Belief in divine control, coping, and race/ethnicity among older women with breast cancer

Factors Predicting Poor Mental and Physical Health in Parents of Children with Autism Spectrum Disorder: Results from 2016 to 2019 National Survey of Children's Health

Although poor health has been reported in parents of children with autism spectrum disorder (ASD), most studies excluded fathers and focused on mental health. We combined 2016-2019 data from the National Surveys of Children's Health to determine child and parent characteristics that predict poor mental and physical health in fathers (n = 818) and mothers (n = 2111) of children with ASD. For fathers of children with ASD, higher parenting stress was significantly associated with greater odds of poor physical health, whereas racial and ethnic minorities and living at 400% above the federal poverty were significantly associated with lower odds of poor mental health. For mothers of children with ASD, greater child sleep problems were significantly associated with greater odds of poor physical health, and two-parent household living 400% above the poverty line was significantly associated with reported lower odds of poor mental health. Continued efforts to reduce parenting stress and improve child sleep problems, along with expanding existing services and coverages of ASD services, especially for low-income families, may help reduce the burden on these families, preventing adverse future health outcomes in this population.

Psychosocial symptoms associated with spiritual well-being in Latino patients and caregivers coping with advanced cancer

PURPOSE

The objective of this study was to investigate the relationship among hopelessness, anxiety, and depression, with spiritual well-being in patients and family caregivers.

METHODS

A cross-sectional survey was administered to patients (n = 57) and caregivers (n = 57) that incorporated assessments that measured spiritual well-being, depression, anxiety, hopelessness, quality of life, family relationship, burden, fatalism, religiosity, and distress. Logistic regression and cross-tabulation analyses were conducted to examine the relationship between hopelessness, anxiety, and depression, with spiritual well-being. Logistic regression was used to quantify the impact of spiritual well-being on anxiety, depression, and hopelessness. Additionally, cross-tabulations with chi-square tests were conducted to explore associations between severity of hopelessness and severity of anxiety and depression.

RESULTS

Logistic regression analyses showed negative associations between spiritual well-being and mental health outcomes, although not all findings were statistically significant. Among caregivers, a significant negative relationship was observed for depression (B =  - 0.161, p = 0.022). Hopelessness also exhibited a negative association with spiritual well-being among caregivers (B =  - 0.099, p = 0.054) and patients (B =  - .152, p = 0.038). Cross-tabulations highlighted significant associations in the severity of hopelessness symptoms with anxiety and depression levels among caregivers (p < .001).

CONCLUSION

Results reveal a relationship among psychosocial symptoms among Latino patient-caregivers coping with cancer. By emphasizing spiritual well-being, hopelessness, and anxiety and involving family patients and caregivers in the treatment process as a unit of care. Also, it indicates the need to develop culturally tailored interventions that aim to provide valuable assistance to Latino patients and caregivers coping with cancer.

Religion/Spirituality and Prevalent Hypertension among Ethnic Cohorts in the Study on Stress, Spirituality, and Health

BACKGROUND

Hypertension is a significant public health issue, particularly for Blacks, Hispanics/Latinos, and South Asians who are at greater risk than whites. Religion and spirituality (R/S) have been shown to be protective, but this has been identified primarily in whites with limited R/S measures examined (i.e., religious service attendance).

PURPOSE

To assess hypertension prevalence (HP) in four racial/ethnic groups while incorporating an array of R/S variables, including individual prayer, group prayer, nontheistic daily spiritual experiences, yoga, gratitude, positive religious coping, and negative religious coping.

METHODS

Data were drawn from the Study on Stress, Spirituality, and Health, a consortium of ethnically diverse U.S. cohorts. The sample included 994 Black women, 838 Hispanic/Latino men and women, 879 South Asian men and women, and 3681 white women. Using a cross-sectional design, prevalence ratios for R/S and hypertension were reported for each cohort, in addition to pooled analyses. Given differences in R/S among men and women, all models were stratified by gender.

RESULTS

Different patterns of associations were found between women and men. Among women: 1) religious attendance was associated with lower HP among Black and white women; 2) gratitude was linked to lower HP among Hispanic/Latino, South Asian, and white women; 3) individual prayer was associated with higher HP among Hispanic/Latino and white women; 4) yoga was associated with higher HP among South Asian women, and 5) negative religious coping was linked to higher HP among Black women. Among men: significant results were only found among Hispanic/Latino men. Religious attendance and individual prayer were associated with higher HP, while group prayer and negative religious coping were associated with lower HP.

CONCLUSION

Religion/spirituality is a multifaceted construct that manifests differently by race/ethnicity and gender. Medical practitioners should avoid a one-size-fits-all approach to this topic when evaluating prevalent hypertension in diverse communities.

