Does Religiosity Affect Health Risk Behaviors in Pregnant and Postpartum Women?

Roles of Income and Acculturation in the Hispanic Paradox: Breastfeeding Among Hispanic Women

OBJECTIVES

Despite Hispanics' high prevalence of breastfeeding compared to other racial/ethnic groups, contributing factors remain unclear. This study examines the complex relationship among Hispanic nativity, acculturation, income, and breastfeeding.

METHODS

The Fragile Families Child Wellbeing Study baseline (1998-2000) and Year 1 data (1999-2001) were used, including 4,077 women (933 non-Hispanic white, 2,046 non-Hispanic Black, 352 US-born Mexicans [USM], 299 US-born other Hispanics [USH], 302 foreign-born Mexicans [FBM], and 145 foreign-born other Hispanics [FBH]). Logistic regression estimated odds ratios(OR) and 95% confidence intervals(CI) for associations between Hispanic nativity and breastfeeding initiation and 4-month and 6-month breastfeeding, accounting for acculturation (Spanish language use, cultural engagement, religiosity, and traditional gender role attitudes), demographics, income, and health factors. Models were run for the overall sample and stratified by low vs. high income (above median: $21,600).

RESULTS

FBM(OR:2.35, 95%CI 1.33,4.15) and FBH(OR:2.28, 95%CI 1.23,4.24) had higher odds, while USM(OR:0.55, 95%CI 0.41,0.73) and USH(OR:0.50, 95%CI 0.37,0.67) had lower odds of breastfeeding initiation, compared to white women. USM had lower odds of 4-month(OR:0.53, 95%CI 0.36,0.80) and 6-month breastfeeding(OR:0.38, 95%CI 0.23,0.63), as did USH for 4-month(OR:0.64, 95%CI 0.42,0.99) and 6-month breastfeeding(OR:0.50, 95%CI 0.30,0.85). In stratified models, low-income (vs. high-income) FBH had higher odds of breastfeeding initiation(OR:3.73 95%CI 1.43,9.75) and 4-month(OR:3.01 95%CI 1.12,8.04) and 6-month breastfeeding(OR:3.08 95%CI 1.07,8.88), yet effects of acculturation across income strata are inconsistent.

CONCLUSIONS FOR PRACTICE

The Hispanic paradox operates differentially due to nativity, income, and acculturation. Breastfeeding intervention and promotion may require tailored approaches to Hispanic subgroups.

Differences in Psychosocial Protective Factors by Race/Ethnicity and Socioeconomic Status and Their Relationship to Preterm Delivery

Background: Non-Hispanic Black (“Black”) women in the United States deliver preterm at persistently higher rates than non-Hispanic White (“White”) women, and disparities in preterm delivery (PTD) also exist by socioeconomic factors. Research is needed to identify and understand factors that are protective against PTD for Black women and low socioeconomic status (SES) women.

Methods: We examined seven potential protective factors at the individual, interpersonal, and neighborhood levels during pregnancy to determine if they (1) differed in prevalence by race/ethnicity and SES and (2) were associated with risk of PTD overall or within specific race/ethnicity and SES groups. We used prospectively collected data from n = 2474 women who were enrolled in the Pregnancy Outcomes and Community Health Study conducted in Michigan (1998–2004).

Results: White women reported higher levels of self-esteem, mastery, perceived social support, instrumental social support, and reciprocity compared to Black women (all p < 0.01), while Black women reported higher levels of religiosity compared to white women (p < 0.01). High SES women reported higher levels of all protective factors compared to middle and low SES women (all p < 0.01). While protective factors were not independently associated with PTD, religiosity was associated with lower odds of PTD among low SES women (OR 0.6, 95% CI 0.4-0.9) and among Black women (OR 0.6, 95% CI 0.4–1.0), respectively.

Conclusions: Our findings highlight the importance of assessing how protective factors may operate differently across race/ethnicity and SES to promote healthy pregnancy outcomes. Future studies should examine mechanisms that elucidate potential causal pathways between religiosity and PTD for Black women and low SES women.

