Equipping the Public Health Workforce of the Future: Evaluation of an Evidence-Based Public Health Training Delivered Through Academic-Health Department Partnerships.

OBJECTIVE: Maintaining a skilled public health workforce is essential but challenging given high turnover and that few staff hold a public health degree. Situating workforce development within existing structures leverages the strengths of different organizations and can build relationships to address public health challenges and health equity. We implemented and evaluated an innovative, sustainable model to deliver an established evidence-based public health (EBPH) training collaboratively among Prevention Research Centers (PRC), local and state health departments, and Public Health Training Centers (PHTC). DESIGN: Quantitative data: quasi-experimental, 1-group pre-post. Qualitative data: cross-sectional. Data were collected between December 2021 and August 2022. SETTING: Four US sites, each a partnership between a PRC, local or state health department, and a PHTC. PARTICIPANTS: Governmental public health staff and representatives from other organizations that implement public health programs in practice settings. MAIN OUTCOME MEASURES: Course participants completed a pre- and postcourse survey self-rating 14 skills on a 5-point Likert scale. Differences were analyzed using mixed effects linear models. In-depth interviews (n = 15) were conducted with course faculty and partners to understand: (1) resources contributed, (2) barriers and facilitators, (3) benefits and challenges, and (4) resources needed to sustain this model. Interviews were transcribed verbatim, and a thematic analysis identified themes. RESULTS: Statistically significant increases in all skills were observed from pre- to postcourse (n = 241 at post, 90% response). The skills with the largest increases were understanding economic evaluation enough to inform decision-making (mean change = 1.22, standard error [SE] = 0.05) and developing an action plan (mean change = 1.07, SE = 0.07). Facilitators to delivering the course included having a shared goal of workforce development, existing course curricula, and dedicated funding for delivering the course. CONCLUSIONS: Collaborative delivery of the EBPH training can ameliorate the effects of high staff turnover, strengthen academic-practice relationships, and promote population-wide health and health equity.

Psychological needs fulfillment and perinatal well-being among low-SES individuals: a mixed methods investigation.

Poor perinatal mental health is associated with deleterious effects and individuals with low socioeconomic status (SES) are at elevated risk. Fortifying multi-level resources of low-SES pregnant individuals to boost their well-being is a crucial step toward achieving equity in perinatal health. The purpose of this project was to explore what patterns of resources supported well-being among low-SES pregnant individuals in Colorado. In a prospective mixed methods cohort study, 23 low-SES pregnant individuals completed surveys and interviews. Participants were separated into 3 subgroups based on their overall Warwick-Edinburgh Mental Well-being Scale (WEMWBS) score and interviewed to identify multi-level resources that supported their well-being. Our analysis was framed by Self-Determination Theory which contends that three universal basic psychological needs are required for individuals to function in a healthy manner: autonomy, competence, and relatedness. We extrapolated resources that promoted perinatal competence, autonomy, and relatedness from the high well-being group. Perinatal-related knowledge (construct related to competence); mindfulness and intended pregnancy (constructs related to autonomy); and emotional, informational, and friend support, social capital, and connection to nature (constructs related to relatedness) were identified as the resources more frequently endorsed in the high well-being group. Targeting interventions to fortify specific multi-level resources that support the autonomy, competence, and relatedness of pregnant individuals facing socioeconomic disadvantage is a crucial step toward achieving equity in perinatal health.

A process evaluation of a randomized-controlled trial of community gardening to improve health behaviors and reduce stress and anxiety.

