Health Policy Briefs are short, jargon-free tools used to convey the implications of scientific evidence for policy and practice. They are used when an individual or group (e.g., decision-maker, community organization,) needs to be “briefed” on scientific evidence in a concise form in order to take action or participate intelligently in some

The Policy Brief Checklist (designed for self-review, to be submitted with your brief) will help you ensure that you have met the criteria for an effective Policy Brief.

Your task will be to “translate” the scientific findings from the articles included in your Critical Review for a public health agency/organization that you select.  The maximum length of your Policy Brief is 2 pages, with 1-inch margins. The brief should be appropriately referenced. The references should be provided at the end of the brief, but will not be counted in the page limit.

Your Policy Brief needs to include the following elements:

• Title (keep it engaging, short, and informative)
• Executive Summary. A 2-3 sentence overview summarizing the entire brief.  Use recognizable lay terms for complex scientific concepts and emphasize the relevance of your research findings for policy to draw the reader’s attention.
• Body of the Brief which explains the public health problem and why it is particularly important or why action is currently needed. You will provide background and contextual information regarding the relevance and importance of the public health problem to the health status of and/or the services provided to the community agency’s patient population or clients. This will include 1-2 key graphics from your Key Health Indicator Report or similar graphics more closely aligned with your public health problem. You will also highlight key findings from the Critical Review Summary and explain how they relate to action steps (policy recommendations) for your agency/organization. As needed, you may reference prior policy, practice and/or research that was not included in your Key Health Indicator report or Critical Review to make your recommendations comprehensible. You should aim to make no more than 2 feasible recommendations/action steps for policy in the brief.
• Conclusions- reinforces the key message to take away from the policy

Your Policy Brief will be evaluated (see rubric and self-evaluation checklist for details) based on these criteria: argument flows clearly; content appropriate for audience; language is clear, concise, and engaging; visual cues help the reader navigate and digest information; data are presented effectively.

 

 

 

 

 

 

 

 

 

            Article Critique

Article #1: Very Low Birthweight in African American Infants: The Role of Maternal Exposure to Interpersonal Racial Discrimination (Collins et al., 2004).

Overview of the Study

This study aimed to determine the association between pregnancy outcomes and the lifetime exposure of African American women to interpersonal discrimination. The researchers employed a case-control study design that involved recruiting 234 control subjects and 117 case subjects in conducting the study. However, by the end of the study, only 208 control subjects and 104 case subjects were deemed eligible for the study. Those who did not end up in the study were excluded for reasons such as turning down of consent, failure to turn up for interviews, and premature infants’ expiration. The study also made use of interviewer-administered questionnaires.

The variables for which data were collected include sociodemographic variables such as age and level of education. Most importantly, the study variables comprised questions about interpersonal racial discrimination, categorized into five domains: discrimination at school, at work, when seeking medical care, getting a job, and when getting served at a store or a restaurant. To better capture the results, the responses were dichotomized after the data was collected into “none,” standing for where discrimination experience once per year or less, and “regularly” where discrimination was experienced more frequently than that.

Data analysis was done using the logistic regression method to find the odds ratios for the measured risk factors. The results indicated odds ratios of more than 3, which led to the conclusion that racial discrimination toward African American women is a significant risk factor for preterm delivery.

Evaluation of the Written Presentation of the Study

The study hypotheses/aims, methods, results, and conclusions were clearly described. In my opinion, no information to evaluate the scientific robustness of the study was missing. All basic requirements were met by the study. The study even when ahead to justify why the observed attrition was so, and to great detail. The methodology was clear enough for anyone to understand as well. The data analysis process and the reporting of results were also done to standard. To make it even easier to peruse, the results have been organized into tables.

Evaluation of Sources of potential bias/confounders

Considering the sample size, population sampled/sampling method, study design, appropriateness of comparison groups, measurement of the dependent and independent variables, this study was pretty on point. First, this study spans about 3 years (November 1, 1997, to October 31, 2000). This alone is a good spread time-wise, which means the study variables could be captured appropriately even concerning changes in time.

