R Jeanne Ruiz

The Ohio State University, Columbus, OH, United States

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Publications (27)34.52 Total impact

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    ABSTRACT: Coping strategies may help explain why some minority women experience more stress and poorer birth outcomes, so a psychometrically sound instrument to assess coping is needed. We examined the psychometric properties, readability, and correlates of coping in pregnant Black (n = 186) and Hispanic (n = 220) women using the Brief COPE. Exploratory and confirmatory factor analysis tested psychometric properties. The Flesch-Kincaid Reading Level test assessed readability. Linear regression models tested correlates of coping. Findings suggested two factors for the questionnaire: active and disengaged coping, as well as adequate reliability, validity, and readability level. For disengaged coping, Cronbach's α was .78 (English) and .70 (Spanish), and for active coping .86 (English) and .92 (Spanish). A two group confirmatory factor analysis revealed both minority groups had equivalent factor loadings. The reading level was at the sixth grade. Age, education, and gravidity were all found to be significant correlates with active coping.
    Western Journal of Nursing Research 03/2014; · 1.22 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the efficacy of a guided imagery (GI) intervention for stress reduction in pregnant African American women beginning early in the second trimester. This prospective longitudinal study of 72 women used a randomized controlled experimental design with two groups conducted over 12 weeks. The intervention was a CD with 4 professionally recorded tracts designed and sequenced to influence study variables. Participants in both GI and usual care (UC) completed measures and donated 5 cc of blood at baseline, 8 weeks and 12 weeks. Participants also completed a daily stress scale. A mixed-effects linear model tested for differences between groups for self-reported measures of stress, anxiety, and fatigue as well as corticotrophin releasing hormone (CRH), a biologic marker of stress. Significant differences in perceived stress daily scores and at week 8 but not week 12 were found in the GI group compared to UC group. The GI group reported significantly less fatigue and anxiety than the UC group at week 8 but not week 12. There were no significant differences in CRH levels between groups. Results suggest that GI intervention may be effective in reducing perceived stress, anxiety, and fatigue measures among pregnant African American women.
    Evidence-based Complementary and Alternative Medicine 01/2014; 2014:840923. · 1.72 Impact Factor
  • Gwen Latendresse, R Jeanne Ruiz, Bob Wong
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    ABSTRACT: Evidence supports the premise that maternal psychological distress adversely affects pregnancy outcomes and that inflammatory markers and placentally-produced corticotrophin-releasing hormone (pCRH) are likely mediating factors. The primary aim of the study was to explore the associations between maternal psychological distress, use of selective serotonin re-uptake inhibitors, pCRH, and maternal plasma inflammatory markers during pregnancy. Measures of maternal plasma pCRH, Interleukins-1, 6, & 10, C-Reactive Protein, Macrophage Migration Inhibitory Factor, and Tumor Necrosis Factor-α were completed in 100 pregnant women. Measures of depression, anxiety, and perceived stress were completed, as well as collection of demographic/behavioral data, e.g. use of selective serotonin re-uptake inhibitors (SSRIs). Significant correlations were found at 14-20 weeks gestation between IL-6 & 10, and depression, anxiety, and perceived stress. Also at 14 - 20 weeks gestation, IL10 levels were significantly lower in women with 4th quartile pCRH levels and IL1β, IL6, and IL10 were significantly lower among women who took an SSRI during pregnancy. After controlling for maternal age, BMI, pCRH level, and SSRI use, psychological distress remained to explain variation in maternal inflammatory markers. These results might suggest that future research should focus on whether depression and anxiety are effectively being treated during pregnancy, and how such a scenario might contribute to an immune system pathway to poor pregnancy outcome.
    Open Journal of Obstetrics and Gynecology 02/2013; 3(1A):184-191.