Family communication and coping among racial-ethnic minority cancer patients: A systematic review

The ability to actively cope with cancer has been extensively associated with better patient-reported outcomes (PROs). This systematic review aims to synthesise the available literature assessing the experience of cancer patients from racial-ethnic minoritised groups. Given the role of sociocontextual factors, greater emphasis was placed on the relationship between family communication and cancer patients' coping within the three largest racial-ethnic minority groups in the United States. Five databases (CINAHL, MEDLINE, PsycINFO, PubMed, Web of Science) were used to search for peer-reviewed empirical studies published between 2008 and 2021, investigating family communication patterns, coping, and well-being among Black/African American, Asian, and Hispanic/Latinx cancer survivors. Short reports, chapters, abstracts/summaries, systematic reviews, and conference proceedings were excluded. This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). The Criteria for Critically Appraising Systematic Reviews and Meta-Analyses were used to assess the quality and risk of bias in the included studies. The synthesis process focused on study aims, methods, measures of interests, sample characteristics, data analysis, and study findings. A total of 117 articles were identified, of which 9 met the inclusion criteria. The selected articles were cross-sectional, implementing both quantitative and qualitative designs. Studies included breast, prostate, and mixed cancer types. Sample sizes of quantitative studies ranged from 64 to 338 respondents, while qualitative studies' samples ranged between 9 and 43 participants. Family communication and coping styles varied across minoritised groups, with open family communication contributing to effective individual and family coping. However, empirical evidence about the nature and contribution of family communication to the coping process is sparse. Future research is needed to increase knowledge and psychosocial assessment techniques and interventions targeting family communication and coping among minority communities.

Everyday discrimination and cancer metaphor preferences: The mediating effects of needs for personal significance and cognitive closure

Metaphors are often used to describe cancer experiences (e.g., battle, journey). Few studies explore how social threats (e.g., discrimination) shape metaphor preferences. We examined the relationship between discrimination and preferences for cancer battle metaphors (i.e., concrete, action-based) versus journey metaphors (i.e., open-ended, reflective) and mediating effects of needs for personal significance and cognitive closure. We also stratified the analysis when discrimination was/was not attributed to race and by racial/ethnic group. Four-hundred twenty-seven U.S. participants completed an online survey. Items included everyday discrimination, need for personal significance, need for cognitive closure, and preference for cancer scenarios using battle or journey metaphors. Multigroup structural equation modeling examined: serial mediation (i.e., discrimination predicting metaphor preference via needs for personal significance and cognitive closure) stratified by discrimination attribution; and single mediation (i.e., discrimination predicting need for cognitive closure via need for personal significance) stratified by racial/ethnic group. Discrimination was associated with battle metaphor preferences through serial mediation when discrimination was not attributed to race (β = 0.02, 95% CI [0.01,0.05]). Discrimination was directly associated with journey metaphor preferences (β = -0.20, 95% CI [-0.37,-0.06]) and the serial mediation was nonsignificant when discrimination was attributed to race. The single mediation model varied across racial/ethnic groups and was strongest for Non-Hispanic White participants (β = 0.17, 95% CI [0.07,0.30]). Discrimination may shape cancer metaphor preferences through needs for personal significance and cognitive closure, yet these relationships differ based on whether discrimination is attributed to race and racial/ethnic group. Given that the U.S. health system often focuses on battle metaphors when framing cancer treatment and screenings, individuals who prefer journey metaphors (i.e., those who experienced more frequent racial discrimination in the present study) may experience a systematic disadvantage in cancer communication. A more careful consideration of cultural, racial, and ethnic differences in metaphor use may be a crucial step towards reducing cancer disparities.

Do Racial Differences in Coping Resources Explain the Black-White Paradox in Mental Health? A Test of Multiple Mechanisms

A central paradox in the mental health literature is the tendency for black Americans to report similar or better mental health than white Americans despite experiencing greater stress exposure. However, black Americans' higher levels of certain coping resources may explain this finding. Using data from the Nashville Stress and Health Study (n = 1,186), we examine whether black Americans have higher levels of self-esteem, social support, religious attendance, and divine control than white Americans and whether these resources, in turn, explain the black-white paradox in mental health. In adjusted models, the black-white paradox holds for depressive symptoms and any DSM-IV disorder. Findings indicate that black Americans have higher levels of self-esteem, family social support, and religiosity than white Americans. Causal mediation techniques reveal that self-esteem has the largest effect in explaining black-white differences in depressive symptoms, whereas divine control has the largest effect in explaining differences in disorder.

Parental Perceptions of Autism Spectrum Disorder in Latinx and Black Sociocultural Contexts: A Systematic Review

Parents of children with autism spectrum disorder (ASD) face challenges in accessing diagnostic and treatment services; these challenges vary by race, ethnicity, and culture. This systematic review examines parental perceptions of ASD within Latinx and Black American communities. Findings indicate that interconnections with family and religious groups promoted positive coping and describe positive impacts of having a child with ASD. Relative to White families, community members reported reduced access to information and more inaccurate beliefs about ASD, higher levels of ASD-related stigma, and more negative experiences with healthcare providers, which serve to exacerbate healthcare disparities. Conclusions are limited by an underrepresentation of minority groups in research. We call for efforts to address the specific needs of racial and ethnic minorities.

Young Child-Rearing Latina Cancer Survivors Living in the US-Mexico Border Region: A Qualitative Study

Background:

Despite increasing cancer incidence among young Latinas (<50 yrs.) in the US, little is known about how young, child-rearing Latinas cope with cancer in the US-Mexico border region.

Objective:

The purpose of this study was to explore how young, child-rearing Latinas described their challenges, strengths, and social support sources for coping with cancer in the US-Mexico border region.

