Publications by authors named "Jenn Leiferman"

40 Publications

Maternal mental health and early childhood development: Exploring critical periods and unique sources of support.

Infant Ment Health J 2021 May 16. Epub 2021 May 16.

Rocky Mountain Prevention Research Center, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, 80045, USA.

Background: The objective of this study was to explore associations between maternal depression and anxiety during early sensitive periods, child social-emotional and behavioral problems and the moderating roles of financial, instrumental, and partner emotional support.

Methods: Analyses was conducted using data from the Fragile Families and Child Wellbeing Study. Hierarchical linear regression modeling was used to explore associations between maternal depression and anxiety at 1- and 3-years postpartum, three unique types of social support, and childhood behavioral problems at 5-years of age (n = 2,827).

Results: Mothers who were depressed at one or both timepoints, compared to nondepressed mothers, reported higher externalizing behavioral problems scores of 1.96 and 2.90, and internalizing behavioral problems scores of 1.16 and 2.20, respectively, at 5-years of age (both p < .01), after controlling for covariates. Financial, instrumental, and partner emotional support were independently and inversely associated with behavioral problems (p < .05); however, none of these types of support moderated the relationship between maternal depression and behavioral problems, after controlling for covariates.

Implications: Promoting maternal mental health as well as different sources of support throughout the first five years of life, instead of one critical period, may help to reduce the burden of chronic disease in the next generation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/imhj.21925DOI Listing
May 2021

A qualitative investigation of a prenatal yoga intervention to prevent excessive gestational weight gain: A thematic analysis of interviews.

Complement Ther Clin Pract 2021 May 6;44:101414. Epub 2021 May 6.

Arizona State University, College of Health Solutions, 500 N 3rd St., Mail Code 3020, Phoenix, AZ, 85004, USA. Electronic address:

Purpose: To describe pregnant women's experiences and perceived facilitators/barriers of a prenatal yoga intervention to prevent excessive gestational weight gain (EGWG).

Methods: Pregnant women (N = 13) were interviewed after participation in a 12-week prenatal yoga intervention to prevent EGWG. Interviews were summarized using thematic analysis.

Results: Twelve themes were identified and organized into four categories: 1) experiences of prenatal yoga (positive experience/enjoyment, pain relief, connecting to body), 2) prenatal yoga and weight (increased mindfulness/self-awareness, increased physical activity, weight management), 3) barriers to prenatal yoga (physical body, commute/traffic, schedule), and 4) facilitators of prenatal yoga (healthy pregnancy, support from other pregnant women, the feeling from prenatal yoga).

Conclusion: Prenatal yoga may relieve pain and help women be more connected to their bodies. Prenatal yoga may also help women become more aware of their health behaviors and increases their physical activity which may have important implications for reducing EGWG.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ctcp.2021.101414DOI Listing
May 2021

Perinatal Depression Educational Training for Graduate Nursing Students.

Int Q Community Health Educ 2021 Mar 20:272684X211004685. Epub 2021 Mar 20.

Virginia Consortium Program in Clinical Psychology, Norfolk, USA.

The purpose of this study was to implement and assess an educational intervention for nursing students pertaining to perinatal depression (PD) screening and treatment. A single group (n = 59), repeated-measures design (i.e., pre- and post-intervention assessments) was used to assess the impact of an online intervention. Demographics, Theory of Planned Behavior constructs, intention to screen and treat PD, and PD-related knowledge were tested. The intervention resulted in positive gains in PD-related perceived behavioral control (PBC), attitudes, subjective norms, knowledge, intention to screen and treat PD, and perceived importance of screening and treating PD from pre- to post-intervention. PBC demonstrated a small-to-moderate positive association with perceived importance of screening and treating PD at post-intervention. Results from the current study suggest that the PD online educational intervention is effective in improving participants' PD-related PBC, attitudes, subjective norms, knowledge, and intention to screen and treat PD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0272684X211004685DOI Listing
March 2021

Anxiety among fathers during the prenatal and postpartum period: a meta-analysis.

J Psychosom Obstet Gynaecol 2021 Jun 25;42(2):152-161. Epub 2021 Feb 25.

Department of Psychology, Old Dominion University, Norfolk, VA, USA.

Introduction: The purpose of this review was to determine the prevalence of anxiety among fathers during the perinatal (pre- and post-natal) period.

Methods: A systematic search was conducted to identify studies published between 1995-2020. One hundred and seventy-two of the records met inclusion criteria and full texts were screened for eligibility. The authors followed PRISMA guidelines to extract the data.

Results: A total of 23 studies, representing 40,124 participants, are included in this meta-analysis. The overall random effects estimate of paternal perinatal anxiety was 10.69% (95% confidence interval (CI): 8.14 - 13.91%). Rates of paternal perinatal anxiety demonstrated significant heterogeneity that was large in magnitude ( = 304,494, < .001, I = 99.93 and τ = .5381). Study quality rating did not appear to moderate rates of paternal perinatal anxiety (low: 10.74%; 95% CI: 6.56-17.11%; high: 10.65%; 95% CI: 6.02- 18.15%).

Discussion: Paternal perinatal anxiety rates in this meta-analysis are considerably higher than the global WHO regional prevalence rates for anxiety among men suggesting the transition into parenthood may place men at greater risk for anxiety.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/0167482X.2021.1885025DOI Listing
June 2021

Self-Reported and Diagnosed Depression in Rural Colorado: Findings from the San Luis Valley Community Health Survey.

J Health Care Poor Underserved 2020 ;31(4):1573-1586

Purpose: To gain a better understanding of depression in a rural community, survey results were used to compare differences in self-reported depressive symptoms and medical professional diagnosed depression among demographic groups.

Methods: A chi-square test of independence was performed to examine relationships among the depression-related variables. Logistic regression analyses were also performed to ascertain the effects of demographic characteristics and social support on depression.

