Long-Term Efficacy of a Mobile Mental Wellness Program: Prospective Single-Arm Study.

BACKGROUND: Rising rates of psychological distress (symptoms of depression, anxiety, and stress) among adults in the United States necessitate effective mental wellness interventions. Despite the prevalence of smartphone app-based programs, research on their efficacy is limited, with only 14% showing clinically validated evidence. Our study evaluates Noom Mood, a commercially available smartphone-based app that uses cognitive behavioral therapy and mindfulness-based programming. In this study, we address gaps in the existing literature by examining postintervention outcomes and the broader impact on mental wellness. OBJECTIVE: Noom Mood is a smartphone-based mental wellness program designed to be used by the general population. This prospective study evaluates the efficacy and postintervention outcomes of Noom Mood. We aim to address the rising psychological distress among adults in the United States. METHODS: A 1-arm study design was used, with participants having access to the Noom Mood program for 16 weeks (N=273). Surveys were conducted at baseline, week 4, week 8, week 12, week 16, and week 32 (16 weeks' postprogram follow-up). This study assessed a range of mental health outcomes, including anxiety symptoms, depressive symptoms, perceived stress, well-being, quality of life, coping, emotion regulation, sleep, and workplace productivity (absenteeism or presenteeism). RESULTS: The mean age of participants was 40.5 (SD 11.7) years. Statistically significant improvements in anxiety symptoms, depressive symptoms, and perceived stress were observed by week 4 and maintained through the 16-week intervention and the 32-week follow-up. The largest changes were observed in the first 4 weeks (29% lower, 25% lower, and 15% lower for anxiety symptoms, depressive symptoms, and perceived stress, respectively), and only small improvements were observed afterward. Reductions in clinically relevant anxiety (7-item generalized anxiety disorder scale) and depression (8-item Patient Health Questionnaire depression scale) criteria were also maintained from program initiation through the 16-week intervention and the 32-week follow-up. Work productivity also showed statistically significant results, with participants gaining 2.57 productive work days from baseline at 16 weeks, and remaining relatively stable (2.23 productive work days gained) at follow-up (32 weeks). Additionally, effects across all coping, sleep disturbance (23% lower at 32 weeks), and emotion dysregulation variables exhibited positive and significant trends at all time points (15% higher, 23% lower, and 25% higher respectively at 32 weeks). CONCLUSIONS: This study contributes insights into the promising positive impact of Noom Mood on mental health and well-being outcomes, extending beyond the intervention phase. Though more rigorous studies are necessary to understand the mechanism of action at play, this exploratory study addresses critical gaps in the literature, highlighting the potential of smartphone-based mental wellness programs to lessen barriers to mental health support and improve diverse dimensions of well-being. Future research should explore the scalability, feasibility, and long-term adherence of such interventions across diverse populations.

The relationship between sleep quantity, sleep quality and weight loss in adults: A scoping review.

Sleep is hypothesized to interact with weight gain and loss; however, modelling this relationship remains elusive. Poor sleep perpetuates a cascade of cardiovascular and metabolic consequences that may not only increase risk of adiposity, but also confound weight loss efforts. We conducted a scoping review to assess the research on sleep and weight loss interventions. We searched six databases for studies of behavioural weight loss interventions that included assessments of sleep in the general, non-clinical adult human population. Our synthesis focused on dimensions of Population, Intervention, Control, and Outcomes (PICO) to identify research and knowledge gaps. We identified 35 studies that fell into one of four categories: (a) sleep at baseline as a predictor of subsequent weight loss during an intervention, (b) sleep assessments after a history of successful weight loss, (c) concomitant changes in sleep associated with weight loss and (d) experimental manipulation of sleep and resulting weight loss. There was some evidence of improvements in sleep in response to weight-loss interventions; however, randomized controlled trials of weight loss interventions tended not to report improvements in sleep when compared to controls. We conclude that baseline sleep characteristics may predict weight loss in studies of dietary interventions and that sleep does not improve because of weight loss alone. Future studies should enrol large and diverse, normal, overweight and obese short sleepers in trials to assess the efficacy of sleep as a behavioural weight loss treatment.