As part of the Community Activation for Prevention (CAPS) randomized controlled trial (RCT) of community gardening, we conducted a process evaluation to assess the implementation of a community gardening intervention over nine months, as measured by reach, fidelity (delivery, receipt, enactment), and acceptability. Evaluation instruments included repeated semi-structured interviews with study participants, direct observation of community garden sites, and an exit survey of participants. Primary outcomes were diet, physical activity, and anthropometry; secondary outcomes were stress and anxiety. The CAPS trial included 291 participants (19% non-white; 34% Hispanic/Latino; 35% without a college degree; 58% with income < $50,000 per year). Intervention delivery and receipt were high for environmental supports. Garden social events were offered by 73% of gardens, although only 48% of intervention participants reported attending these events. Of the 145 participants assigned to the gardening intervention, 97 (67%) reported gardening the entire season and reported visiting the community garden a median of 90 min per week (range: 0-840). Of the participants who completed the exit survey (48%), 89% were highly satisfied with the overall garden experience. The CAPS trial was favorably received and implemented with high fidelity, supporting the validity of the trial outcomes. These findings suggest that community gardens are a viable health promotion strategy that can be successfully implemented among new gardeners from diverse backgrounds. Strategies that engage new gardeners in the social aspects of the garden environment and connect gardeners with garden "mentors" or "buddies" to ensure new gardeners achieve success in their first years of gardening are recommended.Trial registration: NCT03089177. Registered 24 March 2017, https://clinicaltrials.gov/study/NCT03089177 .

Understanding rural social networks addressing adverse childhood experiences: A case study of the San Luis Valley.

INTRODUCTION: The purpose of this study is to assess a cross-sector, interorganizational network addressing adverse childhood experiences (ACEs) in a rural Colorado community. We characterize the organizations in the network, assess their awareness of ACEs, and evaluate how they participate in the network. We also assess the network health. METHOD: Employing a social network analysis approach, we collected survey data from 45 organizations that support young children and their families, including nonprofits, health care clinics, and early childhood education centers, among others. RESULTS: On average, nonprofit organizations had relationships with a greater percentage of network members than other types of organizations. Network members engaged in relationships focused on a wide range of activities (e.g., client assessments, sharing information, providing services), with some organizational types leading the network in certain activities. Scores across all dimensions of trust and value were above 3 (range: 2.1-3.8), which is advantageous for a network and network relationships existed across a range of relational intensities (from awareness to organizational integration). DISCUSSION: Nonprofit organizations that reported high levels of connectedness in the network were able to effectively mobilize the ACEs network. Health clinics participated in a greater share of relationships involving assessment, service provision, and tool sharing than other types of organizations. As such, health care clinics may serve as leaders in directly serving children and families experiencing ACEs in rural communities. The rural context may also explain high levels of trust and value, which can serve as assets for future network development and mobilization. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

My Baby, My Move+: feasibility of a community prenatal wellbeing intervention.

BACKGROUND: Excessive gestational weight gain (EGWG), insufficient prenatal physical activity and sleep, and poor psychological wellbeing independently increase risks for adverse maternal and infant outcomes. A novel approach to mitigate these risks is utilizing peer support in a community-based prenatal intervention. This study assessed the feasibility (acceptability, demand, implementation, and practicality) of a remotely delivered prenatal physical activity intervention called My Baby, My Move + (MBMM +) that aims to increase prenatal physical activity, enhance mood and sleep hygiene, and reduce EGWG. METHODS: Participants were recruited through community organizations, local clinics, and social media platforms in the Fall of 2020 and Spring of 2021. Eligible pregnant women were randomized to either the MBMM + intervention or the control group. Each group met over Zoom for 16 sessions (twice weekly for 60 min over 8 weeks) to learn either behavioral change and wellbeing knowledge and skills (MBMM +) or knowledge and skills related to parenting (control group). Multiple methods of evaluation to better understand the feasibility of the intervention were conducted. RESULTS: A total of 49 women (25 MBMM + intervention, 24 control) completed both pre- and post-survey assessments and were included in the analyses. A subsample of 19 (39%) intervention participants completed a combination of semi-structured interviews/surveys to assess acceptability, demand, implementation, and practicality. Participants expressed positive feedback regarding acceptability (satisfaction and intent to continue use) and were extremely likely or likely to recommend the program to a friend (demand). Implementation metrics were assessed by observation and feedback forms completed by peer leaders and demonstrated high-quality control. Findings suggest that the intervention was practical due to remote sessions and cost-effectiveness. CONCLUSION: The MBMM + intervention was deemed to be a feasible intervention with high acceptability, demand, implementation, and practicality. These findings can be used to inform the scalability of the intervention and implementation of a larger efficacy trial. TRIAL REGISTRATION: 19-1366, initial date is on January 23, 2020.

