Biomedical subjects

Jeannette R Ickovics

Publications and source records attributed to Jeannette R Ickovics.

At least 19 recordsLinked to original sources

PubMed2006

Prenatal and parenting stress on adolescent maternal adjustment: identifying a high-risk subgroup.

OBJECTIVES: Identifying adolescents who are at increased risk for a particularly difficult pregnancy and adjustment into parenthood is important, as the physical and psychological development of their infants rest in the well-being of these new mothers. This study aims to examine the effects of prenatal stress and parenting stress and the association with: (1) adolescent maternal adjustment; and (2) postpartum emotional distress. METHODS: In a prospective longitudinal cohort study, 154 pregnant adolescents (age 14-19) from 10 public clinics were interviewed four times from the third trimester of pregnancy to 16 months postpartum. Planned comparisons of four stress groups were used to compare mean scores for measures of feelings about motherhood, infant care, parenting competency, and emotional distress. RESULTS: Adolescent mothers who experienced high prenatal stress and high parenting stress had lower maternal adjustment (i.e., fewer positive feelings about motherhood, less infant care, and low parenting competency) and high postpartum emotional distress. Even when compared to adolescent mothers who experienced prenatal or parenting stress only, these adolescents were still at a greater disadvantage. CONCLUSIONS: Results suggest that adolescents who experience high stress during and after pregnancy are at increased risk for difficult maternal adjustment and high postpartum emotional distress. Findings support the need for health services targeting this subgroup of adolescent mothers, including both prenatal and parenting support. Early intervention to increase maternal adjustment and decrease emotional distress should remain a priority in facilitating the most optimal maternal and child health outcomes.

Adaptation, Psychological↗

PubMed2006

Psychological resources protect health: 5-year survival and immune function among HIV-infected women from four US cities.

OBJECTIVE: Guided by Cognitive Adaptation Theory, the aim was to determine whether psychological resources (positive affect, positive expectancy regarding health outcomes, finding meaning in challenging circumstances) protect against HIV-related mortality and decline in CD4 lymphocyte counts among women with HIV. DESIGN: The HIV Epidemiologic Research Study, a longitudinal prospective cohort study, with semi-annual interview, physical examination and laboratory assays. METHODS: A total of 773 HIV-seropositive women aged 16 to 55 years were recruited from four academic medical centers in Baltimore, Maryland; Bronx, New York; Providence, Rhode Island; and Detroit, Michigan. Semi-annually for up to 5 years, the women were interviewed, underwent physical examination, medical record abstraction, and venipuncture. Primary outcomes for these analyses included HIV-related mortality and CD4 cell count slope decline over 5 years. RESULTS: Psychological resources were inversely associated with HIV-related mortality and time to death, beyond the effects of potential confounding variables such as clinical status (e.g., HIV viral load, symptoms, antiretroviral therapy), sociodemographic characteristics (e.g. age, race), and depression at study entry (P < 0.05). Psychological resources also were inversely associated with CD4+ cell count decline (P < 0.01), serving as a possible mechanism linking resources to mortality. CONCLUSIONS: Psychological resources may protect against HIV-related mortality and immune system decline. Findings have implications for understanding individual variability in HIV disease progression. Moreover, because psychological resources are potentially amenable to change, results can be applied to clinical interventions aimed at improving the health of women with HIV.

Adult↗

PubMed2006

Self-esteem, emotional distress and sexual behavior among adolescent females: inter-relationships and temporal effects.

