An abundance of evidence supports that high stress levels often predict poor health, and high levels of religiosity, broadly defined, predict good health. It is possible that one mechanism by which religiosity positively impacts health is by preventing or reducing stress response. Studies measuring Surrender (Surrender to God from a Christian Religious Tradition) have shown that religiosity measured in this way is consistently negatively related to stress levels in college samples and community samples of pregnant women. The next step toward investigating a possible causal mechanism of religiosity on stress level is to experimentally manipulate religiosity. If it is found that it is possible to experimentally increase religiosity, the stage is then set to endeavor to change health and influences on health, such as stress, by such an increase. Specifically religiosity could be manipulated to determine whether changes in religiosity actually affect stress levels. Although this is the normal progression when investigating the efficacy of medical treatments, there has been significant opposition to the manipulation of religiosity. It is understandable that attempting to reduce religiosity would be unethical, but if there are potential health benefits to increasing religiosity, this field of research would seem to be worthy of investigation. The research community has been resistant to fund or even to approve such studies. Even more surprisingly, the medical community, while embracing the use of pharmacological substances to improve health or reduce disease (even for pregnant patients), remains reluctant to even investigate the efficacy of prescribed increases in religiosity, which would represent less physiological risk. Why is there this specific prejudice against religiosity as an intervention? Is it due to the lack of an observable mechanism? There are medications for which the true mechanism of effect is unclear, yet they are used because of the value of the effect. Is it because of the potentially reduced need for medical or pharmacologic intervention? Is it because it is poorly understood by many health care providers? If the ethics regarding human subjects research are embraced, a study should illustrate the potential benefits for both participants and others that outweighs any potential harm to the participants. It seems that on that basis, such experimental studies of the effects of increased religiosity on health should be considered.

This attempt to validate the brief AAS and WAST against the gold-standard CTS2 resulted in sensitivities of 34.8% (AAS) and 45.5% (WAST) for physical IPV; however both identified a much smaller number of cases of sexual violence than the CTS2 in a rural pregnant population.

Breastfeeding has health benefits for mother and child, allowing a mother to protect her newborn from numerous infections while promoting healthy nutrition and growth. Breastfed babies have decreased risk of later negative health problems including respiratory infection, asthma, obesity, and Type II diabetes. The minimum acceptable time a mother should breastfeed is six weeks, but major healthcare organizations, such as the American Academy of Pediatrics, recommend exclusive breastfeeding for the first six months of life. Nationally, 43.1% of babies were exclusively breastfed the first six weeks in 2009, and rates in rural Appalachia are known to be significantly lower than national averages. Researchers have found factors such as age, socioeconomic, marital, and smoking statuses to be predictive of breastfeeding continuation, but maternal innate characteristics have not been explored extensively. To clarify why a mother chooses to breastfeed or not, it is important to additionally look at intrinsic characteristics such as temperament. Temperament is an individual’s biologically based ability to think, behave, and react. Effortful control, a specific component of temperament, is the voluntary regulation of emotions and behaviors. The current study examined the impact of effortful control on participants’ likelihood of breastfeeding at six weeks postpartum. Informationwas collected from pregnant women recruited from Northeast Tennessee as part of the Tennessee Intervention for Pregnant Smokers Program. As part of the larger study, women completed detailed research interviews multiple times during pregnancy, and at six weeks post-partum. The responses of interest came from 230 women who had complete demographic questionnaire, Adult Temperament Questionnaire (ATQ), delivery and birth chart information, and six-week interview breastfeeding status. Logistic regression was used to assess the impact of maternal effortful control (subscale of the ATQ) on the mother’s decision to exclusively breastfeed the child up to six weeks postpartum. The model contained five variables that were significantly correlated with the breastfeeding continuation: maternal age, birth weight (normal/low), prematurity (yes/no), delivery type (vaginal/C-section), and maternal effortful control scores. The full model containing all predictors was statistically significant, X2 (5, N=230) =24.610, p < .001. Effortful control had an Exp(B) of .420, CI (.264, .668) p<.001. Those women who are still breastfeeding at six weeks have significantly higher self-reported effortful control than those who are not still breastfeeding at six weeks, controlling for several other known correlates of breastfeeding continuation. Effortful control was found to predict decreased breastfeeding at six weeks. Because effortful control is an aspect of temperament, and is therefore relatively fixed, its measurement may be useful for identifying women who are less likely to breastfeed so they can be targeted by health educators and clinicians for more intensive intervention. Any increase in breastfeeding holds the potential for positive health outcomes for both mother and child.

