Novel Interventions to Reduce Stress and Overeating in Overweight Pregnant Women: A Feasibility Study.

Background High stress and depression during pregnancy are risk factors for worsened health trajectories for both mother and offspring. This is also true for pre-pregnancy obesity and excessive gestational weight gain. Reducing stress and depression may be one path to prevent excessive caloric intake and gestational weight gain. Study Purpose We tested the feasibility of two novel interventions aimed at reducing stress and overeating during pregnancy. Reflecting different theoretical underpinnings, the interventions target different mechanisms. Mindful Moms Training (MMT) uses mindfulness to improve awareness and acceptance of experiences and promote conscious rather than automatic behavior choices. Emotional Brain Training (EBT) uses active coping to change perceptions of negative experience and promote positive affective states. Methods Forty-six overweight/obese low-income women were assigned to either MMT (n = 24) or EBT (n = 22) for an 8-week feasibility study. Pre-post changes in perceived stress, eating and presumed mechanisms were assessed. Results Women reported high levels of stress at baseline. Both interventions were well attended and demonstrated clinically significant pre-post reductions in stress, depressive symptoms, and improved eating behaviors. MMT significantly decreased experiential avoidance, whereas EBT significantly increased positive reappraisal; these changes were marginally significantly different by group. Conclusions This feasibility study found that both interventions promoted meaningful reductions in stress and depressive symptoms and improved reported eating behaviors in a high-risk group of pregnant women. Each intervention has a potentially different pathway-acceptance for MMT and reappraisal for EBT. Larger studies are needed to test efficacy on longer term reductions in stress and overeating.

Psychological stress and reproductive aging among pre-menopausal women.

BACKGROUND: Life history models suggest that biological preparation for current versus longer term reproduction is favored in environments of adversity. In this context, we present a model of reproductive aging in which environmental adversity is proposed to increase the number of growing follicles at the cost of hastening the depletion of the ovarian reserve over time. We evaluated this model by examining psychological stress in relation to reproductive aging indexed by antral follicle count (AFC), a marker of total ovarian reserve. We hypothesized that stress would be related to (i) higher AFC in younger women, reflecting greater reproductive readiness as well as (ii) greater AFC loss across women, reflecting more accelerated reproductive aging. METHODS: In a multi-ethnic, community sample of 979 participants [ages 25-45 (mean (standard deviation) = 35.2 (5.5)); 27.5% Caucasian] in the Ovarian Aging study, an investigation of the correlates of reproductive aging, the interaction of age-x-stress was assessed in relation to AFC to determine whether AFC and AFC loss varied across women experiencing differing levels of stress. Stress was assessed by the perceived stress scale and AFC was assessed by summing the total number of antral follicles visible by transvaginal ultrasound. RESULTS: In linear regression examining AFC as the dependent variable, covariates (race/ethnicity, socio-economic status, menarcheal age, hormone-containing medication for birth control, parity, cigarette smoking, bodymass index, waist-to-hip ratio) and age were entered on step 1, stress on step 2 and the interaction term (age-x-stress) on step 3. On step 3, significant main effects showed that older age was related to lower AFC (b = -0.882, P = 0.000) and greater stress was related to higher AFC (b = 0.545, P = 0.005). Follow-up analyses showed that the main effect of stress on AFC was present in the younger women only. A significant interaction term (b = -0.036, P = 0.031) showed the relationship between age and AFC varied as function of stress. When the sample was divided into tertiles of stress, the average follicle loss was -0.781, -0.842 and -0.994 follicles/year in the low-, mid- and high-stress groups, respectively. CONCLUSIONS: Psychological stress was related to higher AFC among younger women and greater AFC decline across women, suggesting that greater stress may enhance reproductive readiness in the short term at the cost of accelerating reproductive aging in the long term. Findings are preliminary, however, due to the cross-sectional nature of the current study.

Psychological responses after abortion.

