Loneliness, Spirituality, and Health-Related Quality of Life in Hispanic English-Speaking Cancer Caregivers: A Qualitative Approach

Hispanic caregivers experiencing higher caregiving burden than their non-Hispanic cohorts, due in part to contextual factors, such as barriers to accessing health care, challenging employment environments, low education and income, immigration issues, and minority stress. Spirituality may serve as a coping strategy for Hispanic caregivers that influences health-related quality of life (HRQoL), possibly by modifying loneliness associated with caregiving. We explored these concepts using semi-structured interviews (N = 10 Hispanic caregivers). Participants shared perceptions of loneliness, spirituality, and how these factors related to HRQoL. Five themes emerged: caregiver experience, coping strategies, loneliness, religion and spirituality to gain strength. Findings suggested that spirituality and religion improved HRQoL partially by reducing loneliness. Future programs to improve HRQoL in Hispanic English-speaking cancer caregivers should address spirituality.

Connected Community Classification (C3): Development, Validation, and Geospatial Application for Population Health Promotion and Equity

CONTEXT

Social determinants of health (SDOH) impact population health. Leveraging community-level strengths related to SDOH through a social infrastructure perspective can optimize health behaviors and health outcomes to promote health equity.

OBJECTIVE

Our aims were to develop, validate, and apply the Connected Community Classification (C3) as comprehensive community-level measure of protective SDOH and structural factors in the Four Corners states region of the United States.

DESIGN

C3 was developed using an iterative principal component analysis of publicly available data mapped to 5 SDOH domains. Regional clustering of C3 by zip code tabulation area (ZCTA) was identified using spatial autocorrelation methods.

MAIN OUTCOMES

In adjusted spatial autoregressive models, we analyzed the association of C3 with high-risk health behaviors and chronic disease prevalence using publicly available data for population-level estimates of fruit and vegetable intake, physical activity, obesity, smoking, alcohol use, coronary heart disease (CHD), diabetes, and cancer.

RESULTS

C3 was found to be reliable and valid; a C3 value of 10 indicates communities with greater connection (high), while a value of 1 indicates communities with greater separation (low) to social infrastructure. Lower connection, as measured by C3, was significantly inversely associated with lower fruit and vegetable intake, lower physical activity, and higher rates of obesity, smoking, CHD, diabetes, and cancer. C3 was significantly positively associated with heavy alcohol use.

CONCLUSIONS

These findings demonstrate that communities connected to social infrastructure have better population health outcomes. C3 captures protective community attributes and can be used in future applications to assist health researchers, practitioners, nonprofits, and policymakers to advance social connection and health equity in geographically diverse underserved regions.

Predictors of persistence of post-chemotherapy symptoms among survivors of solid tumor cancers

CONTEXT

Late or residual symptoms diminish quality of life for many cancer survivors after completion of treatment.

OBJECTIVES

Examine risk factors associated with persisting symptom burden after chemotherapy and the lack of symptom improvement over time.

METHODS

Survivors who completed curative-intent chemotherapy within two years for solid tumors were enrolled into a symptom management trial. There were 375 survivors with two or more comorbid conditions or one comorbid condition and elevated depressive symptoms (pre-defined risk factors in the trial design) who received interventions and 71 survivors without these risk factors who did not receive interventions. For all survivors, symptoms were assessed at intake, 4, and 13 weeks and categorized as mild, moderate, or severe based on the interference with daily life. The probabilities of moderate or severe symptoms and symptom improvement were analyzed using generalized mixed-effects models in relation to comorbidity, depressive symptoms, age, sex, race/ethnicity, employment, time since chemotherapy completion, and physical function. Multiple symptoms were treated as nested within the survivor.

RESULTS

Moderate or severe symptoms at baseline and the lack of improvement over time were associated with younger age and lower physical function over and above a greater number of comorbidities and elevated severity of depressive symptoms.

CONCLUSION

Risk factors identified in this research (younger age, lower physical function, greater comorbidity, and higher depressive symptoms) can be used to allocate resources for post-treatment symptom management for cancer survivors in order to relieve symptoms that do not necessarily resolve with time.

Autonomy and overparenting: Are parents of emerging adults being responsive?

Recognizing the various negative consequences of overparenting for the child such as poor mental health and relationship quality and delayed transition to full adulthood, this study examined to what extent parents of emerging adults were being responsive and tailoring their parenting practices to meet their child's characteristics, such as need for autonomy and trait autonomy. Survey data from 256 parent-emerging adult child dyads were used for analyses. The results showed that parent-reported overparenting was not associated with child-reported autonomy features. Nevertheless, parents engaged in lower levels of tangible assistance and higher levels of advice/affect management if they perceived their child as high in autonomy need or trait autonomy. Collectively, these findings suggest that parents might practice overparenting out of their own desires and needs rather than taking into account their child's developmental needs and traits. Practical recommendations for family therapists are offered.

