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Hanna Kim, Samara Viner-Brown, Rachel Cain Center for Health Data and Analysis Rhode Island Department of Health

Racial and Ethnic Disparities in the Knowledge of Shaken Baby Syndrome among Recent Mothers Findings from the 2004-2008 Rhode Island PRAMS. Hanna Kim, Samara Viner-Brown, Rachel Cain Center for Health Data and Analysis

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Hanna Kim, Samara Viner-Brown, Rachel Cain Center for Health Data and Analysis Rhode Island Department of Health

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  1. Racial and Ethnic Disparities in the Knowledge of Shaken Baby Syndrome among Recent MothersFindings from the 2004-2008 Rhode Island PRAMS Hanna Kim, Samara Viner-Brown, Rachel Cain Center for Health Data and Analysis Rhode Island Department of Health

  2. Background Shaken Baby Syndrome (SBS) is a form of child abuse that can result in permanent brain damage or death. SBS usually occurs when a parent or caregiver violently shakes a baby or toddler due to frustration or anger. If a baby is forcefully shaken, his or her fragile brain moves back and forth inside the skull, which causes bruising, swelling and bleeding.

  3. Background Serious injuries associated with SBS may include blindness or eye injuries, brain damage, damage to the spinal cord, and delay in normal development. In 2001, 903,000 children suffered from SBS in the U.S. and an additional 1,300 died from it. About 20% of cases are fatal in the first few days after injury, and the majority of the survivors are left with disabilities.

  4. Shaken Baby Syndrome Source: Healthlinewebsite:http://www.healthline.com/galecontent/shaken-baby-syndrome-2

  5. Shaken Baby Syndrome Source: The National Center on SBS website

  6. Study Questions What is the prevalence of Lack of Knowledge of Shaken Baby Syndrome (LKSBS) among Rhode Island recent mothers? Are there any Racial and Ethnic Disparities in the LKSBS? How does the Immigrant Status interact across race/ethnicity in the LKSBS?

  7. Methods Data Source:2004-2008 RI Pregnancy Risk Assessment Monitoring System (PRAMS) Total Respondents for 5 years: 6,959 Weighted Response Rate (5-year average): 73.2% Average PRAMS population per year: 11,816

  8. What is the PRAMS?(Pregnancy Risk Assessment Monitoring System) A surveillance project of the CDC and state Health Departments to monitor the health of mothers and infants. Collects state-specific, population-based data on maternal behaviors and experiences before, during, and after pregnancy. A sample survey of recent mothers and administered 2-5 months after baby’s delivery by mail or telephone. The PRAMS sample is chosen from all women who had a live birth recently.

  9. Variables Used Outcome Variable: Lack of Knowledge of SBS (LKSBS): “No” to the question “Have you ever heard or read about what can happen if a baby is shaken?” Exposure Variables: Race/Ethnicity: NH-White NH-Black NH-Asian/PI Hispanic Immigrant Status: Non-Immigrant (US-born) Immigrant (Foreign-born) Confounders: Maternal Age, Education, Income, Marital Status, and Parity

  10. Statistical Analysis Chi-square tests for bivariate relationships between socio-demographic factors and LKSBS. Multivariable logistic regression analyses to determine independent and joint effects of race/ethnicity and immigrant status on LKSBS. SUDAAN (Survey Data Analysis) v10 software was used for statistical analyses to account for complex sample design of the survey.

  11. Results

  12. Race/Ethnicity NH-White: 66% NH-Black : 9% NH-Asian/PI : 4% Hispanic: 20% NH- Others, including AI: 1%(excluded) Immigrant Status Immigrant: 25% Non-Immigrant: 75% Rhode Island PRAMS Population Distribution (2004-2008)

  13. Proportion of Immigrant by Race/Ethnicity NH-White: 5% NH-Black : 48% NH-Asian/PI : 69% Hispanic: 72% Rhode Island PRAMS Population Distribution (2004-2008) Minority groups have higher proportion of immigrant

  14. Year (2004-2008) Race/Ethnicity Immigrant Status Maternal Age Education Household Income Marital Status Parity Prevalence of LKSBS: Bivariate Analysis Exposure Vars. Confounding Vars.

  15. Prevalence of LKSBS by Year, RI 2004-08 P = .6197

  16. Prevalence of LKSBS by Race/Ethnicity P < .0001

  17. Prevalence of LKSBS by Immigrant Status P < .0001

  18. Prevalence of LKSBSby Maternal Age P < .0001

  19. Prevalence of LKSBSby Maternal Education P < .0001

  20. Prevalence of LKSBSby Household Income P < .0001

  21. Prevalence of LKSBSby Marital Status P < .0001

  22. Prevalence of LKSBSby Parity P = 0.0040

  23. The prevalence of LKSBS was significantly higher among NH-Blacks (15.8%), NH- Asians (16.7%), Hispanics (13.6%), Immigrants (17.1%), Teens (10.5%),mothers with < High School Education (11.2%), Incomes < $20,000 (9.8%), Unmarried (8.8%), First Time (7.2%) mothers. Prevalence of LKSBS: Bivariate Analysis

  24. Multivariable Logistic Regression To determine the independent effects of race/ethnicity and immigrant status on LKSBS, while controlling for confounding factors (maternal age, education, income, marital status and parity). To determine the joint effects of race/ethnicity and immigrant status on LKSBS, while controlling for confounding factors.