Findings: A statistically significant association was found between the two depression-related variables (X2=145.17, P <.001). Income was significantly associated with both depression-related variables. Hispanic ethnicity, higher income, and some high school education were associated with decreased odds of self-reported medically diagnosed depression. Those reporting no or some social support had increased odds of both depression-related variables compared with those who reported always having social support.

Conclusions: These findings provide a better understanding of depression in a rural community and may inform future public health interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1353/hpu.2020.0119DOI Listing
January 2020

Mental Health During the COVID-19 Pandemic in the United States: Online Survey.

JMIR Form Res 2020 Oct 23;4(10):e22043. Epub 2020 Oct 23.

Colorado School of Public Health, Aurora, CO, United States.

Background: The COVID-19 pandemic has had numerous worldwide effects. In the United States, there have been 8.3 million cases and nearly 222,000 deaths as of October 21, 2020. Based on previous studies of mental health during outbreaks, the mental health of the population will be negatively affected in the aftermath of this pandemic. The long-term nature of this pandemic may lead to unforeseen mental health outcomes and/or unexpected relationships between demographic factors and mental health outcomes.

Objective: This research focused on assessing the mental health status of adults in the United States during the early weeks of an unfolding pandemic.

Methods: Data was collected from English-speaking adults from early April to early June 2020 using an online survey. The final convenience sample included 1083 US residents. The 71-item survey consisted of demographic questions, mental health and well-being measures, a coping mechanisms checklist, and questions about COVID-19-specific concerns. Hierarchical multivariable logistic regression was used to explore associations among demographic variables and mental health outcomes. Hierarchical linear regression was conducted to examine associations among demographic variables, COVID-19-specific concerns, and mental health and well-being outcomes.

Results: Approximately 50% (536/1076) of the US sample was aged ≥45 years. Most of the sample was White (1013/1054, 96%), non-Hispanic (985/1058, 93%), and female (884/1073, 82%). Participants reported high rates of depression (295/1034, 29%), anxiety (342/1007, 34%), and stress (773/1058, 73%). Older individuals were less likely to report depressive symptomology (OR 0.78, P<.001) and anxiety symptomology (OR 0.72, P<.001); in addition, they had lower stress scores (-0.15 points, SE 0.01, P<.001) and increased well-being scores (1.86 points, SE 0.22, P<.001). Individuals who were no longer working due to COVID-19 were 2.25 times more likely to report symptoms of depression (P=.02), had a 0.51-point increase in stress (SE 0.17, P=.02), and a 3.9-point decrease in well-being scores (SE 1.49, P=.009) compared to individuals who were working remotely before and after COVID-19. Individuals who had partial or no insurance coverage were 2-3 times more likely to report depressive symptomology compared to individuals with full coverage (P=.02 and P=.01, respectively). Individuals who were on Medicare/Medicaid and individuals with no coverage were 1.97 and 4.48 times more likely to report moderate or severe anxiety, respectively (P=.03 and P=.01, respectively). Financial and food access concerns were significantly and positively related to depression, anxiety, and stress (all P<.05), and significantly negatively related to well-being (both P<.001). Economy, illness, and death concerns were significantly positively related to overall stress scores (all P<.05).

Conclusions: Our findings suggest that many US residents are experiencing high stress, depressive, and anxiety symptomatology, especially those who are underinsured, uninsured, or unemployed. Longitudinal investigation of these variables is recommended. Health practitioners may provide opportunities to allay concerns or offer coping techniques to individuals in need of mental health care. These messages should be shared in person and through practice websites and social media.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/22043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588260PMC
October 2020

A Mixed-Methods Pilot Study of Perinatal Risk and Resilience During COVID-19.

J Prim Care Community Health 2020 Jan-Dec;11:2150132720944074

University of Colorado Denver, Aurora, CO, USA.

National guidelines underscore the need for improvement in the detection and treatment of mood disorders in the perinatal period. Exposure to disasters can amplify perinatal mood disorders and even have intergenerational impacts. The primary aim of this pilot study was to use mixed-methods to better understand the mental health and well-being effects of the coronavirus disease 2019 (COVID-19) pandemic, as well as sources of resilience, among women during the perinatal period. The study team used a simultaneous exploratory mixed-methods design to investigate the primary objective. Thirty-one pregnant and postpartum women participated in phone interviews and were invited to complete an online survey which included validated mental health and well-being measures. Approximately 12% of the sample reported high depressive symptomatology and 60% reported moderate or severe anxiety. Forty percent of the sample reported being lonely. The primary themes related to stress were uncertainty surrounding perinatal care, exposure risk for both mother and baby, inconsistent messaging from information sources and lack of support networks. Participants identified various sources of resilience, including the use of virtual communication platforms, engaging in self-care behaviors (eg, adequate sleep, physical activity, and healthy eating), partner emotional support, being outdoors, gratitude, and adhering to structures and routines. Since the onset of COVID-19, many pregnant and postpartum women report struggling with stress, depression, and anxiety symptomatology. Findings from this pilot study begin to inform future intervention work to best support this highly vulnerable population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2150132720944074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370556PMC
July 2020

Online yoga to reduce post traumatic stress in women who have experienced stillbirth: a randomized control feasibility trial.

BMC Complement Med Ther 2020 Jun 5;20(1):173. Epub 2020 Jun 5.

Arizona State University, Tempe, USA.

Background: About 1 in every 150 pregnancies end in stillbirth. Consequences include symptoms of post traumatic stress disorder (PTSD), depression, and anxiety. Yoga has been used to treat PTSD in other populations and may improve health outcomes for stillbirth mothers. The purpose of this study was to determine: (a) feasibility of a 12-week home-based, online yoga intervention with varying doses; (b) acceptability of a "stretch and tone" control group; and (c) preliminary efficacy of the intervention on reducing symptoms of PTSD, anxiety, depression, perinatal grief, self-compassion, emotional regulation, mindfulness, sleep quality, and subjective health.

