A randomized controlled trial of the Happy, Healthy, Loved personalized text-message program for new parent couples: impact on breastfeeding self-efficacy and mood.

BACKGROUND: Breastfeeding self-efficacy has been identified as an important influence on breastfeeding outcomes. Among new parent couples, partners are uniquely positioned to be sources of support for developing breastfeeding self-efficacy, yet few breastfeeding programs have attempted to involve partners directly. The purpose of this study was to test the impact of a novel program, Happy, Healthy, Loved, on breastfeeding self-efficacy and maternal mood through emphasizing partner support and actively addressing postpartum-specific stress management in a tailored text message delivery program. METHODS: A randomized trial was conducted in which primiparous mother-partner dyads intending to exclusively breastfeed were recruited at midwestern hospitals 2-3 days after delivery. The clinical trial was pre-registered at clinicaltrials.gov (#NCT04578925, registration date 7/24/2020). Couples were randomized to receive intervention or an attentional control. Couples randomized to the intervention group then completed a brief interactive educational tablet program together (Happy, Healthy, Loved), followed by 6 weeks of tailored text messages providing reminders, coping strategies, and motivational milestones to improve breastfeeding self-efficacy. Participants in the control group received usual care followed by 6 weeks of attentional control text messages about infant development. Surveys were delivered at baseline, 6 weeks, and 6 months postpartum to both mother and partner to assess breastfeeding self-efficacy, mood, and social support (n = 62 couples). RESULTS: Outcomes of ANCOVA with baseline self-efficacy as a covariate showed a significant effect of intervention on 6 months breastfeeding self-efficacy when compared to control group. No other significant differences were found at 6 weeks or 6 months postpartum in breastfeeding self-efficacy, depressive or anxious symptoms. CONCLUSIONS: Results of the present investigation suggest that a text-based dyad intervention improved breastfeeding self-efficacy at 6 months, but not 6 weeks, postpartum, indicating that text-based mother-partner interventions are a promising direction to continue exploring in postpartum health research. TRIAL REGISTRATION: Clinicaltrials.gov #NCT04578925.

Feeding under fire: Relations between parental stress hormones and controlling feeding behaviors.

Under stress, parents tend to use more controlling feeding behaviors toward their children (Berge et al., 2017; Doan et al., 2022; Loth et al., 2016). However, the majority of prior work focuses on subjective reports of stress, and there is a dearth of research examining parental physiological stress and its impact on feeding behaviors. In the current study, we examined how parental physiological stress reactivity would influence their feeding behaviors under mild stress in a lab-based setting. Parents (n = 83, 50 % females) and their children (59% female, Mage = 42 months, SD = 4.48) participated. Stress was induced using the Trier Social Stress Test in the laboratory (Kirshbaum et al., 1993). Salivary samples were collected at 4 time points during the visit to index stress reactivity and later assayed for cortisol and DHEA. Parent-child interactions during the anticipatory period of the stress test were observationally coded for parent use of controlling feeding behaviors. To examine whether parent stress physiology predicts their feeding behaviors, we ran a Poisson regression using income, parent ethnicity, parent sex (mom/dad), time of day, and DHEA/cortisol ratio as predictors of controlling feeding behavior. Latinx parents used less controlling feeding behaviors, b = -0.323, p = 0.041 than non-Latinx parents. Parents with a higher DHEA/Cortisol ratio were less likely to use controlling feeding behaviors, b = -0.231, p = 0.008. To our knowledge, this is the first study to show that for both mothers and fathers, DHEA relative to cortisol has a protective role in controlling feeding practices, and lends support to the role of acute stress reactivity in predicting behavioral outcomes.

Brief Report: An Examination of Curvilinear Relations Between Perceived Mother-Child Closeness and Maternal Hair Cortisol.

