[Show abstract][Hide abstract] ABSTRACT: There is a critical need to examine protective and risk factors of anxiety and depressive symptoms among people living with HIV in order to improve quality of life. Structural equation modeling was used to examine the associations between HIV-related shame, sexual abuse-related shame, posttraumatic growth, and anxiety and depressive symptoms among a cohort of 225 heterosexual women and men who have sex with men (MSM) living with HIV who have experienced childhood sexual abuse (CSA). Higher sexual abuse-related shame was related to more anxiety and depressive symptoms for heterosexual women. Higher posttraumatic growth predicted less anxiety symptoms for only heterosexual women. Higher posttraumatic growth predicted less depressive symptoms for heterosexual women and MSM, but the magnitude of this effect was stronger for heterosexual women than MSM. Psychosocial interventions may need to be tailored to meet the specific needs of heterosexual women and MSM living with HIV and CSA.
Full-text · Article · Feb 2016 · AIDS and Behavior
[Show abstract][Hide abstract] ABSTRACT: Adolescent and young mothers transitioning from pregnancy to postpartum need to maintain an optimal quality of life. Stress and exposure to violence (e.g., intimate partner violence (IPV), nonpartner violence) are predictors of poor quality of life for adult women; however, these associations remain understudied among adolescent and young mothers in urban areas. Guided by the social ecological model, the current study created a latent variable, urban social stress, to examine the impact of the urban social environment (i.e., stressful life events, discrimination, family stress, and neighborhood problems) on the quality of life of adolescent and young mothers during both pregnancy and postpartum. The current study is a secondary data analysis of a prospective cohort study of 296 expectant young mothers recruited at obstetrics and gynecology clinics. Results from structural equation and multigroup models found that higher urban social stress predicted lower mental and physical quality of life during pregnancy, but these associations were significantly stronger for IPV-exposed and nonpartner violence-exposed mothers. In the postpartum period, higher urban social stress predicted lower mental and physical quality of life, but these associations were significantly stronger for IPV-unexposed and nonpartner violence-exposed mothers. Stress reduction programs need to help adolescent and young mothers in urban areas develop stress management skills specific to urban social stress. Pregnancy and parenting programs need to be tailored to the specific needs of young mothers in urban areas by becoming sensitive to the role of IPV and nonpartner violence in these young women’s lives.
Full-text · Article · Jan 2016 · Journal of Urban Health
[Show abstract][Hide abstract] ABSTRACT: Objective:
To assess the risk for neurodevelopmental delays for children of mothers who were obese (≥200 pounds) prior to pregnancy, and to characterize delays associated with maternal obesity among children referred to and found eligible to receive Early Intervention Program services.
We conducted a retrospective cohort study (N = 541,816) using a population-based New York City data warehouse with linked birth and Early Intervention data. Risks for children suspected of a delay and 'significantly delayed', with two moderate or one severe delay, were calculated. Among the group of children eligible by delay for Early Intervention, analyses assessed risk for being identified with a moderate-to-severe delay across each of five functional domains as well as risks for multiple delays.
Children of mothers who were obese were more likely to be suspected of a delay (adjusted RR 1.19 [CI 1.15-1.22]) and borderline association for 'significantly delayed' (adjusted RR 1.01 [CI 1.00-1.02). Among children eligible by delay, children of mothers who were obese evidenced an increased risk for moderate-to-severe cognitive (adjusted RR 1.04 [CI 1.02-1.07]) and physical (adjusted RR 1.04 [CI 1.01-1.08]) delays and for global developmental delay (adjusted RR 1.05 [CI 1.01-1.08]).
Maternal obesity is associated with increased risk of developmental delay in offspring. Among children with moderate or severe delays, maternal obesity is associated with increased risk of cognitive and physical delays as well as with increased risk for global developmental delay. While causation remains uncertain, this adds to the growing body of research reporting an association between maternal obesity and neurodevelopmental delays in offspring.
