Cal State Long Beach’s (CSULB) Guido Urizar, an assistant professor of psychology, recently received funding from the National Institutes of Health (NIH) to help confirm initial results from his 2011 research paper in the journal Psychoneuroendocrinology based on grant-supported work with low-income Latina mothers and a perinatal mood management program.
“Impact of a prenatal cognitive-behavioral stress management intervention on salivary cortisol levels in low-income mothers and their infants” was published in April 2011 by Urizar and his collaborator/mentor Ricardo Muñoz of UC San Francisco.
Urizar’s preliminary findings suggest that elevated stress levels during the pre- and postpartum periods are related to poor maternal and infant health outcomes. Yet, he believes few studies have looked at the ability of stress management interventions to regulate stress levels among mothers and their infants.
Urizar examined whether a prenatal cognitive behavioral stress management (CBSM) intervention would be effective in regulating salivary cortisol (a biological marker of stress) and self-reported stress levels among mothers and their infants at 6 months and 18 months postpartum, relative to two control groups.
“Our sample was comprised of predominantly Spanish-speaking, low-income women (80 percent with a mean age of 25) who were screened for depression during their second trimester of pregnancy,” Urizar said. “Women at high risk for depression (i.e., either having a past history of major depression or current elevated symptoms of depression) were randomized to either a CBSM group or a usual care group while a low-risk comparison (LRC) group was comprised of women not meeting either depression criteria.
“Later analysis demonstrated that infants of women in the CBSM and LRC groups had significantly lower cortisol levels and suggested that prenatal CBSM interventions may be efficacious in regulating biological markers of stress among mothers and their infants, thereby decreasing their risk for developing health complications over time.”
Urizar and Munoz sought to develop a program to prevent episodes of depression in pregnant women.
“Our goal was not only to reduce stress levels in the participating women but to reduce the stress levels in their infants,” he pointed out. “Our research revealed that intervention offered promise in two ways. First, we looked at the body’s total output of cortisol and found that if pregnant women were stressed during the day, their bodies produced more than the usual amount of cortisol. We found the mood management intervention to show promise in reducing those overall levels.”
Based on these preliminary results, Urizar received a $300,000, three-year career development grant in 2010 from the NIH and its National Institute of Child Health and Human Development. That research on stress and anxiety during pregnancy is being conducted in collaboration with colleagues from UCLA and UCI.
The name of this current project is SMART Moms (Smart Management and Relaxation Training for Moms), which seeks to instruct mothers in how to affect stress hormones through increased use of relaxation and coping skills.
“Cortisol is a stress hormone that has been shown to peak in the morning and then decrease as the day progresses. But if you are chronically stressed, your body goes on producing cortisol all day instead of peaking in the morning,” Urizar explained. “If these women could benefit from an intervention program like ours, then they might develop more normal patterns of cortisol.”
The stress management plan includes the use of relaxation exercises, such as diaphragmatic breathing and muscle relaxation, and coping skills. “We teach relaxation exercises like diaphragmatic breathing and muscle relaxation,” he said.
“Participating women are taught to recognize negative thoughts and learn to reframe those thoughts. We want them to learn the techniques to manage their emotions and solve problems,” he said. “We offer social support and how to communicate with others. We’re giving participants a tool box of techniques, some of which they are using already without knowing it.”
Urizar noted that one reason the SMART Moms project was initiated was because the data they were seeing indicated that low-income mothers had children with low birth weight. If cortisol is elevated to certain levels during pregnancy, it can be related to low birth weight in the baby and postpartum depression in the mothers.
Results from their previous research studies also revealed long-term effects on the child’s cognitive and social development. The interventions have proven to be effective in producing health benefits for mother and child.
One of the goals of Urizar’s research is to help train undergraduate and graduate students in health psychology research. “I’m looking for students who are interested in working with underserved communities,” he explained. “These students talk with women in the clinics with which we collaborate here in Long Beach as well as the city’s Department of Health and Human Services and St. Mary Medical Center.
“I want our students to be involved in every phase of the project,” he added. “My philosophy in mentoring students is train them in the skills necessary to design and implement health research in underserved populations. They are there to get the full experience of what it means to be a health psychologist.”
Urizar noted that several students have won awards and scholarships through this and previous projects. These are the kinds of achievements, he said, that help them enter graduate school.
“Many of our participating students go on to doctoral programs in clinical psychology while others go on to medical school. Others move into master’s programs in social work,” he stated. “They learn the discipline of scholarship. What I hope our students gain from their participation in this project is a strong work ethic. We see this project as a launching pad for student careers.”
Urizar has dubbed his research program “PRO-Health” (Partners in Research and Outreach for Health). The goal is to design programs that can be offered for free to promote good health in underserved communities.
“There is a misperception that low-income populations will not be able to adopt these practices,” he said. “In fact, they adopt them really well.”
Urizar also pointed to his project titled “Active Moms” with its goal of increasing exercise among low-income mothers of young children (3 months to 10 years of age). For this project, Urizar is collaborating with CSULB Health Sciences’ Professor Britt Rios-Ellis and Kinesiology Professor Jan Schroeder to develop a free exercise program for Long Beach mothers with the idea of getting low-income mothers together to exercise in their communities.
“Although my collaborators and I did not receive funding for the Active Moms Project, we pooled our financial resources and expertise to offer this free exercise program in our community,” Urizar pointed out. “We worked with the Parks and Recreation Department to find sites and were provided with free space.”
Recently, project organizers conducted a focus group with their first graduating exercise class. One women from the class stated, “Being in this program has taught us to be more independent. It’s created a way for us…through this vehicle of the program...to create that independency that all of us really need.” Another woman from the group was in tears and said, “Little by little it has all clicked in…my kids participate…my husband is very happy, and I get excellent feedback.”
“These are the changes that make all of our work worthwhile,” Urizar said.