Methods:

Nine Latinas that had been diagnosed with cancer, had at least one child 5 to 13 years old, and lived in one of two targeted border counties participated in audio-recorded, semi-structured focus groups (n = 6) or interviews (n = 3) in their preferred language (i.e., English or Spanish). Interview recordings were transcribed and inductively coded using methods based on grounded theory.

Results:

Three major themes emerged. First, in reporting their physical and emotional struggles with cancer as the most difficult time of their lives, participants described feeling alone as they navigated treatment side effects and continued fear of cancer. Second, they explained figuring out how to live day-by-day, reporting the negative impact of cancer on their families and on their ability to maintain their roles as mothers. Third, they highlighted factors that gave them the strength to fight and carry on, emphasizing their children and their inner strength.

Conclusions:

Even with a supportive family, young Latina mothers felt alone as they navigated cancer (i.e., treatment, fear, and impact on their families) and as they worked to garner the strength to overcome the stress of cancer. Interventions for young Latina survivors should be designed to address their needs, build on their fighting spirit, incorporate the family, and connect them with other survivors for personalized support. Further research is warranted to better understand cancer survivorship among child-rearing Latina mothers experiencing a cancer diagnosis in under-resourced communities like the US-Mexico border region.

"I Struggle with Breast Cancer and I Struggle with God": Insights from African American Breast Cancer Survivors

PURPOSE

Recognizing that spiritual and religious beliefs are personal and vary within communities, the purpose of this qualitative study was to explore the influence of these beliefs on experiences with breast cancer care and social support among African American Christian breast cancer survivors.

METHODS

Forty-seven African American breast cancer survivors participated in focus groups (n = 7) in three northeastern urban cities. We used thematic analyses to identify major themes.

RESULTS

Three themes emerged relating to how spirituality influenced participants' cancer journeys: (1) struggling with God, (2) reclaiming my power, and (3) needing religious social support. Participants described the rhythmic flow of their spiritual beliefs as they navigated their lived experiences during diagnosis, treatment, and post-treatment. Spirituality was intimately intertwined with their illness experience as they grappled with their health and well-being.

CONCLUSIONS

Participants used spirituality as an avenue to cope and navigate through their diagnosis and treatment. These spiritual relationships created "church families" and provided the survivors' access to cancer support groups, financial support, and therapeutic support. Our findings support faith-based approaches to health promotion and call for more studies to understand the influence of religion on health.

Spirituality and quality of life in women with breast cancer: The role of hope and educational attainment

OBJECTIVE

This study investigated relationships among spirituality, hope, and overall quality of life in Muslim women with breast cancer in Malaysia.

METHOD

A cross-sectional descriptive design with a convenience sample of 145 Malay patients was used. The mediating role of hope in the relationship between spirituality and quality of life as well as the moderating effect of education level on the spirituality hope link were examined.

RESULTS

Participants with higher self-reported spirituality reported more hope (b = 6.345, p < 0.001) and higher levels of quality of life (b = 1.065, p < 0.001). Higher educational attainment weakened relationships between spirituality and hope (b = -1.460, p < 0.001).

SIGNIFICANCE OF RESULTS

The role of advanced education in contributing to lessened hope in relation to spirituality emphasizes the importance of skilled and personalized spiritual counseling in the respective socio-cultural religious context.

Factors Associated with Depression in African American Patients Being Treated for Cancer Pain

BACKGROUND

Among cancer patients in the United States, African American cancer patients have the highest mortality rate and shortest survival rate. Although depression is known as a predictor of mortality in cancer and a potential barrier to health care utilization, research on depression in African American patients is limited. Cancer pain can interfere with an individual's ability to cope with depression.

AIMS

To identify factors that are associated with a positive screening of depressive symptoms assessed by the PHQ-8 in African American patients treated for cancer pain.

DESIGN

Secondary data analysis of a cross-sectional study of opioid adherence.

SETTING

Medical oncology, palliative care, and radiation oncology clinics in Atlanta, Georgia.

PARTICIPANTS/SUBJECTS

African American patients with cancer pain in the parent study.

METHODS

Independent samples t-test was used to assess variable correlations with and without depressive symptoms. Adjusted logistic regression was conducted to identify factors that were associated with presence of depressive symptoms.

RESULTS

Mean patient age was 55.6 years, and nearly 38% had a PHQ-8 score of >10 indicating presence of moderate to severe depressive symptoms. Participants with depressive symptoms had significantly higher means for anxiety and pain interference with mood than those without depressive symptoms. Factors that were significantly associated with depressive symptoms were anxiety, pain interfering with mood, and lack of involvement with a religious congregation.

CONCLUSIONS

The findings of this study help to identify African American cancer patients at risk for depression and demonstrates the need for increased screening for depression in this underserved population.

The Mediating Effect of Coping Strategies on Religious/Spiritual Struggles and Life Satisfaction

A growing number of researchers are testing potential problematic forms of religiousness that denote anxieties regarding sacred matters. However, only a few studies have assessed how religious/spiritual struggle is associated with positive outcomes. Because people’s coping responses to stressors are key determinants of their well-being, we expected that different coping strategies could be potential mediators between religious problems/tensions and life satisfaction. The research was conducted on a group of 744 Roman Catholics. We used the Religious Comfort and Strain Scale, Satisfaction with Life Scale, and Brief Coping Orientation to Problems Experienced (COPE) questionnaire. The outcomes show that religious comfort correlated positively with life satisfaction, while fear/guilt, negative emotions toward God, and negative social interactions surrounding religion correlated negatively with life satisfaction. Our research amplifies the understanding of the religious/spiritual struggles and life satisfaction relationship, mediated by “secular” coping strategies. It confirms that both religious and secular methods of experiencing different strains seem to coexist with multiple other strategies in the context of broadly understood life satisfaction.

