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Langer SL, Joseph RP, Mistretta EG, Tao C, Porter LS, Campos AS, Khera N. Family-Focused Facilitated Fitness: Feasibility and Acceptability of a Couple-Based Physical Activity Intervention for Hematopoietic Cell Transplant Recipients and Their Caregiving Partners. Transplant Cell Ther 2024; 30:450.e1-450.e17. [PMID: 38244696 DOI: 10.1016/j.jtct.2024.01.066] [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: 06/30/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
Reductions in physical activity (PA) are common among patients following hematopoietic cell transplantation, and a risk factor for poor physical functioning. PA among spouses/cohabiting partners, who frequently serve as the patient's primary caregiver, may also be reduced due to caregiving demands and limited bandwidth for self-care. In addition, the patient-caregiver relationship can be compromised, and communication patterns disrupted. All PA interventions in the hematopoietic cell transplantation setting have focused entirely on patients, ignoring an opportunity to synergistically engage and benefit the caregiver as well. We sought to test feasibility and acceptability of a couple-based intervention entitled Family-Focused Facilitated Fitness (FFFF), designed to improve PA as assessed by daily step counts among both patients undergoing hematopoietic cell transplantation and their caregivers. Guided by interdependence and communal coping perspectives, FFFF is an 8-week, remotely-delivered intervention that provides training in communication skills and joint problem-solving to help patients and caregivers support one another in PA. Participants are also given a Fitbit to track their steps and weekly individualized step prescription based on the 75th percentile ranked value of their last 7 recorded daily step counts. A priori benchmarks for feasibility and acceptability in this single-arm pilot were as follows: 50% of eligible couples would agree to participate, 70% of couples would attend all 8 sessions, 80% of participants would provide valid Fitbit wear data 4/7 days/ week, and among sessions reviewed for treatment fidelity, 85% of treatment protocol elements would be covered. Couples were recruited prior to transplant. Among 26 couples approached and deemed eligible, 17 enrolled (65% agreement) and completed baseline assessment. Three couples later withdrew after transplantation but prior to receiving the intervention, resulting in 14 couples commencing the intervention, on average 21 days post-transplant. Four couples subsequently discontinued due to medical complications (n = 3) or caregiver schedule (n = 1). Among the 10 couples who completed the intervention, the percentage of participants meeting our benchmark of valid Fitbit wear at least 4 days per week was 85% in week 1, 90% in weeks 2 to 7, and 80% in week 8. Treatment fidelity was 95% on average across 24 sessions reviewed (3 cases). Treatment satisfaction scores were uniformly high across multiple dimensions, with all means above 4 on the 1 to 5 scale. Daily step counts among those attending all 8 intervention sessions increased from 2249 ± 302 steps/day in week 1 to 4975 ± 1377 steps/day in week 8 among patients, and from 8676 ± 3760 steps/day in week 1 to 9838 ± 3723 steps/day in week 8 among caregivers. Qualitative feedback indicated perceived mental and physical health benefits of the program. Participants also offered suggestions for adaptations to accommodate medical setbacks and constraints. All a priori feasibility benchmarks were met or exceeded. Results offer promise for utility of the program to engage and leverage patient-caregiver dyads to increase PA following transplant. An investigation using a randomized controlled design will be necessary to adequately examine change over time relative to control and its possible impact on clinical and patient-reported outcomes.
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Affiliation(s)
- Shelby L Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ.
| | - Rodney P Joseph
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Erin G Mistretta
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Chun Tao
- Mayo Clinic Arizona, Phoenix, AZ
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Leo K, Langer SL, Porter LS, Ramos K, Romano JM, Baucom DH, Baucom BRW. Couples communication and cancer: Sequences and trajectories of behavioral affective processes in relation to intimacy. J Fam Psychol 2024; 38:246-259. [PMID: 38127494 DOI: 10.1037/fam0001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Cancer poses a set of physical and emotional challenges to the patient, spouse, and their relationship. One challenge for couples is discussing cancer-related concerns in a manner that facilitates intimacy. Current couple-based interventions have been shown to have mixed efficacy, and little is known about how they bring about improvements. This study aims to expand our understanding of dyadic communication and intimacy to adapt and/or develop more effective interventions for couples coping with cancer. To accomplish this goal, the present study examined affective and behavioral processes associated with intimacy using the valence-affective-connection (VAC) framework and observational coding methods. Participants were 134 couples in which a patient was diagnosed with breast, colorectal, or lung cancer. Couples completed a battery of questionnaires, including a self-report measure of intimacy. Couples also completed a 15-min videotaped interaction about a cancer topic of their choosing, which was observationally coded for communication behavior and affective expression. Couples coping with cancer who reported higher versus lower intimacy engaged in qualitatively different levels, types, and patterns of communication behavior and affective expression. Specifically, couples who reported lower relationship intimacy used negative approach behavior and hard negative affect more frequently and for longer periods of time and were more likely to use avoidance-based communication. Higher intimacy couples were less likely to sustain the use of negative behavior and affect and displayed more reciprocity of positive joining affect. The study highlights important considerations for couple-based interventions and research in the context of cancer. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Karena Leo
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Shelby L Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Katherine Ramos
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Joan M Romano
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | - Donald H Baucom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
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Bell-Brown A, Watabayashi K, Delaney D, Carlos RC, Langer SL, Unger JM, Vaidya RR, Darke AK, Hershman DL, Ramsey SD, Shankaran V. Assessment of financial screening and navigation capabilities at National Cancer Institute community oncology clinics. JNCI Cancer Spectr 2023; 7:pkad055. [PMID: 37561111 PMCID: PMC10471524 DOI: 10.1093/jncics/pkad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 05/24/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Cancer-related financial hardship is a side effect of cancer diagnosis and treatment, and affects both patients and caregivers. Although many oncology clinics have increased financial navigation services, few have resources to proactively provide financial counseling and assistance to families affected by cancer before financial hardship occurs. As part of an ongoing randomized study testing a proactive financial navigation intervention, S1912CD, among sites of the National Cancer Institute Community Oncology Research Program (NCORP), we conducted a baseline survey to learn more about existing financial resources available to patients and caregivers. METHODS The NCORP sites participating in the S1912CD study completed a required 10-question survey about their available financial resources and an optional 5-question survey that focused on financial screening and navigation workflow and challenges prior to starting recruitment. The proportion of NCORP sites offering financial navigation services was calculated and responses to the optional survey were reviewed to determine current screening and navigation practices and identify any challenges. RESULTS Most sites (96%) reported offering financial navigation for cancer patients. Sites primarily identified patients needing financial assistance through social work evaluations (78%) or distress screening tools (76%). Sites revealed challenges in addressing financial needs at the outset and through diagnosis, including lack of proactive screening and referral to financial navigation services as well as staffing challenges. CONCLUSIONS Although most participating NCORP sites offer some form of financial assistance, the survey data enabled identification of gaps and challenges in providing services. Utilizing community partners to deliver comprehensive financial navigation guidance to cancer patients and caregivers may help meet needs while reducing site burden.
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Affiliation(s)
- Ari Bell-Brown
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Kate Watabayashi
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Debbie Delaney
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Ruth C Carlos
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, MI, United States
| | - Shelby L Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, AZ State University, Phoenix, AZ, United States
| | - Joseph M Unger
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States
- SWOG Statistics and Data Management Center, Seattle, WA, United States
| | - Riha R Vaidya
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States
- SWOG Statistics and Data Management Center, Seattle, WA, United States
| | - Amy K Darke
- SWOG Statistics and Data Management Center, Seattle, WA, United States
| | - Dawn L Hershman
- Division of Hematology/Oncology, Columbia University, New York, NY, United States
| | - Scott D Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Veena Shankaran
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA, United States
- Division of Hematology, University of Washington, Seattle, WA, USA, United States
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Weber DM, Baucom BRW, Baucom DH, Fischer MS, Ramos K, Romano JM, Porter LS, Langer SL. Concurrent and Prospective Associations Between Communicated Emotional Arousal and Adjustment Among Couples Coping With Cancer. Ann Behav Med 2023; 57:753-764. [PMID: 37178456 PMCID: PMC10441863 DOI: 10.1093/abm/kaad017] [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: 05/15/2023] Open
Abstract
BACKGROUND The experience of cancer can create considerable emotional distress for patients and their committed partners. How couples communicate about cancer-related concerns can have important implications for adjustment. However, past research has primarily utilized cross-sectional designs and retrospective self-reports of couple communication. While informative, little is known about how patients and partners express emotion during conversations about cancer, and how these emotional patterns predict individual and relational adjustment. PURPOSE The current investigation examined how patterns of emotional arousal within couples' communication about cancer was associated with concurrent and prospective individual psychological and relational adjustment. METHODS At baseline, 133 patients with stage II- breast, lung, or colorectal cancer and their partners completed a conversation about a cancer-related concern. Vocally expressed emotional arousal (f0) was extracted from recorded conversations. Couples completed self-report measures of individual psychological and relational adjustment at baseline and at 4, 8, and 12 months later. RESULTS Couples who started the conversation higher in f0 (i.e., greater emotional arousal) reported better individual and relational adjustment at baseline. If the non-cancer partner had lower f0 relative to patients, this predicted worse individual adjustment across follow-up. Additionally, couples who maintained their level of f0 rather than decreasing later in the conversation reported improvements in individual adjustment across follow-up. CONCLUSIONS Elevated emotional arousal within a cancer-related conversation may be adaptive for adjustment, as it may reflect greater emotional engagement and processing of an important topic. These results may suggest ways for therapists to guide emotional engagement to enhance resilience in couples experiencing cancer.
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Affiliation(s)
- Danielle M Weber
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian R W Baucom
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Donald H Baucom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melanie S Fischer
- Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Katherine Ramos
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Joan M Romano
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Shelby L Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
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Cheng Q, Krajmalnik-Brown R, DiBaise JK, Maldonado J, Guest MA, Todd M, Langer SL. Relationship Functioning and Gut Microbiota Composition among Older Adult Couples. Int J Environ Res Public Health 2023; 20:ijerph20085435. [PMID: 37107717 PMCID: PMC10138905 DOI: 10.3390/ijerph20085435] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/11/2023] [Accepted: 03/23/2023] [Indexed: 05/11/2023]
Abstract
An emerging area of research extends work on couple functioning and physical health to gut health, a critical marker of general health and known to diminish with age. As a foray into this area, we conducted a pilot study to (1) determine the feasibility of remote data collection, including a fecal sample, from older adult couples, (2) examine within-couple concordance in gut microbiota composition, and (3) examine associations between relationship functioning and gut microbiota composition. Couples (N = 30) were recruited from the community. The participants' demographic characteristics were as follows: M (SD) age = 66.6 (4.8), 53% female, 92% White, and 2% Hispanic. Two of the couples were same-sex. All 60 participants completed self-report measures and supplied a fecal sample for microbiome analysis. Microbial DNA was extracted from the samples, and the 16S rRNA gene V4 region was amplified and sequenced. The results indicated that individuals shared more similar gut microbial composition with their partners than with others in the sample, p < 0.0001. In addition, individuals with better relationship quality (greater relationship satisfaction and intimacy and less avoidant communication) had greater microbial diversity, p < 0.05, a sign of healthier gut microbiota. Further research with a larger and more diverse sample is warranted to elucidate mechanisms.
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Affiliation(s)
- Qiwen Cheng
- Biodesign Center for Health through Microbiomes, Arizona State University, Tempe, AZ 85281, USA; (Q.C.); (R.K.-B.)
| | - Rosa Krajmalnik-Brown
- Biodesign Center for Health through Microbiomes, Arizona State University, Tempe, AZ 85281, USA; (Q.C.); (R.K.-B.)