Interpersonal closeness has important health benefits; however, recent work suggests that in certain contexts, closeness can come at a cost. In the current study, curvilinear relations between mother-child closeness and health (e.g., depressive and anxiety symptoms and hair cortisol concentrations [HCC]) were tested. Our sample consisted of 117 mother (Mage = 36.86) and child (Mage = 73.07 months, 50.86% male) dyads. A quadratic relationship between maternal perceived closeness with their child and self-reported depressive and anxiety symptoms, along with overall hair cortisol output, was hypothesized. Path analysis suggested that the quadratic term was predictive of maternal cortisol (ß = 0.28, p = 0.001) and depression (ß = 0.23, p = 0.014), such that both high and low perceived closeness predict greater maternal depressive symptoms and HCCs as compared to moderate levels of closeness. Results are discussed in terms of parenting support and burnout.

Psychosocial predictors of early postpartum depressive and anxious symptoms in primiparous women and their partners.

BACKGROUND: While the majority of research on postpartum depressive and anxious symptoms has focused on mothers, a growing body of research suggests a need to understand the role of the partner's health and relationship quality as predictors of postpartum maternal depression, while also better understanding correlates of partner or paternal depression in the postpartum period. The purpose of the current study is to evaluate mother and partner stress, anxiety, mood, infant care support, and relationship quality as predictors of perinatal depressive and anxious symptoms in first time mothers and partners during the postpartum hospital stay. METHODS: First time parent couples (n = 116) completed a survey during the two-day postpartum stay in a Midwest hospital. Depressive (EPDS) and anxiety symptoms (DASS-21-Anxiety) were assessed in both mothers and partners. Hierarchical linear regression was used to evaluate relationship satisfaction, partner infant care support, stress, and co-parent mood as predictors of mood in mothers and partners separately. RESULTS: Stress was a predictor of anxiety and depression symptoms in both mothers and partners. Additionally, co-parent anxiety significantly predicted anxiety in both mothers and partners. Maternal relationship satisfaction was a predictor of the partner's depressive symptoms, and maternal perceptions of partner infant support predicted maternal depressive symptoms. CONCLUSIONS: Together, these results suggest that stress, relationship satisfaction, and co-parent mood are related to depressive and anxious symptoms in mothers and partner, underscoring the need to continue exploring mother and partner mental health in a dyadic framework.

Negative emodiversity is associated with emotional eating in adolescents: An examination of emotion dynamics in daily life.

INTRODUCTION: Emotional eating is a mental health concern, common in adolescents, that develops as a result of their tendency to use high-energy food to regulate their fluctuating emotions. Due to their highly fluctuating emotional life, adolescents tend to have unique within-person profiles of emotional experiences that change across moments and days, often lost in global assessments of emotions. Hence, it is imperative to examine individual differences in dynamics of emotions, as experienced in daily life, in relation to emotional eating in adolescents. METHODS: In an Ecological Momentary Assessment study, we examined individual differences in three within-person dynamic characteristics (baseline levels, intraindividual variability, and emodiversity) of emotions in 158 dominantly Hispanic adolescents in the United States, aged 14-17 years old, predicting trait-level emotional eating. RESULTS: Results indicated that higher negative emodiversity, baselines, and variability in stress were predictive of emotional eating in adolescents. When all considered together, negative emodiversity (i.e., variety of the types of negative emotions experienced in one's daily life) remained the only significant predictor of emotional eating. CONCLUSIONS: This study affirms the importance of diversity in emotional experiences in relation to emotional eating, particularly in daily contexts of adolescents' lives. Additionally, the study emphasizes the importance of distinguishing between diversity (i.e., variety in types) in positive versus negative emotional experiences with regard to emotional eating. By taking into account the ecological validity of adolescents' daily lives and individual differences in dynamical changes in emotions, we are taking a step forward by shedding light on how the dynamics of negative emotions-in terms of within-person baselines, variability, and diversity-might be related to general levels of emotional eating in adolescents.

Stressed out and fed up: The effect of stress on maternal feeding behaviors and the moderating role of executive function.

