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Erschienen in: Maternal and Child Health Journal 7/2016

07.03.2016

Longitudinal Assessment of Effort–Reward Imbalance and Job Strain Across Pregnancy: A Preliminary Study

verfasst von: John D. Meyer, Carles Muntaner, Patricia O’Campo, Nicolas Warren

Erschienen in: Maternal and Child Health Journal | Ausgabe 7/2016

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Abstract

Objectives

To assess longitudinal changes in occupational effort–reward imbalance (ERI) and demand-control (DC) scores across pregnancy and examine associations with blood pressure (BP) during pregnancy.

Methods

A pilot repeated-measures survey was administered four times to a sample of working women across pregnancy using the ERI and DC instruments. Demographic data and blood pressure measurements were collected at each interval. Growth mixture modeling was used to examine trajectories of change in occupational characteristics. Associations with BP were examined using repeated-measures linear regression models.

Results

ERI model components (effort, reward, and overcommitment) all declined across pregnancy while job control remained stable. Increasing ERI trajectory was associated with higher systolic BP (b = 8.8; p < 0.001) as was high overcommitment; declining ERI also showed a lesser association with higher BP. Associations between DC trajectories and BP were much smaller, and non-significant once controlled for overcommitment.

Conclusions

Self-assessed efforts, rewards, and overcommitment at work decline across pregnancy in our participants, while job control remains stable. Replication in a more diverse pregnant working population is warranted to confirm these results. These preliminary data suggest that further investigation into the factors that may be linked with improved work psychosocial climate during pregnancy may be useful in order to improve pregnancy outcomes.
Literatur
1.
Zurück zum Zitat Murphy, J. F., Dauncey, M., Newcombe, R., Garcia, J., & Elbourne, D. (1984). Employment in pregnancy: Prevalence, maternal characteristics, perinatal outcome. Lancet, 1(8387), 1163–1166.CrossRefPubMed Murphy, J. F., Dauncey, M., Newcombe, R., Garcia, J., & Elbourne, D. (1984). Employment in pregnancy: Prevalence, maternal characteristics, perinatal outcome. Lancet, 1(8387), 1163–1166.CrossRefPubMed
2.
Zurück zum Zitat Saurel-Cubizolles, M. J., Zeitlin, J., Lelong, N., Papiernik, E., Di Renzo, G. C., & Breart, G. (2004). Employment, working conditions, and preterm birth: Results from the Europop case–control survey. Journal of Epidemiology and Community Health, 58(5), 395–401.CrossRefPubMedPubMedCentral Saurel-Cubizolles, M. J., Zeitlin, J., Lelong, N., Papiernik, E., Di Renzo, G. C., & Breart, G. (2004). Employment, working conditions, and preterm birth: Results from the Europop case–control survey. Journal of Epidemiology and Community Health, 58(5), 395–401.CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Meyer, J. D., Nichols, G. H., Warren, N., & Reisine, S. (2008). Maternal occupation and risk for low birth weight delivery: Assessment using state birth registry data. Journal of Occupational and Environmental Medicine, 50(3), 306–315.CrossRefPubMed Meyer, J. D., Nichols, G. H., Warren, N., & Reisine, S. (2008). Maternal occupation and risk for low birth weight delivery: Assessment using state birth registry data. Journal of Occupational and Environmental Medicine, 50(3), 306–315.CrossRefPubMed
4.
Zurück zum Zitat Savitz, D. A., Olshan, A. F., & Gallagher, K. (1996). Maternal occupation and pregnancy outcome. Epidemiology, 7(3), 269–274.CrossRefPubMed Savitz, D. A., Olshan, A. F., & Gallagher, K. (1996). Maternal occupation and pregnancy outcome. Epidemiology, 7(3), 269–274.CrossRefPubMed
5.