Intergenerational Influences on Faith-based Strategies Used in Response to Racial Discrimination Among Young African American Adults

OBJECTIVE

In this report, we used a qualitative descriptive design to explore young African American adults' intergenerationally influenced strategies to experienced racial discrimination.

METHODS

The study was guided by a qualitative descriptive design using criterion and snowball sampling, and semi-structured interview questions. We also explored, quantitatively, gender differences among the racial discrimination experiences encountered and the strategies used.

FINDINGS

Forty-nine participants included in this report were an average age of 29.5 (SD = 10.1). Racial discrimination experiences included daily microaggressions such as insensitive comments, stereotyping, exclusion from work and school activities, perceived low expectations, inequities in employment, and police profiling. Intergenerationally influenced strategies used in response to these experiences included religious beliefs and practices, positive reframing, and modeling behaviors used by previous generations. These intergenerationally influenced strategies enabled participants to remain calm, to express goodwill toward others, and to be patient and hopeful for a better future.

CONCLUSION

Since intergenerationally influenced strategies are likely potential sources of strength and resilience for young African Americans, knowledge of these strategies might be useful to health care practitioners seeking to improve the mental health care of this population.

Sociodemographic correlates of cancer fatalism and the moderating role of religiosity: Results from a nationally-representative survey

In general, it has been found that cancer fatalism is negatively associated with important cancer prevention and control behaviors, whereas religiosity is positively associated with these behaviors. Yet, the notion that religiosity gives rise to fatalistic beliefs that may discourage health behaviors is deeply ingrained in the public health literature. In addition, racial/ethnic group membership is associated with higher reports of cancer fatalism, though this association may be confounded by socioeconomic status (SES). A better understanding of the relationships between racial/ethnic group membership, SES, and religiosity may contribute to the development of effective interventions to address cancer fatalism and improve health behaviors. In this study, we examined associations between racial/ethnic group membership, SES, and cancer fatalism as the outcome. In addition, we tested whether religiosity (as measured by religious service attendance) moderated these relationships.

Association of cognitive-emotional regulation strategies to depressive symptoms in type 2 diabetes patients

Aim. The present cross-sectional observational study aimed to investigate the relation between cognitive–emotional regulation strategies and depressive symptoms in type 2 diabetes patients in the context of sociodemographic and clinical factors, of diabetes distress, perception of illness consequences and previous depression.

Method. Multiple logistic regression was performed on the responses of 354 adults with type 2 diabetes (58.5% women; mean ± SD age: 61.14 ± 8.5 years; diabetes duration: 9.7 ± 6.4 years; BMI: 30.9 ± 5.3 kg/m2). Depressive symptoms were present in 16.9% and diabetes distress in 45.5%. Participants completed questionnaires on depression (BDI-II), cognitive-emotional regulation strategies (CERQ), diabetes distress (DDS), illness perceived consequences (IPQ-R).

Results. Of the cognitive–emotional strategies, lower positive reappraisal of diabetes (OR:0.49;CI:0.34-0.70) and increased catastrophizing (OR:2.08; CI:1.47-2.91) were found to increase the likelihood of experiencing depressive symptoms in the presence of higher diabetes distress (OR: 1.53; CI:1.07-2.19), increased negative perception of diabetes consequences (OR:2.02; CI:1.34-3.06) and the presence of previous depression (OR:4.18; CI:2.03-8.63).

Conclusion. To our knowledge, this is the first study to report on cognitive-emotional regulation strategies in type 2 diabetes and provides evidence for the beneficial influence of positive reappraisal and adverse effect of catastrophizing on depressive symptoms in the context of diabetes distress, perceived consequences of diabetes and previous history of depression.

The Relationship Between Optimism, Coping, and Depressive Symptoms in Hispanic Mothers and Fathers of Children with Autism Spectrum Disorder

This study examined gender differences in the relationship between dispositional optimism, coping, and depressive symptoms of Hispanic mothers (n = 46) and fathers (n = 43) of children with autism spectrum disorder. Coping was hypothesized to mediate the relationship between optimism and depressive symptoms. The results revealed that mothers reported greater depressive symptoms and greater use of positive and support coping than fathers; however, both mothers and fathers reported similar levels of optimism and use of avoidant coping. In addition, positive and avoidant coping strategies mediated the association between optimism and depressive symptoms for both mothers and fathers. Clinical implications for this study include interventions for improving optimistic outlooks as well as interventions that improve parents' coping skills and therefore reduce negative outcomes.

