Prenatal expectations in Mexican American women: development of a culturally sensitive measure

Prenatal expectations describe various domains a woman envisions in preparation for her role as a new mother and influence how women transition into the maternal role. Although the maternal role is strongly influenced by the prevailing familial and sociocultural context, research characterizing prenatal expectations in ethnic minority and low-income women is lacking. As part of the largest growing minority group in the USA, Latina mothers represent an important group to study. Two hundred and ten low-income Mexican American women were administered the Prenatal Experiences Scale for Mexican Americans (PESMA) that was adapted to capture specific cultural aspects of prenatal expectations. Measures of current support, prenatal depressive symptoms, and other sociodemographic characteristics were also completed to assess validity. Exploratory factor analysis identified three underlying factors of prenatal expectations: paternal support, family support, and maternal role fulfillment. Associations among these subscales and demographic and cultural variables were conducted to characterize women who reported higher and lower levels of expectations. The PESMA demonstrated good concurrent validity when compared to measures of social support, prenatal depressive symptoms, and other sociodemographic constructs. A culturally sensitive measure of prenatal expectations is an important step towards a better understanding of how Mexican American women transition to the maternal role and identify culturally specific targets for interventions to promote maternal health.     

Multiple domains of stress predict postpartum depressive symptoms in low-income Mexican American women: the moderating effect of social support

Prenatal stress can have a lasting effect on women’s mental health after childbirth. The negative effects may be particularly salient in women from low income and ethnic minority backgrounds, who are at increased risk for postpartum depression. However, social support may have the potential to attenuate the negative impact of stress. The present study evaluated 269 Mexican American women (ages 18–42; 83 % Spanish-speaking; median income $10,000–$15,000) for prenatal stress (daily hassles, family stress, partner stress, and culture-specific stress) in relation to depressive symptoms 6 weeks postpartum. Prenatal social support was examined as a buffer against the impact of prenatal stress. Partner stress, family stress, and daily hassles uniquely predicted depressive symptoms. Moderate and high levels of social support attenuated risk for depression due to family stressors. Prenatal interpersonal and daily stressors negatively impact the mental health of women after birth, but social support can mitigate some of these effects. Among Mexican American pregnant women, effective interpersonal support and stress management may be associated with reduced risk for postpartum depression.     

Race/ethnicity,acculturation, and psychological distress: Fatalism and religiosity as cultural resources

Data from a community sample of 1,784 Anglo, African-American, and Mexican-American adults were examined to assess: (1) the nature and magnitude of observed racial/ethnic and acculturation level differences in depression, (2) the relative contribution of sociodemographic and psychosocial factors (fatalism and religiosity) to observed differences, and (3) the joint effects of fatalism and religiosity as sociocultural resources with regard to depression in differing racial/ethnic and acculturation level subgroups. Analyses indicate the most dramatic differences in depression among males—African Americans were roughly similar to Anglos and levels of depression were significantly higher among the least acculturated Mexican Americans relative to Anglos, even after statistical controls. Acculturation level differences among Mexican-American females were explained by statistical controls. Lower levels of depression among more highly acculturated than among less acculturated Mexican Americans provide little support for a simplistic stress formulation of acculturation. Rather, the interplay of acculturation, fatalism, and religiosity supports a more complex cultural marginality model, emphasizing the consistency of attitudinal elements and language use as facilitators or inhibitors of assimilation into Anglo culture. Both those who successfully acculturate and those who are most insulated in traditional culture appear least depressed from this perspective.     

Mental health, family function and obesity in African-American women

CONTEXT: African-American women are disproportionately affected by obesity and its related diseases. How psychological and psychosocial factors that affect this population differ across weight categories remains poorly understood. PURPOSE: To determine whether poor mental health and family functioning are associated with obesity in African-American women. METHODS: African-American women patients aged 21-65 years were interviewed at three primary care centers. Four well-established assessment tools were used to measure general mental and physical health status, family functioning, depressive symptoms and anxiety levels. Demographics, health behaviors and family and personal histories of overweight were assessed. RESULTS: Among 113 patients, after controlling for age and parity, obese women had significantly higher anxiety levels, poorer perception of their physical health, more often were overweight as a child, had overweight parents or siblings and experienced more psychosocial problems in their family growing up, compared to overweight and normal weight women. CONCLUSIONS: The observed findings of poor mental health, perception of physical health and family function in obese African-American women support a need for clinical attention and further study.     

