Do Maternal Psychosocial Factors Predict Adolescent Weight? Sandra Jody MarksDepartment of Exercise Sciences, BYUMaster of SciencePurpose: This study investigated the possible relationship between maternal psychosocial factors, mainly maternal stress and maternal depression, and adolescent weight status. Also, this study examined the predictive effect of these maternal psychosocial factors on adolescent weight loss during a health education intervention as well as the months following the health education. Methods: Study design was a longitudinal pretest posttest with a health education intervention. We assessed 40 adolescents and their mothers on four occasions over a 1-year period. At each occasion, the Stress Index for Parents of Adolescents (SIPA) was used to measure maternal stress and the Beck Depression Inventory (BDI-II) was used to measure maternal depression. Also, at the four occasions, adolescent anthropometric data were obtained by research assistants using a digital scale for weight and a portable stadiometer for measuring height. Body Mass Index scores (BMI = [weight (kg)]/[height (m)]2) were calculated and converted into a percentile score (zBMI), adjusting for age and gender, using the standard Center for Disease Control and Prevention calculator. At the onset of the study, the adolescent participants and their mothers all received 12 weeks of health education, which included group behavioral therapy, family-based intervention, motivational interviewing and electronic intervention. Results: Hierarchical regression analysis revealed that no significant relationships existed between maternal stress and adolescent zBMI or between maternal depression and adolescent zBMI at baseline (Time 1). Nor did the study find that maternal stress and/or depression scores at Time 1 significantly predicted a greater amount of adolescent weight loss. Lower stress and/or depression also did not significantly predict adolescent weight maintenance after the 12-week intervention (Time 2). However, results did indicate that the adolescent component of the maternal stress domain (AD) from Time 1 to Time 2 was a significant predictor of adolescent zBMI from Time 1 to Time 2, (R2 = 0.238, F (1,21) = 6.571, p = 0.018). This means that 23.8% of the variability in overall zBMI change from Time 1 to Time 2 is being accounted for by change in the maternal AD stress domain from Time 1 to Time 2. Conclusion: Adolescent zBMI decreased concurrently with maternal stress during the health education intervention stage. Although the correlational nature of this study prevents causal claims, this result suggests that decreasing maternal stress may strengthen the ability of obese adolescents to effectively lose weight. This study encourages further research to examine the effects that maternal psychosocial factors may have on adolescent weight status, weight loss, and weight maintenance.

Breastfeeding (BF) reduces maternal and infant risk for the development of a variety of short and long-term health outcomes. Appalachia faces several health disparities, with infants at increased risk for poor birth outcomes. The purpose of this study was to explore postpartum patients’ (PP) infant feeding experiences (IFE) and examine perceived barriers to BF among PPs and international board-certified lactation consultants (IBCLC) in Northeast Tennessee, located in Appalachia. PPs and IBCLCS were recruited using convenience and snowball sampling, respectively. Fourteen semi-structured interviews were conducted, 7 PPs and 7 IBCLCs. Interviews were conducted in-person or via Zoom and were recorded, transcribed, and de-identified. PPs were asked about their IFEs and barriers to BF, while IBCLCs were asked about perceived barriers to BF for their patient population. Rapid qualitative analysis was conducted with two coders, both summarizing the first interview for each participant type. Summaries were compared to ensure consistency and subsequent interviews were coded by a single coder. Summaries were used to identify high-level themes related to barriers to BF for each participant type. All analysis was conducted in Microsoft Excel, and the study was approved by the ETSU Institutional Review Board. High-level themes for PP IFEs included stressful experiences and the positive impacts of IBCLCs. Stressful experience sub-themes included latch and supply issues, pump and syringe feeding, PP and infant health complications, lack of hospital support, and expectations for supplementing. Barriers to BF for PPs incorporated physiological (latch and milk supply sub-themes) and environmental barriers (employment and family support sub-themes). High-level themes for IBCLCs perceived barriers to BF included PPs having access to too much information, perceptions and expectations of BF, cultural barriers, lack of support and prenatal education, physiological barriers, and maternal comorbidities. Overlap between PPs stressful IFEs and IBCLCs perceived barriers to BF included themes related to BF expectations, lack of support, physiological barriers, and comorbidities. Similarly, overlap between PPs and IBCLCs perceived barriers to BF included physiological and environmental factors. IBCLCs mentioned additional barriers such as access to too much information and lack of prenatal BF education, while these themes were not identified in PP interviews. A future focus for BF support includes discussions with clinicians after delivery about any physiologic barriers that PPs may face and informing providers on how to both avoid and treat these barriers as they arise to alleviate stress. Connection to BF support in the community before and after delivery could improve the chances that mothers receive help in addressing these issues as they arise. Furthermore, including family members in these discussions may help build family and overall social support.

