Thesis--Ph. D., University of Hong Kong. / Mimeographed.

This dissertation is based on an ethnographic study of the lives of six student-parents (four young women and two young men) from Barlow High School in northwest Austin, Texas. The lived experiences of student-parents from a predominately Latina/o high school and my interactions with Barlow High School's student body, staff, educators, administrators, and social workers from an on-campus organization called A-Space illustrate how the discursive construction of teenage pregnancy as a social problem intersects with the schooling process to (re)produce gendered, classed, and racialized notions of belonging in the American body politic. My analysis considers the development of an American cultural concern with teenage pregnancy through a history of reproductive and racial politics, and it examines the work of The National Campaign to Prevent Teenage and Unplanned Pregnancy, which, I argue, is a racializing campaign. An American cultural concern with teenage pregnancy has yielded a discourse of teenage pregnancy prevention that constructs the solution to teenage pregnancy around responsibility rather than access to contraception and information. The lives of Barlow High students and student-parents highlight the complexity of deterritorialized lived experiences, which sometimes include early family formation. While Barlow High School's student body of color learned about belonging in the first decade of the new millennium, educators vacillated between understanding the intersecting hierarchies of power impeding socioeconomic mobility and academic achievement in the community and believing that they did the best they could in the given situation. Educators and social workers, as agents of the state, failed to recognize their role in creating community. In sum, this dissertation documents a borderlanding or the creation of a borderlands in the new millennium. / text

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Anxiety is common among pregnant and postpartum women. The research attention in the area of reproductive mental health has mainly focused on postpartum depression in past decades. Given the health implications of maternal anxiety on the physical and psychological well being of both mothers and their offspring, there is an urgent need to fill the current research gaps. The objectives of the present study were to determine the prevalence of antenatal and postpartum anxiety symptoms; investigate the nature and development of antenatal and postpartum anxiety; clarify the constructs of antenatal anxiety; identify demographic and psychosocial risk factors; and examine the effects of antenatal anxiety on postpartum anxiety and infant development and temperament. A prospective longitudinal design with quantitative approach was adopted in the present study. Pregnant women from two regional hospitals in Hong Kong were invited to participate in the study. They were assessed using standardized and validated psychological instruments on 5 time points including the first, second and third trimesters of pregnancy, 6-weeks and 6-months postpartum. A total sample of 1470 pregnant women was assessed on antenatal general anxiety and postpartum anxiety and hypothesized risk factors. A subset of 186 pregnant women was assessed on pregnancy-specific anxiety and infant temperament and development. The results showed that an appreciable proportion of pregnant women manifested general anxiety symptoms and pregnancy-specific anxiety symptoms during pregnancy. A mixed-effects model analysis for repeated measures showed that both forms of anxiety followed a U-pattern across pregnancy (p<.05 for both), with both being less prevalent in the second trimester. Findings supported that pregnancy-specific anxiety symptoms and general anxiety symptoms are two distinct but inter-related forms of anxiety. Different demographic risk factors for anxiety symptoms vary across different trimesters. Self esteem and marital satisfaction were consistently associated with both general anxiety symptoms and pregnancy-specific anxiety symptoms over the course of pregnancy. Regarding the impact of antenatal anxiety, general anxiety symptoms in the third trimester had the strongest association with postpartum anxiety at 6-weeks postpartum (p<.05). In general, general anxiety symptoms were more strongly associated with postpartum anxiety than pregnancy-specific anxiety symptoms. After adjusting for the effects of postpartum anxiety and depression and other covariates, pregnancy-specific anxiety symptoms were independent predictors for fewer infant’s falling reactivity response (p<.05), greater infant’s fear response (p<.05) and greater distress to limitations (p<.05), whereas general anxiety symptoms were independent predictors for poorer social (p<.05) and speech (p<.05) development. The present study points to the need for greater research and clinical attention to antenatal anxiety given that antenatal anxiety is a prevalent problem with changing course and has serious impacts on maternal well-being and infant development. General anxiety symptoms and pregnancy-specific anxiety symptoms reflect different pathologies with potentially different pathogeneses and different pathways to postpartum well-being and infant outcomes which deserved further investigation. The present findings contributed to the understanding of maternal anxiety and have implications for the design of effective identification, prevention and treatment of these significant clinical problems. / published_or_final_version / Psychiatry / Doctoral / Doctor of Philosophy