Weight loss maintenance after a digital commercial behavior change program (Noom Weight): Observational cross-sectional survey study.

Background: Behavioral weight loss programs often lead to significant short-term weight loss, but long-term weight maintenance remains a challenge. Most weight maintenance data come from clinical trials, in-person programs, or general population surveys, but there is a need for better understanding of long-term weight maintenance in real-world digital programs. Methods: This observational survey study examined weight maintenance reported by individuals who had used Noom Weight, a digital commercial behavior change program, and identified factors associated with greater weight maintenance. The cross-sectional survey was completed by 840 individuals who had lost at least 10% of their body weight using Noom Weight 6-24 months prior. Results: The study found that 75% of individuals maintained at least 5% weight loss after 1 year, and 49% maintained 10% weight loss. On average, 65% of initial weight loss was maintained after 1 year and 57% after 2 years. Habitual behaviors, such as healthy snacking and exercise, were associated with greater weight maintenance, while demographic factors were not. Conclusion: This study provides real-world data on the long-term weight maintenance achieved using a fully digital behavioral program. The results suggest that Noom Weight is associated with successful weight maintenance in a substantial proportion of users. Future research will use a randomized controlled trial to track weight maintenance after random assignment and at a 2 year follow-up.

Mobile health lifestyle intervention program leads to clinically significant loss of body weight in patients with NASH.

BACKGROUND AIMS: Lifestyle intervention remains the foundation of clinical care for patients with NASH; however, most patients are unsuccessful in enacting sustained behavioral change. There remains a clear unmet need to develop lifestyle intervention programs to support weight loss. Mobile health (mHealth) programs offer promise to address this need, yet their efficacy remains unexplored. APPROACH RESULTS: We conducted a 16-week randomized controlled clinical trial involving adults with NASH. Patients were randomly assigned (1:1 ratio) to receive Noom Weight (NW), a mHealth lifestyle intervention program, or standard clinical care. The primary end point was a change in body weight. Secondary end points included feasibility (weekly app engagement), acceptability (>50% approached enrolled), and safety. Of 51 patients approached, 40 (78%) were randomly assigned (20 NW and 20 standard clinical care). NW significantly decreased body weight when compared to standard clinical care (-5.5 kg vs. -0.3 kg, p = 0.008; -5.4% vs. -0.4%, p = 0.004). More NW subjects achieved a clinically significant weight loss of ≥5% body weight (45% vs. 15%, p = 0.038). No adverse events occurred, and the majority (70%) of subjects in the NW arm met the feasibility criteria. CONCLUSIONS: This clinical trial demonstrated that NW is not only feasible, acceptable, and safe but also highly efficacious because this mHealth lifestyle intervention program led to significantly greater body weight loss than standard clinical care. Future large-scale studies are required to validate these findings with more representative samples and to determine if mHealth lifestyle intervention programs can lead to sustained, long-term weight loss in patients with NASH.

Changes in Health-Promoting Behaviors and Their Association with Weight Loss, Retention, and Engagement on a Digital Program: Prospective Study.

