The role of locus of control in daily life

Locus of Control as a Mediator of the Relationships Between Motivational Systems and Trait Anxiety

The Reinforcement Sensitivity Theory, first proposed by Gray and later revised, describes three motivational systems: Behavioral Inhibition System (BIS), Behavioral Activation System (BAS), and Fight-Flight-Freeze System (FFFS). Studies have shown that high BIS and FFFS activation are positively related to anxiety symptoms, yet the relationship between BAS and anxiety remains unclear. Research data have also suggested that anxiety symptoms occur with the loss of perceived control. Thus, although studies on the direct effect of locus of control (LOC) on trait anxiety have accumulated for many years, the issue of how LOC may mediate the relationship between BIS/BAS/FFFS sensitivity and anxiety has not been addressed. This study aimed to explore the mediating role of LOC orientation on trait anxiety among young adults in association with these three motivational systems. Cross-sectional data were obtained from 422 volunteers. The BIS/BAS Scale, Trait Anxiety Inventory, and Rotter's Internal-External LOC Scale were applied. A series of mediation analyses were performed to estimate total, indirect, and direct effects. The results showed that BIS and FFFS positively predicted trait anxiety. In addition, LOC positively predicted trait anxiety and BIS. The results of the mediation analyses indicated that LOC functioned as a partial mediator between BIS and trait anxiety. This finding revealed that a high BIS level, one of the motivational systems, was associated with external LOC, which in turn contributed to reporting high trait anxiety in young adults. Hence, BIS and external LOC orientation could be suggested as risk factors for trait anxiety. As the external LOC orientation of individuals with high punishment sensitivity increased, their trait anxiety levels also increased. Therefore, it was suggested that it might be useful to be aware that LOC orientations of individuals with BIS sensitivity may pose a risk for trait anxiety.

Coping equally: Equity of dyadic coping and depressive symptoms among adolescent couples

INTRODUCTION

Many adolescents are in their first romantic relationship; at the same time, depressive symptoms generally increase during this developmental stage. In adults, equity of support in romantic relationships is associated with less depressive symptoms-especially in female partners, who are generally on "the losing side" of support transactions with male partners. This study examines whether equity of dyadic coping is associated with depressive symptoms in adolescent mixed-gender couples. We disentangle equity of positive and negative dyadic coping, as differential effects might arise.

METHODS

Self-report data on dyadic coping and depressive symptoms were gathered from 124 mixed-gender couples aged between 16 and 21 years living in Switzerland between 2011 and 2013. Equity of dyadic coping was quantified by calculating the difference between received dyadic coping and provided dyadic coping for each partner separately. These difference scores and the overall level of dyadic coping were used to predict depressive symptoms in both partners using an Actor-Partner-Interdependence Model.

RESULTS

For female adolescents, we found the expected curvilinear association between equity of negative dyadic coping behaviors and depressive symptoms (actor effect). Additionally, the female perception of equity of positive dyadic coping was correlated with less depressive symptoms in male partners (partner effect). For male adolescents, receiving more positive dyadic coping than they provided was associated with more depressive symptoms (actor effect).

DISCUSSION

In female partners, results resembled those in adult mixed-gender couples. In male partners, results changed depending on the direction of inequity-possibly due to gender role development.

Association between nutrition self-efficacy, health locus of control and food choice motives in consumers in nine European countries

We investigated associations between food choice motives and psychological determinants of dietary health behaviour change (nutrition self-efficacy, NS-E, and health locus of control, HLoC) among 9381 participants (18-65 years, 49.4% females) from nine European countries. Price was the highest rated food choice motive. Higher importance of all motives was associated with higher NS-E and with higher Internal HLoC. Relationships between food choice motives and External HLoC were also in the expected direction in showing negative associations with Health, Natural Content, Weight Control, Mood and Sensory Appeal. Higher External HLoC was also associated with perceived greater importance of 'external' motives Ethical Concern, Familiarity and Convenience. Relationships between External HLoC and food choice motives were not all in the expected direction. Price was unrelated to External HLoC. Females rated the importance of all motives higher than males. People with less education ascribed greater importance to Price in motivating food choices. Together, these findings imply that self-efficacy and health locus of control should be considered along with motivations for food choice in dietary health promotion.

