1. 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

2. 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

3. 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

4. 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

5. 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

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

7. Methods: Sample
Derived from a larger ongoing randomized clinical trial with infants born between 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

8. 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

9. 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.

10. 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).

11. 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

12. 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

13. 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

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

15. 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)

16. 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

17. 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

18. 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

19. 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

20. Acknowledgements
Funded by the National Institute of Child Health and Development, the National Institute of Nursing Research (1 R01 HD A2) and the Harris Foundation
The authors wish to acknowledge the infants and their parents who participated in this research