Zurück zum Zitat Landsbergis, P., Schnall, P. L., Belkic, K. L., Baker, D., Schwartz, J., & Pickering, T. G. (2001). Work stressors and cardiovascular disease. Work, 17(3), 191–208.PubMed Landsbergis, P., Schnall, P. L., Belkic, K. L., Baker, D., Schwartz, J., & Pickering, T. G. (2001). Work stressors and cardiovascular disease. Work, 17(3), 191–208.PubMed
6.
Zurück zum Zitat Karasek, R. (1996). Job strain and the prevalence and outcome of coronary artery disease. Circulation, 94(5), 1140–1141.PubMed Karasek, R. (1996). Job strain and the prevalence and outcome of coronary artery disease. Circulation, 94(5), 1140–1141.PubMed
7.
Zurück zum Zitat Muntaner, C., Nieto, F. J., Cooper, L., Meyer, J., Szklo, M., & Tyroler, H. A. (1998). Work organization and atherosclerosis: Findings from the ARIC study. Atherosclerosis Risk in Communities. American Journal of Preventive Medicine, 14(1), 9–18.CrossRefPubMed Muntaner, C., Nieto, F. J., Cooper, L., Meyer, J., Szklo, M., & Tyroler, H. A. (1998). Work organization and atherosclerosis: Findings from the ARIC study. Atherosclerosis Risk in Communities. American Journal of Preventive Medicine, 14(1), 9–18.CrossRefPubMed
8.
Zurück zum Zitat Warren, N., Dillon, C., Morse, T., Hall, C., & Warren, A. (2000). Biomechanical, psychosocial, and organizational risk factors for WRMSD: Population-based estimates from the Connecticut upper-extremity surveillance project (CUSP). Journal of Occupational Health Psychology, 5(1), 164–181.CrossRefPubMed Warren, N., Dillon, C., Morse, T., Hall, C., & Warren, A. (2000). Biomechanical, psychosocial, and organizational risk factors for WRMSD: Population-based estimates from the Connecticut upper-extremity surveillance project (CUSP). Journal of Occupational Health Psychology, 5(1), 164–181.CrossRefPubMed
9.
Zurück zum Zitat MacDonald, L. A., Karasek, R. A., Punnett, L., & Scharf, T. (2001). Covariation between workplace physical and psychosocial stressors: Evidence and implications for occupational health research and prevention. Ergonomics, 44(7), 696–718.CrossRefPubMed MacDonald, L. A., Karasek, R. A., Punnett, L., & Scharf, T. (2001). Covariation between workplace physical and psychosocial stressors: Evidence and implications for occupational health research and prevention. Ergonomics, 44(7), 696–718.CrossRefPubMed
10.
Zurück zum Zitat Muntaner, C., Van Dussen, D. J., Li, Y., Zimmerman, S., Chung, H., & Benach, J. (2006). Work organization, economic inequality, and depression among nursing assistants: A multilevel modeling approach. Psychological Reports, 98(2), 585–601.CrossRefPubMed Muntaner, C., Van Dussen, D. J., Li, Y., Zimmerman, S., Chung, H., & Benach, J. (2006). Work organization, economic inequality, and depression among nursing assistants: A multilevel modeling approach. Psychological Reports, 98(2), 585–601.CrossRefPubMed
11.
Zurück zum Zitat Soderfeldt, B., Soderfeldt, M., Jones, K., O’Campo, P., Muntaner, C., Ohlson, C. G., et al. (1997). Does organization matter? A multilevel analysis of the demand-control model applied to human services. Social Science and Medicine, 44(4), 527–534.CrossRefPubMed Soderfeldt, B., Soderfeldt, M., Jones, K., O’Campo, P., Muntaner, C., Ohlson, C. G., et al. (1997). Does organization matter? A multilevel analysis of the demand-control model applied to human services. Social Science and Medicine, 44(4), 527–534.CrossRefPubMed
12.
Zurück zum Zitat Karasek, R., Brisson, C., Kawakami, N., Houtman, I., Bongers, P., & Amick, B. (1998). The Job Content Questionnaire (JCQ): An instrument for internationally comparative assessments of psychosocial job characteristics. Journal of Occupational Health Psychology, 3(4), 322–355.CrossRefPubMed Karasek, R., Brisson, C., Kawakami, N., Houtman, I., Bongers, P., & Amick, B. (1998). The Job Content Questionnaire (JCQ): An instrument for internationally comparative assessments of psychosocial job characteristics. Journal of Occupational Health Psychology, 3(4), 322–355.CrossRefPubMed
13.