The association between the sense of control and depression during the COVID-19 pandemic: a systematic review and meta-analysis

Introduction

High levels of depression and low sense of control have been reported during the COVID-19 pandemic. The removal of typical freedoms through public health restrictions may have played an important role. The aim of this review was to examine data collected during the pandemic and (1) estimate the strength of the association between sense of control and depression, (2) examine whether the different types of control measures affected the strength of the association, and (3) whether this changed as a function of pandemic indicators.

Methods

We conducted a systematic review and meta-analysis of studies published in English between December 2019 and November 2022. A total of 993 articles were identified, of which 20 were included in the review and 16 in the meta-analysis after conducting a quality assessment using the standard NIH tool.

Results

The control-depression association gave a bias-independent pooled effect size of r = .41, and grew stronger over the 130 weeks covered by this review but did not change as a function of local COVID incidence rates. Subgroup analyses showed that external and overall control were more strongly related to depression than internal control.

Discussion

These findings emphasize that external factors are important to the sense of control and the importance of preserving the sense of control in situations where the removal of personal freedoms is necessary, such as public health emergencies.

Illness intrusiveness, health locus of control, and anxiety symptoms among veterans with congestive heart failure

Disease severity, illness intrusiveness, and health locus of control (HLC) each contribute to psychosocial wellbeing in patients with congestive heart failure (CHF). To better understand the relationships between these variables regarding anxiety symptoms, we analyzed data from 116 adult male veterans with comorbid CHF and anxiety. Results suggested that illness intrusiveness significantly mediated the relation of CHF severity to anxiety symptom severity, and that the illness intrusiveness domains of physical well-being/diet, work/finances, and other aspects of life (religious/spirituality, community/civic, self-improvement/expression) were also significant mediators of that relationship. The relation of illness intrusiveness to anxiety was not moderated by internal HLC. Findings highlight the importance of assessing and treating various aspects of illness intrusiveness to manage anxiety symptoms in CHF patients.

Associations of locus of control, information processing style and anti-reflexivity with climate change scepticism in an Australian sample

A proportion of the Australian public remains sceptical about the reality of climate change, its causes, impacts and the need for mitigatory action. To date, scepticism research largely focuses on factors highly resistant to change, particularly socio-demographic and value factors. This mixed-methods study investigated whether more malleable psychological factors: locus of control; information processing style; and anti-reflexivity, predicted climate change scepticism above and beyond socio-demographic and value factors. A sample of 390 participants (Mean age = 41.31, standard deviation = 18.72; 230 male) completed an electronic survey. Using hierarchical regression, trust in forces of anti-reflexivity and external locus of control predicted impact scepticism. Decreased trust in forces of reflexivity also predicted attribution and impact scepticism. Finally, external locus of control predicted response scepticism. Key qualitative themes identified were, trust in alternative science; mistrust of climate science; belief in natural cycles; predictions not becoming reality; and ulterior motives of interested parties.

Association of personality with habituation of physical and non-physical activities among Japanese adults: Results from questionnaire research before COVID-19 pandemic

Background

Physical activity has benefits for public health as it reduces the risk of non-communicable diseases and improves the quality of life. Previous studies have shown that health conditions, lifestyle, and socioeconomic status influence one's tendency to engage in physical activity. However, the influence of psychological traits on engagement in physical activity is not yet fully understood. In this study, we explored personality traits associated with the habituation of physical activity and compared them with personality traits associated with the habituation of non-physical activity.

Methods

We recruited 1600 Japanese adult volunteers and conducted an online survey just before the spread of COVID-19. We collected data for the prevalence of physical and non-physical activities, and various aspects of personality traits including the Big Five personality traits, sensitivity to behavioral activation, dark triad personality, levels of internal locus of control, and the degree of just-world belief.

Findings

The results demonstrated that high levels of extraversion, sensitivity to behavioral activation, and an internal locus of control had a positive influence on the habituation of physical activity. Moreover, our results were contradictory as they also showed that high levels of openness, sensitivity to behavioral activation, and just world belief related to the habituation of non-physical activity.

Interpretation

These results suggest that the personality traits that influenced the habituation of activities depend on the characteristics of the activity and reveal extraversion and internal locus of control as the personality traits specific to the habituation of physical activity.

Fundings

This study was supported by Senryakuteki-kenkyu from Chukyo University, a Grant-in-Aid for Early-Career Scientists (Grant No. 19 K20650 and 22 K13880), the Promotion of Joint International Research (Grant No. 20KK0054). This work was also supported by a Grant-in-Aid for Scientific Research on Innovative Areas "Construction of the Face-Body Studies in Transcultural Conditions" (Grant No. 17H06342).