No preview · Article · Dec 2015 · Maternal and Child Health Journal
[Show abstract][Hide abstract] ABSTRACT: Objectives:
We compared an evidence-based model of group prenatal care to traditional individual prenatal care on birth, neonatal, and reproductive health outcomes.
We performed a multisite cluster randomized controlled trial in 14 health centers in New York City (2008-2012). We analyzed 1148 pregnant women aged 14 to 21 years, at less than 24 weeks of gestation, and not at high obstetrical risk. We assessed outcomes via medical records and surveys.
In intention-to-treat analyses, women at intervention sites were significantly less likely to have infants small for gestational age (< 10th percentile; 11.0% vs 15.8%; odds ratio = 0.66; 95% confidence interval = 0.44, 0.99). In as-treated analyses, women with more group visits had better outcomes, including small for gestational age, gestational age, birth weight, days in neonatal intensive care unit, rapid repeat pregnancy, condom use, and unprotected sex (P = .030 to < .001). There were no associated risks.
CenteringPregnancy Plus group prenatal care resulted in more favorable birth, neonatal, and reproductive outcomes. Successful translation of clinical innovations to enhance care, improve outcomes, and reduce cost requires strategies that facilitate patient adherence and support organizational change. (Am J Public Health. Published online ahead of print December 21, 2015: e1-e7. doi:10.2105/AJPH.2015.302960).
No preview · Article · Dec 2015 · American Journal of Public Health
[Show abstract][Hide abstract] ABSTRACT: Purpose:
Group models of prenatal care continue to grow in popularity. However, little is known about how group composition (similarity or diversity between members of groups) relates to care-related outcomes. The current investigation aimed to explore associations between prenatal care group composition with patient satisfaction, engagement, and group attendance among young, urban women of color.
Data were drawn from two studies conducted in New Haven and Atlanta (2001-2004; n = 557) and New York City (2008-2011; n = 375) designed to evaluate group prenatal care among young, urban women of color. Women aged 14 to 25 were assigned to group prenatal care and completed surveys during their second and third trimesters of pregnancy. Group attendance was recorded. Data were merged and analyzed guided by the Group Actor-Partner Interdependence Model using multilevel regression. Analyses explored composition in terms of age, race, ethnicity, and language.
Women in groups with others more diverse in age reported greater patient engagement and, in turn, attended more group sessions, b(se) = -0.01(0.01); p = .04.
The composition of prenatal care groups seems to be associated with young women's engagement in care, ultimately relating to the number of group prenatal care sessions they attend. Creating groups diverse in age may be particularly beneficial for young, urban women of color, who have unique pregnancy needs and experiences. Future research is needed to test the generalizability of these exploratory findings.
No preview · Article · Nov 2015 · Women s Health Issues
[Show abstract][Hide abstract] ABSTRACT: Background: Transitioning into parenthood can be difficult for adolescent parents who experienced violence victimization. Previous research has shown that experiences of child abuse and intimate partner violence (IPV) can impact parenting. Although one in five children experience polyvictimization, experiencing multiple types of violence victimization (e.g., IPV, stranger violence, family violence, peer violence), the impact of polyvictimization among adolescent and young couples has been unexplored. The current study examined patterns of polyvictimization for adolescent and young parents; and its association with parenting behaviors and involvement.
Methods: Data were collected from 592 expectant adolescents and their partners (N = 296 couples) between 2007 and 2011 as part of a longitudinal study. Participants were recruited at obstetrics and gynecology clinics and an ultrasound clinic in four university-affiliated hospitals. At baseline, participants provided data on violence victimization and sociodemographics. Parenting outcomes were reported at 6 months postpartum.
Results: Results from two latent class analyses showed three-class models for both women and men, with latent classes being described by the probabilities of the polyvictimization. The classes of women were: (1) No Violence; (2) Stranger Violence/Prior IPV; and the (3) Prior IPV /Peer Violence. The classes of men were: (1) No Violence; (2) Prior IPV; and (3) High Polyvictimization. Results from ANOVAs revealed that men in the High Polyvictimization class were less likely to be involved in raising the child (p = 0.004) and had more negative parenting experiences at postpartum (p = 0.002). Women in Prior IPV/Peer Violence class were more likely to have negative parenting experiences (p = 0.005), and low partner involvement in parenting (p = 0.01).