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, AZ 85281, USA
| | - John K. DiBaise
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Scottsdale, AZ 85259, USA;
| | - Juan Maldonado
- Knowledge Enterprise Genomics Core, Arizona State University, Tempe, AZ 85281, USA;
| | - M. Aaron Guest
- Center for Innovation in Healthy and Resilient Aging, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA;
| | - Michael Todd
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA
| | - Shelby L. Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA
- Correspondence: ; Tel.: +1-602-496-0823
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Ramos K, Leo K, Porter LS, Romano JM, Baucom BRW, Langer SL. Attachment in Couples Coping with Cancer: Associations with Observed Communication and Long-Term Health. Int J Environ Res Public Health 2023; 20:5249. [PMID: 37047865 PMCID: PMC10094343 DOI: 10.3390/ijerph20075249] [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] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
Cancer poses a threat to well-being that may activate the attachment system and influence interpersonal dynamics, such as communication. Research indicates that avoidant and anxious attachment, as well as communication, are independently associated with poorer psychosocial well-being, yet studies examining links between attachment, communication, and long-term physical well-being are lacking. We examined (a) associations between patient and partner attachment (measured with the adult attachment scale [AAS-Revised]) and observed communication (across affect [the Relational Affective Topography System (RATS) coding system] and behavior [the Asymmetric Behavior Coding System (ABCS) coding system]) and (b) the extent to which attachment and communication independently predicted long-term physical well-being (measured by the Functional Assessment of Cancer Therapy-General Population [FACT-GP]). Participants were 134 couples [mean age 53.9 (SD = 13.4), 86.2% Caucasian, 66% of patients, 36% of partners female]. Patient participants had either breast, colorectal, or lung cancer. Couples individually completed self-report measures of attachment (baseline) and physical well-being (baseline and 4, 8, and 12 months later). At baseline, couples engaged in a 15 min videorecorded cancer-related conversation coded for communication behavior and affective expression. Patients and partners with higher anxious and avoidant attachment exhibited more negative affect and negative approach behaviors. A greater avoidant attachment was associated with less positive affective expression. Attachment insecurity and affective expression were prospectively linked with physical well-being. Findings indicate that attachment is associated with overt communication behaviors and that insecure attachment and affective expression may be risk factors for poorer health outcomes.
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Affiliation(s)
- Katherine Ramos
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
- Center for the Study of Human Aging and Development, Duke University, Durham, NC 27705, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC 27705, USA
| | - Karena Leo
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
| | - Laura S. Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
| | - Joan M. Romano
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA
| | - Brian R. W. Baucom
- Department of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Shelby L. Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA
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Langer SL, Yi JC, Syrjala KL, Schoemans H, Mukherjee A, Lee SJ. Prevalence and Factors Associated with Marital Distress among Hematopoietic Cell Transplant Survivors: Results from a Large Cross-sectional Study. Transplant Cell Ther 2022; 28:333.e1-333.e7. [DOI: 10.1016/j.jtct.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/28/2022]
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Langer SL, Romano JM, Keefe F, Baucom DH, Strauman T, Syrjala KL, Bolger N, Burns J, Bricker JB, Todd M, Baucom BRW, Fischer MS, Ghosh N, Gralow J, Shankaran V, Zafar SY, Westbrook K, Leo K, Ramos K, Weber DM, Porter LS. Couple Communication in Cancer: Protocol for a Multi-Method Examination. Front Psychol 2022; 12:769407. [PMID: 35222142 PMCID: PMC8865086 DOI: 10.3389/fpsyg.2021.769407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/28/2021] [Indexed: 01/18/2023] Open
Abstract
Cancer and its treatment pose challenges that affect not only patients but also their significant others, including intimate partners. Accumulating evidence suggests that couples' ability to communicate effectively plays a major role in the psychological adjustment of both individuals and the quality of their relationship. Two key conceptual models have been proposed to account for how couple communication impacts psychological and relationship adjustment: the social-cognitive processing (SCP) model and the relationship intimacy (RI) model. These models posit different mechanisms and outcomes, and thus have different implications for intervention. The purpose of this project is to test and compare the utility of these models using comprehensive and methodologically rigorous methods. Aims are: (1) to examine the overall fit of the SCP and RI models in explaining patient and partner psychological and relationship adjustment as they occur on a day-to-day basis and over the course of 1 year; (2) to examine the fit of the models for different subgroups (males vs. females, and patients vs. partners); and (3) to examine the utility of various methods of assessing communication by examining the degree to which baseline indices from different measurement strategies predict self-reported adjustment at 1-year follow up. The study employs a longitudinal, multi-method approach to examining communication processes including: standard self-report questionnaires assessing process and outcome variables collected quarterly over the course of 1 year; smartphone-based ecological momentary assessments to sample participant reports in real time; and laboratory-based couple conversations from which we derive observational measures of communicative behavior and affective expression, as well as vocal indices of emotional arousal. Participants are patients with stage II-IV breast, colon, rectal, or lung cancer and their spouses/partners, recruited from two NCI-designated comprehensive cancer centers. Results will be published in scientific journals, presented at scientific conferences, and conveyed to a larger audience through infographics and social media outlets. Findings will inform theory, measurement, and the design and implementation of efficacious interventions aimed at optimizing both patient and partner well-being.
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Affiliation(s)
- Shelby L. Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Joan M. Romano
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Francis Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Donald H. Baucom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Timothy Strauman
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Karen L. Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Niall Bolger
- Department of Psychology, Columbia University, New York, NY, United States
| | - John Burns
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Jonathan B. Bricker
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Michael Todd
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Brian R. W. Baucom
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Melanie S. Fischer
- Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Neeta Ghosh
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Julie Gralow
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA, United States
| | - Veena Shankaran
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA, United States
| | - S. Yousuf Zafar
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Kelly Westbrook
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Karena Leo
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Katherine Ramos
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Danielle M. Weber
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Laura S. Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
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Langer SL, Castro FG, Chen ACC, Davis KC, Joseph RP, Kim WS, Larkey L, Lee RE, Petrov ME, Reifsnider E, Youngstedt SD, Shaibi GQ. Recruitment and retention of underrepresented and vulnerable populations to research. Public Health Nurs 2021; 38:1102-1115. [PMID: 34240459 DOI: 10.1111/phn.12943] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 11/23/2020] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
Per principles outlined in the Belmont Report, research involving human subjects should minimize risks to participants and maximize benefits to participants and society. Recruitment of participants should be equitable. Once enrolled, participants have the right to withdraw at any point. Researchers must balance these principles with pressures to meet enrollment goals and, in the context of repeated-measures designs, retain participants across time. The purpose of this perspective is to describe the approach and corresponding activities for recruiting and retaining underrepresented and vulnerable populations that are the focus of a transdisciplinary academic research center. To this effort, we offer diverse disciplinary backgrounds, experience working with a wide range of populations (from infants to older adults and across multiple health conditions), and spanning a variety of research designs. Effective strategies offered include partnering with community entities, approaching potential participants where they are and at a time of readiness, using population-appropriate modes of communication and data collection, conducting study activities in familiar settings and at convenient times, maintaining frequent contact, and offering meaningful incentives. These strategies are consistent with population-specific reports found in the extant literature and underscore their cross-cutting nature, with adaptations based on participant and community partner needs and preferences.
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Affiliation(s)
- Shelby L Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Felipe González Castro
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Angela Chia-Chen Chen
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Kelly Cue Davis
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Rodney P Joseph
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Wonsun Sunny Kim
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Linda Larkey
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Megan E Petrov
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Elizabeth Reifsnider
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Shawn D Youngstedt
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
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10
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Joseph RP, Pituch KA, Guest MA, Maxfield M, Peckham A, Coon DW, Kim W, Langer SL. Physical Activity Among Predominantly White Middle-Aged and Older US Adults During the SARS-CoV-2 Pandemic: Results From a National Longitudinal Survey. Front Public Health 2021; 9:652197. [PMID: 33928065 PMCID: PMC8076643 DOI: 10.3389/fpubh.2021.652197] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/11/2021] [Accepted: 03/08/2021] [Indexed: 01/21/2023] Open
Abstract
Background: The first COVID-19 case in the US was diagnosed late January 2020. In the subsequent months, cases grew exponentially. By March 2020, SARS-CoV-2 (the novel coronavirus that causes COVID-19) was a global pandemic and the US declared a national emergency. To mitigate transmission, federal guidelines were established for social and physical distancing. These events disrupted daily routines of individuals around the world, including Americans. The impact of the pandemic on PA patterns of Americans is largely unknown, especially among those at greater risk for severe COVID-19 outcomes. The aim of this study was to assess levels of PA over time during the pandemic among US adults aged >50 years. Methods: Data were collected as part of a web-based, longitudinal, 3-wave study examining health and well-being among adults aged > 50. PA data were collected at Waves 2 and 3 using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). At Wave 2 (conducted mid-May to early June, 2020), participants completed the IPAQ-SF twice, once in reference to a typical 7-day period before the pandemic, and again in reference to the past 7 days. At Wave 3 (conducted mid-June to early July 2020), participants completed the IPAQ-SF once, with reference to the past 7 days. Potential predictors of PA change were collected using items from previously established surveys and included demographic characteristics, pre-pandemic PA levels, perceived COVID-19 threat, self-rated general health, and number of chronic disease conditions. Results: Respondents (N = 589) had a mean age of 63 ± 7.39 years and were mostly female (88%) and non-Hispanic White (96%). Mean MET-min/week across the three time-referents were 2,904 (pre-pandemic), 1,682 (Wave 2 past 7-days), and 2,001 (Wave 3 past 7-days), with PA declining between the first and second time referents (d = -0.45, p < 0.001) and remaining below pre-pandemic levels at the third (d = -0.34, p < 0.001). Changes over time were predicted by pre-pandemic PA and self-rated general health (p's < .05). Conclusions: Effective strategies are needed to promote safe and socially-distanced PA among adults aged >50 years until the risk of contracting COVID-19 subsides. In the post-pandemic era, PA programming will be imperative to address pandemic-associated declines in PA.
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Affiliation(s)
- Rodney P Joseph
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Keenan A Pituch
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - M Aaron Guest
- Center for Innovation in Healthy and Resilient Aging, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Molly Maxfield
- Center for Innovation in Healthy and Resilient Aging, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Allie Peckham
- Center for Innovation in Healthy and Resilient Aging, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - David W Coon
- Center for Innovation in Healthy and Resilient Aging, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Wonsun Kim
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Shelby L Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
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11
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Syrjala KL, Schoemans H, Yi JC, Langer SL, Mukherjee A, Onstad L, Lee SJ. Sexual Functioning in Long-Term Survivors of Hematopoietic Cell Transplantation. Transplant Cell Ther 2020; 27:80.e1-80.e12. [PMID: 33002641 DOI: 10.1016/j.bbmt.2020.09.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 07/27/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022]
Abstract
This investigation characterized sexual activity and sexual function in hematopoietic cell transplantation (HCT) survivors, compared them with norms, and examined factors associated with sexual dysfunction, with the goal of identifying targets for intervention to improve sexual health. Surviving adults from a large transplantation center were asked to complete an annual survey with a core of health questions and a module on sexual activity and function. Participants completed the Sexual Function Questionnaire, Cancer and Treatment Distress form, and Revised Dyadic Adjustment Scale. Clinical data were collected from the transplantation medical database. Multivariate logistic regressions identified factors associated with sexual activity and function. Participating survivors (n = 1742) were a mean of 11.9 years (range, .4 to 43.1 years) after HCT, mean age 57.6 years, and 53% male. Women were more likely than men to report being sexually inactive in the past year (39% versus 27%) and, among those sexually active, to report low sexual function (64% versus 32%). Male and female survivors reported lower rates of sexual activity and function than comparison norms (all P < .01). In regressions, factors associated with being sexually inactive included older age, having <4 years of college education, low performance status, and not being in a committed relationship. Additional factors for men included receipt of nonmyeloablative conditioning and not being employed or in school. Low sexual functioning for men and women was associated with low performance status, and, for women, a committed relationship of lower quality, while for men the association was with older age. Sexual dysfunction is common in both men and women after HCT, regardless of time since treatment. Survivors need routine evaluation and access to multimodal interventions.
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Affiliation(s)
- Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Psychiatry and Behavioral Science and Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
| | - Hélène Schoemans
- Department of Hematology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Jean C Yi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Shelby L Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Ahona Mukherjee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lynn Onstad
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Psychiatry and Behavioral Science and Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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12
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Khera N, Kumbamu A, Langer SL, Jatoi A, Kamath CC, Mathew E, Zafar YS, Griffin JM. Developing an Educational Intervention to Address Financial Hardship in Cancer Patients. Mayo Clin Proc Innov Qual Outcomes 2020; 4:424-433. [PMID: 32793870 PMCID: PMC7411165 DOI: 10.1016/j.mayocpiqo.2020.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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] [Indexed: 11/26/2022] Open
Abstract
Objective To develop an educational intervention to empower patients to manage their financial health better. Participants and Methods This study was conducted from September 1, 2017, to January 31, 2019. Focus groups were held with social workers, case managers, and patient financial service staff and interviews were conducted with patients and caregivers to inform the content, delivery format, and timing of an intervention for mitigating financial hardship from treatment (phase 1). Based on qualitative data, theories of adult learning, and a review of the literature, we created an educational presentation to be delivered in a classroom setting. Two patient focus groups were then held for feedback on the presentation (phase 2). Results In phase 1, both patients and allied health care staff providers believed that an educational intervention about financial aspects of care early during treatment would help them cope and plan better. Participants' suggestions for the intervention's content included billing information, insurance, authorization processes, employment policies related to health care and disability benefits, and alternative financial resources. Based on these suggestions, a preliminary educational presentation was developed with 3 main themes: insurance issues, employment issues, and financial health. Phase 2 focus group participants suggested refinement of the presentation, including targeting specific groups, adding graphics, and more information about resources. Conclusion Our study provides the basis for a patient-centered education module for emotional, instrumental, and informational support for financial distress for use in a clinical setting.