The study identified 234 potentially eligible control subjects against 117 potentially eligible subjects. Out of these, 208 (88.8%) controls and 104 (88.8%) cases participated in the study. This return rate was still good enough to since it is more than 50%, which means it can still represent the population. Since this was universal sampling, which means that the entire eligible population at the study site for the particular study period was potentially eligible for participation, then the sample is not biased in the least.

 

 

Evaluation  of  Study  Generalizability

This study stands the test in terms of the determinants of generalizability (data collection, inclusion/exclusion criteria, population definition, recruitment of subjects, definition of outcome, length of follow-up, and subject retention). I consider this study generalizable especially considering that it used inferential statistics (Odds Ratio) to infer relationships between the study variables.

Article 2: Maternal Experiences with Everyday Discrimination and Infant Birth Weight: A Test of Mediators and Moderators among Young, Urban Women of Color (Earnshaw et al., 2012).

Overview of the Study

This study aimed to establish the association between maternal discrimination and infant birth weight outcomes among urban young women of color and mediators and moderators of the association. The study considered a sample size of 420 women aged from 14 years to 21 years, of which 38% were Black while 62% were Latina. The participants completed a survey on everyday discrimination, the moderators, and mediators as designed by the researchers. Birth weight was abstracted from medical records.

The results intimated that everyday discrimination was linked to low birth weight. The mediating factors included depressive symptoms. However, no moderating factors were identified. This study concluded that given the apparent relationship between racial discrimination and low birth weight, it is imperative to activate measures that eradicate racial discrimination among young urban women of color.

 

 

Evaluation of the Written Presentation of the Study

The study aims/hypotheses, design/methods, results, and conclusions were clearly described. No vital information was missing as far as the scientific robustness of the study is concerned.

Evaluation of Sources of potential bias/confounders

This study made a disclaimer that the appropriateness of comparison groups is questionable given that the age range was somehow not well spread. In addition, the discrimination factors linked to race were confounded by other discrimination factors otherwise not related to age, which poses a problem when trying to arrive at pure conclusions.

Evaluation  of  Study  Generalizability

This study is considerably generalizable considering factors proper methodological factors like sampling and data analysis, etc.

Article #3: Effects Of Social and Psychosocial Factors on Risk of Preterm Birth in Black Women (Misra et al., 2010).

Overview of the Study

This study aimed at examining how psychosocial factors influence the risk of preterm birth among African American women in Baltimore, Maryland. The study employed a hybrid of retrospective design and prospective cohort design. The sample size was 872 women, while the study period was 41 months (from March 2001 to July 2004, or about 3 years. However, 832 participants were considered for data analysis after activating the exclusion criteria during the study. The results revealed that exposure to racism did not significantly affect the risk of preterm birth. However, racism scores that were above the median were linked to preterm birth risk. This means that psychosocial factors were also related to the risk of preterm birth, which the study established a complex interrelationship between the individual social and psychological factors.

Evaluation of the Written Presentation of the Study

The study hypotheses/aims, methods, results, and conclusions were presented. No vital information was missing in the study.

Evaluation of Sources of potential bias/confounders

This study had a return rate of 68%, which is way lower than the targeted 100%. This can be a source of bias in the results. Other factors like appropriateness of comparison groups, measurement of the dependent and independent variables, etc., did not seem to have identifiable issues.

Evaluation  of  Study  Generalizability

Since the study had a return rate of 68%, which is way lower than the targeted 100%, this can impact some level on the generalizability of the results due to the severe attrition rate. Other factors of generalizability were well handled, nonetheless.

Article #4: African American Women’s Exposure to Interpersonal Racial Discrimination in Public Settings And Preterm Birth: The Effect of Coping Behaviors (Rankin et al., 2011).