PURPOSE: The current analyses attempt to clarify the relationship between psychological factors and sexual behavior. We test a model examining relationships between sexual history (e.g., age at initiation, partner history) and self-esteem and emotional distress (e.g., depression, anxiety, stress, hostility) and their impact on future sexual risk behavior (e.g., unprotected sex, multiple sexual partners). METHODS: The current analyses included 155 sexually active adolescent females, aged 14-19 years, who participated in the first two waves of a longitudinal study of human immunodeficiency virus (HIV)/sexually transmitted disease (STD) and pregnancy risk. The Rosenberg Self-esteem scale, the Perceived Stress Scale, and three subscales of the Brief Symptom Inventory (depression, anxiety, hostility) and a variety of self-report measures of sexual history and sexual behavior were administered. Structural equation modeling using LISREL 8.51 was used to assess the proposed model. RESULTS: Our model exhibited adequate fit and demonstrated that sexual history reported retrospectively at baseline was related to self-esteem and emotional distress also measured at baseline. These variables predicted sexual risk behavior measured 6 months later. Adolescents who had lower self-esteem at baseline reported initiating sex earlier and having had risky partners. Alternatively, adolescents with more emotional distress at baseline were less likely to have had a previous STD, had more partners per year of sexual activity and a history of risky partners. Self-esteem influenced subsequent unprotected sex and emotional distress influenced subsequent multiple partners. CONCLUSIONS: This model suggests that self-esteem and emotional distress have contrasting relationships with sexual behavior and demonstrates the importance of the temporal nature of these variables. Implications for intervention are discussed.

Adolescent↗

PubMed2006

Urban teens: Trauma, posttraumatic growth, and emotional distress among female adolescents.

Urban teens face many traumas, with implications for potential growth and distress. This study examined traumatic events, posttraumatic growth, and emotional distress over 18 months among urban adolescent girls (N = 328). Objectives were to (a) describe types of traumatic events, (b) determine how type and timing of events relate to profiles of posttraumatic growth, and (c) prospectively examine effects of event type and posttraumatic growth on short- and long-term emotional distress with controls for pre-event distress. Results indicate that type of event was related to profiles of posttraumatic growth, but not with subsequent emotional distress. When baseline emotional distress was controlled, posttraumatic growth was associated with subsequent reductions in short- and long-term emotional distress. Implications for future research and clinical practice with adolescents are addressed.

Adolescent↗

PubMed2005

Data collection for sexually transmitted disease diagnoses: a comparison of self-report, medical record reviews, and state health department reports.

PURPOSE: To compare three methods of data collection on case ascertainment of past chlamydia or gonorrhea diagnoses. METHODS: Data collection for 361 adolescent females between 1998 and 2000 included: 1) face-to-face interviews; 2) computerized and paper medical record reviews; and 3) chlamydia and gonorrhea reports to the state health department. Statistical methods include latent class and composite reference standard analyses. RESULTS: The estimated prevalence of past diagnoses did not differ significantly by data collection method for chlamydia (20.5%, 23.0%, and 19.7% by self-report, medical record reviews, and state health department reports, respectively) or gonorrhea (4.7%, 6.9%, and 5.5%, respectively) during the 2-year study period. The estimated latent class and composite reference standard prevalences for chlamydia were 23.5% and 26.9%, respectively (p=.04 and p < .01 for differences from self-report alone, respectively). For gonorrhea, the estimated latent class and composite reference standard prevalences were 7.8% and 6.9%, respectively (p < .01 for both differences from self-report alone). Kappa scores for self-report compared with the latent class and composite reference standard prevalences ranged from .67 to .80, and the magnitude of under-reporting ranged from 21% to 47%. CONCLUSIONS: The similar case ascertainment from the three sources separately and high reliability of self-report, coupled with its feasibility and low cost, suggest that self-report is a viable data collection method for STD diagnoses. However, using multiple sources may be preferable when time and resources permit given that under-reporting by self-report is likely to occur (particularly for gonorrhea) and that greater case ascertainment can be achieved.

Adolescent↗

PubMed2005

Shared decision making, preoperative expectations, and postoperative reality: differences in physician and patient predictions and ratings of knee surgery outcomes.