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    ABSTRACT: To examine the potential moderating effects of family cohesion and acculturation on the physiological stress response (cortisol) as a predictor of preterm birth (PTB) in pregnant Mexican-American women. The sample included 470 participants; 33 had preterm births. All participants were self-identified as Mexican-American. In this cross-sectional study, family cohesion was measured by a self-report questionnaire. Acculturation was measured by self-report questionnaire as well as by years in the United States and country of birth. Stress was measured by serum cortisol. All measures were obtained at 22-24 weeks gestation. Additional data including history of PTB were obtained from the health record. Data analysis was primarily conducted using logistic regression. The relationship between stress and PTB was predicted by family cohesion (estimate/ standard error [E/SE] = -2.46, P = 0.014) and acculturation (E/SE = 2.56, P = 0.011). In addition, there was an interaction between family cohesion and history of previous PTB (E/SE = -2.12, P = 0.035). Results indicate that the impact of cortisol on PTB is predicted by acculturation and family cohesion such that higher levels of cortisol in conjunction with higher levels of acculturation and lower levels of family cohesion are associated with increased risk of PTB. In addition, low family cohesion in combination with a history of PTB was associated with higher levels of PTB. Assessment of family cohesion, including problem solving, adherence to family decisions, family shared space, and activity, should be included as part of prenatal assessment for risk of PTB. Subsequently, interventions that focus on improving the individual's response to an imbalance in family functioning are needed. In addition, prenatal assessment of level of acculturation may also identify those who are at risk for PTB.
    International Journal of Women's Health 01/2013; 5:243-52.
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    ABSTRACT: In Hispanics, acculturation may lead to negative health outcomes. This study used a cross-sectional design to investigate the psychosocial and biological risks in acculturating pregnant women of Hispanic origin (n = 470). Psychosocial risks-depressive symptoms, anxiety, and stress-were assessed by self-report, whereas biological measures included stress-related and reproductive hormones. Mental health deteriorated across generations, with worsening depression, anxiety, and stress with successive generations. Stress and reproductive hormone levels decreased across generations, whereas body mass index and number of sexual partners increased. These data provide potential biobehavioral explanations of the relationship between acculturation and declining health among Hispanic women in the United States.
    ANS. Advances in nursing science 07/2012; 35(3):E1-E10. · 0.82 Impact Factor
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    ABSTRACT: To examine the interaction of the cytokines interleukin-1 receptor antagonist (IL)-1Ra, IL-6 and IL-10 to predict preterm birth (PTB) in pregnant Hispanic women (n=470). In this prospective study, demographic data were obtained prenatally and birth outcome data were obtained from the medical chart. Cytokines were measured from plasma obtained at 22 to 24 weeks gestation. Data analysis utilized logistic regression. PTB was predicted by level of IL-1Ra (odds ratio (OR)=2.55; 95% confidence interval (CI)=1.24, 5.24). The interaction between IL-1Ra and IL-6 and between IL-1Ra and IL-10 was significant (Wald=4.01, P=0.04 and Wald=8.84, P<0.003, respectively) and was also predictive of PTB. As IL-1Ra levels increased while IL-10 levels were low, the probability of PTB greatly increased. The interactions of select cytokines and cytokine receptor antagonists were associated with PTB. Future research should focus on the changes in cytokines during pregnancy to identify critical periods of change, and examine predictors of the cytokine response.
    Journal of perinatology: official journal of the California Perinatal Association 03/2012; 32(7):483-90. · 1.59 Impact Factor
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    ABSTRACT: We examined the effects of acculturation, depressive symptoms, progesterone, and estriol (E3) as predictors of preterm birth (PTB) in pregnant Hispanic women. This cross-sectional study recruited a sample of 470 Hispanic women between 22- and 24-week gestation from physician practices and community clinics. We used the CES-D to measure maternal depressive symptoms. We measured acculturation by English proficiency on the Bidimensional Acculturation Scale, residence index by years in the USA minus age, nativity, and generational status. Serum progesterone and E3 were analyzed by EIA. Ultrasound and medical records determined gestational age after delivery. In χ (2) analysis, there were a significantly greater percentage of women with higher depressive scores if they were born in the USA. In a structural equation model (SEM), acculturation (English proficiency, residence index, and generational status) predicted the estriol/progesterone ratio (E/P), and the interaction of depressive symptoms with the E/P ratio predicted PTB. Undiagnosed depressive symptoms during pregnancy may have biological consequences increasing the risk for PTB.