Overview of the Study

This study aimed to determine whether African American women’s coping behaviors have a modifying effect on the relationship between exposure to interpersonal racial discrimination and preterm birth. The study employed a case-control study design involving a sample size of 117 controls and 160 cases. Data collection was done using a self-administered questionnaire. After data analysis, it was found out that there was a significant relationship between racism and preterm birth among African American women, as confirmed by odds ratios and Chi-squared statistics. In addition, positive coping mechanisms led to the attenuation of the effects of racism on preterm births. The study concluded that exposure to racism among African American women in public settings is a risk factor for preterm birth. However, active coping behaviors can attenuate that relationship.

Evaluation of the Written Presentation of the Study

The study hypotheses/aims, methods, results, and conclusions were presented. No important information was missing in the study.

Evaluation of Sources of potential bias/ confounders

No sources of bias can be identified in the study. It had a seamless methodology which counts as methodological strength.

Evaluation  of  Study  Generalizability

This study is generalizable in light of the factors of generalizability (data collection, inclusion/exclusion criteria, population definition, recruitment of subjects, definition of outcome, length of follow-up, and subject retention). In addition, the fact that the study uses inferential statistics like Chi-squared statistics and odds ratios makes the study’s findings corroborated.

 

Integrative Summary of the Four Articles

The four articles (Collins et al., 2004; Earnshaw et al., 2012; Misra et al., 2010; Rankin et al., 2011) seem to rotate around one recurring theme: the correlation between birth outcomes everyday exposure to racism among women of color. Interestingly enough, the results of all of these studies also echo just one core message: exposure to racism has significant adverse effects on birth outcomes among women of color. It is also interesting to note that the studies were conducted through different time frames by many other individuals among several diverse populations (geographically) of varying sample sizes, yet the results keep recurring. This only goes on to show that this is a topic that cannot be downplayed. A call to action is in order. In fact, given that the last study mentioned here was done in 2012, which is about ten years ago, similar studies should be encouraged as a follow-up to see the current situation out there regarding the same topic.

In addition, similar studies should be done to eliminate confounding variables so that the pure effects of racism toward women of color can be elucidated more confidently. This is because one of these studies (Earnshaw et al., 2012) issues a disclaimer that some of its limitations could be the fact that the pure effects of discrimination due to racism could not be ascertained since the participants mentioned some kinds of discrimination which are otherwise not directly ascribed to elements of racism. If these confounding factors could be filtered out, a better picture of the situation could be formed.

In conclusion, these articles have provided valuable information on the relationship between racism and birth outcomes regarding incidences of preterm birth and low birth weight. As already suggested in one of the articles (Earnshaw et al., 2012), the remedy of this situation involves the curbing of factors that promote racial discrimination.

References

Collins, J., David, R., Handler, A., Wall, S., & Andes, S. (2004). Very Low Birthweight in African American Infants: The Role of Maternal Exposure to Interpersonal Racial Discrimination. American Journal Of Public Health, 94(12), 2132-2138. https://doi.org/10.2105/ajph.94.12.2132

Earnshaw, V., Rosenthal, L., Lewis, J., Stasko, E., Tobin, J., & Lewis, T. et al. (2012). Maternal Experiences with Everyday Discrimination and Infant Birth Weight: A Test of Mediators and Moderators Among Young, Urban Women of Color. Annals Of Behavioral Medicine, 45(1), 13-23. https://doi.org/10.1007/s12160-012-9404-3

Misra, D., Strobino, D., & Trabert, B. (2010). Effects of social and psychosocial factors on risk of preterm birth in black women. Paediatric And Perinatal Epidemiology, 24(6), 546-554. https://doi.org/10.1111/j.1365-3016.2010.01148.x

Rankin, K., David, R., & Collins Jr, J. (2011). African American women’s exposure to interpersonal racial discrimination in public settings and preterm birth: the effect of coping behaviors. Ethnicity And Disease, 21(3), 370-376. Retrieved 9 July 2021, from https://pubmed.ncbi.nlm.nih.gov/21942172/.

