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Kristin Rankin, PhD Camille Fabiyi , MPH Kathleen Norr, PhD Rosemary White- Traut , PhD, RN, FAAN

Multiple Social-Environmental Risks and Mother-Infant Interaction among Mother-Premature Infant Dyads. Kristin Rankin, PhD Camille Fabiyi , MPH Kathleen Norr, PhD Rosemary White- Traut , PhD, RN, FAAN University of Illinois at Chicago. Presenter Disclosures. Kristin Rankin.

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Kristin Rankin, PhD Camille Fabiyi , MPH Kathleen Norr, PhD Rosemary White- Traut , PhD, RN, FAAN

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  1. Multiple Social-Environmental Risks and Mother-Infant Interaction among Mother-Premature Infant Dyads Kristin Rankin, PhD Camille Fabiyi, MPH Kathleen Norr, PhD Rosemary White-Traut, PhD, RN, FAAN University of Illinois at Chicago

  2. Presenter Disclosures Kristin Rankin (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 • 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

  4. 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

  5. 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

  6. 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-emotionaland 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

  7. Independent Variables:Social Environmental Risk Factors

  8. Independent Variables:Social Environmental Risk Factors

  9. Independent Variables:Social Environmental Risk Factors

  10. Other Sample Characteristics

  11. Data Analysis – 3 Methods • T-tests to identify the impact of individual SE risk factors on mean NCAST scores • Linear regressions for the cumulative number of risk factors as predictors of NCAST scores • 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)

  12. Mean NCAST scores by Individual SE risks *p < 0.05

  13. Mean NCAST scores by Cumulative Number of SE Risks

  14. Mean NCAST Scores by Patterns of SE Risks *p < 0.01 compared to Adult-1

  15. Strengths/Limitations Strengths Limitations Small sample size Dichotomous risk factors Generalizability • Wide variety of SE risk factors measured at baseline • Underserved and understudied population of women and infants

  16. 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

  17. 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

  18. 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

  19. 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

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