Exploring the Role of Marianismo and Loneliness in Latinas' Physical and Mental Well-Being

The goal of this study is to better understand the role of social relationships and traditional gender norms in Latina health. Utilizing Hawkley and Cacioppo's theoretical model of loneliness and health as a framework, loneliness is proposed as a key component in the relationship between the Latina gender norm of marianismo and health. Participants were 178 female adults who identified as Latina (N = 97) or non-Latina White (N = 81), ranging in age from 19-88, who completed measures of loneliness, marianismo, depression, overall health, and health practices. Results indicate that being Latina was associated with family pillar marianismo, which includes characteristics centered on women's roles as the core of the family, that was associated with lower loneliness, and lower loneliness was subsequently associated with better overall health, lower depression, and beneficial health practices. However, being Latina had no association with silencing self to maintain harmony marianismo, that in turn had no association with loneliness, or health outcomes. These results suggest that elements of marianismo can play a protective role in Latina health and well-being, particularly when Latinas endorse the positive aspects of the gender norm that place women at the center of their families. Results also help explain the Latino health paradox by providing more specificity in the links between Latina ethnicity and positive health outcomes.

Neighborhood disadvantage has an indirect effect on problem drinking through increased psychological distress

OBJECTIVE

Neighborhood disadvantage has been documented as a risk factor for problem drinking. The specific aim of this investigation is to test a model of neighborhood disadvantage, psychological distress, and problem drinking in a demographically and socioeconomically diverse sample.

METHOD

A sample of 618 adults (21-65-year-olds; Mage = 30.80, SD = 9.81; 58% female) who reported drinking alcohol at least once in the past 6 months, completed an online questionnaire with questions about psychological distress (depression, stress, social isolation) and problem drinking (drinking problems, drinking to cope, binge drinking) twice over the course of 6 months. Their data were merged with the American Community Survey data from the U.S. Census Bureau to form an index of neighborhood disadvantage (median income, % residents with less than high school education, % living in poverty, % receiving income assistance).

RESULTS

A structural equation modeling analysis showed that neighborhood disadvantage was associated with increases in psychological distress during the T1-T2 interval. Psychological distress was also positively associated with problem drinking at both T1 and T2. There was an indirect effect of neighborhood disadvantage on problem drinking through increased psychological distress. However, there was no direct effect of neighborhood disadvantage on problem drinking in this sample.

CONCLUSIONS

Increased psychological distress may be a key mechanism that links living in disadvantaged neighborhoods and problem drinking. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Social determinants of health, psychological distress, and caregiver burden among informal cancer caregivers of cancer survivors during treatment

OBJECTIVE

This study compared three ethnic/racial groups of informal cancer caregivers on social determinants of health and tested social determinants of health as predictors of psychological distress and caregiver burden.

METHODS

This study was a secondary analysis of baseline data of a sequential multiple assignment randomized trial (SMART) testing symptom management interventions with caregiver-survivor dyads. Caregivers completed baseline measures of social determinants of health (SDoH), functional limitations, psychological distress, and caregiver burden. Hispanic, non-Hispanic White, and non-Hispanic other races caregivers were compared on these variables. Multivariate tests of associations between SDoH and caregiver burden and psychological distress were conducted in structural equation modeling with caregiver burden and psychological distress as latent variables.

RESULTS

Hispanic caregivers reported significantly higher caregiver burden, specifically for finances, family, and schedules. Caregiver burden was significantly predicted by having income barely or not meeting needs, being female, socially isolated, married, Hispanic, and having poor physical functioning. Significant predictors of caregivers' psychological distress: being female, being socially isolated, and having poor physical functioning.

CONCLUSION

Hispanic caregivers experience significant challenges associated with caregiver burden, especially if they are female, socially isolated, and have poor physical functioning. Assessment of these SDoH is important in caregiver health to provide supportive care during caregiving.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03743415 www.clinicaltrials.gov.

Parent-Child Relationships and the Health of Incarcerated Mothers: Exploring the Mediating Role of Loneliness

The current study utilizes Hawkley, Cacioppo, and colleagues' model of loneliness and health to examine the influence of parent-child relationships on the health of incarcerated women. Participants were 121 incarcerated female adults who have at least one child, and who completed a questionnaire with measures of parental involvement, parent-child closeness, loneliness, overall health, physical functioning, depression, and anxiety. Results reveal that among incarcerated women, perceptions of close and involved relationships with their children were associated with less loneliness, and less loneliness was associated with better overall health and physical functioning, as well as lower depression and anxiety. Findings highlight the importance of including loneliness in studies that examine the impact of parent-child relationships on health, especially for this vulnerable population, and suggest that it is worthwhile to engage in efforts to help incarcerated women maintain close and involved relationships with their children through high-quality communication.

