Linda F. C. Bullock

Retrospective study of the association of stress and smoking during pregnancy in rural women.

Women who continue to smoke during pregnancy put themselves and their fetuses at serious risk for complications. Various smoking cessation programs have been designed that specifically target pregnant smokers. Longitudinal studies, however, have shown that there is a group of women who are unable to quit smoking while pregnant. Women from a rural area of the Mid-West (N=299) were interviewed postpartum to determine the stresses these women experienced prenatally and the association of the stress with continuing to smoke during pregnancy. Subjects were divided into three groups: Nonsmokers, Quitters, Smokers. This study not only confirms other reports that these women are more stressed but also documents some of the major stressors. Statistically significant differences were found between groups for financial worries (P=.0002), problems with the family (P<.001), and domestic violence (P<.001). Assessing pregnant women for stress and, especially, domestic violence should be part of the implementation of the Clinical Practice Guidelines for Smoking Cessation.

Baby BEEP: A randomized controlled trial of nurses' individualized social support for poor rural pregnant smokers.

Objectives We tested the effect of nurse-delivered telephone individualized social support (“Baby BEEP”) and eight mailed prenatal smoking cessation booklets singly and in combination (2 × 2 factorial design) on smoking cessation in low-income rural pregnant women (N = 695; 75% participation). Methods Participants randomized to Baby BEEP groups (n = 345) received weekly calls throughout pregnancy plus 24-7 beeper access. Saliva cotinine samples were collected monthly from all groups by other nurses at home visits up to 6 weeks post-delivery. Primary outcomes were point prevalence abstinence (cotinine < 30 ng/ml) in late pregnancy and post-delivery. Results Only 47 women were lost to follow-up. Intent-to-treat analyses showed no difference across intervention groups (17–22%, late pregnancy; 11–13.5%, postpartum), and no difference from the controls (17%, late pregnancy; 13%, postpartum). Post hoc analyses of study completers suggested a four percentage-point advantage for the intervention groups over controls in producing early and mid-pregnancy continuous abstainers. Partner smoking had no effect on late pregnancy abstinence (OR = 1.7, 95% CI = 0.95, 3.2), but post-delivery, the effect was pronounced (OR = 3.2, 95% CI = 1.8, 5.9). Conclusions High abstinence rates in the controls indicate the power of biologic monitoring and home visits to assess stress, support, depression, and intimate partner violence; these elements plus booklets were as effective as more intensive interventions. Targeting partners who smoke is needed.

Breastfeeding and Employment: An Assessment of Employer Attitudes

Both research and anecdotal reports suggest that maternal employment is associated with failure to initiate breastfeeding and early breastfeeding attrition. The objective of this studywas to describe the experience with and attitudes toward breastfeeding of a sample of employers in a small Midwestern city in the United States. Based on an analysis of 85 mail-out questionnaires, we found that less than half of the employers had personal experience with breastfeeding. A large percentage of the sample, however, indicated that they would be willing to facilitate women who wished to breastfeed or express milk in the workplace. However, these employers also stated that they saw little value to their business of supporting breastfeeding in the work environment. Thus, enhancement of breastfeeding opportunity in the work environment may come as a result of public and employer education but, more likely, will require some type of directive from official sources.

The Wavering Line in the Sand: The Effects of Domestic Violence and Sexual Coercion

Control and power regarding sexuality and fertility challenges many women, especially those involved in abusive relationships. This preliminary study was done to explore the relationship between domestic violence, sexual coercion, and pregnancy. The sample was comprised of community-dwelling women attending support groups for survivors of abuse, and women attending group therapy sessions while housed at a battered womans shelter. Both questionnaires and focus groups addressed the womens experiences with contraception, sexuality, pregnancy, and domestic violence. Only the qualitative phase of the study, plus demographics from the questionnaires, are presented in this article. The responses suggest that many of the women felt they could not avoid intercourse with their abusers, despite fears of pregnancy. Focus group transcript analysis revealed recurrent themes of problems regarding pregnancy, tactics of abuse, inability to access birth control, and denial and mistrust. This article explores the reality these women face and the thought processes they employ to survive and remain in their relationship. Health care providers can use this information to better understand their clients, to assist them in obtaining and using effective contraception, and to support clients as they make their decisions.

Abuse Disclosure in Privately and Medicaid-Funded Pregnant Women

Disclosure of abuse by pregnant women can vary depending on whether the woman is assessed directly by a trained interviewer versus written questionnaires, and if she is asked repeatedly during the course of pregnancy. One thousand pregnant women were enrolled in a randomized clinical trial designed to assess the effects of a nursing case management intervention on the mental and physical well-being of pregnant women experiencing or at risk for abuse. Thirteen percent of the total study participants reported current abuse and/or abuse within the past year, with only 2% of those reporting that the abuse occurred during pregnancy. The incidence of reported abuse was much higher among Medicaid-funded women (28.9%) than privately insured women (8.7%). Regardless of source of payment, women reporting abuse were significantly younger, less educated, nonwhite with lower income, and had significantly higher stress and lower self-esteem than women not reporting abuse. A high incidence of women reporting intimate partner violence described being choked on the Danger Assessment Screen (34%). We strongly urge that choking be added to routine screening questions used during pregnancy and that the Danger Assessment tool is used for further evaluation of women who screen positive. In addition, we believe another barrier to reporting abuse was fear of being reported to child protective services, contributing to the overall low rate of abuse disclosure.