    Archives of Women s Mental Health 02/2012; 15(1):57-67. · 2.01 Impact Factor
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    ABSTRACT: Pre-eclampsia is a multi-system disorder caused by inadequate placentation in early pregnancy; however, little is known about the influence of nutrient intake on placental development during the crucial 1st trimester. The objective of this study was to examine the relationships between nutrient intake and the raw values and ratios of angiogenic [placental growth factor (PlGF)] and antiangiogenic [soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng)] placental biomarkers in the 1st trimester. A cross-sectional study of low-income, pregnant women (n = 118). Average nutrient intake was calculated from three 24-h dietary recalls. Biomarker values were adjusted for gestational age and nutrients were adjusted for energy. The angiogenic to antiangiogenic ratio [PlGF/(sFlt-1 × sEng)] was positively related to intake of vitamin D (r = 0.24), vitamin B(2) (r = 0.25), B(12) (r = 0.20), dietary folate equivalents (r = 0.19), iron (r = 0.19), and zinc (r = 0.19) and negatively related to transfats (r = -0.24). Principal component analysis revealed that a vitamin/mineral factor [t (112) = 2.58, p = 0.011] and transfats factor [t (112) = -2.03, p = 0.045] were significant predictors of the PlGF/(sFlt-1 × sEng) ratio. The vitamin and mineral factor was a significant predictor of sFlt-1 [t (122) = 2.29, p = 0.024]. Expression of placental biomarkers in the early weeks of pregnancy may be influenced by intake of nutrients. Understanding the influence of maternal nutrient intake and placental development in the 1st trimester may provide the opportunity to avert the development or blunt the severity of preeclampsia.
    Archives of Gynecology 01/2012; 285(4):891-9. · 0.91 Impact Factor
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    ABSTRACT: The purpose of our study was to examine the effects of socioeconomic status, acculturative stress, discrimination, and marginalization as predictors of depression in pregnant Hispanic women. A prospective observational design was used. Central and Gulf coast areas of Texas in obstetrical offices. A convenience sample of 515 pregnant, low income, low medical risk, and self-identified Hispanic women who were between 22-24 weeks gestation was used to collect data. The predictor variables were socioeconomic status, discrimination, acculturative stress, and marginalization. The outcome variable was depression. Education, frequency of discrimination, age, and Anglo marginality were significant predictors of depressive symptoms in a linear regression model, F (6, 458) = 8.36, P<.0001. Greater frequency of discrimination was the strongest positive predictor of increased depressive symptoms. It is important that health care providers further understand the impact that age and experiences of discrimination throughout the life course have on depressive symptoms during pregnancy.
    Ethnicity & disease 01/2012; 22(4):497-503. · 1.12 Impact Factor
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    ABSTRACT: Objective. Among Hispanics living in the United States, acculturation is associated with an increased risk for preterm birth. Inflammatory pathways are also associated with preterm birth. As such, the current study sought to investigate the potential relationships among preterm birth, acculturation of Hispanic women, and inflammatory markers. Study Design. The authors performed an observational study on pregnant Hispanic women in Texas at 22-24 weeks' gestation (n = 470). The authors obtained demographic data prenatally as well as birth outcome data from the medical chart after delivery. The authors obtained venous blood and used plasma to assay interleukin-1 receptor antagonist (IL-1RA), interleukin-6 (IL-6), and interleukin-10 (IL-10). The authors used logistic regression to understand whether the presence or the absence of IL-10 levels was related to acculturation and the risk of preterm birth. Results. The authors observed interactions between undetectable IL-10 levels and years in the United States and undetectable IL-10 levels and being born in the United States in models predicting preterm birth. Follow-up probes of these interactions suggested that when IL-10 was undetectable, preterm birth became more likely as time living in the United States increased, χ(2) = 5.15 (1, 416), p = .020, odds ratio (OR) = 3.17, and was more likely in participants born in the United States than in those born elsewhere, χ(2) = 5.35 (1, 462), p = .020, OR = 16.78. The authors observed no interactions among acculturation, preterm birth, and IL-1RA and IL-6 levels. Conclusion. Acculturated Hispanics who lack the protective effects of IL-10 experience a markedly higher risk of preterm birth than nonacculturated Hispanics.
    Biological Research for Nursing 08/2011; · 1.85 Impact Factor
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    Gwen Latendresse, Roberta Jeanne Ruiz
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    ABSTRACT: Studies support the premise that chronic maternal stress may trigger a premature sequence of physiologic events ending in preterm birth (PTB). Furthermore, chronic stress is highly correlated with depression and anxiety, which also are associated with PTB. However, some studies report that medication status rather than depression and/or anxiety may reflect the risk for PTB. Although the purpose of this small, preliminary study was to evaluate the association between chronic maternal stress and PTB, this report focuses on the unexpected finding of the association between maternal use of selective serotonin reuptake inhibitors (SSRIs) and PTB. A prospective cohort study of 100 pregnant women included measures of contributors to chronic maternal stress and corticotropin-releasing hormone (CRH). Demographic and behavioral data included smoking, substance use, and use of medications for depression and anxiety. Pregnant women who used SSRIs to treat depression and/or anxiety were nearly 12 times more likely to give birth before term when compared with women who did not use these medications. Women with CRH levels in the fourth quartile were 6 times more likely to give birth before term when compared with women whose CRH levels were in the lower 3 quartiles. No associations were found between SSRI use and CRH levels. Associations between PTB and maternal use of SSRIs are not understood. It is important not to alter current approaches to the treatment of depression and anxiety without thorough discussion with women regarding the potential benefits and harms of various treatment options.