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Affiliation(s)
- Nandita Khera
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ
| | - Ashok Kumbamu
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | - Shelby L Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Aminah Jatoi
- Division of Medical Oncology, Mayo Clinic, Rochester, MN
| | - Celia C Kamath
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | - Joan M Griffin
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
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13
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Langer SL, Ghosh N, Todd M, Randall AK, Romano JM, Bricker JB, Bolger N, Burns JW, Hagan RC, Porter LS. Usability and Acceptability of a Smartphone App to Assess Partner Communication, Closeness, Mood, and Relationship Satisfaction: Mixed Methods Study. JMIR Form Res 2020; 4:e14161. [PMID: 32628614 PMCID: PMC7381078 DOI: 10.2196/14161] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/14/2020] [Indexed: 01/29/2023] Open
Abstract
Background Interpersonal communication is critical for a healthy romantic relationship. Emotional disclosure, coupled with perceived partner responsiveness, fosters closeness and adjustment (better mood and relationship satisfaction). On the contrary, holding back from disclosure is associated with increased distress and decreased relationship satisfaction. Prior studies assessing these constructs have been cross-sectional and have utilized global retrospective reports of communication. In addition, studies assessing holding back or perceived partner responsiveness have not taken advantage of smartphone ownership for data collection and have instead required website access or use of a study-provided device. Objective This study aimed to examine the (1) usability and acceptability of a smartphone app designed to assess partner communication, closeness, mood, and relationship satisfaction over 14 days and (2) between-person versus within-person variability of key constructs to inform the utility of their capture via ecological momentary assessment using the participants’ own handheld devices. Methods Adult community volunteers in a married or cohabiting partnered relationship received 2 smartphone prompts per day, one in the afternoon and one in the evening, for 14 days. In each prompt, participants were asked whether they had conversed with their partner either since awakening (afternoon prompt) or since the last assessment (evening prompt). If yes, a series of items assessed enacted communication, perceived partner communication, closeness, mood, and relationship satisfaction (evening only). Participants were interviewed by phone, 1 week after the end of the 14-day phase, to assess perceptions of the app. Content analysis was employed to identify key themes. Results Participants (N=27; mean age 36, SD 12 years; 24/27, 89% female; 25/27, 93% white and 2/27, 7% Hispanic) responded to 79.2% (555/701) of the total prompts sent and completed 553 (78.9%) of those assessments. Of the responded prompts, 79.3% (440/555) were characterized by a report of having conversed with one’s partner. The app was seen as highly convenient (mean 4.15, SD 0.78, scale: 1-5) and easy to use (mean 4.39, SD 0.70, scale: 1-5). Qualitative analyses indicated that participants found the app generally easy to navigate, but the response window too short (45 min) and the random nature of receiving notifications vexing. With regard to the variability of the app-delivered items, intraclass correlation coefficients were generally <0.40, indicating that the majority of the variability in each measure was at the within-person level. Notable exceptions were enacted disclosure and relationship satisfaction. Conclusions The findings of this study support the usability and acceptability of the app, with valuable user input to modify timing windows in future work. The findings also underscore the utility of an intensive repeated-measures approach, given the meaningful day-to-day variation (greater within-person vs between-person variability) in communication and mood.
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Affiliation(s)
- Shelby L Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Neeta Ghosh
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Michael Todd
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Ashley K Randall
- Counseling and Counseling Psychology, College of Integrative Sciences and Arts, Arizona State University, Phoenix, AZ, United States
| | - Joan M Romano
- Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Department of Psychology, University of Washington, Seattle, WA, United States
| | - Niall Bolger
- Department of Psychology, Columbia University, New York, NY, United States
| | - John W Burns
- Psychiatry and Behavioral Sciences, Rush Medical College, Rush University, Chicago, IL, United States
| | - Rachel C Hagan
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Laura S Porter
- Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, United States
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14
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Langer SL, Yi JC, Chi NC, Lindhorst T. Psychological Impacts and Ways of Coping Reported by Spousal Caregivers of Hematopoietic Cell Transplant Recipients: A Qualitative Analysis. Biol Blood Marrow Transplant 2020; 26:764-771. [DOI: 10.1016/j.bbmt.2019.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/08/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022]
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15
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Sherwood NE, Levy RL, Seburg EM, Crain AL, Langer SL, JaKa MM, Kunin‐Batson A, Jeffery RW. The Healthy Homes/Healthy Kids 5-10 Obesity Prevention Trial: 12 and 24-month outcomes. Pediatr Obes 2019; 14:e12523. [PMID: 30873752 PMCID: PMC8853652 DOI: 10.1111/ijpo.12523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/21/2018] [Revised: 01/22/2019] [Accepted: 02/17/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pediatric primary care is an important setting for addressing obesity prevention. OBJECTIVE The Healthy Homes/Healthy Kids 5-10 randomized controlled trial evaluated the efficacy of an obesity prevention intervention integrating pediatric primary care provider counseling and parent-targeted phone coaching. METHODS Children aged 5 to 10 years with a BMI between the 70th and 95th percentile and their parents were recruited from pediatric primary care clinics. Participants received well-child visit provider counseling about obesity and safety/injury prevention and were then randomized to a 14-session phone-based obesity prevention (OP; n = 212) or safety and injury prevention contact control (CC; n = 209) intervention. The primary outcome was 12 and 24-month child BMI percentile. RESULTS There was no overall significant treatment effect on child BMI percentile. Caloric intake was significantly lower among OP compared with CC participants at 12 months (P < .005). In planned subgroup analyses, OP condition girls had significantly lower BMI percentile (P < .05) and BMI z-score (P < .02) at 12 and 24 months relative to CC girls and were less likely to be overweight (38.0% vs 53.0%, P < .01) or (obese 3.4% vs 8.8%, P < .10) at follow-up. CONCLUSIONS AND RELEVANCE An obesity prevention intervention integrating brief provider counseling and parent-targeted phone counseling did not impact 12 and 24-month BMI status overall but did have a significant impact on BMI in girls.
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Affiliation(s)
- Nancy E. Sherwood
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rona L. Levy
- UW School of Social Work (SSW), Seattle, WA, USA
| | | | | | - Shelby L. Langer
- UW School of Social Work (SSW), Seattle, WA, USA,Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Meghan M. JaKa
- DC Department of Behavioral Health, Applied Research and Evaluation, Washington, DC, USA
| | | | - Robert W. Jeffery
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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16
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Beresford SA, Bowen DJ, Littman AJ, Albano DL, Chan KG, Langer SL, Barrington WE, Patrick DL. Relationship of Socioeconomic Status Indicators to Obesity in Hispanic and Non-Hispanic White Middle-Aged Women: A Population Study. ACTA ACUST UNITED AC 2019; 5. [PMID: 31008438 DOI: 10.23937/2474-1353/1510090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/05/2022]
Abstract
Background Obesity rates differ between Hispanic and White (non-Hispanic) women in the United States, with higher rates among Hispanic women. Socioeconomic processes contribute to this disparity both at the individual and the environmental level. Understanding these complex relationships requires multilevel analyses within cohorts of women that have a shared environment. In population-based samples of Hispanic and White (non-Hispanic) women from the same neighborhoods, we evaluated within each ethnic group a) The association of individual-level socioeconomic status (SES) with body mass index (BMI); and b) The additional contribution of neighborhood-level measures of SES. Methods Using population-based multi-stage sampling methods, we oversampled low SES and Hispanic block groups. During household screening, we identified women aged 30 to 50 years. Among White women, we specifically oversampled women with low educational levels. 515 Hispanic and 503 White women completed baseline. Height and weight were measured. Baseline surveys, in Spanish and English, included four measures of SES. Three measures of area-level SES were examined. Analysis of loge BMI on each SES measure used linear mixed models, incorporating design effects. Results Among White women, low education, social status, and neighborhood SES were associated with higher BMI (p < 0.001, p < 0.0001, and p < 0.05, respectively), independent of other SES measures. Although the highest grouped category of education, income and subjective social status within the Hispanic cohort had the lowest mean estimated BMI, the point estimates across categories were not monotonic, and had wide confidence intervals. As a result, in contrast to the findings among White women, no statistically significant associations were found between BMI and measures of SES among Hispanic women. Discussion Neighborhood and individual measures of SES operate differently in Hispanic compared with White women. We had assumed the measures we included to be most salient and operate similarly for both groups of women. Rather the salient factors for Hispanic women have yet to be identified. Improved understanding may ultimately inform the design of culturally-relevant multilevel obesity prevention strategies.
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Affiliation(s)
- Shirley Aa Beresford
- Department of Epidemiology, University of Washington, Seattle, USA.,Cancer Prevention Program, Fred Hutch, Seattle, USA
| | - Deborah J Bowen
- Department of Bioethics & Humanities, University of Washington, Seattle, USA
| | - Alyson J Littman
- Department of Epidemiology, University of Washington, Seattle, USA.,Seattle Epidemiologic Research and Information Center (ERIC), VA Puget Sound Health Care System, USA.,Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, USA
| | - Denise L Albano
- Department of Epidemiology, University of Washington, Seattle, USA.,Cancer Prevention Program, Fred Hutch, Seattle, USA
| | - Kc Gary Chan
- Department of Biostatistics, University of Washington, Seattle, USA
| | - Shelby L Langer
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, USA
| | - Wendy E Barrington
- Department of Psychosocial & Community Health, Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, USA
| | - Donald L Patrick
- Department of Health Services, University of Washington, Seattle, USA.,Cancer Prevention Program, Fred Hutch, Seattle, USA
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17
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Langer SL, Soltero EG, Beresford SA, McGregor BA, Albano DL, Patrick DL, Bowen DJ. Socioeconomic status differences in food consumption following a laboratory-induced stressor. Health Psychol Open 2018; 5:2055102918804664. [PMID: 30345065 PMCID: PMC6187431 DOI: 10.1177/2055102918804664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Indexed: 11/17/2022] Open
Abstract
We examined food consumption in response to a laboratory-induced stressor (two challenging neuropsychological tasks) among non-Hispanic White women categorized as lower or higher in socioeconomic status based on education. The two socioeconomic status groups did not differ with respect to current hunger or baseline dietary habits. Perceived stress was measured pre- and post-challenge. Snacks were offered post-challenge; food consumption was measured by weighing snack bowls pre- and post-offering. Perceived stress increased pre- to post-challenge for both groups, but this effect was stronger for women lower in socioeconomic status. In addition, women lower versus higher in socioeconomic status consumed more food overall and more high-fat sweet food in particular (large effect sizes). These findings provide evidence of socioeconomic status differences in food consumption following an acute stressor.