Risk and protective factors for mental health and wellbeing among adolescent orphans.

Background: Research has demonstrated the importance of understanding risk factors for mental health and wellbeing. Less research has focused on protective factors that protect mental health and promote wellbeing in diverse contexts. Estimating structural paths from risk protective factors to psychopathology and wellbeing can inform prioritization of targeted investment in adolescent health programs that seek to modify factors that are most closely associated with mental wellbeing. Study objective: The purpose of this study was to examine risk factors (e.g. emotional neglect, emotional abuse, physical neglect, stigma) and protective factors (e.g. community relationships, self-esteem, and autonomy) among adolescent orphans, protective associations with depression, anxiety and externalizing behaviors and promotive associations with hope, happiness, and health. Methods: The analytic sample was collected between January and March of 2019 and included 350 adolescent orphans ages 10-15 from three districts in Tanzania. Participants completed survey interviews, 75-90 min in length, that measured risk and protective factors, psychological symptoms, and mental wellbeing measures. Results: Results of the fitted structural equation model indicated that structural paths from protective factors to psychopathology (ß = -0.53, p = 0.015) and mental wellbeing (ß = 0.72, p = 0.014) outcomes were significant. Structural paths from risk factors to psychopathology (ß = -0.34, p = 0.108) and mental wellbeing (ß = -0.24, p = 0.405) were not significant. Conclusion: In a sample of vulnerable youth, protective factors (e.g. community relationships, self-esteem, and autonomy) were significantly associated with reduced depression, anxiety and externalizing behaviors and increased hope, happiness, and health in a structural equation model that included risk factors (emotional neglect, emotional abuse, physical neglect). Results suggest that strong community relationships, self-esteem and autonomy may be important modifiable factors to target in intervention programs aimed at supporting adolescent mental wellbeing.

Psychometric validation of the collective asset Utu: associations with coping strategies and resilience during adolescence.

BACKGROUND: Utu is a Kiswahili term with a long history of cultural significance in Tanzania. It conveys a value system of shared, collective humanity. While variants of Utu have been studied in other contexts, a measure of Utu that captures this important collective asset has not been developed in Tanzania. The aims of this study were to (1) examine dimensional constructs that represent Utu, (2) validate a measurement scale of Utu for use with adolescents, (3) examine differences between orphan and non-orphan adolescents in self-reported Utu and, (4) examine structural paths between adverse life experiences, coping strategies, Utu, and resilience.  METHODS: This study collected survey data from adolescents from three districts in peri-urban Tanzania in two samples: 189 orphan adolescents ages 10-17 in May 2020 and 333 non-orphan adolescents ages 10-14 in August 2020. Confirmatory factor analysis was used to validate the hypothesized factor structure of the developed Utu measure. Structural equation models were used to examine path associations with adverse life experiences, coping and resilience. RESULTS: The five dimensional constructs comprising the Utu measure included Resource Sharing, Group Solidarity, Respect and Dignity, Collectivity, and Compassion. Confirmatory factor analysis of the Utu measure demonstrated excellent fit (CFI = 0.98; TLI = 0.97; SRMR = 0.024; RMSEA = 0.046) and internal consistency (α = 0.94) among adolescents in this study. Positive, significant associations were found between Utu and coping (ß = 0.29, p < 0.001) and Utu and intra/interpersonal and collective resilience (ß = 0.13, p < 0.014). Utu was not significantly associated with adverse life experiences, age or gender. CONCLUSIONS: A five-dimensional measurement scale for Utu was validated in a sample of orphan and non-orphan adolescents in Tanzania. Utu is a collective asset associated with higher levels of reported resilience in both orphan and non-orphan adolescent populations in Tanzania. Promoting Utu may be an effective universal public health prevention approach. Implications for adolescent programming are discussed.

Effects of a community gardening intervention on diet, physical activity, and anthropometry outcomes in the USA (CAPS): an observer-blind, randomised controlled trial.