Attachment security and recent stressful life events predict oxytocin levels: a pilot study of pregnant women with high levels of cumulative psychosocial adversity

Purpose: Recent reports indicate that prenatal levels of the neuropeptide oxytocin (OT) are inversely related to depressive symptomatology and positively associated with more optimal interactive behaviors in mothers with high levels of cumulative psychosocial adversity (CPA). In the present pilot study, we aimed to identify factors associated with high versus low levels of OT in pregnant women with high levels of CPA. We hypothesized that insecurely attached women, and those who recently experienced stressful life events (SLE), would have lower levels of prenatal OT. Methods: Thirty pregnant women with mood and anxiety disorders and high levels of CPA were recruited from the perinatal mental health service of a general hospital. Participants completed self-report measures of psychosocial stress and adult attachment style, and blood was then drawn to assess OT. Results and conclusions: Lower OT levels were found among those who were insecurely attached, and among those who experienced SLE within the last year. In a multiple linear regression, both attachment security and SLE significantly contributed to a model of prenatal OT levels. These individual difference factors explained 38% of the variance in prenatal OT, which may in turn predict poorer maternal mental health and caregiving outcomes during the postpartum period.     

Parenting concerns,family support systems,and life problems in Mexican-origin women: A comparison by nativity

Low-income Mexican-origin families have been neglected in studies of normative family functioning and transition to parenting roles. This study examined the child and family concerns and perception of parenting role among 122 Mexican-origin women in Los Angeles and assessed differences by parity and nativity. The results showed significant sociodemographic differences among respondents by nativity. Mexican-American women had significantly higher levels of education and were less likely to be married than recent Mexican immigrant women. There were no significant differences between groups on reported levels of life problems by nativity. Family social support data revealed that Mexican Americans were more likely to have large family networks, to live with parents and siblings, and to report that their family provided “a lot of help.” Data on perception of parenting for first-time mothers revealed that Mexican immigrant women were twice as likely as Mexican-American women to report that they “anticipated doing a better job of parenting than most mothers.” Baby concerns in first-time pregnant women revealed that married respondents reported more concerns than nonmarried respondents. Among mothers, Mexican-American mothers reported fewer child concerns than Mexican immigrant mothers. The major implication of these results is related to the provision of psychoeducational parenting programs compatible with the concerns and needs of Latino parents.     

THE PARENT–CHILD ACCULTURATION GAP,PARENTAL MONITORING,AND SUBSTANCE USE IN MEXICAN HERITAGE ADOLESCENTS IN MEXICAN NEIGHBORHOODS OF THE SOUTHWEST U.S.

A sample of 206 Mexican‐heritage 7th‐grade adolescents attending predominantly Mexican‐heritage schools in Arizona was assessed on their linguistic acculturation, perceived parental monitoring, and substance use. One of their parents also reported on their own parental level of acculturation. While greater parental acculturation predicted greater marijuana use, the acculturation gap (child's level of acculturation over and above that of the parent) was not predictive of substance use. There was a significant acculturation gap by parental monitoring interaction for marijuana use, where the negative correlation between parental monitoring and marijuana use was attenuated for parent–youth dyads that exhibited the largest acculturation gap. This suggests that a greater parent–youth cultural distance (the acculturation gap) attenuates that protective effect of parental monitoring on youth marijuana use. Results are discussed in terms of how the acculturation gap increases the risk for problem behaviors in Mexican American adolescents through its effect on family processes.     