Social and Cultural Factors, Self-efficacy, and Health in Latino Cancer Caregivers

BACKGROUND

Latino cancer caregivers are at risk of physical, mental, and emotional health issues. Sociocultural factors such as informational support, Anglo orientation, and spiritual practice may compound or protect against these risks.

OBJECTIVE

The purpose of this research project was to examine self-efficacy as a mediator between sociocultural factors and health outcomes in Latino cancer caregivers.

METHODS

This is a secondary analysis of baseline caregiver data from an experimental study testing two psychoeducational interventions in Latina individuals with breast cancer and their caregivers. Caregivers (N = 233) completed items assessing self-efficacy, informational support, Anglo orientation, spiritual practice, depression, and global health. Caregiver data were analyzed using hierarchical linear regression and mediation analysis.

RESULTS

Spiritual well-being was not significantly associated with health outcomes or self-efficacy. In regression analysis, both informational support ( b = 0.32; 95% confidence interval [CI], 0.20 to 0.45; P < .001) and Anglo orientation ( b = 0.15; 95% CI, 0.11 to 2.48; P < .05) were significant predictors of global health, but informational support ( b = -0.43; 95% CI, -0.55 to -0.30; P < .001) was the only significant predictor of depression. There were indirect relationships through self-efficacy for symptom management for both informational support and Anglo orientation and health outcomes.

CONCLUSIONS

Informational support and Anglo orientation were significantly related to health outcomes directly and indirectly through self-efficacy in Latino cancer caregivers.

IMPLICATIONS FOR PRACTICE

Informational support through the health system and community, when provided with attention to culture and Spanish language translation, can increase Latino cancer caregivers' self-efficacy to care for themselves and improve health outcomes.

Social Determinants of Health and Symptom Burden During Cancer Treatment

BACKGROUND

Cancer survivors (defined as individuals from diagnosis to the end of life) in treatment experience multiple physical and psychological symptoms (e.g., fatigue, pain, depression, anxiety, disturbed sleep) that influence their well-being and treatment outcomes. Underrepresented cancer survivors may disproportionately experience greater symptom burden (number of symptoms, symptom severity, depression, anxiety).

OBJECTIVES

The aim of this study was to examine the relationships of social determinants of health, including age, ethnicity, education, income and whether income meets the survivor's needs, neighborhood (rural vs. urban), access to healthcare (e.g., insurance), and social isolation, with symptom burden in cancer survivors.

METHODS

This secondary analysis included baseline data from 400 cancer survivors of solid tumor cancers undergoing chemotherapy or targeted therapy who participated in a larger randomized trial of symptom management interventions. Symptom burden was measured by the Center for Epidemiological Studies-Depression scale for depression and Patient-Reported Outcomes Measurement Information System scores for anxiety and social isolation, summed severity index of 16 symptoms from the General Symptom Distress Scale, and the total number of symptoms. Self-reported comorbid conditions were measured using the Bayliss tool. General linear models were used to relate symptom measures (one at a time) to age, number of comorbid conditions, level of education, marital status, income meeting needs, and size of metropolitan neighborhood. Additional covariates included site of cancer, its treatment, and whether the cancer was metastatic.

RESULTS

Non-Hispanic White survivors ( n = 191) were older and had more comorbid conditions, a higher proportion of metastatic cancers, and higher levels of education and income compared with Hispanic survivors ( n = 168) and non-Hispanic survivors of other races ( n = 41). Compared with the other two groups, Hispanic survivors had the lowest rate of health insurance availability, and non-Hispanic survivors of other races had the lowest social isolation. Age, number of comorbid conditions, and social isolation were significantly associated with number of symptoms, symptom severity, and depression. Age and social isolation were associated with anxiety. In addition, the symptom severity of non-Hispanic White survivors was lower than that of Hispanic survivors and non-Hispanic survivors of other races.

DISCUSSION

These findings highlight the health disparities in symptom burden experienced among cancer survivors when considering their social determinants of health. Assessing these may help clinicians address health disparities in cancer care.

A Sequential Multiple Assignment Randomized Trial of Symptom Management After Chemotherapy

CONTEXT

Many cancer survivors experience a lingering symptom burden after chemotherapy.

OBJECTIVES

In this sequential multiple assignment randomized trial, we tested optimal sequencing of two evidence-based interventions for symptom management.

METHODS

Survivors of solid tumors (N = 451) were interviewed at baseline and stratified as high or low need for symptom management based on comorbidity and depressive symptoms. High need survivors were randomized initially to the 12-week Symptom Management and Survivorship Handbook (SMSH, N = 282) or 12-week SMSH with eight weeks of Telephone Interpersonal Counseling (TIPC, N = 93) added during weeks one to eight. After four weeks of the SMSH alone, non-responders on depression were re-randomized to continue with SMSH alone (N = 30) or add TIPC (N = 31). Severity of depression and summed severity index of 17 other symptoms over weeks one to13 were compared between randomized groups and among three dynamic treatment regimes (DTRs): 1) SMSH for 12 weeks; 2) SMSH for 12 weeks with eight weeks of TIPC from week one; 3) SMSH for four weeks followed by SMSH+TIPC for eight weeks if no response to the SMSH alone on depression at week four.

