When does Spousal Social Control Provoke Negative Reactions in the Context of Chronic Illness?: The Pivotal Role of Patients' Expectations

Inequalities in lifespan and mortality risk in the US, 2015-2019: a cross-sectional analysis of subpopulations by social determinants of health

OBJECTIVE

To quantify inequalities in lifespan across multiple social determinants of health, how they act in tandem with one another, and to create a scoring system that can accurately identify subgroups of the population at high risk of mortality.

DESIGN

Comparison of life tables across 54 subpopulations defined by combinations of four social determinants of health: sex, marital status, education and race, using data from the Multiple Cause of Death dataset and the American Community Survey.

SETTING

United States, 2015-2019.

MAIN OUTCOME MEASURES

We compared the partial life expectancies (PLEs) between age 30 and 90 years of all subpopulations. We also developed a scoring system to identify subgroups at high risk of mortality.

RESULTS

There is an 18.0-year difference between the subpopulations with the lowest and highest PLE. Differences in PLE between subpopulations are not significant in most pairwise comparisons. We visually illustrate how the PLE changes across social determinants of health. There is a complex interaction among social determinants of health, with no single determinant fully explaining the observed variation in lifespan. The proposed scoring system adds clarification to this interaction by yielding a single score that can be used to identify subgroups that might be at high risk of mortality. A similar scoring system by cause of death was also created to identify which subgroups could be considered at high risk of mortality from specific causes. Even if subgroups have similar mortality levels, they are often subject to different cause-specific mortality risks.

CONCLUSIONS

Having one characteristic associated with higher mortality is often not sufficient to be considered at high risk of mortality, but the risk increases with the number of such characteristics. Reducing inequalities is vital for societies, and better identifying individuals and subgroups at high risk of mortality is necessary for public health policy.

Couples-based health behavior change interventions: A relationship science perspective on the unique opportunities and challenges to improve dyadic health

Epidemiological studies indicate that better marital quality is associated with less morbidity and premature mortality. A number of interpersonal processes related to marital quality are also associated with health-relevant surrogate biomarkers across different physiological systems. Despite these replicated correlational findings, few interventions have harnessed interpersonal processes as potential interventions to enhance health. Building on Dr. Janice Kiecolt-Glaser's model of relationships and health, we propose that couples-based health behavior change interventions may represent an effective way to decrease dysregulation across autonomic, endocrine and immune systems and, ultimately, improve dyadic health. Given that the cohabiting partner is an essential part of the social context in which the behavior change is being pursued, it is important to consider the relational issues triggered by dyadic interventions. Using a relationship science perspective, this article reviews the literature on couples' concordance in health behaviors and health outcomes, the potential pathways underlying this concordance, theories of the couple as a self-sustaining social system, dyadic adaptation of individual self-regulation strategies, effective and ineffective social support and social control in couple relationships, the integration of relationship-building and health behavior change strategies, and the consideration of key moderators related to the nature of the relationship and the context surrounding the relationship. These findings highlight the importance of adopting a relationship science perspective when designing and testing dyadic interventions to improve health outcomes. The data reviewed provide insights on how to optimize couples-based health behavior change interventions to reduce physiological dysregulation and improve dyadic health.

The American Friendship Project: A report on the status and health of friendship in America

Friendship is critical for individuals' well-being, but recent efforts to characterize Americans' friendship have suggested that these relationships are in peril. The present study is a report on the methods and results of three surveys from the American Friendship Project (AFP). The goal of the AFP is to be the most accurate and most complete account of American friendship as well as its health and change over time. The AFP reports on five critical facets of social health as it relates to friendship: 1) the structural factors of friendship (e.g., who are they, how many); 2) friendship quality (e.g., satisfaction, closeness); 3) social support from friends; 4) the quantity of online and offline communication; and 5) well-being (e.g., life satisfaction, loneliness, connection). Data was collected from two national samples of American adults in 2022 and 2023 and from a large sample of college students across three universities in 2022. The key finding from this investigation is, compared to the discouraging results of other recent surveys, Americans reported having more friends and fewer were friendless. AFP results also suggest that face-to-face (FtF) meetings among friends are quite common, as are telephone calls and text messaging. College student and adult samples reported very similar attitudes and experiences with friendship overall, but students were more likely to meet friends at school and to keep them for a shorter length of time. Another key finding is Americans long for greater closeness with friends; though over 75% were satisfied with the number of friends they had, over 40% felt they were not as close to their friends as they would like. Overall, the AFP is a rich source of data that can be used to answer a multitude of questions about friendship and its connection to well-being.

Confirmation, Disconfirmation, and Communal Coping for Joint Physical Activity in Romantic Dyads

Most people in the United States do not engage in sufficient physical activity (PA). However, certain communication behaviors from romantic partners can motivate PA. Research indicates that confirming communication and communal coping (CC) in romantic relationships can increase PA efforts, but less research has examined the role of explicitly disconfirming communication or relationships between confirmation, disconfirmation, and CC on PA outcomes. We examined models in which shared PA appraisals mediate relationships between (a) confirmation and (b) disconfirmation and joint PA behavior in heterosexual, romantic dyads. Sex differences in actor and partner effects were also considered. Partners (N = 144) in 72 dyads completed assessments of key constructs. Results indicated that shared PA appraisals were critical in the confirmation model, mediating relationships between perceptions of confirmation and reports of joint PA. Unexpectedly, both partners' reports of partner disconfirmation were positively associated with their partners' reports of joint PA. Only one statistically significant sex difference emerged. Theoretical and pragmatic implications are discussed.

From Organizing Medicine to Cooking With More Leafy Greens: A Dyadic, Qualitative Analysis of How Older African American Couples Take Care of Each Other's Health

Guided by the Dyadic Theory of Illness Management, we explored spousal health management behaviors and their congruence within seventeen older African American married couples participating in a dyadic exercise intervention. Both prior to and after the intervention, spouses reported how they took care of their partner's health as well as what their partner did for them. Data were analyzed using theoretical thematic analysis, and five health management behaviors domains were identified (diet, exercise, self-care, medical compliance, relationship maintenance). Both partners were most likely to encourage healthier diets and exercise. Wives tended to report more behaviors compared to husbands. Couples had little congruence in their appraisals of each other's health management behaviors, and patterns were stable over time. Findings suggest incongruence in couples' health management behaviors represented complementary, collaborative efforts to support each other and that husbands may underestimate how much care they both provide to and receive from their wives.