Kept in His Care: The Role of Perceived Divine Control in Positive Reappraisal Coping

A formidable body of literature suggests that numerous dimensions of religious involvement can facilitate productive coping. One common assumption in this field is that religious worldviews provide overarching frameworks of meaning by which to positively reinterpret stressors. The current study explicitly tests this assumption by examining whether perceived divine control—i.e., the notion that God controls the course and direction of one’s life—buffers the adverse effects of recent traumatic life events on one’s capacity for positive reappraisal coping. We analyze cross-sectional survey data from Vanderbilt University’s Nashville Stress and Health Study (2011–2014), a probability sample of non-Hispanic black and white adults aged 22 to 69 living in Davidson County, Tennessee (n = 1252). Findings from multivariate regression models confirm: (1) there was an inverse association between past-year traumatic life events and positive reappraisals; but (2) perceived divine control significantly attenuated this inverse association. Substantively, our findings suggest that people who believe God controls their life outcomes are better suited for positively reinterpreting traumatic experiences. Implications, limitations, and avenues for future research are discussed.

The association between fear of cancer recurrence and quality of life among Chinese cancer survivors: main effect hypothesis and buffering hypothesis

PURPOSE

The aim of the present study is to examine whether fear of cancer recurrence (FCR) is related to health-related quality of life (HRQOL) among Chinese cancer survivors, an understudied population (i.e., main effect hypothesis). Also, we investigated whether the FCR-HRQOL link is moderated by two coping strategies, avoidance and positive reappraisal (i.e., buffering hypothesis).

METHODS

This is a cross-sectional study conducted among 238 Chinese cancer survivors in Beijing. Participants completed a set of questionnaires including FCR, coping, and HRQOL.

RESULTS

FCR was related to lower physical, psychological, social, and spiritual well-beings, even when demographics, cancer-related factors, and coping were taken into account. There was only one moderation effect between FCR and avoidance coping. Surprisingly, the detrimental effect of FCR on spiritual well-being was lessened among those with high avoidance coping such that the negative association between FCR and spiritual well-being was only found in those with low avoidance coping and not among those with high avoidance coping.

CONCLUSIONS

Findings largely supported the main effect hypothesis. FCR was associated with diverse domains of HRQOL among Chinese cancer survivors. The buffering hypothesis was largely not supported in this population. Rather, in some cases, the effects of FCR and coping strategies on HRQOL were independent. Thus, ways to attenuate the harmful effects of FCR on HRQOL among Chinese cancer survivors remain unresolved. It is urgent and timely that future studies focus on FCR and HRQOL in this population.

African American elders' psychological-social-spiritual cultural experiences across serious illness: an integrative literature review through a palliative care lens

Disparities in palliative care for seriously ill African American elders exist because of gaps in knowledge around culturally sensitive psychological, social, and spiritual care. The purpose of this integrative literature review is to summarize the research examining African American elders' psychological, social, and spiritual illness experiences. Of 108 articles, 60 quantitative, 42 qualitative, and 6 mixed methods studies were reviewed. Negative and positive psychological, social, and spiritual experiences were noted. These experiences impacted both the African American elders' quality of life and satisfaction with care. Due to the gaps noted around psychological, social, and spiritual healing and suffering for African American elders, palliative care science should continue exploration of seriously ill African American elders' psychological, social, and spiritual care needs.

Cultural and Linguistic Adaptation of a Healthy Diet Text Message Intervention for Hispanic Adults Living in the United States

Hispanics represent a critical target for culturally adapted diet interventions. In this formative research, we translated HealthyYouTXT, an mHealth program developed by the U.S. National Cancer Institute, into HealthyYouTXT en Español, a linguistically and culturally appropriate version for Spanish speakers in the United States. We report a three-stage, mixed-methods process through which we culturally adapted the text messages, evaluated their acceptability, and revised the program based on the findings. In Stage 1, we conducted initial translations and adaptations of the text libraries using an iterative, principle-guided process. In Stage 2, we used mixed methods including focus groups and surveys with 109 Hispanic adults to evaluate the acceptability and cultural appropriateness of the program. We used survey data to evaluate whether self-determination theory (SDT) factors (used to develop HealthyYouTXT) of autonomous motivation, controlled motivation, and amotivation and Hispanic cultural beliefs about familism, fatalism, and destiny predict program interest and its perceived efficacy. Mixed-methods analyses revealed substantial interest in HealthyYouTXT, with most participants desiring to use it and viewing it as highly efficacious. Both cultural beliefs (i.e., beliefs in destiny and, for men, high familism) and SDT motivations (i.e., autonomy) predicted HealthyYouTXT evaluations, suggesting utility in emphasizing them in messages. Higher destiny beliefs predicted lower interest, suggesting that they could impede program use. In Stage 3, we implemented the mixed-methods findings to finalize HealthyYouTXT en Español. The emergent linguistic principles and multistage, multimethods process can be applied in health communication adaptations.

Advancing our understanding of religion and spirituality in the context of behavioral medicine

Recognizing and understanding the potentially powerful roles that religiousness and spirituality (RS) may serve in the prevention and amelioration of disease, as well as symptom management and health related quality of life, significantly enhances research and clinical efforts across many areas of behavioral medicine. This article examines the knowledge established to date and suggests advances that remain to be made. We begin with a brief summary of the current knowledge regarding RS as related to three exemplary health conditions: (a) cardiovascular disease; (b) cancer; and, (c) substance abuse. We then focus on particular concerns for future investigations, emphasizing conceptual issues, possible mediators and moderators of relationships or effects, and methodology. Our discussion is framed by a conceptual model that may serve to guide and organize future investigations. This model highlights a number of important issues regarding the study of links between RS and health: (a) RS comprise many diverse constructs, (b) the mechanisms through which RS may influence health outcomes are quite diverse, and (c) a range of different types of health and health relevant outcomes may be influenced by RS. The multidimensional nature of RS and the complexity of related associations with different types of health relevant outcomes present formidable challenges to empirical study in behavioral medicine. These issues are referred to throughout our review and we suggest several solutions to the presented challenges in our summary. We end with a presentation of barriers to be overcome, along with strategies for doing so, and concluding thoughts.

