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Researcher Studies How Race and Culture Influence Parenting, Children’s Development
mccannn [at] email.chop.edu (By Nancy McCann)
National data reflects disparities in morbidity and mortality of not only Black women, but also Black infants. Wanjiku Njoroge, MD, an infant and preschool psychiatrist at Children’s Hospital of Philadelphia, is exploring the challenges faced specifically by Black women living in Philadelphia in the midst of two pandemics (COVID-19 and structural racism), and she looks at ways in which brief interventions could be helpful.
Dr. Njoroge’s research interests involve thinking critically about how culture, race, and ethnicity influence developing children and families, and understanding ways in which social determinants of health and systemic racism affect early neurodevelopment. She is on faculty at CHOP’s PolicyLab and the Perelman School of Medicine at University of Pennsylvania.
Dr. Njoroge and Penn colleagues collaborating on projects at the Lifespan Brain Institute (LiBI) are in the early stages of developing a study that will look at peripartum women and infants in Philadelphia during the pandemic. These are moms who already were surveyed about stress, depression, and anxiety in the midst of COVID-19 in April, when they were either in their second or third trimester and now have delivered within the Penn Medicine Health System.
The researchers are re-approaching these mothers (more than 1,000) post-delivery, with an additional survey asking about postpartum mental health (depression, anxiety, etc.), physician trust, provider support, bonding with baby, race/ethnicity, stressful life events, perceived discrimination, and area deprivation index.
“Through this work, we hope to better understand the diversity of women’s experiences and be able to create care models that are nuanced, culturally appropriate, and effective in supporting mothers and infants,” Dr. Njoroge said. “Knowing that Philadelphia and Pennsylvania have disproportionality in the ways in which COVID-19 has been impacting African-American, Latinx, and some immigrant communities, this is an opportunity for us to help by thinking about how we can support these women in the context of these larger issues that are happening.”
Recent Research: Neighborhoods, Moms, and Parenting
All of the children who Dr. Njoroge sees clinically and in her research program are under the age 5, which means that parents and caregivers are by default included in that work. She looks at cross-cultural populations in terms of differences and similarities across infant and early childhood development and parenting practices changes within socio-environmental and structural contexts.
Dr. Njoroge’s recent work measured the prevalence of mental health conditions and symptoms of hospitalized infants’ parents, differences in outcomes, and later, utilization of services for both children and parents by cross-cultural differences.
In a study on the stressors of moms with babies in the Neonatal Intensive Care Unit (NICU) published in the Journal of the American Academy of Child and Adolescent Psychiatry, Dr. Njoroge and collaborators examined how maternal depressive symptoms and stress in the NICU are related to parenting behaviors at age 5 years, in mothers of children born very preterm. The research team’s findings suggested that early maternal peripartum depression and stress in the NICU could have lasting effects on multiple parenting behaviors, emphasizing the need for screening and targeted interventions in the NICU.
Today, these researchers are looking at the same cohort of women from an area deprivation index perspective, which takes into account the larger picture of systemic and institutional racism and how that may differ across these women.
“These metrics, which rank neighborhoods by socioeconomic disadvantage, could very well be another layer that’s impacting these women,” Dr. Njoroge said.
After completing their initial analysis, the researchers found that neighborhood context does play a role in how these women are faring. They will be diving deeper into the data to look specifically across the four different mental health classes of women identified in the original study (doing fairly well, high state anxiety, highly depressed and anxious, acute NICU stress) to see if neighborhood factors play more into any particular presentation in terms of the women who are doing very poorly.
Not only will the researchers identify how the mother is doing years after their infant’s NICU discharge, but also whether or not there is an impact on the way in which the mother is parenting, and if there are differences in the children’s behaviors and development at age 5.
“We absolutely need to look at these larger structural issues,” Dr. Njoroge said. “The questions that need answering now are, ‘How can we dismantle these structural inequities that are leading to significant disturbances in very young children’s and parents’ mental health and well-being?’ And as we are trying to garner the political will to change and rebuild some of these long-standing structures, ‘What interventions may be effective, when should we offer them, and for whom are they most effective?’”
Editor’s Note: CHOP is a member of the Healthcare Anchor Network, a national collaboration of leading healthcare systems, which published the “Racism is a Public Health Crisis” statement. See this press release for more information.