Healthy couple, better sleep: Exploring connections and changes in couple relationship education participants

Considerable evidence suggests couple relationship education (CRE) programs are effective in improving couples' relationship functioning, yet few studies have examined the implications of CRE programs on indicators of physical health despite substantial research supporting links between relational and physical health. This study utilized a sample of 308 couples randomly assigned to a CRE curriculum to explore the dyadic links between conflict management and self-care skills (emphasized in CRE), stress, and sleep dysfunction concurrently. We prospectively tested whether changes in skills drove changes in sleep dysfunction or vice versa, for both self and partner. Results from a series of structural equation models indicated indirect links for men and women between conflict management and self-care skills and sleep dysfunction through lower stress level at program start. Dyadically, men's and women's better conflict management skills were associated with partners' lower stress, which was in turn associated with partners' lower sleep dysfunction. Men's better self-care skills were linked with partners' lower stress levels, which were linked with partners' lower sleep dysfunction. Tests of dyadic prospective cross-lagged effects among changes in sleep and changes in skills indicated that initial improvements in both partners' sleep predicted improvements in their own conflict management skills 1 year later. Initial improvements in women's conflict management skills predicted reduced sleep dysfunction for themselves. Additionally, for both partners, early changes in self-care predicted later reductions in sleep dysfunction. Dyadically, immediate improvements in men's self-care predicted reduced sleep dysfunction for their partner a year later. Implications for research and practice are discussed.

Health-Related Social Control and Perceived Stress Among High-Risk Latina Mothers with Type 2 Diabetes and Their At-Risk Adult Daughters

BACKGROUND

Diabetes-related multi-morbidity and cultural factors place Latinas with diabetes at increased risk for stress, which can threaten illness management. Families provide an ideal focus for interventions that seek to strengthen interpersonal resources for illness management and, in the process, to reduce stress. The current study sought to examine whether participating in a dyadic intervention was associated with reduced perceived stress and, furthermore, whether this association was mediated by persuasion and pressure, two forms of health-related social control.

METHOD

Latina mothers with diabetes and their at-risk adult daughters participated in either (1) a dyadic intervention that encouraged constructive collaboration to improve health behaviors and reduce stress, or (2) a usual-care minimal control condition. Actor-partner interdependence model analysis was used to estimate the effect of the intervention on dyads' perceived stress, and mother-daughter ratings of health-related social control as potential mediators.

RESULTS

Results revealed that participating in the intervention was associated with significantly reduced perceived stress for daughters, but not for mothers (β =  - 3.00, p = 0.02; β =  - 0.57, p = 0.67, respectively). Analyses also indicated that the association between the intervention and perceived stress was mediated by persuasion, such that mothers' who experienced more health-related persuasion exhibited significantly less post-intervention perceived stress (indirect effect =  - 1.52, 95% CI = [- 3.12, - 0.39]). Pressure exerted by others, however, did not evidence a mediating mechanism for either mothers or daughters.

CONCLUSION

These findings buttress existing research suggesting that persuasion, or others' attempts to increase participants' healthy behaviors in an uncritical way, may be a driving force in reducing perceived stress levels.

The influence of the significant other on treatment adherence in chronic pain management: a qualitative analysis

Objectives. Adherence to treatment recommendations is critical for optimising quality of life for individuals with chronic pain, however adherence rates are low. This study explores the role that significant others are perceived to play in supporting or impeding treatment adherence, as well as examining patient views of the impact of their adherence regimes on their significant others.Design. 25 treatment seeking adults with chronic pain, who were currently living with a romantic partner or adult family member, took part in individual semi-structured interviews.Main outcome measures Interviews were transcribed verbatim and analysed using thematic analysis.Results. Three treatment adherence support themes emerged: social support (emotional, instrumental), positive social control, and supporting autonomy. Participants did not perceive significant others as having any negative influence on their adherence. By contrast, patients perceived that their adherence behaviors had both positive and negative effects on their significant others.Conclusions. These data present an encouraging perspective on the interpersonal context of coping with chronic pain. Significant others facilitated adherence in a range of ways. Future research identifying how best to integrate significant other support into patient self-management programs is needed, in order to lift the poor treatment adherence rates that are noted in the literature.

Unplanned Costs and Benefits: Gender and Spousal Spillover Effects of Retirement on Health

Objective

Our study assesses how women and men's health indicators are shaped by their spouse's retirement.

Background

The retirement process can reshape the health of a retiree, but these effects can also extend onto the health of spouses. Although past research has largely focused on how men's retirement might negatively shape their wife's health outcomes, it is possible that wives' retirement has detrimental effects on their husband's health as well.

Method

Using data from the Health and Retirement Study (HRS), we employ a fuzzy regression discontinuity design to identify the causal effects of spousal retirement on indicators of physical and mental health in married older adults.

Results

Our results suggested that men, not women, experience the most negative spousal spillover effects of retirement on their health outcomes. We found the most support for spillover effects on spouses' physical health outcomes. Additionally, men who are not working when their spouse retires experienced the most negative health effects.

Conclusion

Women and men's health is differentially affected by spousal retirement, where men might be the most negatively affected by their spouses' transition in the U.S. context. These results contradict conventional wisdom that undergirds numerous untested assumptions underlying prior research on this significant life transition.

Examining the link between exercise-specific relational processes and physical activity, psychological distress, and relationship satisfaction among heterosexual and gay male couples

Despite the important role of romantic relationships in physical activity, little research has examined the role of gender and sexual orientation in exercise-specific relational processes. Utilizing cross-sectional, dyadic data from 462 heterosexual and gay couples, the present study examined how exercise encouragement, exercise discouragement, and frequency of exercise disagreements are related to physical activity, psychological distress, and relationship satisfaction. We included important covariates and examined gender and sexual orientation as moderators. Higher exercise encouragement was associated with more frequent physical activity (for gay men only), lower psychological distress (for women only), and higher relationship satisfaction regardless of gender and sexual orientation. Higher exercise discouragement was associated with more physical activity for all participants and higher levels of psychological distress for gay men only. Finally, more frequent exercise disagreements were associated with more psychological distress for all participants. These findings highlight important implications for physical activity promotion, prevention, and intervention.

Gender differences in social support for diabetes self-management: A qualitative study among veterans

OBJECTIVE

Describe the role of social support in veterans' diabetes self-management and examine gender differences.

METHODS

We conducted semi-structured interviews among veterans with diabetes from one Veterans Health Administration Health Care System. Participants described how support persons influenced their diabetes self-management and perspectives on a proposed self-management program incorporating a support person. We used thematic analysis to identify salient themes and examine gender differences.

RESULTS

Among 18 women and 18 men, we identified four themes: 1) women felt responsible for their health and the care of others; 2) men shared responsibility for managing their diabetes, with support persons often attempting to correct behaviors (social control); 3) whereas both men and women described receiving instrumental and informational social support, primarily women described emotional support; and 4) some women's self-management efforts were hindered by support persons. Regarding programs incorporating a support person, some participants endorsed including family/friends and some preferred programs including other individuals with diabetes.

CONCLUSIONS

Notable gender differences in social support for self-management were observed, with women assuming responsibility for their diabetes and their family's needs and experiencing interpersonal barriers.

PRACTICE IMPLICATIONS

Gender differences in the role of support persons in diabetes self-management should inform support-based self-management programs.

Motives for spousal involvement in a Partner's diabetes management: Considering the role of gender and links to diet-related involvement

Using data from 148 middle-aged and older adult spouses whose partners had type 2 diabetes, we sought to examine spouses' motives for involvement in their partners' diabetes management and whether these motives were related to common types of diabetes-related spousal involvement; we also sought to understand gender differences in these dynamics. Spouses indicated being motivated to be involved in their partners' diabetes management due to altruistic motives to the greatest extent and egoistic motives to the least extent. Results from multivariable regression analyses that controlled for gender, marital quality, and spouses' own conditions requiring dietary changes revealed that all types of motives were related to the frequency of providing diet-related spousal support, whereas only egoistic motives were related to the frequency of exerting diet-related spousal control. We did not find gender differences in any motives nor in associations with spousal involvement. Findings have potential implications for couples-oriented chronic illness interventions.

A Qualitative Investigation on the Roles of Social Support on Physical Activity Behaviour among the Rural-Dwelling Older Women in Malaysia

Despite many health benefits of physical activities, both physically and mentally, the majority of the older women in the rural areas of Malaysia are showing a low prevalence of physical activities. Understanding the roles of social support to improve physical activities is imperative to promote active and healthy ageing among the rural-dwelling older women in Malaysia. Hence, this qualitative study adopted an inductive design using 17 in-depth interviews to understand the role of social support on physical activity behaviour among the rural community-dwelling older woman in Kuala Pilah District, Negeri Sembilan, Malaysia from December 2019 to January 2020. Three categories of themes were identified in this study. Firstly, adaptive social support in terms of informational, companionship and emotional supports reported enhancing physical activity levels among older women. Secondly, the absence of help and assistance from the social network asserts independence and triggers the older women to perform the activities by themselves, thus engage in physically active lifestyles. Thirdly, lacking social support demotivate older women to be engaged in physical activities. In particular, loss of companionship support, poor acceptance or appraisal support, logistic issues to attend exercise programmes and neighbourhood safety and security issues were among the main barriers of physical activities reported by the older women. The main findings of this study shed some light on the exigency of strengthening social support from the social network to engage the older women in physical activities. The roles of social media, effective patient-doctor communication and interventions targeting the spouses and family members must be strengthened to create a supportive atmosphere to enhance physical activity levels among older women.

Differences in how spouses influence each other's alcohol use in same- and different-sex marriages: A daily diary study

RATIONALE

Different-sex spouses influence each other's alcohol consumption, with women having more influence on their spouses than men. Because women drink less than men, this long-term influence partly explains why married men and women consume less alcohol than their unmarried peers. However, much less is known about possible gender differences in the ways spouses influence each other's alcohol use on a day-to-day basis in same-compared to different-sex marriages. Because sexual minority people are at higher risk for alcohol use disorders compared to their heterosexual counterparts, such knowledge could shed light on ways to reduce this risk and alcohol use disparities between sexual minority and heterosexual people.

METHOD

We use 10 days of diary data collected in 2014-2015 in the United States from 157 female same-sex, 106 male same-sex, and 115 different-sex married couples in midlife (ages 35-65) to examine how one spouse's drinking influences how much the other spouse drinks on the following day.

RESULTS

Men reported higher levels of daily drinking than women; after including covariates, men in different-sex marriages reported drinking at the highest levels. Results from actor-partner interdependence models show that men in same- and different-sex marriages drink more, and women in different-sex marriages drink less when their spouse drinks more the previous day. Female same-sex spouses did not change their drinking behaviors in response to their spouse's drinking.

CONCLUSIONS

Overall higher rates of drinking among men in same-sex marriages suggest an accumulation effect of drinking that may contribute to sexual minority health disparities. Women and men in different-sex marriages may be engaging in social control or navigating masculinity norms. Women in same-sex marriages may not feel the need to adjust to low levels of drinking by their spouses. Findings suggest that spousal influence over alcohol consumption unfolds differently in same-sex compared to different-sex marriages.

Older adults' physical activity-related social control and social support in the context of personal norms

This study investigated whether perceived physical activity norms moderated the effects of physical activity-related social interactions on intentions to engage in physical activity among community-residing older adults (N = 217). Structural equation modeling tested whether two types of social support and social control interacted with personal norms in predicting intentions to be active. Emotional and informational support were associated with higher intentions, and negative social control was associated with lower intentions to engage in activity. Each of these effects was more prominent in the context of weak personal norms, suggesting future research and interventions should consider joint effects of support and norms.

Invisible Social Support and Invisible Social Control in Dual-smoker Couple's Everyday Life: A Dyadic Perspective

BACKGROUND

Invisible exchange processes (i.e., invisible support, invisible control) are commonly operationalized as support or control provided by a partner, but unnoticed by the recipient, and have been reported to be beneficially related to affect. However, studies have almost exclusively focused on affect as an outcome and rather neglected other outcomes, such as health behavior. One study so far demonstrated a coupling of invisible support and increased unhealthy behavior.

PURPOSE

The present study aimed to investigate differences in invisible exchanges within a dyadic context of heterosexual, romantic dual-smoker couples. We tested whether women's and men's invisible exchanges were associated with negative affect and smoking in everyday life of dual-smoker couples.

METHODS

In a dyadic daily diary study, invisible emotional and instrumental support, invisible positive and negative control, negative affect, and daily smoking were independently assessed in both partners of 83 dual-smoker couples after a joint self-set quit date.

RESULTS

Analyses based on the two-intercept model revealed that at the between-person level invisible support and control were both related to less negative affect, albeit in men only, and were unrelated to smoking behavior. At the within-person level, invisible exchanges were on the whole unrelated to negative affect and smoking.

CONCLUSIONS

Invisible support and invisible control may serve as protective buffers for negative affect in a health-behavior change context for male partners of dual-smoker couples. Future research should clarify under what conditions invisible exchanges unfold positive effects on partners' well-being and health behavior in different health contexts.

Strategies in Context: How Perceptions of Romantic Partner Support for Weight Loss Vary by the Relational Context

Because romantic partners can be a strong influence on individuals' weight loss efforts and progress, the current study assessed the relational context of weight loss-dynamics within the relationship that pertain to weight loss. Three relational characteristics were examined: whether the weight loss was a team effort, how much partners had opposing approaches to weight loss, and individuals' difficulty in balancing their weight loss goals within their relationship goals. Findings showed that the relational characteristics were associated with both the perceived frequency and effectiveness of partner strategies (i.e., instrumental influence, encouragement, and coercion). Team effort was associated with perceiving all three strategies as more frequent and effective; opposing approaches were negatively associated with encouragement but positively associated with coercion for both frequency and effectiveness; and balance struggle was positively associated with coercion frequency and effectiveness. Additionally, a cluster analysis of the three relational characteristics yielded four relational climates: synchronized (high team effort, low relational strains), contentious cooperatives (moderate in all three relational characteristics), autonomous (low in all relational characteristics), and lone battlers (low team effort, high relational strains). The groups varied in the strategies they perceived as effective. All of these findings emerged beyond the variance explained by general relationship satisfaction. Overall, these results better explicate relationship characteristics that can be incorporated into a larger, ecological model on health behavior change.

Skin Self-Examination: Partner Comfort and Support During Examinations as Predictors of Self-Efficacy in Patients At Risk for Melanoma Recurrence

BACKGROUND

Skin self-examination (SSE) is an effective method for melanoma survivors to detect potential cancerous growths sooner.

OBJECTIVES

The purpose of this study was to examine whether the SSE self-efficacy of patients with melanoma and their partners is affected by their partners' comfort and support during skin examinations.

METHODS

100 patient-partner dyads completed a 25-item sociodemographic questionnaire. Fifty-two partners attended an education session with the patient on skin examinations and the early detection of melanoma. All patients attended the education session.

FINDINGS

Having their partners attend the education session, as well as being supportive and comfortable with skin examinations, significantly predicted patients' self-efficacy with SSEs. In addition, male patients were found to be significantly more comfortable with partner-assisted skin examinations and reported feeling more supported by their partner than female patients.

Capturing motivating versus demotivating self-management support: Development and validation of a vignette-based tool grounded in Self-determination Theory

BACKGROUND

The trend towards more active involvement of patients in the management of their chronic condition requires professionals to interact in a way that facilitates patients' autonomy and motivation. A self-assessment tool that measures simultaneously motivating and demotivating interaction styles in counselling chronic ill patients is currently not available.

OBJECTIVES

Grounded in Self-Determination Theory, this study aimed to develop and validate a self-report tool that captures healthcare professionals' motivating (i.e., autonomy-support and structure) and demotivating (i.e., control and chaos) interaction styles while supporting patients towards self-management.

METHODS

The Situations In Self-management support - HealthCare Professionals (SIS-HCP) was developed throughout a five-phased psychometric validation study with (1) construct definition, (2) development of the vignette-based questionnaire, (3) ecological validation and piloting, (4) psychometric evaluation (round 1) by multidimensional scaling analysis, and (5) psychometric evaluation (round 2) by internal and construct validity, and reliability testing procedures in 5 independent samples (total N = 1133), between August 2015 and March 2018.

RESULTS

Multidimensional scaling analysis provided evidence for a two-dimensional structure, with motivating, relative to demotivating counselling and high, relative to low, directive counselling representing the two axes. Four styles could be distinguished: autonomy-support (rather motivating and non-directive), structure (rather motivating & directive), control (rather demotivating & directive) and chaos (rather demotivating & non-directive) within self-management support. The SIS-HCP demonstrated good construct validity, and high internal consistency and test-retest reliability.

CONCLUSION

The SIS-HCP is a vignette-based tool, which allows to explore, in an integrative way, which motivating (i.e., autonomy-support and structure) and demotivating (i.e., control and chaos) styles healthcare professionals use when counselling patients living with a chronic illness. The SIS-HCP might enhance professionals' awareness of their (de)motivating counselling styles and the extent to which they promote ownership among patients. The SIS-HCP represents an interesting addition to existing instruments which measure what professionals do in the field of self-management support, and how confident they feel doing so. The thorough process of development and validation led to a theoretical underpinned tool, with the identified (de)motivating dimensions yielding strong psychometric properties. The SIS-HCP can be used as a reflective tool for professionals and for tailored training.

Two for one? Effects of a couples intervention on partners of persons with Type 2 diabetes: a randomized controlled trial

AIMS

To compare the outcomes of partners who participated in a telephone couples behavioural intervention to improve glycaemic control in persons with Type 2 diabetes with those of untreated partners of participants in an individual intervention or education; to explore 'ripple effects', i.e. positive behaviour changes seen in untreated partners.

METHODS

The Diabetes Support Project was a three-arm randomized telephone intervention trial comparing outcomes of couples calls (CC), individual calls (IC) and diabetes education calls (DE). Couples included one partner with Type 2 diabetes and HbA_1c ≥ 58 mmol/mol (7.5%). All arms received self-management education (two calls). CC and IC arms participated in 10 additional behaviour change calls. CC included partners, emphasizing partner communication, collaboration and support. Blinded assessments were performed at 4, 8 and 12 months. Partner outcomes were psychosocial (diabetes distress, relationship satisfaction, depressive symptoms), medical (BMI, blood pressure) and behavioural (fat intake, activity).

RESULTS

Partners' (N = 268) mean age was 55.8 years, 64.6% were female and 29.9% were from minority ethnic groups. CC (vs. IC and DE) partners had greater reductions in diabetes distress, greater increases in marital satisfaction (4 and 8 months), and some improvements in diastolic BP. There were no consistent differences among arms in other outcomes. There was no evidence of a dietary or activity behaviour ripple effect on untreated partners, i.e. comparing partners in the IC and DE arms.

CONCLUSIONS

A collaborative couples intervention resulted in significant improvements in partner diabetes distress and relationship satisfaction. There were no consistent effects on behavioural or medical partner outcomes, and no evidence of diet or activity behaviour ripple effects, suggesting that partners should be targeted directly to achieve these changes. (Clinical Trial Registry No: NCT01017523).

"Don't Drink Too Much!" Reactance Among Young Men Following Health-Related Social Control

This study investigated conditions under which young men responded with reactance to the suggestion to reduce their alcohol consumption. In an experimental study, 84 young men (university students, mean age: 24 years) listened to a recorded telephone call and were asked to imagine that they themselves were the recipients of this call. In this call, either a girlfriend or a male friend suggested that the recipient of the call should reduce his alcohol intake that evening. In one condition, the suggestion was highly restrictive; in the other condition, the suggestion was framed in a nonrestrictive way. Perceived threat, negative thoughts, and feelings of anger after listening to the call were assessed. Further outcome variables were intention and perceived probability of complying with the suggestion. Participants felt more anger after hearing the highly restrictive suggestion and more threatened by the suggestion made by the girlfriend. Interaction effects emerged. Participants reported more negative thoughts and lower intention and perceived probability to comply when a highly restrictive suggestion was made by the girlfriend. The male friend’s highly restrictive suggestion resulted in a perceived probability of complying (54%) that was similar to the probability of the girlfriend’s nonrestrictive suggestion (55%). Women’s efforts to reduce their male partners’ alcohol consumption can result in boomerang effects. Male peers might be more effective in motivating other men to behave in a healthier way. These results support recent findings with regard to the potential of peer positive social control.

The role of spousal support for dietary adherence among type 2 diabetes patients: a narrative review

Healthy eating is key to successful management of type 2 diabetes (T2D). As discussed in this narrative review, there are strong indications that spousal support is an important element affecting dietary adherence in T2D. To provide a synthesized review of this evidence, Google Scholar and PubMed were searched, 28 relevant studies were selected, and the results were narratively summarized. A framework for information synthesis was developed which categorized results into three major themes: how gender roles and spousal dynamics function in spousal support for dietary adherence, the role of race and ethnicity in the influence of spousal support on dietary adherence, and the extant interventional work specifically targeting spousal support for T2D. The reviewed studies indicate that gender role performance is the principal factor in the relationship between spousal support and dietary adherence in T2D, though race and ethnicity also contribute. Despite this evidence, interventions that specifically target spousal support to improve dietary adherence in T2D have had limited efficacy. A better understanding of the relationship between spousal support and dietary adherence, as well as a subsequent utilization of this information to create targeted and effective interventions, would be of great benefit to the field of diabetes management.

Marriage, Social Control, and Health Behavior: A Dyadic Analysis of Same-sex and Different-sex Couples

Prior research based on studies of heterosexual populations suggests that men's health benefits more from marriage than women's, in part because women do more than men to influence the health habits of their spouse. We extend this work by using dyadic survey data from 838 spouses in 419 gay, lesbian, and heterosexual marriages to consider differences in social control tactics across same-sex and different-sex couples-that is, how spouses monitor and regulate each other's health habits. Results suggest that although gender differences in social control are common, gendered patterns sometimes differ depending on whether one is in a same-sex or different-sex marriage. Results also point to the importance of health habits as strong drivers of relationship dynamics across gay and lesbian as well as heterosexual marriages.

Inter-relations among negative social control, self-efficacy, and physical activity in healthy couples

OBJECTIVES

In romantic relationships, partners can influence each other's health-relevant behaviour by exerting negative social control (e.g., pressuring), however, with mixed success. To elucidate this phenomenon, we examined couples motivated to increase their physical activity and investigated the degree to which both partners exerted negative control on each other, their self-efficacy, reciprocal associations among the two behaviour-specific constructs, and their relationship with moderate-to-vigorous physical activity (MVPA).

DESIGN

This was a longitudinal study with three assessment periods (T0, T2, T3) spanning 7 weeks.

METHODS

We performed secondary analyses with data from the control condition (N = 113 heterosexual couples) of a published randomized controlled trial. Dyadic mediator models specified either both partners' self-efficacy as predictors and provided negative partner control to each other as mediators or vice versa. The outcomes comprised both partners' accelerometer-assessed MVPA. Mediators and outcomes were controlled for their T0 values.

RESULTS

The first model showed that women's and men's provided negative partner control (T0) was positively related to the other partners' self-efficacy (T2). Testing the alternative predictive direction, the second model showed that only women's self-efficacy (T0) was associated with more provided negative partner control (T2) by men. Women and men showed less MVPA (T3) when their partners had provided them with more negative control at T2.

CONCLUSIONS

As negative control provided to partners may be detrimental to their behaviour change, interventionists should advise couples to avoid it. However, active ingredients of negative control that may benefit recipients' self-efficacy beliefs should be investigated in future work. Statement of contribution What is already known on this subject? Couples often try to change each other's health behaviour not just using supportive tactics, but also controlling ones. Negative partner control (e.g., rebuking and nagging) was found to have adverse or no effects on control recipients' health behaviour change. To understand underlying mechanisms of this relationship, reactance and negative affect of recipients have been investigated, but only rarely their self-efficacy, a consistent individual predictor of behaviour change that is likely to share reciprocal relations with social exchange processes, including negative social control. What does this study add? Although harmful for behaviour change, negative partner control may increase control recipients' self-efficacy. Higher self-efficacy of one partner may also increase provided negative partner control by the other.

"Miscarried helping" in adults with Type 2 diabetes: Helping for Health Inventory-Couples

OBJECTIVE

Family-partner support has been associated with better blood glucose control, self-care adherence, and quality of life in adult patients with Type 2 diabetes (T2D). "Miscarried helping" has described interactions between youth with chronic diseases and their family members, in which a family member is helpful, but efforts are perceived as negative by the patient. Miscarried helping has not, however, been measured in adults with diabetes, which was the purpose of our study.

METHOD

Data from a randomized clinical trial (n = 268) were analyzed to establish the psychometric properties and correlates of an adaptation of a measure of miscarried helping developed in pediatric populations, for use with adults with T2D.

RESULTS

The Helping for Health Inventory-Couples Version (HHI-C) was found to have three underlying factors and demonstrated adequate internal consistency across time (α at baseline = .86, 4 months = .87, 8 months = .86, and 12 months = .83) and showed high test-retest reliability (p < .01) over a 12-month period. Convergent validity was partially supported, because baseline HHI-C was positively associated with maladaptive conflict resolution strategies (p = .03) and negatively associated with adaptive conflict resolution strategies (p = .04) and diabetes knowledge (p < .01). The HHI-C did not correlate with body mass index or hemoglobin A1c, a measure of glycemic control. The HHI-C was positively associated with diabetes distress (p < .01) and depressive symptoms (p = .01).

DISCUSSION

This study is the 1st known reporting of the psychometric properties of a measure of miscarried helping for adults with T2D. This valid measure of miscarried helping could be useful in future studies evaluating novel, relationship-based approaches to assist adults with T2D in disease management. (PsycINFO Database Record

A qualitative meta-synthesis examining the role of women in African American men's prostate cancer screening and treatment decision making

OBJECTIVE

Being an African American man is a risk factor for prostate cancer, and there is little consensus about the use of screening, early detection, and the efficacy of treatment for the disease. In this context, this systematic review examines the roles women, particularly wives, play in African American men's prostate cancer screening and treatment decision making.

METHODS

We searched OVID Medline (R), CINAHL (EBSCO), PsychInfo (EBSCO), PubMED, Cochrane Library, ERIC (Firstsearch), and Web of Science to identify peer-reviewed articles published between 1980 and 2016 that reported qualitative data about prostate cancer screening, diagnosis, or treatment in African American men. We conducted a systematic review of the literature using study appraisal and narrative synthesis.

RESULTS

Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for identifying and screening 1425 abstracts and papers, we identified 10 papers that met our criteria. From our thematic meta-synthesis of the findings from these publications, we found that women played 3 key roles in African American men's decision making regarding prostate cancer screening, diagnosis, or treatment: counselor (ie, offering advice or information), coordinator (ie, promoting healthy behaviors and arranging or facilitating appointments), and confidant (ie, providing emotional support and reassurance).

CONCLUSIONS

Women are often important confidants to whom men express their struggles, fears, and concerns, particularly those related to health, and they help men make appointments and understand medical advice. Better understanding women's supportive roles in promoting positive mental and physical outcomes may be key to developing effective interventions to improve African American men's decision making and satisfaction regarding prostate cancer screening and treatment.

Support and negation of colorectal cancer risk prevention behaviors: analysis of spousal discussions

The shared social context created in a marriage may be important in motivating engagement in health behaviors, but spousal influence may not be uniformly applied. Our goal was to examine how spouses discuss health behaviors relevant for colorectal cancer (CRC) risk-reduction to better understand how spouses exert or fail to exert influence. In this pilot study, first degree relatives of CRC patients and their spouses completed demographic and self-reported health questionnaires. After a genetic counseling session regarding risk and risk reduction, couples engaged in a semi-structured discussion task to discuss lifestyle choices they currently undertake or could undertake to reduce risk. Demographic and health data was analyzed using descriptive statistics. Using a directed content analysis based on the transtheoretical model of behavior change, we coded discussion transcripts for depth and direction of talk for seven behavioral CRC risk factors. Spouses engaged in several strategies to reduce their risk for CRC, and problem-solved together to increase these preventative efforts. All couples mentioned diet and exercise as important factors in CRC risk; however, other risk factors received less attention. Despite evidence of support and encouragement, spouses ignored, minimized, or negated the importance of some health behaviors. Spousal influence could be an important tool to improve participation in health behaviors, but more guidance may be necessary to hold couples accountable to evidence-based guidelines to reduce risk. Health care providers should address couples as a unit to assess and address health behaviors.

Disease factors associated with spousal influence on diabetic diet: An exploratory comparison of Vietnamese American and White older adults

This study examined whether disease-specific factors were important for how and how often White versus Vietnamese American spouses influenced their partners' diabetic diet. Results from a cross-sectional survey of 145 older adult spouses whose partners had type 2 diabetes revealed that Vietnamese American spouses used more frequent spousal influence (positive and negative) than White spouses. In addition, most of the factors associated with spousal influence differed for Vietnamese American and White spouses. Findings from this study highlight the importance of proximal and sociocultural factors in understanding older spouses' influence on their partners' diabetic diet.

Partner Influence in Diet and Exercise Behaviors: Testing Behavior Modeling, Social Control, and Normative Body Size

Previous research has documented social contagion in obesity and related health behaviors, but less is known about the social processes underlying these patterns. Focusing on married or cohabitating couples, we simultaneously explore three potential social mechanisms influencing obesity: normative body size, social control, and behavior modeling. We analyze the association between partner characteristics and the obesity-related health behaviors of focal respondents, comparing the effects of partners' body type, partners' attempts to manage respondents' eating behaviors, and partners' own health behaviors on respondents' health behaviors (physical activity, fruit and vegetable consumption, and fast food consumption). Data on 215 partners are extracted from a larger study of social mechanisms of obesity in family and community contexts conducted in 2011 in the United States. Negative binomial regression models indicate that partner behavior is significantly related to respondent behavior (p < .001), net of controls. These results are suggestive of a behavior modeling mechanism in obesity-related patterns of consumption and physical activity. In contrast, we find little support for the influence of normative body size or partner social control in this sample, though generalizations about the relevance of these processes may be inappropriate. These results underscore the importance of policies and interventions that target dyads and social groups, suggesting that adoption of exercise or diet modifications in one individual is likely to spread to others, creating a social environment characterized by mutual reinforcement of healthy behavior.

Health and Psychosocial Outcomes of a Telephonic Couples Behavior Change Intervention in Patients With Poorly Controlled Type 2 Diabetes: A Randomized Clinical Trial

OBJECTIVE

To compare glycemic control and secondary outcomes of a 4-month telephonic couples behavioral intervention to individual intervention, and to education, for adults with type 2 diabetes.

RESEARCH DESIGN AND METHODS

A randomized trial with the following three arms: couples calls (CC) (n = 104); individual calls (IC) (n = 94); and diabetes education (DE) (n = 82). All arms had self-management education (two calls). CC and IC had 10 additional behavior change calls. CC addressed collaboration and relationships/communication. Participants consisted of 280 couples, among whom one partner had type 2 diabetes and an A1C level ≥7.5%. Blinded assessments occurred at 4, 8, and 12 months. The primary outcome was change in A1C; and secondary outcomes were BMI, waist circumference, blood pressure, depressive symptoms, diabetes self-efficacy, and diabetes distress.

RESULTS

Patients had a mean age of 56.8 years; 61.6% were male, and 30.4% were minorities. The baseline mean A1C level was 9.1%. Intention-to-treat analyses found significant A1C reductions for all (12 months: CC -0.47%, IC -0.52%, DE -0.57%), with no differences between arms. Preplanned within-arm analyses were stratified by baseline A1C tertiles: lowest tertile (7.5-8.2%), no change from baseline; middle tertile (8.3-9.2%), only CC led to significantly lower A1C level; and highest tertile (≥9.3%), significant improvement for all interventions. For BMI, CC showed significant improvement, and CC and DE led to decreased waist circumference. The IC group showed greater blood pressure improvement. Results for secondary psychosocial outcomes favored the CC group.

CONCLUSIONS

In adults with poorly controlled type 2 diabetes, a collaborative couples intervention resulted in significant, lasting improvement in A1C levels, obesity measures, and some psychosocial outcomes. For those with exceedingly high A1C levels, education alone was beneficial, but additional intervention is needed to achieve glycemic targets.

Self-Care Adherence and Psychological Functioning of Older Patients with Type 2 Diabetes: Effects of Persuasion, Social Pressure, and Self-Efficacy

This cross-sectional study examined the role of family members' use of persuasion versus pressure as distinct forms of social control by which family members attempt to encourage better diabetes management among older adults with type 2 diabetes mellitus (T2DM). The study also examined how self-efficacy might moderate the relationship between persuasion/pressure, psychological functioning, and self-care adherence. Participants were 96 men and 103 women with T2DM, with a mean age of 63.3 years. Regression results show that neither persuasion nor pressure was significantly related to self-care adherence, but persuasion and pressure were associated in complex ways with diabetes-related emotional distress and depressive symptoms for which significant interaction effects were found. Patients with lower self-efficacy benefited from persuasion, but were adversely affected by pressure. In contrast, patients with higher self-efficacy were adversely affected by persuasion, but were less negatively affected by pressure. Findings highlight the importance of reducing pressure-based social control, considering patients' self-efficacy when family members seek to influence patients' self-care behaviors, and targeting patient-family interactions in future interventions.

The social context of managing diabetes across the life span

Diabetes self-management is crucial to maintaining quality of life and preventing long-term complications, and it occurs daily in the context of close interpersonal relationships. This article examines how social relationships are central to meeting the complex demands of managing Type I and Type 2 diabetes across the life span. The social context of diabetes management includes multiple resources, including family (parents, spouses), peers, romantic partners, and health care providers. We discuss how these social resources change across the life span, focusing on childhood and adolescence, emerging adulthood, and adulthood and aging. We review how diabetes both affects and is affected by key social relationships at each developmental period. Despite high variability in how the social context is conceptualized and measured across studies, findings converge on the characteristics of social relationships that facilitate or undermine diabetes management across the life span. These characteristics are consistent with both Interpersonal Theory and Self-Determination Theory, 2 organizing frameworks that we utilize to explore social behaviors that are related to diabetes management. Involvement and support from one's social partners, particularly family members, is consistently associated with good diabetes outcomes when characterized by warmth, collaboration, and acceptance. Underinvolvement and interactions characterized by conflict and criticism are consistently associated with poor diabetes outcomes. Intrusive involvement that contains elements of social control may undermine diabetes management, particularly when it impinges on self-efficacy. Implications for future research directions and for interventions that promote the effective use of the social context to improve diabetes self-management are discussed. (PsycINFO Database Record

Social support and social control in the context of cancer patients' exercise: A pilot study

Social support is an important factor for exercise among cancer patients, but too much control might elicit reactance and lead to detrimental effects. In this pilot study, 56 dyads (cancer patient + relative) filled out a questionnaire assessing social support, social control, and reactance. After 4 weeks (T2), patients' exercise was assessed with a 7-day recall. About half of the patients did not engage in any self-reported exercise behavior. Relative-reported support was the only variable associated with exercise behavior at T2. Perceived control (r = .4) but not perceived support was significantly correlated with reactance. Male patients reported more support, but were also more prone to reactance.

Spouse confidence and physical function among adults with osteoarthritis: The mediating role of spouse responses to pain

OBJECTIVE

This study of adults with osteoarthritis and their spouses examined spouse responses to patients' pain as mediators of the associations between spouse confidence in patients' ability to manage arthritis and improvements in patients' physical function and activity levels over time.

METHOD

Participants were 152 older adults with knee osteoarthritis and their spouses. In-person interviews were conducted with patients and spouses (separately) at 3 time points: baseline (Time[T] 1), 6 months after baseline (T2), and 18 months after baseline (T3). At each time point, patients reported their self-efficacy for arthritis management, functional limitations, and time spent in physical activity; spouses reported their confidence for patients' arthritis management and their empathic, solicitous, and punishing responses to patients' pain. Multiple mediation regression models were used to examine hypothesized associations across 2 distinct time frames: 6 months (T1-T2) and 12 months (T2-T3).

RESULTS

Across 6 months, spouse confidence was indirectly related to improvements in patients' functional limitations and activity levels through increased empathic responses to patient pain. Across 12 months, spouse confidence was indirectly related to improvements in patients' functional limitations and activity levels through decreased solicitous responses to patient pain.

CONCLUSIONS

This study adds to the literature on spousal influences on health by identifying 2 spouse behaviors that help to explain how spouse confidence for patients' illness management translates into improvements in patients' physical health over time. Findings can inform the development of couple-focused illness management interventions aiming to increase the positive influence of the spouse on patients' health behaviors and outcomes. (PsycINFO Database Record

‘Are you sure you’re going to have another one of those?’: A qualitative analysis of the social control and social support models in type 2 diabetes

While there is evidence that spouses can impact the self-management of adults with type 2 diabetes mellitus, less is known about the influence of the wider social network. This qualitative study explored the perceived impact of the family as well as friends and work colleagues on type 2 diabetes mellitus self-management. A total of 25 adults with type 2 diabetes mellitus participated in semi-structured interviews regarding their social experiences of living with diabetes. Deductive thematic analysis was applied to the data. Pre-existing themes of health-related social control and social support were identified in the wider social network, with additional themes of non-involvement and unintentional undermining also emerging.

Multiple Chronic Conditions, Spouse's Depressive Symptoms, and Gender within Marriage

Multiple chronic conditions (i.e., multimorbidity) increase a person's depressive symptoms more than having one chronic condition. Little is known regarding whether multimorbidity similarly increases the depressive symptoms of one's spouse and whether this depends on type of condition, gender, or both spouses' health status. Analysis of multiple waves of the Health and Retirement Study reveals husband's number of chronic conditions is positively related to wife's depressive symptoms when both spouses are chronically ill. The association between wife's chronic conditions and husband's depressive symptoms is weaker and less robust. Type of chronic condition also matters but which type depends on the gender and health status of both spouses. By highlighting key contexts where chronic conditions are connected to spousal depressive symptoms, this study identifies areas of vulnerability and urges researchers and clinicians to consider multimorbidity when designing and implementing interventions, along with gender, both spouses' chronic conditions, and condition type.

Gender, BMI, and eating regulation in the context of same-sex and heterosexual couples

Research suggests that romantic partners may benefit each other's health, but factors contributing to partners' involvement in eating regulation have been relatively unexplored. In this study, 104 heterosexual couples, 72 female same-sex and 72 male same-sex couples were examined in order to understand how partners' weight statuses were related to attempts to regulate eating behaviors. Weight status was assessed via body mass index and eating regulation was assessed using the Partner Feeding Questionnaire. Actor-Partner Interdependence Models revealed that gay men were particularly likely to regulate their partners' eating behaviors. Additionally, partners were found to regulate their significant others' eating behaviors when their significant others were heavy. Women were most likely to attempt to regulate their partners' eating behaviors when they were thin and their partners were heavy. These findings are discussed in the context of current obesity trends and the role of romantic partners in healthy weight management.

Diet and Exercise in Parenthood: A Social Control Perspective

Previous work on social control-the direct and indirect regulation of an individual's health behaviors by others-suggests that parent-child relationships promote healthy diet and exercise. Yet parenthood is associated with less healthy diet and exercise patterns. The authors investigated this paradox by examining social control processes in 40 in-depth interviews with mothers and fathers. They found that parenthood involves social control processes that both promote and compromise healthy behavior, contributing to contradictory perceived effects of parenthood on health behavior. Moreover, the dynamics of social control appear to unfold in different ways for mothers and fathers and depend on the child's gender and life stage, suggesting that gender and age dyads are central to understanding the seemingly contradictory consequences of parenthood at the population level. These articulations of gendered social control processes provide new insight into the consequences of the gendered organization of parenthood for diet and exercise.

An intersectional approach to social determinants of stress for African American men: men's and women's perspectives

Stress is a key factor that helps explain racial and gender differences in health, but few studies have examined gendered stressors that affect men. This study uses an intersectional approach to examine the sources of stress in African American men's lives from the perspectives of African American men and important women in their lives. Phenomenological analysis was used to examine data from 18 exploratory focus groups with 150 African American men, ages 30 years and older, and eight groups with 77 African American women. The two primary sources of stress identified were seeking to fulfill socially and culturally important gender roles and being an African American man in a racially stratified society. A central focus of African American men's daily lives was trying to navigate chronic stressors at home and at work and a lack of time to fulfill roles and responsibilities in different life domains that are traditionally the responsibility of men. Health was rarely mentioned by men as a source of stress, though women noted that men's aging and weathering bodies were a source of stress for men. Because of the intersection of racism and economic and social stressors, men and women reported that the stress that African American men experienced was shaped by the intersection of race, ethnicity, age, marital status, and other factors that combined in unique ways. The intersection of these identities and characteristics led to stressors that were perceived to be of greater quantity and qualitatively different than the stress experienced by men of other races.

"She looks out for the meals, period": African American men's perceptions of how their wives influence their eating behavior and dietary health

OBJECTIVE

Women play a critical role in men's dietary health, but how men think about the nature and mechanisms of their wives' influence on their eating behavior is not well understood. This study examined how African American men described the roles their wives played in shaping their eating behavior.

METHODS

Thematic content analysis was used to analyze data from nine exploratory focus groups conducted with a convenience sample of 83 African American men who were middle aged or older and lived in southeast Michigan.

RESULTS

Men perceived having more freedom to choose what they ate while eating out, even when accompanied by their wives, compared with at home. The men indicated their wives influenced what they ate at home more than their own preferences. They described traditional gendered food roles at home and were satisfied that their wives played a dominant role in household food preparation and decision making. Men had mixed feelings about wives' efforts to prepare healthier meals. While they appreciated that their wives cared about their health, the men felt they were rarely consulted on how meals could be healthier and often disliked the healthy changes their wives made. The men prioritized keeping their wives happy, preserving spousal division of roles, and maintaining marital harmony over participating in food decision making or expressing their personal food preferences.

CONCLUSIONS

Interventions to improve married African American men's eating behaviors need to explicitly consider that men may prioritize marital harmony and the preservation of spousal food roles over their tastes, preferences, and desired food decision making roles.

Spouse Control and Type 2 Diabetes Management: Moderating Effects of Dyadic Expectations for Spouse Involvement

For married patients, chronic illness management often includes involvement of their spouses. We examined expectations regarding spouse involvement in the health of a partner with type 2 diabetes (N = 139 couples) from the perspectives of the patient and spouse. Partners' dyadic expectations and spouses' gender were posited to moderate spouses' diet-related control and patients' diet adherence. Among male patients, when both partners shared an expectation for spouse involvement greater diet-related spouse control was associated with better diet adherence of patients. In contrast, when expectations for spouse involvement were not shared, greater spouse control by wives was associated with poorer diet adherence. Dyadic expectations for spouse involvement did not moderate the association between spouse control and diet adherence among female patients. Findings suggest that shared expectations for spouse involvement can facilitate spouses' attempts to improve patients' dietary adherence, especially among male patients and their wives.