PROBLEM: Little is known about the rates, correlates, and consequences of depression among a sample of first‐time mothers.
METHODS: Four‐site prospective study of the first 3 years of life among ...first children born to first‐time mothers, including adolescent (N= 396), lower‐ (N= 169), and higher‐resource adult (N= 117). Mothers were administered the Beck Depression Inventory prenatally and 6 months postpartum. Measures of maternal and infant behaviors were taken at 8 months.
FINDINGS: Adolescent mothers displayed higher prenatal and 6‐month rates of depression than lower‐ and higher‐resource adult mothers, with significantly more adolescent mothers “consistently” depressed at the two time points than lower‐ and higher‐resource adult mothers. Further, adolescent mothers were significantly more likely to become depressed after their babies were born than lower‐ or higher‐resource adult mothers. Depression was negatively related to parenting practices and babies' behavior. As depression increased, mothers scored less favorably in maternal warmth and sensitivity, contingent responsiveness, and general verbalness; children scored less favorably in warmth seeking toward their mothers.
CONCLUSION: Findings signify the need for counseling and nurse‐based intervention and prevention services geared at preparing pregnant adolescents for motherhood.
Although teen pregnancy rates decreased dramatically in the United States over the past decade, the rates of sexually transmitted infections (STIs) among adolescents and young adults increased. STI ...rates disproportionately affect African American youth and young adults. Innovative, accessible, and culturally relevant sexual health interventions are urgently needed.
This study aimed to identify the optimal modality for a game-based sexual health intervention; develop the educational, entertainment, and technological aspects of the serious game; and demonstrate its usability and acceptance by the target population.
This project was grounded in formative data collection with community-based participatory research principles and practices combined with a user-centered design and development approach. Sexually Active Adolescent-Focused Education (SAAFE) was developed using input and feedback from African American youths aged 15 to 21 years who participated in a youth advisory board and focus group discussions to inform the co-design and cocreation of the serious game. The process was highly iterative with multiple sessions for user input following design changes. It proceeded in 3 stages. Social cognitive theory and problem-solving theory were leveraged to provide evidence-based, trauma-informed education through a serious game. Usability testing assessed the quality of user experience with the prototype.
Across all 3 stages, a total of 86 self-identified African American males and females aged 15 to 21 years from the District of Columbia and Birmingham, Alabama, participated. Participants requested a dating simulation game. They wanted SAAFE to be customizable, realistic, entertaining, educational, modern, and experiential, linking consequences to their gameplay decisions. Usability testing resulted in an initial System Usability Survey score of 77.7, placing the game in the 82nd percentile and above average for usability.
Initial results suggest that the SAAFE prototype is a promising intervention to engage African American youth in sexual health education using a role-playing game. If proven efficacious, the game has the potential to meet the need for sex education, counterbalance unhealthy portrayals of sex in popular media, and respond to the disparities in the STI epidemic.
Elevated levels of C-reactive protein (CRP) are associated with increased risk of cardiovascular and metabolic disease. The current study tested associations between psychosocial stress and CRP in a ...large sample of women during the first postpartum year.
We analyzed data collected by the five-site Community Child Health Network study, which studied a predominately poor population. Participants (n = 1206 women; 54% African American, 23% white, 23% Hispanic/Latina) were recruited shortly after the birth of a child. Multiple linear regression analyses tested associations of psychosocial stress in several life domains (financial, neighborhood, family, coparenting, partner relationship, discrimination, and interpersonal violence) with log-transformed CRP concentrations at 6-month and 1-year postpartum.
Forty-eight percent of participants showed evidence of elevated CRP (≥3 mg/L) at 6-month postpartum, and 46% had elevated CRP at 12-month postpartum. Chronic financial stress at 1-month postpartum predicted higher levels of CRP at 6- (b = .15, SE = .05, p = .006) and 12-month postpartum (b = .15, SE = .06, p = .007) adjusting for race/ethnicity, income, education, parity, health behaviors, and chronic health conditions, though associations became nonsignificant when adjusted for body mass index.
