Latent growth trajectories of substance use among pregnant and parenting adolescents.

We examine changes among adolescent girls in substance use during pregnancy and the postpartum period. Three separate latent growth curve analyses assessed the impact of psychosocial, behavioral, and sociodemographic factors on resumption of or change in use of cigarettes, alcohol, and marijuana. The Vulnerable Populations Model for Research and Clinical Practice (Flaskerud & Winslow, 1998) provided the theoretical foundation for this study. This is a secondary analysis of data from a sample of 305 ethnic minority females (245 Latina, 60 African American), aged 13–18 years, who were pregnant at baseline and were participating in an HIV prevention study conducted in inner-city alternative schools in Los Angeles County. Data collected at 4 time points captured changes in substance use from pregnancy through the postpartum period. Baseline predictors included ethnicity/race, partner substance use, childhood abuse history, religiosity, acculturation, depressive symptoms, length of gestation at baseline, and previous substance use. Common predictors of greater resumption and/or greater level of use included greater history of use before pregnancy, partner substance use, childhood abuse, and a longer time since childbirth. African Americans were more likely to be smoking at baseline when they were still pregnant and to use marijuana postpartum; Latinas were more likely to use alcohol over the course of pregnancy and postpartum. Other variables exerted an influence on specific substances. For instance, religiosity impacted cigarette and alcohol use. Findings may assist prenatal care providers to identify and counsel pregnant adolescents at risk for perinatal substance use and to prevent resumption or initiation of substance use after childbirth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hispanic subgroup differences in prenatal care

Within SES categories in the United States, racial and ethnic minorities generally fare less well on a variety of health-related indicators than do majority groups. Important differences exist within subgroups, however, and at present, these differences are poorly understood. In this paper we address Hispanic subgroup (Cuban American, Mexican American. Puerto Rican, and Central/South American) differences in utilization of prenatal care. Data from the 1986 and 1987 national Linked Birth/Infant Death files are used to assess patterns of prenatal care utilization across subgroups. Using Kotelchuck's Adequacy of Prenatal Care Utilization Index, we find that when controlling for other factors, Cuban American and Puerto Rican women are more likely to obtain adequate care than are Hispanic women of Mexican or Central/South American origin. Other factors important in understanding utilization patterns include marital status, education level, birthplace, and region of the country. We conclude with a discussion of the relatively weak link between prenatal care and birth outcomes and identify important cultural factors that may be important in understanding why this relationship is not stronger.     

HIV risk behaviors among inner-city African American women. The Community Housing AIDS Prevention Study Group

This study examined the prevalence and predictors of HIV risk behaviors among a sample of 875 low-income, African American women residents of inner-city housing developments. The women completed an anonymous questionnaire that revealed that one third of them were at high risk for HIV either because they had multiple partners or because of the high-risk behaviors of their regular partner. HIV risk was highest among women who accurately perceived themselves to be at increased HIV risk, reported weak behavioral intentions to reduce risk, and held stronger beliefs about psychosocial barriers to condom use. Women at high risk were also younger, reported higher rates of substance use, and indicated that their housing development lacked social cohesiveness. These findings suggest that HIV prevention efforts for this population should focus on strengthening women's risk reduction behavioral intentions and self-efficacy through skill development, overcoming psychosocial barriers to condom use, managing the risk related to substance use, and incorporating approaches that take into account the social, psychological, and relationship barriers to change among economically impoverished African American women.     

Motivational Enhancement Therapy for Nicotine Dependence in Methadone-Maintained Pregnant Women.

Pregnant women who are dependent on nicotine and illicit substances are at especially high risk for health complications and psychosocial problems. Motivational enhancement therapy (MET) for reducing smoking during pregnancy was compared with standard-care practitioner advice in a 2-group randomized design. Participants were 63 pregnant opioid-dependent smokers seeking substance abuse treatment, methadone maintenance, and prenatal care. At a 10-week follow-up, self-report and biological measures (i.e., CO, cotinine) indicated no differences in smoking between the MET and standard-care groups. However, MET participants were more likely to have moved forward on the stage of change continuum than those in standard care. Intensive treatment for nicotine dependence, environmental interventions, and innovative harm reduction strategies are recommended to address the barriers to quitting observed in this population of pregnant women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A closed culture system for the ex vivo transduction and expansion of human T lymphocytes

The purpose of this qualitative study was to explore traditional beliefs and practices related to pregnancy and childbirth among Native American women and examine the relationship of these beliefs and practices to current use of prenatal care. Focus groups of elders and young women were held and the data analyzed with the Ethnograph software. The central theme was the breakdown in transmission of cultural wisdom among Native American women. The major causes described by women were federal assimilation policies and deaths of elders. Major factors influencing young women's nonutilization of prenatal care were this breakdown, the "Western model" of prenatal care, substance abuse, and domestic violence. Recommendations for improving the use of prenatal care are grounded in the reality that Native American women live in two different worlds. Prenatal care should be reconceptualized as traditional cultural wisdom, with the majority of care provided by natural helpers in the Native American community, including tribal elders, grandmothers, and aunts in collaboration with licensed providers.     