PURPOSE: The present study was performed to determine the extent to which physicians and patients rate preoperative and postoperative knee pain and function differently, and to determine whether physicians or patients more accurately predict postoperative knee pain and function. TYPE OF STUDY: Longitudinal, prospective study. METHODS: Ninety-eight patients requiring either anterior cruciate ligament reconstruction surgery or meniscectomy and related surgery were interviewed 1 week before surgery, as well as 3 and 24 weeks postoperatively. Patients and their physicians completed ratings on knee pain and function at each time point. In addition, at their preoperative visit, patients and physicians completed ratings predicting their postoperative pain and functional status. RESULTS: Physicians rated patients as having less pain and greater knee function preoperatively and at 24 weeks postoperatively. Patients had more significant differences between predicted and actual ratings. CONCLUSIONS: Physicians tended to underestimate knee pain and overestimate knee function compared with patients. However, physicians better predicted postoperative knee pain and function ratings than did patients. These findings suggest that physician-patient discussions about preoperative expectations and postoperative reality might be an important part of clinical care. LEVEL OF EVIDENCE: Level II, Prospective Longitudinal Study.

Anterior Cruciate Ligament↗

PubMed2005

Systematic review of sexual risk among pregnant and mothering teens in the USA: pregnancy as an opportunity for integrated prevention of STD and repeat pregnancy.

Behaviors that lead to teen pregnancy also place young women at risk for STDs and repeat pregnancy. Compared to the broad literature on adolescent sexual risk behavior, our understanding of sexual risk in pregnant/mothering teens lags far behind. Primary objectives of this systematic review (1981-2003) of pregnant/mothering teens were to: (1) document rates of STD, repeat pregnancy, condom use, and contraception; (2) identify correlates of these biological and behavioral outcomes; (3) review sexual risk reduction interventions; and (4) discuss directions for future research and implications for clinical care. Fifty-one studies met inclusion criteria. Rates of STD and repeat pregnancy were high, with the majority of teens engaging in unprotected sex during and after pregnancy. An Ecological Model of Sexual Risk, based on Bronfenbrenner's (1989) Ecological Systems Theory, was proposed to organize findings on correlates of sexual risk. Improvements in research, including integration of outcomes and risk factors, stronger methodologies, and standardized assessments, are essential. Results suggest that teen pregnancy is a marker for future sexual risk behavior and adverse outcomes, and that pregnant/mothering teens need hybrid interventions promoting dual use of condoms and hormonal contraception. Pregnancy may provide a critical "window of opportunity" for sexual risk reduction.

Adolescent↗

PubMed2004

New sex partner acquisition and sexually transmitted disease risk among adolescent females.

PURPOSE: To determine the association between new sex partner acquisition and incident STDs, to describe predictors of acquiring a new sex partner, and to compare new and established sex partnerships among adolescent females. METHODS: Interview data and biological specimens for STD testing were collected from a sample of 411 adolescent females (average age 17.3 years, 44% black and 42% Hispanic) enrolled in a longitudinal study. The relationship between having a new sex partner and incident STD infection was estimated with logistic regression. RESULTS: Acquisition of a new sex partner during the 12-month follow-up period was common (24%) and significantly associated with an incident STD infection (OR = 3.0, 95% CI = 1.6-5.7). Predictors of new partner acquisition were younger age, younger age at first intercourse, and alcohol or drug use before sex in past 30 days. Being in a new partnership was significantly associated with greater uncertainty about the partners' STD history and recent sex with others. CONCLUSIONS: Being in a new sex partnership is an important predictor of incident STD infection. Awareness of this risk can help clinicians identify individuals who are more likely to get STDs and therefore target STD testing and appropriate prevention messages.

Adolescent↗

PubMed2004

The impact of physical maltreatment history on the adolescent mother-infant relationship: mediating and moderating effects during the transition to early parenthood.