BACKGROUND: Unhealthy diet, physical inactivity, and social disconnection are important modifiable risk factors for non-communicable and other chronic diseases, which might be alleviated through nature-based community interventions. We tested whether a community gardening intervention could reduce these common health risks in an adult population that is diverse in terms of age, ethnicity, and socioeconomic status. METHODS: In this observer-blind, randomised, controlled trial, we recruited individuals who were on Denver Urban Garden waiting lists for community gardens in Denver and Aurora (CO, USA), aged 18 years or older, and had not gardened in the past 2 years. Participants were randomly assigned (1:1), using a randomised block design in block sizes of two, four, or six, to receive a community garden plot (intervention group) or remain on a waiting list and not garden (control group). Researchers were masked to group allocation. Primary outcomes were diet, physical activity, and anthropometry; secondary outcomes were perceived stress and anxiety. During spring (April to early June, before randomisation; timepoint 1 [T1]), autumn (late August to October; timepoint 2 [T2]), and winter (January to March, after the intervention; timepoint 3 [T3]), participants completed three diet recalls, 7-day accelerometry, surveys, and anthropometry. Analyses were done using the intention-to-treat principle (ie, including all participants randomly assigned to groups, and assessed as randomised). We used mixed models to test time-by-intervention hypotheses at an α level of 0·04, with T2 and T3 intervention effects at an α level of 0·005 (99·5% CI). Due to potential effects of the COVID-19 pandemic on outcomes, we excluded all participant data collected after Feb 1, 2020. This study is registered with ClinicalTrials.gov, NCT03089177, and data collection is now complete. FINDINGS: Between Jan 1, 2017, and June 15, 2019, 493 adults were screened and 291 completed baseline measures and were randomly assigned to the intervention (n=145) or control (n=146) groups. Mean age was 41·5 years (SD 13·5), 238 (82%) of 291 participants were female, 52 (18%) were male, 99 (34%) identified as Hispanic, and 191 (66%) identified as non-Hispanic. 237 (81%) completed measurements before the beginning of the COVID-19 pandemic. One (<1%) participant in the intervention group had an adverse allergic event in the garden. Significant time-by-intervention effects were observed for fibre intake (p=0·034), with mean between-group difference (intervention minus control) at T2 of 1·41 g per day (99·5% CI -2·09 to 4·92), and for moderate-to-vigorous physical activity (p=0·012), with mean between-group difference of 5·80 min per day (99·5% CI -4·44 to 16·05). We found no significant time-by-intervention interactions for combined fruit and vegetable intake, Healthy Eating Index (measured using Healthy Eating Index-2010), sedentary time, BMI, and waist circumference (all p>0·04). Difference score models showed greater reductions between T1 and T2 in perceived stress and anxiety among participants in the intervention group than among those in the control group. INTERPRETATION: Community gardening can provide a nature-based solution, accessible to a diverse population including new gardeners, to improve wellbeing and important behavioural risk factors for non-communicable and chronic diseases. FUNDING: American Cancer Society, University of Colorado Cancer Centre, University of Colorado Boulder, National Institutes of Health, US Department of Agriculture National Institute of Food and Agriculture, Michigan AgBioResearch Hatch projects.

Evaluating an Online Intervention to Improve Provider Management of Prenatal Depression: A Randomized Controlled Trial.

INTRODUCTION: Prenatal depression is associated with numerous deleterious maternal and child health outcomes. Providers play a significant role in managing (i.e., identifying and treating or referring to care for) prenatal depression. We conducted a randomized controlled trial to test the effects of a brief online training on self-reported provider management practices related to prenatal depression. METHODS: Providers (i.e., physicians, nurses, mental health specialists, and public health educators) were randomized into intervention (i.e., online training) or waitlist control arms. The online training covered guidelines and evidence-based practices related to managing prenatal depression. Changes in providers' knowledge, attitudes, and self-reported practices were assessed by the Management of Maternal Depression Inventory at baseline (T1), 6 weeks after baseline (T2), and 12 weeks after baseline (T3). RESULTS: A total of 108 providers from Colorado and Virginia participated in the trial. Over the three time periods, repeated measures analysis of variance revealed Time × Group relative improvements for the intervention group with respect to satisfaction with working with mental health services, F(1,97) = 10.89, p = .001, partial η2 = 0.10, and increased self-reported screening, counseling, and referral for prenatal depression, F(1,97) = 6.25, p = .014, partial η2 = 0.06. A similar improving pattern was observed for self-efficacy, F(1,99) = 2.48, p = .13, partial η2 = .02. CONCLUSIONS: Findings from our study suggest a brief online training may enhance the likelihood of providers screening, treating, and/or referring at-risk patients for follow-up care for prenatal depression.