Depression Among Women Experiencing Intimate Partner Violence in a Chinese Community

Background:Depression is one of the significant mental health impacts of intimate partner violence. However, there is a lack of empirical evidence on the factors associated with depression among abused Chinese women. Objective:The purpose of this study was to identify the factors associated with a higher level of depression among abused Chinese women. Methods:This was a cross-sectional study with participation of 200 abused Chinese women in a local community center in Hong Kong. The measurement tools used are the Chinese Abuse Assessment Screen, the Chinese Beck Depression Inventory Version II, the Revised Conflict Tactics Scale, the Interpersonal Support Evaluation List 12, and the demographic data. Structured multiphase regression analysis was used for data analysis. Results:Factors significantly associated with a higher level of depression in Chinese abused women were low educational level (estimate = −2.49, p = .038), immigration (estimate = 4.99, p = .025), financial support from friends and relatives (estimate = 4.72, p = .006), and chronic psychological abuse (estimate = 0.09, p < .001). A protective factor against depression is the perception of social support (estimate = −1.11, p < .001). Discussion:An overwhelming number of abused Chinese women have moderate or severe levels of depression. There is a need for more awareness of the detrimental mental health impact of abuse on women, screening for depression when women are found to be abused, and provision of social support at an earlier stage to minimize depression.

Engaging and retaining abused women in perinatal home visitation programs.

OBJECTIVES: Intimate partner violence (IPV) during pregnancy affects 0.9% to 17% of women and affects maternal health significantly. The impact of IPV extends to the health of children, including an increased risk of complications during pregnancy and the neonatal period, mental health problems, and cognitive delays. Despite substantial sequelae, there is limited research substantiating best practices for engaging and retaining high-risk families in perinatal home visiting (HV) programs, which have been shown to improve infant development and reduce maltreatment. METHODS: The Domestic Violence Enhanced Home Visitation Program (DOVE) is a multistate longitudinal study testing the effectiveness of a structured IPV intervention integrated into health department perinatal HV programs. The DOVE intervention, based on an empowerment model, combined 2 evidence-based interventions: a 10-minute brochure-based IPV intervention and nurse home visitation. RESULTS: Across all sites, 689 referrals were received from participating health departments. A total of 339 abused pregnant women were eligible for randomization; 42 women refused, and 239 women were randomly assigned (124 DOVE; 115 usual care), resulting in a 71% recruitment rate. Retention rates from baseline included 93% at delivery, 80% at 3 months, 76% at 6 months, and 72% at 12 months. CONCLUSIONS: Challenges for HV programs include identifying and retaining abused pregnant women in their programs. DOVE strategies for engaging and retaining abused pregnant women should be integrated into HV programs’ federal government mandates for the appropriate identification and intervention of women and children exposed to IPV.

Impact of intimate partner violence on pregnant women's mental health: mental distress and mental strength

The mental health consequences of living with intimate partner violence (IPV) are substantial. Despite the growing awareness of the incidence of depression and PTSD in women experiencing IPV, few studies have examined prospectively the experience of IPV during pregnancy and the impact of the abuse on womens mental health. As a component of a larger clinical trial of an intervention for pregnant abused women, 27 women participated in a qualitative study of their responses to the abuse in the context of pregnancy and parenting. Results indicate that womens changing perceptions of self was related to mental distress, mental health, or both mental distress and mental health.

Continuing Education: Improving Perceived Competence in School Nurses:

An investigator-designed survey was used to determine if attendance at specific continuing education programs increased the perceived competence of school nurses who enrolled and completed the programs. Respondents were queried about the general content of six courses offered by the Missouri Department of Health and Senior Services in conjunction with the University of Missouri—Columbia Sinclair School of Nursing. Specific content areas were mental health concerns, suicide prevention, diabetes management, asthma management, seizure disorders, and developing clinical skills as they pertained to school-age children. Comparing a sample of school nurses who had attended the programs with a group whom had not, a statistically significant difference was found in the participant group who reported higher self-perceived competence than the nonparticipant group in all content areas. Results of the study suggest that school nurses who attend specific continuing education programs feel more competent in practice than nurses who do not attend.

Telephone Social Support for Low‐Income Pregnant Women

OBJECTIVE To assess whether social support can be provided to low-income pregnant women by telephone. DESIGN A qualitative pilot study. SETTING Nonurban prenatal clinics. PARTICIPANTS Convenience sample of 20 pregnant women who were eligible for Medicaid, spoke English, were at least 24 weeks gestation, and had a telephone or access to a telephone. RESULTS The Baby-Beep pilot program provides strong evidence that a telephone social support intervention is feasible and highly acceptable to a group of low-income pregnant women. Through the use of the telephone, a strong rapport appeared to develop between the health care provider and the women because nonverbal cues were eliminated. The study also found that collaboration between mental health nurses and prenatal care providers could help create safe, cost-effective psychosocial care for pregnant women. CONCLUSION The Baby-Beep pilot study provides important information about one way to deliver social support to low-income women who may have little or no social support and feel alienated in a clinical setting.