Stress is associated with a range of unhealthy eating habits, yet few studies have examined how stress may influence the intergenerational transmission of eating habits from parents to their children. Specifically, there is a lack of data regarding the role of stress on feeding practices. Moreover, most work investigating the associations between parental stress and their feeding behaviors has been correlational, limiting our understanding of causality. In the current study, we used an experimental design, induced high and low stress in mothers using a standard laboratory stressor, and observed mother-child interactions during a snack break. We also examined the potential role of maternal executive functioning (EF) for buffering the effects of stress on maternal feeding behaviors. Levels of maternal stress were manipulated with the Trier Social Stress Task (TSST) in a community sample (N = 80 dyads, Child Mage = 41.89 months, female = 43). We measured maternal EF with a series of computerized tasks. Maternal feeding behaviors were coded for controlling behaviors, which included pressuring and restricting behaviors. Results indicate a main effect of stress on controlling feeding behaviors, such that mothers in the high-stress condition exhibited higher levels of controlling behaviors. The effect of stress on controlling feeding behaviors was ameliorated among mothers with higher levels of EF after controlling for child age and income. Results provide causal evidence for the role of stress on feeding behaviors and suggest EF as a factor to be considered in the treatment and prevention of diet-related illnesses.

A mother's touch: Preschool-aged children are regulated by positive maternal touch.

Positive maternal touch plays an important role in the development of children's physiological regulation and cognitive development in infancy, as well as the development of sociality in early childhood. However, few studies have looked beyond infancy to consider the possible continuing impact of positive maternal touch on child stress reactivity during early childhood. A diverse community sample of mothers (N = 114, Mage  = 33.52 years, SD = 5.33) and their preschool-aged children (Mage  = 41.68 months, SD = 4.67; 49.1% female) participated in the study. Basic demographics were reported by mothers. We coded maternal touch behaviors during an emotionally charged laboratory conversation task and assessed children's physiological reactivity to stressful laboratory tasks with salivary cortisol. Results reveal a significant negative association between positive maternal touch and child salivary cortisol reactivity. In addition, family income, adjusted for family size, and child sex were significantly associated with child cortisol stress reactivity. Findings are discussed in terms of persistent downregulating effects of positive maternal touch on child stress reactivity, as well as possible links of stress reactivity with family income, a proxy for economic stress, and child sex.

Allostatic load: Developmental and conceptual considerations in a multi-system physiological indicator of chronic stress exposure.

Developmental researchers studying how stress affects health have often focused on specific, individual, physiological parameters such as cortisol. Yet, recent theories of stress biology emphasize that the stress response is multi-faceted and engages distinct yet interconnected physiological systems, including metabolic, immune, and cardiovascular systems that respond to one another. Moreover, advocates of a systems approach also argue that the confluence of changes across several physiological systems presents a health risk, even when one indicator alone is not predictive of health outcomes. Allostatic load is one potential multi-system indicator of stress, capturing the cumulative, physiological burden of chronic stress exposure on the body. At the same time, studying allostatic load during early development raises several issues, including how allostatic load is operationalized, the clinical importance of commonly used biomarkers during distinct periods of development, and the fundamental role of timing. In this review paper, we discuss the potential of allostatic load in the context of studies of stress in developmental science, review developmental studies that have assessed allostatic load, and articulate critical conceptual questions regarding the study of allostatic load during the childhood years.

Both High and Low Levels of Negative Emotions Are Associated with Higher Blood Pressure: Evidence from Whitehall II Cohort Study.

