Blog 1: TRANSLATIONAL RESEARCH FOR ANTENATAL STRESS IN ADOLESCENTS' CHILDBEARING: ENGAGEMENT, PRACTICE AND EVIDENCE
Partnerships are essential to addressing health disparities for adolescent’ parents and their families. The development of strategic and effective partnerships requires planning, but above all, it demands a high level of respect, humbleness, and recognition of the potential of contribution from all the parties involved. It is the researcher’s honesty to the inquiry process as well as the community-partner’s acknowledgement of its understanding of practice in the real-world setting that shall establish an honest foundation to engaging in partnership. According to Acosta (n.d.) partnerships are pivotal to “the translation of results into community-based practice (evidence-based practice), and to the integration of community knowledge, needs, and preferences into research (practice-based evidence)”. The interactions of community-engagement, practice-based evidence, and evidence-based practice generate a bridge for translational researchers; to achieving their purpose of addressing multi-leveled, transdisciplinary, and transformational knowledge to eliminate health disparities (Danka-Mullan et al., 2010). Though the use of these strategies, translational researchers position themselves to address complex needs, in a cost-effective manner, by using evidence-based practices and upstream approaches to practice (Hommel et al., 2010).
Translational Research for Antenatal Stress in Adolescents’ Childbearing: Engagement, Practice and Evidence
According to Bèhague, Gonçalves, Gigante, and Kirkwood (2011) 48% of adolescent mothers exhibit high stress levels due to social stigma. Florsheim et al. (2012) also stated that adolescent mothers demonstrated high stress levels due to adverse relationship with the fathers of their children. Neuroscience researchers have identified high fetal cortisol levels due to maternal stress, and their effect as they increase the potential for developmental delays in their children; specifically, language delay, anxiety, and attentional deficit/hyperactivity (Talge et al., 2007). A meta-data analysis done by Talge et al. (2007) recorded the following associated factors and multi-level determinants that impact neurodevelopmental outcomes in children whose mothers have experienced antenatal stress as detailed in Table 1.
Table 1. Stressors impacting antenatal life: Outcomes, results, and associated factors in child
Results (health determinants)
Life events, daily hassles, depression, anxiety symptoms, occupational stress, natural disasters (earthquake, ice-storm, flood), PTSDC due to terrorism 9/11 and World War II, anger symptoms, pregnancy-specific anxiety, and psychological distress.
Birth outcomes, neurobehavioral development at 4-14 days, gestational length, vagal tone neurobehavioral, behavioral problems, temperament issues, irregular Bayley scales, laterality and other neurodevelopmental disorders in children, handedness, cognitive infant/childhood outcomes, autism, and adult developed phychopathology.
Lower birth weight, short gestational length (preterm births), smaller head circumference, lower Prechtl scores, high strain full-time jobs, higher risk of intrauterine growth restriction, emotional problems, males born exhibit higher hyperactivity/attention problems, higher depression/anxiety, temperament issues, externalizing problems, impulsivity, lower WISC, MDI and MacArthur vocabulary scores, high incidence of mixed-handedness, autism, adult-course developed schizophrenia, and affective disorders.
Biomedical risks, higher amount of life events, maternal age, education, substance use, race, socioeconomic status, maternal health, obstetric risk, maternal CRH levels, vagal tone development, higher right frontal EEG asymmetry, poorer performance of Brazelton, post-natal anxiety and depression, parity, birth outcomes, gender, postnatal maternal anxiety and depression, obstetric complications, fetal sex, and parent handedness.
On the one hand, I could not identify in current scientific literature that translational researchers are identifying antenatal maternal stress in adolescents as a health disparity priority. But multiple disciplines are identifying maternal antenatal stress as an important issue that impacts child outcomes through their life-course (Talge et al., 2007). On the other hand, it is a national health priority to reduce low birth weight and gestational periods, which have been associated to adolescent mother’s childbearing outcomes in the context of health disparities (Branson, Ardington, & Leibbrandt, 2015). In order to promote maternal antenatal stress impact on children outcomes, a paradigm shift and transdisciplinary approach needs to be used to strengthen the neurodevelopmental research, behavioral initiatives, and public health planning; to eliminate health disparities that are acting in a population-level (Danka-Mullan et al., 2010). Also, eliminating health disparities as a broad issue is contemplated at the national level as a priority. In order to make adolescent maternal antenatal stress a translational research priority a meaningful conceptual framework, effective merge of disciplines for the development of satisfactory approaches, and agreement of a model to be used in the health disparity elimination should be put in place (Hommel et al., 2010).
Even when adolescent pregnancies and births incidence are declining continuously in the United States it is an ethnic and racial issue. Adolescent births are observed as a disparity situation, which affect non-Hispanic blacks and Hispanics population disproportionately (Centers for Disease Control and Prevention [CDC], 2013). Upstream approaches, such as translational research is needed to address the continuance of disadvantage cycles and their related risk factors which are essential at early developmental stages. Thus, addressing the outcomes that are affecting children born to adolescent parents is an upstream approach that should be taken into consideration when comprehensive initiatives are developed. These type of “bench to bed side” approaches should be adopted by researchers that intend to have significant and population-level impact.