Ethnic identity and acculturation in a young adult Mexican-origin population

The relations among ethnic identity, measured by the Multigroup Ethnic Identity Measure (MEIM) and acculturation, as measured by the Acculturation Rating Scale-II (ARSMA-11) were studied in 1,367 freshmen college students, 87% of whom were of Mexican origin. The results strongly support the concept that ethnic identity and acculturation are related but separate processes. Ethnic identity scores were found to be highest in first generation, less acculturated subjects, and traditional acculturative types. Higher levels of acculturation were associated with less feelings of affirmation and belonging, and less feelings of ethnic identity achievement. The Pearson correlation coefficient obtained for Ethnic Identity and Acculturation was r = -.32 (p < .001). Ethnic Identity Achievement (r = -.25), Affirmation and Belonging (r = -.35), and Ethnic Behaviors (r = -.14), were all negatively correlated with linear acculturation. High Biculturals were found to obtain higher scores in ethnic identity than Low Biculturals, and High Biculturals were found to be oriented more toward others than those who were classified as Traditional or Assimilated. The findings suggest that one's sense of ethnic group membership diminishes with behavioral acculturation among Mexican Americans. © 1997 John Wiley & Sons, Inc.     

Temperament, Coping, and Psychological Adjustment in Young Children with Myelomeningocele

The psychosocial factors that increase the risk of psychologicalproblems among children with myelomeningocele are not well delineated.In this study, the parents of 34 children (18 boys, 16 girls)with myelomeningocele who were between the ages of 3 and 8 yearscompleted questionnaires describing the child's temperament,coping ability, and level of family cohesiveness and familyorganization. Total behavior problem scores on the Child BehaviorChecklist were associated with lower levels of family cohesiveness,lower self-coping ability, greater temperament difficulty, andlower distractibility. Regression analyses with each variableentered separately indicated that distractibility and self-copingability accounted for 57% of the variance in total behaviorproblem scores and 52% of the variance in externalizing problemscores. Temperamental difficulty and distractibility accountedfor 44% of the variance in internalizing problem scores. Whencombined coping and temperamental difficulty variables wereentered into regression analysis, family cohesiveness also wasassociated with total behavior problems and internalizing problems.     

The effects of prenatal care utilization and maternal risk factors on pregnancy outcome between Mexican Americans and non-Hispanic whites.

This study evaluates the effects of prenatal care classification and levels of maternal risk status on pregnancy outcomes in Mexican Americans and non-Hispanic whites in Arizona. All live birth certificates from 1986 and 1987 were reviewed yielding a total population of 101,206 (26,827 Mexican Americans). The adequacy of prenatal care was evaluated based on an index that includes six prenatal care groups. Two levels of maternal risk status (low and high) were defined based on a series of maternal risk factors. Overall, Mexican Americans had a greater proportion of maternal risk factors and a greater proportion of mothers with inadequate or no prenatal care compared with non-Hispanic whites. Prematurity and macrosomia were more prevalent than low birthweight in Mexican Americans. Low-risk status and adequate prenatal care regardless of ethnicity were found to be associated with a lower prevalence of low birthweight and preterm delivery. Whites, however, had a greater variation in the prevalence of low birthweight associated with changes in prenatal care utilization and maternal risk status compared with Mexican Americans. Finally, logistic regression analysis showed an independent effect of prenatal care, maternal risk status, maternal age, and maternal birthplace in predicting the overall low birthweight rate in Mexican Americans. The implications of these results are discussed relative to the usefulness of prenatal care as a health-care intervention in Mexican Americans.     