Fear is an adaptive emotion that typically increases across infancy to help keep infant exploration in check. Too much fear, however, can become maladaptive and lead to psychopathology later in childhood. Thus, it is important to understand how both fear reactivity and regulation develop early in life in order to identify at-risk children early on. Maternal factors, such as parenting behaviors and personality, are associated with both fear reactivity and regulation, but results have been mixed, possibly due to a trait-based approach to assessing maternal personality. The goal of my dissertation was to examine the growth trajectories of fear reactivity and regulation across infancy and toddlerhood both unconditionally and within the contexts of maternal parenting and personality functioning. Infants and mothers were assessed when infants were 10-months (n = 48), 14-months (n = 42), and 18-months (n = 34) old. At each age, infant fear reactivity was assessed using behavioral coding during the Laboratory Temperament Assessment Battery fear tasks and infant fear regulation was examined via respiratory sinus arrhythmia reactivity during the fear tasks. At 10- and 14-months, maternal parenting behaviors were coded during an interaction task and maternal personality functioning was assessed via maternal self-report. Hierarchical linear modeling demonstrated that maternal personality functioning moderated the association between maternal affect and infant fear reactivity growth and maternal personality functioning moderated the association between maternal directiveness and infant fear regulation growth. These results aid in the understanding of how maternal factors relate to infant fear development. / Doctor of Philosophy / Fear is an adaptive emotion that increases across infancy to help keep infants safe as they gain the ability to explore their environments independently. Some infants, however, exhibit heightened levels of fear that set them on a path for negative consequences, like anxiety disorders, in childhood. This typically occurs when infants have high levels of fear without appropriate regulation strategies to manage such. Maternal factors, like parenting behaviors and personality, have both been shown to affect the development of fear and the regulation of fear, but results are not consistent. Given this, the goal of my dissertation was to examine how level of fear (fear reactivity) and management of fear (fear regulation) develop across infancy and toddlerhood under the context of maternal parenting and personality. Infants and mothers were assessed when infants were 10-months (n = 48), 14-months (n = 42), and 18-months (n = 34) old. At each age, infant fear reactivity was assessed using behavioral coding during the Laboratory Temperament Assessment Battery fear tasks and infant fear regulation was examined via physiological means based on heart rate. At 10- and 14-months, maternal parenting behaviors were coded during an interaction task and maternal personality functioning was assessed via maternal self-report. Results demonstrated that maternal personality functioning moderated the association between maternal affect and infant fear reactivity development and maternal personality functioning moderated the association between maternal directiveness and infant fear regulation development. These results aid in the understanding of how maternal factors relate to infant fear development.

The introduction of Primary Health Care (PHC) in Saudi Arabia has given nurses excellent opportunities and more responsibility to provide health education and advice in health promotion activities. Provision of appropriate and affordable dietary advice is an important role of the nurses in the Primary Health Care Centres (PHCC). Maternal nutrition is an essential element for the health status of the child, the family and the wider society. Many studies have suggested that there is a relationship between good nutritional intake during pregnancy and the successful outcome of the pregnancy. The present study was conducted to explore the knowledge and understanding of Saudi women and nurses in PHCC regarding nutritional intake during pregnancy. The study also looked at the effect of a short education programme on the nurses' nutritional knowledge and their subsequent practice. The aims of the study were to identify the understanding of Saudi women of pregnancy and nutritional intake during pregnancy, and to evaluate the effect of a short nutritional programme on diploma nurses. To achieve the aims, data collection was carried out in three phases. Phase one used semi-structured interview (tape recorded) on 10 pregnant women, selected randomly, to elicit the general understanding pregnant women had on pregnancy and pregnancy related areas. Phase two used a structured interview schedule on 100 pregnant women attending PHCC, selected systematically, to assess nutritional knowledge and their perception of nutritional advice given by the nurses in PHCC. Phase three was divided into two stages. The first stage used a self-administered questionnaire on 20 diploma nurses working in antenatal clinics in PHCC to assess their nutritional knowledge in relation to pregnancy. The questionnaire was used as both a pre-test and post-test instrument. Thereafter, based on the findings from phase one and two, a 20-hour continuing education (CE) programme was developed by the researcher on maternal nutrition for the diploma nurses. The second stage was to implement the programme to the nurses in five days. The effect of the programme was evaluated by an immediate post-test on nurses' knowledge and a follow-up post-test (after six months) to assess any lasting changes. Data analysis was carried out using content analysis for phase one. For the phase two and three, SPSS programme was used. Chi square was used to look for any association between knowledge scores and personal variables, paired Hest was used to assess the difference between pre-test and post-test. The results from the study showed that the majority of women attending the PHCC were illiterate or had little formal education, had a high pregnancy rate and had poor nutritional knowledge in relation to pregnancy. They preferred female health professional care and they preferred to have female doctors attending their antenatal care rather than the nurses. There was no significant difference between nurses' and women's nutritional knowledge. The results also showed a significant correlation between poor nutritional knowledge scores of the women and certain factors: the scores correlated positively with the level of education and negatively with the number of pregnancies. Regarding the programme, the results showed a significant increase in the nurses' nutritional knowledge scores from pre-test to post-test at p< 0.05, indicating that participants demonstrated increased nutritional knowledge as a result of participation in the programme. There was no significant difference between the initial post-test and the six-month follow-up. No significant relationships were identified between the nurses' scores and their age and years of experiences. The study also indicated that nurses in PHCC were not giving adequate nutritional advice to pregnant women in the views of these women and in my own observation. The findings suggest that frequent continuing education is essential for nurses in PHCC in Saudi Arabia to improve their skills and nutritional knowledge to be able to provide better care for women.

