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Barbara Jones Singer Doctor of Philosophy, 2012 Directed By: Sandra L. Hofferth, Ph.D.

Professor, Department of Family Science Rates of low birth weight and preterm birth in the United States remain higher than those of other industrialized countries. The influence of fathers during the pregnancy period and the impact they have on birth outcomes represent under-researched areas in the field of maternal and child health.

This study used nationally representative data from the Early Childhood Longitudinal Study – Birth cohort (2001) to explore three lines of research.

Approximately 850 children of unmarried residential fathers comprised the analytic sample. First, as several studies have used paternity acknowledgement as a proxy for paternal involvement during the pregnancy, this study tested three fatherhood constructs to determine if they were associated with whether the father’s name was listed on the birth certificate. This study then examined if these fatherhood constructs were associated

with low birth weight and preterm birth. Two mediating pathways were considered:

change in maternal smoking during pregnancy and adequacy of prenatal care. Finally, the influence of state-level paternity establishment rates on the association between fatherhood constructs and father’s name on the birth certificate was studied.

The results indicated that paternal history of negative behaviors was associated with the unmarried residential father being named on the birth certificate. Furthermore, children who lived in states with high rates of paternity establishment were more likely to have their father’s name on the birth certificate. Paternal prenatal involvement was associated with both an increased chance of receiving adequate prenatal care and a reduced risk of low birth weight. Maternal smoking during pregnancy was reduced when both parents wanted the pregnancy, and not reduced when the father had a history of negative behaviors.

This study supports the conclusion that paternal prenatal involvement is an important area to be considered in the reduction of adverse birth outcomes. Moreover, this study adds to our understanding of some limitations of using the father’s name on the birth certificate as a proxy for paternal involvement during pregnancy for unmarried residential fathers. Finally, althoughmediation was not evident, this study confirms the influential role that unmarried residential fathers play in maternal health behaviors.




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Advisory Committee:

Professor Sandra L. Hofferth, Chair Professor Elaine A. Anderson Associate Professor Natasha Cabrera Assistant Professor Xin He Professor of the Practice Samuel S. Kessel © Copyright by Barbara Jones Singer Acknowledgements I would like to acknowledge all of the individuals who have provided guidance and support throughout the process of completing this dissertation. I would first like to

express my gratitude to my dissertation committee:

Dr. Sandra Hofferth, who sparked my interest in father involvement and then helped to breathe life into this study, thank you for your patience, guidance, wisdom, time and most importantly, encouragement. Thank you also for considering no question too silly to ask.

Dr. Woodie Kessel, my long-time mentor and friend, thank you for taking the time to remind me of the important lessons: MCH and otherwise.

Dr. Elaine Anderson, thank you for sharing your policy expertise, and for always emphasizing the family in Family Science to me and the other parents in the

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Dr. Natasha Cabrera and Dr. Xin He, thank you for your valuable comments at different phases of this work, and for graciously seeing me through to the end.

It is safe to say that I would not be here without the support of my family.

To my mom, Nancy Jones, who juggled roles as college student and mother when I was young, thank you for providing me a model of the importance of pursuing your education while also caring for and nurturing your children.

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showing an interest in my studies, even if it sounded at times like a foreign language.

To my mother-in-law and father-in-law, Ruth and John Singer, thank you (also) for endless hours of babysitting and for always reminding me that “you can do this”. Your encouragement and advice have provided more comfort, support and motivation along the way than you can possibly know.

To my daughters, Alex and Samara, who always gave me endless reasons to work harder and faster, while simultaneously helping me to slow down and check out the ants on the sidewalk. Thank you for keeping me sane these past five years (and also making me a little insane at times).

And to my husband, Dan Singer, who enjoyed joking about his wife doing research on his paternal involvement during our two pregnancies. I could not ask for a more involved father for our girls, or a more supportive and helpful partner.

Thank you for always giving me what I needed to get through these last 5 years. I am forever grateful.

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Table of Contents

List of Tables

List of Figures

Chapter 1: Introduction

Research Questions

Conceptual model


Chapter 2: Review of the Literature

Theoretical framework

Social Exchange Theory

Theory of Reasoned Action

Dependent Variables: Birth outcomes

Low birth weight

Preterm birth

Mediating Variables: Maternal health behaviors

Reducing maternal smoking during pregnancy

Prenatal care utilization

Independent Variables: Fatherhood constructs

Fatherhood construct 1: Father’s name on the birth certificate

Fatherhood construct 2: Paternal prenatal involvement

Fatherhood construct 3: Pregnancy wantedness concordance

Fatherhood construct 4: Paternal history of negative behaviors

Moderating variable: State-level paternity establishment policies

Control variables

Chapter 3: Methods

Description of the data


Survey descriptions

Survey of parent

Survey of father

Birth certificate data

Weighting and complex survey design

Analytic sample

Handling missing data


Dependent variables

Independent variables

Mediators of birth outcomes


Control Variables

Data Analysis

Human Subjects protection

iv Chapter 4: Results

Descriptive Analysis

Children of unmarried residential fathers

Children of unmarried nonresidential fathers

Multivariate Results

Research Question 1: Association between various fatherhood constructs and father’s name on the birth certificate

Research Question 2: Association between various fatherhood constructs and birth outcomes

Research Question 3: Mediation of maternal health behaviors in the association between fatherhood constructs and birth outcomes