Alleviating perinatal depressive symptoms and stress: a nurse-community health worker randomized trial

To determine whether a Nurse-Community Health Worker (CHW) home visiting team, in the context of a Medicaid enhanced prenatal/postnatal services (EPS), would demonstrate greater reduction of depressive symptoms and stress and improvement of psychosocial resources (mastery, self-esteem, social support) when compared with usual Community Care (CC) that includes Medicaid EPS delivered by professionals. Greatest program benefits were expected for women who reported low psychosocial resources, high stress, or both at the time of enrollment. Medicaid eligible pregnant women (N?=?613) were randomly assigned to either usual CC or the Nurse-CHW team. Mixed effects regression was used to analyze up to five prenatal and postnatal psychosocial assessments. Compared to usual CC, assignment to the Nurse-CHW team resulted in significantly fewer depressive symptoms, and as hypothesized, reductions in depressive symptoms were most pronounced for women with low psychosocial resources, high stress, or both high stress and low resources. Outcomes for mastery and stress approached statistical significance, with the women in the Nurse-CHW group reporting less stress and greater mastery. Women in the Nurse-CHW group with low psychosocial resources reported significantly less perceived stress than women in usual CC. No differences between the groups were found for self-esteem and social support. A Nurse-CHW team approach to EPS demonstrated advantage for alleviating depressive symptoms in Medicaid eligible women compared to CC, especially for women at higher risk.     

Perceived discrimination,family functioning,and depressive symptoms among immigrant women in Taiwan

This study examined the moderating effect of family functioning on the relationship between perceived discrimination and depressive symptoms in immigrant women. A total of 239 immigrant women were selected from four administrative regions in Central Taiwan. Questionnaires concerning perceived discrimination, family functioning (including family cohesion and family adaptability), depressive symptoms, and demographic characteristics were completed by either women themselves (N?=?120) or their husbands (N?=?119). The moderating effect of family functioning on the relationship between perceived discrimination and depression symptoms was analyzed using multiple regression analysis. Findings showed that a higher level of perceived discrimination among immigrant women is associated with more severe depressive symptoms. Family functioning serves as a moderator between the relationship of perceived discrimination and depressive symptoms, but the moderating effect of family adaptability was evident only in data reported by immigrant women. The results indicate that perceived discrimination has negative mental health implications, and also point to the importance of family functioning for depression. Findings suggest that providers should consider addressing immigrant women’s mental health needs through declining their psychosocial distress at multiple ecological levels.     

The influence of acculturation on the Wisconsin Card Sorting Test by Mexican Americans.

This study examined the speculation that the Wisconsin Card Sorting Test (WCST) might be a relatively culture-free neuropsychological test. The relationship between level of acculturation and performance on the Spanish version of the WCST was investigated, using a sample of Mexican American adults (N=52). When the sample was divided into two groups based on level of acculturation as measured by the Acculturation Rating Scale for Mexican Americans--2nd Edition, within-group contrasts demonstrated that higher levels of acculturation significantly improved performance on the WCST. The performance of this sample was compared to select Spanish norms, finding no clinically significant differences. Contrasts with English norms for the WCST yielded significant differences on a majority of the WCST measures, demonstrating that the English norms are inappropriate for use with this population. This study concludes that the WCST is not a culture-free neuropsychological test.     

A randomized trial of psychosocial support during high-risk pregnancies. The Latin American Network for Perinatal and Reproductive Research.

BACKGROUND. It is often suggested that psychological and social support and health education for women at high risk for delivering a low-birth-weight infant can improve the outcomes of pregnancy, but the evidence is inconclusive. We undertook this prospective trial to evaluate a program of home visits designed to provide psychosocial support during pregnancy. METHODS. At four centers in Latin America, 2235 women at higher-than-average risk for delivering a low-birth-weight infant were recruited before the 20th week of pregnancy. The women were randomly assigned either to an intervention group (n = 1115) that received four to six home visits from a nurse or social worker in addition to routine prenatal care or to a control group (n = 1120) that received only routine prenatal care (with a mean of eight prenatal visits). The principal measures of outcome were low birth weight (< 2500 g), preterm delivery (< 37 weeks of gestation), and specified categories of maternal and neonatal morbidity. RESULTS. The women who received the home visits as well as routine prenatal care had outcomes that differed little from those of the women who received only routine care. The risks of low birth weight (odds ratio for the intervention group as compared with the control group, 0.93; 95 percent confidence interval, 0.68 to 1.28), preterm delivery (odds ratio, 0.88; 95 percent confidence interval, 0.67 to 1.16), and intrauterine growth retardation (odds ratio, 1.08; 95 percent confidence interval, 0.83 to 1.40) were similar in the two groups. There was no evidence that the intervention had any significant effect on the type of delivery, the length of hospital stay, perinatal mortality, or neonatal morbidity in the first 40 days. There was no protective effect of the psychosocial-support program even among the mothers at highest risk. CONCLUSIONS. Interventions designed to provide psychosocial support and health education during high-risk pregnancies are unlikely to improve maternal health or to reduce the incidence of low birth weight among infants.     