Multiple studies that address adolescent childbearing and antenatal stress should be done. These should involve a behavioral science approach to the translational research model, such as the one developed and implemented by Hommel et al. (2015). The designs should include T1, T2, and T3 phases as the case-control group’s effects are recorded through the implementation of the behavioral treatments or lack of treatment. As well as T4 phases to promote quality improvement, evidence of nonadherence across multiple sites (using community-partners) to translate the best practices to eliminate disparities in maternal antenatal stress for adolescent mothers. Longitudinal, mixed methods design, time-series quantitative and qualitative testing, for random comparison groups should be used. An Action Research approach should be employed to promote translational approach implementation through community-engagement (Warnecke et al., 2011).
Early developmental stages are essential for potential health outcomes in adult life. The understanding of the importance of protecting children at their early development has been extensively researched; public health approaches and public policy has been developed based on this knowledge, such as the Life-Course Theory. At the initial period of development Talge, Neal, and Glover (2007) stated that toxic agents have a potential impact in child health outcomes. The level of impact is dependent on the level and timing of exposure in the gestational period (Talge, Neal, & Glover, 2007). According to Edwards, Towle, and Levitz (2014) the Life-Course theory is an adequate approach to understand the summative impact of risk factors in early life development; including shifts that occur genetically, biologically, and to the social and economic environments, which are also happening at a certain cultural and historical period that affect the health outcomes at multiple levels. Thus, the use of translational research within a partnership relation with community agents shall increase the potential for the development of multiple-level interventions that address antenatal stress outcomes in adolescent mothers, as a disparity issue that affects health outcomes at the life course.
An example of an intervention at the community-level that could be involved in translational research to generate evidence-based practice that is practice-informed and engaged, is the Family Incubator Model developed by Proyecto Nacer in Puerto Rico. The Family Incubator Model of service is a comprehensive wrap-around model to addressing the needs of adolescent parent’s families, that use a three-generation approach that is family-centered. The purpose of this model is to increase the social inclusion outcomes and break the social disadvantage cycles in adolescent parent’s families. One of the social inclusion promoters used by the organization is the development of life-course protective factors, which is an upstream approach to increase the factors that will guard adolescent parents, their children, and supporting family members to negative health outcomes. These efforts are implemented by a multidisciplinary team of professionals that decrease their chances of suffering from toxic stress in their gestational periods. Also, socioeconomic position and nurturing family environments promoters for social inclusion are employed as part of the model of service.
Acosta, E. (n.d.). Analysis: Health disparities. [PowerPoint presentation]. Retrieved on November 19, 2018 from https://epsblackboard9.rcm.upr.edu/bbcswebdav/pid-7870-dt-content-rid-109604_1/courses/INCL6008/Introduction%20Unit%20III%20%28Oct%2020%29%281%29.pdf
Bèhague, D., Gonçalves, H., Gigante, D., and Kirkwood, B. (2011). Taming troubled teens: the social production of mental morbidity amongst young mothers in Pelotas, Brazil. Social Science & Medicine. 74. 434-443. doi: http://dx.doi.org/10.1016/j.socscimed.2011.10.014
Branson, N., Ardington, C., & Leibbrandt, M. (2015). Health outcomes for children born to teen mothers in Cape Town, South Africa. Economic Development Cultural Change, 63 (3). doi: https://doi.org/10.1086/679737
Centers for Disease Control and Prevention [CDC]. (2013). Declines in state teen birth rates by race and Hispanic origin. Retrieved on November 19, 2018 from https://www.cdc.gov/nchs/data/databriefs/db123.htm
Dankawa-Mullan, I., Rhee, K., Stoff, D., Pohlhaus, J., Sy, F., Stinson, N., & Ruffin, J. (2010). Moving toward paradigm-shifting research in health disparities through translational, transformational, and transdisciplinary approaches. American Journal of Public Health, 100 (S1). S19-S24. doi: https://doi.org/10.2105/ajph.2009.189167
Edwards, K., Towle, P., & Levitz, B. (2014). Incorporating life course theory and social determinants of health into LEND curriculum. Maternal & Child Health Journal, 18 (2). doi: https://doi.org/10.1007/s10995-013-1283-0
Florsheim, P., Burrow-Sanchez, J., Minami, T., Heavin, S., & Hudak, C. (2012). Young parenthood program: Supporting positive paternal engagement through coparenting counseling. American Journal of Public Health, 102 (10). doi: https://doi.org/10.2105/ajph.2012.300902
Hommel, K., Modi, A., Piazza-Waggoner, C., & Myers, J. (2015). Topical review: Translating research in behavioral science. Journal of Pediatric Psychology, 40 (10). 1034-1040. doi: https://doi.org/10.1093/jpepsy/jsv049
Proyecto Nacer, (n.d.). Sobre nosotros [About us]. Retrieved on November 29, 2018 from http://proyectonacer.com/sobre-nosotros/
Talge, N., Neal, C., & Glover, V. (2007). Antenatal maternal stress and long-term effects on child neurodevelopment: how and why? Journal of Child Psychology and Psychiatry, 48 (3-4). doi: https://doi.org/10.1111/j.1469-7610.2006.01714.x
Warnecke, R., Oh, A., Breen, N., & Gehlert, S. (2011). Approaching health disparities from a population perspective: The National Institutes of Health Centers for Population Health and Health Disparities. American Journal of Public Health, 98 (9). 1608-1615. doi: https://doi.org/10.2105/ajph.2006.102525