Wantedness of pregnancy and prenatal health behaviors

This study examined the relationships between wantedness of pregnancy and the initiation of prenatal care as well as smoking and drinking alcohol during pregnancy. Three hundred and eighty post-partum women were interviewed in a randomly selected sample of Chicago area hospitals. Approximately half of the women said that they had wanted their recently completed pregnancy. Unadjusted analyses revealed that women who wanted their pregnancies were more likely to begin prenatal care in the first trimester and were less likely to smoke while there was no relationship between wantedness and alcohol use during pregnancy. After adjustment for sociodemographic variables, women who wanted their pregnancies were less likely to have smoked cigarettes or drunk alcohol during pregnancy, but were not more likely to have initiated prenatal care in the first trimester. These results suggest that positive health behaviors during pregnancy are influenced by wantedness of pregnancy as well as sociodemographic characteristics. Therefore, efforts to reduce unwanted pregnancies are an important strategy to improve the health of women and children.     

Sexual functioning and intimacy in African American and white breast cancer survivors: a descriptive study

This study examines ethnic differences in sexual socialization and attitudes, sexual history and current practices, and the effects of treatment in 147 African American and White breast cancer survivors. Sex-related research in younger healthy populations has shown that cultural values associated with ethnicity influence sexual functioning, but small numbers of African American participants in previous research in breast cancer survivors has limited what we know about that population. In this study, there were few differences between the 2 ethnic groups in a predominantly well-educated, high-income, highly functional sample. However, African American women were significantly less likely to be comfortable with and to practice oral sex, self-touching, and masturbatory behaviors. White women were more likely to report that breast cancer had a negative impact on their sex lives. These differences in sexual repertoire and functioning should be noted by health care practitioners treating the sexual sequelae of breast cancer treatment.     

Ethnic differences in the psychosocial antecedents of needle/syringe disinfection

This study examined psychosocial antecedents of needle/syringe disinfection by 209 injection drug users in three ethnic groups. Among Whites, high perceived self-efficacy for risk reduction had a positive effect on subsequent disinfection attempts. Among African Americans and Mexican Americans, peer norms favorable to risk reduction had a positive effect on subsequent disinfection attempts, while self-efficacy had no effect. These results suggest that risk-reduction capabilities may be rooted in individualistic perceptions of the self among White drug users, while 'collective self' perceptions are more relevant to these capabilities among African American and Mexican American drug users. HIV risk intervention may have more impact in specific ethnic groups if these distinctions are taken into account. Results also demonstrate the importance of comparing models of behavior change across ethnic groups.     

Gender differences in substance use among Mexican American school-age children

This study identified differences in gender between and among fourth, fifth, and sixth grade Mexican American students for use of four specific "minor" substances: cigarettes, beer, wine/liquor, and marijuana. Minor substances are believed to serve as a "gateway" to more intense and frequent use of minor and major substances. Students (N = 2,216; males 52% and females 48%) were surveyed to ascertain information pertaining to their substance use. The chi-square statistic found significant gender differences at the fourth and fifth grade for use of minor substances. Patterns of initiation of minor substance use by gender and grade are discussed in the context of substance use stage theory. Overall, results support the need for further research emphasizing within group variations in the substance use of singular ethnic groups.     

The African-American Health Project (AAHP): study overview and select findings on high risk behaviors and psychiatric disorders in African American men

The AAHP investigated the neurobehavioral and psychosocial sequelae of HIV-1 and substance use in urban African American men. A community resident sample of 502 African American men stratified by HIV-1 serostatus, drug use and sexual orientation were recruited. A comprehensive battery of measures of neurobehavioral and health status, lifestyle and psychosocial characteristics were administered to all participants, and a stratified sub-sample of 120 participants were tested using state of the art brain imaging techniques to investigate differences in the functional and neurophysiologic effects of HIV-1 and substance use. An overview of the methodology of the AAHP and results on high risk sexual and substance use behaviors, and psychiatric disorders are presented and discussed. The sample was primarily HIV-negative (63%), heterosexual (49% gay or bisexual) and a high percentage used substances during the past year (56% used drugs and 30% moderate/heavy drinkers). High-risk sexual practices were relatively prevalent, and a high percentage reported a history of STDs and other infections. Finally, 25% had a current psychiatric disorder, with gays/bisexuals and HIV-seropositives evidencing greater psychiatric vulnerability. More research is needed to further explore the apparent greater risk for psychiatric disorders among gay and bisexual men, and to determine whether being African American and lower social class exacerbate this risk.     