RESULTS

There were no main effects for randomized arms or DTRs, but there was a significant interaction of trial arm with baseline depression favoring SMSH alone during weeks one to four in the first randomization and SMSH+TIPC in the second randomization.

CONCLUSION

The SMSH may represent a simple effective option for symptom management, adding TIPC only when there is no response to SMSH alone for people with elevated depression and multiple co-morbidities.

Moderating the Association Between Overparenting and Mental Health: Open Family Communication and Emerging Adult Children's Trait Autonomy

Research shows that overparenting (a.k.a. helicopter parenting) is associated with many child issues, among which disrupted mental health is one of the most consistently observed. The present study aims to examine if open family communication and child trait autonomy alter the associations between overparenting and emerging adult children's general self-efficacy, environmental mastery, anxiety, and depression. Cross-sectional data were collected from college students (N = 442, M age = 20.28 years, SD = 1.48) in the United States. Results showed that open family communication strengthened the negative association between overparenting and environmental mastery, and trait autonomy weakened the negative association between overparenting and general self-efficacy. None of these two moderators altered the associations between overparenting and child anxiety and depression. The effects of open family communication and trait autonomy in a controlling context are discussed. Overall, notwithstanding the moderation effects observed from open family communication and trait autonomy, the findings suggest that the effects of overparenting might be difficult to buffer.

Neighborhood Disadvantage and Mental Health: Test of a Parallel Mediation Model through Social Support and Negative Emotionality

According to the life stress model, stressful circumstances occur in the context of social, psychological, and environmental features that can function as either resources or aggravating factors, each of which are associated with well-being. This research was designed to test indirect effects of living in disadvantaged neighborhoods on mental health, through reduced social support and increased negative emotionality. This model was tested with data from a national sample of 1050 adults residing in the United States. Participants completed measures of social support, negative emotionality, depression, loneliness, stress, and alcohol consumption. These scores were merged with data from the 2015 American Community Survey to assess indicators of neighborhood disadvantage at the zip code level. The test of a parallel mediation model with structural equation modeling indicated that neighborhood disadvantage did not have direct effects on either psychological distress or alcohol consumption. However, neighborhood disadvantage was associated with greater negative emotionality, and through negative emotionality, exhibited indirect effects on psychological distress and alcohol consumption. These results are consistent with elements of the life stress model that specify various psychosocial traits as maladaptive in the context of stressful environments.

Use of scheduled and unscheduled health services by cancer survivors and their caregivers

PURPOSE

The purpose was to determine predictors of scheduled and unscheduled health services use by cancer survivors undergoing treatment and their informal caregivers.

METHODS

English- or Spanish-speaking adult cancer survivors undergoing chemotherapy or targeted therapy for a solid tumor cancer identified a caregiver (N = 380 dyads). Health services use over 2 months was self-reported by survivors and caregivers. Logistic regression models were used to relate the likelihood of service use (hospitalizations, emergency department [ED] or urgent care visits, primary care, specialty care) to social determinants of health (age, sex, ethnicity, level of education, availability of health insurance), and number of comorbid conditions. Co-habitation with the other member of the dyad and other member's health services use were considered as additional explanatory variables.

RESULTS

Number of comorbid conditions was predictive of the likelihood of scheduled health services use, both primary care and specialty care among caregivers, and primary care among survivors. Greater probability of specialty care use was associated with a higher level of education among survivors. Younger age and availability of health insurance were associated with greater unscheduled health services use (hospitalizations among survivors and urgent care or ED visits among caregivers). Unscheduled health services use of one member of the dyad was predictive of use by the other.

CONCLUSIONS

These findings inform efforts to optimize health care use by encouraging greater use of scheduled and less use of unscheduled health services. These educational efforts need to be directed especially at younger survivors and caregivers.

When goodbyes matter: The conditional relationship between final conversations and symptoms of depression

An online survey of 528 people who lost someone close to them in the last 5 years was used to test associations between having final conversations (FCs) and depression. The direct effect was nonsignificant, but there were two significant moderation effects. Time since bereavement moderated the FC-depression relationship; there was a negative relationship between FCs and depression shortly following bereavement, but no relationship after more time had passed. The age of the deceased also moderated this relationship; there was a negative relationship between FCs and depression when the deceased was older, but no relationship when the deceased was younger.