Methods: Participants (N = 90) were recruited nationally and randomized into one of three groups for yoga or exercise (low dose (LD), 60 min per week; moderate dose (MD), 150 min per week; and stretch-and-tone control group (STC)). Baseline and post-intervention surveys measured main outcomes (listed above). Frequency analyses were used to determine feasibility. Repeated measures ANCOVA were used to determine preliminary efficacy. Multiple regression analyses were used to determine a dose-response relationship between minutes of yoga and each outcome variable.

Results: Over half of participants completed the intervention (n = 48/90). Benchmarks (≥70% reported > 75% satisfaction) were met in each group for satisfaction and enjoyment. Participants meeting benchmarks (completing > 90% of prescribed minutes 9/12 weeks) for LD and MD groups were 44% (n = 8/18) and 6% (n = 1/16), respectively. LD and MD groups averaged 44.0 and 77.3 min per week of yoga, respectively. The MD group reported that 150 prescribed minutes per week of yoga was too much. There were significant decreases in PTSD and depression, and improvements in self-rated health at post-intervention for both intervention groups. There was a significant difference in depression scores (p = .036) and grief intensity (p = .009) between the MD and STC groups. PTSD showed non-significant decreases of 43% and 56% at post-intervention in LD and MD groups, respectively (22% decrease in control).

Conclusions: This was the first study to determine the feasibility and preliminary efficacy of an online yoga intervention for women after stillbirth. Future research warrants a randomized controlled trial.

Trial Registration: ClinicalTrials.gov. NCT02925481. Registered 10-04-16.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12906-020-02926-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275350PMC
June 2020

Development and Modification of a Mobile Health Program to Promote Postpartum Weight Loss in Women at Elevated Risk for Cardiometabolic Disease: Single-Arm Pilot Study.

JMIR Form Res 2020 Apr 9;4(4):e16151. Epub 2020 Apr 9.

Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO, United States.

Background: Pregnancy complications in combination with postpartum weight retention lead to significant risks of cardiometabolic disease and obesity. The majority of traditional face-to-face interventions have not been effective in postpartum women. Mobile technology enables the active engagement of postpartum women to promote lifestyle changes to prevent chronic diseases.

Objective: We sought to employ an interactive, user-centered, and participatory method of development, evaluation, and iteration to design and optimize the mobile health (mHealth) Fit After Baby program.

Methods: For the initial development, a multidisciplinary team integrated evidence-based approaches for health behavior, diet and physical activity, and user-centered design and engagement. We implemented an iterative feedback and design process via 3 month-long beta pilots in which postpartum women with cardiometabolic risk factors participated in the program and provided weekly and ongoing feedback. We also conducted two group interviews using a structured interview guide to gather additional feedback. Qualitative data were recorded, transcribed, and analyzed using established qualitative methods. Modifications based on feedback were integrated into successive versions of the app.

Results: We conducted three pilot testing rounds with a total of 26 women. Feedback from each pilot cohort informed changes to the functionality and content of the app, and then a subsequent pilot group participated in the program. We optimized the program in response to feedback through three iterations leading to a final version.

Conclusions: This study demonstrates the feasibility of using an interactive, user-centered, participatory method of rapid, iterative design and evaluation to develop and optimize a mHealth intervention program for postpartum women.

Trial Registration: ClinicalTrials.gov NCT02384226; https://www.clinicaltrials.gov/ct2/show/NCT02384226.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/16151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7180508PMC
April 2020

An iterative design process to develop a randomized feasibility study and inform recruitment of minority women after stillbirth.

Pilot Feasibility Stud 2019 27;5:140. Epub 2019 Nov 27.

4School of Social Work, Arizona State University, 411 N. Central 8th Floor, Phoenix, AZ 85004 USA.

Background: Yearly, approximately 25,000 US women experience stillbirth and African American women have a 2.2 fold increased risk of stillbirth compared with white women. After stillbirth, women are subject to a sevenfold increased risk of post-traumatic stress compared with women after a live-birth. This paper presents findings from phase one of a National Institutes of Health funded, two-phase feasibility study to examine an online yoga intervention to reduce symptoms of post-traumatic stress in mothers after stillbirth. An iterative design was used to (1) inform the development of the online yoga intervention and (2) inform recruitment strategies to enroll minority women into phase two.

Methods: Ten mothers ( = 5 stillbirth moms with no yoga experience, = 5 nonstillbirth moms with yoga experience) participated in a series of online yoga videos ( = 30) and were assessed for self-compassion (SC) and emotional regulation (ER) before and after each video. An independent group of five minority women who had experienced stillbirth were interviewed about cultural barriers to recruitment and perceptions/opinions of yoga. A mean was calculated for SC and ER scores for each video at pre- and post-time points. The percent change of the mean difference between pre-post SC and ER scores were used to select videos for phase two. Videos with a negative change score or that had a 0% change on SC or ER were not used. A combination of deductive and inductive coding was used to organize the interview data, generate categories, and develop themes.

Results: Five of the 30 tested yoga videos were not used. An additional 12 videos were developed, filmed, and used in the prescription for phase two. Topics from interview findings included perceived benefits/barriers of and interest in yoga, preferred yoga environment, suggested recruitment methods, content of recruitment material, and recommended incentives.

Conclusions: Online yoga may be beneficial for improving emotional regulation and self-compassion, but further testing is needed. Additionally, minority women express interest in online yoga but suggest that researchers apply culturally specific strategies regarding methods, content of material, and incentives to recruit minority women into a study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40814-019-0526-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882004PMC
November 2019

Using the Technology Acceptance Model to Develop StartSmart: mHealth for Screening, Brief Intervention, and Referral for Risk and Protective Factors in Pregnancy.

J Midwifery Womens Health 2019 Sep 26;64(5):630-640. Epub 2019 Jul 26.

College of Nursing, University of Colorado-Anschutz Medical Campus, Aurora, Colorado.

Introduction: Technology decision support with tailored patient education has the potential to improve maternal and child health outcomes. The purpose of this study was to develop StartSmart, a mobile health (mHealth) intervention to support evidence-based prenatal screening, brief intervention, and referral to treatment for risk and protective factors in pregnancy.