Rural parents' attitudes and beliefs on the COVID-19 pediatric vaccine: An explanatory study.

The coronavirus disease 2019 (COVID-19) first came to the Unites States in January 2020. Though adult and pediatric vaccines became available to the public, vaccine uptake among youth and particularly younger children has been gradual. This explanatory study aimed to better understand parents' attitudes and beliefs of the pediatric COVID-19 vaccine and the barriers and facilitators to vaccine uptake in a rural community through a brief, online demographic survey, and in-depth qualitative interviews. Forty-one in depth interviews were conducted with parents (31-English and 10-Spanish-speaking) residing in rural and frontier counties in Colorado between September 2021 and February 2022. Six emergent themes related to COVID-19 pediatric vaccine uptake were identified among the population. These themes spanned the three levels of influence in the Social Ecological Model (individual, interpersonal, and community levels). The six themes were identified as such; 1) Vaccine accessibility was associated with pediatric COVID vaccine uptake in rural communities, 2) Previous pediatric vaccine behaviors were not associated with COVID-19 pediatric vaccine uptake, 3) Perceived health status of a child or family member influenced pediatric COVID-19 vaccine uptake, 4) COVID-19 health seeking behaviors, like COVID pediatric vaccine uptake, are influenced by an individual's prosocial or individualistic perspectives, 5) Child autonomy and "age of consent" frames vaccine decision making behaviors in parents, and lastly 6) Social networks impacted COVID-19 pediatric vaccine decision making. These findings inform next steps for COVID-19 pediatric vaccine uptake including targeted and tailored messaging for communities (cues to actions), engaging youth stakeholders, and identifying trusted sources to build rapport and trust between health professionals and community members. The growing vaccine hesitancy among parents has serious implications for disease eradication and future viral outbreaks. Understanding the perceived barriers and facilitators to pediatric vaccine uptake is important to maintain the health of our youth and communities.

Psychometric properties of the empathy questionnaire for children and adolescents in a sample of Tanzanian adolescents.

Construct definitions of empathy have sought to distinguish between different domains of empathetic capacity that are related to psychological distress or wellbeing. This study aims to validate the psychometric properties of the Empathy Questionnaire for Children and Adolescents (EmQue-CA) and to test for measurement invariance by gender in a sample of 579 very young adolescents (270 boys and 309 girls) ages 9-12 from Tanzania. Exploratory and confirmatory factor analysis were completed to assess the factor analytic structure of the EmQue-CA, indicating a three-factor model fit these data well. Concurrent validity was demonstrated through strong significant correlations with prosocial behavior and generosity measures. Convergent validity indicated the behavioral subdimension of empathy, intent to comfort, was significantly and negatively associated with externalizing behaviors. Measurement invariance by gender was not supported for these data due to configural invariance in covariance between cognitive empathy and intent to comfort latent constructs. These findings confirm the EmQue-CA is an important measure of three dimensions of empathy; affective empathy, cognitive empathy, and behavioral empathy (intent to comfort) in a sample of Tanzanian adolescents.

Mother's Milk Messaging™: trial evaluation of app and texting for breastfeeding support.