Developing Social Entrepreneurship Orientation: The Impact of Internal Work Locus of Control and Bricolage

Using core self-evaluation theory, the current study assesses the effect of internal work locus of control and bricolage on social entrepreneurship orientation. We adopted the cross-sectional survey design using a sampling frame to engage 400 top executives of social enterprises in mainland China. Three hundred and seventy-two of the executives replied, presenting a response rate of 93%. Results of structural equation modeling analysis show significant positive relationships between internal work locus of control, bricolage, and social entrepreneurship orientation. The positive mediating effect of bricolage on the relationship between internal work locus of control and social entrepreneurship orientation was also found to be true. Consequently, to foster social entrepreneurship orientation, top executives of social enterprises need to gather available resources for bricolage tasks. These findings contribute new knowledge to how internal work locus of control affects social entrepreneurship orientation through the bricolage activity of Chinese social enterprises. Through core self-evaluation theory, we demonstrate the effect of internal work locus of control as a preceding factor in the relationship between bricolage and social entrepreneurship orientation.

The relationship between racial discrimination and substance use: Does locus of control help explain risk?

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The racial discrimination, locus of control, substance use pathway was tested.

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The sample was comprised of racial/ethnic minority adults.

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Indirect effects were found for chance and powerful others external locus of control.

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Internal locus of control was not found to be a significant mediator.

Introduction

Exposure to racial discrimination has been consistently linked with risk for substance use. However, outside of externalizing and affect-based factors, few other mechanisms have been examined. One potential candidate is locus of control, a learning processes that involves the degree to which one attributes rewards as resulting from their own control (internal locus of control) versus outside control (external locus of control). There is evidence that exposure to stressors is associated with locus of control, with a separate body of literature linking locus of control with substance use. Thus, it is plausible that locus of control may be a mechanism underlying the relationship between racial discrimination and substance use.

Methods

The current study investigated this pathway among 503 racial/ethnic minority adults aged 18–35 who completed an online questionnaire including measures on racial discrimination related stress, locus of control, and substance use.

Results

Results indicated a significant indirect effect between racial discrimination related stress, two external domains of locus of control (i.e., powerful others and chance), and substance use. A significant indirect effect was not found for internal locus of control.

Conclusion

These findings expand our understanding on potential mechanisms that underlie the racial discrimination-substance use risk pathway among racial/ethnic minority adults, which may in turn provide important targets for substance use intervention programming.

Transactional processes between childhood maltreatment and depressive symptoms from middle childhood to early adolescence: Locus of control as a mediator

BACKGROUND

Previous research has identified a significant, positive relation between childhood maltreatment and depressive symptoms. However, the findings required replication at the within-person level. Moreover, the mediating mechanism of locus of control accounting for their relations has yet to be fully evaluated. Thus, this study examined the dynamic longitudinal relations between childhood maltreatment and depressive symptoms including whether locus of control functioned as a mediator between them after separating between-person effects from within-person effects.

METHODS

A sample of 4110 Chinese children (50.60% boys; M_age = 9.89 at Wave 1) covering the transitional period from middle childhood to early adolescence completed a package of self-report measures on 5 occasions across 2.5 years, using 6-month intervals. Random Intercept Cross-Lagged Panel Models were applied to disaggregate between- and within-person effects. Also, alternative Cross-Lagged Panel Models were applied.

RESULTS

Locus of control played a mediating role in the reciprocal relations between childhood maltreatment and depressive symptoms at the within-person level.

LIMITATIONS

Some limitations existed in the measures. Moreover, sexual abuse was not investigated in this study.

CONCLUSIONS

The findings highlighted the mediating role of locus of control in the reciprocal relations between childhood maltreatment and depressive symptoms at the within-person level, suggesting that interventions targeted at promoting internal locus of control may help prevent the developmental pathway from childhood maltreatment to depressive symptoms and vice versa from middle childhood to early adolescence.

Depressed mood trajectories in the first year postpartum among Taiwanese mothers: Associations with perceived support, financial stress, and marital satisfaction

This study examined the typology of depressed mood trajectories and the associated factors over the first year postpartum among Taiwanese mothers. Data of 4332 mothers from a nationwide longitudinal study on child development and care were analyzed. Three classes of depressed mood trajectories were identified, two with lower initial scores and a decreasing trajectory and one with a higher initial score and an increasing trajectory. Subjective financial stress, perceived support, and marital satisfaction were significant in predicting mothers' membership of the depressed mood trajectory classes. The results highlighted the individual susceptibility to the postpartum depressed mood among Taiwanese mothers.