Family Connections and the Latino Health Paradox: Exploring the Mediating Role of Loneliness in the Relationships Between the Latina/o Cultural Value of Familism and Health

This study aims to understand Latina/o health from a social relationships perspective. Specifically, a major goal of the study is to explain how despite disadvantages (e.g., lower income and less education), Latinas/os in some cases have superior health compared to non-Latina/o whites, a phenomenon known as the Latino Health Paradox. Based on the central role of familial relationships in Latina/o culture, and utilizing Hawkley and Cacioppo's theoretical model of loneliness and health as a foundation for the study, the premise underlying this research is that the Latina/o cultural value of familism has a beneficial impact on health via reduced loneliness. Participants were 255 adults who identified as Latina/o (N = 139) or non-Latina/o white (N = 116), ranging in age from 19-88. Results indicate that being Latina/o predicted strong endorsement of familism, that predicted lower loneliness, and lower loneliness subsequently predicted better overall health, mental health, and health practices. These results suggest that the cultural value of familism provides health-related benefits for Latinas/os, which contributes to understanding the Latino health paradox. Results also underscore the value of including loneliness in studies examining the impact of cultural values on health, as only loneliness had statistically significant direct associations with all three health outcomes.

Unique Effects of Psychological Distress in Victimization and Perpetration of Intimate Partner Violence

Introduction: Intimate partner violence (IPV) reliably co-occurs with psychological distress. However, understanding the precise nature of the association between these two classes of variables, as potential cause or effect, is complicated by the fact that victimization of IPV is not often studied controlling for simultaneous perpetration, and vice versa. It is therefore important to control for one form of IPV when testing predictors of the other to accurately understand the extent to which psychological distress may predispose people to these serious interpersonal problems. Method: Two national survey studies were conducted to test the unique associations between victimization and perpetration of IPV with psychological distress. In the first study, 773 adults completed survey measures of IPV (victimization and perpetration) and psychological distress (depression and stress). In the second study, 389 participants completed the same measures as in Study 1, but at two waves separated by three months (T1-T2 follow-up rate 73%). Results: In study 1, both depression and stress were concurrently associated with perpetrating IPV, when controlling for victimization. However, only depression was associated with victimization, after controlling for perpetration. Results of study 2 showed that both depression and stress are prospectively associated with IPV victimization. However, they are not prospectively associated with IPV perpetration, net the effect of IPV victimization. Discussion: These results are consistent with the interactional model of depression by showing that people with depression, and high levels of stress, are at heightened risk for experiencing IPV, even after controlling for their own propensity to enact IPV.

Patterns of intimacy crisis resolution and their associations with romantic loneliness in Polish and U.S. young adults

In Erikson's model of development, intimacy and isolation denote polar outcomes of psychosocial crisis in young adulthood. Drawing on this model, the present study used three-wave longitudinal data to examine patterns of the success and lack of success in the resolution of Eriksonian crisis in relation to romantic loneliness as a negative outcome of the intimacy crisis, and compared across Poland and the United States. The data were collected from Polish and U.S. individuals aged 18-40 for Wave 1 (N = 763). Four patterns of the Eriksonian intimacy crisis were identified: (a) stable partnered status; (b) stable single status; (c) transition from single to partnered status; (d) transition from partnered to single status. In both countries, transition from single to partnered status was related to decreased romantic loneliness. Greater initial romantic loneliness was observed among Polish single adults who transited to partnered status in contrast to stable single adults. In turn, the U.S. partnered adults who transited to single status initially experienced lower romantic loneliness than stable single adults. Bivariate latent growth curve models pairing romantic loneliness with relationship satisfaction revealed that higher initial relationship satisfaction was associated with lower initial romantic loneliness, and a greater increase in relationship satisfaction was associated with smaller increases in romantic loneliness. The findings highlight that different resolutions of the intimacy crisis are related to diverse romantic loneliness and relationship satisfaction trajectories and these associations also appear to differ as a function of various marital and loneliness contexts in Poland and the United States. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Depression among Underserved Rural and Urban Caregivers of Latinas with Breast Cancer

Among Latino/as, informal caregiving duties are often deemed a family responsibility. Understanding psychological outcomes tied to caregivers of Latina breast cancer survivors is important to identify the impacts of cancer. Secondary analysis of baseline data collected in a randomized clinical trial (RCT) from 230 Latina breast cancer survivor-caregiver dyads. Characteristics of caregivers residing in rural/underserved and urban areas were compared using t- or chi-square tests. General linear models were used to analyze depressive symptoms in relation to residence, survivor-caregiver relationship, acculturation, obligation, reciprocity, and comorbidities. Urban residence was significantly associated with higher levels of depression controlling for survivor-caregiver relationship acculturation, obligation, reciprocity, and comorbidities. Mother caregivers had significantly higher levels of depression than other caregivers. Depression among Latino/a caregiver's providing care to an adult child is an important consideration as Latino/as are less likely to seek out/have access to mental health services than other groups.