Adjusting to Chronic Health Conditions

Research on adjustment to chronic disease is critical in today's world, in which people are living longer lives, but lives are increasingly likely to be characterized by one or more chronic illnesses. Chronic illnesses may deteriorate, enter remission, or fluctuate, but their defining characteristic is that they persist. In this review, we first examine the effects of chronic disease on one's sense of self. Then we review categories of factors that influence how one adjusts to chronic illness, with particular emphasis on the impact of these factors on functional status and psychosocial adjustment. We begin with contextual factors, including demographic variables such as sex and race, as well as illness dimensions such as stigma and illness identity. We then examine a set of dispositional factors that influence chronic illness adjustment, organizing these into resilience and vulnerability factors. Resilience factors include cognitive adaptation indicators, personality variables, and benefit-finding. Vulnerability factors include a pessimistic attributional style, negative gender-related traits, and rumination. We then turn to social environmental variables, including both supportive and unsupportive interactions. Finally, we review chronic illness adjustment within the context of dyadic coping. We conclude by examining potential interactions among these classes of variables and outlining a set of directions for future research.

Cultural challenges to engaging patients in shared decision making

OBJECTIVE

Engaging patients in their health care through shared decision-making is a priority embraced by several national and international groups. Missing from these initiatives is an understanding of the challenges involved in engaging patients from diverse backgrounds in shared decision-making. In this commentary, we summarize some of the challenges and pose points for consideration regarding how to move toward more culturally appropriate shared decision-making.

DISCUSSION

The past decade has seen repeated calls for health policies, research projects and interventions that more actively include patients in decision making. Yet research has shown that patients from different racial/ethnic and cultural backgrounds appraise their decision making process less positively than do white, U.S.-born patients who are the current demographic majority.

CONCLUSION

While preliminary conceptual frameworks have been proposed for considering the role of race/ethnicity and culture in healthcare utilization, we maintain that more foundational and empirical work is necessary. We offer recommendations for how to best involve patients early in treatment and how to maximize decision making in the way most meaningful to patients. Innovative and sustained efforts are needed to educate and train providers to communicate effectively in engaging patients in informed, shared decision-making and to provide culturally competent health care.

Coping with breast cancer: Reflections from Chinese American, Korean American, and Mexican American women

OBJECTIVE

The present study identified and compared the coping strategies of Chinese American, Korean American, and Mexican American breast cancer survivors (BCS).

METHODS

Six focus groups were conducted with Chinese American (n = 21), Korean American (n = 11), and Mexican American (n = 9) BCS. Interviews were audio-recorded, transcribed, and translated for thematic content analysis of coping experiences and strategies.

RESULTS

Women reported the use of 8 coping strategies (religious/spiritual, benefit finding, fatalism, optimism, fighting spirit, information seeking, denial, and self-distraction). Among Chinese American BCS, benefit finding was the most referenced coping strategy, whereas religious/spiritual coping was most frequently reported among Korean American and Mexican American BCS. Denial and self-distraction were the least cited strategies.

CONCLUSIONS

Survivors draw upon new found inner strength to successfully integrate their cancer experience into their lives. Coping models must consider the diversity of cancer survivors and the variability in coping strategies among cultural ethnic minority BCS.

Positive reappraisal in older adults: a systematic literature review

OBJECTIVES

Positive reappraisal is a meaning-based cognitive emotion regulation strategy that is frequently used by older adults to deal with stressors. The strategy involves finding personally relevant positive meaning from an experience in the face of its negative reality. As positive reappraisal has not been previously systematically examined and appears to be particularly relevant to older adults, this paper reviews the research on positive reappraisal in older adult populations.

METHOD

Database searches identified 302 studies, of which 22 addressed positive reappraisal in older adult samples. The findings were categorised into four core themes: use and value for older adults, effects on mental health, benefit for physical illness, and influence of cognitive functioning and gender.

RESULTS

The literature indicates that positive reappraisal is an adaptive coping strategy for older adults with wide-ranging benefits. Specifically, positive reappraisal appears to be related to improved mental health for older adults, and particularly in the context of physical illness.

CONCLUSION

Helping older adults find meaning in their negative experiences appears to be a worthwhile research area to pursue. Questions for future research on positive reappraisal in older adulthood are proposed.

Do coping strategies mediate the effects of emotional support on emotional well-being among Spanish-speaking Latina breast cancer survivors?

OBJECTIVE

This study aimed to assess the relationship between emotional social support and emotional well-being among Latina immigrants with breast cancer and test whether two culturally relevant coping strategies, fatalism and acceptance, mediate this relationship.

METHODS

One hundred fifty Spanish-speaking Latinas within 1 year of breast cancer diagnosis participating in a randomized trial of a stress management intervention were assessed in person at baseline and via telephone 6 months later. Survey measures included baseline emotional support, fatalism, and acceptance and emotional well-being 6 months later. Generalized linear models estimated direct effects of emotional support on emotional well-being and indirect effects through fatalism and acceptance.