Zurück zum Zitat Ceron-Mireles, P., Harlow, S. D., & Sanchez-Carrillo, C. I. (1996). The risk of prematurity and small-for-gestational-age birth in Mexico City: The effects of working conditions and antenatal leave. American Journal of Public Health, 86, 825–831.CrossRefPubMedPubMedCentral Ceron-Mireles, P., Harlow, S. D., & Sanchez-Carrillo, C. I. (1996). The risk of prematurity and small-for-gestational-age birth in Mexico City: The effects of working conditions and antenatal leave. American Journal of Public Health, 86, 825–831.CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Escriba-Aguir, V., Perez-Hoyos, S., & Saurel-Cubizolles, M. J. (2001). Physical load and psychological demand at work during pregnancy and preterm birth. International Archives of Occupational and Environmental Health, 74, 583–588.CrossRefPubMed Escriba-Aguir, V., Perez-Hoyos, S., & Saurel-Cubizolles, M. J. (2001). Physical load and psychological demand at work during pregnancy and preterm birth. International Archives of Occupational and Environmental Health, 74, 583–588.CrossRefPubMed
15.
Zurück zum Zitat Brandt, L. P., & Nielsen, C. V. (1992). Job stress and adverse outcome of pregnancy: A causal link or recall bias? American Journal of Epidemiology, 135(3), 302–311.PubMed Brandt, L. P., & Nielsen, C. V. (1992). Job stress and adverse outcome of pregnancy: A causal link or recall bias? American Journal of Epidemiology, 135(3), 302–311.PubMed
16.
Zurück zum Zitat Brett, K. M., Strogatz, D. S., & Savitz, D. A. (1997). Employment, job strain, and preterm delivery among women in North Carolina. American Journal of Public Health, 87(2), 199–204.CrossRefPubMedPubMedCentral Brett, K. M., Strogatz, D. S., & Savitz, D. A. (1997). Employment, job strain, and preterm delivery among women in North Carolina. American Journal of Public Health, 87(2), 199–204.CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Oths, K. S., Dunn, L. L., & Palmer, N. S. (2001). A prospective study of psychosocial job strain and birth outcomes. Epidemiology, 12(6), 744–746.CrossRefPubMed Oths, K. S., Dunn, L. L., & Palmer, N. S. (2001). A prospective study of psychosocial job strain and birth outcomes. Epidemiology, 12(6), 744–746.CrossRefPubMed
18.
Zurück zum Zitat Meyer, J. D., Warren, N., & Reisine, S. (2007). Job control, substantive complexity, and risk for low birth weight and preterm delivery: An analysis from a state birth registry. American Journal of Industrial Medicine, 50(9), 664–675.CrossRefPubMed Meyer, J. D., Warren, N., & Reisine, S. (2007). Job control, substantive complexity, and risk for low birth weight and preterm delivery: An analysis from a state birth registry. American Journal of Industrial Medicine, 50(9), 664–675.CrossRefPubMed
19.
Zurück zum Zitat Lee, B. E., Ha, M., Park, H., Hong, Y. C., Kim, Y., Kim, Y. J., et al. (2011). Psychosocial work stress during pregnancy and birthweight. Paediatric and Perinatal Epidemiology, 25(3), 246–254.CrossRefPubMed Lee, B. E., Ha, M., Park, H., Hong, Y. C., Kim, Y., Kim, Y. J., et al. (2011). Psychosocial work stress during pregnancy and birthweight. Paediatric and Perinatal Epidemiology, 25(3), 246–254.CrossRefPubMed
20.
Zurück zum Zitat Siegrist, J., Starke, D., Chandola, T., Godin, I., Marmot, M., Niedhammer, I., et al. (2004). The measurement of effort–reward imbalance at work: European comparisons. Social Science and Medicine, 58(8), 1483–1499.CrossRefPubMed Siegrist, J., Starke, D., Chandola, T., Godin, I., Marmot, M., Niedhammer, I., et al. (2004). The measurement of effort–reward imbalance at work: European comparisons. Social Science and Medicine, 58(8), 1483–1499.CrossRefPubMed
21.
