Allecia E. Reid

Group Prenatal Care: Model Fidelity and Outcomes

OBJECTIVE CenteringPregnancy group prenatal care has been demonstrated to improve pregnancy outcomes. However, there is likely variation in how the model is implemented in clinical practice, which may be associated with efficacy, and therefore variation, in outcomes. We examined the association of fidelity to process and content of the CenteringPregnancy group prenatal care model with outcomes previously shown to be affected in a clinical trial: preterm birth, adequacy of prenatal care, and breast-feeding initiation. STUDY DESIGN Participants were 519 women who received CenteringPregnancy group prenatal care. Process fidelity reflected how facilitative leaders were and how involved participants were in each session. Content fidelity reflected whether recommended content was discussed in each session. Fidelity was rated at each session by a trained researcher. Preterm birth and adequacy of care were abstracted from medical records. Participants self-reported breast-feeding initiation at 6 months postpartum. RESULTS Controlling for important clinical predictors, greater process fidelity was associated with significantly lower odds of both preterm birth (B = -0.43, Wald χ(2) = 8.65, P = .001) and intensive utilization of care (B = -0.29, Wald χ(2) = 3.91, P = .05). Greater content fidelity was associated with lower odds of intensive utilization of care (B = -0.03, Wald χ(2) = 9.31, P = .001). CONCLUSION Maintaining fidelity to facilitative group processes in CenteringPregnancy was associated with significant reductions in preterm birth and intensive utilization of care. Content fidelity also was associated with reductions in intensive utilization of care. Clinicians learning to facilitate group care should receive training in facilitative leadership, emphasizing the critical role that creating a participatory atmosphere can play in improving outcomes.

Integration of five health behaviour models: Common strengths and unique contributions to understanding condom use

The purpose of this research was to select from the health belief model (HBM), theories of reasoned action (TRA) and planned behaviour (TPB), information–motivation–behavioural skills model (IMB) and social cognitive theory (SCT) the strongest longitudinal predictors of womens condom use and to combine these constructs into a single integrated model of condom use. The integrated model was evaluated for prediction of condom use among young women who had steady versus casual partners. At Time 1, all constructs of the five models and condom use were assessed in an initial and a replication sample (n = 193, n = 161). Condom use reassessed 8 weeks later (Time 2) served as the main outcome. Information from IMB, perceived susceptibility, benefits, and barriers from HBM, self-efficacy and self-evaluative expectancies from SCT, and partner norm and attitudes from TPB served as indirect or direct predictors of condom use. All paths replicated across samples. Direct predictors of behaviour varied with relationship status: self-efficacy significantly predicted condom use for women with casual partners, while attitude and partner norm predicted for those with steady partners. Integrated psychosocial models, rich in constructs and relationships drawn from multiple theories of behaviour, may provide a more complete characterisation of health protective behaviour.

Interventions to reduce college student drinking: state of the evidence for mechanisms of behavior change

Interventions to reduce college student drinking, although efficacious, generally yield only small effects on behavior change. Examining mechanisms of change may help to improve the magnitude of intervention effects by identifying effective and ineffective active ingredients. Informed by guidelines for establishing mechanisms of change, we conducted a systematic review of alcohol interventions for college students to identify (a) which constructs have been examined and received support as mediators, (b) circumstances that enhance the likelihood of detecting mediation, and (c) the extent of evidence for mechanisms of change. We identified 61 trials that examined 22 potential mediators of intervention efficacy. Descriptive norms consistently mediated normative feedback interventions. Motivation to change consistently failed to mediate motivational interviewing interventions. Multiple active ingredient interventions were not substantially more likely to find evidence of mediation than single ingredient interventions. Delivering intervention content remotely reduced likelihood of finding support for mediation. With the exception of descriptive norms, there is inadequate evidence for the psychosocial constructs purported as mechanisms of change in the college drinking literature. Evidence for mechanisms will be yielded by future studies that map all active ingredients to targeted psychosocial outcomes and that assess potential mediators early, inclusively, and at appropriate intervals following interventions.