Health-promoting lifestyle behaviors (e.g., as measured by the HPLP-II) are associated with reductions in lifestyle disease mortality, as well as improved well-being, mental health, and quality of life. However, it is unclear how a weight-management program relates to a broad range of these behaviors (i.e., health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management), especially a fully digital program on which individuals have to self-manage their own behaviors in their daily lives (with assistance from a virtual human coach). In the context of a digital setting, this study examined the changes in health-promoting behaviors over 12 months, as well as the associations between health-promoting behaviors and weight loss, retention, and engagement, among participants who self-enrolled in a mobile CBT-based nutritionally focused behavior change weight management program (n = 242). Participants lost a statistically significant amount of weight (M = 6.7 kg; SD = 12.7 kg; t(80) = 9.26, p < 0.001) and reported significantly improved overall health-promoting lifestyle behaviors (i.e., HPLP-II summary scores), as well as, specifically, health responsibility, physical activity, nutrition, spiritual growth, stress management, and interpersonal relations behaviors from baseline to 6 months and from 6 months to 12 months (all ps < 0.008). Health-promoting behaviors at 6 months (i.e., learned health-promoting behaviors) compared to baseline were better predictors of retention and program engagement. A fully digital, mobile weight management intervention can improve HPLP-II scores, which, in turn, has implications for improved retention, program engagement, and better understanding the comprehensive effects of weight management programs, particularly in a digital setting.

Feasibility, Acceptability, and Preliminary Outcomes of a Cognitive Behavioral Therapy-Based Mobile Mental Well-being Program (Noom Mood): Single-Arm Prospective Cohort Study.

BACKGROUND: The prevalence of anxiety, depression, and general distress has risen in recent years. Mobile mental health programs have been found to provide support to nonclinical populations and may overcome some of the barriers associated with traditional in-person treatment; however, researchers have voiced concerns that many publicly available mobile mental health programs lack evidence-based theoretical foundations, peer-reviewed research, and sufficient engagement from the public. OBJECTIVE: This study aimed to evaluate the feasibility, acceptability, and preliminary outcomes of Noom Mood, a commercial mobile cognitive behavioral therapy- and mindfulness-based program. METHODS: In this single-arm prospective cohort study, individuals who joined Noom Mood between August and October 2021 completed surveys at baseline and 4-week follow-up. Per-protocol analyses included those who completed both surveys (n=113), and intention-to-treat analyses included all participants (N=185). RESULTS: A majority of the sample reported that the program is easy to use, they felt confident recommending the program to a friend, and they perceived the program to be effective at improving stress and anxiety. There were significant improvements in anxiety symptoms, perceived stress, depressive feelings, emotion regulation, and optimism in both the per-protocol and intention-to-treat analyses (all P<.001). Participants reported benefiting most from learning skills (eg, breathing and cognitive reframing techniques), interacting with the program features, and gaining awareness of their emotions and thought patterns. Participants also made a number of suggestions to improve product functionality and usability. CONCLUSIONS: Results suggest that Noom Mood is feasible and acceptable to participants, with promising preliminary outcomes. Future studies should build on these results to evaluate the effects of Noom Mood using more rigorous designs.

Body Positivity and Self-Compassion on a Publicly Available Behavior Change Weight Management Program.

According to recent research, body positivity and self-compassion are key outcomes that are tied to better psychological and physical health. To date, it is unclear whether body positivity and self-compassion improve, stay constant, or deteriorate over the course of a weight management program, particularly one that addresses the psychological roots of behavior change. Additionally, beyond controlled settings, there are no studies on body positivity and self-compassion in individuals who choose to join a commercial weight management program. Therefore, this single-arm prospective study examined changes in body positivity and self-compassion from baseline to the 16 week milestone of Noom Weight, a commercial behavior change weight management program informed by acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and cognitive behavioral therapy (CBT). We also examined how baseline and over-time changes in body positivity and self-compassion predicted engagement in program-measured relevant behaviors (e.g., exercises logged). Participants were a random subset of individuals who had recently self-enrolled in the program (n = 133). Body positivity and self-compassion were measured via survey at baseline and end of the core program (16 weeks). Self-reported weight and program-recorded engagement were extracted from the program database. Compared to baseline, body appreciation, body image flexibility, self-compassion, and body-focused rumination significantly improved at 16 weeks (all ps < 0.007). Participants lost a statistically significant amount of weight (3.9 kg; t(128)) = 10.64, p < 0.001) by 16 weeks, which was 4.4% body weight. Greater engagement, especially messaging a coach, reading articles, and logging meals, was associated with improvements over time in body appreciation (r = 0.17, p = 0.04), body image flexibility (r = -0.23, p = 0.007), and the brooding component of rumination (r = -0.23, p = 0.007). Greater engagement was also associated with baseline total self-compassion (r = 0.19, p = 0.03) and self-judgment (r = 0.24, p = 0.006). The results suggest that individuals experience improvements in body positivity and self-compassion while learning about ACT, DBT, and CBT through curriculum and coaching in this setting. The results also have important clinical implications, such as the possibility that psychologically-oriented (i.e., ACT, DBT, and CBT-based) weight management could be important to improve body positivity or that baseline self-compassion could be used to target individuals at risk for lower engagement. Future work should investigate these possibilities as well as delineate the causal relationships between body positivity, self-compassion, engagement, and weight loss.