A review of methodologically sound studies of the psychological responses of U.S. women after they obtained legal, nonrestrictive abortions indicates that distress is generally greatest before the abortion and that the incidence of severe negative responses is low. Factors associated with increased risk of negative response are consistent with those reported in research on other stressful life events.

Environmental impact assessment and control of pharmaceuticals: the role of environmental agencies.

In 2005, the new legislation for pharmaceuticals came into effect. Since then environmental risk assessments are required for all new marketing authorisation applications. The German Federal Environment Agency has been assessing the environmental impact of 136 veterinary and 134 human pharmaceuticals. The authorisation of pharmaceuticals has shown that the authorisation of some groups of substances have to be combined with risk mitigation measures. Environmental risks may also arise from those pharmaceuticals which were authorised before the environmental risk assessment was added to the requirements of authorisation. Four examples of "existing" pharmaceuticals, i.e. diclofenac, ethinyl estradiol, ivermectin, and florfenicol are highlighted in this article. Risk management options for veterinary and human pharmaceuticals are discussed.

Sugary beverage and food consumption, and leukocyte telomere length maintenance in pregnant women.

Leukocyte telomere length (LTL) has been inversely associated with sugar-sweetened beverage (SSB) consumption in cross-sectional studies, but no studies have examined whether dietary intake influences LTL over time. This study examined longitudinal associations between sugary foods and beverages and LTL. Participants were 65 overweight and obese pregnant women, aged 18-45 years, from a mindfulness intervention study conducted from early pregnancy (⩽16 weeks gestation) and followed through 9 months postpartum. During pregnancy and postpartum, dietary intake was measured with 24-h diet recalls, and LTL was assessed using quantitative PCR. Adjusting for sociodemographic and health characteristics, decreased SSB consumption from baseline to 9 months postpartum was associated with greater concurrent LTL lengthening (ß=-0.102, 95% confidence interval (CI) -0.192, -0.013). No associations between sugary foods and LTL were found in either period. The finding that reduced SSB consumption is associated with increased LTL warrants investigation in large cohort studies.

Conceptions of illness in young adolescents.

This study examined conceptions of illness in young adolescents. A group of 77 urban junior high school students aged 11 to 15 years were asked for their definitions of illness. Themes occurring in definitions of illness were identified and coded according to a previously developed coding scheme. Evidence in support of a developmental process underlying conceptions of illness was found by examining adolescents' definitions and comparing them with child and adult norms established in prior research. Results for adolescents showed the frequency of use of specific themes to fall between child and adult norms. The strongest evidence in support of a developmental trend was seen in definitions of illness pertaining to changes in daily activities. However, the relative frequency of adolescents' definitions was more like that of children than adults, indicating that whereas adolescents used a greater frequency of adult-like themes, they did so within a framework more descriptive of children. Qualitative aspects of definitions of illness showed age-linked differences with adolescents generating more adult-like, conceptually sophisticated definitions than children. In addition to developmental differences, similarities in definitions of illness were also found; among all age groups the most common delineators of illness were physical symptoms. Psychosocial themes were less frequently mentioned. Clinicians who discuss with their adolescent patients the ways in which illness affects social interaction may be communicating more effectively than practitioners who focus solely on signs and symptoms of physical disease.

Health-risk behaviors and health concerns among young adolescents.

This study examined the health concerns and behaviors of 563 adolescents (aged 11 through 14) from a variety of social, racial, and ethnic backgrounds. Behaviors associated with adolescent morbidity and mortality were examined, including sexual behavior, substance use, and injury-related behaviors. Although young adolescents are often viewed as unlikely participants in these risk behaviors, the results of this study suggest that greater attention should be paid to this younger group and their health-risk behaviors. A majority of the sample had tried alcohol and tobacco, and almost a third had used marijuana. Twenty-one percent were sexually active. Prevalence rates varied by social class, race-ethnicity, gender, and age. More than 75% of the sample had visited a physician during the prior year, suggesting an important role physicians may serve as sources of information and positive role models for these young adolescents. The results suggest that we stop viewing young adolescents as naive children and begin to view them as observers of and participants in a changing social environment that has important implications for their current and future health status. Without a realistic appraisal of the young adolescent, we can expect to have little overall effect on the status of adolescent health in the United States.