Zurück zum Zitat Peter, R., Siegrist, J., Hallqvist, J., Reuterwall, C., & Theorell, T. (2002). Psychosocial work environment and myocardial infarction: Improving risk estimation by combining two complementary job stress models in the SHEEP Study. Journal of Epidemiology and Community Health, 56(4), 294–300.CrossRefPubMedPubMedCentral Peter, R., Siegrist, J., Hallqvist, J., Reuterwall, C., & Theorell, T. (2002). Psychosocial work environment and myocardial infarction: Improving risk estimation by combining two complementary job stress models in the SHEEP Study. Journal of Epidemiology and Community Health, 56(4), 294–300.CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Ostry, A. S., Kelly, S., Demers, P. A., Mustard, C., & Hertzman, C. (2003). A comparison between the effort–reward imbalance and demand control models. BMC Public Health, 3, 10.CrossRefPubMedPubMedCentral Ostry, A. S., Kelly, S., Demers, P. A., Mustard, C., & Hertzman, C. (2003). A comparison between the effort–reward imbalance and demand control models. BMC Public Health, 3, 10.CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Muntaner, C., & Schoenbach, C. (1994). Psychosocial work environment and health in U.S. metropolitan areas: A test of the demand-control and demand-control-support models. International Journal of Health Services, 24(2), 337–353.CrossRefPubMed Muntaner, C., & Schoenbach, C. (1994). Psychosocial work environment and health in U.S. metropolitan areas: A test of the demand-control and demand-control-support models. International Journal of Health Services, 24(2), 337–353.CrossRefPubMed
24.
Zurück zum Zitat Muntaner, C., & O’Campo, P. J. (1993). A critical appraisal of the demand/control model of the psychosocial work environment: Epistemological, social, behavioral and class considerations. Social Science and Medicine, 36(11), 1509–1517.CrossRefPubMed Muntaner, C., & O’Campo, P. J. (1993). A critical appraisal of the demand/control model of the psychosocial work environment: Epistemological, social, behavioral and class considerations. Social Science and Medicine, 36(11), 1509–1517.CrossRefPubMed
25.
Zurück zum Zitat Bosma, H., Peter, R., Siegrist, J., & Marmot, M. (1998). Two alternative job stress models and the risk of coronary heart disease. American Journal of Public Health, 88(1), 68–74.CrossRefPubMedPubMedCentral Bosma, H., Peter, R., Siegrist, J., & Marmot, M. (1998). Two alternative job stress models and the risk of coronary heart disease. American Journal of Public Health, 88(1), 68–74.CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Calnan, M., Wadsworth, E., May, M., Smith, A., & Wainwright, D. (2004). Job strain, effort–reward imbalance, and stress at work: Competing or complementary models? Scand J Public Health, 32, 84–93.CrossRefPubMed Calnan, M., Wadsworth, E., May, M., Smith, A., & Wainwright, D. (2004). Job strain, effort–reward imbalance, and stress at work: Competing or complementary models? Scand J Public Health, 32, 84–93.CrossRefPubMed
27.
Zurück zum Zitat Laughlin, L. L., U.S. Census Bureau. (2011). Maternity leave and employment patterns of first-time mothers: 1961–2008. Washington, D.C.: U.S. Dept. of Commerce, Economics and Statistics Administration, U.S. Census Bureau. Laughlin, L. L., U.S. Census Bureau. (2011). Maternity leave and employment patterns of first-time mothers: 1961–2008. Washington, D.C.: U.S. Dept. of Commerce, Economics and Statistics Administration, U.S. Census Bureau.
28.
Zurück zum Zitat United States. Bureau of Labor Statistics. (2006). Women in the labor force: A databook. Washington, D.C.: U.S. Department of Labor, Bureau of Labor Statistics. United States. Bureau of Labor Statistics. (2006). Women in the labor force: A databook. Washington, D.C.: U.S. Department of Labor, Bureau of Labor Statistics.
29.
Zurück zum Zitat American College of Obstetricians and Gynecologists. (2013). Exposure to toxic environmental agents. Committee opinion no. 575. Obstetrics and Gynecology, 122(4), 931–935.CrossRef American College of Obstetricians and Gynecologists. (2013). Exposure to toxic environmental agents. Committee opinion no. 575. Obstetrics and Gynecology, 122(4), 931–935.CrossRef