    Journal of midwifery & women's health 03/2011; 56(2):118-26. · 1.13 Impact Factor
  • Eileen R Fowles, Christina Murphey, Roberta Jeanne Ruiz
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    ABSTRACT: To examine the relationships between maternal psychosocial factors and dietary quality and explore the relationships among dietary quality and selected biomarkers of nutrition and placental development. A cross-sectional design in 18 low-income, pregnant women. Partner support was positively related to vegetable intake (r = .54) and negatively related to intake of iron (r = -.68) and grains (r = -.67). Emotional eating in response to anger was negatively related to intake of iron-(r /it> = -.53) and folate-rich (r = -.75) foods, and emotional eating in response to anxiety was negatively related to intake of folate-rich foods (r = -.51). Depressed women had an increased intake of calcium-rich foods (r = .60). Levels of vascular endothelial growth factor (VEGF) were negatively related to depression (r = -.56) and intake of foods high in calcium (r = -.53) and iron (r = -.34) but positively related to serum calcium levels (r = .60). VEGF was negatively relationship to soluble fms-like tyrosine kinase 1 (sFlt-1; r = -.56). Placental growth factor had a negative relationship with maternal serum levels of albumin (r = -.61) and calcium (r = -.65). Low-income pregnant women who eat to cope with anger and anxiety may have an inadequate intake of nutrients that contribute to positive pregnancy outcomes. Placental development in the early weeks of pregnancy may be influenced by maternal psychosocial and nutritional status. More research is needed to explore the relationship of dietary quality and placental development in the first trimester of pregnancy.
    Biological Research for Nursing 01/2011; 13(1):70-9. · 1.85 Impact Factor
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    ABSTRACT: Despite the potential importance of nutrition to pregnancy outcomes, little is known about the factors influencing dietary quality, especially during the first trimester. The aim of this study was to examine the relationships of distress (an index of depression and stress), social support, and eating habits with dietary quality in low-income pregnant women. A cross-sectional design and path analytic methods was used in a clinic-based sample of low-income women (n = 118) in their first trimester of pregnancy. Women completed questionnaires and received training on estimating food portion sizes. Three 24-hour dietary recalls were collected over 2 weeks. Overall dietary quality was assessed using the Dietary Quality Index-Pregnancy. The final path model fit well (comparative fit index [CFI] = .97, root mean square error of approximation [RMSEA] = .05) and revealed that distress had a direct effect on poor eating habits (β = .36) and a direct (β = -.23) and indirect effect on dietary quality (β = -.30). Poor eating habits had a direct effect on dietary quality (β = -.18). Social support had no effect on dietary quality. Age had significant direct effects on education (β = .39) and nutritional knowledge (β = .18) and an indirect effect on dietary quality (total effect, β = .19). Maternal age, education, and nutritional knowledge did not have significant effects on psychosocial variables. Psychosocial distress and poor eating habits contributed to inadequate dietary quality. Assessing for depression, stress, poor eating habits, and overall dietary quality during the crucial first trimester may identify women needing more intensive dietary monitoring and intervention throughout pregnancy.
    Nursing research 01/2011; 60(5):286-94. · 1.80 Impact Factor
  • Gwen Latendresse, Roberta Jeanne Ruiz
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    ABSTRACT: This exploratory study examines the role of psychosocial-behavioral variables as predictors of elevated corticotropin-releasing hormone (CRH) at 14-20 weeks of gestation. One hundred and twenty women were enrolled into the study. Blood samples were collected at 14-20 weeks of pregnancy and assayed for CRH. Participants completed questionnaires that included the Perceived Stress Scale, the Center for Epidemiologic Studies (CES) Depression Scale, the Pregnancy-Specific Anxiety (PAS) Scale, the Norbeck Social Support Questionnaire, the Life Orientation Test, the Brief COPE scale, and questions regarding violence/abuse, and work, sleep, and nutritional patterns. Pregnant women with high CRH levels (15 pcg/ml and above) perceived their income to be inadequate, slept more hours at night, stood more hours during the day, and used the coping styles of disengagement or religion but not humor. Logistic regression identified three predictors for high CRH (accounting for 42.2% of the variance): perceived inadequacy of income and the use of ''religion'' and ''disengagement'' to cope with stress. These results are the first known to identify coping style and perceived income inadequacy as predictors of high CRH. Women with perceived inadequacy of income had almost three times the odds for high CRH. Women who used religion or disengagement to cope with stress had 14 times and 7 times the odds for high CRH levels, respectively. Higher CRH levels are associated with preterm birth (PTB). Thus, it may be important to include maternal coping style and perceptions of income inadequacy in future investigations of CRH levels and PTB.