Stress, psychosocial resources, and depressive symptomatology during pregnancy in low-income, inner-city women.

The authors examined the prospective influence of stress, self-esteem, and social support on the postpartum depressive symptoms of 191 inner-city women (139 European Americans and 52 African Americans) over 3 waves of data collection. Depressive symptomatology was measured by multiple indicators, including self-report and clinical scales. Women became less depressed as they move from prenatal to postpartum stages and adjusted to their pregnancy and its consequences. LISREL and regression analyses indicated that stress was related to increased depression, whereas greater income and social support were related to decreased depression. Self-esteem was related to lower depression at the prenatal and postpartum periods but not to change in depression from the prenatal to the postpartum period. The results also indicated that self-esteem and social support did not have additional stress-buffering effects over and above their direct effects on depression. Finally, African American women did not differ from European American women terms of depression or in terms of how they were impacted by stress or psychosocial resources. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Talon cusp in permanent dentition associated with other dental anomalies: review of literature and reports of seven cases

A longitudinally linked data set for Georgia was used to identify characteristics, including previous prenatal care use and complications at the first birth, associated with prenatal care use in the second pregnancy among 8,224 African-American women. More than 70% of the women who were < 25 years of age at their first birth (younger women) and almost 40% of women who were > or = 25 years at their first birth received inadequate care with at least one of their first two births. Women who received inadequate care in their first pregnancy were more likely to receive inadequate care in their second pregnancy than women who received adequate care in their first pregnancy. Younger women with a history of a stillbirth, neonatal death, or vacuum extraction were less likely to receive inadequate care in their subsequent pregnancy. Although this study was not able to evaluate the content of prenatal care, it suggested that many African-American women may not receive sufficient care to prevent adverse pregnancy outcomes. Women who receive inadequate care in their first pregnancy must be targeted for interventions that help them overcome economic, situational, or attitudinal barriers to receiving adequate care in their next pregnancy.     

Registered image subtraction for CT-, MR- and coronary angiography

The study described regional fat distribution and anthropometric variables in an ethnically diverse sample of women (N = 143) who were between 20 and 30 (premenopausal) or 40 and 50 (perimenopausal) yr of age and of normal weight for height. Measurements included 11 skinfolds (abdomen, biceps, calf, forearm, midaxillary, pectoral, subscapular, suprailiac, suprapatellar, thigh, and triceps), waist and hip circumferences, height and mass. Regional fat distribution for African American, Mexican American, and Caucasian women was described as gluteal femoral. African American women had the smallest waist-to-hip ratio, with larger absolute measures for both the waist and gluteal C than the Caucasians or Mexican Americans. Native American women had an abdominal fat distribution pattern which was explained by more fat on the abdomen rather than less fat on the gluteal-femoral area. Native Americans had a different fat distribution from the other ethnic groups. Caucasians are not a good comparison group for African Americans or Native Americans because there are large differences as indicated by effect sizes in regional fat distribution. Variation within the ethnic groups was larger than differences between the groups for most variables. The distribution within ethnic groups was biased by extreme scores; thus 50-70% of the subjects were similar regardless of ethnic group.     

Developmental, family, and ethnic in influences on adolescent alcohol usage: A growth curve approach.

The influence of the developmental process of individuation, family conflict and cohesion, and ethnicity on adolescent alcohol use was examined in a 3-year longitudinal study. Participants included non-Hispanic White, Mexican American, and African American adolescents (n?=?6,522) from 6th, 7th, and 8th grades. They were surveyed annually for 3 years. Depending on which aspect of individuation was measured, hierarchical linear modeling indicated that changes in adolescent individuation were related to either increases or decreases in alcohol use over the 3-year period. Separation and family conflict were related to increases in alcohol use, and intergenerational individuation and family cohesion were related to decreases in alcohol use. White and Mexican American adolescents had a faster rate of increase in alcohol use than did African American youth. Separation and family process similarly influenced adolescent alcohol use from different ethnic groups. Implications for prevention and intervention programs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pubertal maturation and early substance use risks among African American children.