Conclusions: Polyvictimization plays an important role in how adolescent parents transition into parenthood. Policy and intervention development should be sensitive to the intersection between polyvictimization and parenting, particularly among adolescents.
[Show abstract][Hide abstract] ABSTRACT: Background: Polyvictimization, experiencing multiple forms of victimization (e.g., intimate partner violence (IPV), family violence, peer violence, stranger violence), has been strongly associated with mental health problems among adolescents. However, very little research has examined the impact of polyvictimization on sexual health. The current study examined patterns of polyvictimization for females and males; and their association with sexual risk and psychosocial outcomes.
Methods: Data were collected from 592 pregnant adolescents and their partners(N = 296 couples) between 2007 and 2011 as part of a longitudinal study. During baseline interviews, participants provided data on victimization, sexual risk, and psychosocial outcomes.
Results: Latent class analyses showed three-class models for both females and males. Females’ classes were: No Violence; Stranger Violence/Prior IPV; and Prior IPV/Peer Violence; while, males’ classes were: No Violence; Prior IPV; and High Polyvictimization. ANOVAs revealed that females in the Stranger Violence/Prior IPV class reported less condom use in the past six months(F=6.00,p=0.003) and communicated more about HIV with their partner(F=3.83,p=0.02) than the No Violence class. Females in the Prior IPV/Peer Violence reported lower condom use self-efficacy(F=6.38,p=0.002) and less positive attitudes about condoms(F=3.26,p=0.03) than the Stranger Violence/Prior IPV class. Males in the High Polyvictimization class reported less condom use in the past six months(F=3.27,p=0.03) then the No Violence and Prior IPV class. Males in the Prior IPV class reported more HIV risks(F=8.81,p<0.001) than the No Violence class.
Conclusions: Polyvictimization impacts the sexual health of adolescents. It may be useful for HIV/STI interventions to identify and address experiences of polyvictimization among adolescent couples.
[Show abstract][Hide abstract] ABSTRACT: Young expecting parents face a great deal of challenges as they transition into parenthood. This paper sought to identify racial and gender differences in the relationship between general discrimination, neighborhood problems, neighborhood cohesion, and social support on the depressive and stress symptoms among young expecting couples. Results indicated perceived general discrimination and less social support was associated with increased stress and depression. More neighborhood problems were related to increased depression and more neighborhood cohesion was related to less stress. Moderator analyses showed that the influence of general discrimination and stress was stronger for women than men. In addition, neighborhood cohesion was protective on stress for Blacks and Whites but not for Hispanics. These results indicate the need to address the broader social context for young expectant couples.
Full-text · Article · Oct 2015 · Journal of Child and Family Studies
[Show abstract][Hide abstract] ABSTRACT: Background:
Psychoeducational interventions, tested for efficacy in randomized clinical trials, are seldom implemented in clinical practice where cancer survivors and their family caregivers can benefit from them.
This study examined the effectiveness of the FOCUS Program on cancer survivors' and their family caregivers' outcomes when implemented at a Cancer Support Community (CSC) affiliate by agency social workers. Study aims were to (1) test effects of the program on survivor and caregiver outcomes as a unit and (2) determine program feasibility in terms of enrollment, retention, intervention fidelity, and satisfaction.
A preintervention and postintervention pilot effectiveness study was conducted with 34 cancer survivor-caregiver dyads (ie, pairs). The FOCUS Program, originally delivered by nurses in dyads' homes, was modified to a small-group format and delivered by CSC social workers. The primary outcome was quality of life (QOL). Intermediary outcomes were benefits of illness/caregiving, communication, support, and self-efficacy. Analyses included repeated-measures analysis of variance.