BACKGROUND: New mothers experience BF challenges but have limited evidence-based technology-enabled support. OBJECTIVES: 1) Determine if using the Mother's Milk Messaging™ app improved aspects of breastfeeding and breastfeeding rates and 2) Describe engagement as well as themes from the qualitative feedback on the app. METHOD: Randomized Controlled Trial National sample of primiparous, singleton mothers recruited online and then randomized using stratification by language into three arms: 1) BF text messages plus app; 2) BF text messages, app and physician-moderated private Facebook (FB) group; 3) Attention control group who received injury prevention texts. Exclusive breastfeeding rates as primary outcome and knowledge/attitude, confidence, and social support as secondary outcomes. We determined engagement through analysis of app usage metrics. We conducted and content-coded interviews with participants to learn more about app usage and BF experience. Due to the nature of the intervention participants could not be blinded. RESULTS: There were a total of 346 participants in the trial, with 227 in the Intervention (n = 154 group 1 and n = 156 group 2) and 119 in the control group. Because of minimal Facebook activity, the two intervention groups 1 and 2 were combined. There were no differences in breastfeeding exclusivity and duration. (NS). Women in the intervention arm reported significantly higher confidence with breastfeeding and perceived social support to the control group (p < .05). Greater than 80% registered the app and those that engaged with the app had higher scores with time. Mothers appreciated receiving text messages and videos with reliable information. No harm was reported in this study. CONCLUSION: MMM increased confidence with breastfeeding and with gathering social supports. Exclusively BF was high in all participants. Mothers perceived it as useful and dependable especially the texting.

Prenatal yoga and excessive gestational weight gain: A review of evidence and potential mechanisms.

PURPOSE: To review the evidence of the potential mechanisms (behavioral, psychological/emotional, and physical factors) of prenatal yoga for preventing excessive gestational weight gain (GWG) in pregnant women to guide future research. MAIN BODY: Prenatal yoga is a common form of physical activity during pregnancy and includes a combination of physical postures, breath control and meditation. This review theorizes how combining physical activity (i.e., prenatal yoga postures) with the add-ons brought by prenatal yoga (e.g., breath control, meditation), might provide a more comprehensive and effective strategy to prevent excessive GWG than physical activity alone. This article a) summarizes the literature on potential mechanisms of prenatal yoga to prevent excessive GWG specifically focusing on behavioral (diet, physical activity, and sleep), psychological/emotional (self-awareness, emotion regulation, stress, mood, mindfulness) and physical factors (pregnancy discomforts), b) highlights limitations of current studies, and c) provides suggestions for future research. The findings demonstrate there is insufficient evidence that prenatal yoga improves behavioral, psychological/emotional and physical factors in pregnant women and more research is needed. Though these factors have been more strongly linked to improved weight outcomes in non-pregnant populations, further testing in pregnant women is necessary to draw definitive conclusions for the efficacy of prenatal yoga to prevent excessive GWG. CONCLUSION: Effective strategies are needed to prevent excessive GWG to encourage optimal maternal and child health outcomes. More research is warranted to evaluate the impact of prenatal yoga on weight outcomes during pregnancy and design studies to test the proposed mechanisms discussed in this review.

Fostering Resilience Among Mothers Early (FRAME): using growth mixture modeling to identify resources that mitigate perinatal depression.

The primary objective of this study was to delineate classes of individuals based on depression trajectories from the antenatal period through 54-month postpartum and internal and external resources that are associated with low depression risk. Participants came from the Growing Up in New Zealand (GUiNZ) study (n = 5664), which is a pregnancy cohort study and is nationally representative of the ethnic and socioeconomic diversity of contemporary New Zealand births. Growth curve mixture modeling was used to identify distinct subgroups based on depression scores from the antenatal period through 54-month postpartum. Logistic regression models were run to investigate socioeconomic factors and internal and external resources that were associated with depression class membership. A two-class model, "low risk" and "high risk," resulted in the best model fit. Most of the sample (n = 5110, 90%) fell into the "low-risk" class defined by no-to-mild depression symptoms during pregnancy and decreasing depressive symptoms over time (bintercept = - .05, bslope = - .05). Approximately 10% of the sample fell into the "high-risk" class (n = 554, 10%) defined by mild-to-moderate depressive symptoms during pregnancy and increasing depressive symptomology over time (bintercept = .39, bslope = .57). More positive parenting-related attitudes, better pre-pregnancy self-reported health, informal social supports, and community belonging were significantly associated with greater odds of being in the "low-risk" class, after controlling for socioeconomic factors. These findings suggest that targeting internal and external resources for individuals across the perinatal and early childhood periods is important to mitigating maternal depression.