Comparing Outcomes of a Digital Commercial Weight Loss Program in Adult Cancer Survivors and Matched Controls with Overweight or Obesity: Retrospective Analysis.

Maintaining a healthy weight is beneficial for cancer survivors. However, weight loss program effectiveness studies have primarily been in highly controlled settings. This is a retrospective study exploring real-world outcomes (weight loss and program engagement) after use of a digital commercial weight loss program (Noom) in cancer survivors and matched controls. All participants had voluntarily self-enrolled in Noom. Weight and engagement data were extracted from the program. Cancer-related quality of life was secondarily assessed in a one-time cross-sectional survey for survivors. Controls were a sample of Noom users with overweight/obesity who had no history of cancer but 0-1 chronic conditions. Primary outcomes were weight change at 16 weeks and program engagement over 16 weeks. Engagement included frequency of weight, food, and physical activity logging, as well as number of coach messages. Multiple regression controlling for baseline age, gender, engagement, and BMI showed that survivors lost less weight than controls (B = -2.40, s.e. = 0.97, p = 0.01). Survivors also weighed in less (survivors: 5.4 [2.3]; controls: 5.7 [2.1], p = 0.01) and exercised less (survivors: 1.8 [3.2]; controls: 3.2 [4.1], p < 0.001) than controls. However, survivors sent more coach messages (survivors: 2.1 [2.4]; controls: 1.7 [2.0], p < 0.001). Despite controls losing more weight than cancer survivors (-7.0 kg vs. -5.3 kg), survivors lost significant weight in 4 months (M = -6.2%). Cancer survivors can have success on digital commercial programs available outside of a clinical trial. However, they may require additional support to engage in weight management behaviors.

Preconception Marijuana Use in Rhode Island: Rates, Demographics, and Psychosocial Correlates.

INTRODUCTION: Rates of marijuana use in Rhode Island (RI) exceed the national average; prevalence during preconception and characteristics of users remain unknown. METHODS: Prevalence of marijuana use in the 3 months preconception was assessed by a RI-based telephone survey of a diverse, low-income sample of pregnant women (n=1683). Sociodemographic characteristics, substance use, and mental health were compared between preconception marijuana users, tobacco users and non-users. RESULTS: 25.1% of respondents reported using marijuana during preconception. Marijuana users were younger, poorer, and less educated than non-users (ps<0.001) and more likely to report alcohol use and mental illness (ps<0.001). Marijuana users were younger with fewer children than tobacco-only users (ps<0.001). CONCLUSIONS: Rates of preconception marijuana use in RI exceed national rates of prenatal use. Preconception marijuana users have a distinct sociodemographic profile, with higher rates of concurrent mental health conditions and alcohol use. Understanding this characterization enables targeted screening and interventions.

Electronic Cigarette Use During Preconception and/or Pregnancy: Prevalence, Characteristics, and Concurrent Mental Health Conditions.