30.
Zurück zum Zitat Croteau, A., Marcoux, S., & Brisson, C. (2006). Work activity in pregnancy, preventive measures, and the risk of delivering a small-for-gestational-age infant. American Journal of Public Health, 96(5), 846–855.CrossRefPubMedPubMedCentral Croteau, A., Marcoux, S., & Brisson, C. (2006). Work activity in pregnancy, preventive measures, and the risk of delivering a small-for-gestational-age infant. American Journal of Public Health, 96(5), 846–855.CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Elo, A. L., Leppanen, A., & Jahkola, A. (2003). Validity of a single-item measure of stress symptoms. Scandinavian Journal of Work, Environment & Health, 29(6), 444–451.CrossRef Elo, A. L., Leppanen, A., & Jahkola, A. (2003). Validity of a single-item measure of stress symptoms. Scandinavian Journal of Work, Environment & Health, 29(6), 444–451.CrossRef
32.
Zurück zum Zitat Schnall, P. L., Pieper, C., Schwartz, J. E., Karasek, R. A., Schlussel, Y., Devereux, R. B., et al. (1990). The relationship between ‘job strain’, workplace diastolic blood pressure, and left ventricular mass index. Results of a case-control study. JAMA, 263(14), 1929–1935.CrossRefPubMed Schnall, P. L., Pieper, C., Schwartz, J. E., Karasek, R. A., Schlussel, Y., Devereux, R. B., et al. (1990). The relationship between ‘job strain’, workplace diastolic blood pressure, and left ventricular mass index. Results of a case-control study. JAMA, 263(14), 1929–1935.CrossRefPubMed
33.
Zurück zum Zitat Sturgis, P., & Sullivan, L. (2008). Exploring social mobility with latent trajectory groups. Journal of the Royal Statistical Society: Series A (Statistics in Society), 171(1), 65–88. Sturgis, P., & Sullivan, L. (2008). Exploring social mobility with latent trajectory groups. Journal of the Royal Statistical Society: Series A (Statistics in Society), 171(1), 65–88.
34.
Zurück zum Zitat Muthen, B., & Muthen, L. K. (2000). Integrating person-centered and variable-centered analyses: Growth mixture modeling with latent trajectory classes. Alcoholism, Clinical and Experimental Research, 24(6), 882–891.CrossRefPubMed Muthen, B., & Muthen, L. K. (2000). Integrating person-centered and variable-centered analyses: Growth mixture modeling with latent trajectory classes. Alcoholism, Clinical and Experimental Research, 24(6), 882–891.CrossRefPubMed
35.
Zurück zum Zitat Mutambudzi, M., & Meyer, J. D. (2014). Construction of early and midlife work trajectories in women and their association with birth weight. American Journal of Public Health, 104(Suppl 1), S58–S64.CrossRefPubMedPubMedCentral Mutambudzi, M., & Meyer, J. D. (2014). Construction of early and midlife work trajectories in women and their association with birth weight. American Journal of Public Health, 104(Suppl 1), S58–S64.CrossRefPubMedPubMedCentral
36.
Zurück zum Zitat Krause, N., Burgel, B., & Rempel, D. (2010). Effort–reward imbalance and one-year change in neck-shoulder and upper extremity pain among call center computer operators. Scandinavian Journal of Work, Environment & Health, 36(1), 42–53.CrossRef Krause, N., Burgel, B., & Rempel, D. (2010). Effort–reward imbalance and one-year change in neck-shoulder and upper extremity pain among call center computer operators. Scandinavian Journal of Work, Environment & Health, 36(1), 42–53.CrossRef
37.
Zurück zum Zitat de Jonge, J., Bosma, H., Peter, R., & Siegrist, J. (2000). Job strain, effort–reward imbalance and employee well-being: A large-scale cross-sectional study. Social Science and Medicine, 50(9), 1317–1327.CrossRefPubMed de Jonge, J., Bosma, H., Peter, R., & Siegrist, J. (2000). Job strain, effort–reward imbalance and employee well-being: A large-scale cross-sectional study. Social Science and Medicine, 50(9), 1317–1327.CrossRefPubMed
38.