Methods: StartSmart was developed using Davis' Technology Acceptance Model with end users engaged in the technology development from initial concept to clinical testing. The prototype was developed based upon the current guidelines, focus group findings, and consultation with patient and provider experts. The prototype was then alpha tested by clinicians and patients. Clinicians were asked to give feedback on the screening questions, treatment, brief motivational interviewing, referral algorithms, and the individualized education materials. Clinicians were asked about the feasibility of using the materials to provide brief intervention or referral to treatment. Patients were interviewed using the think aloud technique, a cognitive engineering method used to inform the design of mHealth interventions. Interview questions were guided by the Screening, Brief Intervention, Referral to Treatment theory and attention to usefulness and usability.

Results: Expert clinicians provided guidance on the screening instruments, resources, and practice guidelines. Clinicians suggested identifying specific prenatal visits for the screening (first prenatal visit, 28-week visit, and 36-week visit). Patients reported that the tablet-based screening was useful to promote adherence to guidelines and provided suggestions for improvement including more information on the diabetic diet and more resources for diabetes. During alpha testing, participants commented on navigability and usability. Patients reported favorable responses about question wording and ease of use.

Discussion: Clinicians reported the use of mHealth to screen and counsel pregnant patients on risk and protective factors facilitated their ability to provide comprehensive care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jmwh.13009DOI Listing
September 2019

Relationship Between Mindfulness and Posttraumatic Stress in Women Who Experienced Stillbirth.

J Obstet Gynecol Neonatal Nurs 2018 11 5;47(6):760-770. Epub 2018 Oct 5.

Objective: To explore the potential factors that mediate the relationship between mindfulness and symptoms of posttraumatic stress (PTS) in women who experienced stillbirth.

Design: A cross-sectional analysis of baseline data before women's participation in an online mindfulness intervention (i.e., online yoga).

Setting: This was a national study, and women participated in their own homes.

Participants: Women who experienced stillbirth (N = 74) within the past 2 years and resided in the United States.

Methods: Women were recruited nationally, primarily through social media. Participants (N = 74) completed baseline assessments (self-report mental and physical health surveys) via a Web-based survey tool. We conducted an exploratory factor analysis of the COPE Inventory subscales to reduce the number of variables before entry into a mediation model. We then tested the mediation effects of sleep quality, self-esteem, resilience, and maladaptive coping on the relationship between mindfulness and PTS symptoms.

Results: Through the exploratory factor analysis we identified a two-factor solution. The first factor included nine subscales that represented adaptive coping strategies, and the second factor included five subscales that represented maladaptive coping strategies. Results from multiple mediation analysis suggested that mindfulness had a significant inverse relationship to PTS symptoms mediated by sleep quality.

Conclusion: Mindfulness practices may have potential benefits for grieving women after stillbirth. Evidence-based approaches to improve sleep quality also may be important to reduce PTS symptoms in women after stillbirth.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jogn.2018.09.002DOI Listing
November 2018

Use of complementary approaches in pregnant women with a history of miscarriage.

Complement Ther Med 2018 Feb 7;36:1-5. Epub 2017 Nov 7.

Arizona State University, School of Nutrition and Health Promotion, 500 N. 3rd Street, Phoenix, AZ 8500, United States.

Objectives: To describe the use of complementary approaches in pregnant women with a history of miscarriage and to investigate whether a miscarriage is associated with the use of complementary approaches during their pregnancy.

Design: A cross-sectional survey was distributed to pregnant women residing in the United States (N=890).

Results: Women who had a history of miscarriage, were Caucasian, were college educated, reported a high income, had low depression scores, and had low anxiety scores (all P<0.001) were more likely to use complementary approaches. In pregnant women with a history of miscarriage (N=193), the most frequently reported complementary approaches used were prayer (22.3%), yoga (15%), massage (14.5%), chiropractic (13%), and meditation (11.4%). Finally, after adjustment for age, race, education, and income, the odds of using a complementary approach in women with a history of miscarriage was 1.8 (95% CI: 1.3, 2.5, P<0.001) as compared with women without a history of miscarriage (model 1). Associations persisted after additional adjustment for depression, anxiety, and stress; the odds of using a complementary approach in women with a history of miscarriage was 1.7 (95% CI: 1.2, 2.4, P<0.001) (model 2), compared with women without a history of miscarriage.

Conclusions: Findings from this study may help inform future studies for pregnant women with a history of miscarriage and may also provide information about appropriate strategies in which health care providers can refer their patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ctim.2017.11.003DOI Listing
February 2018

Experiences of women who participated in a beta-test for an online-streamed yoga intervention after a stillbirth.

Int J Yoga Therap 2017 Nov;27(1):59-68

3. School of Social Work, Arizona State University.

Background: Little is known about how to best care for mothers after stillbirth. As such, this paper will report the satisfaction and perceptions of an online yoga intervention (12-week beta test) in women after stillbirth.

Methods: Participants (n=74) had a stillbirth within the last 24-months (M time since loss 9.65 ± 6.9 months). Post-intervention satisfaction surveys and interviews and dropout surveys were conducted. Descriptive statistics were used to analyze survey responses and demographic information. A phenomenological approach was used to explore and understand unique experiences of participant interviews. Data were analyzed using NVivo10.

Results: Twenty-six women (M age 33.73 ± 4.38) were completers (> 3 wks of yoga), 26 (M age 31.82 ± 4.13) were non-completers (< 3 wks of yoga), and 22 (M age 32.94 ± 2.93) dropped out. Twenty completers participated in a post-intervention satisfaction survey with 75% (n=15) reporting being very satisfied or satisfied with the online yoga intervention, found it to be very enjoyable or enjoyable, and very helpful or helpful to cope with grief. Satisfaction and perceptions of the intervention in those who completed an interview (n=12) were clustered around the following themes: benefits, barriers, dislikes, satisfaction, and preferences. Of the 22 dropouts, 14 completed a dropout survey. Women withdrew from the study due to pregnancy (n=3, 21%), burden (n=3, 21%), stress (n=2, 14%), lack of time (n=2, 14%), did not enjoy (n=1, 7%), and other (n=3, 21%).