Improving Asthma Care Together (IMPACT) mobile health intervention for school-age children with asthma and their parents: a pilot randomised controlled trial study protocol

INTRODUCTION

Asthma is an incurable, lifelong condition that places children at increased risk for exacerbation, hospitalisation and school absences. Most paediatric asthma interventions target parents alone and are overly prescriptive. Improving Asthma Care Together (IMPACT) is a novel shared management system comprised of a mobile health (mHealth) application, symptom watch and tailored health intervention that pairs parent and child together as an asthma management team. IMPACT helps families monitor asthma status, tailor asthma management strategies and facilitate intentional transition of asthma management to the child. The purpose of this study is to determine the feasibility, acceptability and preliminary efficacy of the IMPACT intervention.

METHODS AND ANALYSIS

This pilot randomised controlled trial will recruit 60 children with asthma (7-11 years) and one parent. All parent-child dyads will complete data collection sessions at baseline, postintervention and follow-up. Dyads randomised to the intervention group (IMPACT) will complete the 8-week intervention comprised of weekly activities including symptom monitoring, goal setting and progress monitoring. Dyads randomised to the control group will receive usual care but then be provided access to IMPACT at the end of the study. Feasibility will be measured by the proportion of eligible dyads enrolled and retained. Acceptability of IMPACT will be assessed using the Acceptability of Intervention Measure, the System Usability Scale and a semistructured interview. Preliminary efficacy is determined based on change in primary outcomes, parent-reported and child-reported asthma responsibility and asthma self-efficacy scores, from baseline.

ETHICS AND DISSEMINATION

This study has been approved by the University of Washington Institutional Review Board; study ID: STUDY00010461. Participants gave informed consent to participate in the study before taking part. Study results will be disseminated in peer-reviewed journals and scientific conferences. A lay summary will be provided to study participants.

TRIAL REGISTRATION NUMBER

NCT04908384 (ClinicalTrials.gov identifier).

Abstract PO-094: Financial hardship associations with presenteeism and absenteeism among survivors and informal caregivers during cancer treatment

Purpose: People with low perceived work performance and those who are absent from work may be at increased risk for negative employment and financial outcomes during cancer treatment. Thus, we evaluated associations between reports of financial hardship and cancer survivors' and caregivers' perceived work performance and absenteeism. Methods: Participants were surveyed during a larger study on symptom management in survivor-caregiver dyads. We limited to respondents who were employed (N=165). Survey variables included employment status, work performance, sociodemographics, perceived work performance in the prior week, performance in the prior year, and absences from work in the prior week using items from the World Health Organization Health and Work Questionnaire, and financial hardship. Financial hardship included four questions asking whether participants' income met their financial needs, adequacy of financial resources to pay for needs, and for caregivers, whether caregiving had caused financial strain. We summarized sociodemographics and conducted regression analyses to evaluate associations between presenteeism and absenteeism and financial hardship, controlling for sociodemographic factors. Results: On average, caregivers were 50.0 years (Standard Deviation (SD): 13.4) and survivors were 53.9 years (SD: 10.4). The most common relationship between survivors and caregivers was caregivers being spouses (41.7%) and children (22.9%). Caregivers reported working at higher rates (53.9% vs 22.1%, p&lt;0.001) and more hours than survivors (Mean=34.8 vs 33.6 hours, p=0.77). Survivors reported their job performance as 79.5% while caregivers reported theirs as 83.1% on a 0-100% scale. In the week prior, survivors reported absence from work for 0.95 hours while caregivers reported 0.84 hours. In the year prior to diagnosis, survivors and caregivers reported higher than current performance (84.4% and 85.2%, respectively). Caregivers whose finances were adequate to pay for the things they needed for caregiving reported 5.8% higher job performance in the prior year compared to those whose finances did not cover their caregiving expenses (95% Confidence Interval: 0.17-11.5, p=0.04), when controlling for sex, ethnicity, race, income, and education. Conclusions: Cancer patients and caregivers suffer work performance problems during cancer treatment, and this may influence their quality of life. Spouses and children of cancer survivors missed work and reported not working up to their prior performance level. Interventions to address symptom management and psychological distress may decrease absenteeism, promote higher perceived job performance, and allow more survivors and their caregivers to maintain or return to stable employment. Young adult cancer survivors and caregivers, who are still establishing themselves in careers and financially, may especially benefit from these interventions and flexible workplace policies.

Citation Format: Echo L. Warner, Jessica G. Rainbow, Alla Sikorski, Chris Segrin, Terry Badger. Financial hardship associations with presenteeism and absenteeism among survivors and informal caregivers during cancer treatment [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-094.

