pregnancy Wantedness
Predictor = Partner social support scale and pregnancy wantedness (N = 433)
Characteristica Odds Ratio
P-value
95% Confidence Interval
Social support 1.16 0.009 1.04-1.30
• For every one point increase in the social support scale, women are 16% more likely to say their pregnancy is wanted compared with a decrease in the scale.
a Logistic regression adjusting for age, educational attainment, marital status, pre-pregnant weight, BMI
Results – Analysis of Pregnancy Wantedness
• Subgroup analysis of partner social support and ethnicity (Full Model) N = 349Characteristica Odds
RatioP-value 95% Confidence
Interval
Social support 0.90 0.112 0.78-1.03
Ethnicity 0.88 0.801 0.33-2.38
Social support*ethnicity 0.90 0.318 0.72-1.11a Logistic regression adjusting for age, educational attainment, marital status, pre-pregnant weight, BMI
• No significant interaction
Results – Analysis of Physical and/or Verbal Abuse
Partner social support (present or absent and abuse (N = 433)– No significant findings after adjusting for
confoundingSubgroup analysis of partner support and ethnicity
(Full model) N = 397Characteristica Odds
RatioP-value 95% Confidence
Interval
Social support 0.87 0.712 0.41-1.85
Ethnicity 1.30 0.370 0.73-2.32
Social support*ethnicity 2.43 0.144 0.74-8.00a Logistic regression adjusting for age, educational attainment, marital status, alcohol and drug use during pregnancy
Results – Physical and/or Verbal Abuse Subgroup Analysis
• White women (N = 170)
Characteristica Odds Ratio
Lacking Social Support 1.30a Logistic regression adjusting for age, educational attainment, marital status, alcohol and drug use during pregnancy
• White women who lack partner support are 30% more likely to report physical and/or verbal abuse compared with socially supported white women (and 2.74 times more likely than black women with support).
Results – Physical and/or Verbal Abuse Subgroup Analysis
• Black women (N = 227)Characteristica Odds
Ratio
Lacking social support 0.34a Logistic regression adjusting for age, educational attainment, marital status, alcohol and drug use during pregnancy
• Black women lacking social support are less likely to report abuse than black women with social support (about 3 times less likely).
Results – Analysis of Physical and/or Verbal Abuse
Predictor = Partner social support scale and abuse (N = 433)– No significant findings after adjusting for
confoundingSubgroup analysis of partner support and ethnicity
(Full model) N = 397Characteristica Odds
RatioP-value 95% Confidence
Interval
Social support 0.97 0.609 0.85-1.10
Ethnicity 2.64 0.38 1.05-6.62
Social support*ethnicity 0.87 0.18 0.71-1.07a Logistic regression adjusting for age, educational attainment, marital status, alcohol and drug use during pregnancy
Results – Physical and/or Verbal Abuse Subgroup Analysis
• White women (N = 170)
Characteristica Odds Ratio
Lacking Social Support 2.64a Logistic regression adjusting for age, educational attainment, marital status, alcohol and drug use during pregnancy
• White women who lack partner support are 2.64 times more likely to report physical and/or verbal abuse compared with socially supported white women (and 2.22 times more likely compared with socially supported black women).
Results – Physical and/or Verbal Abuse Subgroup Analysis
• Black women (N = 227)Characteristica Odds
Ratio
Lacking social support 0.46a Logistic regression adjusting for age, educational attainment, marital status, alcohol and drug use during pregnancy
• Black women who lack partner support are less likely to report physical and/or verbal abuse compared with black women who have social support (over 2 times less likely).
Discussion of Findings
• Partner social support is significantly associated with pregnancy wantedness– Presence of support is significantly associated with
wantedness
– The magnitude of support is significantly associated with wantedness
• Findings are consistent across both ethnic groups/no interaction with ethnicity
• Findings are consistent with current research• Findings have an intuitive appeal
Discussion of Findings
• Partner social support during pregnancy is significantly associated with abuse only in the presence of ethnicity– Presence or absence of support is significantly associated with
abuse (interactive with ethnicity)– The magnitude of support is significantly associated with abuse
(interactive with ethnicity)
• Findings are inconsistent across ethnic groups: white women with no support are MORE likely to report abuse whereas black women with no support are LESS likely to report abuse
• Findings appear counterintuitive
Discussion of Findings
• Possible explanations for disparate findings– Type of abuse plays a role in reporting– Perceived abuse may differ among cultural groups– Cultural differences in the role and definition of social
support– Social support measures may be masking
associations on subscales (e.g., emotional versus instrumental support may vary between the two groups)
– The role of the partner in providing social support may differ among groups (e.g., familial support may play a more defined role compared with partner support in specific groups)
Discussion of Findings
• Next steps in analysis– Abuse will be divided into physical and
verbal abuse– The social support scale will be divided
into it’s emotional and material components
– Roles other family members play in social support will be analyzed
– The role of bias will be further assessed• Response bias and interviewer bias
Conclusions – Recommendations to Practitioners
• Assessing the presence or absence of partner support during pregnancy is key to decreasing specific stressors
• Further, the magnitude of partner support plays a role in buffering the affects of stressors
• Practitioners can take a proactive role in primary prevention of stressors, and may alleviate existing stressors by intervening in current relationships and encouraging increased support throughout the pregnancy process
Conclusions – Recommendations for Further Research
• Ongoing analysis of the current study will enable further explanation of preliminary findings
• Other psychosocial and physical stressors may be analyzed for assessment of the buffering effect of social support
• Future studies may focus on specific culturally defined subgroups for studying the buffering effect of partner support on stressors during pregnancy