Using attachment theory as a framework, this paper examines how pregnant adolescents' experiences of physical maltreatment during childhood influence the subsequent mother-infant relationship in 203 low-income adolescents followed from the 3rd trimester of pregnancy through the 1st year of parenthood. The relation between physical maltreatment history and early difficulty in the mother-infant relationship was mediated by adolescents' evaluations of the relationship with their primary caretaker and the feelings they associated with motherhood measured prior to childbirth. In addition, a supportive romantic relationship during pregnancy acted as a protective factor by moderating the impact of maltreatment history on the quality of the subsequent mother-infant relationship. Findings support the importance of assessments and interventions that consider the social context and relational history of pregnant and parenting adolescents.

Adolescent↗

PubMed2004

Sexual risk following a sexually transmitted disease diagnosis: the more things change the more they stay the same.

The purpose of this study is to assess changes in sexual risk behaviors, attitudes toward using condoms, and perceived susceptibility to fiuture STDs for adolescent females who recently were diagnosed with an incident STD compared to those who were not diagnosed with an incident STD. Adolescent females (N = 308) were assessed at two time points, 6 months apart. Ninety-two participants were diagnosed with an STD, and 216 were not diagnosed with an STD in between the two time points. Results indicated that adolescents did not significantly change their behaviors, attitudes, or perceptions following the diagnosis of an incident STD compared to those who were not diagnosed with an incident STD. This suggests that an STD diagnosis alone is not sufficient to motivate adolescent females to reduce their sexual risk behavior and change their sexual risk attitudes and perceptions.

Adolescent↗

PubMed2004

Prenatal care utilization and the implementation of prophylaxis to prevent perinatal HIV-1 transmission.

OBJECTIVES: To describe prenatal care utilization among women with HIV-1 in 4 US states, and to determine whether the adequacy of prenatal care utilization is associated with the implementation of prenatal, intrapartum, and postnatal HIV antiretroviral therapy (ARV). METHODS: Three-hundred three women completed a prenatal interview. Prenatal, labor and delivery, and infant medical records were reviewed. RESULTS: Thirty-nine percent of women did not receive adequate prenatal care; nearly one quarter of women did not begin care within the recommended timeframe, and approximately one-fifth of women received fewer than the recommended number of prenatal care visits from the time of entry into care until delivery. Those classified as less than adequate in terms of receipt of recommended visits were at increased risk for not receiving ARV during the prenatal care period and during labor and delivery, and were more likely to have had an infant subsequently diagnosed with HIV infection. CONCLUSION: Although women with HIV require adequate prenatal care for their own health as well as to improve perinatal outcomes, many are at risk for not receiving this care. Lower adherence to prenatal care appointments is an important risk factor for not receiving full HIV prophylactic regimens.

Adult↗

PubMed2004

Prevalence, course, and predictors of emotional distress in pregnant and parenting adolescents.

This study examines trajectories and correlates of emotional distress symptoms in pregnant adolescents (n = 203) and nulliparous adolescents (n = 188) from economically disadvantaged communities over an 18-month period. For both groups, the prevalence of significant emotional distress exceeded expectation based on adolescent norms; however, the severity of symptoms did not differ between the 2 groups. Results from growth curve modeling revealed a significant decline in symptoms during the study period for both groups, but pregnant adolescents experienced a different pattern of decline. Also, certain interpersonal factors (e.g., history of physical maltreatment, partner support) appeared to play a more important role in the emotional well-being of pregnant and parenting adolescents relative to nulliparous adolescents. Implications for early identification and intervention are discussed.

Adolescent↗

PubMed2003

Effects of propranolol on recovery of heart rate variability following acute myocardial infarction and relation to outcome in the Beta-Blocker Heart Attack Trial.