Exploring the relationship between loneliness, spirituality, and health-related quality of life in Hispanic cancer caregivers

Caregivers of cancer patients find it challenging to perform their roles and to meet the demands of caregiving. Spirituality has been investigated as a potential coping strategy employed by caregivers, yet spirituality and related practices vary among cultural groups. In this study, we investigated the relationship between spirituality and health-related quality of life (HRQOL) and evaluated mediation effects of loneliness on this relationship. The sample was 234 lower socioeconomic status (SES) Hispanic caregivers of breast cancer survivors using existing data from the Support for Latinas with Breast Cancer and Their Intimate and Family Partners study, funded by the American Cancer Society (Badger, PI). A cross-sectional analysis was conducted at baseline, using self-reported spirituality, loneliness, and HRQOL data collected from 2012 to 2017. The exposures and outcomes were assessed using the Spiritual Well-Being Scale, the Social Isolation-Short Form 8a PROMIS Item Bank v2.0 scale, and the Global Health Scale PROMIS v.1.0/1.1 scale. Descriptive and mediation analyses using the Preacher and Hayes' approach were conducted to estimate the direct effect of spirituality on HRQOL and the indirect effect of spirituality through mediation of loneliness in relation to HRQOL. A positive association between spirituality and HRQOL was found, whereas loneliness was inversely associated with HRQOL (b =  - .18, SE = .03, p < .0001). Age did not function as a moderator of the spirituality-HRQOL association in any of the models tested, but in the model testing mediation, loneliness was shown to mediate the association between spirituality and HRQOL (b =  - .17, p < .0001). These results suggest that spirituality may be beneficial to HRQOL in caregivers of Hispanic breast cancer survivors, due in part to reduced loneliness among more spiritual caregivers.

Abstract PO-095: Improving informal caregivers and cancer survivors' psychological distress, symptom management and health care use follow-up interviews

Purpose: Adolescents and young adults (AYAs) experience disparately higher burden of negative psychological outcomes (e.g., depression, anxiety, stress) during the first six months of cancer compared to older patients and caregivers (i.e., dyads). This is due to their unfamiliarity with severe illness, multiple caregiving responsibilities, and developmental transitions of young adulthood. We aimed to receive feedback about adaptation of a telephone-based interpersonal psychotherapy intervention for AYA cancer dyads. Methods: We conducted semi-structured telephone interviews to elicit feedback about the intervention. Participants ages 18-39 years were eligible if they completed the 12-week intervention study (N=7). Participants were asked to share 1) their overall experience with the intervention content and delivery methods, 2) suggestions on how the intervention content and delivery could be improved, and 3) topics they found especially helpful or 4) they felt should have been included. The interviews were recorded, transcribed, and quality checked. We categorized qualitative feedback through interpretive description. Results: We interviewed 7 participants: 5 women and 2 men; 3 of whom were cancer survivors and 4 were caregivers. The interviews lasted between 5-20 minutes (average=10.5 minutes). Most participants enjoyed the content and found the information provided extremely helpful. Some participants continue to use the information provided after their participation. They explained that although some content was not relevant to them during their participation, it has since become relevant and has helped them navigate later stages of their cancer care. Participants felt that the study team was courteous and would have liked to speak to them more often, if given the opportunity. Suggestions for improving the intervention content delivery were providing a digital version of the handbook that they could access on a kindle or other eBook device, and a website or app with more information related to the intervention. Another suggestion was to provide the option to have video calls, instead of only phone calls, with the counselors, as face-to-face interactions would have helped them feel more connected during their sessions. Stand out topics included a sleep topic which included tips on how to fall asleep faster and stay asleep longer, and family topics which included family bonding tips. A topic that should have been included was how to improve self-confidence with intimate relationships. Conclusions: During their cancer experience, AYA cancer dyads are at a unique stage of life and are undergoing developmental transitions of young adulthood (e.g., completing higher education, establishing a career, developing intimate relationships) which results in disparities in their cancer survival and care. These disparities may be addressed through the adaptation of targeted interventions, specifically those that incorporate technology into the delivery of psychotherapy for addressing psychological sequela of cancer.

Citation Format: Jennifer Traslavina Jimenez, Ashley Green, Keely Smith, Echo L Warner, Terry Badger, Alla Sikorskii, Chris Segrin. Improving informal caregivers and cancer survivors' psychological distress, symptom management and health care use follow-up interviews [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-095.

Exploring Spirituality, Loneliness and HRQoL In Hispanic Cancer Caregivers

Providing care to an aging society in the new normal requires increased attention to the informal caregivers who support the health and well-being of older adults with chronic conditions. Hispanic caregivers carry a high caregiver-associated burden. Health disparities experienced by Hispanics, coupled with the emotional, social and physical demands of caregiving, may set an unprecedented risk for lower health-related quality of life (HRQoL). In a quantitative analysis, we investigated the relationship between spirituality, loneliness and HRQoL in Hispanic cancer caregivers using baseline data from the Support for Latinas with Breast Cancer study (N= 234 Hispanic caregivers). Findings suggested an indirect effect of spirituality on HRQoL through reduced loneliness among more spiritual caregivers, effects that were independent of age. The second study was conducted using qualitative semi-structured interviews (N= 10) with Hispanic caregivers. Interviews evaluated spirituality and HRQoL in Hispanic cancer caregivers who reported variable levels of loneliness. Five themes emerged: caregiver experience, coping strategies, loneliness, religion to gain strength or support, and spirituality to gain strength or support. Results supported the role of spirituality in promoting higher HRQoL in Hispanic cancer caregivers and elucidated pathways to intervene on HRQoL through spirituality. With Hispanics often underutilizing formal services, having an improved understanding of caregiving experiences, particularly related to spirituality, will support the development of culturally-relevant strategies and programming to promote HRQoL for Hispanic caregivers.

