Rosemary White-Traut, PhD, RN, FAAN Anxiety & Social Support among Black and Latina Mothers with Premature Infants at Social-Environmental Risk Camille Fabiyi, MPH Kristin Rankin, PhD Kathleen Norr, PhD Rosemary White-Traut, PhD, RN, FAAN

Presenter Disclosures All Authors (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose

Background Approximately half a million premature infants are born each year in the U.S. Mothers of premature infants often experience high stress, anxiety and depression Related to: Worry about their infant and loss of their expected early mothering experience Difficulty in parenting Negative mother-infant interaction Poor child health and development

Background One source of stress/anxiety is the infant’s immature behavioral organization. Examples: Difficulty with feeding & sucking Hypersensitive to stimulation May reduce mother’s ability to recognize/respond to infant’s behaviors Decrease mother’s confidence in ability to provide infant care

Significance Mothers were selected because they had multiple social-environmental risk factors These factors can increase maternal anxiety related to prematurity and interfere with early mothering Few studies have explored the differences in reported maternal anxiety and social support after a premature birth across racial groups and language preferences

Purpose To describe the relationships among race/ethnicity, language preference, anxiety and social support for mothers of premature infants

Methods: Sample Derived from a larger ongoing randomized clinical trial with infants born between 29-34 weeks of age and mothers with at least 2 of the following risk factors: Minority status Less than high school education History of mental illness Household income < 150% poverty line More than 1 child under 24 months of age Four or more children in household Resides in a disadvantaged neighborhood

Maternal intake interviews Methods: Procedures Maternal intake interviews When: Postnatal, following their infant’s birth How: Face-to-face format Where: In hospital (NICU or Nursery) Mothers selected language of interview Spanish Latina English Black

Methods: Measures Social Support Personal Resources Questionnaire (PRQ-2000): measures perceived level of actual & potential social support 15 item scale: respondents rank the extent to which they agree on a scale of 1(strongly disagree) to 7 (strongly agree) with statements about perceived social support.

Methods: Measures Anxiety State and Trait Anxiety Sub-scales of the State-Trait Anxiety Inventory (STAI): each sub-scale measures state (present) and trait (usual) feelings of apprehension, tension, nervousness, and worry 20 items on each scale: respondents circle the value (1-Not at all; 4- Very much so) that describes how they felt usually (trait) and presently at the time of interview (state).

Data Analysis Bivariate analysis with chi-square tests Multivariable logistic regression Explore the relationships between race/ethnicity, language preference, maternal state & trait anxiety, and social support Anxiety (highest quartile) & Social Support (lowest quartile) were dichotomized

Results: Demographic Characteristics Black- English Int. (n=67 ) Latina-English Int. (n=25 ) Latina-Spanish Int. (n= 48) Age at delivery, Mean (SD) 25.6 (6.3) 25.7 (6.5) 28.5 (6.1) Education (< HS) 29.9 24.0 45.8 Parity (% Primiparous) 32.8 32.0 37.5 % Working at time of infant’s birth 44.8 60.0 31.3

Results: Demographic Characteristics Black- English Int. (n=67 ) Latina-English Int. (n=25 ) Latina-Spanish Int. (n= 48) % Enrolled in School at time of infant’s birth * 31.3 24.0 6.3 % Live with baby’s father * 76.0 89.6 % Live with mother/grandmother * 38.8 40.0 14.6 * Denotes Chi-square statistic significant at p < .05

Results: Anxiety & Social Support by Race/Language *Denotes Chi-square statistic significant at p < .05

Results: Multivariable Logistic Regression of High State Anxiety Odds Ratio 95% CI for Odds Ratio Lower Upper Latina-Spanish 3.75 1.14 12.33 Latina-English 1.63 0.38 7.02 PRQ score 0.95 0.92 0.99 Reference Categories: Black women, > 30 yrs. Adjusted for Age, Social Support, Living Arrangements (i.e. Live with Baby’s Father, Live with 2 or more children under age 2)

Conclusion There were no significant differences in trait or usual anxiety between groups Latina mothers preferring Spanish interviews reported: Highest state anxiety Lowest social support More likely to live with baby’s father Social support was negatively associated with high state anxiety

Conclusion Findings underscore the need for culturally appropriate interventions to reduce anxiety among Spanish-interviewed Latina mothers Interventions might include: Racial/ethnically diverse healthcare workforce Bilingual healthcare providers Trained medical interpreters Potential intervention: social networking group to address the decrease in social support

Insufficient sample size within groups Limitations Insufficient sample size within groups Race/language preference was strong predictor in models but could not disentangle Could not explore relationships between other factors and anxiety & social support Lack of information on acculturation Length of residence in the U.S. Language(s) spoken outside of interview

Future Research Examine the strength of these relationships with a larger final sample Evaluate these relationships with additional variables that are being collected from the larger trial Examine the predictors of high state anxiety within groups to identify the most salient factors Qualitative research is needed to better understand what sources of social support Spanish-interviewed Latina mothers need and have

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