Using 2 waves of longitudinal data collected from approximately 870 African American adolescents, this study examined (a) changes in early risk factors for substance use during transition to early adolescence, including perceived prototypes of substance-using peers, willingness and intention to use substances, number of substance-using peers, and youths' own actual substance use; (b) the relationship between pubertal timing and these substance use risks; and (c) the interaction between pubertal timing and peer substance use in predicting the risks. Results showed that, first, risks for substance use increased, particularly among girls, during the transition to early adolescence. Children's prototypic images of substance users became increasingly favorable during this transitional period; a greater number of them were willing and intended to use substances during the transition to early adolescence; and an increased number of early adolescents and their friends began to use substances. Second, these changes were significantly more likely to occur among early maturing girls. Third, early physical maturation interacted with peer substance use to affect these changes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV prevention among drug users: Outcome of a network-oriented peer outreach intervention.

A network-oriented HIV prevention intervention based on social identity theory and peer outreach was implemented for HIV positive and negative drug users. A community sample of 250 were randomly assigned to an equal-attention control condition or a multisession, small-group experimental condition, which encouraged peer outreach; 94% of participants were African American and 66% used cocaine or opiates. At follow-up, 92% of participants returned, and experimental compared with control group participants were 3 times more likely to report reduction of injection risk behaviors and 4 times more likely to report increased condom use with casual sex partners. Results suggest that psychosocial intervention emphasizing prosocial roles and social identity, and incorporating peer outreach strategies, can reduce HIV risk in low-income, drug-using communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical subtypes of bipolar mixed states: validating a broader European definition in 143 cases

Low-income women are among those at risk for delivering low-birth-weight babies (Lia-Hoagberg et al., 1990; Miller, Magolis, Schwethelm, & Smith, 1989; St. Clair, Smeriglio, Alexander, Connell, & Niebyl, 1990). These women tend to use prenatal care less often, perceive more barriers to care, have less positive reinforcement for receiving care, have less access to care, have lower education levels, maintain less healthy lifestyles, and have lower compliance with recommendations (Henderson, 1994; Koska, 1990; Lia-Hoagberg et al., 1990; Miller et al., 1989). This article will highlight three attributes of the problem of low-income women and prenatal care. First, low-income pregnant women are at risk for delivering low-birth-weight and preterm babies, which usually leads to expensive subsequent care. Second, an unhealthy maternal lifestyle increases the risk of delivering a low-birth-weight or preterm baby. Third, there are social, programming, and lifestyle barriers that low-income women face in receiving prenatal care. Finally, this article examines the use of the Health Belief Model as a theoretical basis for future prenatal care programming for low-income women.     

Drug use among pregnant adolescents.

Despite concern over the co-occurrence of substance use, unplanned pregnancy, and other problem behaviors in adolescence, little information is available on substance use before, during, and after adolescent pregnancy. The authors report data from the first 100 Ss enrolled in an ongoing longitudinal study on drug use before and during pregnancy in adolescence. Unmarried pregnant adolescents, ages 17 and under, were recruited for the study from urban alternative school programs and community social and health service agencies. Findings indicate that although lifetime prevalence of drug use was relatively high and pregnant respondents appear embedded in drug prevalent environments, substance use declined voluntarily and substantially during pregnancy. Prepregnancy drug use predicted substance use during pregnancy, but neither best friends' nor boyfriends' use of alcohol or marijuana predicted subjects' use of these substances during pregnancy after taking prepregnancy use into account. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of the effect of fundoplication on primary and secondary peristalsis in the esophagus

BACKGROUND: Delay of prenatal care is an important risk for poor birth outcome, yet its association with maternal knowledge and beliefs remains insufficiently studied. This research examined the relationship of unintended childbearing and beliefs about the importance of prenatal care with initiation after the first trimester, adjusting for key sociodemographic determinants. METHODS: One hundred fifty-four Texas hospitals accounting for 80 percent of state births were asked to collect surveys from all women delivering infants during a one-week interval in 1986. Seventy-four percent of hospitals and 70 percent of women participated (n = 2032). No differences occurred between the sample and the population on rates of delayed care and low birthweight or maternal demographics. RESULTS: Since delayed prenatal care is more frequent among low-income women, analyses were limited to those below the 200 percent poverty level. After adjustment for maternal age, marital status, education, parity, race, and health insurance status employing logistic regression, unintended births were 1.6 times more likely to involve delayed care. Mothers who believed prenatal care was unimportant were 2.1 times more likely to delay care. These coefficients exceeded or about equaled those for the covariates. CONCLUSIONS: Preconception education about the value of prenatal care and family planning programs to prevent unintended pregnancies should be conducted together with efforts to overcome financial and structural barriers if progress toward national prenatal care objectives is to be achieved.