Introduction: Substance use, including cigarette smoking, while pregnant can lead to a plethora of health concerns for both the mother and unborn child including premature birth, low birth weight, and stillbirth. Compared with women nationally, pregnant women in Tennessee are more than three times as likely to smoke during pregnancy. Preliminary findings suggest high levels of religious commitment may be reliable predictors of negative health behaviors. However, the association between religious commitment and substance use has not been thoroughly investigated in pregnant populations. Using a brief measure of religious commitment, it was hypothesized that pregnant women with higher levels of religious commitment would be significantly less likely to engage in cigarette smoking and other substance use. Methods: Participants included 654 pregnant women involved in the Tennessee Intervention for Pregnant Smokers program who completed multiple interviews during pregnancy. Of interest in the current investigation, participants’ religious commitment was measured using two items from the 12-item Surrender Scale, and a 1-item church attendance measure from the Brief Multidimensional Measure of Religiousness/Spirituality. Participants also completed a background information form assessing demographic characteristics, smoking habits, and drug use, with final substance use variables composites of both self-report and urine drug screen results. Results: Direct logistic regression was performed to assess associations between religious commitment and both smoking status (at conception and delivery) and other substance use. All models included level of education, age, marital status, and insurance status. The full direct model predicting smoking status at conception was statistically significant, χ2 (5, n = 654) = 178.76, p < .001, indicating the model could distinguish between participants who did and did not report smoking early in pregnancy. The model as a whole explained between 24% and 32% of the variance in smoking status, and correctly classified 71% of cases. All variables made statistically significant and unique contributions to the model, including religious commitment (OR=.857). A similar pattern was found in the model predicting smoking status at delivery χ2 = 157.01, p < .001. A third regression, using the same predictors, examining the impact of religious commitment on any illicit drug use prior to or during pregnancy, was also statistically significant, χ2 = 58.46, p < .001. Conclusions and Implications: In this sample, religious commitment predicted smoking status and other drug use during and prior to pregnancy. Inquiry into religious commitment as an additional gauge of health behaviors may be beneficial to healthcare professionals. Future research should investigate the possible mechanism of how religious commitment influences health behaviors in pregnancy.