Conclusion: Findings here may be used to help design future research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17761/1531-2054-27.1.59DOI Listing
November 2017

Psychosocial predictors of gestational weight gain and the role of mindfulness.

Midwifery 2018 Jan 16;56:86-93. Epub 2017 Oct 16.

Arizona State University, Department of Exercise Science and Health Promotion, 500 N 3rd St., Mail Code 9020, Phoenix, AZ, USA. Electronic address:

Objective: To identify the psychosocial factors (i.e., stress, anxiety, depression, social support) that are associated with gestational weight gain (GWG) and the relationship of mindfulness with GWG during each trimester of pregnancy.

Design: In this cross-sectional study, an online survey that assessed physical and mental health and wellness practices was administered to pregnant women.

Participants: Pregnant women ≥8 weeks gestation, ≥18 years old, and could read and write in English.

Measurement And Findings: Women who responded to the survey (N=1,073) were on average 28.7±4.6 years old. Findings from a regression analysis suggest that increased levels of depression may be predictive of increased GWG in the second trimester and decreased levels of mindfulness may be predictive of increased GWG in the first trimester. Anxiety, stress, and overall social support were not associated with GWG in any trimester.

Key Conclusions: Mindfulness-based strategies (e.g., yoga) may have the potential to manage both depression and excessive GWG and may beneficial for and preferred by pregnant women. More research is warranted to determine clear relationships between psychosocial health, mindfulness, and GWG.

Implications For Practice: Health care providers are encouraged to screen for depression in early pregnancy (i.e., first or second trimester) and provide resources to manage symptoms of depression and GWG to promote optimal birth outcomes. Health care providers may want to counsel patients on how to manage depression and/or GWG by suggesting mindfulness-based approaches.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.midw.2017.10.008DOI Listing
January 2018

A study protocol of a three-group randomized feasibility trial of an online yoga intervention for mothers after stillbirth (The Mindful Health Study).

Pilot Feasibility Stud 2018 6;4:12. Epub 2017 Jul 6.

Department of Family Medicine, Department of Obstetrics & Gynecology, University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48104-1213 USA.

Background: In the USA, stillbirth (in utero fetal death ≥20 weeks gestation) is a major public health issue. Women who experience stillbirth, compared to women with live birth, have a nearly sevenfold increased risk of a positive screen for post-traumatic stress disorder (PTSD) and a fourfold increased risk of depressive symptoms. Because the majority of women who have experienced the death of their baby become pregnant within 12-18 months and the lack of intervention studies conducted within this population, novel approaches targeting physical and mental health, specific to the needs of this population, are critical. Evidence suggests that yoga is efficacious, safe, acceptable, and cost-effective for improving mental health in a variety of populations, including pregnant and postpartum women. To date, there are no known studies examining online-streaming yoga as a strategy to help mothers cope with PTSD symptoms after stillbirth.

Methods: The present study is a two-phase randomized controlled trial. will involve (1) an iterative design process to develop the online yoga prescription for phase 2 and (2) qualitative interviews to identify cultural barriers to recruitment in non-Caucasian women (i.e., predominately Hispanic and/or African American) who have experienced stillbirth ( = 5). is a three-group randomized feasibility trial with assessments at baseline, and at 12 and 20 weeks post-intervention. Ninety women who have experienced a stillbirth within 6 weeks to 24 months will be randomized into one of the following three arms for 12 weeks: (1) intervention low dose (LD) = 60 min/week online-streaming yoga ( = 30), (2) intervention moderate dose (MD) = 150 min/week online-streaming yoga ( = 30), or (3) stretch and tone control (STC) group = 60 min/week of stretching/toning exercises ( = 30).

Discussion: This study will explore the feasibility and acceptability of a 12-week, home-based, online-streamed yoga intervention, with varying doses among mothers after a stillbirth. If feasible, the findings from this study will inform a full-scale trial to determine the effectiveness of home-based online-streamed yoga to improve PTSD. Long-term, health care providers could use online yoga as a non-pharmaceutical, inexpensive resource for stillbirth aftercare.

Trial Registration: NCT02925481.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40814-017-0162-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5501104PMC
July 2017

Exploring the need for interventions to manage weight and stress during interconception.

J Behav Med 2017 Feb 17;40(1):145-158. Epub 2016 Nov 17.

Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.

Interventions to manage weight and stress during the interconception period (i.e., time immediately following childbirth to subsequent pregnancy) are needed to promote optimal maternal and infant health outcomes. To address this gap, we summarize the current state of knowledge, critically evaluate the research focused on weight and stress management during the interconception period, and provide future recommendations for research in this area. Evidence supports the importance of weight and stress management during the reproductive years and the impact of weight on maternal and child health outcomes. However, evidence-based treatment models that address postpartum weight loss and manage maternal stress during the interconception period are lacking. This problem is further compounded by inconsistent definitions and measurements of stress. Recommendations for future research include interventions that address weight and stress tailored for women in the interconception period, interventions that address healthcare providers' understanding of the significance of weight and stress management during interconception, and long-term follow-up studies that focus on the public health implications of weight and stress management during interconception. Addressing obesity and stress during the interconception period via a reproductive lens will be a starting point for women and their families to live long and healthy lives.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10865-016-9813-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5358329PMC
February 2017

Dose and timing of text messages for increasing physical activity among pregnant women: a randomized controlled trial.

Transl Behav Med 2017 06;7(2):212-223

Exercise Science and Health Promotion, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85004, USA.