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18
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Langer SL, Romano JM, Todd M, Strauman TJ, Keefe FJ, Syrjala KL, Bricker JB, Ghosh N, Burns JW, Bolger N, Puleo BK, Gralow JR, Shankaran V, Westbrook K, Zafar SY, Porter LS. Links Between Communication and Relationship Satisfaction Among Patients With Cancer and Their Spouses: Results of a Fourteen-Day Smartphone-Based Ecological Momentary Assessment Study. Front Psychol 2018; 9:1843. [PMID: 30364167 PMCID: PMC6191515 DOI: 10.3389/fpsyg.2018.01843] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 06/04/2018] [Accepted: 09/10/2018] [Indexed: 11/13/2022] Open
Abstract
Cancer treatment poses significant challenges not just for those diagnosed with the disease but also for their intimate partners. Evidence suggests that couples' communication plays a major role in the adjustment of both individuals and in the quality of their relationship. Most descriptive studies linking communication to adjustment have relied on traditional questionnaire methodologies and cross-sectional designs, limiting external validity and discernment of temporal patterns. Using the systemic-transactional model of dyadic coping as a framework, we examined intra- and inter-personal associations between communication (both enacted and perceived) and relationship satisfaction (RS) among patients with stage II-IV breast or colorectal cancer and their spouses (N = 107 couples). Participants (mean age = 51, 64.5% female patients, and 37.4% female spouses) independently completed twice-daily ecological momentary assessments (EMA) via smartphone for 14 consecutive days. Items assessed RS and communication (expression of feelings, holding back from expression, support and criticism of partner, and parallel ratings of partner behavior). Linear mixed models employing an Actor Partner Interdependence Model were used to examine concurrent, time-lagged, and cross-lagged associations between communication and RS. Expressing one's feelings was unassociated with RS. Holding back from doing so, in contrast, was associated with lower RS for both patients and spouses in concurrent models. These effects were both intrapersonal and interpersonal, meaning that when individuals held back from expressing their feelings, they reported lower RS and so too did their partner. Giving and receiving support were associated with one's own higher RS for both patients and spouses in concurrent models, and for patients in lagged models. Conversely, criticizing one's partner and feeling criticized were maladaptive, associated with lower RS (own and in some cases, partner's). Cross-lagged analyses (evening RS to next-day afternoon communication) yielded virtually no effects, suggesting that communication may have a stronger influence on short-term RS than the reverse. Findings underscore the importance of responsive communication, more so than expression per se, in explaining both concurrent and later relationship adjustment. In addition, a focus on holding back from expressing feelings may enhance the understanding of RS for couples coping with cancer.
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Affiliation(s)
- Shelby L Langer
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Joan M Romano
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Michael Todd
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | | | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Jonathan B Bricker
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Neeta Ghosh
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - John W Burns
- Department of Behavioral Sciences, Rush Medical College, Rush University, Chicago, IL, United States
| | - Niall Bolger
- Department of Psychology, Columbia University, New York, NY, United States
| | - Blair K Puleo
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Julie R Gralow
- Medical Oncology, University of Washington School of Medicine, Seattle, WA, United States
| | - Veena Shankaran
- Medical Oncology, University of Washington School of Medicine, Seattle, WA, United States
| | - Kelly Westbrook
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - S Yousuf Zafar
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
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19
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JaKa MM, French SA, Wolfson J, Jeffery RW, Lorencatto F, Michie S, Levy RL, Langer SL, Sherwood NE. Understanding Outcomes in Behavior Change Interventions to Prevent Pediatric Obesity: The Role of Dose and Behavior Change Techniques. Health Educ Behav 2018; 46:312-321. [PMID: 30215279 DOI: 10.1177/1090198118798679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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]
Abstract
BACKGROUND Behavioral interventions to prevent pediatric obesity have shown inconsistent results across the field. Studying what happens within the "black box" of these interventions and how differences in implementation lead to different outcomes will help researchers develop more effective interventions. AIM To compare the implementation of three features of a phone-based intervention for parents (time spent discussing weight-related behaviors, behavior change techniques used in sessions, and intervention activities implemented by parents between sessions) with study outcomes. METHODS A random selection of 100 parent-child dyads in the intervention arm of a phone-based obesity prevention trial was included in this analysis. Sessions were coded for overall session length, length of time spent discussing specific weight-related behaviors, number of behavior change techniques used during the sessions, and number of intervention-recommended activities implemented by the parents between sessions (e.g., parent-reported implementation of behavioral practice/rehearsal between sessions). The primary study outcome, prevention of unhealthy increase in child body mass index (BMI) percentile, was measured at baseline and 12 months. RESULTS Overall session length was associated with decreases in child BMI percentile ( b = -0.02, p = .01). There was no association between the number of behavior change techniques used in the sessions and decreases in child BMI percentile ( b = -0.29, p = .27). The number of activities the parents reported implementing between sessions was associated with decreases in child BMI percentile ( b = -1.25, p = .02). DISCUSSION To improve future interventions, greater attention should be paid to the intended and delivered session length, and efforts should be made to facilitate parents' implementation of intervention-recommended activities between sessions (ClinicalTrials.gov, No. NCT01084590).
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Affiliation(s)
- Meghan M JaKa
- 1 DC Department of Behavioral Health, Applied Research and Evaluation, Washington, DC, USA
| | | | | | | | | | | | - Rona L Levy
- 5 University of Washington, Seattle, WA, USA
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20
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Langer SL, Porter LS, Romano JM, Todd MW, Lee SJ. A Couple-Based Communication Intervention for Hematopoietic Cell Transplantation Survivors and Their Caregiving Partners: Feasibility, Acceptability, and Change in Process Measures. Biol Blood Marrow Transplant 2018; 24:1888-1895. [PMID: 29772351 DOI: 10.1016/j.bbmt.2018.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 03/05/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
Abstract
Hematopoietic cell transplantation (HCT) poses significant challenges for recipients and their caregiving partners. Couples may refrain from talking about treatment-related fears and concerns to minimize distress. This single-group, pre-post study examined feasibility and acceptability of an intervention designed to optimize communication between HCT patients and partners; it also assessed change in process measures. Couples met with a therapist 5 times to learn skills for disclosing illness-related thoughts and feelings and responding supportively to one another. The extent to which participants disclosed thoughts, feelings, and information during the session and felt supported was assessed at the close of each session. Forty of 89 eligible couples consented (45%). Thirty couples commenced intervention 1-month post-transplant; 26 of these completed all sessions (87%) and 27 completed follow-up (90%). Ratings of self-disclosure and feeling supported by one's partner increased linearly across intervention sessions among both patients and caregivers (all P ≥ .01). Ratings of satisfaction with the intervention were high. HCT couples can be recruited and retained for this intervention. They found it acceptable and were amenable to skills training. A randomized trial is needed to test efficacy and to identify moderators of treatment response.
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Affiliation(s)
- Shelby L Langer
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona.
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Joan M Romano
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Michael W Todd
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Gordon LM, Johnson RH, Au MA, Langer SL, Albritton KH. Primary Care Physicians' Decision Making Regarding Initial Oncology Referral for Adolescents and Young Adults With Cancer. J Adolesc Health 2018; 62:176-183. [PMID: 29248393 DOI: 10.1016/j.jadohealth.2017.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 02/01/2017] [Revised: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The objectives of this study were to determine whether pediatricians are more likely than other primary care physicians (PCPs) to refer newly diagnosed adolescent and young adult patients with cancer to pediatric oncological specialists, and to assess the physician and patient characteristics that affect patterns of referral. METHODS A cross-sectional vignette survey was mailed to PCPs to examine hypothetical referral decisions as a function of physician characteristics and patient characteristics, including diagnosis, age, gender, race/ethnicity, family support, transportation, insurance, and patient preference for site of care. Pediatrician PCPs and nonpediatrician PCPs (family medicine, internal medicine, and emergency medicine physicians) practicing in North Carolina and in Washington State participated in the study. RESULTS A total of 406 surveys were completed (35.8% response rate). Sixty percent of pediatric PCPs referred their hypothetical patients with cancer to pediatric specialists (PSs), compared with only 37% of nonpediatric PCPs. Patient age also influenced referral patterns; 89% of 13-year-olds, 74% of 16-year-olds, 25% of 19-year-olds, and only 9% of 22-year-old patients were referred to a PS. Multivariate logistic regression demonstrated that diagnosis and physician practice setting also were associated with referral patterns. CONCLUSIONS Both patient age and PCP specialty were significant predictors of referral patterns in hypothetical vignettes of newly diagnosed adolescent and young adult patients with cancer. Pediatricians were more likely than nonpediatrician PCPs to refer patients to a PS. Referrals to PSs decreased dramatically between ages 16 and 19. Because the site of oncological care can impact outcomes, these data have the potential to inform awareness and education initiatives directed at PCPs.
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Affiliation(s)
- Lynne M Gordon
- Department of Public Health, University of Washington, Seattle, Washington
| | - Rebecca H Johnson
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Margaret A Au
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Shelby L Langer
- School of Social Work, University of Washington, Seattle, Washington
| | - Karen H Albritton
- Departments of Medical and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
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22
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Reed-Knight B, van Tilburg MAL, Levy RL, Langer SL, Romano JM, Murphy TB, DuPen MM, Feld AD. Maladaptive Coping and Depressive Symptoms Partially Explain the Association Between Family Stress and Pain-Related Distress in Youth With IBD. J Pediatr Psychol 2018; 43:94-103. [PMID: 28541526 PMCID: PMC5896627 DOI: 10.1093/jpepsy/jsx082] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 11/10/2016] [Revised: 04/24/2017] [Accepted: 04/29/2017] [Indexed: 12/31/2022] Open
Abstract
Objective To extend existing research on the pain burden experienced by youth with inflammatory bowel disease (IBD) by examining the complexity of psychosocial factors involved in pain-related distress. Methods Parents completed measures of family stress and their child's pain-related expressions of distress and coping. Youth with IBD rated their depressive symptoms (n = 183 dyads). Mediation analyses were performed using regression-based techniques and bootstrapping. Results Greater family stress was positively related to children's pain-related expressions of distress and passive coping. Significant indirect effects were found in the relationship between family stress and expressed pain-related distress through parent-reported passive coping, depressive symptoms, and both passive coping and depressive symptoms sequentially. Conclusions Results suggest that family stress can place children at risk for greater expressed pain-related distress through effects on coping and depressive symptoms. Addressing psychosocial difficulties is important for closing the gap between disability and health in youth with IBD.
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Affiliation(s)
- Bonney Reed-Knight
- Children’s Healthcare of Atlanta
- Division of Gastroenterology, Hepatology, & Nutrition, Emory University School of Medicine
- GI Care for Kids
| | | | - Rona L Levy
- School of Social Work, University of Washington
| | - Shelby L Langer
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University
| | - Joan M Romano
- Department of Psychiatry & Behavioral Sciences, Psychiatry & Behavioral Sciences, University of Washington
| | | | | | - Andrew D Feld
- Gastroenterology Kaiser Permanente, Washington
- Clinical Professor of Medicine, University of Washington
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van Tilburg MA, Claar RL, Romano JM, Langer SL, Drossman DA, Whitehead WE, Abdullah B, Levy RL. Psychological Factors May Play an Important Role in Pediatric Crohn's Disease Symptoms and Disability. J Pediatr 2017; 184:94-100.e1. [PMID: 28238483 PMCID: PMC5407185 DOI: 10.1016/j.jpeds.2017.01.058] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 10/06/2016] [Revised: 12/07/2016] [Accepted: 01/24/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the relative contributions of disease activity and psychological factors to self-reported symptoms and disability in children with Crohn's disease. STUDY DESIGN Participants (n = 127 children age 8-18 years) completed questionnaires on symptom severity and disability, as well as psychological measures assessing anxiety, depression, pain beliefs and coping. Disease activity was measured by the Pediatric Crohn's Disease Activity Index. Structural equation modeling was used to test the effects of disease activity and psychological factors on symptoms and disability. RESULTS In the hypothesized model predicting symptoms, psychological factors (β = 0.58; P < .001) were significantly associated with disease symptoms but disease activity was not. The model for disability yielded significant associations for both psychological factors (β = 0.75; P < .001) and disease activity (β = 0.61, P < .05). CONCLUSION Crohn's disease symptoms in children and adolescents are not only driven by disease activity. Coping, anxiety, depression, and cognition of illness are important in the patient-reporting of symptom severity and disability. Physicians need to be aware that symptom self-reporting can be driven by psychological factors and may not always be simply an indicator of disease activity. TRIAL REGISTRATION ClinicalTrials.gov: NCT00679003.