Introduction: More than 324,000 women per year are identified as having experienced intimate partner violence (IPV) during pregnancy. Correctly identifying women experiencing all forms of IPV is necessary to inform the development and implementation of interventions to prevent and address IPV. The Abuse Assessment Screen (AAS) and Women Abuse Screening Tool (WAST) were designed to quickly identify violence against women, but clinical practice and research are hindered by the lack of validity date for these and other similar screening tools. The purpose of the current study was to compare and validate the brief AAS and WAST against the longer well-validated Revised Conflict Tactics Scale (CTS2) in a rural pregnant population. Methods: Participants in the Tennessee Intervention for Pregnant Smokers (TIPS) program (N=540) completed several questionnaires during a prenatal visit,including the AAS, WAST, and CTS2. The AAS questions: “within the last year have you been hit slapped or physically hurt by someone?” was used for physical violence comparison with the corresponding CTS2 subscale, and “within the last year has anyone forced you to have sexual activities” was used for sexual violence comparison with the corresponding CTS2 subscale. The WAST was compared to the CTS2 subscales using the two questions “has your partner ever abused you physically” and “has your partner ever abused you sexually?” In addition, a third comparison was made between the CTS2 psychological abuse subscale and the WAST question, “Has your partner ever abused you emotionally?” There are no questions on the AAS that specifically addresses psychological abuse to use for comparison to the WAST and CTS2. Results: Prevalence of any form of IPV, as indicated by answering “yes” to any of the IPV assessment questions, was 45% for the AAS, 74% for the WAST, and 80% for the CTS2. According to the CTS2 subscales, the prevalence of physical, sexual, and psychological violence within the last year was 21%, 19%, and 76% respectively. Taking the CTS2 results as standard, sensitivity on the AAS for physical violence was 35%, and for sexual violence was 2%. Sensitivity on the WAST for physical violence was 46%, for sexual violence was 1%, and for psychological violence was 29%. Conclusions and Implications: The WAST performed better at identifying cases of physical violence than the AAS, while the two screening tools performed similarly in identifying cases of sexual violence. However, neither IPV screen identified a large number of sexual violence victims. Because the WAST includes questions regarding psychological abuse in addition to physical and sexual abuse, the WAST captured more cases of any form of IPV compared to the AAS. These results suggest that the WAST should be used with caution as a stand-alone assessment of IPV, and that the AAS should not be used as a stand-alone assessment for physical or sexual violence in this pregnant population.

Introduction: Smoking during pregnancy can lead to many negative health outcomesfor the mother and child. More than 30% of pregnant women in rural Appalachia smoke, which is three times the national average. Prenatal appointments present a unique opportunity for health care professionals to address smoking in this population. However, many cessation efforts during pregnancy address only the physical health impact of smoking rather than the personal circumstances surrounding cigarette use. Therefore, the current project investigated self-reported barriers to pregnancy smoking cessationand whether these differed by smoking cessation status at delivery. Methods: Study participants (N=459) were women from the state-funded Tennessee Intervention for Pregnant Smokers (TIPS) program who were self-reported smokers at the beginning of their pregnancy. Women receiving prenatal care in Northeast Tennessee were recruited for participation. The majority of participants were Caucasian, low income, and received state-assisted medical insurance coverage. Participants completed multiple questionnaires, including an assessment of background characteristics and smoking behaviors/beliefs. Of interest to the current investigation was the following open-ended question, asked at entry into prenatal care: “What do you see as the biggest barriers to your quitting smoking (i.e. what would be most likely to keep you from being able to quit)?” Common themes of responses were developed and coded using an iterative process by three independent reviewers, resulting in ten themes. Finally, medical charts were reviewedfor self-reported smoking status at delivery, and participants were subsequently coded as either continued smokers (N=347) or successful quitters (N=112). Results: The majority of women, regardless of delivery smoking status, responded that stress was their primary barrier to smoking cessation, followed by second-hand smoke. Significant differences were found between continuing smokers and those who were able to quit, with quitters less likely to report stress, Χ2 (1, 459) = 7.32, p = .007, or emotional/mental health Χ2 (1, 459) = 12.90, p < .001), as barriers. Continued smokers also listed significantly more barriers per person than quitters t(238.2) = -2.81, p = .005, while quitters were more likely to report that they had no barriers to smoking cessation. Conclusions and Implications: This study suggests that smoking cessation interventions during pregnancy should specifically address stress management and emotional/mental health, as well as second hand smoke, and underlines the importance of addressing mental health issues early in pregnancy. In sum, understanding women’s perceptions of why they believe they cannot quit smoking during pregnancy may help in the development of more effective smoking cessation interventions.