The Effect of the Affordable Care Act on Women's Postpartum Insurance and Depression in 5 States That Did Not Expand Medicaid, 2012-2015.

BACKGROUND: Before the Affordable Care Act (ACA), most women who gained pregnancy-related Medicaid were not eligible for Medicaid as parents postpartum. The ACA aimed to expand health insurance coverage, in part, by expanding Medicaid; introducing mandates; reforming regulations; and establishing exchanges with federal subsidies. Federal subsidies offer a means to coverage for individuals with income at 100%-400% of the federal poverty level who do not qualify for Medicaid. OBJECTIVE: The objective of this study was to identify the effects of the ACA's non-Medicaid provisions on women's postpartum insurance coverage and depressive symptoms in nonexpansion states with low parental Medicaid thresholds. PARTICIPANTS: Women with incomes at 100%-400% of the federal poverty level who had prenatal insurance and completed the Pregnancy Risk Assessment Monitoring System (2012-2015). SETTING: Five non-Medicaid expansion states with Medicaid parental eligibility thresholds below the federal poverty level. DESIGN: Interrupted time-series analyses were conducted to examine changes between pre-ACA (January 2012-November 2013) and post-ACA (December 2013-December 2015) trends for self-reported loss of postpartum insurance and symptoms of postpartum depression. RESULTS: The sample included 9,472 women. Results showed significant post-ACA improvements where the: (1) trend for loss of postpartum insurance reversed (change of -0.26 percentage points per month, P=0.047) and (2) level of postpartum depressive symptoms decreased (change of -3.5 percentage points, P=0.042). CONCLUSIONS: In these 5 states, the ACA's non-Medicaid provisions were associated with large increases in retention of postpartum insurance and reductions in postpartum depressive symptoms, although depressive symptoms findings are sensitive to model specification.

Parents' Mental Health Experiences during the Perinatal Transition: A Qualitative Study.

Capturing the voices of both parents regarding perinatal mental health is imperative. This qualitative study employed a purposive sampling technique to interview 23 individuals, including mothers, partners, and perinatal practitioners/educators. Qualitative data analysis utilized an inductive, data-driven approach. Four themes emerged. First, mothers' perception of risk of postpartum depression (PPD) changed over time and with subsequent children. Theme two focused on identity loss. Third, the stay-at-home parent often feels unrecognized by their partner. Fourth, a PPD prevention class for parents should include certain key elements. These themes can aid practitioners in prioritizing the needs of parents during the perinatal period.

Maternal depression trajectories and child BMI in a multi-ethnic sample: a latent growth modeling analysis.

BACKGROUND: Perinatal (antenatal and postpartum) depression impacts approximately 12% of mothers. Perinatal depression can impact everyday functioning for mothers, and the relationship with, and development of, their children. The purpose of this study was to investigate depression trajectories from the antenatal period through 54-months postpartum and associations with child body mass index at 54-months postpartum. METHODS: This study applied latent growth modeling to the Growing Up in New Zealand study, which is a longitudinal pregnancy cohort study that provides nationally representative-level data, to investigate associations between depression at three time points (antenatal, 9-months postpartum, 54-months postpartum) and child body mass index at 54-months (n=4897). RESULTS: The average slope of depression for this sample is low and decreases over time. When child BMI was added to the model as an outcome variable, both antenatal depression (B=.25, p<.01), and the rate of change of depression across the perinatal and postpartum periods (B=.09, p<.01) were associated with child BMI at 54-months postpartum. After controlling for sociodemographic characteristics, antenatal depression, but not the slope of depression, remained significantly associated with child BMI (B=.05, p<.05). When controlling for maternal pre-pregnancy BMI the effect of antenatal depression on child BMI at 54-months was entirely attenuated (χ2 (9) = 39.60, p < .05, SRMR = 0.01, CFI = .99, RMSEA = 0.03, BIC=53213). CONCLUSIONS: Our findings align with the Developmental Origins of Health and Disease theory and imply that both the physical and mental health of mothers during pregnancy may be important indicators of child growth and development outcomes. Early intervention directed towards women who have even mild depression scores during pregnancy may promote healthy child development outcomes. Additionally, given the heterogeneity of depressive symptoms over time seen in this study, multiple assessment periods across the postpartum period may be valuable to adequately address and support maternal mental health.