Text4baby (T4b), a free nation-wide mobile health information service, delivers health-related text messages (SMS) to pregnant women. The objective of this study was to determine the effectiveness of physical activity (PA) specific SMS to improve PA in pregnant women (vs standard T4b) and the most effective dose/timing of PA-specific SMS to improve PA. Pregnant women (N = 80) were randomized to one of four groups that differed in frequency and time of SMS. The Fitbit™ Flex measured PA. Data were analyzed using mixed model analyses. There were no increases in PA regardless of frequency or time. Those that received six PA SMS/week had greater decreases in activity and greater increases in sedentary time. SMS may not be a "potent" enough strategy to improve PA. Future studies should explore a modified focus on behavior change (e.g., decrease sedentary activity, increase light activity) and incorporate SMS as part of a multi-level approach with other evidence-based strategies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13142-016-0445-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526801PMC
June 2017

When a Baby Dies: A Systematic Review of Experimental Interventions for Women After Stillbirth.

Reprod Sci 2017 07 29;24(7):967-975. Epub 2016 Sep 29.

4 School of Social Work, Arizona State University, Phoenix, AZ, USA.

Objectives: To identify and evaluate intervention studies (ie, experimental study in which the participants undergo some kind of intervention in order to evaluate its impact) that target mental and/or physical health outcomes in women who have experienced stillbirth and to provide specific recommendations for future research and intervention work.

Methods: A librarian conducted an initial search using CINAHL, Cochrane Library, PsycInfo, PubMed, SocIndex, and Web of Knowledge in the spring of 2016. Reference mining provided further articles. Articles were eligible if they were: (1) published in English, (2) published in a peer-reviewed journal, (3) published in 1980 or later, (4) an intervention that evaluated (qualitative or quantitative methods) mental and/or physical health, and (5) included women who had experienced a stillbirth (in utero fetal death at ≥20 weeks of gestation).

Results: The combined searches produced 2733 articles (including duplicates). After duplicate articles were removed (n = 928), the research team screened the titles, abstracts, and full texts (when necessary) for eligibility (n = 1805). Two articles were identified that met our eligibility criteria. Conclusion for Practice: There is a lack of intervention research in women with stillbirth. It is imperative to develop and implement interventions to improve both mental and physical health in this population, especially in the interconception period (ie, stillbirth aftercare). Future intervention research is needed to determine appropriate support and efficacious delivery of support interventions, feasibility and effectiveness of physical activity interventions and complementary approaches, appropriate timing and dose of interventions, and culturally sensitive interventions appropriate for racial/ethnic minority women with stillbirth.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1933719116670518DOI Listing
July 2017

Trajectories of objectively-measured physical activity and sedentary time over the course of pregnancy in women self-identified as inactive.

Prev Med Rep 2016 Jun 22;3:353-60. Epub 2016 Apr 22.

Arizona State University, Exercise Science and Health Promotion, 500 North 3rd Street, Phoenix, AZ 85004, United States.

There is a need for investigations that document the daily course of pregnancy-related changes in PA and sedentary behavior. The purpose of this study was to describe the trajectory of PA and sedentary behavior and whether they differ among weight status in pregnant women self-identified as inactive. Eighty inactive pregnant women (8-16 weeks) were recruited from a nationwide text-message intervention. PA was measured using a Fitbit. Chi-square analyses and t-tests were used to analyze univariate demographic and PA variables. Mixed model-repeated measures ANOVA was used to analyze trajectory changes in daily PA and sedentary behavior. Light activity (beta [SE] = 2.79 [0.30], p < .001), active time (b [SE] = 1.62 [0.16], p < .001), and steps (b [SE] = 112.21 [10.66], p < .001) increased during the second trimester followed by a precipitous decline during the third trimester. Sedentary behavior followed an opposite pattern (b = - 9.88 [1.07], p < .001). Overweight and obese women took significantly fewer steps/day (b [SE] = - 742.37 [362.57], p < .05 and - 855.94 [381.25], p < .05, respectively) than normal weight women, and obese women had less "active" minutes/day (~> 3.0 metabolic equivalents; b [SE] = - 12.99 [5.89], p < .05) than normal weight women (P's < 0.05). Women who self-identify as inactive, become more sedentary and less physically active as pregnancy progresses. This study was among the first to describe the trajectory of daily PA and sedentary behavior throughout pregnancy. This study may help inform health care provider and patient communication related to PA, sedentary behavior, and the time in which to communicate about these behaviors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pmedr.2016.04.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4929212PMC
June 2016

Perceptions, Uses of, and Interests in Complementary Health Care Approaches in Depressed Pregnant Women: The PAW Survey.

J Evid Based Complementary Altern Med 2017 Jan 12;22(1):81-95. Epub 2016 Apr 12.

Arizona State University, Phoenix, AZ, USA.

Depression affects up to 23% of pregnant women and is associated with adverse physical/mental health outcomes for both the mother and baby. Depressed pregnant women may be more likely to engage in unhealthy lifestyle behaviors that contribute to an increased risk for chronic disease. Little is known regarding depressed pregnant women's perceptions, uses of, and interests in complementary health approaches. Study participants (mean age 28.7 ± 6.8; n = 1032) included pregnant women ≥8 weeks gestation who responded to a survey assessing physical and mental health and wellness practices. Of those completing the survey, depressed pregnant women (n = 272) had significantly higher levels of anxiety (P < .001) and stress (P < .001) and had poorer sleep quality (P < .001), mindfulness (P < .001), and social support (P < .001) compared to nondepressed pregnant women (n = 760). A majority (84%) of depressed pregnant women would consider using a complementary health approach for weight and/or stress management during pregnancy, and more than 50% were interested in yoga.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2156587216641829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871209PMC
January 2017

Effect of Online Training on Antenatal Physical Activity Counseling.

Am J Lifestyle Med 2018 Mar-Apr;12(2):166-174. Epub 2016 Mar 21.

Department of Community and Behavioral Health (JL), Colorado School of Public Health, Aurora, Colorado.