    Biological Research for Nursing 10/2010; 12(2):125-36. · 1.85 Impact Factor
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    Gwen Latendresse, Roberta Jeanne Ruiz
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    ABSTRACT: There are documented associations between elevated maternal corticotropin-releasing hormone (CRH) levels and adverse pregnancy outcomes. However, reports of these findings often lack sufficient detail and rationale regarding the bioassay methodology. This shortcoming can be problematic for researchers who do not possess in-depth laboratory sciences knowledge but who want to include bioassays in their investigations or to evaluate published reports. The quality and reliability of CRH measurement results can be significantly affected by variables encountered during sample collection, processing, storage, and bioassay. Thus, it is important to establish research laboratory protocols that are based on well-informed rationales and to carefully consider and control for relevant variables. A synthesis of laboratory sciences literature regarding variables affecting CRH measurement in pregnancy is presented. Additionally, consultation with experienced researchers provided an in-depth understanding of CRH measurement. From these sources, a laboratory protocol for clinical research was developed. Multiple variables that are specific to the reliability of CRH measurement in pregnancy have been identified. These include sample collection methods, sample processing, sample integrity, sample storage, and the actual assay selected. The reliability of CRH measurements can be significantly improved by identifying and controlling for variables encountered during sample collection, processing, storage, and bioassay. Adequate methodological details are difficult to glean solely from the published literature, thus consultation with well-informed researchers is necessary. A protocol for CRH bioassay in clinical research is proposed.
    Biological Research for Nursing 07/2008; 10(1):54-62. · 1.85 Impact Factor
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    ABSTRACT: To examine the Hispanic acculturation paradox by identifying the effect of acculturation on serum progesterone and estriol levels, the progesterone/estriol ratio, and preterm birth. We used an observational, prospective design with 468 self-identified, low-income, pregnant Hispanic women. We used the Language Proficiency Subscale (from the Bidimensional Acculturation Scale for Hispanics) to measure acculturation. We measured progesterone and estriol in maternal serum at 22-24 weeks of pregnancy. We defined preterm birth as birth before 37 weeks of gestation. Statistical analysis was by Wilcox-Mann-Whitney and Kruskal-Wallis tests, analysis of variance, t tests, logistic regression, and structural equation modeling. English proficiency had an adjusted odds ratio of 4.03 (95% confidence interval 1.44-11.25), P<.001, and the lowest quartile of the progesterone/estriol ratio had an adjusted odds ratio of 2.93 (95% confidence interval 1.25-6.89), P<.001, to predict preterm birth. English proficiency was associated with a decrease in progesterone/estriol ratio and an increase in preterm birth. In structural equation modeling, the progesterone/estriol ratio mediated the relationship between acculturation and preterm birth. Hispanic woman have four times the risk of a preterm birth if they are more acculturated (ie, proficient in English). These findings demonstrate another possible aspect of obstetric risk, that of acculturation. Further refinement of the risk of acculturation is essential to clarify how we can adjust our clinical care to prevent increasing preterm birth with the increasing Hispanic population. III.
    Obstetrics and Gynecology 03/2008; 111(2 Pt 1):309-16. · 4.80 Impact Factor
  • R. Jeanne Ruiz, Sheryl Bishop
    Brain Behavior and Immunity - BRAIN BEHAV IMMUN. 01/2008; 22(4):41-41.