Discrimination and sexual risk among young urban pregnant women of color

OBJECTIVE Discrimination predicts increased risk for many negative health outcomes, helping explain a variety of racial and socioeconomic health disparities. Recent research suggests discrimination may play a role in disparities in HIV and other sexually transmitted infections (STIs); however, this research has focused on risk behaviors and has yet to establish a link between discrimination and STI diagnosis specifically. This investigation tested whether discrimination predicted condom use, risky sexual partners, and self-reported STI diagnosis among a population disproportionately affected by HIV and STIs in the U.S.: young, pregnant, socioeconomically disadvantaged, women of color. METHOD During second and third trimesters, 885 mostly Latina and Black pregnant women, 14-21 years old, attending 14 hospitals and health centers in New York City for prenatal care, completed interviews. RESULTS Greater discrimination during second trimester predicted greater odds of STI diagnosis and having a risky sexual partner during third trimester, but not condom use. Whether discrimination was attributed to race, identifying as Black, or identifying as Latina did not moderate effects. CONCLUSION This is the first investigation establishing a link between discrimination and STI diagnosis, not just risk behavior. It does so among a sample of at-risk, young, pregnant, women of color. Findings suggest implications for sexual risk during pregnancy and across the life span, and risks for the pregnancy and fetus. It is vital to reduce discrimination to eliminate disparities in HIV and STIs. Future research should continue examining the role of discrimination in sexual risk among different populations and work to uncover potential mechanisms.

Changes in Experiences With Discrimination Across Pregnancy and Postpartum: Age Differences and Consequences for Mental Health

OBJECTIVES We aimed to contribute to growing research and theory suggesting the importance of examining patterns of change over time and critical life periods to fully understand the effects of discrimination on health, with a focus on the period of pregnancy and postpartum and mental health outcomes. METHODS We used hierarchical linear modeling to examine changes across pregnancy and postpartum in everyday discrimination and the resulting consequences for mental health among predominantly Black and Latina, socioeconomically disadvantaged young women who were receiving prenatal care in New York City. RESULTS Patterns of change in experiences with discrimination varied according to age. Among the youngest participants, discrimination increased from the second to third trimesters and then decreased to lower than the baseline level by 1 year postpartum; among the oldest participants, discrimination decreased from the second trimester to 6 months postpartum and then returned to the baseline level by 1 year postpartum. Within-subjects changes in discrimination over time predicted changes in depressive and anxiety symptoms at subsequent points. Discrimination more strongly predicted anxiety symptoms among participants reporting food insecurity. CONCLUSIONS Our results support a life course approach to understanding the impact of experiences with discrimination on health and when to intervene.

The Many Faces of Manhood: Examining Masculine Norms and Health Behaviors of Young Fathers Across Race

This study examined the relationship between the traditional masculine norms (“status,” “toughness” and “antifemininity”) of 296 ethnically and racially diverse, young men transitioning to fatherhood and substance use (smoking, alcohol, marijuana, hard drugs) and health behaviors (diet, exercise). Participants were recruited from urban obstetric clinics in the Northeast United States. Logistic and multiple regression equations were constructed to examine the relationship between masculine norms and health behaviors. Moderator effects were also examined. Masculine norm “status” was most endorsed and “antifemininity” was least endorsed. African American young men had higher masculine norm scores than Latino and Whites. Different masculine norms were associated with health-promoting and health-undermining behaviors. Different racial groups who had higher scores on some masculine norms were more likely to engage in either health-promoting or health-undermining behaviors when compared with other ethnic groups in this study. These results observed different relationships between the traditional masculine norms measured and the substance use and health behaviors of diverse, young men transitioning to fatherhood. This may have implications for intervention strategies and future research.

Effects of Normative Feedback for Drinkers Who Consume Less than the Norm: Dodging the Boomerang

Several alcohol interventions designed for college students attempt to correct exaggerated perceptions of alcohol use on college campuses through the use of personalized normative feedback. Personalized normative feedback has been shown to be effective in reducing drinking as a stand-alone intervention and as a part of a multicomponent intervention. This feedback is typically targeted to heavier drinkers to create a discrepancy between their personal beliefs and behavior and the actual lower levels of use on campus. However, little is known about how this form of normative feedback might affect lighter drinkers who learn that they are drinking less than the typical student at their school. The risk is a potential boomerang effect, or an increase in drinking among lighter drinkers receiving personalized feedback. The current study examined four samples from three geographic locations: two using computer-delivered personalized normative feedback alone and two delivering personalized feedback in the context of a brief motivational intervention. We found no evidence for a boomerang effect among lighter drinkers receiving personalized normative feedback in any of the four samples. These findings help to assuage fears of increasing drinking among lighter drinkers through widespread implementation of normative interventions for college students in the absence of screening for current drinking status.