The comparative effects of group prenatal care on psychosocial outcomes

To compare the psychosocial outcomes of the CenteringPregnancy (CP) model of group prenatal care to individual prenatal care, we conducted a prospective cohort study of women who chose CP group (N?=?124) or individual prenatal care (N?=?124). Study participants completed the first survey at study recruitment (mean gestational age 12.5 weeks), with 89 % completing the second survey (mean gestational age 32.7 weeks) and 84 % completing the third survey (6 weeks’ postpartum). Multiple linear regression models compared changes by prenatal care model in pregnancy-specific distress, prenatal planning-preparation and avoidance coping, perceived stress, affect and depressive symptoms, pregnancy-related empowerment, and postpartum maternal-infant attachment and maternal functioning. Using intention-to-treat models, group prenatal care participants demonstrated a 3.2 point greater increase (p?<?0.05) in their use of prenatal planning-preparation coping strategies. While group participants did not demonstrate significantly greater positive outcomes in other measures, women who were at greater psychosocial risk benefitted from participation in group prenatal care. Among women reporting inadequate social support in early pregnancy, group participants demonstrated a 2.9 point greater decrease (p?=?0.03) in pregnancy-specific distress in late pregnancy and 5.6 point higher mean maternal functioning scores postpartum (p?=?0.03). Among women with high pregnancy-specific distress in early pregnancy, group participants had an 8.3 point greater increase (p?<?0.01) in prenatal planning-preparation coping strategies in late pregnancy and a 4.9 point greater decrease (p?=?0.02) in postpartum depressive symptom scores. This study provides further evidence that group prenatal care positively impacts the psychosocial well-being of women with greater stress or lower personal coping resources. Large randomized studies are needed to establish conclusively the biological and psychosocial benefits of group prenatal care for all women.     

南京地区流动人口中孕产妇的保健情况调查分析

目的调查南京地区流动人口孕产妇的保健情况。方法采用分层抽样和按比例分配的方法 ,应用统一问卷进行调查,共收集有效问卷830份,内容包括社会人口学特征、孕产史、建围产保健卡、产前检查次数、妊娠结局等情况。结果调查显示流动人口中孕产妇文化程度低、就业低、经济收入少、医疗费用大多数为自费,超计划生育者较多,与本市孕产妇相关指标均有明显差异（P〈0.01）,这些因素造成流动孕产妇保健率低,不良妊娠结局高等现状。结论针对流动人口孕产妇保健的特点,采用适宜的健康教育方式,健全流动人口妇幼保健保障政策,督促其定期产前检查,以有效降低出生缺陷率及围产儿死亡率。     

Effects of acculturation on prenatal anxiety among Latina women

Anxiety in pregnancy has been associated with adverse birth outcomes. Relatively few studies have investigated how acculturation affects mental health in pregnancy among Latinas. The goal of this study was to determine if acculturation was associated with anxiety over the course of pregnancy in a sample of predominantly Puerto Rican women. Women were recruited in pregnancy for participation in Proyecto Buena Salud, a prospective cohort study of Latina women (n?=?1412). Acculturation was measured via the Psychological Acculturation Scale (PAS), language preference and generation in the USA. Anxiety was measured using the State-Trait Anxiety Instrument. Linear and logistic multivariable regressions were used to investigate associations. After adjustment, women with bicultural identification had significantly lower trait anxiety scores in early pregnancy (β?=??3.62, SE?=?1.1, p?<?0.001) than low acculturated women. Women with higher levels of acculturation as indicated by English-language preference (β?=?1.41, SE?=?0.7, p?=?0.04) and second or third generation in the USA had significantly higher trait anxiety scores in early pregnancy (β?=?1.83, SE?=?0.6, p?<?0.01). Bicultural psychological acculturation was associated with lower trait anxiety in early pregnancy, while English-language preference and higher generation in the USA were associated with higher trait anxiety in early pregnancy.     