Background: Electronic cigarettes (e-cigarettes) are increasing in popularity in the United States. Prior prevalence estimates of e-cigarette use in pregnancy range from 1% to 15%. Materials and Methods: We assessed prevalence of e-cigarette and conventional cigarette use during preconception or pregnancy in a large sample of racially/ethnically diverse, low-income pregnant women via telephone survey (2015-2018) and compared sociodemographic characteristics and mental health conditions. Results: Of 1365 pregnant women surveyed, 54 (4.0%) reported e-cigarette use (regardless of other tobacco use), 372 (27.3%) reported conventional cigarette use without e-cigarette use (conventional cigarette use), and 939 (68.8%) reported no tobacco or nicotine replacement therapy (NRT) product use during the preconception period and/or pregnancy. Seventy-four percent of women using e-cigarettes reported also using conventional cigarettes. Women who used e-cigarettes were more likely to report high school education or greater, income <$30,000, White race, and non-Hispanic ethnicity than women who used conventional cigarettes. Women who used e-cigarettes were more likely than women who used conventional cigarettes or no tobacco/NRT to report symptoms of depression. Women who used e-cigarettes and women who used conventional cigarettes were more likely than women who used no tobacco/NRT to report a history of severe mental health conditions, alcohol use during pregnancy, and marijuana or other drug use during preconception. Conclusions: In this sample, 4% of women used e-cigarettes during preconception and/or pregnancy and most also used conventional cigarettes. Increased efforts by providers to screen for tobacco (including use of e-cigarette) and polysubstance use and to provide cessation services could improve outcomes of mothers and children.

High Rates of Menthol Cigarette Use Among Pregnant Smokers: Preliminary Findings and Call for Future Research.

INTRODUCTION: Smoking during pregnancy remains widespread and is causally associated with infant morbidity and mortality. Despite links between menthol cigarette use and decreased smoking cessation, little is known regarding rates or characteristics of pregnant menthol cigarette smokers. METHODS: Participants were drawn from two low-income, racially/ethnically diverse cohorts of pregnant smokers recruited from 2006 to 2015 (N = 166, Mage = 25 ± 5). Demographics, menthol cigarette use, daily cigarette use, quit status, and consecutive weeks quit were assessed by prospective interviews. Nicotine dependence was assessed using the Fagerström Test of Nicotine Dependence. Nicotine levels were assessed via saliva cotinine. RESULTS: High rates of menthol use were found in both cohorts (85% and 87%). Across both cohorts, menthol smokers were more likely to identify as racial/ethnic minorities, were less educated, and reported lower income than non-menthol smokers (ps < .03). Menthol smokers also reported fewer continuous weeks quit (8.4 vs. 14.5 weeks quit; p < .03) and a tendency toward decreased likelihood of quitting smoking over pregnancy (29% vs. 48%; p < .08) in unadjusted but not in covariate-adjusted analyses. No differences emerged in cigarettes per day, nicotine dependence or nicotine exposure. CONCLUSIONS: We found very high rates of menthol cigarette use in pregnant smokers-particularly among racial/ethnic minority and low socioeconomic status smokers-and some evidence for associations with reduced smoking cessation in pregnancy. Consideration of pregnant smokers as a uniquely vulnerable population is warranted in evaluating regulation of menthol in cigarettes. Further research is needed regarding the impact of menthol on smoking persistence in pregnancy and on maternal and infant health outcomes. IMPLICATIONS: This study highlights high rates of menthol cigarette use in pregnant women in the Northeast, United States, with evidence for higher rates of menthol use among racial/ethnic minority, less educated and low-income pregnant smokers, and preliminary evidence for associations between menthol cigarette use and reduced smoking cessation. Consideration of the effects of menthol on smoking persistence in pregnant women and on the health of their offspring is warranted in the development of regulations regarding menthol in cigarettes.

A multimethod, multi-informant investigation of maternal validation and invalidation of female adolescents who engage in self-inflicted injury.