 

Health Policy Briefs are short, jargon-free tools used to convey the implications of scientific evidence for policy and practice. They are used when an individual or group (e.g., decision-maker, community organization,) needs to be “briefed” on scientific evidence in a concise form in order to take action or participate intelligently in some

The Policy Brief Checklist (designed for self-review, to be submitted with your brief) will help you ensure that you have met the criteria for an effective Policy Brief.

Your task will be to “translate” the scientific findings from the articles included in your Critical Review for a public health agency/organization that you select.  The maximum length of your Policy Brief is 2 pages, with 1-inch margins. The brief should be appropriately referenced. The references should be provided at the end of the brief, but will not be counted in the page limit.

Your Policy Brief needs to include the following elements:

• Title (keep it engaging, short, and informative)
• Executive Summary. A 2-3 sentence overview summarizing the entire brief.  Use recognizable lay terms for complex scientific concepts and emphasize the relevance of your research findings for policy to draw the reader’s attention.
• Body of the Brief which explains the public health problem and why it is particularly important or why action is currently needed. You will provide background and contextual information regarding the relevance and importance of the public health problem to the health status of and/or the services provided to the community agency’s patient population or clients. This will include 1-2 key graphics from your Key Health Indicator Report or similar graphics more closely aligned with your public health problem. You will also highlight key findings from the Critical Review Summary and explain how they relate to action steps (policy recommendations) for your agency/organization. As needed, you may reference prior policy, practice and/or research that was not included in your Key Health Indicator report or Critical Review to make your recommendations comprehensible. You should aim to make no more than 2 feasible recommendations/action steps for policy in the brief.
• Conclusions- reinforces the key message to take away from the policy

Your Policy Brief will be evaluated (see rubric and self-evaluation checklist for details) based on these criteria: argument flows clearly; content appropriate for audience; language is clear, concise, and engaging; visual cues help the reader navigate and digest information; data are presented effectively.

 

 

 

 

 

 

 

 

 

            Article Critique

Article #1: Very Low Birthweight in African American Infants: The Role of Maternal Exposure to Interpersonal Racial Discrimination (Collins et al., 2004).

Overview of the Study

This study aimed to determine the association between pregnancy outcomes and the lifetime exposure of African American women to interpersonal discrimination. The researchers employed a case-control study design that involved recruiting 234 control subjects and 117 case subjects in conducting the study. However, by the end of the study, only 208 control subjects and 104 case subjects were deemed eligible for the study. Those who did not end up in the study were excluded for reasons such as turning down of consent, failure to turn up for interviews, and premature infants’ expiration. The study also made use of interviewer-administered questionnaires.

The variables for which data were collected include sociodemographic variables such as age and level of education. Most importantly, the study variables comprised questions about interpersonal racial discrimination, categorized into five domains: discrimination at school, at work, when seeking medical care, getting a job, and when getting served at a store or a restaurant. To better capture the results, the responses were dichotomized after the data was collected into “none,” standing for where discrimination experience once per year or less, and “regularly” where discrimination was experienced more frequently than that.

Data analysis was done using the logistic regression method to find the odds ratios for the measured risk factors. The results indicated odds ratios of more than 3, which led to the conclusion that racial discrimination toward African American women is a significant risk factor for preterm delivery.

Evaluation of the Written Presentation of the Study

The study hypotheses/aims, methods, results, and conclusions were clearly described. In my opinion, no information to evaluate the scientific robustness of the study was missing. All basic requirements were met by the study. The study even when ahead to justify why the observed attrition was so, and to great detail. The methodology was clear enough for anyone to understand as well. The data analysis process and the reporting of results were also done to standard. To make it even easier to peruse, the results have been organized into tables.

Evaluation of Sources of potential bias/confounders

Considering the sample size, population sampled/sampling method, study design, appropriateness of comparison groups, measurement of the dependent and independent variables, this study was pretty on point. First, this study spans about 3 years (November 1, 1997, to October 31, 2000). This alone is a good spread time-wise, which means the study variables could be captured appropriately even concerning changes in time.