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    ABSTRACT: The purpose of this study was to determine relationships between acculturation, body mass index (BMI), and depressive symptoms with the Interleukin 1-mediated inflammatory response marker IL-1RA in pregnant Hispanic women at 22-24 weeks gestation. An observational, prospective design with data collected at 22-24 weeks gestation. Public prenatal health clinics and private physician practices in central and south Texas serving low-income women. Body mass index (BMI), depression scores on the Center for Epidemiological Studies of Depression (CES-D), years in the United States, the Language Proficiency Scale (LPS), and Interleukin 1 receptor antagonist levels (IL-1RA). The longer the Hispanic women were in the United States, the higher the IL-1RA levels in plasma (F=4.55; P=.002). IL-1RA plasma levels were significantly different between low and normal BMI vs overweight and obese categories of BMI (F=8.54; P<.001). IL-1RA levels were significantly higher between those women who had high scores for depressive symptoms on the CES-D (using a cut off of 20) and those who had scores less than 20 (t-value=-2.41; P=.018). In structural equation modeling, years in the United States significantly positively predicted increased depressive symptoms, increased BMI, and increased IL-1RA levels with a good model fit. We found that increasing years of residency in the United States is associated with the elevated inflammatory marker IL-1RA, and increased BMI. Increased depressive symptoms also predict IL-1RA levels among Hispanic women at 22-24 weeks of pregnancy. The significance of these findings is discussed in relationship to the development and course of disease.
    Ethnicity & disease 01/2007; 17(2):338-43. · 1.12 Impact Factor
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    ABSTRACT: Significant differences have been reported in the prevalence of depression between Mexicans and Mexican Americans. Whether the differences in prevalence are real or are the results of cultural bias in instrumentation is not known. To examine the association between acculturation and the responses to the individual depressive symptom item of the Center for Epidemiologic Studies Depression Scale (CES-D). The CES-D was administered to 395 Hispanic women during their 22-24 weeks' pregnancy clinic visit. Acculturation was defined by a subject's language preference of English or Spanish when completing the CES-D. Those who preferred English belong to the acculturated group and those who preferred Spanish are considered nonacculturated. Logistic regression was used to conduct differential item functioning (DIF) analysis for each of the 20 CES-D items to determine whether they operated differently between the acculturated Hispanic group and the nonacculturated Hispanic group. Reliability of the CES-D total score was .86 and .88 for the nonacculturated and acculturated groups, respectively. None of the items of the Depressed Affect Subscale showed DIF. However, DIF was found in four out of the seven items in the Somatic Activity Subscale and in three out of the four items in the Positive Affect Subscale. The results suggest that even within a homogenous Hispanic group of mostly Mexican Americans, responses to the CES-D differ by acculturation. The nonacculturated group are less likely to endorse somatic symptoms but more likely to endorse positive items than the acculturated group. Depression screening in this population needs to account for acculturation differences within the Hispanic group.
    Nursing Research 01/2007; 56(3):217-23. · 1.56 Impact Factor
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    ABSTRACT: To determine the predictive ability of acculturation as an antecedent of stress, biobehavioral risk, corticotropin-releasing hormone levels, and poor birth outcomes in pregnant Hispanic women. A prospective, observational design with data collected at 22-25 weeks of gestation and at birth through medical record review. Public prenatal health clinics in south Texas serving low-income women. Self-identified Hispanic women who had singleton pregnancies, no major medical risk complications, and consented to answer questionnaires as well as a venipuncture and review of their prenatal and birth medical records. Gestational age, Apgar scores, length, weight, percentile size, and head circumference of the infant at birth. Significant differences were seen in infant birth weight, head circumference, and percentile size by acculturation. English acculturation predicted stress, corticotropin-releasing hormone, biobehavioral risk, and decreased gestational age at birth. Investigation must continue to understand the circumstances that give rise to the decline in birth outcomes observed in Hispanics with acculturation to the dominant English culture in the United States.
    Ethnicity & disease 02/2006; 16(4):926-32. · 1.12 Impact Factor

Publication Stats

157 Citations
34.52 Total Impact Points

Institutions

  • 2012–2013
    • The Ohio State University
      • College of Nursing
      Columbus, OH, United States
  • 2011
    • University of Texas at Austin
      • School of Nursing
      Texas City, TX, United States
  • 2008–2011
    • Salt Lake City Community College
      Salt Lake City, Utah, United States
  • 2006–2008
    • University of Texas Medical Branch at Galveston
      • • Department of Obstetrics and Gynecology
      • • School of Nursing
      Galveston, TX, United States
  • 2003–2004
    • University of Texas Health Science Center at San Antonio
      • School of Nursing
      San Antonio, Texas, United States
  • 2002
    • Texas Tech University Health Sciences Center
      • School of Nursing
      Lubbock, TX, United States