OBJECTIVE: This study aimed to characterize parenting behaviors of mothers of adolescent daughters who engage in repetitive self-inflicted injury (SII) and to test hypothesized associations between parenting behaviors and adolescent psychopathology. METHOD: Participants were mothers and their 14- to 18-year-old daughters (N = 51 dyads), including 24 (47%) adolescents with a history of SII and 27 (53%) with no history of SII. Dyads completed questionnaires assessing perceived maternal validation and invalidation and participated in face-to-face interactions, which were later rated for parenting behaviors. RESULTS: The two groups did not significantly differ on validation and invalidation across all informants and methods of assessment. For the sample as a whole, adolescent perceptions of maternal parenting behaviors interacted to predict adolescent psychopathology. In particular, adolescent perceptions of high maternal invalidation in interaction with perceptions of low validation were associated with higher levels of self-reported borderline pathology and externalizing problems and mother-reported adolescent internalizing and externalizing problems. CONCLUSIONS: We failed to find support for the hypothesized parenting deficits in mothers of female adolescents engaging in SII. Adolescent perceptions of their mothers' high levels of invalidation and low levels of validation were associated with higher levels of adolescent psychopathology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Prenatal tobacco and marijuana co-use: Impact on newborn neurobehavior.

Tobacco and marijuana are some of the most common prenatal substance exposures worldwide. The social acceptability and political landscape of marijuana and its potency have changed dramatically in the last two decades leading to increased use by pregnant women. Despite evidence for increasing marijuana use and high rates of co-use of tobacco (TOB) and marijuana (MJ) during pregnancy, the impact of prenatal exposure to each substance is typically studied in isolation. We investigated the influence of co-exposure to TOB and MJ on infant neurobehavioral development over the first postnatal month. Participants were 111 mother-infant pairs from a low-income, diverse sample (Mean age = 25 ±â€¯5; 54% minorities). TOB and MJ use were assessed by Timeline Followback interview with biochemical confirmation. Three groups were identified: (a) prenatal MJ + TOB, (b) prenatal TOB only, (c) controls. Newborn neurobehavior was assessed at seven time points over the first postnatal month using the NICU Network Neurobehavioral Scale. MJ + TOB-exposed infants showed decreased ability to self-soothe (Self-regulation) and attend to stimuli (Attention), and increased need for examiner soothing (Handling) and low motor activity (Lethargy) versus unexposed infants. Despite low levels of MJ use in MJ + TOB co-users, co-exposure was associated with nearly double the impact on infant self-soothing and need for examiner soothing versus TOB-exposure alone. Effects of MJ + TOB co-exposure appeared more pronounced for daughters than for sons. Although results are preliminary, they highlight additional risk from dual exposure to MJ + TOB vs. TOB exposure alone, particularly for daughters. Results also highlight the critical importance of investigating prenatal exposures in concert and the need for intervention efforts to address MJ co-use in pregnant TOB users.

Impact of maternal prenatal smoking on fetal to infant neurobehavioral development.

Despite recent emphasis on the profound importance of the fetal environment in "programming" postnatal development, measurement of offspring development typically begins after birth. Using a novel coding strategy combining direct fetal observation via ultrasound and actocardiography, we investigated the impact of maternal smoking during pregnancy (MSDP) on fetal neurobehavior; we also investigated links between fetal and infant neurobehavior. Participants were 90 pregnant mothers and their infants (52 MSDP-exposed; 51% minorities; ages 18-40). Fetal neurobehavior at baseline and in response to vibro-acoustic stimulus was assessed via ultrasound and actocardiography at M = 35 weeks gestation and coded via the Fetal Neurobehavioral Assessment System (FENS). After delivery, the NICU Network Neurobehavioral Scale was administered up to seven times over the first postnatal month. MSDP was associated with increased fetal activity and fetal limb movements. Fetal activity, complex body movements, and cardiac-somatic coupling were associated with infants' ability to attend to stimuli and to self-regulate over the first postnatal month. Furthermore, differential associations emerged by MSDP group between fetal activity, complex body movements, quality of movement, and coupling, and infant attention and self-regulation. The present study adds to a growing literature establishing the validity of fetal neurobehavioral measures in elucidating fetal programming pathways.