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Affiliation(s)
| | - Robyn Lewis Claar
- University of North Carolina, Center for Functional GI and Motility, Disorders Chapel Hill, NC
| | - Joan M. Romano
- University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, WA
| | | | - Douglas A. Drossman
- University of North Carolina, Center for Functional GI and Motility Disorders, Chapel Hill, NC
| | - William E. Whitehead
- University of North Carolina, Center for Functional GI and Motility Disorders, Chapel Hill, NC
| | | | - Rona L. Levy
- University of Washington, School of Social Work Seattle, WA
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Levy RL, Langer SL, van Tilburg MA, Romano JM, Murphy TB, Walker LS, Mancl LA, Claar RL, DuPen MM, Whitehead WE, Abdullah B, Swanson KS, Baker MD, Stoner SA, Christie DL, Feld AD. Brief telephone-delivered cognitive behavioral therapy targeted to parents of children with functional abdominal pain: a randomized controlled trial. Pain 2017; 158:618-628. [PMID: 28301859 PMCID: PMC5370191 DOI: 10.1097/j.pain.0000000000000800] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 12/19/2022]
Abstract
Pediatric functional abdominal pain disorders (FAPDs) are associated with increased health care utilization, school absences, and poor quality of life (QoL). Cost-effective and accessible interventions are needed. This multisite study tested the effects of a 3-session cognitive behavioral intervention delivered to parents, in-person or remotely, on the primary outcome of pain severity and secondary outcomes (process measures) of parental solicitousness, pain beliefs, catastrophizing, and child-reported coping. Additional outcomes hypothesized a priori and assessed included functional disability, QoL, pain behavior, school absences, health care utilization, and gastrointestinal symptoms. The study was prospective and longitudinal (baseline and 3 and 6 months' follow-up) with 3 randomized conditions: social learning and cognitive behavioral therapy in-person (SLCBT) or by phone (SLCBT-R) and education and support condition by phone (ES-R). Participants were children aged 7 to 12 years with FAPD and their parents (N = 316 dyads). Although no significant treatment effect for pain severity was found, the SLCBT groups showed significantly greater improvements compared with controls on process measures of parental solicitousness, pain beliefs, and catastrophizing, and additional outcomes of parent-reported functional disability, pain behaviors, child health care visits for abdominal pain, and (remote condition only) QoL and missed school days. No effects were found for parent and child-reported gastrointestinal symptoms, or child-reported QoL or coping. These findings suggest that for children with FAPD, a brief phone SLCBT for parents can be similarly effective as in-person SLCBT in changing parent responses and improving outcomes, if not reported pain and symptom report, compared with a control condition.
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Affiliation(s)
- Rona L. Levy
- School of Social Work, University of Washington, Seattle, WA
| | - Shelby L. Langer
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | | | - Joan M. Romano
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Tasha B. Murphy
- School of Social Work, University of Washington, Seattle, WA
| | - Lynn S. Walker
- Vanderbilt University, Department of Pediatrics, Nashville, TN
| | - Lloyd A. Mancl
- University of Washington, Oral Health Sciences, Seattle, WA
| | - Robyn L. Claar
- University of North Carolina, Division of Gastroenterology and Hepatology, Chapel Hill, NC
| | | | - William E. Whitehead
- University of North Carolina, Division of Gastroenterology and Hepatology, Chapel Hill, NC
| | | | | | | | - Susan A. Stoner
- University of Washington, Alcohol and Drug Abuse Institute, Seattle, WA, USA
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Langer SL, Romano JM, Liu Q, Levy RL, Nielson H, Brown JD. Pain catastrophizing predicts verbal expression among children with chronic pain and their mothers. Health Psychol Open 2017; 3:2055102916632667. [PMID: 28070387 PMCID: PMC5193312 DOI: 10.1177/2055102916632667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 12/31/2022] Open
Abstract
This study examined intra- and inter-personal associations between pain catastrophizing and verbal expression in 70 children with recurrent abdominal pain and their mothers. Participants independently completed the Pain Catastrophizing Scale. Mothers and children then talked about the child’s pain. Speech was categorized using a linguistic analysis program. Catastrophizing was positively associated with the use of negative emotion words by both mothers and children. In addition, mothers’ catastrophizing was positively associated with both mothers’ and children’s anger word usage, whereas children’s catastrophizing was inversely associated with mothers’ anger word usage. Findings extend the literature on behavioral and interpersonal aspects of catastrophizing.
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26
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Langer SL, Seburg E, JaKa MM, Sherwood NE, Levy RL. Predicting dietary intake among children classified as overweight or at risk for overweight: Independent and interactive effects of parenting practices and styles. Appetite 2016; 110:72-79. [PMID: 27940314 DOI: 10.1016/j.appet.2016.12.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 05/23/2016] [Revised: 12/01/2016] [Accepted: 12/06/2016] [Indexed: 12/31/2022]
Abstract
Using baseline data from a randomized controlled pediatric obesity prevention trial, this study sought to examine general parenting style as a potential moderator of the association between feeding-specific parenting practices and child dietary intake. Four hundred and twenty-one parent-child dyads served as participants (49% girls and 93% mothers). Children were, on average, 6.6 years old and either overweight or at-risk for overweight (mean BMI percentile = 84.9). Data were collected in participants' homes. Study staff measured children's height and weight. Parents completed questionnaires designed to assess general parenting styles (authoritative, authoritarian and permissive) and child feeding practices (restriction and monitoring). Child dietary intake was assessed using a 24-h recall system. Outcomes were daily servings of fruits and vegetables, sugar-sweetened beverages (SSB), and unhealthy snacks. Results were as follows: Permissive parenting was inversely associated with fruit and vegetable consumption, and parental monitoring was inversely associated with SSB consumption. There were no other main effects of parenting style or feeding practice on child dietary consumption. Authoritarian parenting moderated the association between restriction and SSB intake (a marginally significant effect after correcting for multiple comparisons). Restriction was inversely associated with SSB consumption when authoritarianism was high but unassociated with SSB consumption when authoritarianism was low. Findings indicate that the parenting practice of monitoring child dietary intake was associated with more healthful consumption regardless of parenting style; interventions may thus benefit from encouraging parental monitoring. The parenting strategy of restricting child dietary intake, in contrast, was associated with lower SSB intake in the context of higher parental authoritarianism but inconsequential in the context of lower parental authoritarianism. This exploratory finding warrants further investigation.
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Affiliation(s)
- Shelby L Langer
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA.
| | - Elisabeth Seburg
- HealthPartners Institute for Education and Research, Bloomington, MN 55425, USA
| | - Meghan M JaKa
- HealthPartners Institute for Education and Research, Bloomington, MN 55425, USA
| | - Nancy E Sherwood
- HealthPartners Institute for Education and Research, Bloomington, MN 55425, USA
| | - Rona L Levy
- School of Social Work, University of Washington, Seattle, WA 98105, USA
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DuPen MM, van Tilburg MAL, Langer SL, Murphy TB, Romano JM, Levy RL. Parental Protectiveness Mediates the Association between Parent-Perceived Child Self-Efficacy and Health Outcomes in Pediatric Functional Abdominal Pain Disorder. Children (Basel) 2016; 3:E15. [PMID: 27657151 PMCID: PMC5039475 DOI: 10.3390/children3030015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 12/12/2022]
Abstract
Previous studies have shown that parental protectiveness is associated with increased pain and disability in Functional Abdominal Pain Disorder (FAPD) but the role that perceived child self-efficacy may play remains unclear. One reason why parents may react protectively towards their child's pain is that they perceive their child to be unable to cope or function normally while in pain (perceived low self-efficacy). This study sought to examine (a) the association between parent-perceived child pain self-efficacy and child health outcomes (symptom severity and disability); and (b) the role of parental protectiveness as a mediator of this association. Participants were 316 parents of children aged 7-12 years with FAPD. Parents completed measures of perceived child self-efficacy when in pain, their own protective responses to their child's pain, child gastrointestinal (GI) symptom severity, and child functional disability. Parent-perceived child self-efficacy was inversely associated with parent-reported child GI symptom severity and disability, and parental protectiveness mediated these associations. These results suggest that parents who perceive their child to have low self-efficacy to cope with pain respond more protectively when they believe he/she is in pain, and this, in turn, is associated with higher levels of GI symptoms and disability in their child. This finding suggests that directly addressing parent beliefs about their child's ability to manage pain should be included as a component of FAPD, and potentially other child treatment interventions.
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Affiliation(s)
- Melissa M DuPen
- School of Social Work, University of Washington, Seattle, WA 98105, USA.
| | - Miranda A L van Tilburg
- Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC 27599, USA.
| | - Shelby L Langer
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA.
| | - Tasha B Murphy
- School of Social Work, University of Washington, Seattle, WA 98105, USA.
| | - Joan M Romano
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98105, USA.
| | - Rona L Levy
- School of Social Work, University of Washington, Seattle, WA 98105, USA.
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28
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Levy RL, van Tilburg MA, Langer SL, Romano JM, Walker LS, Mancl LA, Murphy TB, Claar RL, Feld SI, Christie DL, Abdullah B, DuPen MM, Swanson KS, Baker MD, Stoner SA, Whitehead WE. Effects of a Cognitive Behavioral Therapy Intervention Trial to Improve Disease Outcomes in Children with Inflammatory Bowel Disease. Inflamm Bowel Dis 2016; 22:2134-48. [PMID: 27542131 PMCID: PMC4995069 DOI: 10.1097/mib.0000000000000881] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 12/27/2022]
Abstract
BACKGROUND Studies testing the efficacy of behavioral interventions to modify psychosocial sequelae of inflammatory bowel disease in children are limited. This report presents outcomes through a 6-month follow-up from a large randomized controlled trial testing the efficacy of a cognitive behavioral intervention for children with inflammatory bowel disease and their parents. METHODS One hundred eighty-five children aged 8 to 17 years with a diagnosis of Crohn's disease or ulcerative colitis and their parents were randomized to one of two 3-session conditions: (1) a social learning and cognitive behavioral therapy condition or (2) an education support condition designed to control for time and attention. RESULTS There was a significant overall treatment effect for school absences due to Crohn's disease or ulcerative colitis (P < 0.05) at 6 months after treatment. There was also a significant overall effect after treatment for child-reported quality of life (P < 0.05), parent-reported increases in adaptive child coping (P < 0.001), and reductions in parents' maladaptive responses to children's symptoms (P < 0.05). Finally, exploratory analyses indicated that for children with a higher level of flares (2 or more) prebaseline, those in social learning and cognitive behavioral therapy condition experienced a greater reduction in flares after treatment. CONCLUSIONS This trial suggests that a brief cognitive behavioral intervention for children with inflammatory bowel disease and their parents can result in improved child functioning and quality of life, and for some children may decrease disease activity.
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Affiliation(s)
| | | | | | - Joan M. Romano
- University of Washington, Psychiatry & Behavioral Sciences
| | | | | | | | - Robyn L. Claar
- University of North Carolina, Division of Gastroenterology and Hepatology
| | - Shara I. Feld
- University of Wisconsin, School of Medicine and Public Health
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29
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Chi NC, Demiris G, Lewis FM, Walker AJ, Langer SL. Behavioral and Educational Interventions to Support Family Caregivers in End-of-Life Care. Am J Hosp Palliat Care 2016; 33:894-908. [DOI: 10.1177/1049909115593938] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The demand for family caregivers steadily increases as the number of people receiving hospice and palliative care rises. Family caregivers play a significant role in supporting their loved ones in end-of-life care. However, there is limited evidence about the effectiveness of the interventions for supporting family caregivers. This article synthesizes behavioral and educational interventions that support family caregivers in end-of-life care. A systematic review was conducted and searched interventional studies published between 2004 and 2014 in PubMed, CINAHL, Embase, and The Cochrane Library electronic databases. Fourteen studies were identified and analyzed: 4 educational studies, 6 cognitive behavioral therapy studies, and 4 psychoeducational studies. All educational and behavioral interventions had developed structures and treatment manuals and improved family caregivers’ outcomes. The cognitive behavioral therapy resulted in more positive outcomes than the other 2 interventions. More rigorous randomized controlled trials are needed to replicate current effective interventions with larger and diverse sample. Future studies need to develop tools for assessing family caregivers’ needs, create consistent and specific tools to effectively measure family caregivers’ outcomes, incorporate a cost-effectiveness analysis, and find the most efficient intervention format and method.
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Affiliation(s)
- Nai-Ching Chi
- School of Nursing, University of Washington, Seattle, WA, USA
| | - George Demiris
- School of Nursing, University of Washington, Seattle, WA, USA
- School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Amy J. Walker
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Shelby L. Langer
- School of Social Work, University of Washington, Seattle, WA, USA
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30
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Noel M, Alberts N, Langer SL, Levy RL, Walker LS, Palermo TM. The Sensitivity to Change and Responsiveness of the Adult Responses to Children's Symptoms in Children and Adolescents With Chronic Pain. J Pediatr Psychol 2015; 41:350-62. [PMID: 26493601 DOI: 10.1093/jpepsy/jsv095] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 09/17/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To examine the sensitivity to change and responsiveness of the Adult Responses to Children's Symptoms (ARCS) among parents of youth with chronic pain. METHODS Participants included 330 youth (89 children aged 7-11 years, 241 children aged 12-17 years) and their parents who participated in randomized controlled trials of family-based cognitive-behavioral therapy for chronic pain. Child pain and disability, parental emotional functioning, and parental responses to child pain were assessed at baseline and posttreatment. RESULTS The Protect and Monitor scales of the ARCS were sensitive to change following intervention for both developmental groups, with clinically meaningful reductions in these behaviors, thereby demonstrating responsiveness. Among the adolescent sample, greater change on some ARCS scales was associated with better parental emotional functioning and lower child pain at posttreatment. CONCLUSIONS Findings support the sensitivity to change and responsiveness of the Protect and Monitor scales among parents of youth with chronic pain.