RESULTS

Mean age was 50.1 (SD = 10.9) years; most women had low education and acculturation levels. Emotional support was negatively associated with fatalism (r = -0.24, p < 0.01) and positively associated with acceptance (r = 0.30, p < 0.001). Emotional support (r = 0.23, p = 0.005) and acceptance (r = 0.28, p = 0.001) were positively associated with emotional well-being, whereas fatalism (r = -0.36, p < 0.0001) was negatively associated with emotional well-being. In multivariable models, emotional support was associated with emotional well-being (b = 0.88, 95% CI: 0.24, 1.52). This direct effect remained significant when additionally controlling for fatalism (b = 0.66, 95% CI: 0.03, 1.30) and acceptance (b = 0.73, 95% CI: 0.09, 1.37) in separate models. There was a significant indirect effect of emotional support on emotional well-being through fatalism (b = 0.21, 95% CI: 0.04, 0.51) as well as a marginally significant effect through acceptance (b = 0.15, 95% CI: 0.001, 0.43).

CONCLUSIONS

Emotional support may increase well-being among Spanish-speaking Latina cancer survivors by reducing cancer fatalism.Copyright © 2015 John Wiley & Sons, Ltd.

Psychological distress, social withdrawal, and coping following receipt of an abnormal mammogram among different ethnicities: a mediation model

PURPOSE/OBJECTIVES

To explore ethnic differences in psychological distress and social withdrawal after receiving an abnormal mammogram result and to assess if coping strategies mediate ethnic differences.

DESIGN

Descriptive correlational.

SETTING

Two urban mobile mammography units and a rural community hospital in the state of Washington.

SAMPLE

41 Latina and 41 non-Latina Caucasian (NLC) women who had received an abnormal mammogram result.

METHODS

Women completed standard sociodemographic questions, Impact of Event Scale-Revised, the social dimension of the Psychological Consequences Questionnaire, and the Brief COPE.

MAIN RESEARCH VARIABLES

Ethnicity, psychological distress, social withdrawal, and coping.

FINDINGS

Latinas experienced greater psychological distress and social withdrawal compared to NLC counterparts. Denial as a coping strategy mediated ethnic differences in psychological distress. Religious coping mediated ethnic differences in social withdrawal.

CONCLUSIONS

Larger population-based studies are necessary to understand how ethnic differences in coping strategies can influence psychological outcomes. This is an important finding that warrants additional study among women who are and are not diagnosed with breast cancer following an abnormal mammogram.

IMPLICATIONS FOR NURSING

Nurses may be able to work with Latina patients to diminish denial coping and consequent distress. Nurses may be particularly effective, given cultural values concerning strong interpersonal relationships and respect for authority figures.

Developing spiritually framed breast cancer screening messages in consultation with African American women

Despite efforts to increase breast cancer screening (BCS) among African American women, disparities in breast cancer mortality persist. Culturally framed health communication may provide a useful strategy to address this issue. Spirituality not only represents an integral aspect of African American culture, but it has also been identified as a potential barrier to BCS among this population. Rather than continuing to focus on spirituality as a barrier, there is an opportunity to develop promotional messages that tap into the protective properties of spirituality among this population. The goals of this study were to engage a group of African American women to identify important spiritual elements to be included in health communication materials, and to subsequently develop a spiritually framed BCS message in response to their feedback. Three nominal group sessions were conducted with 15 African American women. Results revealed three important spiritual elements that can be incorporated into BCS health messages: (a) the body as a temple; (b) going to the doctor does not make you faithless; and (c) God did not give us the spirit of fear. These elements were used to draft a spiritually framed BCS message. Next, 20 face-to-face semistructured interviews were conducted to help finalize the spiritually framed BCS message for use in a future study on culturally framed health communication.

Religion, fatalism, and cancer control: a qualitative study among Hispanic Catholics

OBJECTIVES

To assess cancer perceptions among churchgoers and to examine the potential influence of fatalism and religious beliefs on the use of cancer screening tests.

METHODS

Eight semi-structured focus groups were conducted among 67 Hispanic Catholics in Massachusetts.

RESULTS

In this sample, there were few references to fatalistic beliefs about cancer and nearly universal endorsement of the utility of cancer screening for cancer early detection. Most participants reported that their religious beliefs encouraged them to use health services, including cancer-screening tests. Although participants agreed that God plays an active role in health, they also affirmed the importance of self-agency in determining cancer outcomes.

CONCLUSIONS

Our findings challenge the assumption that fatalism is an overriding perspective among Hispanics. Catholic religious beliefs may contribute to positive health attitudes and behaviors.

Intrinsic religiousness and well-being among cancer patients: the mediating role of control-related religious coping and self-efficacy for coping with cancer

We examined the relationship between intrinsic religiousness and well-being, with control-related religious coping and self-efficacy for coping with cancer as potential mediators of this relationship among cancer patients. In a cross-sectional design, 179 ambulatory cancer patients completed measures of intrinsic religiousness, religious coping, self-efficacy for coping with cancer, well-being, and demographic variables. Type of cancer, stage of cancer, and time since diagnosis were collected from electronic medical charts. In a path model, the positive association between intrinsic religiousness and three types of well-being--physical, functional, and social-was fully mediated by active religious surrender and self-efficacy for coping with cancer. In addition, the negative association between passive religious deferral and all four types of well-being--physical, functional, social, and emotional--was fully mediated by self-efficacy for coping with cancer. Finally, there was a negative direct association between pleading for God's direct intercession and emotional well-being. These findings suggest pathways by which intrinsic religiousness and control-related religious coping are linked to various dimensions of well-being among cancer patients.