Role of discrimination and resilience on birth weight: A systematic examination in a sample of Black, Latina, and White women

Introduction:

Health inequities begin before birth with Black women being more likely to have low birth weight babies than White and Latina women. Although both Latina and Black women experience discrimination, only Black women appear to be affected.

Methods:

In this study using medical records and face-to-face interviews, we systematically examined the role of discrimination (daily, environmental, vicarious) on continuous birth weight (controlling for gestational age and baby’s gender) in a sample of 329 Black, Latina, and White pregnant women, as well as whether familism, prayer, and/or discrimination attribution buffered this association.

Results:

Linear regression analyses revealed that only prayer acted as a resilience factor, with Latina women appearing to benefit from prayer in the link between vicarious and daily discrimination on birth weight conditional on gestational age, whereas Black women showed no moderation and White women showed an exacerbation in the link.

Discussion:

The results of this study suggest that sociocultural norms may play a role in explaining the Latina epidemiological paradox, but more research is needed to understand the significance.

Health promotion behaviours of pregnant women and spiritual well-being: Mediatory role of pregnancy stress, anxiety and coping ways

AIM

Little is known about the link between spiritual well-being and health promotion behaviours in pregnant women. The study aimed to explore the direct and indirect effects of spirituality on health promotion behaviours with the mediatory roles of pregnancy stress, anxiety and coping ways.

DESIGN

Cross-sectional.

METHODS

Two hundred women aged above 18 years completed Spiritual Well-Being scale (SWBS), State-Anxiety Inventory (SAI), Promoting Lifestyle Profile (HPLP), Prenatal Coping Inventory (Nu-PCI) and Revised Prenatal Distress Questionnaire (NuPDQ).

RESULTS

Spirituality directly and negatively affected the state anxiety (β = -.41; p < .001) and NuPDQ (β = -.36; p < .001). Health promotion behaviours were negatively related to state anxiety (β = -.36; p < .001) and positively to planning-preparation coping (β = .23; p = .001). Spirituality had a significant indirect effect on health promotion behaviours (β = .33; p < .001), mediated through its association with state anxiety and planning-preparation coping. Thus, health professionals are proposed to consult pregnant women on the benefits of spirituality for improving healthy behaviours.

Health-promotion and health-harming behaviours in pregnant women: role of coping strategies, anxiety, and depression

There is a lack information on psychological predictors of health-promotion and health-harming behaviours during pregnancy. The study aimed to examine whether psychological factors including anxiety, depression, and coping strategies could predict the health-promotion and health-harm behaviours of pregnant women. In a cross-sectional study 200 pregnant women with singleton pregnancies, older than 18 years, and with at least 5 years of education were enrolled. The participants completed four questionnaires during their prenatal care appointments. The questionnaires included the prenatal health behaviour scale (PHBS), Revised Prenatal Coping Inventory (NU-PCI), Beck Depression Inventory (BDI-II), and State-Anxiety Inventory. The results revealed that planning-preparation coping was a strong positive independent variable associated with healthy behaviours (health-promoting behavioural/nutrition (β = 0.800, p = .001); health-promoting physical activity (β = 0.191, p = .049)). It was negatively associated with unhealthy behaviours (health-harming behavioural/nutrition (β = 0.290, p < .001) as well as health-harming physical activity (β = -0.290, p = .010)). Anxiety was significantly associated negatively with healthy behaviours. Depression was the strongest positive independent variable correlated with health-harming behavioural/nutrition (β = 0.290, p < .001). Finally, avoidance coping (β = 0.179, p = .037) was significant for health-harming physical activity.Impact statementWhat is already known on this subject? Previous studies have shown that there is a correlation between psychological factors and healthy behaviours of pregnant women.What do the results of this study add? The findings highlight the significant roles of coping strategies, anxiety, and depression for predicting healthy or unhealthy behaviours of pregnant women.What are the implications of these findings for clinical practice and/or further research? The findings implied that pregnant women who use more adaptive coping strategies, especially planning- preparing coping, reported lower levels of anxiety/depression and engaged more in healthy behaviours. The study also suggests that obstetricians and health care providers should pay more attention to the roles of coping strategies, especially planning-preparation and avoidance coping, anxiety, and depression in improving health-promotion/health-harming behaviours of pregnant women.