In this low-income and ethnic/racially diverse sample of women, higher financial stress at 1-month postbirth predicted higher CRP. Study findings suggest that perceived financial stress stemming from socioeconomic disadvantage may be a particular deleterious form of stress affecting maternal biology during the year after the birth of a child.
Although CDC guidelines call for universal, “opt-out” HIV testing, barriers to testing continue to exist throughout the United States, with the rural South particularly vulnerable to both HIV ...infection and decreased awareness of status. Therefore, the objectives of this study were to evaluate uptake of “opt-out” HIV testing and barriers to testing within the primary care setting in the South. A concurrent triangulation design guided the collection of quantitative data from patients (
N
=
250
) and qualitative data from providers (
N
=
10
) across three primary health clinics in Alabama. We found that 30% of patients had never been tested for HIV, with the highest ranked barrier among patients being perceived costs, access to specialty care, and not feeling at risk. Significant differences existed in perceived barriers between patients and providers. Increased provider-patient engagement and the routine implementation of “opt-out” HIV testing would effectively reveal and mitigate barriers to testing, thus, increasing awareness of status.
Nearly half of HIV infections in the United States are concentrated among African Americans, and over half of new HIV infections occur in the South. African Americans have poorer outcomes in the ...entire continua of HIV and PrEP care. Complex social, structural, and behavioral factors contribute to our nation’s alarming racial disparities in HIV infection, particularly in the Deep South. Despite the importance of faith, spirituality and religious practice in the lives of many African Americans, there has been little scientific investment exploring how African Americans’ religious participation, faith and spirituality may impact our nation’s HIV epidemic. This article summarizes the state of the science on this critical issue. We also identify opportunities for new scholarship on how faith, spirituality and religious participation may impact HIV care continuum outcomes in the South and call for greater federal research investment on these issues.
The COVID-19 pandemic continues to have a global and multifaceted impact on public health. Marginalized and vulnerable populations, such as college students and postdoctoral fellows with disabilities ...or pre-existing conditions, are being disproportionately affected by the COVID-19 pandemic. Various barriers contribute to an individual’s intentions to seek mental health help, but with COVID-19’s unprecedented permeability, more research is needed to support this student population. This phenomenological study explored the coping strategies and help-seeking behaviors of college students and postdoctoral fellows with disabilities during the COVID-19 pandemic. Using semi-structured, in-depth interviews from fall 2020 (n = 36) and spring 2021 (n = 28), a thematic analysis was conducted. The Transactional Model of Stress and Coping was used to triangulate findings, to better understand the relationship between perceived stressors, coping mechanisms, and psychological outcomes. The findings show that (1) college students with disabilities coped in multiple ways (i.e., behavioral, relational, and mental), with some noting improvements in their coping abilities by spring, and (2) stigma prevented college students with disabilities from seeking help when needed. These findings emphasize the need for higher education to address ableism and use factors beneficial to fostering resiliency (i.e., social support, optimism, and self-advocacy) among college students with disabilities.
The inclusion of biomarkers in studies of stress and health outcomes is of growing interest, including for community-based participatory research (CBPR) studies. Yet the perspectives of participants ...and communities have been infrequently consulted to inform the biomarker collection process. The objective of this paper is to describe the process and outcomes of using CBPR in framing biomarker collection in a study of allostatic load in a maternal and child health population. Through analysis of focus group data, we identify aspects of CBPR that facilitate increased community trust and endorsement related to collecting biological samples, and also provide a community perspective that is often overlooked in the literature. We found that a CBPR approach facilitated greater understanding among community members about the importance of biomarkers, while simultaneously informing the design of a biomarker data collection protocol that was responsive to the desired scope and data collection procedures that reflected community priorities.