Varicella serology among school age children with a negative or uncertain history of chickenpox.

BACKGROUND: Clinicians who offer varicella vaccination to school age children face the dilemma of whether to serotest or vaccinate presumptively. Varicella seroprevalence among 7- to 12-year-old children with negative or uncertain histories has not previously been studied. Our main objective was to describe varicella seroprevalence among children ages 7 to 12 years with a negative or uncertain history of chickenpox. METHODS: This was a cross-sectional study of children whose clinicians had ordered varicella serotesting. Guidelines from the medical group's regional pediatric infectious disease specialists recommended obtaining varicella serology on all children 7 to 12 years old with a negative or uncertain history. Parents were interviewed by telephone about the child's history of chickenpox before test results were completed. RESULTS: Varicella seroprevalence ranged from 9% among 7-year-olds whose parents said they had definitely not had chickenpox to 68% among 11-year-olds whose parents were not sure whether they had had chickenpox. Among children whose parents were uncertain about their chickenpox history, almost one-half (48%) were seropositive. Twenty-five percent of children whose parents said they definitely had not and 32% of children whose parents said they had probably not had chickenpox were seropositive. Of parents whose children had experienced serotesting, 73% said they would prefer to have the blood test first rather than presumptive vaccination. For a large health maintenance organization, it was projected to be most cost-effective (in terms of cost per chickenpox case prevented) to recommend testing for children 9 to 12 years old with uncertain histories of chickenpox. CONCLUSIONS: We conclude that among children 7 to 12 years old with negative or uncertain histories of chickenpox, varicella seroprevalence ranges from 9 to 68% depending on age and clinical history. Parents are generally receptive to serotesting, although individual preferences vary. In the population we studied it would be most cost-effective to recommend testing before deciding about vaccination for children 9 to 12 years old with uncertain histories of chickenpox.

Socioeconomic status and health: what we know and what we don't.

In the past 15 years, we have seen a marked increase in research on socioeconomic status (SES) and health. Research in the first part of this era examined the nature of the relationship of SES and health, revealing a graded association; SES is important to health not only for those in poverty, but at all levels of SES. On average, the more advantaged individuals are, the better their health. In this paper we examine the data regarding the SES-health gradient, addressing causal direction, generalizability across populations and diseases, and associations with health for different indicators of SES. In the most recent era, researchers are increasingly exploring the mechanisms by which SES exerts an influence on health. There are multiple pathways by which SES determines health; a comprehensive analysis must include macroeconomic contexts and social factors as well as more immediate social environments, individual psychological and behavioral factors, and biological predispositions and processes.

Adolescents and the contraceptive pill: the impact of beliefs on intentions and use.

OBJECTIVES: To determine which beliefs about the contraceptive pill predict adolescent females' intentions to use the pill and their actual pill use, and to examine how intentions toward other birth control methods influence adolescents' intentions to use the pill and their eventual pill use. METHODS: Three hundred forty-five adolescents were interviewed about their beliefs regarding the consequences of using the pill and about their intentions to use the pill and other contraceptive methods. Follow-up interviews were conducted 1 year later, during which subjects reported their sexual activity and oral contraceptive use over the course of the year. RESULTS: Concerns about health and physical appearance differentiated subjects who intended to use the pill from those who did not, those who reported actually using the pill at all from those who did not, and those who did or did not use the pill consistently. The impact of beliefs differed between sexually active subjects and those who first had sex after the initial interview. Intentions to use withdrawal were negatively related to subjects' use of the pill (beta = -0.19, P < .05), although intentions to use condoms were unrelated to pill use. Intentions toward abortion were unrelated to either intentions to use the pill or eventual pill use. CONCLUSIONS: Female adolescents' beliefs about the contraceptive pill predicted their initial intentions to use the pill and their actual pill use over the course of a year. Adolescents may view withdrawal-although apparently not condoms-as an alternative to pill use. Abortion appears to be a backup to pill use rather than a substitute.