This study evaluated the effects of propranolol on recovery of heart rate variability (HRV) after acute myocardial infarction and its relation to outcome in the Beta-blocker Heart Attack Trial (BHAT). Beta blockers improve mortality after acute myocardial infarction, but through an unknown mechanism. Depressed HRV, a measure of autonomic tone, predicts mortality after acute myocardial infarction. Whether beta blockers influence recovery of HRV after acute myocardial infarction, and thereby improve outcome, is unknown. We compared 24-hour HRV parameters at 1 week after acute myocardial infarction and after 6 weeks of treatment with propanolol (n = 88) or placebo (n = 96). The relation between 25-month outcome (death/acute myocardial infarction/congestive heart failure), propranolol treatment, and HRV was further analyzed. After 6 weeks, high-frequency (HF) power (log-normalized), an index of vagal tone, increased more in propranolol-treated patients (4.28 +/- 0.1 to 5.17 +/- 0.09 ms(2)) than in placebo-treated patients (4.26 +/- 0.09 to 4.77 +/- 0.1 ms(2), p <0.05). Sympathovagal balance measured by the low-frequency (LF) to HF ratio increased in placebo-treated patients (3.55 +/- 0.24 to 3.86 +/- 0.24) but decreased in those treated with propranolol (3.76 +/- 0.29 to 3.17 +/- 0.23, p <0.01). Other frequency-domain parameters increased over time but were not affected by propranolol. Propranolol blunted the morning increase in the LF/HF ratio. Recovery of HF, the strongest HRV predictor of outcome, and propranolol therapy independently predicted outcome. In summary, after acute myocardial infarction, propranolol therapy improves recovery of parasympathetic tone, which correlates with improved outcome, and decreases morning sympathetic predominance. These findings may elucidate the mechanisms by which beta blockers decrease mortality and reduce the early morning risk of sudden death after acute myocardial infarction.

Adrenergic beta-Antagonists↗

PubMed2003

Group prenatal care and preterm birth weight: results from a matched cohort study at public clinics.

OBJECTIVE: To examine the impact of group versus individual prenatal care on birth weight and gestational age. METHODS: This prospective, matched cohort study included pregnant women (N = 458) entering prenatal care at 24 or less weeks' gestation; one half received group prenatal care with women of the same gestational age. Women were matched by clinic, age, race, parity, and infant birth date. Women were predominantly black and Hispanic of low socioeconomic status, served by one of three public clinics in Atlanta, Georgia or New Haven, Connecticut. RESULTS: Birth weight was greater for infants of women in group versus individual prenatal care (P < .01). Among those born preterm, infants of group patients were significantly larger than infants of individual-care patients (mean, 2398 versus 1990 g, P < .05). Although not statistically significant, infants of group patients were less likely than those of individual-care patients to be low birth weight (less than 2500 g; 16 versus 23 infants); very low birth weight (less than 1500 g; three versus six infants); early preterm (less than 33 weeks; two versus seven infants); or to experience neonatal loss (none versus three infants). There were no differences in number of prenatal visits or other risk characteristics (patient age, race, prior preterm birth). CONCLUSIONS: Group prenatal care results in higher birth weight, especially for infants delivered preterm. Group prenatal care provides a structural innovation, permitting more time for provider-patient interaction and therefore the opportunity to address clinical as well as psychological, social, and behavioral factors to promote healthy pregnancy. Results have implications for design of sustainable prenatal services that might contribute to reduction of racial disparities in adverse perinatal outcomes.

Adolescent↗

PubMed2003

Short and long-term impact of adolescent pregnancy on postpartum contraceptive use: implications for prevention of repeat pregnancy.

PURPOSE: To describe patterns and changes in contraceptive use among pregnant adolescents in early and later postpartum compared with nonpregnant adolescents. METHODS: One-hundred-seventy-six pregnant and 187 nonpregnant adolescents, recruited through community clinics, were interviewed three times (baseline, 6-month follow-up, 12-month follow-up) about their condom and hormonal contraceptive practices. Changes in contraception use and patterns of consistent hormonal and/or condom use were examined. Statistical analyses included General Estimating Equations (GEE) and multinomial regression. RESULTS: Pregnant adolescents increased hormonal contraceptive use from baseline to early postpartum, but decreased use from early postpartum to late postpartum. Nonpregnant adolescents did not change their hormonal contraceptive use over time. Neither group changed condom use over time. Pregnant adolescents were more likely to be consistent dual users and hormonal-only users during the 6-month follow-up compared with nonpregnant adolescents. These findings persisted at the 12-month follow-up, although there was a decline in hormonal contraception use. CONCLUSIONS: Adolescents change their contraceptive use during the postpartum period. Given the slight decline in contraceptive use in late postpartum in this sample, more work is necessary to maintain motivation to continue these positive postpartum trends.