Women's Mental Health and Wellbeing in the Interconception Period.

PURPOSE: Promoting women's health during the interconception period is critical for the health of future pregnancies. METHODS: This was a cross-sectional study to better understand interconception mental health and wellbeing using a convenience sample of women recruited on social media who completed an online survey. RESULTS: Women who participated in the survey (N = 146) were 1 to 4 years since last pregnancy, primarily non-Hispanic White (81.2%), with an average age of 30 years (SD = 5.0; range = 19-47 years); 20% were insured by Medicaid. Depression, anxiety, stress, social support, mindfulness, and resilience were assessed. Approximately 22.9% reported depressive symptomatology, 18.8% symptoms of anxiety, 6.5% high stress, and 52.9% moderate stress. These patterns differed across years after giving birth, with percentages peaking for depressive symptoms during the first to second year (χ2 = 9.81, p = 0.007), and anxiety symptoms peaking after the third year (χ2 = 7.28, p = 0.026). Women reported moderate scores on wellbeing measures, with resilience scores decreasing as years since last pregnancy increased (F = 3.24, p = 0.042). Less than 25% reported that a provider discussed depressed mood during the interconception period. CLINICAL IMPLICATIONS: Our findings revealed high prevalence and temporal patterns of depressive and anxiety symptoms during the interconception period, identifying a need for nurses to continue to follow-up with their patients about mental health concerns well after the traditionally defined 1 year postpartum. Further investigation of women's mental health and wellbeing and their unique needs during the interconception period is warranted.

Exploring Predictors of Social Distancing Compliance in the United States during the COVID-19 Pandemic.

OBJECTIVE: Through the application of the Health Belief Model, this study sought to explore how relationships between perceived susceptibility, severity, and benefits of social distancing recommendations, as well as psychological factors, may impact compliance with COVID-19 social distancing recommendations in the United States. METHODS: Between October and November 2020, a convenience sample of English-speaking adults in the United States completed an online, cross-sectional survey which included items assessing beliefs around threats (e.g., perceived susceptibility and severity), response efficacy (e.g., perceived benefits), psychological factors (e.g., stress and COVID-specific anxiety), and compliance with social distancing measures (e.g., avoiding social gatherings). RESULTS: Social distancing compliance was positively associated with perceived susceptibility of COVID-19 (b = 0.42, P < 0.05) and perceived benefits of social distancing recommendations (b = 0.81, P < 0.01). No significant associations were found between perceived severity of COVID-19 (P = 0.38), general stress (P = 0.28), COVID-19-related anxiety (P = 0.12), and compliance. CONCLUSIONS: Findings suggest that perceived susceptibility to COVID-19 and perceived benefits of social distancing measures significantly increased compliance with social distancing recommendations in this convenience sample of U.S. adults.

Perinatal Depression Educational Training for Graduate Nursing Students.

The purpose of this study was to implement and assess an educational intervention for nursing students pertaining to perinatal depression (PD) screening and treatment. A single group (n = 59), repeated-measures design (i.e., pre- and post-intervention assessments) was used to assess the impact of an online intervention. Demographics, Theory of Planned Behavior constructs, intention to screen and treat PD, and PD-related knowledge were tested. The intervention resulted in positive gains in PD-related perceived behavioral control (PBC), attitudes, subjective norms, knowledge, intention to screen and treat PD, and perceived importance of screening and treating PD from pre- to post-intervention. PBC demonstrated a small-to-moderate positive association with perceived importance of screening and treating PD at post-intervention. Results from the current study suggest that the PD online educational intervention is effective in improving participants' PD-related PBC, attitudes, subjective norms, knowledge, and intention to screen and treat PD.