The objective of this study was to test the effect of an online education intervention on providers' attitudes, beliefs, knowledge, and practices pertaining to antenatal physical activity. A sample of 181 providers (ie, obstetricians, family medicine physicians, and certified nurse-midwives) was directed to view an online training on antenatal physical activity guidelines, counseling methods, and resources. Providers completed surveys before and 12 weeks after viewing the educational website material. Repeated-measures analyses were conducted to examine the effects of the online education. A total of 164 providers (87.2%) completed baseline and follow-up surveys. After viewing the online training, participants more strongly agreed that it was their responsibility to encourage engagement in antenatal physical activity (P = .02) and believed that women would follow their advice about beginning antenatal physical activity (P = .01). Viewing the website material facilitated an increased confidence in ability to effectively talk with overweight and obese women about physical activity (P = .04) and more frequent advising to begin a moderate-intensity physical activity program for sedentary women (P = .02). Knowledge on antenatal physical activity guidelines also improved. Findings suggest that online educational interventions may be an effective tool in altering providers' knowledge and practices pertaining to antenatal physical activity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1559827616639023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124996PMC
March 2016

The course and interrelationship of maternal and paternal perinatal depression.

Arch Womens Ment Health 2016 08 20;19(4):655-63. Epub 2016 Jan 20.

Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA.

The aims of the study were to describe course of depression in both mothers and fathers from the third trimester of pregnancy through 6 months postpartum and to examine the relationship between maternal and paternal depression. Hypotheses were as follows: (a) Depressive symptoms would be correlated between parents and (b) earlier depressive symptoms in one parent would predict later increases in depression in the other. Eighty cohabitating primiparous couples were recruited from prenatal OBGYN visits and community agencies and enrolled during pregnancy, between 28-week gestation and delivery. Participants completed measures of depression on four occasions: baseline and 1, 3, and 6 months postpartum. Ninety-eight percent of the enrolled couples (78; 156 individuals) completed the study. For both mothers and fathers, symptom severity ratings and classification as a probable case were stable across time, with prenatal depression persisting through 6 months in 75 % of mothers and 86 % of fathers. Prenatal depression in fathers predicted worsening depressive symptom severity in mothers across the first six postpartum months but not vice versa. In both expecting/new mothers and fathers, depression demonstrates a stable pattern of occurrence and symptom severity between 28-month gestation and 6 months postpartum. Although prenatal maternal depression is not predictive of symptom change in fathers, mothers with prenatally depressed partners showed significant worsening in overall symptom severity during the first six postpartum months.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00737-016-0598-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957140PMC
August 2016

A randomized controlled trial of yoga for pregnant women with symptoms of depression and anxiety.

Complement Ther Clin Pract 2015 Aug 9;21(3):166-72. Epub 2015 Jun 9.

Department of Psychology and Neuroscience, University of Colorado Boulder, Muenzinger D244, 345 UCB, Boulder, CO 80309, USA. Electronic address:

Background: Yoga may be well suited for depressed and anxious pregnant women, given reported benefits of meditation and physical activity and pregnant women's preference for nonpharmacological treatments.

Methods: We randomly assigned 46 pregnant women with symptoms of depression and anxiety to an 8-week yoga intervention or treatment-as-usual (TAU) in order to examine feasibility and preliminary outcomes.

Results: Yoga was associated with high levels of credibility and satisfaction as an intervention for depression and anxiety during pregnancy. Participants in both conditions reported significant improvement in symptoms of depression and anxiety over time; and yoga was associated with significantly greater reduction in negative affect as compared to TAU (β = -0.53, SE = 0.20, p = .011).

Conclusion: Prenatal yoga was found to be a feasible and acceptable intervention and was associated with reductions in symptoms of anxiety and depression; however, prenatal yoga only significantly outperformed TAU on reduction of negative affect.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ctcp.2015.06.005DOI Listing
August 2015

Primary Care Providers Perceptions of Racial/Ethnic and Socioeconomic Disparities in Hypertension Control.

Am J Hypertens 2015 Sep 27;28(9):1091-7. Epub 2015 Jan 27.

Department of Community and Behavioral Health and Health Systems Management Policy, Colorado School of Public Health , Aurora, CO, USA.

Objective: To evaluate the attitudes and perceptions of primary care providers (PCPs) regarding the presence and underlying sources of racial/ethnic and socioeconomic disparities in hypertension control.

Methods: We conducted a survey of 115 PCPs from 2 large academic centers in Colorado. We included physicians, nurse practitioners, and physician assistants. The survey assessed provider recognition and perceived contributors of disparities in hypertension control.

Results: Respondents were primarily female (66%), non-Hispanic White (84%), and physicians (80%). Among respondents, 67% and 73% supported the collection of data on the patients' race/ethnicity and socioeconomic status (SES), respectively. Eighty-six percent and 89% agreed that disparities in race/ethnicity and SES existed in hypertension care within the US health system. However, only 33% and 44% thought racial/ethnic and socioeconomic disparities existed in the care of their own patients. Providers were more likely to perceive patient factors rather than provider or health system factors as mediators of disparities. However, most supported interventions such as improving provider communication skills (87%) and cultural competency training (89%) to reduce disparities in hypertension control.

Conclusions: Most providers acknowledged that racial/ethnic and socioeconomic disparities in hypertension control exist in the US health system, but only a minority reported disparities in care among patients they personally treat. Our study highlights the need for testing an intervention aimed at increasing provider awareness of disparities within the local health setting to improve hypertension control for minority patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ajh/hpu294DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4542848PMC
September 2015

Physical activity and depressive symptoms after stillbirth: informing future interventions.

BMC Pregnancy Childbirth 2014 Nov 29;14:391. Epub 2014 Nov 29.

College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.

Background: In the United States, approximately one in 110 pregnancies end in stillbirth affecting more than 26,000 women annually. Women experiencing stillbirth have a threefold greater risk of developing depressive symptoms compared to women experiencing live birth. Depression contributes negatively to health outcomes for both mothers and babies subsequent to stillbirth. Physical activity may improve depression in these women, however, little is known about acceptable physical activity interventions for women after stillbirth. This is the purpose of this descriptive exploratory study.

Methods: Eligible women were between ages 19 and 45, and experienced stillbirth within one year of the study. An online survey was used to ask questions related to 1) pregnancy and family information (i.e., time since stillbirth, weight gain during pregnancy, number of other children) 2) physical activity participation, 3) depressive symptomatology, and 4) demographics.