Additive drug-specific and sex-specific risks associated with co-use of marijuana and tobacco during pregnancy: Evidence from 3 recent developmental cohorts (2003-2015).

BACKGROUND: Methodologic challenges related to the concomitant use (co-use) of substances and changes in policy and potency of marijuana contribute to ongoing uncertainty about risks to fetal neurodevelopment associated with prenatal marijuana use. In this study, we examined two biomarkers of fetal neurodevelopmental risk-birth weight and length of gestation-associated with prenatal marijuana use, independent of tobacco (TOB), alcohol (ALC), other drug use (OTH), and socioeconomic risk (SES), in a pooled sample (N = 1191) derived from 3 recent developmental cohorts (2003-2015) with state-of-the-art substance use measures. We examined differential associations by infant sex, and multiplicative effects associated with co-use of MJ and TOB. METHODS: Participants were mother-infant dyads with complete data on all study variables derived from Growing Up Healthy (n = 251), Behavior and Mood in Babies and Mothers (Cohorts 1 and 2; n = 315), and the Early Growth and Development Study (N = 625). We estimated direct effects on birth weight and length of gestation associated with MJ, TOB, and co-use (MJ x TOB), using linear regression analysis in the full sample, and in male (n = 654) and female (n = 537) infants, separately. RESULTS: Mean birth weight and length of gestation were 3277 g (SD = 543) and 37.8 weeks (SD = 2.0), respectively. Rates of prenatal use were as follows: any use, n = 748 (62.8%); MJ use, n = 273 (22.9%); TOB use, n = 608 (51.0%); co-use of MJ and TOB, n = 230 (19.3%); ALC use, n = 464 (39.0%); and OTH use n = 115 (9.7%.) For all infants, unique effects on birth weight were observed for any MJ use [B(SE) = -84.367(38.271), 95% C.I. -159.453 to -9.281, p = .028], any TOB use [B(SE) = -0.99.416(34.418), 95% C.I. -166.942 to -31.889, p = .004], and each cigarette/day in mean TOB use [B(SE) = -12.233(3.427), 95% C.I. -18.995 to -5.510, p < .001]. Additional effects of co-use on birth weight, beyond these drug-specific effects, were not supported. In analyses stratified by sex, while TOB use was associated with lower birth weight in both sexes, MJ use during pregnancy was associated with lower birth weight of male infants [B(SE) = -153.1 (54.20); 95% C.I. -259.5 to -46.7, p = .005], but not female infants [B(SE) = 8.3(53.1), 95% C.I. -96.024 to 112.551, p = .876]. TOB, MJ, and their co-use were not associated with length of gestation. CONCLUSIONS: In this sample, intrauterine co-exposure to MJ and TOB was associated with an estimated 18% reduction in birth weight not attributable to earlier delivery, exposure to ALC or OTH drugs, nor to maternal SES. We found evidence for greater susceptibility of male fetuses to any prenatal MJ exposure. Examination of dose-dependence in relationships found in this study, using continuous measures of exposure, is an important next step. Finally, we underscore the need to consider (a) the potential moderating influence of fetal sex on exposure-related neurodevelopmental risks; and (b) the importance of quantifying expressions of risk through subtle alterations, rather than dichotomous outcomes.

Extending Models of Sensitive Parenting of Infants to Women at Risk for Perinatal Depression.