Self-concept in the diethylstilbestrol daughter.

To evaluate the possible psychologic impact of diethylstilbestrol (DES) in utero exposure on young women, the authors studied self-concept as a multifaceted construct in 25 known DES in utero exposed young women compared with 25 age-matched controls. Psychologic inventories used included Rosenberg's Self-Esteem Scale, Adjective Check List, Who Am I Test, Wyeth 's Self-Satisfaction Ladder, and the Draw Yourself Test, as well as semi-structured personal interview. Diethylstilbestrol subjects differed significantly from controls on the adjective check list subscales of Defensiveness, Nurturance, and Affiliation (P less than or equal to .05), as well as in the Draw Yourself Test, by omitting or obscuring body parts, especially sexual characteristics (P = .001). Subjects with known physical sequelae associated with DES were less satisfied with their lives (P = .05). On other measures of self-concept, no peer differences between DES subjects and controls were found. In fact, a trend for DES subjects to describe themselves more positively emerged. Most women also mentioned that they trusted physicians and were concerned about their future fertility and about the possibility of developing cancer. These findings suggest that young women exposed to DES may be using protective denial in their attempt to cope with their DES exposure. Physicians need to be aware of the possible psychologic impact of DES exposure, especially as more data become available regarding decreased fertility in these women and as new attention is focused on young men exposed to DES in utero.

Perceived competencies, peer group affiliation, and risk behavior among early adolescents.

This study examined the role of self-esteem and peer group membership in risk behavior among 183 8th graders in a multiethnic school. The hypothesis was that domain-specific rather than global self-esteem would be associated with "crowd" membership that in turn would be related to risk behavior. Data were gathered through informant interviews and individual surveys. Domain-specific self-esteem was related to crowd affiliation as well as to alcohol and cigarette use; global self-esteem was not related. Crowd affiliation related to alcohol use and sexual behavior after controlling for the effects of demographic and self-esteem variables, but crowd membership did not fully mediate the relationship between self-esteem and risk behavior. Availability of alcohol and cigarettes mediated the relationship between crowd affiliation and use of these substances. Findings support growing evidence that multiple adolescent peer groups exist and that group membership is closely tied to behavior.

Relationship of subjective and objective social status with psychological and physiological functioning: preliminary data in healthy white women.

This preliminary study compared the associations between objective and subjective socioeconomic status (SES) with psychological and physical variables among 157 healthy White women, 59 of whom subsequently participated in a laboratory stress study. Compared with objective indicators, subjective social status was more consistently and strongly related to psychological functioning and health-related factors (self-rated health, heart rate, sleep latency, body fat distribution, and cortisol habituation to repeated stress). Most associations remained significant even after controlling for objective social status and negative affectivity. Results suggest that, in this sample with a moderately restricted range on SES and health, psychological perceptions of social status may be contributing to the SES-health gradient.

Objective and subjective assessments of socioeconomic status and their relationship to self-rated health in an ethnically diverse sample of pregnant women.

A new measure of subjective socioeconomic status (SES) was examined in relation to self-rated physical health in pregnant women. Except among African Americans, subjective SES was significantly related to education, household income, and occupation. Subjective SES was significantly related to self-rated health among all groups. In multiple regression analyses, subjective SES was a significant predictor of self-rated health after the effects of objective indicators were accounted for among White and Chinese American women; among African American women and Latinas, household income was the only significant predictor of self-rated health. After accounting for the effects of subjective SES on health, objective indicators made no additional contribution to explaining health among White and Chinese American women; household income continued to predict health after accounting for subjective SES among Latinas and African American women.

Underreporting sensitive behaviors: the case of young women's willingness to report abortion.