Associations between Volunteering and Mental Health during COVID-19 among Chinese Older Adults

Evidence about the association between volunteering and the mental health of older adults during COVID-19 remains underexplored. This study investigated (1) patterns of volunteering among older adults in Hong Kong during COVID-19; (2) associations between volunteering and mental health of older adults during COVID-19; and (3) associations between key psychological resources (e.g., self-efficacy and self-esteem) and volunteering among older adults during COVID-19. This study applied a cross-sectional design with data collected from 128 older adults in June 2020, who were trained as volunteers in a volunteer program that began before COVID-19. The study found that older adults continued to actively contribute to their communities by engaging in volunteering during COVID-19. The specific type of volunteering activities was linked to few depressive and anxiety symptoms. Older adults with increased self-esteem prior to COVID-19 were more likely to participate in volunteering activities related to COVID-19. Our study suggested that encouraging older adults to volunteer during the pandemic is a key pathway to maintain mental health. Social workers are encouraged to engage older adults in volunteerism regularly to offset the risk of depression and anxiety symptoms in times of crisis.

SIMON: A Digital Protocol to Monitor and Predict Suicidal Ideation

Each year, more than 800,000 persons die by suicide, making it a leading cause of death worldwide. Recent innovations in information and communication technology may offer new opportunities in suicide prevention in individuals, hereby potentially reducing this number. In our project, we design digital indices based on both self-reports and passive mobile sensing and test their ability to predict suicidal ideation, a major predictor for suicide, and psychiatric hospital readmission in high-risk individuals: psychiatric patients after discharge who were admitted in the context of suicidal ideation or a suicidal attempt, or expressed suicidal ideations during their intake. Specifically, two smartphone applications -one for self-reports (SIMON-SELF) and one for passive mobile sensing (SIMON-SENSE)- are installed on participants' smartphones. SIMON-SELF uses a text-based chatbot, called Simon, to guide participants along the study protocol and to ask participants questions about suicidal ideation and relevant other psychological variables five times a day. These self-report data are collected for four consecutive weeks after study participants are discharged from the hospital. SIMON-SENSE collects behavioral variables -such as physical activity, location, and social connectedness- parallel to the first application. We aim to include 100 patients over 12 months to test whether (1) implementation of the digital protocol in such a high-risk population is feasible, and (2) if suicidal ideation and psychiatric hospital readmission can be predicted using a combination of psychological indices and passive sensor information. To this end, a predictive algorithm for suicidal ideation and psychiatric hospital readmission using various learning algorithms (e.g., random forest and support vector machines) and multilevel models will be constructed. Data collected on the basis of psychological theory and digital phenotyping may, in the future and based on our results, help reach vulnerable individuals early and provide links to just-in-time and cost-effective interventions or establish prompt mental health service contact. The current effort may thus lead to saving lives and significantly reduce economic impact by decreasing inpatient treatment and days lost to inability.

Prevalence of sleep disturbances during COVID-19 outbreak in an urban Chinese population: a cross-sectional study

OBJECTIVE

The COVID-19 pandemic is a large-scale public health emergency that likely precipitated sleep disturbances in the community. This study aimed to investigate the prevalence and correlates of sleep disturbances during the early phase of COVID-19 pandemic.

METHODS

This web-based cross-sectional study recruited 1138 Hong Kong adults using convenience sampling over a two-week period from 6th April 2020. The survey collected data on sleep disturbances, mood, stress, stock of infection control supplies, perceived risk of being infected by COVID-19, and sources for acquiring COVID-19 information. The participants were asked to compare their recent sleep and sleep before the outbreak. The Insomnia Severity Index (ISI) was used to assess their current insomnia severity. Prevalence was weighted according to 2016 population census.

RESULTS

The weighted prevalence of worsened sleep quality, difficulty in sleep initiation, and shortened sleep duration since the outbreak were 38.3%, 29.8%, and 29.1%, respectively. The prevalence of current insomnia (ISI score of ≥10) was 29.9%. Insufficient stock of masks was significantly associated with worsened sleep quality, impaired sleep initiation, shortened sleep duration, and current insomnia in multivariate logistic regression (adjusted OR = 1.57, 1.72, 1.99, and 1.96 respectively, all p < 0.05).