Religiosity/Spirituality and Mental Health and Quality of Life of Early Pregnant Women

The present study aims to investigate how religious/spiritual (R/S) beliefs are associated with depressive, anxious and stress symptoms and quality of life (QOL) of 160 Brazilian women in early pregnancy. In this cross-sectional study, religiosity/spirituality (DUREL, Daily Spiritual Experiences, Brief-RCOPE), mental health (DASS-21) and quality of life (WHOQOL-Bref) were assessed. Negative R/S coping was associated with higher levels of depressive, anxious and stress symptoms and worse physical and psychological QOL. On the other hand, positive R/S coping, intrinsic religiosity, and spirituality were associated with better psychological QOL, while only spirituality was associated with better social QOL.

Breastfeeding and the Role of Maternal Religion: Results From a National Prospective Cohort Study

Background

Recent research on religion and breastfeeding from a low-income, urban sample in the USA found that religious affiliation and religious attendance were associated with breastfeeding initiation.

Purpose

We assessed the relationship between religion (religious affiliation and religious attendance) and breastfeeding (initiation and duration) in a nationally representative prospective cohort study. We examined whether education and other sociodemographic characteristics mediated or moderated relationships.

Methods

Using data from the National Longitudinal Survey of Youth 1979 (n = 3,719), we regressed breastfeeding initiation and breastfeeding duration for first births on religious affiliation and religious attendance, comparing conservative Protestants with other religious groups. Sociodemographic characteristics were explored as potential mediators or moderators of relationships.

Results

Other than black Protestants, all religious groups reported higher odds of breastfeeding initiation compared to conservative Protestants (odds ratios = 1.43-3.01; p < .01 for all). All groups also breastfed longer than conservative Protestants, with the exception of black Protestants and Catholics. Educational attainment explained breastfeeding initiation differences with the exception of nonaffiliates and "other" religious affiliates. Educational attainment also explained religious group breastfeeding duration differences with the exception of nonaffiliates. In our final models, regular religious attendance was not directly associated with breastfeeding, but it magnified the breastfeeding duration advantage seen among mothers who had a later age at first birth.

Conclusions

The role of educational attainment in explaining breastfeeding differences between conservative Protestants and other groups suggests that educational interventions may be beneficial within this population.

Prevalence and outcomes of prenatal recreational cannabis use in high-income countries: a scoping review

BACKGROUND

With expanding recreational cannabis legalisation, pregnant women and their offspring are at risk of potentially harmful consequences.

OBJECTIVES

To assess the prevalence of recreational cannabis use among pregnant women, health outcomes associated with prenatal recreational cannabis use, and the potential impact of recreational cannabis legalisation on this population.

SEARCH STRATEGY

Five databases and the grey literature were systematically searched (2000-2019).

SELECTION CRITERIA

Human studies published in English or French reporting on the prevalence of prenatal recreational cannabis use in high-income countries.

DATA COLLECTION AND ANALYSIS

Data on study characteristics, prenatal substance use, and health outcomes were extracted and qualitatively synthesised.

MAIN RESULTS

Forty-one publications met our inclusion criteria. The overall prevalence of prenatal cannabis use varied substantially (min-max: 0.24-22.6%), with the greatest use in the first trimester. In the three studies with temporal data available, rates of prenatal cannabis use increased across years. Only 7/41 and 5/41 studies provided information on gestational age of exposure and frequency of use, respectively. The concomitant use of alcohol, illicit drugs, and tobacco was higher among cannabis users than nonusers. Prenatal cannabis use was associated with select neonatal, but not maternal, health outcomes. There were insufficient data to compare prenatal cannabis use between the pre- and post-legalisation periods.

CONCLUSION

Cannabis use among pregnant women is prevalent and may be associated with adverse neonatal outcomes. Future studies should assess the gestational age and frequency of cannabis exposure, and usage patterns prior to and following legalisation.

TWEETABLE ABSTRACT

Women who consume cannabis during pregnancy could risk predisposing their newborns to poor birth outcomes.

