Immunization Hesitancy

Instructions
Please create one response to each peer ( I am providing their posts below). Response posts to peers have no minimum word requirement but must demonstrate topic knowledge and scholarly engagement with peers. Substantive content is imperative for all posts. All discussion prompt elements for the topic must be addressed. Please proofread your response carefully for grammar and spelling. All posts should be supported by a minimum of one scholarly resource, ideally within the last 5 years. Journals and websites must be cited appropriately. Citations and references must adhere to APA format.
Classroom Participation
Substantive means that you add something new to the discussion supported with citation(s) and reference(s), you are not just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion, however should be correlated to the literature.
Discussion Peer/Participation Prompt (ie; responses)
Instructions:
Please respond to at least 2 of your peer’s posts. To ensure that your responses are substantive, use at least two of these prompts:
• Do you agree with your peers’ assessment?
• Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
• Share your thoughts on how you support their opinion and explain why.
• Present new references that support your opinions.
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with citations and references in APA format.

Peer 1

Robyn S.
Hello Professor and Class,
Health disparities such as living environment, lack of education, and being employed in a job that barely makes end meet can have negative effects on health and pregnancy. Martha has a history of hypertension, elevated hemoglobin A1C, and a BMI of 32. Because of her history, she is at high risk for developing preeclampsia, miscarriage, macrosomia in the fetus, and stillbirth. “Obesity increases the risk of the problems during pregnancy such as birth defects, macrosomia, preterm birth, and delivering a stillborn baby”, (ACOG, 2021). Martha is currently taking metformin due to her elevated hemoglobin A1C, she will need to closely monitor her blood sugar as well as have her obstetrician monitor her and her baby closer due to risk of complications.
Martha is an African American woman who has three children and must work two jobs to provide for her family. “Many low-income women rely on often unreliable public transportation and may arrive late to appointments and be forced to reschedule, which creates the impression of nonadherence. Such examples highlight the importance of inquiry into the underlying reasons for these care challenges. In fact, asking about certain social factors can be timesaving in some circumstances and can help to address systematic barriers to health care”, (ACOG, 2018).
She works two jobs and only has a 90-minute break in between them. By working two jobs she is creating more stress on her physical and mental health. She does not spend enough time with her children which can also lead to an increase in stress. “Stress may lead to high blood pressure during pregnancy. This puts you at risk of a serious high blood pressure condition called preeclampsia, premature birth and having a low-birthweight infant. Stress also may affect how you respond to certain situations. Some women deal with stress by smoking cigarettes, drinking alcohol or taking street drugs, which can lead to serious health problems in you and you baby”, (March of Dimes, 2019).
Reference
ACOG. (2018, January). Importance of social determinants of health and cultural awareness in the delivery of reproductive health
care. https://www.acog.org/-/media/project/acog/acogorg/clinical/files/committee-opinion/articles/2018/01/importance-of-social-
determinants-of-health-and-cultural-awareness-in-the-delivery-of-reproductive-health-care
ACOG. (2021, May). Obesity and pregnancy. https://www.acog.org/womens-health/faqs/obesity-and-pregnancy (Links to an external site.)
March of Dimes. (2019, October). Stress and pregnancy. https://www.marchofdimes.org/complications/stress-and-pregnancy

Peer 2

Nathan N.
What are the effects of income inequality on her health and ability to be an active participant in her care.
This case is an unfortunate situation for a single mom of African American descent. She is overweight, with hypertension and has diabetes. Recently, she was found to be 20 weeks pregnant. As stated above, she works two jobs to support her children and her partner who is in-charge of maintaining the home. Her household is experiencing more severe economic inequities with her as the breadwinner. In a recent study, women are 53 percent more likely to live in poverty compared to men, and earn 84 percent of what men earn (Zare et al., 2022). Additionally, African American women are more likely to experience several comorbidities compared to their white counterparts (Zare et al., 2022). They are also up to four times likely to die from pregnancy-related complications compared to non-Hispanic white women (Comfort et al., 2022). Some of these reasons include the racially insensitive biomedical studies and approaches, lack of fair treatment based on insurance policies, and race as a social concept which usually dismisses their struggles because they are a strong African American woman (Comfort et al., 2022). Clearly, sex, socioeconomic status and race are strong influences in her accession to appropriate care. It is pivotal that she is provided with appropriate resources to maintain the health of her household.
For this post, I will focus on her poverty status due to income inequality. As mentioned previously, women make less than men. In the US, the lower the income, the shorter the life expectancy (Marmot, 2022). This can be very true for this patient. Her work and family schedule do not permit her to seek medical services including prenatal care. Prenatal care can help reduce neonatal and maternal morbidity and mortality (Genet et al., 2022). Her pregnancy while dealing with a mild hypertension and diabetes adds complexity to her current medical needs. In addition to that, the time away form her children while doing physical work can put added stress to her health. Women living in poverty have a weak social network that results to poor access to basic resources and health insurance (Liyanto et al., 2022). I recall an encounter with a patient months ago. She is a single mom of two children. One of her children has a cognitive disability. I remember how frequently she had to reschedule her appointments due to a lack of caregiver. During the consultation, she did mention her financial struggles. She explained that she could not afford a caregiver for her child. She can barely make ends meet with the two jobs she currently has. Every hour lost at work can be a meal missed in her home. She was willing to forego her personal needs in order to provide for her children. There is an increased likelihood that the same goes for the patient in this case study. Both patients may have the intent to be healthy. However, it is expensive to be one. Providing a healthy meal can be a challenge. Healthier foods are found to be more expensive than less healthy foods (Kern et al., 2017).
As a provider, I will offer her a list of community resources that can potentially benefit her and her family. One of those will have to be a health center that can accommodate her schedule. She needs a provider that offers prenatal care and can also monitor her hypertension and diabetes. I will also refer her to a social worker who is more knowledgeable in tapping community resources for situations like this. She will eventually be on maternity leave and may need more assistance. Perhaps, helping her enroll in the Women, Infants, and Children (WIC) Program can offer her a much-needed relief. She may even qualify for a Medicaid program that can benefit her and her children. The social worker can also offer job placement information for her partner if a dual-income household remains to be their plan.
References
Comfort, T. A., Parcell, E. S., Mkandawire-Valhmu, L., & Olukotun, O. (2022). African American women’s maternal
healthcare experiences: A critical race theory perspective. Health Communication, 37(9), 1135-1146.
https://doi.org/10.1080/10410236.2021.1888453
Genet, A. H., Weret, Z. S., Adasho, Z. A., & Eshete, B. M. (2022). Quality of antenatal care and associated factors in
public health centers in Addis Ababa, Ethiopia, a cross-sectional study. PLoS One, 17(6). https://doi.org/10.1371/
journal.pone.0269710
Kern, D. M., Auchincloss, A. H., Stehr, M. F., Roux, A., Moore, L. V., Kanter, G. P., & Robinson, L. F. (2017). Neighborhood
prices of healthier and unhealthier foods and associations with diet quality: Evidence from the multi-ethnic study of
atherosclerosis. International Journal of Environmental Research and Public Health, 14(11), 1394.
https://doi.org/10.3390/ijerph14111394
Liyanto, E., Nuryana, D., Restu, A. C., Utomo, B., & Magnani, R. (2022). How well are Indonesia’s urban poor being provided access to quality reproductive health services? PLoS One, 17(4). https://doi.org/10.1371/ journal.pone.0265843
Marmot, Michael (2022). Recreating society for better health. American Journal of Public Health, 112(4), 535-537. https://prx-herzing.lirn.net/login?url=https://www.proquest.com/scholarly-journals/recreating-society-better-health/docview/2647726718/se-2
Zare, H., Fugal, A., Azadi, M., & Gaskin, D. J. (2022). How income inequality and race concentrate depression in low-income women in the US; 2005–2016. Healthcare, 10(8), 1424. https://doi.org/10.3390/healthcare10081424