Dyads had significant improvements in total QOL; physical, emotional, and functional QOL; benefits of illness; and self-efficacy. Effect sizes were similar to prior randomized clinical trial findings. Although dyads were difficult to recruit (enrollment, 60%), both retention (92%) and intervention fidelity (94%) were high.
It was possible to implement the FOCUS Program at a CSC affiliate by agency staff, obtain positive intervention effects, and maintain intervention fidelity.
Implications for practice:
Researchers and clinicians need to collaborate to implement more evidence-based interventions in practice settings for cancer survivors and their family caregivers.
[Show abstract][Hide abstract] ABSTRACT: Background:
The challenges of advanced cancer have health implications for patients and their family caregivers from diagnosis through end of life. The nature of the patient/caregiver experience suggests that their mental and physical health may be interdependent, but limited empirical evidence exists.
This study used social cognitive theory as a framework to investigate individual and interpersonal influences on patients' and their family caregivers' mental health, physical health, and self-efficacy as individuals to manage the challenges of advanced disease over time.
Patients and caregivers (484 patient-caregiver dyads) completed surveys at baseline, 3 and 6 months. Longitudinal dyadic analysis techniques were used to examine (i) the influence that patients and caregivers had on their own mental health, physical health, and self-efficacy (actor effects) and (ii) the influence that they had on each other's health outcomes (partner effects). We also examined the influence of self-efficacy on mental and physical health over time.
Consistent with our hypotheses, each person's mental health, physical health, and self-efficacy had significant effects on their own outcomes over time (actor effects). Patients and caregivers influenced one another's mental and physical health (partner effects), but not their self-efficacy. In addition, patients and caregivers with higher self-efficacy had better mental health, and their partners had better physical health.
Patients' and caregivers' mental and physical health were interdependent. Each person's cancer-related self-efficacy influenced their own mental and physical health. However, a person's self-efficacy did not influence the other person's self-efficacy.
Full-text · Article · Oct 2015 · Annals of Behavioral Medicine
[Show abstract][Hide abstract] ABSTRACT: Social networking technologies are influential among men who have sex with men (MSM) and may be an important strategy for HIV prevention. We conducted focus groups with HIV positive and negative participants. Almost all participants used social networking sites to meet new friends and sexual partners. The main obstacle to effective HIV prevention campaigns in social networking platforms was stigmatization based on homosexuality as well as HIV status. Persistent stigma associated with HIV status and disclosure was cited as a top reason for avoiding HIV-related conversations while meeting new partners using social technologies. Further, social networking sites have different social etiquettes and rules that may increase HIV risk by discouraging HIV status disclosure. Overall, successful interventions for MSM using social networking technologies must consider aspects of privacy, stigma, and social norms in order to enact HIV reduction among MSM.
No preview · Article · Aug 2015 · AIDS education and prevention: official publication of the International Society for AIDS Education
[Show abstract][Hide abstract] ABSTRACT: Mental health issues often become apparent as adolescents emerge into young adulthood. The use of mental health services is low among adolescents and young adults, and use is particularly low among minorities. In this study, we examine mental health utilization among diverse young parenting couples. The sample consisted of 296 couples. We used the social-personal framework to examine personal, family, partner relationship, and environmental predictors for using mental health services. We used the Actor-Partner Interdependence Model to assess actor and partner effects on mental health utilization. We also examined moderator effects for gender and internalizing and externalizing behaviors. We found that being female, being White, higher income, more conduct problems, and less anxious romantic attachment predicted mental health utilization. Significant moderator effects included depression × gender, depression × medical insurance, and stress × Latino. Implications for community mental health practice include conducting mental health assessments during medical visits and systematic mental health follow-up for individuals and couples with identified mental health and support needs. Future research should include married couples and the spouse's influence on mental health use and examine relevant parenting factors that may also predict mental health utilization among couples.
Full-text · Article · Jul 2015 · American Journal of Community Psychology
[Show abstract][Hide abstract] ABSTRACT: To examine differences in healthcare service utilization among patients with advanced cancer participating in a nurse-led psychoeducational intervention.