Prenatal depression is a significant problem because of the myriad psychosocial, somatic and obstetrical complications it poses. Numerous studies have confirmed that religiosity is related to positive health consequences, such as decreased levels of depression, but few have looked at religiosity’s relation to prenatal depression. Evidence is accumulating that Surrender to God, a specific measure of religiosity, is a possible mechanism by which religiosity positively impacts health, and this study is an investigation of Surrender’s relationship to prenatal depression. The 3-item Religious Surrender and Attendance Scale (RSAS-3) is a brief religiosity measurement that incorporates Surrender and church attendance. RSAS-3 was previously found to better predict stress levels during pregnancy than church attendance alone, and it was theorized that it would also be useful in predicting depression levels. Participants in the current study included 330 pregnant women who were enrolled in the state funded project, Tennessee Intervention for Pregnant Smokers, which enrolled smokers and nonsmokers. Participants met with a case manager at their prenatal care provider and completed two packets of questionnaires: one in the first trimester and one in the third trimester. Measures used in this study included the RSAS-3, and the Centers for Epidemiologic Studies Depression Scale (CESD-10). Participants were paid $20 for each research meeting. Zero order correlations revealed that Education level and RSAS-3 were significantly negatively related to depression levels in the first trimester and approaching significance in the third trimester. Education was therefore included in the hierarchical regression model in step 1 and RSAS-3 in step 2. Hierarchical multiple regression revealed that the full model explained 4% of the variance in 1st trimester depression scores (F 2, 325) = 11.5, p <.001., with RSAS-3 explaining an additional 2.6% of the variance in depression after controlling for education, R squared change = .026, F change (1, 325) p = .003 The full model for 3rd trimester depression explained 6.7% of the variance in 1st trimester depression scores (F 2, 197) = 9.00, p <.001. RSAS-3 explained an additional 1.7% of the variance in depression after controlling for education, R squared change = .017, F change (1, 197) p = .058. RSAS-3 was found to predict depression levels throughout pregnancy, with those scoring higher on RSAS-3 having significantly lower depression scores. A noteworthy strength of the current study is the prospective design. While being religious does not guarantee depression will not occur, early treatment of depression symptoms can assuage negative health consequences for the mother and child. If further research verifies a causal mechanism between Surrender and depression, non-pharmacologic treatments utilizing religious coping may be useful for prenatal depression.

Over 30% of women in Northeast Tennessee smoke during pregnancy. Understanding how psychosocial variables relate to smoking status and amount is important for cessation interventions. During pregnancy, this information is even more imperative, as the well-being of the developing child is also at risk. Stress, self-esteem, and smoking have the potential to be modified during pregnancy to improve pre- and postnatal health outcomes for the mother and child. Stress levels have been clearly linked to smoking habits; however, the research on self-esteem and smoking habits has been mixed. The purpose of the current study was to analyze stress and self-esteem in pregnancy, and to examine how they are both related to smoking status. Data were analyzed using questionnaire responses acquired from 581 TIPS (Tennessee Intervention for Pregnant Smokers) participants during their first trimester. TIPS is a state funded project which enrolls smokers and nonsmokers. Participants met with a case manager at their prenatal care provider, and completed a packet of questionnaires which included the Prenatal Psychosocial Profile (PPP), and several questions inquiring about their past and current smoking status. The participants were paid $20 for each research meeting. The PPP instrument is a composite measure of stress, self-esteem and social support. Both stress t (485.27) = -6.01, p < 0.001, and self-esteem t (573) = 5.60, p < 0.001 measures were significantly different for smokers and non-smokers As predicted, stress levels were higher and self-esteem levels were lower in pregnant smokers compared to non-smokers. The full direct logistic regression model predicting smoking status based on stress and self-esteem, controlling for age and marital status was significant, χ2 (2, n = 575) = 35.02, p < .001. Stress, self-esteem, and marital status all made significant contributions to the model. Because both stress and self-esteem levels were related to smoking status during pregnancy, efforts to change stress and self-esteem levels in pregnancy should be investigated as a possible aid to smoking cessation efforts. Future research should also investigate how stress and self-esteem levels may change over time throughout pregnancy and how that may affect birth outcomes, such as low birth weight or premature delivery.

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Abstract available through the Developmental Psychobiology.