CONCLUSION

A high proportion of people in Hong Kong felt that their sleep had worsened since the COVID-19 outbreak. Insufficient stock of masks was one of the risk factors that were associated with sleep disturbances. Adequate and stable supply of masks may play an important role to maintain the sleep health in the Hong Kong general population during a pandemic outbreak.

Testing the Effectiveness of a Salutogenic Model for Reducing Suicidal Tendencies in a Population of Elderly and Young Adults

Suicide is a leading cause of mortality worldwide, with the elderly having the highest suicide rates. This study tests the effectiveness of a salutogenic model in normative elderly people compared with young adults in protecting against risk behaviors and suicidal tendencies, based on two variables: locus of control and meaning in life (mediating variable between locus of control and suicidal tendency). Participants were 191 people aged 65 to 100 years and 200 young adults aged 18 to 28 years old. Participants completed questionnaires on locus of control and purpose in life and were assessed for suicidal tendencies. Findings reveal a negative effect of age on locus of control, purpose in life, and a negative correlation between purpose in life and internal locus of control and suicidal tendency. Purpose in life mediates between internal locus of control and suicidal tendency in both populations. The salutogenic model has significant implications and can be used to reduce suicidal tendencies.

Playing with fire. Understanding how experiencing a fire in an immersive virtual environment affects prevention behavior

A potentially effective way to influence people's fire prevention behavior is letting them experience a fire in an immersive virtual environment (IVE). We analyze the effects of experiencing a fire in an IVE (versus an information sheet) on psychological determinants of behavior-knowledge, vulnerability, severity, self-efficacy, and locus of control-based mainly on arguments from Protection Motivation Theory and the Health Belief Model. Crucial in our setup is that we also relate these determinants to actual prevention behavior. Results show that IVE has the hypothesized effects on vulnerability, severity, and self-efficacy, and an unexpected negative effect on knowledge. Only knowledge and vulnerability showed subsequent indirect effects on actual prevention behavior. There remains a direct positive effect of IVE on prevention behavior that cannot be explained by any of the determinants. Our results contradict the implicit assumption that an induced change in these psychological determinants by IVE, necessarily implies a change in behavior. A recommendation for research on the effects of IVE's is, whenever possible, to study the actual target behavior as well.

Health cognitions mediate physical (in)activity and walking in midlife women

This study sought to identify which of the many facilitators and barriers to physical activity (PA) and walking are most significant to changing midlife women's exercise behaviour, with a view to informing future interventions. A cross-sectional survey explored associations of PA and sedentary time with self-reported health value, health locus of control (HLOC) and physical and mental health. Open-ended questions were included to elicit barriers and facilitators to walking. A sample of 295 women, aged 35-55, was recruited via women's groups, social media, online forums, and posters in doctors' surgeries, and completed the survey online. Quantitative data were analysed using descriptive statistics, t-test, analysis of variance and regression analyses. The low activity levels reported underline the urgency of developing interventions for this population. Results suggest that the key factors associated with higher activity levels are having a more internal HLOC, better mental health and placing greater value on health. While health cognitions may therefore be one important factor to target, these must be tackled in the context of women's other barriers to and facilitators of exercise. Thematic analysis of the open-ended questions revealed that the key barrier to walking was women's busy lives and their many competing priorities and that the most important facilitators were mental health and social connection. Overall, results suggest that, rather than emphasizing physical health and activity targets, practitioners should seek to make walking more relevant to women by emphasizing mental wellbeing and self-care, and more enjoyable by focusing on social and family-based walking interventions.

Avoidance coping and academic locus of control as mediators of the relationship between posttraumatic stress and academic achievement among first-year college students

Background and Objectives: Posttraumatic stress (PTS) has been found to be associated with poor academic performance among college students. However, our understanding of the mechanisms underlying this relationship is limited to the results of a few recent studies. The present study is aimed at expanding the literature in this area by examining whether avoidance coping and external academic locus of control (LOC) mediate the relationship between PTS and academic achievement among first-year college students. Design: A correlational study design was used. Students completed a quantitative survey in their first semester of college. After they completed their first academic year, we obtained their grade point averages (GPAs) through the university. Method: Participants included 280 first-year college students with a history of potentially traumatic events. Data obtained from these participants were analyzed using path analysis. Results: Two indirect paths from PTS to first-year GPA were significant, suggesting that external academic LOC mediated the effects of both PTS and avoidance coping on first-year GPA. Conclusion: Our findings suggest that the interventions that target external academic LOC may help reduce the detrimental effects of PTS on academic achievement among trauma-exposed college students.