Mediators of the Association Between Religious Service Attendance and Mortality

Mounting evidence consistently shows associations between religious service attendance and reduced mortality risk, yet research identifying mediators remains limited. Using prospective data from the Health and Retirement Study (2006-2014; n = 5,200 US adults), we evaluated a range of potential mediators. After robust control for confounders (demographic, health, health-behavior, and social factors), among positive psychological factors, we observed mediation through increased life satisfaction (5.27%; P ≤ 0.001) and possibly positive affect (1.52%; P = 0.06) but not optimism, mastery, or purpose. Among dimensions of psychological distress, we observed mediation through reductions in hopelessness (1.92%; P = 0.01), trait anger (1.98%; P = 0.03), state anger (2.23%; P = 0.03), and possibly loneliness (1.21%; P = 0.06), but not cynical hostility or negative affect, and some evidence that increased anxiety (-3.61%; P = 0.008) and possibly depressive symptoms (-1.14%; P = 0.05) increased mortality odds. Among social factors, we observed mediation through contact with friends (10.73%; P = 0.005) but not living with a spouse or contact with children or other family. Among health behaviors, we observed mediation through exercise (5.38%; P ≤ 0.001) and negative mediation through alcohol frequency (-2.55%; P = 0.03) and possibly body mass index (-2.34%; P = 0.08) but not smoking. These results highlight a range of mediators that might underlie the association between religious service attendance and reduced risk of mortality.

Religiosity and Health: A Holistic Biopsychosocial Perspective

The resurgence of interest in the influence of religion and spirituality on health is examined within the context of the holistic paradigm and historical connection between nursing and spirituality. While nursing and spirituality often intersect with end-of-life considerations, this article presents findings from studies that demonstrate that religious involvement favors health and longevity across the life course. Examples include protective associations with stress, depression, self-rated health, and infant birth weight. Theoretical and empirical explanations for this relationship are offered, such as social and psychological resources and healthy behaviors. The effects of religion on biological functioning, including allostatic load and telomere length, are also discussed, although this area is understudied. Considerations for the "dark-side" of religious involvement are also offered. Suggestions for nurses wishing to protect and promote the health of their patients using a holistic approach include expanding knowledge of research on religion and health and advocating for patients' spiritual needs by conducting a comprehensive spiritual assessment in primary, secondary, and tertiary clinical settings.

The Relationship Between Religiosity and Health-Promoting Behaviors in Pregnant Women

Pender's health promotion model guided this descriptive/correlational study exploring the relationship between religiosity and health-promoting behaviors of pregnant women at Pregnancy Resource Centers (PRCs). A consecutive sample included women who knew they were pregnant at least 2 months, could read/write English, and visited PRCs in eastern Pennsylvania. Participants completed self-report surveys that examined religiosity, demographics, pregnancy-related variables, services received at PRCs, and health-promoting behaviors. Women reported they "sometimes" or "often" engaged in health-promoting behaviors, Hispanic women reported fewer health-promoting behaviors than non-Hispanic women, and women who attended classes at the centers reported more frequent health-promoting behaviors than those who did not attend classes. In separate multiple linear regressions, organized, non-organized, and intrinsic religiosity and satisfaction with surrender to God explained additional variance in health-promoting behaviors above and beyond what Hispanic ethnicity and attending classes at the PRCs explained in pregnant women at PRCs.

Sexual health is dead in my body: participatory assessment of sexual health determinants by refugees, asylum seekers and undocumented migrants in Belgium and The Netherlands

Background

Although migrants constitute an important proportion of the European population, little is known about migrant sexual health. Existing research mainly focuses on migrants’ sexual health risks and accessibility issues while recommendations on adequate sexual health promotion are rarely provided. Hence, this paper explores how refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands define sexual health, search for sexual health information and perceive sexual health determinants.

Methods

Applying Community-based Participatory Research as the overarching research approach, we conducted 223 in-depth interviews with refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. The Framework Analysis Technique was used to analyse qualitative data. We checked the extensiveness of the qualitative data and analysed the quantitative socio-demographic data with SPSS.