Research Question 4: Effect of state paternity establishment rates on association between fatherhood constructs and father’s name on the birth certificate................ 90 Chapter 5 – Discussion

Summary of findings

Interpretation of findings

Hypothesis 1a

Hypothesis 1b

Hypothesis 1c

Hypothesis 2a

Hypothesis 2b

Hypothesis 2c

Hypothesis 2d

Hypothesis 3a

Hypothesis 3b

Hypothesis 3c

Hypothesis 4

Study limitations

Cross-sectional research methodology

Recall Bias and Under/Over-reporting

Use of Birth Certificate data


Generalizability of findings

Missing data in sample

Implications for research, programming and policy

Future directions for research

Practice/programming implications

Policy implications


Appendix A: State Paternity Establishment Percentages (FY2001)

Appendix B: Definitions of fatherhood constructs

Appendix C. Institutional Review Board application approval


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Table 2. Frequencies – Children of unmarried parents with resident father ……….

.......71 Table 3. Limited frequencies – Children of unmarried parents by father-type ……........75 Table 4. Fatherhood constructs predicting father’s name on the birth certificate ……....77 Table 5. Factors predicting birth outcomes – low birth weight and preterm birth …….. 80 Table 6. Association between fatherhood constructs and maternal health behaviors …..83 Table 7. Association between maternal health behaviors and birth outcomes – low birth weight and preterm birth ………………………………………………………………...86 Table 8. Fatherhood constructs predicting fathers name on the birth certificate, with inclusion of state Paternity Establishment rates ……………………………………...... 90 Table 9. Summary of research questions, hypotheses, and findings ……………...........95

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Figure 1. Conceptual Model …………………………………………………………… 8 Figure 2.

Development of analytic sample …………………………………………... 50

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services, the U.S. ranks poorly compared to other industrialized nations with regard to birth outcomes (MacDorman & Mathews, 2009). In particular, unmarried women are at higher risk for adverse birth outcomes such as low birth weight and preterm birth than married women (Mathews & McDorman, 2010; Ventura & Bachrach, 2000). These birth outcomes have been linked to a multitude of other maternal risk factors including maternal age, stress, income, education, employment, housing, prenatal care utilization, smoking, and alcohol consumption (Lu & Halfon, 2003). Despite a vast amount of literature on low birth weight and preterm birth, there is still a great deal we don’t know about predicting and ultimately preventing these birth outcomes.

An area of evolving research in maternal and child health shines light on the importance of fathers during pregnancy. Little is known about the role of the expectant father in pregnancy outcomes (The Commission on Paternal Involvement in Pregnancy Outcomes, 2010), how the father supports or does not support the mother during a pregnancy (Martin, McNamara, Milot, Halle, & Hair, 2007), or which specific aspects of paternal involvement in pregnancy lead to optimal outcomes (Bond, 2010). The research that does exist related to the impact of fathers on birth outcomes establishes that paternal prenatal involvement is beneficial to maternal and child health outcomes. It is also understood that paternal prenatal involvement is quite important as it relates to later paternal involvement throughout childhood (Bronte-Tinkew, Ryan, Carrano, & Moore, 2007; Cabrera, Fagan & Farrie, 2008; Cook, Jones, Dick & Singh, 2005; Cowan, 1998).

The current study focuses on children born to couples who live together but do not marry, building upon our understanding of the influence of unmarried residential fathers during pregnancy on the health status of the mother and child. Marital status alone as an indicator of paternal prenatal involvement has become increasingly less relevant as an accurate measure of paternal involvement as the number of births to unmarried women increases and stigma surrounding childbearing by unmarried cohabiting couples decreases (Martinez, Chandra, Abma, Jones, & Mosher, 2006). A study by Bumpass and Lu (2000) suggests that births to cohabitors represent close to 40% of nonmarital births.

Perhaps more meaningful measures than marital status are fathers’ attitudes towards the pregnancy, fathers’ behaviors during the prenatal period, and the relationship between the mother and father (Bird, Chandra, Bennett, & Harvey, 2000; Misra, Caldwell, Young, & Abelson, 2010). Studies that only take into account marital status may underestimate the contribution of many unmarried fathers who are very involved with the pregnancies but are simply not married to the mother of their child. Many other studies on father involvement have, as a result of growing divorce and separation rates, been interested in the absent, or nonresidential father (Hofferth et al., 2007).

Because very few nationally representative studies include information on unmarried fathers (Kotelchuck, 2009), the literature on their influence on birth outcomes is scarce. As a result, researchers in this field have had to rely on proxies for paternal prenatal involvement. For unmarried fathers, one proxy is the listing of father’s name on the birth certificate as an indication of his presence or absence during the pregnancy. The studies using this proxy have primarily been conducted using linked infant birth-death vital statistics data that have connected the father’s name on the birth certificate to infant mortality and other adverse health outcomes in infancy (Guadino, Jenkins, & Rochat, 1999; Luo, Wilkins, & Kramer, 2004; Phipps, Sowers, & Demonner, 2002; Tan, Wen, Walker, & Demissie, 2004). Because vital statistics data collects a relatively low level of information on the father, the father’s name on the birth certificate proxy for paternal prenatal involvement has not been validated in these studies, and has received only very limited validation in other research (Knight et al., 2006; Phipps et al., 2005). Therefore, the first objective of this study is focused on learning more about what is meant by the appearance of the father’s name on a birth certificate.

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