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Affiliation(s)
- Melanie Noel
- Department of Psychology, University of Calgary and Alberta Children's Hospital Research Institute,
| | - Nicole Alberts
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute
| | | | - Rona L Levy
- School of Social Work, University of Washington
| | - Lynn S Walker
- Department of Pediatrics, Vanderbilt University School of Medicine, and
| | - Tonya M Palermo
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Departments of Anesthesiology, Pediatrics, and Psychiatry, University of Washington School of Medicine
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31
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van Tilburg MAL, Claar RL, Romano JM, Langer SL, Walker LS, Whitehead WE, Abdullah B, Christie DL, Levy RL. Role of Coping With Symptoms in Depression and Disability: Comparison Between Inflammatory Bowel Disease and Abdominal Pain. J Pediatr Gastroenterol Nutr 2015; 61:431-6. [PMID: 25944213 PMCID: PMC4581886 DOI: 10.1097/mpg.0000000000000841] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) and abdominal pain of functional origin (AP) are common gastrointestinal disorders in children, which are associated with increased risk for depression and disability. Both symptom severity and coping with symptoms may contribute to these outcomes. We hypothesized that children with AP use different coping strategies compared with those with IBD for a number of reasons, including the fact that fewer treatment options are available to them. We also examined whether coping was related to depression and functional disability beyond the contributions of symptom severity. METHODS The study method included secondary data analysis of 2 existing data sets including 200 children with AP (73% girls, mean age 11.2 years) and 189 children with IBD (49% girls, mean age 13.8 years). RESULTS Compared with patients with IBD, patients with AP reported more use of coping strategies of self-isolation, behavioral disengagement, and catastrophizing, as well as problem solving and seeking social support. Multivariate analyses revealed that, in both samples, ≥1 coping strategies were associated with depression and functional disability, independent of symptom severity, and controlling for age and sex. In IBD, symptoms were not a significant predictor of depression but coping was. Catastrophizing predicted depression and disability in both samples. CONCLUSIONS Patients with AP report more frequent use of several of the coping strategies we measured compared with patients with IBD. Certain types of coping, particularly catastrophizing, were associated with greater depression and functional disability in both groups. Clinicians should be aware of maladaptive coping, which may be a risk factor for poor psychosocial and functional outcomes in both patient groups.
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Affiliation(s)
- Miranda A L van Tilburg
- *Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, NC †School of Social Work ‡Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA §Department of Pediatrics, Vanderbilt University, Nashville, TN ||Prime Health Clinic, Puyallup ¶Division of Pediatric Gastroenterology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle WA
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Syrjala KL, Yi JC, Langer SL. Psychometric properties of the Cancer and Treatment Distress (CTXD) measure in hematopoietic cell transplantation patients. Psychooncology 2015; 25:529-35. [PMID: 26130497 DOI: 10.1002/pon.3861] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/30/2015] [Accepted: 05/10/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study examines the psychometric properties of a measure of distress specific to cancer and its treatment, as tested in patients receiving hematopoietic cell transplantation (HCT). METHODS With multicenter enrollment, the Cancer and Treatment Distress (CTXD) measure was administered to adults beginning HCT as part of an assessment that included the Center for Epidemiologic Studies Depression (CESD), Profile of Mood States, and Medical Outcomes Study Short Form 36 (SF-36). RESULTS From eight transplant centers, 176 of 219 eligible patients completed the assessment. Average age was 46.7 years (SD = 11.9), 59% were male, and the majority were identified as Caucasian (93%). Principal components analysis with the CTXD identified 22 items that loaded onto six factors explaining 69% of the variance: uncertainty, health burden, identity, medical demands, finances, and family strain. Internal consistency reliability for the 22 items was 0.91. The receiver operating characteristic area under the curve was 0.85 (95% CI [0.79, 0.91]), with a cut point of 1.1 resulting in a sensitivity rate of 0.91 and a specificity rate of 0.58. Convergent validity and divergent validity were confirmed with large correlations of the CTXD total score with the CESD, Profile of Mood States, and SF-36 mental health; and a smaller correlation with the SF-36 physical function (r = -0.30). CONCLUSIONS The CTXD is a reliable and valid measure of distress for HCT recipients and captures nearly all cases of depression on the CESD in addition to detecting distress in those who are not depressed. It has potential value as both a research and clinical screening measure for distress.
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Affiliation(s)
- Karen L Syrjala
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - Jean C Yi
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Shelby L Langer
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
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Kunin-Batson AS, Seburg EM, Crain AL, Jaka MM, Langer SL, Levy RL, Sherwood NE. Household factors, family behavior patterns, and adherence to dietary and physical activity guidelines among children at risk for obesity. J Nutr Educ Behav 2015; 47:206-15. [PMID: 25748634 PMCID: PMC4428928 DOI: 10.1016/j.jneb.2015.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 01/19/2015] [Accepted: 01/19/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe the proportion of children adhering to recommended physical activity and dietary guidelines, and examine demographic and household correlates of guideline adherence. DESIGN Cross-sectional (pre-randomization) data from a behavioral intervention trial designed to prevent unhealthy weight gain in children. PARTICIPANTS A total of 421 children (aged 5-10 years) at risk for obesity (body mass index percentile, 70-95). MAIN OUTCOMES MEASURED Physical activity (accelerometry), screen time (parent survey), and fruit and vegetable and sugar-sweetened beverage intake (24-hour dietary recall). ANALYSIS Proportions meeting guidelines were calculated. Logistic regression examined associations between demographic and household factors and whether children met recommended guidelines for (1) physical activity (≥ 60 min/d), (2) screen time (≤ 2 h/d), (3) fruit and vegetable intake (≥ 5 servings/d), and (4) sugar-sweetened beverage avoidance. RESULTS Few children met more than 1 guideline. Only 2% met all 4 recommended guidelines and 19% met none. Each guideline had unique sociodemographic and domain-specific household predictors (ie, availability of certain foods and beverages, media, and active play and exercise equipment). CONCLUSIONS AND IMPLICATIONS Families equipped to promote healthy child behavior patterns in 1 activity or dietary domain may not be in others. Results have implications for the development of interventions to affect children's weight-related behaviors and growth trajectories.
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Affiliation(s)
| | | | - A Lauren Crain
- HealthPartners Institute for Education and Research, Bloomington, MN
| | - Meghan M Jaka
- HealthPartners Institute for Education and Research, Bloomington, MN
| | - Shelby L Langer
- School of Social Work, University of Washington, Seattle, WA
| | - Rona L Levy
- School of Social Work, University of Washington, Seattle, WA
| | - Nancy E Sherwood
- HealthPartners Institute for Education and Research, Bloomington, MN
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Noel M, Palermo TM, Essner B, Zhou C, Levy RL, Langer SL, Sherman AL, Walker LS. A developmental analysis of the factorial validity of the parent-report version of the Adult Responses to Children's Symptoms in children versus adolescents with chronic pain or pain-related chronic illness. J Pain 2014; 16:31-41. [PMID: 25451623 DOI: 10.1016/j.jpain.2014.10.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 09/30/2014] [Accepted: 10/08/2014] [Indexed: 02/06/2023]
Abstract
UNLABELLED The widely used Adult Responses to Children's Symptoms measures parental responses to child symptom complaints among youth aged 7 to 18 years with recurrent/chronic pain. Given developmental differences between children and adolescents and the impact of developmental stage on parenting, the factorial validity of the parent-report version of the Adult Responses to Children's Symptoms with a pain-specific stem was examined separately in 743 parents of 281 children (7-11 years) and 462 adolescents (12-18 years) with chronic pain or pain-related chronic illness. Factor structures of the Adult Responses to Children's Symptoms beyond the original 3-factor model were also examined. Exploratory factor analysis with oblique rotation was conducted on a randomly chosen half of the sample of children and adolescents as well as the 2 groups combined to assess underlying factor structure. Confirmatory factor analysis was conducted on the other randomly chosen half of the sample to cross-validate factor structure revealed by exploratory factor analyses and compare it to other model variants. Poor loading and high cross-loading items were removed. A 4-factor model (Protect, Minimize, Monitor, and Distract) for children and the combined (child and adolescent) sample and a 5-factor model (Protect, Minimize, Monitor, Distract, and Solicitousness) for adolescents was superior to the 3-factor model proposed in previous literature. Future research should examine the validity of derived subscales and developmental differences in their relationships with parent and child functioning. PERSPECTIVE This article examined developmental differences in the structure of a widely used measure of caregiver responses to chronic pain or pain-related chronic illness in youth. Results suggest that revised structures that differ across developmental groups can be used with youth with a range of clinical pain-related conditions.
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Affiliation(s)
- Melanie Noel
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington.
| | - Tonya M Palermo
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Department of Psychiatry, University of Washington School of Medicine, Seattle, Washington
| | - Bonnie Essner
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington
| | - Chuan Zhou
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Department of Psychiatry, University of Washington School of Medicine, Seattle, Washington
| | - Rona L Levy
- School of Social Work, University of Washington, Seattle, Washington
| | - Shelby L Langer
- School of Social Work, University of Washington, Seattle, Washington
| | - Amanda L Sherman
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Lynn S Walker
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
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Langer SL, Crain AL, Senso MM, Levy RL, Sherwood NE. Predicting child physical activity and screen time: parental support for physical activity and general parenting styles. J Pediatr Psychol 2014; 39:633-42. [PMID: 24812256 DOI: 10.1093/jpepsy/jsu021] [Citation(s) in RCA: 40] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine relationships between parenting styles and practices and child moderate-to-vigorous physical activity (MVPA) and screen time. METHODS Participants were children (6.9 ± 1.8 years) with a body mass index in the 70-95th percentile and their parents (421 dyads). Parent-completed questionnaires assessed parental support for child physical activity (PA), parenting styles and child screen time. Children wore accelerometers to assess MVPA. RESULTS Parenting style did not predict MVPA, but support for PA did (positive association). The association between support and MVPA, moreover, varied as a function of permissive parenting. For parents high in permissiveness, the association was positive (greater support was related to greater MVPA and therefore protective). For parents low in permissiveness, the association was neutral; support did not matter. Authoritarian and permissive parenting styles were both associated with greater screen time. CONCLUSIONS Parenting practices and styles should be considered jointly, offering implications for tailored interventions.
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Affiliation(s)
- Shelby L Langer
- School of Social Work, University of Washington and HealthPartners Institute for Education and Research
| | - A Lauren Crain
- School of Social Work, University of Washington and HealthPartners Institute for Education and Research
| | - Meghan M Senso
- School of Social Work, University of Washington and HealthPartners Institute for Education and Research
| | - Rona L Levy
- School of Social Work, University of Washington and HealthPartners Institute for Education and Research
| | - Nancy E Sherwood
- School of Social Work, University of Washington and HealthPartners Institute for Education and Research
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Sherwood NE, Levy RL, Langer SL, Senso MM, Crain AL, Hayes MG, Anderson JD, Seburg EM, Jeffery RW. Healthy Homes/Healthy Kids: a randomized trial of a pediatric primary care-based obesity prevention intervention for at-risk 5-10 year olds. Contemp Clin Trials 2013; 36:228-43. [PMID: 23816490 DOI: 10.1016/j.cct.2013.06.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 04/05/2013] [Revised: 06/21/2013] [Accepted: 06/22/2013] [Indexed: 12/28/2022]
Abstract
Pediatric primary care is an important setting in which to address obesity prevention, yet relatively few interventions have been evaluated and even fewer have been shown to be effective. The development and evaluation of cost-effective approaches to obesity prevention that leverage opportunities of direct access to families in the pediatric primary care setting, overcome barriers to implementation in busy practice settings, and facilitate sustained involvement of parents is an important public health priority. The goal of the Healthy Homes/Healthy Kids (HHHK 5-10) randomized controlled trial is to evaluate the efficacy of a relatively low-cost primary care-based obesity prevention intervention aimed at 5 to 10 year old children who are at risk for obesity. Four hundred twenty one parent/child dyads were recruited and randomized to either the obesity prevention arm or a Contact Control condition that focuses on safety and injury prevention. The HHHK 5-10 obesity prevention intervention combines brief counseling with a pediatric primary care provider during routine well child visits and follow-up telephone coaching that supports parents in making home environmental changes to support healthful eating, activity patterns, and body weight. The Contact Control condition combines the same provider counseling with telephone coaching focused on safety and injury prevention messages. This manuscript describes the study design and baseline characteristics of participants enrolled in the HHHK 5-10 trial.