Getting going and letting go: Religiosity fosters opportunity-congruent coping with work-related uncertainties

This study investigated how religiosity relates to goal engagement (i.e., investing time and effort; overcoming obstacles) and goal disengagement (i.e., protecting self-esteem and motivational resources against failure experiences; distancing from unattainable goals) in coping with perceived work-related uncertainties (e.g., growing risk of job loss) that arise from current social change. We hypothesised that religiosity not only expands individuals' capacities for both engagement and disengagement but also fosters an opportunity-congruent pattern of engagement and disengagement, promoting engagement especially under favourable opportunities for goal-striving in the social ecology and facilitating disengagement especially under unfavourable opportunities. Multilevel analyses in a sample of N = 2089 Polish adults aged 20-46 years partly supported these predictions. Religiosity was associated with higher goal engagement, especially under favourable economic opportunities for goal-striving in the social ecology (as measured by the regional net migration rate). For disengagement, the results were more mixed; religiosity was related to higher self-protection independently of the economic opportunity structure and predicted higher goal-distancing only under the most unfavourable opportunities. These results suggest that religiosity can promote different coping strategies under different conditions, fostering a pattern of opportunity-congruent engagement and, to some extent, disengagement that is likely to be adaptive.

Breast cancer and coping among women of color: a systematic review of the literature

Breast cancer is the most commonly diagnosed form of cancer for women regardless of race/ethnicity. Women of color are diagnosed at later stages and experience greater mortality than their White counterparts. However, there has been comparatively little research on coping with breast among racial/ethnic minorities at time of diagnosis, during treatment, or in the course of survivorship. This is despite the fact that research has repeatedly shown that distress can impact disease progression and survival. The questions asked of this systematic literature review include: (1) What is known about coping with breast cancer among major racial/ethnic groups? (2) What are the strengths and gaps in research to date? Over 120 peer-reviewed published studies (1980-2012) were reviewed. A total of 33 met criteria for inclusion including 15 quantitative, 17 qualitative, and 1 mixed methods study. The majority of studies were small sample cross-sectional studies. Only five studies were longitudinal, and two randomized-controlled intervention trials sought to improve coping among survivors. The most common topic in both quantitative and qualitative studies was spirituality and coping among African American breast cancer patients. Thirteen studies included Latinas only or in combination with other groups. Only one quantitative and one qualitative study solely addressed the Asian American population exploring coping and adjustment. In the course of this systematic literature review, we elucidate what is known about coping with breast cancer among racial/ethnic minority women and identify priorities for future research.

Sources of social support and adjustment among Chinese cancer survivors: gender and age differences

INTRODUCTION

Social support has shown to improve adjustment among cancer survivors. However, it is unclear how health benefits of social support depend on the source of support, age, and gender. Chinese culture emphasizes relationship harmony and interdependence, providing a unique opportunity to address these questions. This study investigated how support from different sources was associated with adjustment to cancer and how the association was moderated by gender and age.

METHODS

Chinese cancer survivors (N = 238) from Beijing completed a questionnaire packet assessing support from different sources (e.g., family, friends, special others, society, and cancer organization) and adjustment (e.g., quality of life and positive and negative affect).

RESULTS

Perceived support from family was greater than support from other sources among Chinese cancer survivors. After controlling for support from other sources, greater support from family and society was associated with higher quality of life, more positive affect, and less negative affect. Support from family showed a stronger negative correlation with negative affect among males, and support from special others showed a stronger negative correlation with negative affect among females. Support from society had a stronger positive association with quality of life, and support from friends had a stronger negative association with quality of life among younger survivors than among older survivors.

CONCLUSIONS

Findings highlight that health benefits of social support depend on the source of support, gender, and age among Chinese cancer survivors. The study has implications for delivering individualized healthcare services tailored to the preferences of cancer survivors based on their cultural backgrounds and demographic characteristics.

"It's up to you and God": understanding health behavior change in older African American survivors of colorectal cancer

This study investigated the beliefs and attitudes of older African American colorectal cancer (CRC) survivors that may influence health behavior changes after treatment. Drawing from existing theories of health behavior change and cultural beliefs about health, a semi-structured interview guide was developed to elicit survivors' perspectives. Qualitative focus groups and interviews were conducted with 17 survivors identified through the Detroit Surveillance Epidemiology and End Results registry. Using verbatim transcripts from the sessions and NVivo software, thematic analysis was conducted to analyze patterns of responses. Transcripts were coded for seven categories (health behaviors, who/what motivates change, self-efficacy, fatalism, religion/spirituality, beliefs about cancer, race/ethnicity). Five themes emerged from the data (personal responsibility, resilience, desire for information, intentions to change, beliefs in divine control). Findings support the relevance of existing theories of health behavior change to older African American CRC survivors. Cultural considerations are suggested to improve interventions seeking to maximize changes in diet and exercise among this group of survivors.