The study identified 234 potentially eligible control subjects against 117 potentially eligible subjects. Out of these, 208 (88.8%) controls and 104 (88.8%) cases participated in the study. This return rate was still good enough to since it is more than 50%, which means it can still represent the population. Since this was universal sampling, which means that the entire eligible population at the study site for the particular study period was potentially eligible for participation, then the sample is not biased in the least.

 

 

Evaluation  of  Study  Generalizability

This study stands the test in terms of the determinants of generalizability (data collection, inclusion/exclusion criteria, population definition, recruitment of subjects, definition of outcome, length of follow-up, and subject retention). I consider this study generalizable especially considering that it used inferential statistics (Odds Ratio) to infer relationships between the study variables.

Article 2: Maternal Experiences with Everyday Discrimination and Infant Birth Weight: A Test of Mediators and Moderators among Young, Urban Women of Color (Earnshaw et al., 2012).

Overview of the Study

This study aimed to establish the association between maternal discrimination and infant birth weight outcomes among urban young women of color and mediators and moderators of the association. The study considered a sample size of 420 women aged from 14 years to 21 years, of which 38% were Black while 62% were Latina. The participants completed a survey on everyday discrimination, the moderators, and mediators as designed by the researchers. Birth weight was abstracted from medical records.

The results intimated that everyday discrimination was linked to low birth weight. The mediating factors included depressive symptoms. However, no moderating factors were identified. This study concluded that given the apparent relationship between racial discrimination and low birth weight, it is imperative to activate measures that eradicate racial discrimination among young urban women of color.

 

 

Evaluation of the Written Presentation of the Study

The study aims/hypotheses, design/methods, results, and conclusions were clearly described. No vital information was missing as far as the scientific robustness of the study is concerned.

Evaluation of Sources of potential bias/confounders

This study made a disclaimer that the appropriateness of comparison groups is questionable given that the age range was somehow not well spread. In addition, the discrimination factors linked to race were confounded by other discrimination factors otherwise not related to age, which poses a problem when trying to arrive at pure conclusions.

Evaluation  of  Study  Generalizability

This study is considerably generalizable considering factors proper methodological factors like sampling and data analysis, etc.

Article #3: Effects Of Social and Psychosocial Factors on Risk of Preterm Birth in Black Women (Misra et al., 2010).

Overview of the Study

This study aimed at examining how psychosocial factors influence the risk of preterm birth among African American women in Baltimore, Maryland. The study employed a hybrid of retrospective design and prospective cohort design. The sample size was 872 women, while the study period was 41 months (from March 2001 to July 2004, or about 3 years. However, 832 participants were considered for data analysis after activating the exclusion criteria during the study. The results revealed that exposure to racism did not significantly affect the risk of preterm birth. However, racism scores that were above the median were linked to preterm birth risk. This means that psychosocial factors were also related to the risk of preterm birth, which the study established a complex interrelationship between the individual social and psychological factors.

Evaluation of the Written Presentation of the Study

The study hypotheses/aims, methods, results, and conclusions were presented. No vital information was missing in the study.

Evaluation of Sources of potential bias/confounders

This study had a return rate of 68%, which is way lower than the targeted 100%. This can be a source of bias in the results. Other factors like appropriateness of comparison groups, measurement of the dependent and independent variables, etc., did not seem to have identifiable issues.

Evaluation  of  Study  Generalizability

Since the study had a return rate of 68%, which is way lower than the targeted 100%, this can impact some level on the generalizability of the results due to the severe attrition rate. Other factors of generalizability were well handled, nonetheless.

Article #4: African American Women’s Exposure to Interpersonal Racial Discrimination in Public Settings And Preterm Birth: The Effect of Coping Behaviors (Rankin et al., 2011).