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Affiliation(s)
- Nancy E Sherwood
- HealthPartners Institute for Education and Research, Bloomington, MN 55440-1524, USA.
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McGregor BA, Syrjala KL, Dolan ED, Langer SL, Redman M. The effect of pre-transplant distress on immune reconstitution among adult autologous hematopoietic cell transplantation patients. Brain Behav Immun 2013; 30 Suppl:S142-8. [PMID: 22910186 PMCID: PMC3549315 DOI: 10.1016/j.bbi.2012.07.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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: 02/16/2012] [Revised: 07/06/2012] [Accepted: 07/23/2012] [Indexed: 01/25/2023] Open
Abstract
Myeloablative hematopoietic cell transplantation (HCT) is a common treatment for hematological malignancy. Delayed immune reconstitution following HCT is a major impediment to recovery with patients being most vulnerable during the first month after transplant. HCT is a highly stressful process. Because psychological distress has been associated with down regulation of immune function we examined the effect of pre-transplant distress on white blood cell (WBC) count among 70 adult autologous HCT patients during the first 3 weeks after transplant. The participants were on average 38 years old; 93% Caucasian, non-Hispanic and 55% male. Pre-transplant distress was measured 2-14 days before admission using the Cancer and Treatment Distress (CTXD) scale, and the Symptom Checklist-90-R (SCL-90-R) anxiety and depression subscales. WBC count was measured during initial immune recovery on days 5 through 22 post-transplant. Linear mixed model regression analyses controlling for gender and treatment-related variables revealed a significant effect of the mean pre-transplant SCL Anxiety-Depression score on WBC recovery. We found no significant effect of pre-transplant CTXD on WBC recovery. In general, higher levels of pre-treatment anxiety and depression were associated with slower WBC recovery. Psychological modulation of WBC recovery during HCT suggests a unique mechanism by which psychological distress can exert influence over the immune system. Given that WBC recovery is essential to survival for HCT patients, these data provide a rationale for treating anxiety and depression in HCT patients.
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Affiliation(s)
- Bonnie A. McGregor
- Public Health Sciences, Fred Hutchinson Cancer Research Center,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | - Karen L. Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | - Emily D. Dolan
- Public Health Sciences, Fred Hutchinson Cancer Research Center
| | - Shelby L. Langer
- Clinical Research Division, Fred Hutchinson Cancer Research Center,University of Washington School of Social Work
| | - Mary Redman
- Public Health Sciences, Fred Hutchinson Cancer Research Center
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Levy RL, Langer SL, Walker LS, Romano JM, Christie DL, Youssef N, DuPen MM, Ballard SA, Labus J, Welsh E, Feld LD, Whitehead WE. Twelve-month follow-up of cognitive behavioral therapy for children with functional abdominal pain. JAMA Pediatr 2013; 167:178-84. [PMID: 23277304 PMCID: PMC4167735 DOI: 10.1001/2013.jamapediatrics.282] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether a brief intervention for children with functional abdominal pain and their parents' responses to their child's pain resulted in improved coping 12 months later. DESIGN Prospective, randomized, longitudinal study. SETTING Families were recruited during a 4-year period in Seattle, Washington, and Morristown, New Jersey. PARTICIPANTS Two hundred children with persistent functional abdominal pain and their parents. INTERVENTIONS A 3-session social learning and cognitive behavioral therapy intervention or an education and support intervention. MAIN OUTCOME MEASURES Child symptoms and pain-coping responses were monitored using standard instruments, as was parental response to child pain behavior. Data were collected at baseline and after treatment (1 week and 3, 6, and 12 months after treatment). This article reports the 12-month data. RESULTS Relative to children in the education and support group, children in the social learning and cognitive behavioral therapy group reported greater baseline to 12-month follow-up decreases in gastrointestinal symptom severity (estimated mean difference, -0.36; 95% CI, -0.63 to -0.01) and greater improvements in pain-coping responses (estimated mean difference, 0.61; 95% CI, 0.26 to 1.02). Relative to parents in the education and support group, parents in the social learning and cognitive behavioral therapy group reported greater baseline to 12-month decreases in solicitous responses to their child's symptoms (estimated mean difference, -0.22; 95% CI, -0.42 to -0.03) and greater decreases in maladaptive beliefs regarding their child's pain (estimated mean difference, -0.36; 95% CI, -0.59 to -0.13). CONCLUSIONS Results suggest long-term efficacy of a brief intervention to reduce parental solicitousness and increase coping skills. This strategy may be a viable alternative for children with functional abdominal pain. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00494260.
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Affiliation(s)
| | | | | | - Joan M. Romano
- University of Washington, Psychiatry & Behavioral Sciences
| | | | - Nader Youssef
- Digestive Healthcare Center of Hillsborough, NJ and NPS Pharmaceuticals of Bedminster, NJ
| | | | | | - Jennifer Labus
- University of California, Los Angeles, Psychiatry and Biobehavioral Sciences
| | - Ericka Welsh
- University of Minnesota, Division of Epidemiology
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Welsh EM, Jeffery RW, Levy RL, Langer SL, Flood AP, Jaeb MA, Laqua PS. Measuring perceived barriers to healthful eating in obese, treatment-seeking adults. J Nutr Educ Behav 2012; 44:507-12. [PMID: 21665549 PMCID: PMC3175339 DOI: 10.1016/j.jneb.2010.06.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 05/17/2010] [Accepted: 06/29/2010] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To characterize perceived barriers to healthful eating in a sample of obese, treatment-seeking adults and to examine whether changes in barriers are associated with energy intake and body weight. DESIGN Observational study based on findings from a randomized, controlled behavioral weight-loss trial. PARTICIPANTS Participants were 113 women and 100 men, mean age 48.8 years, 67% white, and mean body mass index at baseline 34.9 kg/m(2). VARIABLES MEASURED Perceived diet barriers were assessed using a 39-item questionnaire. Energy intake was assessed with the Block Food Frequency Questionnaire. Body weight (kg) and height (cm) were measured. ANALYSIS Factor-based scales constructed from exploratory factor analysis. Linear regression models regressed 12-month energy intake and body weight on baseline to 12-month factor-based score changes (α = .05). RESULTS Exploratory factor analysis yielded 3 factors: lack of knowledge, lack of control, and lack of time. Reported declines in lack of knowledge and lack of control from baseline to 12 months were associated with significantly greater energy restriction over 12 months, whereas reported declines in lack of control and lack of time were associated with significantly greater weight loss. CONCLUSIONS AND IMPLICATIONS Results suggest that declines in perceived barriers to healthful eating during treatment are associated with greater energy restriction and weight loss.
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Affiliation(s)
- Ericka M Welsh
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
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Langer SL, Kelly TH, Storer BE, Hall SP, Lucas HG, Syrjala KL. Expressive talking among caregivers of hematopoietic stem cell transplant survivors: acceptability and concurrent subjective, objective, and physiologic indicators of emotion. J Psychosoc Oncol 2012; 30:294-315. [PMID: 22571245 DOI: 10.1080/07347332.2012.664255] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study sought to examine the effects of an expressive talking intervention for 58 caregiving partners of hematopoietic stem cell transplant survivors, persons known to experience distress. Caregivers were randomly assigned to a three-session emotional expression (EE) or control condition. Subjective, objective, and physiologic indicators of emotion were assessed. Relative to controls, EE participants experienced more negative emotion, uttered more negative emotion words, and perceived the exercises as more helpful and meaningful. The trajectory of skin conductance and the use of cognitive mechanism words increased across EE sessions, suggesting sustained emotional engagement. Future research is warranted to determine the optimal dose and timing of EE for this population.
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Affiliation(s)
- Shelby L Langer
- School of Social Work, University of Washington, UW Box 354900, 4101 15th Ave NE, Seattle, WA 98105, USA.
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Syrjala KL, Artherholt SB, Kurland BF, Langer SL, Roth-Roemer S, Elrod JB, Dikmen S. Prospective neurocognitive function over 5 years after allogeneic hematopoietic cell transplantation for cancer survivors compared with matched controls at 5 years. J Clin Oncol 2011; 29:2397-404. [PMID: 21537032 DOI: 10.1200/jco.2010.33.9119] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Research has documented cognitive deficits both before and after high-dose treatment followed by allogeneic hematopoietic cell transplantation (HCT), with partial recovery by 1 year. This study prospectively examined the trajectory and extent of long-term cognitive dysfunction, with a focus on 1 to 5 years after treatment. PATIENTS AND METHODS Allogeneic HCT recipients completed standardized neuropsychological tests including information processing speed (Trail Making A and Digit Symbol Substitution Test), verbal memory (Hopkins Verbal Learning Test-Revised), executive function (Controlled Oral Word Association Test and Trail Making B), and motor dexterity and speed (Grooved Pegboard). Survivors (n = 92) were retested after 80 days and 1 and 5 years after transplantation. Case-matched controls (n = 66) received testing at the 5-year time point. A Global Deficit Score (GDS) summarized overall impairment. Response profiles were analyzed using linear mixed effects models. RESULTS Survivors recovered significant cognitive function from post-transplantation (80 days) to 5 years in all tests (P < .0001) except verbal recall (P > .06). Between 1 and 5 years, verbal fluency improved (P = .0002), as did executive function (P < .01), but motor dexterity did not (P > .15), remaining below controls (P < .0001) and more than 0.5 standard deviation below population norms. In GDS, 41.5% of survivors and 19.7% of controls had mild or greater deficits (NcNemar test = 7.04, P = .007). CONCLUSION Although neurocognitive function improved from 1 to 5 years after HCT, deficits remained for more than 40% of survivors. Risk factors, mechanisms and rehabilitation strategies need to be identified for these residual deficits.
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Affiliation(s)
- Karen L Syrjala
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N., Seattle, WA 98109-1024, USA.
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Yatsuya H, Jeffery RW, Erickson DJ, Welsh EM, Flood AP, Jaeb MA, Laqua PS, Mitchell NR, Langer SL, Levy RL. Sex-specific HDL cholesterol changes with weight loss and their association with anthropometric variables: the LIFE study. Obesity (Silver Spring) 2011; 19:429-35. [PMID: 20885387 PMCID: PMC3020271 DOI: 10.1038/oby.2010.216] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Decrease in the level of high-density lipoprotein cholesterol (HDLC) has been observed in women who start dieting, but not in men. Patterns of HDLC change during intentional weight loss through 30-months of follow-up, and their association with changes in anthropometric measurements were examined in obese women (N = 112) and men (N = 100). Missing HDLC values at 6-, 12-, 18-, and 30-month follow-up (N = 16, 34, 55, and 50, respectively) due to dropout were imputed by multiple imputation. Mean ages and BMIs of subjects at baseline were 47.2 years and 34.8 kg/m(2) for women, and 50.4 years and 35.0 kg/m(2) for men. On average, participants lost weight steadily for 12 months, followed by slow regain. During the first 6 months, HDLC decreased significantly in women (-4.1 mg/dl, P = 0.0007), but not in men. Significant HDLC increases were observed in both men and women from 6- to 12-month follow-up. HDLC changes in women were positively associated with changes in hip circumference from baseline to 12-month independent of changes in triglycerides (TG), glucose, and insulin. Rapid decrease of predominantly subcutaneous fat in the femoral and gluteal area might be associated with HDLC decrease in women during initial weight loss.
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Affiliation(s)
- Hiroshi Yatsuya
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
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Levy RL, Jeffery RW, Langer SL, Graham DJ, Welsh EM, Flood AP, Jaeb MA, Laqua PS, Finch EA, Hotop AM, Yatsuya H. Maintenance-tailored therapy vs. standard behavior therapy for 30-month maintenance of weight loss. Prev Med 2010; 51:457-9. [PMID: 20869984 PMCID: PMC2997186 DOI: 10.1016/j.ypmed.2010.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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: 06/03/2010] [Revised: 09/14/2010] [Accepted: 09/16/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess differences in weight regain one year after an 18-month obesity treatment with standard behavior therapy (SBT) or maintenance-tailored therapy for obesity (MTT). METHOD 213 obese adult volunteers were treated for 18 months using SBT with fixed behavioral prescriptions or MTT that employed varied behavioral prescriptions with treatment breaks. Follow-up analysis focused on weight maintenance after a year of no contact. The trial was conducted at the University of Minnesota between 2005 and 2009. RESULTS Mean (SD) weight change between 18 and 30 months for participants in the SBT group was +4.1 kg (4.4) compared to +2.8 kg (4.5) in the MTT group. This is a 31% reduction in weight regain in MTT relative to SBT (p=0.078). This trend toward better maintenance in MTT versus SBT was due primarily to superior differential maintenance in MTT participants in the highest tertile of total weight loss at 18 months, i.e. MTT participants in this tertile regained 4 kg less than SBT participants between 18 and 30 months. CONCLUSIONS The MTT approach with varied content and timing produced more desirable patterns of weight loss maintenance than the traditional SBT approach, especially among individuals who had achieved greater initial weight loss.
