Transition to Motherhood: Adverse Childhood Experiences, and Support from Partner, Family and Friends.

BACKGROUND: The complex identity changes women have to go through to become mothers makes it a challenging transitional period. Especially, mothers who have experienced childhood adversity (ACEs) may be vulnerable to poor adjustment to motherhood. However, support from a partner, family and friends can act as a buffer to cope with this challenging transitional period. Therefore, the aim was to study whether ACEs and experienced social support (partners, family, and friends) were related to the adjustment to motherhood or 'motherhood constellation' of women after the birth of their first child. METHOD: Data were collected via an online questionnaire among first-time mothers from June-September 2020. Motherhood constellation was measured with four items based on the descriptions by (Stern, 1995) about the motherhood constellation, i.e. worries about Life/Growth, Emotional Engagement, Support Systems, Identity Organisation. Multiple regression analyses with pairwise deletion were conducted. RESULTS: ACEs were related to all four themes of motherhood constellation, indicating that the more frequent these adverse experiences occurred in the past the more concerns, both about the child and herself, the mother had. Moreover, after controlling for ACEs and other forms of support, only support from friends was related to the use of support systems and identity organisation. Finally, statistically significant interactions were found between ACES and support from friends with life/growth and between ACES and support from family with identity organisation. These interactions indicated that contrary to the expectation the positive association between mother's ACEs and worries was stronger for mothers who experienced more support. CONCLUSION: The consequences of ACEs seemed to show up in the transition to motherhood, indicating that interventions targeting first-time mothers should address the motherhood constellation that may arise from earlier adverse life experiences. Moreover, especially support from friends seemed to be associated with less worries among mothers. Social support has no buffering effect for the negative consequences of ACEs on the themes of motherhood constellation. Further research is clearly needed to get more insight into these themes and to understand the meaning of different types of social support during the transition to motherhood.

Stability of and change in substance use risk personality: Gender differences and smoking cigarettes among early adolescents.

OBJECTIVE: Adolescents show a steadily increasing inclination toward health risk behaviors, including smoking cigarettes. There is ample evidence that personality traits are related to smoking behavior. However, less is known about the stability of and change in these personality traits during early adolescence and whether smoking behavior affects the developmental trajectories. Moreover, less is known about the influence of gender on the course of personality. METHOD: Longitudinal data of three waves were used from 1121 early adolescents. To measure personality, the Substance Use Risk Profile Scale was used. Individual growth curve models were conducted to measure the stability, mean-level change and individual differences in change for personality. RESULTS: Stability of personality was moderate for boys and ranged from moderate to high for girls. On average early adolescents became more impulsive and more sensation seeking over a period of 18 months. Furthermore, hopelessness for girls increased and the increase in sensation seeking was higher for girls than for boys. Third, smoking behavior was related to all personality traits, indicating that smoking adolescents are more anxious, hopeless, impulsive and sensation seeking than non-smoking adolescents. CONCLUSIONS: Our results are in line with the disruption hypothesis, i.e., during early adolescence there is a dip in personality maturity. There are clear differences between girls and boys in stability of and change in personality traits. Besides, although smoking behavior is related to personality, the change in personality is probably related to other variables.

Results of outdoor smoking bans at secondary schools on adolescents smoking behaviour: a quasi-experimental study.

BACKGROUND: Research on the effectiveness of school smoking policies on adolescents' smoking behaviour remain inconclusive. This study evaluates the results of an outdoor school ground smoking ban at secondary schools on adolescents smoking behaviour, taking individual characteristics into account. METHODS: Data on 2684 adolescents from 18 Dutch secondary schools (nine with and nine without an outdoor smoking ban) were obtained at two moments. Associations between outdoor school ground smoking bans, individual characteristics, and smoking prevalence and frequency were measured. Multilevel logistic regression analyses were used. At schools with a ban implementation fidelity was checked. RESULTS: Although smoking prevalence and frequency appeared to make a slower increase at schools with an outdoor smoking ban compared with schools without an outdoor smoking ban, the differences were not significant. Differences between schools in the prevalence of smoking behaviour of students could mainly be explained by individual characteristics. Smoking prevalence and frequency were higher among adolescents with a positive attitude towards smoking and when significant others were more positive about smoking. Smoking prevalence and frequency were significantly lower when adolescents perceived it as easy not to smoke. Implementation fidelity was good at schools with a ban. CONCLUSIONS: No short-term effects were found of an outdoor smoking ban. A longer follow-up time than 6 months is needed. In addition, future research should investigate effectiveness in relation to the enforcement of the ban, comprehensiveness of the ban and when it is prohibited to leave school grounds, as smoking behavior might be transferred off school grounds.

Sustainability of outdoor school ground smoking bans at secondary schools: a mixed-method study.