Social Norms and Health Behavior

Despite the long history of research on social norms in psychology, sociology, and other disciplines, social norms remain relatively underutilized as a mechanism for changing health behaviors. However, normative influence is a powerful motivator of behavior that can and should be brought to bear in health promotion research. Accordingly, research that has examined the role of social norms in characterizing, predicting, and ultimately altering health behaviors is reviewed. First, an important distinction between descriptive and injunctive norms is addressed and a brief review of literature that has examined norms as correlates of health behaviors is provided. The remainder of the chapter focuses on applications of normative information to behavior change, with an emphasis on social norms theory. The social psychological phenomena that form the basis of the theory, as well as a number of applications of the theory to behavior change are discussed. Alternative applications of norms to the promotion of health behavior and influences of the media on health are also addressed.

Gender and Depression Moderate Response to Brief Motivational Intervention for Alcohol Misuse Among College Students

OBJECTIVE Brief motivational interventions (BMIs) effectively reduce problematic drinking in college students. However, not all students benefit, and little is known about the subgroups of students for whom BMIs are most effective. In the present study, we examined 2 factors that may influence BMI efficacy: gender and depression. METHOD We reanalyzed data from a clinical trial in which heavy drinking students (N = 330; 65% female) were randomized to a BMI (n = 165) or an assessment only control (n = 165). Depression was assessed at baseline; past-month typical drinks per week, heavy drinking frequency, and consequences were assessed at baseline and 1 month. Three- and 2-way interactions among intervention condition (BMI vs. control), gender (male vs. female), and depression (low vs. high) were tested. RESULTS We observed 3-way interaction effects on 2 outcomes: (a) typical drinks per week and (b) frequency of heavy drinking at 1 month. Relative to controls and adjusting for baseline drinking, low-depression women reduced their drinking more after a BMI whereas high-depression women did not show differential improvement. In contrast, high-depression men showed significant reductions in weekly drinks following the BMI whereas low-depression men did not show differential improvement. In addition, higher levels of depression were associated with higher levels of consequences at follow-up across conditions. CONCLUSIONS BMIs are indicated for heavy drinking, depressed men, consistent with recommendations for implementing screening and brief intervention in mental health settings. However, BMIs may need to be refined to enhance their efficacy for depressed women.

Discrimination and excessive weight gain during pregnancy among Black and Latina young women

RATIONALE Excessive weight gain during pregnancy is a major determinant of later life obesity among both Black and Latina women and their offspring. However, psychosocial determinants of this risk, including everyday discrimination, and potential moderators of such effects remain unexplored. OBJECTIVE We examined the influence of discrimination, a culturally relevant stressor, on odds of gaining weight beyond Institute of Medicine recommendations during pregnancy. Whether the effect was moderated by race/ethnicity, age, or depressive symptoms was also examined. METHOD Participants were 413 Black and Latina pregnant young women, ages 14-21 years. Experience with discrimination and all moderators were assessed in the second trimester. Last weight recorded in the third trimester was abstracted from medical records and used to determine excessive weight gain. RESULTS Ever experiencing discrimination was associated with a 71% increase in the odds of excessive weight gain. The effect of discrimination was primarily present among women who attributed this treatment to membership in a historically oppressed group (e.g., ethnic minority, female) or to membership in other stigmatized groups (e.g., overweight). The effect of ever experiencing discrimination was not moderated by race/ethnicity or age but was moderated by depressive symptoms. Supporting the perspective of the environmental affordances model, discrimination strongly predicted excessive weight gain when women were low in depressive symptoms but had no effect when women were high in depressive symptoms. The moderating role of depressive symptoms was equivalent for Black and Latina women. CONCLUSION Results highlight the role of discrimination in perpetuating weight-related health disparities and suggest opportunities for improving health outcomes among young pregnant women.