OBJECTIVE: Recognizing that not all mothers at risk for depression engage in insensitive parenting, this study examined predictors of individual differences in sensitive parenting of infants by mothers with histories of depression, who are at elevated risk for depression during the perinatal period. DESIGN: We examined maternal personal characteristics, context, and early infant temperament as predictors of sensitive parenting. Seventy-six women with a history of major depression were followed through pregnancy and postpartum and observed during play and feeding interactions with their 12-month-old infants. RESULTS: Maternal personal characteristics (recurrence of clinically significant depression symptom levels during pregnancy or postpartum and higher trait anxiety), context (lower social context and lower income), and early infant temperament (higher negative affectivity, surgency/extraversion, and orienting/regulation) are often associated with less sensitive parenting, with stronger and clearer associations for play than feeding and with some differences based on whether sensitivity was defined as affective matching or rated sensitivity. CONCLUSIONS: The findings extend support for multi-determination of sensitive parenting of infants to women with histories of depression, albeit with small to medium effect sizes, and suggest ways to identify those who may be most at risk for insensitive parenting and the potential value of intervening in pregnancy to enhance subsequent sensitivity of parenting.

Effects of perinatal mental disorders on the fetus and child.

Perinatal mental disorders are associated with increased risk of psychological and developmental disturbances in children. However, these disturbances are not inevitable. In this Series paper, we summarise evidence for associations between parental disorders and offspring outcomes from fetal development to adolescence in high-income, middle-income, and low-income countries. We assess evidence for mechanisms underlying transmission of disturbance, the role of mediating variables (underlying links between parent psychopathology and offspring outcomes) and possible moderators (which change the strength of any association), and focus on factors that are potentially modifiable, including parenting quality, social (including partner) and material support, and duration of the parental disorder. We review research of interventions, which are mostly about maternal depression, and emphasise the need to both treat the parent's disorder and help with associated caregiving difficulties. We conclude with policy implications and underline the need for early identification of those parents at high risk and for more early interventions and prevention research, especially in socioeconomically disadvantaged populations and low-income countries.

Maternal smoking during pregnancy and infant stress response: test of a prenatal programming hypothesis.

BACKGROUND: Maternal smoking during pregnancy (MSDP) is associated with early and long-term neurobehavioral deficits; however mechanisms remain unknown. We tested the hypothesis that MSDP programs the hypothalamic pituitary adrenocortical (HPA) axis of the offspring leading to adverse outcomes. In an intensive, prospective study, we investigated associations between MSDP and infant cortisol stress response and explored whether alterations in cortisol response were mediated by epigenetic modulation of the placental glucocorticoid receptor gene (NR3C1). METHODS: Participants were 100 healthy mother-infant pairs (53% MSDP-exposed; 42% female) from a low income, racially/ethnically diverse sample (55% minorities). MSDP was assessed by timeline followback interview verified by saliva and meconium cotinine. Infant cortisol responses to a neurobehavioral exam were assessed seven times over the first postnatal month. Methylation of placental NR3C1 promoter exon 1F was assessed using bisulfite pyrosequencing in a subsample (n=45). RESULTS: MSDP-exposed infants showed significantly and persistently attenuated basal and reactive cortisol levels over the first postnatal month vs. unexposed infants. Exploratory analyses revealed that MSDP was associated with altered methylation of the placental NR3C1 promoter; degree of methylation of the placental NR3C1 was associated with infant basal and reactive cortisol over the first postnatal month and mediated effects of MSDP on infant basal cortisol. CONCLUSIONS: Results provide initial support for our hypothesis that MSDP programs offspring HPA (dys)regulation. Epigenetic regulation of placental GR may serve as a novel underlying mechanism. Results may have implications for delineating pathways to adverse outcomes from MSDP.

Luminance affects age-related deficits in object detection: implications for computerized psychological assessments.

As psychological instruments are converted for administration on computers, differences in luminance and contrast of these displays may affect performance. Specifically, high-luminance assessments may mask age-group differences that are apparent under lower luminance conditions. We examined the effects of luminance and contrast on object detection using computerized and naturalistic assessments. Younger and older adults displayed more differences in performance across differing contrast levels in conditions that were matched for luminance, despite the conditions appearing perceptually different. These findings indicate that computerized assessments should be created with luminance levels that are similar to those of the tasks they purport to simulate in order to enhance their validity.