Accurate reports are important in health research, yet abortions are underreported in surveys by almost half. This study examined influences on reporting of abortion among adolescents. Participants were 63 young women from varied ethnic backgrounds who had undergone abortions at urban abortion clinics. Participants reported on their willingness to be honest about their abortion in various research settings and in comparison with other sensitive topics. Willingness to report was also examined in relation to the sponsor of the research, the mode of administration, and the characteristics of the interviewer. Adolescents indicated less willingness to report abortion than some behaviors such as cigarette smoking, but they were more willing to report abortion than family income, oral sex, or anal sex. Comparison of willingness to report across research settings indicated that face-to-face interviews appear to generate more accurate reporting than telephone surveys. The implications of these findings for the study of other health behaviors are discussed.

Initiation of substance use in early adolescence: the roles of pubertal timing and emotional distress.

Two hypotheses regarding the effects of pubertal timing on substance use were tested in a prospective study of 221 young adolescents. A maturational-deviance hypothesis predicted that early-maturing girls and late-maturing boys would experience heightened emotional distress, which in turn would influence initiation and use of substances. Alternatively, an early-maturation hypothesis predicted that early-maturing girls would engage in more substance use than all other groups, independent of emotional distress. Early-maturing adolescents reported more substance use within 1 year. Adolescents experiencing elevated levels of negative affect also reported greater substance use within the next year. However, pubertal timing was not related to emotional distress. Results support the early-maturation hypothesis for girls and suggest its extension to boys.

The role of behavioral experience in judging risks.

This study used conditional risk assessments to examine the role of behavioral experiences in risk judgments. Adolescents and young adults (ages 10-30; N = 577) were surveyed on their risk judgments for natural hazards and behavior-linked risks, including their personal experiences with these events. Results indicated that participants who had experienced a natural disaster or engaged in a particular risk behavior estimated their chance of experiencing a negative outcome resulting from that event or behavior as less likely than individuals without such experience. These findings challenge the notion that risk judgments motivate behavior and instead suggest that risk judgments may be reflective of behavioral experiences. The results have implications for health education and risk communication.

The roles of constructive thinking and optimism in psychological and behavioral adjustment during pregnancy.

This study examined the impact of constructive thinking on the anxiety, positive states of mind, and substance use of 221 women during pregnancy and the influence of optimism and perceived stress on these relationships. Participants were interviewed both early and late in pregnancy. Constructive thinking predicted both psychological and behavioral adjustment later in pregnancy, independent of age and social desirability. Subsequent path analyses indicated that constructive thinking mediated the impact of optimism on anxiety, positive states of mind, and substance use during pregnancy. In turn, the effect of constructive thinking on women's adjustment during pregnancy was itself mediated by their perceived stress. Implications for constructive thinking and optimism as independent constructs relevant to adjustment and their potential importance for future research and clinical applications are discussed.

Psychological factors in abortion. A review.

Psychological research is increasingly involved in debates regarding abortion. While recognizing the diversity of ethical and moral issues intertwined with abortion, the American Psychological Association (APA) has focused its involvement on psychological factors, most recently by appointing an expert panel to review the literature on psychological effects. This article notes the history of APA involvement and reports on the panel's conclusions. It presents evidence that abortion is not likely to be followed by severe psychological responses and that psychological aspects can best be understood within a framework of normal stress and coping rather than a model of psychopathology. Correlates of more negative responses following abortion are also discussed.

Socioeconomic status and health. The challenge of the gradient.

Socioeconomic status (SES) is consistently associated with health outcomes, yet little is known about the psychosocial and behavioral mechanisms that might explain this association. Researchers usually control for SES rather than examine it. When it is studied, only effects of lower, poverty-level SES are generally examined. However, there is evidence of a graded association with health at all levels of SES, an observation that requires new thought about domains through which SES may exert its health effects. Variables are highlighted that show a graded relationship with both SES and health to provide examples of possible pathways between SES and health end points. Examples are also given of new analytic approaches that can better illuminate the complexities of the SES-health gradient.