Results

Our results indicate that gender and age do not appear to be decisive determinants. However, incorporated cultural norms and education attainment are important to consider in desirable sexual health promotion in refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. Furthermore, our results demonstrate that these migrants have a predominant internal health locus of control. Yet, most of them feel that this personal attitude is hugely challenged by the Belgian and Dutch asylum system and migration laws which force them into a structural dependent situation inducing sexual ill-health.

Conclusion

Refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands are at risk of sexual ill-health. Incorporated cultural norms and attained education are important determinants to address in desirable sexual health promotion. Yet, as their legal status demonstrates to be the key determinant, the prime concern is to alter organizational and societal factors linked to the Belgian and Dutch asylum system. Refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands should be granted the same opportunity as Belgian and Dutch citizens have, to become equally in control of their sexual health and sexuality.

Racial/Ethnic and nativity differences in birth outcomes among mothers in New York City: the role of social ties and social support

Immigrants have lower rates of low birth weight (LBW) and to some extent preterm birth (PTB), than their US-born counterparts. This pattern has been termed the 'immigrant health paradox'. Social ties and support are one proposed explanation for this phenomenon. We examined the contribution of social ties and social support to LBW and PTB by race/ethnicity and nativity among women in New York City (NYC). The NYC Pregnancy Risk Assessment Monitoring System survey (2004-2007) data, linked with the selected items from birth certificates, were used to examine LBW and PTB by race/ethnicity and nativity status and the role of social ties and social support to adverse birth outcomes using bivariate and multivariable analyses. SUDAAN software was used to adjust for complex survey design and sampling weights. US- and foreign-born Blacks had significantly increased odds of PTB [adjusted odds ratio (AOR) = 2.43, 95 % CI 1.56, 3.77 and AOR = 2.6, 95 % CI 1.66, 4.24, respectively] compared to US-born Whites. Odds of PTB among foreign-born Other Latinas, Island-born Puerto Ricans' and foreign-born Asians' were not significantly different from US-born Whites, while odds of PTB for foreign-born Whites were significantly lower (AOR = 0.47, 95 % CI 0.26, 0.84). US and foreign-born Blacks' odds of LBW were 2.5 fold that of US-born Whites. Fewer social ties were associated with 32-39 % lower odds of PTB. Lower social support was associated with decreased odds of LBW (AOR 0.69, 95 % CI 0.50, 0.96). We found stronger evidence of the immigrant health paradox across racial/ethnic groups for PTB than for LBW. Results also point to the importance of accurately assessing social ties and social support during pregnancy and to considering the potential downside of social ties.

Socio-demographic and lifestyle-related characteristics associated with self-reported any, daily and occasional smoking during pregnancy

Smoking during pregnancy is a risk factor for various adverse birth outcomes. In order to develop effective interventions, insight is needed into the characteristics associated with pregnant women who smoke. Unknown is whether these characteristics differ for women who smoke daily and women who smoke occasionally. Our study sample, drawn from the DELIVER study (Sept 2009-March 2011), consisted of 6107 pregnant women in primary care in the Netherlands who were up to 34 weeks pregnant. The associations of thirteen socio-demographic or lifestyle-related characteristics with 'any smoking', 'daily smoking' and 'occasional smoking' during pregnancy were tested using multiple binary logistic regression with general estimating equations (GEE). Characteristics most strongly associated with any smoking were low education (OR 10.3; 95% confidence interval (CI) 7.0-15.4), being of Turkish ethnicity (OR 3.9; 95%CI 2.3-6.7) and having no partner (OR 3.7; 95%CI 2.3-6.0). Women of Dutch ethnicity were three times more likely to smoke than those from Dutch-speaking Caribbean countries and non-religious women were much more likely to smoke than religious women. Low education was markedly more strongly associated with daily smoking than with occasional smoking (OR 20.3; 95%CI 13.2-31.3 versus OR 6.0; 95%CI 3.4-10.5). Daily smokers were more likely to be associated with other unfavorable lifestyle-related characteristics, such as not taking folic acid, being underweight, and having had an unplanned pregnancy. There is still much potential for health gain with respect to smoking during pregnancy in the Netherlands. Daily and occasional smokers appear to differ in characteristics, and therefore possibly require different interventions.