Overview of the Study

This study aimed to determine whether African American women’s coping behaviors have a modifying effect on the relationship between exposure to interpersonal racial discrimination and preterm birth. The study employed a case-control study design involving a sample size of 117 controls and 160 cases. Data collection was done using a self-administered questionnaire. After data analysis, it was found out that there was a significant relationship between racism and preterm birth among African American women, as confirmed by odds ratios and Chi-squared statistics. In addition, positive coping mechanisms led to the attenuation of the effects of racism on preterm births. The study concluded that exposure to racism among African American women in public settings is a risk factor for preterm birth. However, active coping behaviors can attenuate that relationship.

Evaluation of the Written Presentation of the Study

The study hypotheses/aims, methods, results, and conclusions were presented. No important information was missing in the study.

Evaluation of Sources of potential bias/ confounders

No sources of bias can be identified in the study. It had a seamless methodology which counts as methodological strength.

Evaluation  of  Study  Generalizability

This study is generalizable in light of the factors of generalizability (data collection, inclusion/exclusion criteria, population definition, recruitment of subjects, definition of outcome, length of follow-up, and subject retention). In addition, the fact that the study uses inferential statistics like Chi-squared statistics and odds ratios makes the study’s findings corroborated.

 

Integrative Summary of the Four Articles

The four articles (Collins et al., 2004; Earnshaw et al., 2012; Misra et al., 2010; Rankin et al., 2011) seem to rotate around one recurring theme: the correlation between birth outcomes everyday exposure to racism among women of color. Interestingly enough, the results of all of these studies also echo just one core message: exposure to racism has significant adverse effects on birth outcomes among women of color. It is also interesting to note that the studies were conducted through different time frames by many other individuals among several diverse populations (geographically) of varying sample sizes, yet the results keep recurring. This only goes on to show that this is a topic that cannot be downplayed. A call to action is in order. In fact, given that the last study mentioned here was done in 2012, which is about ten years ago, similar studies should be encouraged as a follow-up to see the current situation out there regarding the same topic.

In addition, similar studies should be done to eliminate confounding variables so that the pure effects of racism toward women of color can be elucidated more confidently. This is because one of these studies (Earnshaw et al., 2012) issues a disclaimer that some of its limitations could be the fact that the pure effects of discrimination due to racism could not be ascertained since the participants mentioned some kinds of discrimination which are otherwise not directly ascribed to elements of racism. If these confounding factors could be filtered out, a better picture of the situation could be formed.

In conclusion, these articles have provided valuable information on the relationship between racism and birth outcomes regarding incidences of preterm birth and low birth weight. As already suggested in one of the articles (Earnshaw et al., 2012), the remedy of this situation involves the curbing of factors that promote racial discrimination.

References

Collins, J., David, R., Handler, A., Wall, S., & Andes, S. (2004). Very Low Birthweight in African American Infants: The Role of Maternal Exposure to Interpersonal Racial Discrimination. American Journal Of Public Health, 94(12), 2132-2138. https://doi.org/10.2105/ajph.94.12.2132

Earnshaw, V., Rosenthal, L., Lewis, J., Stasko, E., Tobin, J., & Lewis, T. et al. (2012). Maternal Experiences with Everyday Discrimination and Infant Birth Weight: A Test of Mediators and Moderators Among Young, Urban Women of Color. Annals Of Behavioral Medicine, 45(1), 13-23. https://doi.org/10.1007/s12160-012-9404-3

Misra, D., Strobino, D., & Trabert, B. (2010). Effects of social and psychosocial factors on risk of preterm birth in black women. Paediatric And Perinatal Epidemiology, 24(6), 546-554. https://doi.org/10.1111/j.1365-3016.2010.01148.x

Rankin, K., David, R., & Collins Jr, J. (2011). African American women’s exposure to interpersonal racial discrimination in public settings and preterm birth: the effect of coping behaviors. Ethnicity And Disease, 21(3), 370-376. Retrieved 9 July 2021, from https://pubmed.ncbi.nlm.nih.gov/21942172/.