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Affiliation(s)
- Rona L Levy
- University of Washington, School of Social Work, 4101 15th Avenue NE, Mailstop 354900, Seattle, WA 98105-6299, USA.
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Langer SL, Yi JC, Storer BE, Syrjala KL. Marital adjustment, satisfaction and dissolution among hematopoietic stem cell transplant patients and spouses: a prospective, five-year longitudinal investigation. Psychooncology 2010; 19:190-200. [PMID: 19189319 DOI: 10.1002/pon.1542] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the trajectory of marital adjustment, satisfaction and dissolution among 121 hematopoietic stem cell transplant (HSCT) couples-as a function of role (patient or spouse) and gender. METHODS Prospective, longitudinal design. Participants completed the Dyadic Adjustment Scale at six time points: pre-transplant (4-7 days after beginning medical workup prior to starting transplant), 6 months post-transplant, and 1, 2, 3 and 5 years post-transplant. They also reported on marital status over time. RESULTS Participants ranged in age from 23-68 (52% female patients and 48% female spouses). Ninety-eight patients received an allogeneic transplant; 23 received an autologous transplant. Marital dissolution was uncommon (four divorces since the transplant among 55 participating 5-year survivors, 7%). Dyadic satisfaction was stable over time for both male and female patients and male spouses, but not for female spouses who reported reductions in satisfaction at all time points relative to baseline. CONCLUSION Couples were by and large resilient. However, caregiver-specific gender differences indicate an increased risk for relationship maladjustment and dissatisfaction among female spouses and ultimately, female spouse/male patient couples.
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Affiliation(s)
- Shelby L Langer
- School of Social Work, University of Washington, Seattle, WA 98105 , USA.
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Levy RL, Langer SL, Walker LS, Romano JM, Christie DL, Youssef N, DuPen MM, Feld AD, Ballard SA, Welsh EM, Jeffery RW, Young M, Coffey MJ, Whitehead WE. Cognitive-behavioral therapy for children with functional abdominal pain and their parents decreases pain and other symptoms. Am J Gastroenterol 2010; 105:946-56. [PMID: 20216531 PMCID: PMC2887246 DOI: 10.1038/ajg.2010.106] [Citation(s) in RCA: 182] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Unexplained abdominal pain in children has been shown to be related to parental responses to symptoms. This randomized controlled trial tested the efficacy of an intervention designed to improve outcomes in idiopathic childhood abdominal pain by altering parental responses to pain and children's ways of coping and thinking about their symptoms. METHODS Two hundred children with persistent functional abdominal pain and their parents were randomly assigned to one of two conditions-a three-session intervention of cognitive-behavioral treatment targeting parents' responses to their children's pain complaints and children's coping responses, or a three-session educational intervention that controlled for time and attention. Parents and children were assessed at pretreatment, and 1 week, 3 months, and 6 months post-treatment. Outcome measures were child and parent reports of child pain levels, function, and adjustment. Process measures included parental protective responses to children's symptom reports and child coping methods. RESULTS Children in the cognitive-behavioral condition showed greater baseline to follow-up decreases in pain and gastrointestinal symptom severity (as reported by parents) than children in the comparison condition (time x treatment interaction, P<0.01). Also, parents in the cognitive-behavioral condition reported greater decreases in solicitous responses to their child's symptoms compared with parents in the comparison condition (time x treatment interaction, P<0.0001). CONCLUSIONS An intervention aimed at reducing protective parental responses and increasing child coping skills is effective in reducing children's pain and symptom levels compared with an educational control condition.
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Affiliation(s)
- Rona L. Levy
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Shelby L. Langer
- School of Social Work, University of Washington, Seattle, Washington, USA
| | | | - Joan M. Romano
- University of Washington, Psychiatry and Behavioral Sciences, Seattle, Washington, USA
| | | | - Nader Youssef
- Digestive HealthCare Center, Hillsborough, New Jersey, USA
| | - Melissa M. DuPen
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Andrew D. Feld
- Group Health Cooperative, Gastroenterology, Seattle, Washington, USA,Rockwood Clinic, Gastroenterology, Spokane, Washington, USA
| | - Sheri A. Ballard
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Ericka M. Welsh
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robert W. Jeffery
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Melissa Young
- Seattle Children's Hospital, Gastroenterology, Seattle, Washington, USA
| | - Melissa J. Coffey
- Seattle Children's Hospital, Gastroenterology, Seattle, Washington, USA
| | - William E. Whitehead
- University of North Carolina, Gastroenterology and Hepatology, Chapel Hill, North Carolina, USA
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Jeffery RW, Levy RL, Langer SL, Welsh EM, Flood AP, Jaeb MA, Laqua PS, Hotop AM, Finch EA. A comparison of maintenance-tailored therapy (MTT) and standard behavior therapy (SBT) for the treatment of obesity. Prev Med 2009; 49:384-9. [PMID: 19695283 PMCID: PMC2783726 DOI: 10.1016/j.ypmed.2009.08.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [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: 01/23/2009] [Revised: 08/05/2009] [Accepted: 08/11/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate a maintenance-tailored therapy (MTT) compared to standard behavior therapy (SBT) for treatment of obesity. MAIN OUTCOME MEASURE change in body weight. METHOD A non-blinded, randomized trial comparing effectiveness of MTT and SBT in facilitating sustained weight loss over 18 months; 213 adult volunteers> or =18 years participated. SBT had fixed behavioral goals, MTT goals varied over time. Study conducted at the University of Minnesota, School of Public Health, January 2005 through September 2007. RESULTS Mean (SD) weight losses at 6, 12, and 18 months were 5.7 (5.0) kg, 8.2 (8.6) kg and 8.3 (8.9) kg for MTT and 7.4 (3.9) kg, 10.7 (8.2) kg and 9.3 (8.8) kg for SBT. Total weight loss did not differ by group at 18 months, but the time pattern differed significantly (p<0.001). The SBT group lost more weight in the first 6 months. Both groups lost similar amounts between 6 and 12 months; MTT had stable weight between 12 and 18 months, while SBT experienced significant weight gain. CONCLUSIONS The MTT approach produced sustained weight loss for an unusually long period of time and not achieved in previous trials of behavioral treatment for weight loss. The MTT approach, therefore, deserves further study.
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Affiliation(s)
- Robert W Jeffery
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, Twin Cities Campus, 1300 South Second Street, Suite 300, Minneapolis, MN 55454-1015, USA.
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Langer SL, Brown JD, Syrjala KL. Intrapersonal and interpersonal consequences of protective buffering among cancer patients and caregivers. Cancer 2009; 115:4311-25. [PMID: 19731352 DOI: 10.1002/cncr.24586] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Protective buffering refers to hiding cancer-related thoughts and concerns from one's spouse or partner. In this study, the authors examined the intrapersonal and interpersonal consequences of protective buffering and the motivations for such behavior (desire to shield partner from distress, desire to shield self from distress). METHODS Eighty hematopoietic stem cell transplantation recipients and their spousal caregivers/partners completed measures that were designed to assess protective buffering and relationship satisfaction at 2 time points: before transplantation (T1) and 50 days after transplantation (T2). Overall mental health also was assessed at T2. RESULTS There was moderate agreement between 1 dyad member's reported buffering of their partner and the partner's perception of the extent to which they felt buffered. Caregivers buffered patients more than patients buffered caregivers, especially at T2. The more participants buffered their partners at T2 and the more they felt buffered, the lower their concurrent relationship satisfaction and the poorer their mental health. The latter effect was particularly true for patients who buffered and for patients who felt buffered. With respect to motivations, patients who buffered primarily to protect their partner at T1 reported increases in relationship satisfaction over time; however, when they did so at T2, their caregiver reported concurrent decreases in relationship satisfaction. CONCLUSIONS Protective buffering is costly, in that those who buffer and those who feel buffered report adverse psychosocial outcomes. In addition, buffering enacted by patients with an intention to help may prove counterproductive, ultimately hurting the object of such protection.
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Affiliation(s)
- Shelby L Langer
- School of Social Work, Department of Psychology, University of Washington, Seattle, Washington 98105, USA.
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Langer SL, Vargas VMF, Flores-Lopes F, Malabarba LR. Effects of bacterial infestation caused by human wastes on the skin structures of Mugil platanus Günther, 1880 (Mugilidae). BRAZ J BIOL 2009; 69:333-8. [PMID: 19675935 DOI: 10.1590/s1519-69842009000200014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Accepted: 07/03/2007] [Indexed: 11/22/2022] Open
Abstract
Manifestation of infectious pathologies in fishes usually increases in environments where organic wastes are disposed. Specimens of Mugil platanus Günther, 1880 and water samples collected at three points of the Tramandaí river were analyzed during a one year period. The macroscopic observation revealed ulcerations in the caudal peduncle area covered with a mass of amorphous and whitened tissues. Histopathologic analysis showed the presence of negative gram bacteria, probably responsible for alterations of the normal structure of the epidermic tissues. Non-parametric statistical analysis for ammonia concentration showed a significant variation among the three collected spots as well as in the multiple comparison between two spots. In this study, we describe cutaneous lesions observed in Mugil platanus specimens and tested their correlation with environmental ammonia concentration.
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Affiliation(s)
- S L Langer
- Faculdade Cenecista de Osório, Osório, RS, Brazil, 95520-000
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Flood A, Mitchell N, Jaeb M, Finch EA, Laqua PS, Welsh EM, Hotop A, Langer SL, Levy RL, Jeffery RW. Energy density and weight change in a long-term weight-loss trial. Int J Behav Nutr Phys Act 2009; 6:57. [PMID: 19682378 PMCID: PMC2741457 DOI: 10.1186/1479-5868-6-57] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 08/14/2009] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Health risks linked to obesity and the difficulty most have in achieving weight loss underscore the importance of identifying dietary factors that contribute to successful weight loss. METHODS This study examined the association between change in dietary energy density and weight loss over time. Subjects were 213 men and women with BMI of 30-39 kg/m2 and without chronic illness enrolled in 2004 in a randomized trial evaluating behavioral treatments for long-term weight loss. Subjects completed a 62-item food frequency questionnaire at baseline and at 6, 12, and 18 months. RESULTS Pearson correlations between BMI and energy density (kcals/g of solid food) at baseline were not significantly different from zero (r = -0.02, p = 0.84). In a longitudinal analysis, change in energy density was strongly related to change in BMI. The estimated beta for change in BMI (kg/m2) of those in the quartile representing greatest decrease in energy density at 18 months compared to those in the quartile with the least was -1.95 (p = 0.006). The association was especially strong in the first six months (estimated beta = -1.43), the period with greatest weight loss (mean change in BMI = -2.50 kg/m2 from 0-6 months vs. 0.23 kg/m2 from 12-18 months) and the greatest contrast with respect to change in energy density. CONCLUSION Decreased energy density predicted weight loss in this 18 month weight loss study. These findings may have important implications for individual dietary advice and public health policies targeting weight control in the general population.
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Affiliation(s)
| | | | | | - Emily A Finch
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Annie Hotop
- University of Minnesota, Minneapolis, MN, USA
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Abstract
This study investigated whether catastrophic thinking about pain by children with functional abdominal pain or by their parents is associated with health outcomes in the child. Subjects were 132 parent-child dyads. Child catastrophizing predicted child depression, anxiety and functional disability. Parents' catastrophizing cognitions about their own pain predicted self-reported protective responses to their children's abdominal pain (responding in ways that encourage illness behavior). Protectiveness, in turn, predicted child functional disability. All findings held despite controlling for child age, gender, and symptom severity. These results suggest that catastrophic cognitions play an important role in how children and parents cope and respond to functional abdominal pain, and may have implications for assessment and treatment in the clinical setting.
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