Development and evaluation of a mother-centered toolkit for postpartum behavioral and psychosocial health

The well-being of mothers and infants is influenced by mothers’ behavioral and psychosocial health (B&PH), yet it is often neglected during healthcare visits. To address this gap, this study aimed to develop and evaluate acceptability of a postpartum toolkit (screening questionnaire, feedback template, and decision aid) to promote B&PH. Using a decision-making model and participatory design (N?=?24), a B&PH screening questionnaire was refined, and prototypes of feedback templates and decision aids for selecting health goals were developed. Most mothers in this multi-ethnic sample rated the resulting toolkit as easy to understand/use and useful, and reported they were likely to act on their health goals. Toolkit ease of use and usefulness ratings were largely unrelated to education, ethnicity, and acculturation. In conclusion, findings support the toolkit’s acceptability and applicability to women of diverse backgrounds. The toolkit is a promising strategy to engage mothers in setting goals to promote B&PH.     

Breast cancer delay in Latinas: the role of cultural beliefs and acculturation

Cultural beliefs about breast cancer may act as a barrier to Latina women seeking preventive services or timely follow-up for breast symptoms regardless of access. This study examines the association between factors and breast cancer cultural beliefs and the extent to which cultural beliefs are associated with delays in breast cancer care. Participants who were Latina, ages 30–79, and had been diagnosed with a primary breast cancer were examined (n = 181). Interviews included a 15-item cultural beliefs scale spanning beliefs inconsistent with motivation to seek timely healthcare. Self-reported date of symptom discovery, date of first medical presentation, and date of first treatment were used to construct measures of prolonged patient, clinical, and total delay. Logistic regression with model-based standardization was used to estimate crude and confounder-adjusted prevalence differences for prolonged delay by number of cultural beliefs held. Women held a mean score of three cultural beliefs. The belief most commonly held was, “Faith in God can protect you from breast cancer” (48 %). Holding three or more cultural beliefs was associated with lower acculturation, lower socioeconomic status and less access to care (p < 0.01). After adjusting for age, education, income, acculturation, trust, and insurance, likelihood of prolonged total delay remained 21 percentage points higher in women who held a higher number cultural beliefs (p = 0.02). Cultural beliefs may predispose Latina women to prolong delays in seeking diagnosis and treatment for breast symptoms. Cultural beliefs represent a potential point of intervention to decrease delays among Latina breast cancer patients.     

Psychosocial and Cultural Influences on Cardiovascular Health and Quality of Life Among Hispanic Cardiac Patients in South Florida

This study examined whether psychosocial and cultural factors were related to four dimensions of cardiac-related quality of life (global, physical, emotional, and social functioning) in 120 Hispanic coronary heart disease (CHD) outpatients in south Florida. Survey data were collected on sociodemographic (age, gender, socioeconomic status), psychosocial (depression, social support), and cultural factors (acculturation, familism, fatalism), and quality of life. Medical data on CHD severity (New York Heart Association class, time since diagnosis) were obtained from patients’ clinic records. Hierarchical regression analyses revealed that women and patients with more severe CHD had poorer quality of life than men or patients with less severe CHD. Psychosocial and cultural factors were associated with poorer quality of life after controlling for sociodemographic and medical variables: Depression was associated with all four quality of life dimensions (p < .001); and fatalism (p < .05) was associated with lower social functioning in women. These findings identify Hispanic subgroups with poor cardiac-related quality of life that can benefit from special outreach.