Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Megan V. Smith


Introduction: With the burden of poverty currently falling heavily on women and poverty as an established risk factor for poor mental health, it is important to understand the pathways by which poverty influences maternal mental health. Diaper need may represent a form of material hardship that has adverse consequences for the mental health of low income mothers. The aim of the present study was to examine the association between maternal mental health, diaper need, and neighborhood context. We hypothesized that mothers who reported diaper need would also report poor mental health and that neighborhood context would significantly impact this association.

Methods: Data were derived from a cross-sectional study of 408 pregnant and parenting women living in the City of New Haven. Women completed surveys on topics related to mental health and basic needs; crime data were obtained through the City of New Haven Police Department. Multivariable logistic regression and geographic information software (GIS) were used to examine the relationship between diaper need, maternal mental health, and neighborhood level crime.

Results: One-fourth of women reported diaper need. Substantial heterogeneity in diaper need, maternal mental health status, and neighborhood level of crime was observed across neighborhoods in the City of New Haven. In the final multivariable logistic model, diaper need was found to be associated with poor maternal mental health such that women who reported diaper need were more likely to report poor mental health than women who did not report diaper need (OR=2.43, 95% CI 1.15, 5.13). Notably, diaper need was more strongly associated with maternal mental health than food need. Neighborhood level crime was not found to be significantly associated with diaper need.

Discussion: The present study found lack of an adequate supply of diapers to be significantly associated with poor maternal mental health, whereas food need and maternal mental health were not related. While many federal antipoverty programs provide food and food subsidies to families in need, diapers are not an allowable expense for families under many federal antipoverty programs. Results suggest that inclusion of diapers on federal anti-poverty programs may be a tangible way of reducing maternal stress and improving maternal mental health with additional benefits for child development and health.

Conclusion: Diapers represent a malleable risk factor for poor maternal mental health that is amenable to public health and public policy interventions. Inclusion of diapers in federal anti-poverty programs may be a way by which the negative emotional consequences of diaper need can be mitigated.


This is an Open Access Thesis.

Open Access

This Article is Open Access