For the writer to know background information:

Case Study:
Martha Miller is a 32-year-old, African American single mother living in a midsize city. She has three children from previous relationships. Her partner is Mick, a 38-year-old White man who lives with her, and who is unemployed. Although he is actively looking for a job, he has not worked in more than a year. Her oldest child is 8 years of age, she has a 4-year-old, and her youngest is 17 months. She works as a hotel housekeeper from 7:30 a.m. to 3:30 p.m. and at a fast-food restaurant from 6 p.m. to 11:30 p.m. She has limited time home with her children, only seeing them briefly after her first job, and then again in the morning before work. Her partner helps with the cooking and childcare. She is overweight with a body mass index of 32, has mild hypertension, and had a second A1c level of 6.4 for which you prescribed Metformin 500 mg twice a day during her last clinic visit 6 months ago. At that visit, she saw a dietitian for dietary counseling, and you spoke with her about developing a plan to get 150 minutes of exercise weekly.
She has not been back to see you despite repeated calls to her cell phone, a number that changes about every 8 to 10 months. She finally came into clinic last week, and you have determined that she is 20 weeks pregnant. You are concerned about the effectiveness of her medication, her very stressful life, and lack of follow-up as problems that can affect her health and that of her baby.
Questions
Select one of the options below and discuss the ways in which this condition/social problem might increase her health risks?

1. The effects of income inequality on her health and ability to be an active participant in her care.
2. Racial discrimination she may experience related to her romantic relationship.
3. Health disparities she may experience related to her pregnancy, such as the risk for preterm labor and the high rate of infant mortality in low-income women.

My initial discussion post ( what I posted):
Martha may not effectively participate in her care due to income inequality, which affects her in two critical ways. Firstly, she lacks an adequate income to cater to her health needs, considering that she works two jobs that do not pay very well. She also supports her family, comprising three children and a husband. Healthcare is expensive, especially in managing chronic conditions that require medication and lifestyle changes (McMaughan et al., 2020). Hence, it is likely that most of her income goes into catering for the family’s food and other basics and little or nothing remains for her healthcare. With the earnings, she also cannot afford medical cover or will likely be underinsured, which impacts her access to services and quality of care. Accordingly, Martha may not afford her medication and cover her healthcare costs, increasing the likelihood of exacerbation, such as developing diabetes during pregnancy and complications with her chronic conditions.
Secondly, due to income inequality, Martha cannot meet the healthcare providers’ recommendations to promote her health. Notably, she is always busy because she has to work two jobs to make ends meet. For this reason, she cannot honor her medical appointment or implement the dietary and exercise plan. The health improvement plan involves dietary changes, which are costly to achieve. Ziso et al. (2022) explain that the reduced availability and high cost of healthy nutritional options directly impact access to healthy diets, especially for low-income families. Hence, Martha may not afford nor have the time to look for healthy foods. Since she works at a fast-food restaurant, she can get unhealthy but inexpensive food. Besides, she does not have 150 minutes daily to exercise as she is always busy. These problems arise because of income inequality because Martha needs to work multiple jobs to meet her family’s needs.
References
McMaughan, D. J., Oloruntoba, O., & Smith, M. L. (2020). Socioeconomic status and access to healthcare: Interrelated drivers for healthy aging. Frontiers in Public Health, 8. https://doi.org/10.3389/fpubh.2020.00231
Ziso, D., Chun, O. K., & Puglisi, M. J. (2022). Increasing access to healthy foods through improving food environment: A review of mixed methods intervention studies with residents of low-income communities. Nutrients, 14(11). https://doi.org/10.3390/nu14112278