Background: Although increasing numbers of countries are implementing outdoor school ground smoking bans at secondary schools, less attention is paid to the post-implementation period even though sustainability of a policy is essential for long-term effectiveness. Therefore, this study assesses the level of sustainability and examines perceived barriers/facilitators related to the sustainability of an outdoor school ground smoking ban at secondary schools. Methods: A mixed-method design was used with a sequential explanatory approach. In phase I, 438 online surveys were conducted and in phase II, 15 semi-structured interviews were obtained from directors of relevant schools. ANOVA (phase I) and a thematic approach (phase II) were used to analyze data. Results: Level of sustainability of an outdoor school ground smoking ban was high at the 48% Dutch schools with an outdoor smoking ban. Furthermore, school size was significantly associated with sustainability. The perceived barriers/facilitators fell into three categories: (i) smoking ban implementation factors (side-effects, enforcement, communication, guidelines and collaboration), (ii) school factors (physical environment, school culture, education type and school policy) and (iii) community environment factors (legislation and social environment). Conclusions: Internationally, the spread of outdoor school ground smoking bans could be further promoted. Once implemented, the ban has become 'normal' practice and investments tend to endure. Moreover, involvement of all staff is important for sustainability as they function as role models, have an interrelationship with students, and share responsibility for enforcement. These findings are promising for the sustainability of future tobacco control initiatives to further protect against the morbidity/mortality associated with smoking.

Schools as smoke-free zones? Barriers and facilitators to the adoption of outdoor school ground smoking bans at secondary schools.

BACKGROUND: Whereas smoking bans inside secondary school buildings are relatively widespread, a smoking ban for the outdoor school grounds is less common. Therefore, this study investigates why many secondary schools fail to adopt an outdoor school ground smoking ban. The aim is to elucidate the perceived barriers and facilitators of stakeholders at schools without an outdoor school ground smoking ban. METHODS: Qualitative data were obtained from 60 respondents of 15 secondary schools. Semi-structured interviews were held with various key stakeholders and a thematic approach was used for analysis of the transcripts. RESULTS: The perceived barriers and facilitators of the stakeholders fell into four categories: 1) socio-political characteristics (legislation and social norm), 2) school characteristics (policy, decision process, enforcement, resources, workforce conditions, communication and collaboration), 3) individual characteristics (support, knowledge, and target group), and 4) smoking ban characteristics (environmental factors, guideline recommendations, outcome expectations, and evidence). CONCLUSIONS: These findings highlight the importance of legislation for outdoor smoking bans. Moreover, collaboration, communication and involving stakeholders during an early stage of the process should be stimulated, as this might increase adoption. These results can be applied in future studies on outdoor tobacco control policies; moreover, they may facilitate tobacco control initiatives leading to more smoke-free environments to further protect youth from the harmful effects of tobacco.

Discrimination in the workplace, reported by people with major depressive disorder: a cross-sectional study in 35 countries.

OBJECTIVE: Whereas employment has been shown to be beneficial for people with Major Depressive Disorder (MDD) across different cultures, employers' attitudes have been shown to be negative towards workers with MDD. This may form an important barrier to work participation. Today, little is known about how stigma and discrimination affect work participation of workers with MDD, especially from their own perspective. We aimed to assess, in a working age population including respondents with MDD from 35 countries: (1) if people with MDD anticipate and experience discrimination when trying to find or keep paid employment; (2) if participants in high, middle and lower developed countries differ in these respects; and (3) if discrimination experiences are related to actual employment status (ie, having a paid job or not). METHOD: Participants in this cross-sectional study (N=834) had a diagnosis of MDD in the previous 12 months. They were interviewed using the Discrimination and Stigma Scale (DISC-12). Analysis of variance and generalised linear mixed models were used to analyse the data. RESULTS: Overall, 62.5% had anticipated and/or experienced discrimination in the work setting. In very high developed countries, almost 60% of respondents had stopped themselves from applying for work, education or training because of anticipated discrimination. Having experienced workplace discrimination was independently related to unemployment. CONCLUSIONS: Across different countries and cultures, people with MDD very frequently reported discrimination in the work setting. Effective interventions are needed to enhance work participation in people with MDD, focusing simultaneously on decreasing stigma in the work environment and on decreasing self-discrimination by empowering workers with MDD.

Predicting change in problem behavior from child and family characteristics and stress in referred children and adolescents.

A three-wave longitudinal study design with two 6-month intervals was used to examine the stability and change in Internalizing, Externalizing, and Total Problem behavior among children and adolescents referred to outpatient mental health services. Our results indicated high stabilities for parent ratings of child psychopathology across a 1-year interval. Additionally, we found decreases in the level of problem behavior. Interindividual differences in change were found for Total Problems and Externalizing behavior but not for Internalizing. While both the child's temperament and intelligence level and family relations were related to the initial level of parent-rated problem behavior, only intermediary stressful life events had an influence on the rate of change of child psychopathology.

The relationship between mutual family relations and child psychopathology.

The associations of the mutual mother-child, father-child, and mother-father relationship and various patterns of family relations with child psychopathology were investigated in a sample of 137 families referred to outpatient mental health services. Assessment of the relative association of the different family dyads showed that both the mother-child and the mother-father relationship were related to child problem behaviour. However, whereas the mother-child relationship was consistently more related to externalising behaviour, the mother-father relationship was particularly related to internalising behaviour. Our findings gave clear support for the cumulative risk model: having more negatively qualified relationships was associated with more problem behaviour. Furthermore, our results suggested a protective influence of the parent-child relationship: having one or two positive parent-child relationships was associated with less problem behaviour. No support was found for the cross-generational coalition hypothesis. Implications for future research are discussed.