"My Body. My Choice": A Qualitative Study of the Influence of Trust and Locus of Control on Postpartum Contraceptive Choice

Postpartum contraception helps reduce unintended pregnancy and space births to improve maternal and child health. This study explored women's perceptions of contraceptive choice during the postpartum period in the context of locus of control and trust in healthcare providers. Researchers conducted six focus groups with 47 women, ages 18-39, receiving postpartum care at an outpatient clinic. Techniques from grounded theory methodology provided an inductive approach to analysis. HyperRESEARCH 3.5.2 qualitative data analysis software facilitated a constant-comparative coding process to identify emergent themes. Participants expressed a preference for relationship-centered care, in which healthcare providers listened, individualized their approach to care through rapport-building, and engaged women in shared decision-making about contraceptive use through open communication, reciprocity, and mutual influence. Conflicting health messages served as barriers to uptake of effective contraception. While participants trusted their healthcare provider's advice, many women prioritized personal experience and autonomy in decisions about contraception. Providers can promote trust and relationship-centered care to optimize contraceptive uptake by listening, exploring patient beliefs and preferences about contraception and birth spacing, and tailoring their advice to individuals. Results suggest that antenatal contraceptive counseling should incorporate information about effectiveness, dispel misconceptions, and engage patients in shared decision-making.

Psychosocial Correlates of Dietary Supplement Use: Results from the National Survey of Midlife Development in the United States

Drawing on data gathered in the National Survey of Midlife Development in the United States, this study examined internal and external locus of control, self-esteem, neuroticism, perceived health status, uniqueness, and somatic amplification as correlates of dietary supplement use. With sex, race, and age measures also included in the study, bivariate analyses showed greater supplement use among women and older respondents as well as those scoring higher on internal locus of control, self-esteem, perceived health status, and somatic amplification. Regression analyses identified sex and internal locus of control as the strongest predictors. Interactions between age and external locus of control also emerged.

Material Hardship and Internal Locus of Control Over the Prevention of Child Obesity in Low-Income Hispanic Pregnant Women

OBJECTIVE

To determine the relations between household material hardships and having a low internal locus of control over the prevention of child obesity in low-income Hispanic pregnant women.

METHODS

We performed a cross-sectional analysis of baseline data collected during a third trimester prenatal visit from women participating in the Starting Early Study, a randomized controlled trial to test the efficacy of a primary care-based family-centered early child obesity prevention intervention. Using multiple logistic regression analyses, we determined whether 4 domains of material hardship (food insecurity, difficulty paying bills, housing disrepair, neighborhood stress), considered individually and also cumulatively, were associated with having a low internal locus of control over the prevention of child obesity.

RESULTS

The sample included 559 low-income Hispanic pregnant women, with 60% having experienced at least 1 hardship. Food insecurity was independently associated with a low internal locus of control over the prevention of child obesity (adjusted odds ratio, 2.38; 95% confidence interval, 1.50-3.77), controlling for other hardships and confounders. Experiencing a greater number of material hardships was associated in a dose-dependent relationship with an increased odds of having a low internal locus of control.

CONCLUSIONS

Prenatal material hardships, in particular food insecurity, were associated with having a lower prenatal internal locus of control over the prevention of child obesity. Longitudinal follow-up of this cohort is needed to determine how relations between material hardships and having a low internal locus of control will ultimately affect infant feeding practices and child weight trajectories.

Socio-demographic inequalities across a range of health status indicators and health behaviours among pregnant women in prenatal primary care: a cross-sectional study

Background

Suboptimal maternal health conditions (such as obesity, underweight, depression and stress) and health behaviours (such as smoking, alcohol consumption and unhealthy nutrition) during pregnancy have been associated with negative pregnancy outcomes. Our first aim was to give an overview of the self-reported health status and health behaviours of pregnant women under midwife-led primary care in the Netherlands. Our second aim was to identify potential differences in these health status indicators and behaviours according to educational level (as a proxy for socio-economic status) and ethnicity (as a proxy for immigration status).