BACKGROUND: Previous studies of negative emotions and blood pressure (BP) produced mixed findings. Based on the functionalist and evolutionary perspective on emotions, we hypothesized that the association between negative emotions and BP is U-shaped, i.e., that both very high levels of negative emotions and the absence thereof are related to high BP. METHODS: Data from 7479 British civil servants who participated in Phases 1-11 (years 1985-2013) of the Whitehall II cohort study was used. Negative emotions were operationalized as negative affect and depressive and anxiety symptoms. Negative affect was measured at Phases 1 and 2. Anxiety and depressive symptoms were assessed at each phase. BP was measured at every other phase. For each negative emotion measure, an average across all phases was computed and used as a predictor of PB levels throughout the follow-up period using growth curve models. RESULTS: Very high values of anxiety and depressive symptoms, but not negative affect, were associated with higher levels of systolic BP. However, low to moderate levels of all negative emotions were associated with lower blood pressure than the absence of negative emotions. CONCLUSIONS: The article offers a theoretical explanation for a previously observed inverse association between negative emotions and blood pressure and underscores that moderate levels of negative emotions that naturally occur in everyday life are not associated with risks of heightened blood pressure.

Maternal expressive suppression moderates the relations between maternal and child hair cortisol.

Self-reports and physiological indicators of stress such as cortisol levels are correlated in maternal and child samples. This relationship is likely to be influenced by maternal emotion regulation. Herein, we investigate the moderating role of maternal regulation strategies on the association between maternal and child hair cortisol levels. Mother-child dyads (N = 63, child mean age = 49.74 months) participated in the study. Hair samples were collected from mother and child, and cortisol was assayed. Mothers reported on their own emotion regulation strategies, namely expressive suppression and cognitive reappraisal. As expected, mother and child hair cortisol levels were significantly correlated. Interestingly, the relation between maternal and child hair cortisol was moderated by maternal suppression of emotion. Mother and child hair cortisol levels were related at low levels of maternal suppression, but not at higher levels of suppression. Maternal cognitive reappraisal of emotion was not associated with cortisol levels.

Life Events, Emotions, and Immune Function: Evidence from Whitehall II Cohort Study.

Stressful life events have been shown to increase vulnerability to infections. However, the effects may be dependent on specific emotional responses associated with these events. In general, negative emotions are thought to exacerbate and positive emotions to protect from the adverse effects of stressors on health. In this study, we adopted an evolutionary and functionalist perspective on emotions and hypothesized that both positive and negative emotions in response to stressful events are protective, whereas absence of emotional reactions exacerbates vulnerability to infections. We assessed immune function using lymphocytes to white blood cells ratio as a proxy for current viral infection in 3,008 British civil workers (30% women). No main effect of stressful life events or emotions on lymphocyte ratio was observed in either sex. However, in men, there was an interaction of life events with both positive and negative emotions as well as a combined measure of general affect. Supporting our hypothesis, stressful life events were associated with impaired immune function in men who reported very low levels of both positive and negative emotions but not in others. We discuss potential benefits of negative and positive emotions in the context of stress and immunity.

Moderate emotional reactions to stressful life events are associated with lowest risk of increased alcohol consumption: evidence from the Whitehall II study.

BACKGROUND: Research investigating the associations between stress-related negative emotions and alcohol consumption often assumes a linear dose-response relationship. Based on the current theories of emotions, we questioned this assumption and hypothesized that both very low and very high levels of negative emotional response (NER) to stressful life events are related to increased alcohol consumption. METHODS: We used data from Phases 1 (1985-88) and 2 (1989-90) of the British Whitehall II study. At both phases, participants reported on their alcohol consumption, recent stressful events and the NER to the events. Two thousand and sixteen participants without recent stressful events at baseline were selected. Logistic regression was used to model the association between emotional response at baseline and increased frequency of alcohol consumption between the two phases. RESULTS: The likelihood of increased alcohol consumption increased with the number of recent stressful events. Among participants with at least one event, 17% increased alcohol consumption, compared with 14% of those who reported no events. Participants with average NER were at lowest risk (14%) of increasing alcohol consumption after major life events. Those with highest NER were significantly more likely to increase alcohol consumption (20%) than those with average NER, but the difference between those with highest NER and those with lowest NER (17%) was not statistically significant. CONCLUSIONS: Increases in alcohol consumption following stressful events are least likely if people experience moderate levels of NER to events. Negative emotions in moderate doses should not be regarded as a risk factor for unhealthy behaviours, but rather a potentially protective factor.

