Health Behaviors as Mediators for the Effect of Partner Abuse on Infant Birth Weight
The title of this study is Health Behaviors as Mediators for the Effect of Partner Abuse on Infant Birth weight. The research topic is reflective of the title. The research question stated that “Intimate partner abuse of pregnant women has been linked to the delivery of low birth-weight infants” ( Kearney, 2004 p.2) . The purpose of this study was to explore the role of substance abuse such as smoking, alcohol, drugs and weight gain of less than 15 pounds as possible factors that contribute to lower infant birth-weight. The problem of this study is to determine whether intimate partner abuse of pregnant women correlates with lower birth weight.
Also, the researchers wanted to find out if substance abuse and other variables such as poor nutrition and demographic risk factors put a woman at risk for low birth -weight infants. This study was done within ethical standards. Chart reviews were completed on the sample since they were standard questions and didn’t need approval. However, the Institutional review board (IRB) did give approval for each prenatal care site to obtain other data throughout the study.
In the review of literature, there were eleven references five years or less and 27 references older than five years. The review was concise in explaining the results of the study. The review does flow logically from the purpose of the study to completion. However, the article was somewhat confusing with all the variables. Both classic and current sources were included. Direct quotes as well as paraphrases were used considering the 38 references. There were many aspects to this study and support for the theory. Opposing literature was also cited in several instances.. The researchers reported their own statistical findings from their chosen analysis. They researched several data sources, and quoted where material was obtained in order to validate the study. For example, authors Curry et al., 1998; and Parker et al., 1994 had published an article on previous studies of abuse during pregnancy. Kearney et al., from this current article used some of the previously published information and statistics, expanding on findings and including data in this research paper.
The opposing theory recorded in this article was the effect of the correlation between the dependant and independent variables. Many instances indicated that there was little correlation between abuse and low birth-weight infants despite the fact that the purpose of this study was to see if there was a correlation between these variables. Several explanations were given as to why theories could not be proven according to revealed statistics and studies. However, there were many links as to what may cause low birth-weight infants. There was really no existing theory, so the researchers in this study used a conceptual framework to serve as the “impetus for the formulation of a theory” (Niewswiadomy, p.95). The hypotheses was based on proposed theoretical relations (Kearney, p. 1). Negative factors such as alcohol use, and poor weight-gain less than 15 pounds may predict the birth-weight. Another theoretical relation was that variables such as low income and maternal age less than 20 years were factors that increase the likelihood of low birth-weight infants. There were many independent variables covered in this article which helped to close the gap between the purpose and the literature findings.
The method by which this study was conducted was stated in the research paper. Thirteen prenatal care sites participated in the study. They conducted and evaluated chart reviews for “non-representative sample of women who had been screened during pregnancy for intimate partner abuse.” (Kearney , p.5) The population of these women included various types of payments for health insurance and some women paid their own health insurance. “A large number of charts (N =5,745) of women who enrolled for care over a 30 month period were reviewed. Screening by hospitals for possible abusive situations was less than 50%. So the final number for this analysis was (N = 1969) of the birth-weight that was actually known after birth ( Kearney, 2004 , p.5). Also, substance abuse data of these women was taken into consideration.
The instruments used for this study were both valid and reliable. Instruments included the Abuse Assessment Screen (AAS) and a Multiple regression analysis. Violence to these women was easily detected through these instruments. Investigators conducted chart reviews and abstracted variables such as “demographic, obstetric, and birth outcome data from medical records” (Kearney , p. 6) . Multiple regression analysis was used with several variables that would account for possible decreases in birth-weight of newborn infants. The correlation of birth weight and abuse were studied. The data was assimilated and ‘in the sample of 1,969 women, small but significant zero-order correlations were seen between birth-weight and recent partner abuse” (Kearney, p.9). It was concluded that there are many factors that predict low birth-weight. The ones cited most were the single mother and negative health behaviors such as smoking and low weight gain, less than 15 pounds. Also, abuse was not a strong factor in predicting low infant birth-weight. However, smoking and drug use may increase the incidence. Single marital status often reflects low social support. Negative health behaviors and race (variables) was weakly linked to abuse. Generally, it depends on one’s social conditions. Åbuse can happen in any social status (Kearney, p. 9).
This article rates number four in the critique category of satisfying the basic requirements of scientific research. The study was approved by the IRB and approval was maintained for each of the 13 sites for the duration of the data collection (Kearney, p.8) . This study can easily be used with other cultures in determining the impact of drugs and abuse. Mostly, the African American population was cited. This is because more African Americans are in a lower socio-economic status often times than are whites. They may not be able to have a well-balanced diet and as a result infant birth-weight could be slightly lower. Several variables were used, especially variables that could explain the low birth-weight of these infants. Some of these variables included demographic, medical and obstetric risk factors. These variables were all recorded (Kearney, 2004, p. 6) . The study was simplified by those conducting the data by use of the Abuse Assessment screen. The assessment screen was used for emotional and physical abuse during pregnancy. However, the yes or no questions may have not always had truthful answers. (Kearney, p. 12) Prior to beginning this research, nurses were trained in each of the 13 settings regarding proper use of this tool, in order to make the study valid. Variables only indirectly caused low birth-weight of infants. It is only natural for abused women to abuse themselves in other ways, due to stress. More often, the low socioeconomic status, poor nutrition, and lack of education regarding the use of illicit substances during pregnancy could cause low birth-weight infants. Single marital status was the strongest contributory factor in causing low birth-weight infants (Kearney, p.ll). The abuse often occurs when a significant other is also stressed due to many concerns surrounding the pregnancy such as financial stress.
In the final discussion and conclusion, according to Kearney, obstetric covariates explained 27% of the variance in birth weight. Abuse explained a very small 0.2%, but significant portion of the variance in birth weight after control was used for the obstetric covariates of gestational age, iatrogenic prematurity, and preterm rupture of membranes.” Scientific methods to obtain the hypothesis were quite detailed, and there were many extraneous variables included that may cause the low birth-weight of infants. This article allowed the reader to see that other variables might be a topic in future studies for the prediction of low birth weight infants. For example, partner abuse may occur simultaneously with substance abuse, but is not the main factor. In conclusion, the author’s of this research study do recommend future studies regarding the role that other factors may play in an infant’s well being (Kearney, p. 12). The studies did make one aware that it is necessary for women to have comprehensive prenatal abuse screenings and more support during their pregnancies in order to assure the best possible outcome for both mother and baby.
Kearney, M., Munro, B., Ursula, K., & Hawkins, J. (2004). Health Behaviors as Mediators for the Effect of Partner Abuse on Infant Birth Weight, Nursing Research, Volume 53 (1), pp 36-45