Background Postnatal depression (PND) has become a world-wide public health problem. Maternal Child Health Centers (MCHCs) provide maternal and child healthcare with community-based Comprehensive Child Development Services (CCDS) aimed for early identification for provision of appropriate referral for intervention. There were 13.8% suspected PND cases in 2011(Department of Health PND Report, 2011). Antenatal Interpersonal Psychotherapy (IPT) has found efficacious for high depression risk (HDR) pregnant women. Evidence-based practice (EBP) antenatal IPT guideline best suited for MCHCs implementation. Purpose This dissertation intends to develop an effective EBP antenatal IPT guideline for HDR pregnant women, and to offer plans for implementation and evaluation. Methods Six electronic databases searched for updated relevant studies. Randomized controlled trails (RCTs) with antenatal IPT intervention for HDR pregnant women targeted. Evidence data related to EBP guideline development were extracted for critical appraisal. Program implementation potentials assessed for transferability, feasibility and cost-benefit ratio. Guideline with level of evidence and recommendation grading developed. Communication plan for different stakeholders and potential users were developed. Pilot test planned for process evaluation. Impact evaluation, outcome evaluation and economic evaluation planned to verify empirical evidences to initial changes in MCHCs. Results Eight RCTs studies, which compare group receiving antenatal IPT intervention with routine antenatal education group, were reviewed. Target population was HDR pregnant women. Antenatal IPT intervention found effective for HDR pregnant women with PND. The studies suggest antenatal IPT intervention give0.89 reductions in EPDS, improved psychological well-being, 0.77 reductions in GHQ and improved role competence2.43 increases in PSOC-E. After critical appraisal of reviewed studies, antenatal IPT guideline developed. Pregnant women should be screened between 20 to 32 gestation weeks. Those with EPDS≥13 scores should enrolled into two 2-hour antenatal IPT program educated by trained nurse educators in class size ≤10. Those refusing to join the program receive routine education. Three-point measurements of EPDS, GHQ and PSOC-E at baseline, postnatal 6 to 8 weeks and 3 to 6 months of both groups are conducted. Postnatal EPDS ≥13 participants referred for psychiatric services upon their consent. Program will propose implementation in MCHCs. Steering Committee is established and communicates with various stakeholders. Pilot test implement in one MCHC and reviewed for clinical applicability, feasibility and to obtain process evaluation for quality improvement. Program should have quasi-experimental non- equivalent pretest-posttest control group and analyze data with ‘two-sample t-test’, ‘paired t-tests’ and ‘chi-square test’. Target achievement should be: i. Primary outcomes: EPDS score reduced to0.89, GHQ reduced to0.77 and PSOC-E score increased to2.43; ii. Secondary outcomes: Reduction of PND incidence and PND management caseloads by 20%. Participants’ gestation ages, program attendance and satisfactory rates recorded. Economic evaluation indicates for every $1invested, the return is $8.45, program is a sound investment suggested. Conclusions Eight RCT studies provide evidence that antenatal IPT program is effective for HDR pregnant women in reducing PND, and in promoting higher maternal role efficacy level and psychological well-being. Implementation of this EBP program guideline can potentially help PND prevention and ease antenatal depression management of HDR pregnant women in MCHCs. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Background Findings for the association of prenatal maternal infections and schizophrenia are inconsistent. Whether specific maternal infections may contribute to central nervous system dysfunction, like schizophrenia remains unknown. Thus, a systematic review is conducted to clarify the role of infections on the pathogenesis of schizophrenia. Methods A manual and electronic search of the literature for prenatal maternal infection at the individual level and the diagnosis of schizophrenia in offspring was conducted. All the included studies are searched from PubMed and EMBASE databases and generally based on population level datasets with cohort or nested case-control studies designs. We only focus on three kinds of maternal infections in the review (i.e. influenza pandemic, rubella and Toxoplasmosis), other infections such as herpes simples, varicella‐zoster virus and polio were excluded. Positive family history of psychotic illness was excluded as genetic disposition is established as a strong risk factor of developing schizophrenia in offspring. Results Fifteen studies were included in this systemic review. Nine (60%) of these studies reported a positive association between maternal infections and the development of schizophrenia in the later lives of their offspring, while six (40%) of these studies indicated that there is no significant difference among cases of schizophrenia in maternal infections exposure and the control subjects or no association between schizophrenia in offspring and the infections during pregnancy as the exposure. Among all the studies, thirteen cohort studies and two nested‐case studies were examined. Eight (61.5%) showed a positive association, meanwhile five (38.5%) showed a null association. Two nested‐case control studies both suggested that maternal infection exposure is a risk factor for schizophrenia. Conclusion Findings for the association of prenatal maternal infections and schizophrenia are not equal to the evidence for causation. Due to the absence of external validity due to small and non‐representative samples, selection bias was suspected even with a significant result. Additionally, multiple exposures were hard to testify during pregnancy. Even we adjusted for the measured confounders, residual confounding such as genetic disposition and socioeconomic status, as well as unmeasured confounding are concerns. Quasi-experimental methods may help improve causal inference such as the use of instrumental variable analysis in future studies. Preventive strategies such as immunizations need to be deliberated carefully to weight the benefit and the potential impact. / published_or_final_version / Public Health / Master / Master of Public Health

North American research on childbearing demonstrates that many first-time mothers rely on educational books for information and advice concerning pregnancy and childbirth. Popular literature on childbearing advises women on a variety of topics including choosing a caregiver, prenatal testing, safety and risk, natural vs. medicated labour, and place of birth. Such information may shape women’s expectations, choices, and belief systems regarding the body, obstetric technology, pregnancy and birth. These varied forces and belief systems coalesce to influence the ways in which women experience birth, thereby affecting post-natal mental, socioemotional, and physical health. Currently, however, research exploring the various messages disseminated by popular literature on pregnancy and birth is limited. In this study, the author examines four popular North American childbearing advice books for discourses related to biomedical and midwifery cultures, ways of knowing, power, and choice. Discourses are considered through a feminist intersectional framework, with particular attention paid to the ways in which childbearing ideologies are shaped by interactive biological, socio- cultural, economic, and political factors. The author explores how power matrices and the privileging of biomedical knowledge can shape conceptualizations of gender and sexuality, women’s bodies, maternity care, pregnancy, labour, and birth. In addition, peripheral discourses that provide possibilities for other, non-normative narratives of birth are highlighted. / Graduate

Not available / text

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences