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Callan S, Ulrich GR, Wooldridge JS, Roberts S, Ranby KW. The development and psychometric examination of the partner investment in health scale. Psychol Health 2024; 39:786-802. [PMID: 35993380 DOI: 10.1080/08870446.2022.2112581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/26/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Relationship partners' impacts on health are not fully captured by existing measures. A measure that applies to a prevention context and accounts for both partners' perspectives is needed. This work developed and assessed the psychometric properties of the novel Partner Investment in Health scale (PI-H). DESIGN A cross-sectional design assessed participants (N = 261) using an online survey. Exploratory factor analyses were used to determine the PI-H factor structure. MAIN OUTCOME MEASURES Items assessed the person's investment in their partner's health and their perception of their partner's investment in their health. RESULTS A 2 factor structure underlying 24 items on the PI-H scale was supported. Factors represented 1) the respondent's investment and 2) the respondent's perception of their partner's investment. The PI-H significantly correlated with related measures (e.g. relationship satisfaction, dyadic and communal coping; p < .05). CONCLUSION A full PI-H scale, two subscales, and a short version of the scale (8 items) are presented. Correlations demonstrated convergent validity and suggested the PI-H is distinct from existing constructs. Theoretical implications and applications are discussed.
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Affiliation(s)
| | | | - Jennalee S Wooldridge
- VA San Diego Healthcare System, United States
- Department of Psychiatry, University of California, San Diego, United States
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Ulrich GR, Ranby KW, Borrayo E. Underserved head-and-neck and lung cancer patient characteristics are associated with caregiver participation in a clinical trial. Contemp Clin Trials Commun 2023; 35:101195. [PMID: 37588772 PMCID: PMC10425903 DOI: 10.1016/j.conctc.2023.101195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/17/2023] [Accepted: 07/30/2023] [Indexed: 08/18/2023] Open
Abstract
Background Patient-caregiver relationships affect cancer outcomes, yet factors related to joint enrollment in cancer research trials are unclear. This work examined associations between cancer patients' sociodemographic and health factors and their caregivers' trial participation. Methods Baseline data were drawn from a parent trial testing psychosocial interventions delivered to medically underserved head-and-neck cancer (HNC) and lung cancer (LC) patients (N = 274) and caregivers (N = 210). Logistic regression evaluated whether patient characteristics were associated with participating alone versus with a caregiver(s) and type of caregiver. Results Many patients (65.0%) had a caregiver in the study, which was more common for married (OR = 2.05, p < .01) and retired patients (OR = 1.95, p < .05). Patients who indicated Hispanic (OR = 2.31, p < .05), Medicaid insurance (OR = 4.12, p < .001), monthly income <$4000 (OR = 3.04, p < .01), and smoked (OR = 2.87, p < .01) were more likely to enroll with a non-spouse/partner caregiver versus a spouse/partner. Participation was unrelated to distress. Conclusions Patient characteristics highlight caregiver relationships, informing trial design and recruitment for medically underserved cancer populations. Psychosocial interventions targeting underserved patients and their informal caregivers, those most in need of intervention support, should consider the inclusion of non-spousal cancer caregivers. Understanding how patient factors may be associated with caregiver involvement informs recruitment strategies and increases the utility of psychosocial interventions.
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Affiliation(s)
- Gillian R. Ulrich
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Krista W. Ranby
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Evelinn Borrayo
- Department of Community & Behavioral Health, University of Colorado School of Public Health, Aurora, CO, USA
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Carr AL, Bilenduke E, Adolf E, Kessler ER, Arch JJ, Ranby KW, Kilbourn K. A pilot randomized study of a telephone-based cognitive-behavioral stress-management intervention to reduce distress in phase 1 oncology trial caregivers. Palliat Support Care 2023; 21:820-828. [PMID: 36994841 PMCID: PMC10544682 DOI: 10.1017/s1478951523000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVES Caregivers of adult phase 1 oncology trial patients experience high levels of distress and face barriers to in-person supportive care. The Phase 1 Caregiver LifeLine (P1CaLL) pilot study assessed the feasibility, acceptability, and general impact of an individual telephone-based cognitive behavioral stress-management (CBSM) intervention for caregivers of phase I oncology trial patients. METHODS The pilot study involved 4 weekly adapted CBSM sessions followed by participant randomization to 4 weekly cognitive behavioral therapy sessions or metta-meditation sessions. A mixed-methods design used quantitative data from 23 caregivers and qualitative data from 5 caregivers to examine the feasibility and acceptability outcomes. Feasibility was determined using recruitment, retention, and assessment completion rates. Acceptability was assessed with self-reported satisfaction with program content and participation barriers. Baseline to post-intervention changes in caregiver distress and other psychosocial outcomes were assessed for the 8-session intervention. RESULTS The enrollment rate was 45.3%, which demonstrated limited feasibility based on an a priori criterion enrollment rate of 50%. Participants completed an average of 4.9 sessions, with 9/25 (36%) completing all sessions and an 84% assessment completion rate. Intervention acceptability was high, and participants found the sessions helpful in managing stress related to the phase 1 oncology trial patient experience. Participants showed reductions in worry and isolation and stress. SIGNIFICANCE OF RESULTS The P1CaLL study demonstrated adequate acceptability and limited feasibility and provided data on the general impact of the intervention on caregiver distress and other psychosocial outcomes. Caregivers of phase 1 oncology trial patients would benefit from supportive care services; a telephone-based intervention may have more utilization and thus make a larger impact.
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Affiliation(s)
- Alaina L. Carr
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control, Washington, DC, USA
| | - Emily Bilenduke
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Esmeralda Adolf
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Elizabeth R. Kessler
- Division of Medical Oncology, Department of Medicine, University of Colorado, Aurora, CO, USA
| | - Joanna J. Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Krista W. Ranby
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Kristin Kilbourn
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
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Ranby KW, Roberts S, Wooldridge JS, Ulrich GR. Differences between complete and incomplete couples in physical health research: Implications for methods and generalizability. Soc Sci Med 2023; 327:115965. [PMID: 37210982 DOI: 10.1016/j.socscimed.2023.115965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 04/27/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
RATIONALE Couples-based interventions to facilitate health behavior change and improve disease outcomes are gaining attention from researchers. Dyadic research, however, poses unique methodological challenges that have raised questions about research samples and the generalizability of findings. OBJECTIVE The current study examined whether couples in which both partners participated (i.e., complete couples) in a couples' health research study systematically differed from those in which only one partner participated (i.e., incomplete couples). METHODS Between January 2014 and November 2015, an online survey was advertised on Facebook to people who were both engaged to be married and living in the Denver, Colorado metropolitan area. When the first member of a couple completed the survey (initially recruited participant), they provided their partner's email address, which prompted the research staff to invite the second partner to complete the same online survey. Constructs assessed included demographics, health behaviors, general health status, and relationship quality. Participants answered questions about themself and their partner. Approximately one-third of the partners of initially recruited participants also participated. Data from initial participants in complete couples (N = 265) were compared to data from initial participants in incomplete couples (N = 509). RESULTS Chi-square tests and independent samples t-tests indicated participants in incomplete couples had significantly lower relationship quality, worse health behaviors, and poorer health status compared to those in complete couples. Reports on partner health behaviors also differed in the same direction between the two groups. Participants in complete couples were more likely to be White, less likely to have children, and had more education than in incomplete couples. CONCLUSIONS Findings suggest that studies requiring both members of a couple may recruit samples that are less diverse with fewer health concerns than research that only requires individual participation if their partner refused participation. Implications and recommendations for future couples-based health research are discussed.
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Affiliation(s)
- Krista W Ranby
- University of Colorado Denver, Department of Psychology, Campus Box 173, PO Box 173364, Denver, CO, 80217-3364, USA.
| | - Sydneyjane Roberts
- University of Colorado Denver, Department of Psychology, Campus Box 173, PO Box 173364, Denver, CO, 80217-3364, USA.
| | - Jennalee S Wooldridge
- VA San Diego Healthcare System & University of California San Diego School of Medicine, Department of Psychiatry, 9500 Gilman Dr.La Jolla, CA, 92093, USA.
| | - Gillian R Ulrich
- University of Colorado Denver, Department of Psychology, Campus Box 173, PO Box 173364, Denver, CO, 80217-3364, USA.
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Ranby KW, LaCaille RA. Introduction to the Special Section: Approaches to Understanding and Increasing Physical Activity. Ann Behav Med 2022; 56:655-657. [PMID: 35568983 DOI: 10.1093/abm/kaac029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Krista W Ranby
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Rick A LaCaille
- Department of Psychology, University of Minnesota Duluth, Duluth, MN, USA
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Ulrich GR, Nogg KA, Freeman SZ, Ranby KW. Effects of remotely-delivered physical activity education on exercise beliefs and intentions of active and nonactive cancer survivors and their partners. Transl Behav Med 2022; 12:663-672. [DOI: 10.1093/tbm/ibac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Physical activity (PA) is recommended for cancer survivors and their romantic partners yet cancer couples may be unaware of the benefits of PA specific to them. Exercise interventions targeting survivors and partners simultaneously may prove effective at increasing exercise knowledge, intentions, and outcomes. To examine the effects of a remotely-delivered cancer-specific exercise education video on cancer survivors’ and their partners’ exercise knowledge, beliefs, and intentions. Cancer survivors (N = 209) and their romantic partners (N = 155) completed an online survey with an embedded education video randomized to half the sample. Group differences (education vs. control) on study constructs among the whole sample and on a subset of the sample not meeting exercise guidelines [i.e., less than 150 min of moderate to vigorous physical activity (MVPA) per week; 50.5% survivors, 45.1% partners] were examined. Group differences on study constructs were also tested between survivors and partners meeting exercise guidelines or not. Survivors and partners in the education condition were more likely to correctly report the MVPA guidelines. The education increased survivors’ personal exercise importance, outcome expectations, and likelihood of joining an individual exercise program. Participants meeting guidelines were significantly different on multiple exercise beliefs compared to those who were not. Among those not meeting guidelines, the education increased survivors’ belief in the importance of exercising with their partner. A remotely-delivered exercise education video increased exercise knowledge and beliefs, which represents an important step in the development of couples’ exercise interventions for cancer survivors and their romantic partners.
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Affiliation(s)
- Gillian R Ulrich
- Department of Psychology, University of Colorado Denver, Denver, CO 80217, USA
| | - Kelsey A Nogg
- Department of Psychology, University of Colorado Denver, Denver, CO 80217, USA
| | - Slaton Z Freeman
- Department of Psychology, University of Colorado Denver, Denver, CO 80217, USA
| | - Krista W Ranby
- Department of Psychology, University of Colorado Denver, Denver, CO 80217, USA
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Sannes TS, Ranby KW, Yusufov M, Brewer BW, Jacobs JM, Callan S, Ulrich GR, Pensak NA, Natvig C, Laudenslager ML. More often than not, we're in sync: patient and caregiver well-being over time in stem cell transplantation. Health Qual Life Outcomes 2022; 20:6. [PMID: 35012566 PMCID: PMC8744240 DOI: 10.1186/s12955-021-01909-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hematopoietic stem cell transplantation (HSCT) is an aggressive medical procedure which significantly impacts the shared emotional well-being of patients and family caregivers (FC). Prior work has highlighted the significant overlap in well-being among patients and FCs; however, how this interdependence may change over the course of HSCT has received less attention. Methods We conducted secondary analyses of a supportive intervention delivered to 154 FCs of HSCT patients and examined relationships at baseline, 6 weeks, 3 and 6 months post-HSCT. Actor Partner Interdependence Modeling examined patient quality of life (QOL) and FC anxiety/depression. Results The data did not fit a multigroup approach limiting our ability to test intervention effects; however, bivariate analyses indicated FC depression significantly correlated to patient QOL at baseline (r = − .32), 6 weeks (r = − .22) and 6 months post-HSCT (r = − .34; p’s < .05); whereas FC anxiety was only correlated with patient QOL at the first two timepoints (p’s < .05). There was an unexpected, partner effect such that worse patient QOL at 6-weeks significantly related to lower FC depression at 3-months (B = .193; p = .026) and changed direction with patient QOL at 3-months being related to more FC depression at 6-months (B = − .187; p = .001). Conclusions These findings highlight the significant, yet nuanced, interdependence of patient QOL and FC well-being during HSCT. Specifically, greater interdependence was observed between patient QOL and FC depression compared to FC anxiety, suggesting potential treatment targets for patients and their families. Trial was registered at ClinicalTrials.gov Identifier: NCT02037568; first registered: January 16, 2014; https://clinicaltrials.gov/ct2/show/NCT02037568
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Affiliation(s)
- Timothy S Sannes
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, USA. .,Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Krista W Ranby
- Department of Psychology, The University of Colorado Denver, Denver, USA
| | - Miryam Yusufov
- Division of Adult Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Benjamin W Brewer
- School of Medicine Anschutz Medical Campus, Division of Hematology, The University of Colorado, Aurora, USA
| | - Jamie M Jacobs
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | - Stephanie Callan
- Department of Psychology, The University of Colorado Denver, Denver, USA
| | - Gillian R Ulrich
- Department of Psychology, The University of Colorado Denver, Denver, USA
| | | | - Crystal Natvig
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Mark L Laudenslager
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, USA
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Martens K, Ulrich GR, Ranby KW, Kilbourn K. What Matters Most? Predictors of Quality of Life and Life Satisfaction Among Young Breast Cancer Survivors. Cancer Nurs 2021; 44:E727-E734. [PMID: 34694091 DOI: 10.1097/ncc.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Younger breast cancer survivors face unique challenges, and research is needed to better understand how to optimize their quality of life (QoL) and satisfaction with life (SwL). OBJECTIVE The aim of this study was to examine a biopsychosocial model of QoL and SwL in young breast cancer survivors. Biological, psychological, and social/practical factors were hypothesized to be associated with both distressing and adaptive reactions during survivorship, which in turn were hypothesized to be associated with QoL and SwL. METHODS Young (age = 19-45 years at diagnosis) breast cancer survivors (N = 284) completed an online survey assessing demographic and biopsychosocial factors, QoL, and SwL. Latent variables were created for adaptive and distressing reactions, and structural equation modeling was used to test the hypothesized relationships. RESULTS The model fit the data (χ2(100) = 332.92, P < .001, comparative fit index = 0.86, root mean square error of approximation = 0.09, standardized root mean square residual = 0.05) and accounted for large proportions of variance in QoL (R2 = 0.86) and SwL (R2 = 0.62). Social support, parenting concerns, and fertility concerns each significantly predicted adjustment. Adaptive reactions positively predicted SwL (β = 0.58, P < .001) but not QoL. Distressing reactions negatively predicted SwL (β = -0.26, P < .01) and QoL (β = -0.87, P < .001). CONCLUSIONS Adjustment in survivorship mediated the association of social support, parenting concerns, and fertility concerns on QoL and SwL in young breast cancer survivors. IMPLICATIONS FOR PRACTICE To support the psychological adjustment of young breast cancer survivors, attention should be given to survivors' social context including survivors' available social support and their concerns about fertility and parenting.
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Affiliation(s)
- Kellie Martens
- Author Affiliations: Department of Bariatric Surgery & Behavioral Health Services, Henry Ford Health System (Dr Martens), Detroit, Michigan; and Department of Psychology, University of Colorado Denver (Ms Ulrich and Drs Ranby and Kilbourn)
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McIlvennan CK, Matlock DD, Allen LA, Thompson JS, Ranby KW, Sannes TS. Perceived Stress and Depressive Symptoms as Predictors of Decisional Conflict in Dyads Considering a Left Ventricular Assist Device. Circ Cardiovasc Qual Outcomes 2020; 13:e006155. [PMID: 32148099 DOI: 10.1161/circoutcomes.119.006155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The decision to pursue a left ventricular assist device (LVAD) commits loved ones to major caregiving responsibilities and, often, medical decision-making. How emotional domains overlap within patients and their caregivers and contribute to conflict around the decision to pursue LVAD remains largely unexplored. METHODS AND RESULTS The associations within and between individuals in patient-caregiver dyads considering LVAD were estimated in a specific type of structural equation model known as the Actor-Partner Interdependence Model. This model tested whether each person's depression and stress predicted their own decisional conflict (actor effects), as well as their partner's decisional conflict (partner effects). At the time of study enrollment when a formal LVAD evaluation was initiated, 162 patient-caregiver dyads completed assessments of decisional conflict using the Decisional Conflict Scale, depressive symptoms using the Patient Health Questionnaire-2, and stress using the Perceived Stress Scale. Across both models, decisional conflict was significantly correlated within patient-caregiver dyads (β=0.47 and 0.44, for depression and perceived stress models, respectively, P<0.001). Greater perceived stress in both the patient (β=0.18; P<0.05) and caregiver (β=0.28; P<0.001) was significantly related to greater decisional conflict (both actor effects). Greater patient depressive symptoms were related to greater patient decisional conflict (β=0.16; P<0.05), whereas caregiver depression symptoms was not related to their own decisional conflict (β=0.07; P=0.37). There were no partner effects identified between decisional conflict and perceived stress or depressive symptoms. CONCLUSIONS Patient and caregiver conflict over the decision to pursue an LVAD was highly correlated in this sample, with greater perceived stress significantly predicting greater decisional conflict in both patients and caregivers. Depressive symptoms in patients also predicted greater patient decisional conflict. No partner effects were identified in predicting decisional conflict. These results contribute to a larger body of work acknowledging the importance of patient-caregiver well-being in serious illness. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02344576.
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Affiliation(s)
- Colleen K McIlvennan
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (C.K.M., D.D.M., L.A.A., J.S.T.), University of Colorado School of Medicine, Aurora, CO.,Division of Cardiology (C.K.M., L.A.A.), University of Colorado School of Medicine, Aurora, CO
| | - Daniel D Matlock
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (C.K.M., D.D.M., L.A.A., J.S.T.), University of Colorado School of Medicine, Aurora, CO.,Veteran Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO (D.D.M.)
| | - Larry A Allen
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (C.K.M., D.D.M., L.A.A., J.S.T.), University of Colorado School of Medicine, Aurora, CO.,Division of Cardiology (C.K.M., L.A.A.), University of Colorado School of Medicine, Aurora, CO
| | - Jocelyn S Thompson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (C.K.M., D.D.M., L.A.A., J.S.T.), University of Colorado School of Medicine, Aurora, CO
| | - Krista W Ranby
- Department of Psychology, University of Colorado Denver (K.W.R.)
| | - Timothy S Sannes
- Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA (T.S.S.)
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Varner S, Lloyd G, Ranby KW, Callan S, Robertson C, Lipkus IM. Illness uncertainty, partner support, and quality of life: A dyadic longitudinal investigation of couples facing prostate cancer. Psychooncology 2019; 28:2188-2194. [PMID: 31418505 DOI: 10.1002/pon.5205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/05/2019] [Accepted: 08/09/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Prostate cancer (PC) and its treatment often result in chronic, negative side-effects that affect both patients and their romantic partners. Illness uncertainty is a chronic stressor that impacts PC patients and their partners and, if left unmanaged, predicts decreased interpersonal functioning and quality of life (QOL) after treatment is complete. This study explored associations among psychosocial constructs, measured from both partners during the first year following a PC diagnosis, to better understand both partners' experiences and identify potential intervention targets for improving QOL. METHODS Couples (N = 165) in which one partner was undergoing treatment for PC were recruited from the Duke University Medical Center of Urology. Patients and their partners were surveyed at four time points: diagnosis and 1-, 6-, and 12-months post treatment. An Actor-Partner Interdependence Model (APIM) framework was used to examine associations among perceived partner support, nonsupportive behaviors, illness uncertainty, relationship satisfaction, and physical and mental QOL. RESULTS Partners feeling more supported at diagnosis was related to patients feeling more supported at 6 months. When patients' illness uncertainty decreased between diagnosis and 1 month, partners reported feeling more supported and engaging in fewer nonsupportive behaviors at 6-months post-treatment. Finally, partners' reports of support at 6 months predicted patients' 12-month ratings of physical and mental QOL and relationship satisfaction. CONCLUSIONS Findings highlight psychological interdependence between PC patients and their partners. Future interventions to improve long-term QOL in couples facing PC may benefit by targeting both partner support and illness uncertainty.
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Abstract
Individuals with type 2 diabetes must engage in daily self-management behaviors to prevent complications. Given that management may be shared with a person's romantic partner, we examined both patients' and their partners' perceptions of relationship characteristics that were hypothesized to affect patients' self-efficacy for diabetes management. Adults with type 2 diabetes and their partners (n = 52 couples, 104 individuals) completed measures of three aspects of relationships that are theorized to affect self-efficacy: partner investment, partner support, and relationship satisfaction. Patients reported their self-efficacy for diabetes management and weekly frequency of diabetes self-management behaviors. A common fate modeling approach in which constructs were modeled as agreement between partner reports showed that relationship factors (investment, support, and satisfaction) significantly predicted patient self-efficacy (R 2 = 0.49), which in turn predicted patient self-management behaviors. This model fit the data well [χ2 (41) = 48.60, P = 0.19; comparative fit index (CFI) = 0.96; root mean square error of approximation = 0.06; and standardized root mean square residual = 0.07]. Interventions designed to support patients in their self-efficacy for self-management behavior may be improved through consideration of patients' romantic relationships.
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Affiliation(s)
| | - Krista W Ranby
- Department of Psychology, University of Colorado, Denver, CO
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Abstract
Most behavior change trials focus on outcomes rather than deconstructing how those outcomes related to programmatic theoretical underpinnings and intervention components. In this report, the process of change is compared for three evidence-based programs' that shared theories, intervention elements and potential mediating variables. Each investigation was a randomized trial that assessed pre- and post- intervention variables using survey constructs with established reliability. Each also used mediation analyses to define relationships. The findings were combined using a pattern matching approach. Surprisingly, knowledge was a significant mediator in each program (a and b path effects [p<0.01]). Norms, perceived control abilities, and self-monitoring were confirmed in at least two studies (p<0.01 for each). Replication of findings across studies with a common design but varied populations provides a robust validation of the theory and processes of an effective intervention. Combined findings also demonstrate a means to substantiate process aspects and theoretical models to advance understanding of behavior change.
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Affiliation(s)
- Diane L Elliot
- Division of Health Promotion and Sports Medicine; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road CR110, Portland, OR, 97239-3098, USA.
| | - Linn Goldberg
- Division of Health Promotion and Sports Medicine; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road CR110, Portland, OR, 97239-3098, USA
| | - David P MacKinnon
- Department of Psychology, Arizona State University, Tempe, AZ, 85287-1104, USA
| | - Krista W Ranby
- Department of Psychology, University of Colorado Denver, Denver, CO, 80217-3364, USA
| | - Kerry S Kuehl
- Division of Health Promotion and Sports Medicine; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road CR110, Portland, OR, 97239-3098, USA
| | - Esther L Moe
- Division of Health Promotion and Sports Medicine; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road CR110, Portland, OR, 97239-3098, USA
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Abstract
OBJECTIVE Potential support providers may rely on observable behaviours (e.g. resisting a cigarette vs. smoking) to determine how much and what kind of support to provide. We evaluated the effect of smokers' salient behaviour on partners' likelihood of providing positive and negative support. DESIGN Partners of smokers (N = 131) were randomly assigned to recall a time when their partner either successfully resisted a cigarette, failed to resist a cigarette or a control condition (no recall). All participants reported the likelihood of providing positive and negative support to their partner. Perceived commitment to quitting smoking was measured as a potential mediator. MAIN OUTCOME MEASURES The main outcome was intention to provide support for a quit attempt. RESULTS Participants who recalled their partners' past failures reported more intentions to engage in negative support and smaller ratios of positive to negative intended support than did participants in the success or control condition. These effects were partially mediated by perception of commitment to quitting. CONCLUSION Lapses in a quit attempt may change the nature of the support quitters receive. Interventions to improve communication between partners about the smoker's commitment to quitting and experienced challenges may result in better support.
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Affiliation(s)
| | - Savannah M Boyd
- a Department of Psychology , University of Georgia , Athens , GA , USA
| | - Krista W Ranby
- b Department of Psychology , University of Colorado Denver , Denver , CO , USA
| | - LeeAnn B Beam
- a Department of Psychology , University of Georgia , Athens , GA , USA
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Hooker SA, Ross KM, Ranby KW, Masters KS, Peters JC, Hill JO. Identifying groups at risk for 1-year membership termination from a fitness center at enrollment. Prev Med Rep 2016; 4:563-568. [PMID: 27818915 PMCID: PMC5094673 DOI: 10.1016/j.pmedr.2016.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 10/06/2016] [Accepted: 10/27/2016] [Indexed: 12/03/2022] Open
Abstract
The vast majority of Americans do not engage in adequate regular physical activity despite its well-known health benefits. Even when individuals attempt to become more active by joining a fitness center, estimates suggest that nearly half terminate their membership within the first 6 months. A better understanding of who is at risk for early membership termination upon joining may help researchers develop targeted interventions to improve the likelihood that individuals will successfully maintain memberships and physical activity. This study's purpose was to identify, based on a wellness assessment (WA) used in fitness centers, individuals at risk for fitness membership termination prior to 1-year. Center members (N = 441; Mage = 41.9, SD = 13.1; 74.4% female) completed a comprehensive WA of stress, life satisfaction, physical fitness, metabolic health, and sleep quality at the beginning of their memberships and were followed for one year. Latent class analyses utilized the WA to identify four groups: (a) healthy, (b) unhealthy, (c) poor psychological wellness, and (d) poor physical wellness. Participants in the poor psychological wellness group (OR = 2.24, p = 0.007) and the unhealthy group (OR = 2.40, p = 0.037) were significantly more likely to terminate their memberships at 1-year as compared to the healthy group. Participants with poor physical wellness visited the fitness center less frequently than healthy participants (p < 0.01). Results suggest that poor psychological wellness is a risk factor for terminating memberships, whereas poor physical wellness is not. Future studies should replicate these latent classes and develop targeted interventions to address psychological wellness as a method to improve fitness membership retention. A person-centered analytical approach to identify at-risk individuals is proposed. Four wellness profiles are identified. Those with poor psychological and overall wellness are more likely to terminate. Those with poor physical wellness visit the fitness center less frequently. Interventions to prevent membership termination should target at-risk individuals.
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Affiliation(s)
- Stephanie A. Hooker
- Department of Psychology, University of Colorado Denver, United States
- Anschutz Health and Wellness Center, University of Colorado Denver, United States
- Corresponding author at: University of Colorado Denver, Campus Box 173, PO Box 173354, 1200 Larimer St., Denver, CO 80217, United States.University of Colorado DenverCampus Box 173PO Box 1733541200 Larimer St.DenverCO80217United States
| | - Kaile M. Ross
- Department of Psychology, University of Colorado Denver, United States
- Anschutz Health and Wellness Center, University of Colorado Denver, United States
| | - Krista W. Ranby
- Department of Psychology, University of Colorado Denver, United States
| | - Kevin S. Masters
- Department of Psychology, University of Colorado Denver, United States
- Anschutz Health and Wellness Center, University of Colorado Denver, United States
| | - John C. Peters
- Anschutz Health and Wellness Center, University of Colorado Denver, United States
- School of Medicine, University of Colorado Denver Anschutz Medical Campus, United States
| | - James O. Hill
- Anschutz Health and Wellness Center, University of Colorado Denver, United States
- School of Medicine, University of Colorado Denver Anschutz Medical Campus, United States
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Ranby KW, Aiken LS. Incorporating husband influences into a model of physical activity among older women. Br J Health Psychol 2016; 21:677-93. [PMID: 27159040 DOI: 10.1111/bjhp.12195] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/29/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Health behaviour models focus primarily on intrapersonal constructs (e.g., self-efficacy) which are good predictors of intention but less so of actual behaviour. Influences from the social environment, namely from close others, may improve prediction of engagement in ongoing behaviour. OBJECTIVES This study sought to broadly assess husband influence on physical activity and to determine whether a multidimensional assessment of husband influence would improve prediction of wives' physical activity. DESIGN A two-wave (separated by 4 months) observational study of married women was employed. METHOD Women (n = 160, Mage = 63 years) reported intention, planning, and self-efficacy for physical activity as well as previous month physical activity through Wave 1 mailed surveys. In Wave 2 telephone interviews conducted 4 months later, women reported on their perception of husband influences and their own physical activity in the previous month. RESULTS Psychometric analyses supported five components of social support along with social control, injunctive norms, and descriptive norms as a broad assessment of husband social influence on physical activity. Husband influences significantly improved prediction of wives' physical activity, over and above intrapersonal predictors (ΔR(2) = .09). Social control related negatively to behaviour; moderation analyses revealed a strong negative association when women's intentions were low. CONCLUSIONS This work highlights the interpersonal social context and post-intentional influences on daily health behaviour and offers guidance on the expansion of models of health behaviour as well as potential targets for intervention. Statement of contribution What is already known on this subject? Behavioural intentions are the best predictors of behaviour; however, much variability in actual behaviour remains to be explained. Romantic partners are frequent providers of health-related social support and social control. What does this study add? Provides multidimensional assessment of husband influence. Improves prediction of behaviour using husband influences. Demonstrates moderator of social control on behaviour.
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Affiliation(s)
- Krista W Ranby
- Department of Psychology, University of Colorado Denver, Colorado, USA
| | - Leona S Aiken
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
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Ross KM, Ranby KW, Wooldridge JS, Robertson C, Lipkus IM. Effects of physical and mental health on relationship satisfaction: a dyadic, longitudinal examination of couples facing prostate cancer. Psychooncology 2015; 25:898-904. [DOI: 10.1002/pon.3931] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 06/05/2015] [Accepted: 07/15/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Kaile M. Ross
- Department of Psychology; University of Colorado Denver; USA
| | - Krista W. Ranby
- Department of Psychology; University of Colorado Denver; USA
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vanDellen MR, Boyd SM, Ranby KW, MacKillop J, Lipkus IM. Willingness to provide support for a quit attempt: A study of partners of smokers. J Health Psychol 2015; 21:1840-9. [PMID: 25603929 DOI: 10.1177/1359105314567209] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Support from close others predicts smoking abstinence, yet little research has investigated what factors promote support. This study investigates predictors of support for a quit attempt. Partners of smokers (N = 131) reported their relationship quality, concern for partner's health, own smoking status, and intended support for a quit attempt. Smokers were less supportive than were nonsmokers. Relationship quality, concern for partners' health, and motivation to quit were positively associated, and nicotine dependence was negatively associated, with intended support. The findings suggest that support for smoking cessation depends on one's own smoking behaviors as well as characteristics of the relationship.
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Affiliation(s)
| | | | | | - James MacKillop
- University of Georgia, USA St. Joseph's Healthcare Hamilton, Canada
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Carrig MM, Manrique-Vallier D, Ranby KW, Reiter JP, Hoyle RH. A Nonparametric, Multiple Imputation-Based Method for the Retrospective Integration of Data Sets. Multivariate Behav Res 2015; 50:383-397. [PMID: 26257437 PMCID: PMC4528674 DOI: 10.1080/00273171.2015.1022641] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Complex research questions often cannot be addressed adequately with a single data set. One sensible alternative to the high cost and effort associated with the creation of large new data sets is to combine existing data sets containing variables related to the constructs of interest. The goal of the present research was to develop a flexible, broadly applicable approach to the integration of disparate data sets that is based on nonparametric multiple imputation and the collection of data from a convenient, de novo calibration sample. We demonstrate proof of concept for the approach by integrating three existing data sets containing items related to the extent of problematic alcohol use and associations with deviant peers. We discuss both necessary conditions for the approach to work well and potential strengths and weaknesses of the method compared to other data set integration approaches.
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Wilson SM, Sikkema KJ, Ranby KW. Gender moderates the influence of psychosocial factors and drug use on HAART adherence in the context of HIV and childhood sexual abuse. AIDS Care 2014; 26:959-67. [PMID: 24410324 DOI: 10.1080/09540121.2013.873765] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study aimed to examine gender moderation within a stress and coping model of HIV medication adherence in adults with a history of childhood sexual abuse (CSA). Sequelae of CSA, including negative coping, psychological distress, and drug use, interfere with adherence to highly active antiretroviral treatment (HAART). These obstacles to adherence are likely moderated by gender. Gender may particularly influence the mediational effect of drug use on adherence. Participants included 206 adults living with HIV/AIDS and CSA. Categorical/continuous variable methodology in a structural equation modeling framework was used to test a multigroup model with women and men. Gender significantly moderated several effects in the model. For women, the effect of psychological distress on HAART adherence was mediated by drug use and the effect of drug use on viral load was mediated by HAART adherence. Among men, drug use did not significantly impact adherence. Since gender appears to moderate the effect of drug use on medication adherence, it is particularly important to address drug use within the context of HIV disease management in women with a history of CSA. Further, interventions to increase HAART adherence should take trauma history, gender, and drug abuse into account when assessing efficacy.
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Affiliation(s)
- Sarah M Wilson
- a Department of Psychology and Neuroscience , Duke University , Durham , NC , USA
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Abstract
INTRODUCTION Couples in which both members smoke (dual-smoker couples) have not been the explicit target of cessation interventions. Quit rates are lower and relapse rates are higher among individuals in dual-smoker couples. A potentially effective strategy to motivate dual-smoker couples to quit is to convey messages that highlight how the positive outcomes of quitting (gain frame) or the negative outcomes of continued smoking (loss frame) affect the couple rather than the individual smoker. We explored whether dual-smoker couples' smoking behaviors (e.g., amount smoked) and desire to quit would differ as a function of message frame (gain vs. loss) or outcome focus (individual vs. couple). METHODS Dual-smoker couples (N = 40) completed a baseline survey and were then randomized to review gain- or loss-framed messages that varied whether the outcomes influenced the individual or the couple. Main outcomes were desire to quit after reading messages and smoking behaviors at a 1-month follow-up. RESULTS Couple-focused messages produced the strongest desire to quit and decreased amount of cigarettes smoked at follow-up. The latter effect was mediated by desire to quit. Loss-framed messages produced inconsistent effects on desire to quit. There were no significant interactions between outcome focus and message framing. CONCLUSIONS Findings suggest that messages emphasizing how smoking affects both partners can motivate cessation among dual-smoker couples. Contrary to findings showing that gain-framed messages motivate cessation targeting individual smokers, results suggest that loss-framed messages may be more persuasive than gain-framed messages when the target of the outcome involves significant others.
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Drabkin AS, Sikkema KJ, Wilson PA, Meade CS, Hansen NB, DeLorenzo A, Kochman A, MacFarlane JC, Watt MH, Aunon FM, Ranby KW, Mayer G. Risk patterns preceding diagnosis among newly HIV-diagnosed men who have sex with men in New York City. AIDS Patient Care STDS 2013; 27:333-41. [PMID: 23730703 PMCID: PMC3701313 DOI: 10.1089/apc.2012.0313] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Men who have sex with men (MSM) are at high risk for contracting and transmitting HIV. They are increasingly encouraged to get tested, but understanding of the interplay between HIV testing and risk behavior is limited. One hundred fifty newly HIV-diagnosed (within past 3 months) MSM were recruited from a community clinic in New York City. Participants completed an interview assessing sexual behavior and substance use during the 3 months pre-diagnosis, current depressive symptoms, and prior HIV testing. HIV-related health characteristics at diagnosis were abstracted from medical records. Analyses examined factors associated with unprotected anal intercourse (UAI) in the 3 months pre-diagnosis, and with a negative HIV test in the 12 months pre-diagnosis. The sample was young (mean age=32.5, SD=8.8), ethnically diverse (62% racial/ethnic minority), low-income (71%≤$30,000/year), and educated (48% college/advanced degree). Most (95%) had a prior negative HIV test, 55% within the last 12 months. Significant risk behavior was reported, with 79% reporting UAI. UAI was associated with recent testing and use of substances during sexual behavior. Recent testing was associated with being employed/a student, having had UAI, and higher CD4 count. Implications for future research addressing perceived HIV risk, HIV testing utilization, and risk behavior are discussed.
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Affiliation(s)
- Anya S Drabkin
- Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA.
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Meade CS, Watt MH, Sikkema KJ, Deng LX, Ranby KW, Skinner D, Pieterse D, Kalichmann SC. Methamphetamine use is associated with childhood sexual abuse and HIV sexual risk behaviors among patrons of alcohol-serving venues in Cape Town, South Africa. Drug Alcohol Depend 2012; 126:232-9. [PMID: 22717338 PMCID: PMC3465508 DOI: 10.1016/j.drugalcdep.2012.05.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 05/10/2012] [Accepted: 05/18/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND South Africa's Western Cape has experienced a dramatic increase in methamphetamine ("meth") use over the past decade. There is concern that meth may further fuel the HIV epidemic in this country because of its association with risky sexual behaviors. This study describes the prevalence of meth use and its relation to HIV sexual risk behaviors among patrons of alcohol-serving venues. METHODS Participants (N=3328) were surveyed in 12 venues in a mixed race township. Logistic regression models were used to examine the relations between meth use and sexual risk behaviors, and structural equation models were used to test whether meth use mediates the relationship between childhood sexual abuse and current sexual risk. RESULTS Meth use in the past 4 months was more common among Coloured than Black persons (10.5% vs. 3.5%). Meth users were more likely than non users to use marijuana, inhalants, and injection drugs, have a history of childhood sexual and/or physical abuse, and experience and/or perpetrate intimate partner violence. Among both men and women, meth use was associated with greater odds of engaging in sexual risk behaviors, and meth use partially mediated the relationships between childhood sexual abuse and all sexual risk behaviors. CONCLUSIONS Meth users in this setting are at increased risk for HIV due to their greater likelihood of engaging in sexual risk behaviors and being in violent relationships. There is an urgent need to provide targeted HIV prevention and substance abuse treatment to meth users living in townships in Cape Town.
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Sikkema KJ, Ranby KW, Meade CS, Hansen NB, Wilson PA, Kochman A. Reductions in traumatic stress following a coping intervention were mediated by decreases in avoidant coping for people living with HIV/AIDS and childhood sexual abuse. J Consult Clin Psychol 2012; 81:274-83. [PMID: 23025248 DOI: 10.1037/a0030144] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine whether (a) Living in the Face of Trauma (LIFT), a group intervention to address coping with HIV and childhood sexual abuse (CSA), significantly reduced traumatic stress over a 1-year follow-up period more than an attention-matched support group comparison intervention; and (b) reductions in avoidant coping over time mediated reductions in traumatic stress. METHOD In a randomized controlled trial, 247 participants completed measures of traumatic stress and avoidant coping at pre- and post intervention, and at 4-, 8-, and 12-month follow-ups. Latent growth curve modeling examined changes over the 5 time points; standardized path coefficients provide estimates of effects. RESULTS As compared with the support intervention, the coping intervention led to a reduction in traumatic stress over time (b = -.20, p < .02). Participants in the coping intervention also reduced their use of avoidant coping strategies more than did participants in the support intervention (b = -.22, p < .05). Mediation analyses showed reductions in avoidant coping related to reductions in traumatic stress (b = 1.45, p < .001), and the direct effect of the intervention on traumatic stress was no longer significant (b = .04, ns), suggesting that changes in avoidant coping completely mediated intervention effects on traumatic stress. CONCLUSIONS The LIFT intervention significantly reduced traumatic stress over time, and changes in avoidant coping strategies mediated this effect, suggesting a focus on current stressors and coping skills improvement are important components in addressing traumatic stress for adults living with HIV and CSA.
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Affiliation(s)
- Kathleen J Sikkema
- Department of Psychology and Neuroscience, Duke University, Durham, NC 27708-0086, USA.
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25
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Watt MH, Ranby KW, Meade CS, Sikkema KJ, MacFarlane JC, Skinner D, Pieterse D, Kalichman SC. Posttraumatic stress disorder symptoms mediate the relationship between traumatic experiences and drinking behavior among women attending alcohol-serving venues in a South African township. J Stud Alcohol Drugs 2012; 73:549-58. [PMID: 22630793 DOI: 10.15288/jsad.2012.73.549] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE South Africa has high rates of traumatic experiences and alcohol abuse or dependence, especially among women. Traumatic experiences often result in symptoms of posttraumatic stress disorder (PTSD), and PTSD has been associated with hazardous drinking. This article examines the relationship between traumatic events and hazardous drinking among women who patronized alcohol-serving venues in South Africa and examines PTSD as a mediator of this relationship. METHOD A total of 560 women were recruited from a Cape Town township. They completed a computerized assessment that included alcohol consumption, history of traumatic events, and PTSD symptoms. Mediation analysis examined whether PTSD symptoms mediated the relationship between the number of traumatic event categories experienced (range: 0-7) and drinking behavior. RESULTS The mean Alcohol Use Disorders Identification Test score in the sample was 12.15 (range: 0-34, SD = 7.3), with 70.9% reaching criteria for hazardous drinking (AUDIT > 8). The mean PTSD score was 36.32 (range: 17-85, SD = 16.3),with 20.9% meeting symptom criteria for PTSD (PTSD Checklist with 20.9% meeting symptom criteria for PTSD (PTSD Checklist-Civilian Version ≥ 50). Endorsement of traumatic experiences was high, including adult emotional (51.8%), physical (49.6%), and sexual (26.3%) abuse; childhood physical (35.0%) and sexual (25.9%) abuse; and other types of trauma (83%). All categories of traumatic experiences, except the "other" category, were associated with hazardous drinking. PTSD symptoms mediated 46% of the relationship between the number of traumatic categories experienced and drinking behavior. CONCLUSIONS Women reported high rates of hazardous drinking and high levels of PTSD symptoms, and most had some history of traumatic events. There was a strong relationship between traumatic exposure and drinking levels, which was largely mediated by PTSD symptoms. Substance use interventions should address histories of trauma in this population, where alcohol may be used in part to cope with past traumas.
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Affiliation(s)
- Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA.
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Abstract
INTRODUCTION Quit rates are lower and relapse rates are higher for people in close relationships with a partner who smokes. Although desire to quit is often related to health concerns for one's self, much less is known about psychosocial factors associated with quitting in dual-smoker couples. This study investigated relations among beliefs about smoking and desire to quit from both partners' perspectives. METHODS We recruited 63 couples in which both partners smoke daily. Participants were aged 21-67 (M = 43.0, SD = 11.3) and had been smoking for 4-51 years (M = 22.9, SD = 11.3). RESULTS Individuals' desire to quit related to worry about partner's health (r = .29, p < .01), perceived risk of partner getting a disease if the partner continues to smoke (r = .39, p < .001), and belief that own smoking has caused partner physical harm (r = .38, p < .001). Within couples, partners were modestly concordant with regard to worry about harm of smoking for oneself (r = .30, p < .05) and partner (r = .30, p < .05), perceived risk of disease for oneself (r = .26, p < .05) and partner (r = .24, p < .05), and desire that partner quit (r = .34, p < .01). Participants had an extremely strong desire (78% = 7 on 1-7 scale) for their partner's help if they attempt to quit. CONCLUSIONS Dual-smoker couples are at heightened health risks due to exposure to passive smoke and their own smoking. Partners' perceived risk and worry about the harms of smoking could be important leverage points for smoking cessation efforts. Interventions can be informed by considering both partners' beliefs and by helping partners develop plans for quitting and supporting each other.
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Affiliation(s)
- Krista W Ranby
- Center for Child and Family Policy, Duke University, Durham, NC, USA.
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Ranby KW, Boynton MH, Kollins SH, McClernon FJ, Yang C, Fuemmeler BF. Understanding the phenotypic structure of adult retrospective ADHD symptoms during childhood in the United States. J Clin Child Adolesc Psychol 2012; 41:261-74. [PMID: 22394329 DOI: 10.1080/15374416.2012.654465] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a highly heterogeneous disorder, and the phenotypic structure comprising inattentive and hyperactive-impulsive type symptoms has been the focus of a growing body of recent research. Methodological studies are needed to better characterize phenotypes to advance research as well as clinical practice. A large U.S. population-based sample of young adults (N = 14,307, aged 17-28 years, 52.8% female) retrospectively reported their experiences of childhood ADHD symptoms. Factor analysis, latent class analysis, and factor mixture modeling of ADHD symptoms were compared to determine which underlying structure best fit the data. Fit statistics as well as substantive criteria compared models within and across model subtypes. Analyses supported a two-factor two-class structure for both male and female subjects. The two latent factors represented inattentive and hyperactive-impulsive symptom dimensions. The two latent classes divided people into a smaller affected class and a larger unaffected class. Individuals who reported having been diagnosed with ADHD were more likely to be in the affected class (OR male subjects = 4.03, 95% CI [2.65, 6.13]; OR female subjects = 5.65, 95% CI [3.15, 10.10]). This work aids in the understanding of ADHD symptomatology within the population; a majority of people experience very low symptom severity, whereas a minority of people experience high symptom severity. Within this high symptom group, however, variability in symptom experiences exists. Empirical models can be helpful in clarifying ADHD phenotypic structure that has the potential to advance research on the etiology and consequences of ADHD symptoms.
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Affiliation(s)
- Krista W Ranby
- Center for Child and Family Policy, Department of Community and Family Medicine, Duke University MedicalCenter, DUMC Box 104006, Durham, NC 27710, USA
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Ranby KW, MacKinnon DP, Fairchild AJ, Elliot DL, Kuehl KS, Goldberg L. The PHLAME (Promoting Healthy Lifestyles: Alternative Models' Effects) firefighter study: testing mediating mechanisms. J Occup Health Psychol 2011; 16:501-13. [PMID: 21728433 PMCID: PMC3328097 DOI: 10.1037/a0023002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper examines the mechanisms by which PHLAME (Promoting Healthy Lifestyles: Alternative Models' Effects), a health promotion intervention, improved healthy eating and exercise behavior among firefighters, a population at high risk for health problems due to occupational hazards. In a randomized trial, 397 firefighters participated in either the PHLAME team intervention with their work shift or a control condition. Intervention sessions taught benefits of a healthy diet and regular exercise, and sought to improve social norms and social support from coworkers for healthy behavior. At posttest, team intervention participants had increased their fruit and vegetable consumption as compared to control participants. An increase in knowledge of fruit and vegetable benefits and improved dietary coworker norms partially mediated these effects. Exercise habits and VO2 max were related to targeted mediators but were not significantly changed by the team intervention. Partial support was found for both the action and conceptual theories underlying the intervention. Our findings illustrate how an effective program's process can be deconstructed to understand the underpinnings of behavior change and refine interventions. Further, fire stations may improve the health of firefighters by emphasizing the benefits of healthy diet and exercise behaviors while also encouraging behavior change by coworkers as a whole.
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Affiliation(s)
- Krista W Ranby
- Center for Child and Family Policy, Duke University, Durham, NC 27708, USA.
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MacKinnon DP, Elliot DL, Thoemmes F, Kuehl KS, Moe EL, Goldberg L, Burrell GL, Ranby KW. Long-term effects of a worksite health promotion program for firefighters. Am J Health Behav 2010; 34:695-706. [PMID: 20604695 DOI: 10.5993/ajhb.34.6.6] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To describe effects of 2 worksite health promotion programs for firefighters, both immediate outcomes and the long-term consequences for 4 years following the interventions. METHODS At baseline, 599 firefighters were assessed, randomized by fire station to control and 2 different intervention conditions, and reevaluated with 6 annual follow-up measurements. RESULTS Both a team-centered peer-taught curriculum and an individual motivational interviewing intervention demonstrated positive effects on BMI, with team effects on nutrition behavior and physical activity at one year. Most differences between intervention and control groups dissipated at later annual assessments. However, the trajectory of behaviors across time generally was positive for all groups, consistent with lasting effects and diffusion of program benefits across experimental groups within the worksites. CONCLUSIONS Although one-year programmatic effects did not remain over time, the long-term pattern of behaviors suggested these worksites as a whole were healthier more than 3 years following the interventions.
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Affiliation(s)
- David P MacKinnon
- Department of Psychology, Arizona State University, Tempe, AZ 85287-1104, USA.
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Ranby KW, Aiken LS, Gerend MA, Erchull MJ. Perceived susceptibility measures are not interchangeable: absolute, direct comparative, and indirect comparative risk. Health Psychol 2010; 29:20-8. [PMID: 20063932 DOI: 10.1037/a0016623] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To provide an explanation of perceived susceptibility judgment that accounts for both inconsistencies among commonly used measures of perceived susceptibility (i.e., absolute risk, direct comparative risk, and indirect comparative risk) and their inconsistent relationships to disease risk factors. Inconsistencies are attributed to differential processing of general versus personal risk factors, coupled with the method of computation of the risk measures. DESIGN AND MEASURES Study 1 characterized risk factors as general versus personal. In Studies 2 and 3, community-residing adult women (ns = 432 and 147, respectively) rated perceived susceptibility to osteoporosis, breast cancer, heart disease, and diabetes, rated risk factors, and reported personal medical history. RESULTS Correlations and regression analyses mainly supported our characterization of the source of inconsistencies among susceptibility measures and their relationships to risk factors. CONCLUSION Perceived susceptibility measures are not interchangeable and can lead to opposite conclusions about correlates of perceived susceptibility. Researchers are cautioned against using indirect comparative measures, computed as difference scores, and are encouraged to use other methods to compel participants to consider the risk of others when making comparative judgments.
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Affiliation(s)
- Krista W Ranby
- Department of Psychology, Arizona State University, AZ, USA.
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Ranby KW, Aiken LS, Mackinnon DP, Elliot DL, Moe EL, McGinnis W, Goldberg L. A mediation analysis of the ATHENA intervention for female athletes: prevention of athletic-enhancing substance use and unhealthy weight loss behaviors. J Pediatr Psychol 2009; 34:1069-83. [PMID: 19386771 DOI: 10.1093/jpepsy/jsp025] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explain, through mediation analyses, the mechanisms by which ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternatives), a primary prevention and health promotion intervention designed to deter unhealthy body shaping behaviors among female high school athletes, produced immediate changes in intentions for unhealthy weight loss and steroid/creatine use, and to examine the link to long-term follow-up intentions and behaviors. METHODS In a randomized trial of 1668 athletes, intervention participants completed coach-led peer-facilitated sessions during their sport season. Participants provided pre-test, immediate post-test, and 9-month follow-up assessments. RESULTS ATHENA decreased intentions for steroid/creatine use and intentions for unhealthy weight loss behaviors at post-test. These effects were most strongly mediated by social norms and self-efficacy for healthy eating. Low post-test intentions were maintained 9 months later and predicted subsequent behavior. CONCLUSIONS ATHENA successfully modified mediators that in turn related to athletic-enhancing substance use and unhealthy weight loss practices. Mediation analyses aid in the understanding of health promotion interventions and inform program development.
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