Zurück zum Zitat Frone, M., Russell, M., & Barnes, G. M. (1996). Work-family conflict, gender, and health-related outcomes: A study of employed parents in two community samples. Journal of Occupational Health Psychology, 1, 57–69.CrossRefPubMed Frone, M., Russell, M., & Barnes, G. M. (1996). Work-family conflict, gender, and health-related outcomes: A study of employed parents in two community samples. Journal of Occupational Health Psychology, 1, 57–69.CrossRefPubMed
39.
Zurück zum Zitat Blumenshine, P., Egerter, S., Barclay, C. J., Cubbin, C., & Braveman, P. A. (2010). Socioeconomic disparities in adverse birth outcomes: A systematic review. American Journal of Preventive Medicine, 39(3), 263–272.CrossRefPubMed Blumenshine, P., Egerter, S., Barclay, C. J., Cubbin, C., & Braveman, P. A. (2010). Socioeconomic disparities in adverse birth outcomes: A systematic review. American Journal of Preventive Medicine, 39(3), 263–272.CrossRefPubMed
40.
Zurück zum Zitat Meyer, J. D., & Mutambudzi, M. (2012). Construction of life-course occupational trajectories: Evidence for work as a mediator of racial disparities in hypertension. Journal of Occupational and Environmental Medicine, 54(10), 1201–1207.CrossRefPubMed Meyer, J. D., & Mutambudzi, M. (2012). Construction of life-course occupational trajectories: Evidence for work as a mediator of racial disparities in hypertension. Journal of Occupational and Environmental Medicine, 54(10), 1201–1207.CrossRefPubMed
41.
Zurück zum Zitat Geronimus, A. T. (2001). Understanding and eliminating racial inequalities in women’s health in the United States: The role of the weathering conceptual framework. Journal of the American Medical Women’s Association, 56(4):133–6, 149–50. Geronimus, A. T. (2001). Understanding and eliminating racial inequalities in women’s health in the United States: The role of the weathering conceptual framework. Journal of the American Medical Women’s Association, 56(4):133–6, 149–50.
42.
Zurück zum Zitat Quinn, M. M., Sembajwe, G., Stoddard, A. M., Kriebel, D., Krieger, N., Sorensen, G., et al. (2007). Social disparities in the burden of occupational exposures: Results of a cross-sectional study. American Journal of Industrial Medicine, 50(12), 861–875.CrossRefPubMed Quinn, M. M., Sembajwe, G., Stoddard, A. M., Kriebel, D., Krieger, N., Sorensen, G., et al. (2007). Social disparities in the burden of occupational exposures: Results of a cross-sectional study. American Journal of Industrial Medicine, 50(12), 861–875.CrossRefPubMed
43.
Zurück zum Zitat Krieger, N. (1999). Embodying inequality: A review of concepts, measures, and methods for studying health consequences of discrimination. International Journal of Health Services, 29(2), 295–352.CrossRefPubMed Krieger, N. (1999). Embodying inequality: A review of concepts, measures, and methods for studying health consequences of discrimination. International Journal of Health Services, 29(2), 295–352.CrossRefPubMed
44.
Zurück zum Zitat Singh-Manoux, A., Ferrie, J. E., Chandola, T., & Marmot, M. (2004). Socioeconomic trajectories across the life course and health outcomes in midlife: Evidence for the accumulation hypothesis? International Journal of Epidemiology, 33(5), 1072–1079.CrossRefPubMed Singh-Manoux, A., Ferrie, J. E., Chandola, T., & Marmot, M. (2004). Socioeconomic trajectories across the life course and health outcomes in midlife: Evidence for the accumulation hypothesis? International Journal of Epidemiology, 33(5), 1072–1079.CrossRefPubMed
Metadaten
Titel
Longitudinal Assessment of Effort–Reward Imbalance and Job Strain Across Pregnancy: A Preliminary Study
verfasst von
John D. Meyer
Carles Muntaner
Patricia O’Campo
Nicolas Warren
Publikationsdatum
07.03.2016
Verlag
Springer US
Erschienen in
Maternal and Child Health Journal / Ausgabe 7/2016
Print ISSN: 1092-7875
Elektronische ISSN: 1573-6628
DOI
https://doi.org/10.1007/s10995-016-1933-0

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