Results: One hundred seventy-five women participated in the study (M age = 31.26 ± 5.52). Women reported participating in regular physical activity (at least 150 minutes of moderate activity weekly) before (60%) and during (47%) their pregnancy, as well as after their stillbirth (61%). Only 37% were currently meeting physical activity recommendations. Approximately 88% reported depression (i.e., score of >10 on depression scale). When asked how women cope with depression, anxiety, or grief, 38% said physical activity. Of those that reported using physical activity to cope after stillbirth, they did so to help with depression (58%), weight loss (55%), and better overall physical health (52%). To cope with stillbirth, women used walking (67%), followed by jogging (35%), and yoga (23%). Women who participated in physical activity after stillbirth reported significantly lower depressive symptoms (M = 15.10, SD = 5.32) compared to women who did not participate in physical activity (M = 18.06, SD = 5.57; t = -3.45, p = .001).

Conclusions: Physical activity may serve as a unique opportunity to help women cope with the multiple mental sequelae after stillbirth. This study provides data to inform healthcare providers about the potential role of physical activity in bereavement and recovery for women who have experienced stillbirth. Additional research is necessary in this vulnerable population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12884-014-0391-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4254184PMC
November 2014

Physical activity and pregnancy: past and present evidence and future recommendations.

Res Q Exerc Sport 2012 Dec;83(4):485-502

Department of Kinesiology at The Pennsylvania State University, University Park 16802, USA.

Purpose: In this review, we provide researchers and practitioners with an overview of the physical activity and pregnancy literature to promote prenatal physical activity, improve measurement, further elucidate the role of activity in reducing maternal health complications, and inform future research.

Method: We examined past and present physical activity and pregnancy studies and highlight key papers with a focus on maternal health outcomes to best inform physical activity promotion efforts.

Results: We discuss: (a) historical overview of prenatal physical activity relative to the physical activity guidelines, how they have changed over time, and how evidence of the effect of prenatal activity on maternal/fetal health outcomes has affected clinical recommendations; (b) existing tools and challenges associated with measuring prenatal physical activity; (c) empirical evidence on multilevel determinants of prenatal activity to guide future intervention work; (d) empirical evidence of prenatal activity on adverse maternal outcomes (gestational diabetes mellitus, preeclampsia, excessive gestational weight gain) from observational and intervention studies; and (e) summary/recommendations for future research and practice.

Conclusions: The physical activity and pregnancy literature has evolved over the past 50 years, and there is sufficient empirical evidence to support the promotion of moderate-to-vigorous prenatal physical activity for maternal health benefits. Future studies and interventions should be carefully designed, theoretically driven, and include validated and reliable activity measures. Researchers and practitioners should also consider the multifaceted determinants and outcomes of prenatal physical activity and intervene to promote physical activity before, during, and after pregnancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563105PMC
http://dx.doi.org/10.1080/02701367.2012.10599138DOI Listing
December 2012

My baby, my move: examination of perceived barriers and motivating factors related to antenatal physical activity.

J Midwifery Womens Health 2011 Jan-Feb;56(1):33-40

Introduction: Based on a socioecological model, the present study examined multilevel barriers and facilitators related to physical activity engagement during pregnancy in women of low socioeconomic status.

Methods: Individual and paired interviews were conducted with 25 pregnant women (aged 18-46 years, 17-40 weeks' gestation) to ask about motivational factors and to compare differences in activity level and parity. Atlas/Ti software was used to code verbatim interview transcripts by organizing codes into categories that reflect symbolic domains of meaning, relational patterns, and overarching themes.

Results: Perceived barriers and motivating factors differed between exercisers and nonexercisers at intrapersonal, interpersonal, and environmental levels.

Discussion: Future interventions should take into account key motivating multilevel factors and barriers to tailor more meaningful advice for pregnant women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1542-2011.2010.00004.xDOI Listing
June 2011

Predictors of Maternal Depression Management among Primary Care Physicians.

Depress Res Treat 2010 25;2010:671279. Epub 2010 Mar 25.

Colorado School of Public Health, 13001 E 17th Place, Mailstop B119, Aurora, CO 80045, USA.

Purpose. The present surveillance study examined predictors of the management of maternal depression in primary care settings. Methods. A total of 217 physicians completed a 60-item survey assessing demographics, physicians' attitudes, beliefs, efficacy, current practices, and perceived barriers regarding the management of maternal depression. Structural equation modeling was used to estimate a model that examined the relationships among physicians' knowledge, beliefs, self-efficacy, perceived barriers, past training toward and current management practices for maternal depression. Results. In a model predicting physician depression management practices, a good overall fit was observed (χ(2) = 136.63, CFI = .97, TLI = .95, RMSEA = .05), with physician comfort with, confidence in, and perceived responsibility for managing maternal depression all having prominent positive associations. Conclusions. These findings will guide the development of future multifaceted intervention strategies to enhance physician skills in managing maternal depression in primary care settings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2010/671279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991642PMC
July 2011

Race-specific transition patterns among alcohol use classes in adolescent girls.

J Adolesc 2011 Jun 13;34(3):407-20. Epub 2010 Aug 13.

The National Center on Addiction and Substance Abuse (CASA) at Columbia University, 633 Third Avenue, New York, NY 10017, USA.

We used data from the National Longitudinal Study of Adolescent Health to examine transitions among alcohol use classes in 2225 White and African American adolescent girls, and race differences in predictors of transition into and out of problematic drinking classes. Latent class analysis confirmed four classes for White girls and three for AA girls, defined in a previous study. Latent transition analysis revealed more stable abstainers and decreasing alcohol use among AA girls, and more increasing alcohol use among White girls, though stable abstainers were the largest group in both races. Increasing use was predicted by delinquency, academic misbehavior, substance use, and peer support for White girls, and by older age and delinquency for AA girls. Decreasing use was predicted by older age and depressive symptoms for White girls, and by family relationship quality and substance use for AA girls. Study limitations and implications of findings are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.adolescence.2010.07.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988084PMC
June 2011