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BACKGROUND: Micronutrient deficiency (vitamin A, iron, and iodine) is highly prevalent in the Dominican Republic as indicated by food consumption patterns, which are not reflective of consumption of micronutrient dense foods. Previous studies (Neves, Ramalho, Padilha, & Saunders, 2014) have shown that nutrition education offered by prenatal providers has a positive impact on nutrition outcomes in mothers and children. Little research exists which examines the difference in micronutrient consumption among mothers in the Dominican Republic. The aim of this study was to determine differences in micronutrient rich food consumption of mothers in the Dominican Republic based on type of prenatal provider (General practitioner, Obstetrics/gynecology (OBGYN) or no Provider). METHODS: The 2007 Dominican Republic DHS dataset was employed for this study. Odds ratios from multivariate logistic regression analyses were used to determine association between sources of prenatal service and micronutrient food intake. Statistical adjustments were made for residence, wealth index, education, marital status, smoking age and number children ever had. RESULTS: Compared with mothers who did not utilize any of the prenatal services, mothers who sought care from General practitioners and OBGYN had increased odds of consuming vitamin A, iodine and iron micronutrient rich foods, adjusting for residence, wealth index, education, marital status, smoking age and mother’s total number of children. However, the associations were not statistically significant. Compared to mothers who did not use prenatal care, mothers who used the services of General practitioners and OB/GYNs had greater odds, (OR=1.09; 95% CI:0.85-1.41) and (OR=1.29; 95% CI:1.01-1.65) respectively, of consuming at least one micronutrient food. Compared to mothers who did not use prenatal care, mothers who used the services of General practitioners (OR=1.31; 95% CI:1.00-1.70) and OB/GYNs and (OR=1.36; 95% CI:1.05-1.75), had greater odds of consuming at least two micronutrient foods. The corresponding odds ratios for consuming all three micronutrients for mothers using the services of General practitioners and OBGYN were 1.48 (95% CI=0.80-2.74) and 1.51 (95% CI=0.84-2.74), respectively. Prenatal Care and Micronutrient Dense Foods 3 DISCUSSION: Improvements and access to programs providing nutrition education for prenatal care providers, and medical and nutrition assistance to poor mothers may help to increase micronutrient rich food consumption in the Dominican Republic. KEY WORDS: micronutrient, diet, maternal, Dominican Republic

Mothers' dating after divorce has been linked to health benefits for mothers (Amato, 2000). However, this association assumes that all repartnering relationships are beneficial for mothers (Symoens et al., 2014). According to the divorce-stress-adaptation perspective (Wang & Amato, 2000), mothers' dating after divorce may be a supportive factor for her adjustment if her relationship is high quality, which can assist mothers with post-divorce stress (Amato, 2000; Wang & Amato, 2000), or can contribute to post-divorce stress through low quality relationships (Hetherington, 2003; Montgomery et al., 1992). However, not all mothers date, and those that do, use different approaches to dating, such as dating only one partner versus multiple partners. Another deficit in the literature is the influence of selection processes during repartnering. As well as examining the impact of relationship quality on maternal well-being, the current study includes the influence of stable traits, such as age and length of marriage, in order to examine the threat of selection across different repartnering histories. The current study used four repartnering histories that mothers reported after divorce (no dating, dating monogamously, dating multiple partners serially, and dating multiple partners simultaneously) to examine consequences on maternal well-being (depressive symptoms, life satisfaction, drunkenness, and unprotected sex). Relationship quality is reported for each relationship. Using longitudinal monthly diary data collected over a two-year period beginning with filing for divorce and multi-level models, I examined changes in the intercept and slope of maternal well-being for each repartnering history, as well as the effect of breakup with a particular focus on the interaction of relationship quality. To test for the threat of selection, I used mothers' stable traits as level-2 predictors. Results for this study show that mothers who enter in a high quality relationship report slightly higher levels of maternal well-being. Mothers entering low quality relationships report slightly lower levels of maternal well-being compared to times when mothers are not dating. Maternal well-being was not consistently influenced by maternal breakup. Mothers also reported increases in unprotected sex throughout the study, which may be a better marker of trust than maternal well-being. Only support was found for selection effects. Implications for maternal well-being are discussed. / text

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