This paper provides a framework for understanding the emotional and behavioral responses of college and university students during the COVID-19 pandemic. It builds on the Substance Abuse and Mental ...Health Services Administration (SAMHSA) Phases of Disaster Model and Maslow’s Hierarchy of Needs. Additionally, we conceptualize a new phase in the Phases of Disaster Model, which we refer to as the “Sandbar Phase,” to address the unique factors of COVID-19 for college and university students. For each phase, we discuss the expected timeline and the associated emotional reactions, behaviors, and applications of Maslow’s Hierarchy of Needs during COVID-19 for college and university students. Our proposed model aims to reveal short- and long-term effects of COVID-19 on the mental health of college and university students and be a resource in the development of effective mitigation efforts to diminish any psychological deficits as the result of future disasters and/or traumatic events.
Pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention intervention and a major strategy for reducing the HIV burden in the United States. However, PrEP provision and uptake ...remain lower than estimated needs, and in ways that may exacerbate HIV disparities among Black adolescent girls and young women in the southern United States. Data suggest that gaps in provider knowledge of HIV epidemiology and PrEP and skills assessing sexual health practices are important barriers to provision and uptake, with limited evidence-based interventions to address these gaps.
This paper describes the "PrEP-Pro" intervention, a multicomponent intervention to train and support family medicine (FM) trainees to promote PrEP for adolescent girls and young women in Alabama.
The PrEP-Pro intervention comprises 3 main components guided by the Capability-Opportunity-Motivation-Behavior (COM-B) model for behavioral change and the Consolidated Framework for Implementation Research (CFIR): (1) provider HIV epidemiology and PrEP education, (2) sexual history taking, and (3) PrEP Champions. In phase 1, we will work with community advisory boards (providers and clients) and then conduct focus groups with FM trainees to adapt content to train FM residents on HIV epidemiology and PrEP and develop implementation strategies, including provider-facing tools and client-facing educational materials. In phase 2, we will pretest and then pilot-test the initially adapted PrEP-Pro intervention with FM trainees. FM trainees will complete baseline, 3-, and 6-month questionnaires post PrEP-Pro intervention. We will also conduct in-depth interviews (IDIs) with FM pilot participants, adolescent girls and young women who accessed care after the PrEP-Pro pilot, and key stakeholders. The primary outcomes are PrEP-Pro acceptability and feasibility, which would be assessed using validated instruments at months 3 (among pretest participants) and 6 (among pilot participants). Secondary outcomes will also be assessed, including PrEP knowledge, sexual history-taking attitudes and practices, PrEP prescriptions among adolescent girls and young women encounters, and sexually transmitted infections (STIs) and HIV testing among adolescent girls and young women encounters in 6 months.
Study results will be disseminated to practices, state health officials, and other key stakeholders to solicit feedback on implementation opportunities and challenges to inform a hybrid effectiveness implementation trial. Our results will also be presented at local and national conferences and submitted to peer-reviewed journals.
As PrEP grows, there is a pressing need to train FM providers and develop appropriate, contextually relevant tools to support PrEP implementation. The PrEP-Pro intervention is a multicomponent intervention to train FM residents across Alabama on sexual history-taking, PrEP provision for adolescent girls and young women, and supporting practice-based PrEP Champions. The PrEP-Pro intervention is anticipated to increase PrEP prescriptions for adolescent girls and young women and expand comprehensive sexual and reproductive health care for adolescent girls and young women in rural and urban Alabama.
PRR1-10.2196/44908.
Many women experience depressive symptoms after childbirth, and rates among African Americans are as high as 40%. Spirituality and religiosity are valued in African American communities, but their ...relevance to new mothers has not been empirically tested. We examined effects of religiosity and spirituality on trajectories of depressive symptoms during the year after childbirth. Data were collected by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Community Child Health Network, which focuses on maternal-child health disparities. The sample consisted of 702 low-socioeconomic-status African American predominantly Christian women. Participants were interviewed in their homes throughout the year after a birth. Spirituality and religiosity each independently predicted changes in depressive symptoms, and low levels predicted increases over time. Effects of religiosity were mediated by a woman’s spirituality. Religiosity and spirituality functioned as significant, interrelated protective factors in this study, which provides novel insight about lower-income African American women after childbirth.
PDF