Secondary analysis of trial data.
Four Michigan cancer centers.
484 patients with advanced cancer.
Patients were randomized to three groups.
Study arm (brief, extensive, or control), ED visitation (one or more times versus none), inpatient hospitalizations (one or more times versus none), and covariates.
No significant differences in ED visits or inpatient hospitalizations were observed among study arms. ED visits were more frequent for patients with lung or colorectal cancer, more comorbidities, and lower baseline QOL. Baseline QOL was associated with inpatient hospitalizations in the adjusted analysis.
The psychoeducational intervention, either in brief or extensive format, is unlikely to increase healthcare service utilization.
Efficacious nurse-led psychoeducational interventions to improve QOL do not place undue burdens on the healthcare system and may improve care.
No preview · Article · Jul 2015 · Oncology Nursing Forum
[Show abstract][Hide abstract] ABSTRACT: When examining older adults' health behaviors and psychological health, it is important to consider the social context.
The purpose of this study was to examine in older adult marriages whether each spouse's physical activity predicted changes in their own (actor effects) and their partner's (partner effects) depressive symptoms. Gender differences were also examined.
Each spouse within 1260 married couples (at baseline) in the Cardiovascular Health Study completed self-report measures at wave 1 (1989-1990), wave 3 (1992-1993), and wave 7 (1996-1997). Dyadic path analyses were performed.
Husbands' physical activity significantly predicted own decreased depressive symptoms (actor effect). For both spouses, own physical activity did not significantly predict the spouse's depressive symptoms (partner effects). However, husbands' physical activity and depressive symptoms predicted wives' physical activity and depressive symptoms (partner effects), respectively. Depressive symptoms did not predict physical activity.
Findings suggest that husbands' physical activity is particularly influential for older married couples' psychological health.
No preview · Article · Apr 2015 · Annals of Behavioral Medicine
[Show abstract][Hide abstract] ABSTRACT: This mixed-methods investigation combines a quantitative survey, focus groups, and in-depth interviews to examine sexual risk behaviors and HIV status disclosure among HIV-positive hijras (male-to-female transgender people) and HIV-positive men who have sex with men (MSM) in Chennai and Mumbai, India. From the survey results, the authors found a relatively high prevalence of inconsistent condom use for anal sex with male partners—about one-fifth to almost one-half, depending on the type of partner (regular, casual) and sexual role (receptive, insertive). One-quarter of MSM and two-fifths of hijras reported having disclosed their HIV status to their male regular partner. The qualitative data helped in understanding social and structural factors that created barriers to disclosure of HIV status and to condom use. Disclosure was not uniformly followed by safer sex, and nondisclosure did not always lead to unprotected sex. Implications for practice and policies and potential interventions are discussed.
Full-text · Article · Mar 2015 · Journal of HIV/AIDS & Social Services
[Show abstract][Hide abstract] ABSTRACT: Objective
Deficits in emotion expression skills have been associated with alcohol and substance use, but the mechanisms through which these associations occur are not well understood. The current study investigated (a) associations between emotion expression and substance use (i.e., alcohol, cigarettes, and marijuana) in newly parenting adolescents and young adults and (b) whether symptoms of depression and stress mediate these associations in young mothers and fathers.Methods
Participants recruited from obstetrics and gynecology clinics completed the Center for Epidemiological Studies-Depression Scale, Perceived Stress Scale, Emotion Expression Scale for Children, and substance use items.ResultsPath analysis indicated that lower emotion expression at 6 months postpartum was significantly associated with more alcohol and marijuana use at 12 months postpartum for males but not females. Also among males, stress levels at 6 months postpartum partially mediated associations between emotion expression and alcohol and marijuana use at 12 months postpartum.Conclusions
Findings suggest that poor emotion expression skills are related to more substance use in young fathers, and levels of stress may partially account for this association.
No preview · Article · Mar 2015 · Journal of Clinical Psychology