Innovations in biological assessments of chronic stress through hair and nail cortisol: Conceptual, developmental, and methodological issues.

Much of the existing research on biological mechanisms underlying the stress experience has focused largely on moment-to-moment stress, rather than on chronic stress, an arguably more powerful predictor of long-term outcomes. Recent methodological innovations have paved the way for new lines of research on chronic stress, with promising implications for developmental researchers and for those who study health and adversity. In particular, there are increasing studies that have focused on chronic stress assessments by relying on cortisol derived from hair and nails as a biomarker for chronic stress. In this paper, we provide an overview of their use, describe how hair and nail cortisol ought to be conceptualized differently across the lifespan, how developmental factors may impact its interpretation, and the circumstances under which its use may be more methodologically sensible. The purpose of this review is to provoke further discussion and encourage careful research designs that utilize hair and nail cortisol for understanding the effects of chronic stress exposure from the early developmental period, across adverse contexts, and in association with psychological and physical health outcomes.

Investigating relations among stress, sleep and nail cortisol and DHEA.

In the current study, we present data investigating the relationships among stress, sleep disturbance, self-control, and levels of cortisol (CORT) and dehydroepiandrosterone (DHEA) in fingernail clippings. Currently, hair CORT is the only routinely used noninvasive, validated, biomarker of chronic exposure to stress-related hormones. Nail clippings represent an important potential alternative sample matrix for assessing chronic hormone exposure, as it offers a different timeline of hormone incorporation than scalp hair, and may be obtainable from populations in which hair either is lacking or is unavailable for cultural reasons. Moreover, there is established precedent for using fingernail clippings to attain biomarker data. However, the value of nail hormone assessment for psychological research is currently unknown due to a paucity of information on the relations between nail hormone concentrations and environmental or psychological variables. In the present study, we collected data from a low income, minority population (N = 47; 97% African American) to demonstrate feasibility and acceptability of nail collection and analysis of the adrenal steroids CORT and DHEA. Participants reported on perceived stress, sleep and self-control abilities. Correlational analyses suggest that exposure to stressful events, disturbances in sleep and waking were associated with higher levels of nail DHEA, while self-control was associated with higher levels of nail CORT. We discuss the potential importance of this methodology for investigating biological, behavioral, and subjective indices of stress and well-being.

Salivary cortisol reactivity in preschoolers is associated with hair cortisol and behavioral problems.

The interplay between children's cortisol reactivity to challenge and cumulative cortisol exposure is not well understood. Examining the role of cortisol reactivity in early childhood may elucidate biological mechanisms that contribute to children's chronic physiological stress and behavioral dysregulation. In a sample of 65 preschool-aged children, we examined the relation between children's salivary cortisol reactivity to challenging tasks and their hair cortisol concentration (HCC). While both are biomarkers of the hypothalamic-pituitary-adrenal (HPA) axis, salivary cortisol reactivity reflects an acute cortisol response to a stressor and HCC reflects cumulative cortisol exposure. In addition, we examined the relations of these stress biomarkers with internalizing and externalizing problems. Salivary cortisol reactivity was associated with higher HCC and with increased externalizing behaviors. Child HCC also was positively correlated with parent HCC. Results highlight the contributions of salivary cortisol reactivity to children's cumulative cortisol exposure, which may add to their biological risk for health problems later. The observed association between externalizing problems and salivary cortisol reactivity indicates concordances between dysregulated behavioral reactions and dysregulated cortisol responses to challenges. The finding that salivary cortisol reactivity to challenge in early childhood plays a role in children's cumulative cortisol exposure and behavioral development suggests pathways through which cortisol reactivity may influence long-term physical and mental health.

Prenatal Life Events, Maternal Employment, and Postpartum Depression across a Diverse Population in New York City.