  25. Outcome Variable: Lack of Knowledge of SBS (LKSBS): Yes/No Exposure Variables: Race/Ethnicity - NH-White: Referent Group - NH-Black - NH-Asian/PI - Hispanic Immigrant Status - Non-Immigrant: Referent Group - Immigrant Confounders: Maternal Age, Education, Income, Marital Status, and Parity Assessing Independent Effects of Race/Ethnicity and Immigrant Status

  26. Effects of Race/Ethnicity and Immigrant Status on LKSBS Adjusted Odds Ratios (AORs) and 95% Confidence Intervals (CIs)* * AORs and 95% CIs were calculated after controlling for maternal age, education, household income, marital status, and parity.

  27. Effects of Race/Ethnicity on LKSBS: Stratified by Immigrant Status Adjusted Odds Ratios (AORs) and 95% Confidence Intervals (CIs)* * AORs and 95% CIs were calculated after controlling for maternal age, education, household income, marital status, and parity.

  28. Outcome Variable: Lack of Knowledge of SBS (LKSBS): Yes/No Exposure Variables: Race/Ethnicity and Immigrant Status - Non-Immigrant, NH-White: Referent Group-Non-Immigrant, NH-Black - Non-Immigrant, NH-Asian/PI -Non-Immigrant, Hispanic - Immigrant, NH-White -Immigrant, NH-Black - Immigrant, NH-Asian/PI -Immigrant, Hispanic Confounders: Maternal Age, Education, Income, Marital Status, and Parity Assessing Joint Effects of Race/Ethnicity and Immigrant Status

  29. Joint Effects of Race/Ethnicity and Immigrant Status on LKSBS Adjusted Odds Ratios (AORs) and 95% Confidence Intervals (CIs)* Indep. Effects: Either Minority OR Immigrant Joint Effects: Both Minority AND Immigrant * AORs and 95% CIs were calculated after controlling for maternal age, education, household income, marital status, and parity.

  30. Joint Effects of NH-Back & Immigrant: Expected Odds Ratio = 2.5+5.0-1.0 = 6.5 Observed Odds Ratio = 13.6 Joint Effects of NH-Asian/PI & Immigrant: Expected Odds Ratio = 2.3+5.0-1.0 = 6.3 Observed Odds Ratio = 14.7 Joint Effects of Hispanic & Immigrant: Expected Odds Ratio = 3.0+5.0­1.0 = 7.0 Observed Odds Ratio = 6.5 Assessing Interaction:Additive Scale Positive Additive Interaction Positive Additive Interaction No Additive Interaction

  31. Joint Effects of NH-Back & Immigrant: Expected Odds Ratio = 2.5*5.0 = 12.5 Observed Odds Ratio = 13.6 Joint Effects of NH-Asian/PI & Immigrant: Expected Odds Ratio = 2.3*5.0 = 11.5 Observed Odds Ratio = 14.7 Joint Effects of Hispanic & Immigrant: Expected Odds Ratio = 3.0*5.0 = 15.0 Observed Odds Ratio = 6.5 Assessing Interaction:Multiplicative Scale No Multiplicative Interaction Positive Multiplicative Interaction ??? Negative Multiplicative Interaction

  32. Conclusions Overall, 6.2% of RI recent mothers lacked a Knowledge of SBS, and the rate did not change during 2004-2008. There were significant Racial and Ethnic Disparities in the LKSBS; the odds of LKSBS were significantly higher among NH-Black, NH-Asian/PI, and Hispanic mothers (vs. NH-White).

  33. Conclusions There was an interaction between race/ethnicity and immigrant status in the LKSBS; being an Immigrant & Black, or being an Immigrant & Asian/PI had the strong positive (synergistic) additive joint effects. A logistic regression model with joint effects fitted the data better than a model with independent effects only.

  34. Limitations Measurement Issue: Knowledge SBS: level of knowledge Length of Immigration Sample Size Issue: Small sample size for some race/ethnicity categories, e.g. non-immigrant Asian/PI mothers (n<100)

  35. Public Health Implications Substantial proportions of RI minority women who recently gave birth are also immigrants. These women are at highest risk for LKSBS. Public health efforts should target minority and immigrant mothers to educate them about the dangers of shaking a baby.

  36. THANK YOU! Contact Information: Hanna Kim, PhD: Hanna.Kim@health.ri.gov

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