Religion and smoking: a review of recent literature

Tobacco smoking and exposure to secondhand smoke are a major threat to human health worldwide. The effort to prevent tobacco use should be regarded as an important public health strategy. Given the significance of religion and spirituality in the daily life of more than 90% of the world's population, the relationship of religion and smoking should be seen as a critical research area. Religions are many and varied, but most value human well-being highly and so do not approve of tobacco use, even though they do not prohibit it entirely. In recent years, researchers have shown more interest in the subject of religion and health, including drug and tobacco use. Differences of focus and methodology notwithstanding, most studies have ascertained a deterrent role for religion as regards tobacco use, and several mechanisms have been proposed to explain the negative relationship between religion or spirituality and smoking. Many of the studies, however, suffer from shortcomings that need to be acknowledged and addressed, such as using nonstandard data-gathering tools, lack of a unified definition of religion or spirituality, and paucity of research in non-Christian and developing countries. Finally, the cross-sectional nature of many of the studies makes the meaningful interpretation of findings difficult.

Maternal religious involvement and breastfeeding initiation and duration

Although religious involvement is associated with a number of beneficial health outcomes, few studies have investigated whether religious involvement is associated with breastfeeding behaviors. Our analyses of 2 waves of data from the Fragile Families and Child Wellbeing Study (n = 4,166) indicate that mothers who frequently attend religious services are more likely to initiate breastfeeding than are mothers who never attend services. Understanding religious variations in breastfeeding may allow public health officials to more effectively target vulnerable populations.

Psychosocial factors associated with patterns of smoking surrounding pregnancy in fragile families

Although research has documented factors associated with maternal smoking, we need a more in-depth understanding of the risk factors associated with changes in smoking behaviors during the postpartum period. We investigate smoking patterns during pregnancy and 1 year postpartum as a function of relevant psychosocial factors. We use data on 3,522 postpartum mothers from the Fragile Families and Child Wellbeing Study to analyze the predictors of smoking among mothers who did not smoke during pregnancy but smoked at 1 year postpartum, mothers who smoked both during pregnancy and postpartum, and mothers who did not smoke during either period. Our covariates are grouped into four categories of risk factors for smoking: socioeconomic status, health care, life course and health, and partner and social support. Postpartum mothers in our sample were more likely to smoke throughout or after their pregnancies if they had only a high school education or less, had a household income three or more times below the poverty line, had public or no health insurance, breastfed for less than 5 months, were not married to the infant's father, if the infant's father currently smoked, and if they attended religious services less than once a week. Mental health problems were consistently associated with an increased risk of constant and postpartum smoking relative to non-smoking. Psychosocial factors play a role in postpartum smoking, but they have a stronger effect in predicting smoking that persists throughout pregnancy and the first year postpartum.

Spirituality in childbearing women

Childbearing is the ideal context within which to enrich spirituality. The purpose of this study was to generate themes regarding spirituality and religiosity among culturally diverse childbearing women. A secondary analysis was performed, using existing narrative data from cross-cultural studies of childbearing women. The following themes emerged from the data: childbirth as a time to grow closer to God, the use of religious beliefs and rituals as powerful coping mechanisms, childbirth as a time to make religiosity more meaningful, the significance of a Higher Power in influencing birth outcomes, and childbirth as a spiritually transforming experience. In clinical settings, understanding the spiritual dimensions of childbirth is essential. Assessments of childbearing women may include the question, "Do you have any spiritual beliefs that will help us better care for you?"

Nursing knowledge about alcohol use and alcohol problems in women: a review of the literature

In this article, the authors review the nursing empirical literature on alcohol and women's health published over the past 5 years (2005-2010). A total of 36 data-based articles authored by nurse investigators met eligibility criteria and were included in this review. Most were single studies by individual nurse investigators; few studies reflected ongoing programs of research related to alcohol and women's health. Studies were categorized into four main groups, including (a) determinants of alcohol use and alcohol problems; (b) patterns of use, assessment of alcohol use, and comorbidity; (c) consequences of alcohol use; and (d) the effects of treatment or specific interventions and the contributions of nursing research to the knowledge base of each group are summarized. The authors then propose a research agenda for nursing that addresses the most pressing issues related to alcohol use and alcohol problems in women.