This study examined racial/ethnic disparities in three core postpartum depression (PPD) symptoms, and identified specific predictors of PPD including sociodemographic variables, life stressors and maternal employment. White, African American, Hispanic, and Asian/Pacific Islander women from the New York City area (n = 3010) completed the 2009-2011 Pregnancy Risk Assessment Monitoring System. African American women were less likely to have PPD than White women. Maternal employment during the postpartum was associated with an increased likelihood of PPD for White women relative to women who were not employed. Life stressors and maternal employment should be considered as culturally contextualized factors related to postpartum depression.

Consequences of 'tiger' parenting: a cross-cultural study of maternal psychological control and children's cortisol stress response.

Parenting strategies involving psychological control are associated with increased adjustment problems in children. However, no research has examined the extent to which culture and psychological control predict children's stress physiology. We examine cultural differences in maternal psychological control and its associations with children's cortisol. Chinese (N = 59) and American (N = 45) mother-child dyads participated in the study. Mothers reported on psychological control. Children's cortisol was collected during a stressor and two indices of Area Under the Curve (AUC) were computed: AUCg which accounts for total output, and AUCi, which captures reactivity. Results indicate that Chinese mothers reported higher levels of psychological control and Chinese children had higher levels of AUCg than their American counterparts. Across both cultures, psychological control was significantly associated with increased cortisol levels as indexed by AUCg. There were no associations for AUCi. Finally, mediation analyses demonstrated that psychological control fully explained cultural differences in children's cortisol stress response as indexed by AUCg.

Getting some space: Infants' and caregivers' containment and support spatial constructions during play.

Using a cross-sectional design, we examined the containment and support spatial constructions infants spontaneously create and those they observe when playing with a nesting toy. Infants (N=76) of 8, 13, or 18months played alone for 2min and then played with a caregiver for another 2min. At 8months, infants created few relations; at 13months, they inserted objects, resulting in containment, and stacked objects, resulting in support; at 18months, they created more than three times more containment relations than support relations, a result replicated in a second study. In contrast, caregivers created more support relations than containment relations, regardless of infant age, but labeled containment more than support. The results highlight differential exposure to containment and support in infant solitary and dyadic play. By 18months, infants gain greater firsthand experience with containment, a relation that is further reinforced by caregiver labeling.

Do as I do, not as I say: Actions speak louder than words in preschoolers learning from others.

To date, no research has examined children's imitative abilities in the context of learning self-regulatory strategies from adults-especially when there is a conflict between communicative intent and later behavior. A sample of 84 4- and 5-year-olds performed a delay-of-gratification task after observing an adult perform the same task. Across four between-participants conditions, the model either did or did not state her intention to complete the task (positive vs. negative communication), modeled self-regulatory strategies, and then either did or did not complete the task successfully (positive vs. negative outcome). Children in the positive outcome conditions were more likely to imitate the novel strategies and successfully wait in both familiar and unfamiliar self-regulation tasks irrespective of the model's communicated intent. We discuss implications for practice and interventions.

Racial and socioeconomic disparities in body mass index among college students: understanding the role of early life adversity.

The role of early life adversity (ELA) in the development of health disparities has not received adequate attention. The current study examined differential exposure and differential vulnerability to ELA as explanations for socioeconomic and racial disparities in body mass index (BMI). Data were derived from a sample of 150 college students (M age  = 18.8, SD = 1.0; 45 % African American; 55 % European American) who reported on parents' education and income as well as on exposure to 21 early adverse experiences. Body measurements were directly assessed to determine BMI. In adjusted models, African American students had higher BMI than European Americans. Similarly, background socioeconomic status was inversely associated with BMI. Significant mediation of group disparities through the pathway of ELA was detected, attenuating disparities by approximately 40 %. Furthermore, ELA was more strongly associated with BMI for African Americans than for European Americans. Efforts to achieve health equity may need to more fully consider early adversity.