Methods

Our cross-sectional study (data obtained from the DELIVER multicentre prospective cohort study conducted from September 2009 to March 2011) was based on questionnaires about maternal health and prenatal care, which were completed by 6711 pregnant women. The relationships of education and ethnicity with 13 health status indicators and 10 health behaviours during pregnancy were examined using multilevel multiple logistic regression analyses, adjusted for age, parity, number of weeks pregnant and either education or ethnicity.

Results

Lower educated women were especially more likely to smoke (Odds Ratio (OR) 11.3; 95 % confidence interval (CI) 7.6– 16.8); have passive smoking exposure (OR 6.9; 95 % CI 4.4–11.0); have low health control beliefs (OR 10.4; 95 % CI 8.5–12.8); not attend antenatal classes (OR 4.5; 95 % CI 3.5–5.8) and not take folic acid supplementation (OR 3.4; 95 % CI 2.7–4.4). They were also somewhat more likely to skip breakfast daily, be obese, underweight and depressed or anxious. Non-western women were especially more likely not to take folic acid supplementation (OR 4.5; 95 % CI 3.5–5.7); have low health control beliefs (OR 4.1; 95 % CI 3.1–5.2) and not to attend antenatal classes (OR 3.3; 95 % CI 2.0–5.4). They were also somewhat more likely to have nausea, back pains and passive smoking exposure.

Conclusions

Substantial socio-demographic inequalities persist with respect to many health-related issues in medically low risk pregnancies in the Netherlands. Improved strategies are needed to address the specific needs of socio-demographic groups at higher risk and the structures underlying social inequalities in pregnant women.

How women with high risk pregnancies use lay information when considering place of birth: A qualitative study

INTRODUCTION

Where to give birth is a key decision in pregnancy. Women use information from family, friends and other sources besides healthcare professionals when contemplating this decision. This study explored women's use of lay information during high risk pregnancies in order to examine differences and similarities in the use of information in relation to planned place of birth. Half the participants were planning hospital births and half were planning to give birth at home.

METHODS

A qualitative study using semi-structured interviews set in a hospital maternity department in South East England. Twenty-six participants with high risk pregnancies, at least 32 weeks pregnant. Results were analysed using thematic analysis.

RESULTS

Three themes emerged: approaches to research - how much information women chose to seek out and from which sources; selection of sources - how women decided which sources they considered reliable; and unhelpful research - information they considered unhelpful. Women planning homebirths undertook more research than women planning to give birth in hospital and were more likely to seek out alternative sources of information. Women from both groups referred to deliberately seeking out sources of information which reflected their own values and so did not challenge their decisions.

CONCLUSIONS

There are similarities and differences in the use of lay information between women who plan to give birth in hospital and those who plan homebirths. Professionals working with women with high risk pregnancies should consider these factors when interacting with these women.

Parent Attribution for Child Eating Scale (PACES). Psychometric characteristics and associations with child and parent variables

Parent participation in interventions for their children's feeding problems may depend on parent attributions for the origins of these problems, but no measure is available to identify these parent perceptions. The purpose of the present paper was to develop a new Parent Attribution for Child Eating Scale (PACES), then to examine how parent perceptions measured by the PACES were associated with child variables and parent feeding practices. Participants included parents of 393 children from a hospital feeding clinic (68.2% boys; mean age = 55.4 months). Parents completed surveys to report children's demographic, medical, and feeding variables, three-point ratings for possible origins of these feeding problems, and their own use of nine child-feeding practices. Exploratory factor analysis of the parent ratings produced the 21-item PACES with four dimensions: Permissive Parenting, Medical Treatments, Oral Problems, and Vomiting Fear. The PACES showed acceptable goodness-of-fit, internal reliability, test-retest reliability, and support for its validity with expected correlations with child and parent variables. Multiple regression revealed that nine child variables (age, body mass index, gender, autism, gastrointestinal problems, neurological problems, oral motor problems, texture feeding problems, diet variety) explained 19-41% of the variance in the four PACES attributions, with oral motor problems significantly correlated with all of them (negatively with Permissive Parenting, positively with the other three), suggesting that its occurrence in combination with other child variables guides parent explanations for children's feeding problems. Multiple regression also found that Many Food Choices was the only parent feeding practice significantly correlated with all four PACES attributions (positively with Permissive Parenting, negatively with the other three), suggesting that it may be parents' primary response to attributions they develop for their children's feeding problems.