Adolescent↗

PubMed2003

Misperceived risk among female adolescents: social and psychological factors associated with sexual risk accuracy.

This study of 411 urban female adolescents had 3 objectives: (a) assess the relationship between perceived risk and sexual risk behavior (condom use, number of partners, partner risk, presence of STDs, and aggregate sexual risk), (b) assess the accuracy of risk perceptions, and (c) identify variables related to inaccurate sexual risk perceptions. Participants were classified as accurate or inaccurate risk perceivers on the basis of actual sexual behavior and perceived risk. Accurate versus inaccurate risk perceivers were compared on psychological maintenance variables (self-esteem, distress, and coping), relationship context variables (partnership duration and pressure to have unprotected sex), and risk knowledge at different levels of sexual risk. Approximately half of the participants underestimated the risk of their sexual behavior. Accurate and inaccurate risk perceivers differed on risk knowledge, partnership duration, and pressure to have unprotected sex.

Adolescent↗

PubMed2003

Pregnant adolescents at risk: sexual behaviors and sexually transmitted disease prevalence.

OBJECTIVE: The purpose of this study was to determine the level of high-risk sexual behaviors and the prevalence of chlamydia and gonorrhea among pregnant adolescents. STUDY DESIGN: These analyses used data from 203 pregnant and 209 nonpregnant adolescents who were recruited from public health clinics. Data sources included interviewer-administered questionnaires, ligase chain reaction tests for chlamydia/gonorrhea in the third trimester of pregnancy, and state health department reports of chlamydia/gonorrhea. Statistical analyses included logistic regression. RESULTS: Pregnant adolescents were significantly more likely to have not used condoms during sexual intercourse in the past 30 days compared with nonpregnant adolescents, although other sexual risk behaviors were reduced. Nineteen percent of pregnant adolescents had chlamydia or gonorrhea diagnosed during the pregnancy. CONCLUSION: Pregnant adolescents have high levels of sexually transmitted diseases during pregnancy, and many adolescents use condoms inconsistently. Prenatal care providers may be in a unique position to decrease sexually transmitted diseases among pregnant adolescents by encouraging the reduction of risk behaviors and aggressively screening for sexually transmitted diseases as part of routine prenatal care.

Adolescent↗

PubMed2002

Adherence to antiretroviral therapy among patients with HIV: a critical link between behavioral and biomedical sciences.

Rapid advances in biomedical science, such as pharmaceutical developments for HIV disease, must be integrated with advances in behavioral science to further our understanding of medication adherence. This article evaluates the current state of the science in adherence to antiretroviral therapy for persons with HIV. The primary objectives are to 1) identify critical determinants of adherence, and 2) describe interventions to improve adherence. Adherence is a complex dynamic behavior influenced by characteristics of the patient, treatment regimen, disease, patient-provider relationship, and clinical setting. Therefore, the most promising interventions are multifaceted and target different locations in this matrix simultaneously. Unfortunately, nonadherence remains a formidable barrier in the management of HIV, resulting in the development of resistance and drug failure. Moreover, adherence is a public health concern, with implications for the transmission of HIV in general and the transmission of drug-resistant strains of HIV specifically. Despite substantial attention to adherence in recent years, much more remains to be done to better understand and promote adherence to antiretroviral therapy through effective interventions. From this integration of biomedical and behavioral science, effective clinical interventions can be developed and implemented to enhance the health of patients with HIV.

Antiretroviral Therapy, Highly Active↗