Multiple Social-Environmental Risks and Mother-Infant Interaction among Mother-Premature Infant Dyads
Kristin Rankin, PhDCamille Fabiyi, MPHKathleen Norr, PhD
Rosemary White-Traut, PhD, RN, FAANUniversity of Illinois at Chicago
Presenter Disclosures
(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
Kristin Rankin
No relationships to disclose
Background Premature infants with biologic risk plus
social-environmental risks have poorer health and development than: – Premature infants in less stressed
families– Full term infants in families with
multiple social-environmental risks
Prematurity and social-environmental risks both lead to lower quality of mother-infant interaction
Poor mother-infant interaction is associated with poorer infant health and development
Purpose To examine the association
between social-environmental (SE) risks and the quality of mother-premature infant interaction
The relative importance of the following will be compared: – Individual risk factors– Cumulative # of factors– Specific patterns of risk factors
Design and Procedure Randomized clinical trial at two community-based hospitals
Recruitment and enrollment of mothers shortly after the birth of a premature infant
Inclusion criteria: Otherwise healthy infants, 29-34 weeks gestational age; Mothers with at least 2 of 10 baseline social-environmental risk factors, e.g. poverty, minority status, mental health issues
Maternal intake interview to assess socio-demographic characteristics, baseline mental health and social support
Follow-up interviews in hospital before infant’s discharge and at six weeks corrected age
Dependent Variable: Mother Infant Interaction
Mother-infant interaction during feeding: NCAST (Nursing Child Assessment Satellite Training – Feeding Scale)– Scored for maternal and infant
behaviors on 76-item scale – Maternal sensitivity to cues, response
to child’s distress, social-emotional and cognitive growth fostering
– Infant clarity of cues and responsiveness to mother
Assessed from a videotaped feeding session in the hospital, just before infant’s discharge
Independent Variables:Social Environmental Risk Factors
SE Risk Definition Sample Prevalence
%
Minority status African-American or Latina 100
Teen birth Age at delivery < 20 19
Low education Teens: <HS and not in school20 and older: <High School 23
Poverty Household income < 185% FPL and/or WIC participation 89
Independent Variables:Social Environmental Risk Factors
SE Risk Definition Sample Prevalence
%
Childcare burden
Previous child <24 months or ≥ 4 children in household 35
Not living with baby’s father Self-report 44
Resides in disadvantaged neighborhood
Index of Neighborhood Disadvantage Score > 0 38
Independent Variables:Social Environmental Risk Factors
SE Risk Definition Sample Prevalence
%
DepressionSelf-reported history,CES-D score ≥ 16, orPDSS score ≥ 60
42
High trait anxiety STAI Y-2 (highest quartile, ≥ 35 25
Low social support
<88 (lowest quartile)Personal Resources Questionnaire (PRQ) 2000
24
Other Sample Characteristics
Characteristics n = 188 MaternalAge at delivery (m, sd) 26 (6.6)Race/ethnicity: African-American Latina
5050
Parity (% Primiparous) 39InfantSex (% Male) 50GA at birth in weeks (m, sd) 32.5 (1.5)Birthweight in grams (m, sd) 1822 (375)
Data Analysis – 3 Methods
1) T-tests to identify the impact of individual SE risk factors on mean NCAST scores
2) Linear regressions for the cumulative number of risk factors as predictors of NCAST scores
3) Hierarchical cluster analysis to identify patterns of risk factors, followed by linear regression to assess relationship between patterns and NCAST scores– Linkage Method= Ward’s Minimum Variance – Assessed Criteria for Number of Clusters (CCC,
Pseudo F, Pseudo T2
– Stratification by age group prior to clustering (≥ 20, <20)
Mean NCAST scores by Individual SE risks
Individual Risk Factors n NCAST scoreMean (SD)
Overall Mean 108 60 (6.7)
Baby’s father not living in HH* 48 61.9 (5.5)Baby’s father living in HH 60 58.7 (7.1)
High Trait Anxiety* 25 56.9 (8.4)Low Trait Anxiety 83 61.1 (5.7)
*p < 0.05
Mean NCAST scores by Cumulative Number of SE Risks
2 (n = 15)
3 (n =
25)
4 (n
= 20)
5 (n =
19)
6 (n = 16)
7-9 (n = 13)
40
45
50
55
60
65
70
75
60.857.3
# SE Risk Factors
Mean NCAST Scores by Patterns of SE RisksCluster Cluster Label n NCAST
Mean (SD)Adult-1 Impoverished only 27 60.8 (5.8)Adult-2 Depressed only 22 61.0 (6.3)Adult-3 Impoverished,
disadvantaged neighborhood, high child care burden, father absence
21 60.7 (5.5)
Adult-4 Impoverished, less than high school education
8 54.0 (9.4)*
Adult-5 Low education, depressed, anxious, low support, disadvantaged neighborhood
13 60.5 (6.6)
Teen-1 Low risk teens 8 60.5 (5.6)Teen-2 Depressed, anxious, low support,
higher childcare burden teens9 58.9 (9.1)
*p < 0.01 compared to Adult-1
Strengths/LimitationsStrengths
Wide variety of SE risk factors measured at baseline
Underserved and understudied population of women and infants
Limitations Small sample size
Dichotomous risk factors
Generalizability
Conclusions
Women with high trait anxiety and those with baby’s father in the household appear to have lower quality interactions
The cumulative number of risk factors is not correlated with mother-infant interaction in a dose-response fashion
Conclusions
Women were identified as belonging to clusters according to patterns of SE risks
Patterns of SE risks may be more relevant than the total number of risk factors with regard to outcomes
A subgroup of impoverished women with less than a high school education had the lowest quality interaction of all groups in the sample
Implications
Education and economic opportunity are crucial
Women with SE risks who just had a preterm infant should receive anticipatory guidance to help improve mother-infant interaction
Women with both low education levels and economic disadvantage may especially be in need of guidance
Future directions include examining other study outcomes by clusters
Acknowledgements
Funded by the National Institute of Child Health and Development, the National Institute of Nursing Research (1 R01 HD050738-01A2) and the Harris Foundation
The authors wish to acknowledge the infants and their parents who participated in this research
