1. Partner Influence on Women’s Perceptions of Pregnancy Charlan Kroelinger, MA, PhD c Department of Epidemiology and Biostatistics College 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

2. 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)?

3. 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.

4. 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

5. Study Population – Basic Demographic Characteristics* CharacteristicAlabamaTuscaloosa County Mobile County Population**4,447,100164,875399,843 Ethnicity Black29.9%31.9%36.9% White71.1%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 births62,0612,2966,216 *All data are from the 1999 census unless otherwise specified **2000 census

6. 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

7. 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

8. Research Model Ethnicity Black White Partner Social Support Physical and/or Verbal Abuse Pregnancy Wantedness Buffers Interacts

9. Results – Descriptive Characteristics CharacteristicFrequencyProportion (%) Ethnicity Black22744.9 White17033.6 Missing10921.5 Educational Level <9 th grade (middle school)5310.5 middle school26752.8 high school/GED16031.6 College or greater265.1 Marital Status Single29658.5 Single, ever-married458.9 Married/Living with partner16532.6

10. Results – Descriptive Characteristics CharacteristicRangeMeanStandard Deviation Missing Age14-3522.54.390 Pre-pregnant weight (lbs.)82.0-411.0151.546.070 Height (inches)57-7864.52.822 Body Mass Index14.0-60.725.57.032

11. Results – Descriptive Statistics: Measures of Partner Support CharacteristicFrequencyProportion (%) Partner Support No11622.9 Yes39077.1 CharacteristicRangeMeanStandard Deviation Missing Partner Support Scale0-63.72.410 Categorical Measure of Partner Social Support Partner Support Scale (0-6)

12. Results – Descriptive Statistics: Pregnancy Wantedness and Abuse CharacteristicFrequencyProportion (%) Pregnancy Wantedness No21041.5% Yes22544.5% Missing7114.0% Abuse Yes17634.8 No33065.2

13. Results – Analysis of Pregnancy Wantedness Partner social support (present or absent) and pregnancy wantedness (N = 433) Characteristic a Odds Ratio P- value 95% Confidence Interval Social support2.230.0041.28-3.87 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

14. Results – Analysis of Pregnancy Wantedness Subgroup analysis of partner social support and ethnicity (Full Model) N = 349 Characteristic a Odds Ratio P-value95% Confidence Interval Social support2.190.0501.00-4.82 Ethnicity0.490.0180.28-0.89 Social support*ethnicity1.770.3830.49-6.34 a Logistic regression adjusting for age, educational attainment, marital status, pre-pregnant weight, BMI No significant interaction

15. Results – Analysis of Pregnancy Wantedness Predictor = Partner social support scale and pregnancy wantedness (N = 433) Characteristic a Odds Ratio P- value 95% Confidence Interval Social support1.160.0091.04-1.30 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

16. Results – Analysis of Pregnancy Wantedness Subgroup analysis of partner social support and ethnicity (Full Model) N = 349 Characteristic a Odds Ratio P-value95% Confidence Interval Social support0.900.1120.78-1.03 Ethnicity0.880.8010.33-2.38 Social support*ethnicity0.900.3180.72-1.11 a Logistic regression adjusting for age, educational attainment, marital status, pre-pregnant weight, BMI No significant interaction

17. Results – Analysis of Physical and/or Verbal Abuse Partner social support (present or absent and abuse (N = 433) –No significant findings after adjusting for confounding Subgroup analysis of partner support and ethnicity (Full model) N = 397 Characteristic a Odds Ratio P-value95% Confidence Interval Social support0.870.7120.41-1.85 Ethnicity1.300.3700.73-2.32 Social support*ethnicity2.430.1440.74-8.00 a Logistic regression adjusting for age, educational attainment, marital status, alcohol and drug use during pregnancy

18. Results – Physical and/or Verbal Abuse Subgroup Analysis White women (N = 170) Characteristic a Odds Ratio Lacking Social Support1.30 a 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).

19. Results – Physical and/or Verbal Abuse Subgroup Analysis Black women (N = 227) Characteristic a Odds Ratio Lacking social support0.34 a 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).

20. Results – Analysis of Physical and/or Verbal Abuse Predictor = Partner social support scale and abuse (N = 433) –No significant findings after adjusting for confounding Subgroup analysis of partner support and ethnicity (Full model) N = 397 Characteristic a Odds Ratio P-value95% Confidence Interval Social support0.970.6090.85-1.10 Ethnicity2.640.381.05-6.62 Social support*ethnicity0.870.180.71-1.07 a Logistic regression adjusting for age, educational attainment, marital status, alcohol and drug use during pregnancy

21. Results – Physical and/or Verbal Abuse Subgroup Analysis White women (N = 170) Characteristic a Odds Ratio Lacking Social Support2.64 a 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).

22. Results – Physical and/or Verbal Abuse Subgroup Analysis Black women (N = 227) Characteristic a Odds Ratio Lacking social support0.46 a 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).

23. 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

24. 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

25. 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)

26. 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

27. 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

28. 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