Psychometric Analysis of the Dating Anxiety Scale for Adolescents in Samples of Polish and U.S. Young Adults: Examining the Factor Structure, Measurement Invariance, Item Functioning, and Convergent Validity

This study explored whether the Dating Anxiety Scale for Adolescents (DAS-A), which was originally developed in the United States to assess dating anxiety in adolescents, is appropriate for use in samples of young adults from Poland and the United States. The factor structure, measurement invariance across country, gender and relationship status, degree of precision across latent levels of the DAS and the functioning of individual items, and convergent validity were examined in a sample of 309 Polish and 405 U.S. young adults. The confirmatory factor analysis (CFA) supported the original three-factor measurement model of the DAS. Invariance tests revealed factor loadings and item thresholds that differed across subgroups, supporting partial metric and partial scalar invariance. The MIRT analysis showed that all items adequately discriminated participants with low and high anxiety. Dating anxiety latent factor correlations with mental health and interpersonal competence were significant in the expected negative directions. The results call for careful interpretation of research involving the DAS in cultural, gender, and relationship status groups, particularly when the primary goal is to compare mean levels of dating anxiety. Further development of the scale is recommended before it can be used across country, gender, and relationship status groups.

Longitudinal effects of U.S. students' reentry shock on psychological health after returning home during the COVID-19 global pandemic

Guided by the stress process model (Pearlin, Mullan, Semple, & Skaff, 1990; Pearlin, 1999), the purpose of this longitudinal investigation was to examine the extent to which the stressor of premature forced reentry from studying abroad during the COVID-19 pandemic (e.g., reentry shock, reacculturative stress) was predictive of stress-related compromised mental health (i.e., perceived stress and loneliness) into the subsequent academic year. A total of 133 college students from different U.S. universities completed a short online questionnaire as soon as they came back from their study abroad experience (T1) and approximately six months after (T2), when they were resuming their Fall 2020 academic semester. Consistent with the stress process model, secondary stressors associated with reacculturation were predictive, concurrently and longitudinally, of mental health outcomes, especially loneliness, indicating that students who had the hardest time returning home unexpectedly were at the highest risk for worsened mental health over the following months. These findings reveal that reacculturation following unplanned termination of a study abroad experience is not an event as much as it is a process that unfolds over a period of months, as would be understood from the perspective of the stress process model.

The Relationship Between Health-Related Quality of Life and Saliva C-Reactive Protein and Diurnal Cortisol Rhythm in Latina Breast Cancer Survivors and Their Informal Caregivers: A Pilot Study

Introduction: To date, no study has explored associations between objective stress-related biomarkers (i.e., inflammatory markers, diurnal rhythm of cortisol) and health-related quality of life (HRQOL) in Latina breast cancer survivors and their informal caregivers (i.e., family, friends). Method: This cross-sectional feasibility study assessed saliva C-reactive protein, saliva diurnal cortisol rhythm (cortisol slope), and self-reported HRQOL (psychological, physical, and social domains) in 22 Latina survivor-caregiver dyads. Feasibility was defined as ≥85% samples collected over 2 days (on waking, in afternoon, and in evening). Associations between biomarkers and HRQOL were examined with correlational analyses. Results: Collection of saliva was feasible. Strongest associations were observed between survivor evening cortisol (as well as cortisol slope) and fatigue, a component of physical HRQOL. Discussion: Associations presented may help promote investigations of mechanisms linking stress-related biomarkers and HRQOL in Latina breast cancer survivor-caregiver dyads, which will facilitate development of culturally congruent interventions for this underserved group.

Longitudinal Dyadic Interdependence in Psychological Distress Among Latinas With Breast Cancer and Their Informal Caregivers

Cancer diagnosis and treatment can generate substantial distress for both survivors and their informal caregivers, defined as family members or friends who provide care and assistance to the cancer survivor. The primary aim of this investigation is to test a model of dyadic interdependence in distress experienced by Latina breast cancer survivors and their informal caregivers to determine if each influences the other. Methods: To test this prediction, 209 Latinas with breast cancer and their informal caregivers (dyads) were followed for 4 waves of assessment over the course of 6 months. Both psychological (depression, anxiety, perceived stress) and physical (number of symptoms, symptom distress) indicators of distress were assessed. Longitudinal analyses of dyadic data were performed in accordance with the actor-partner interdependence model using linear mixed effects modeling. Results: Findings indicated that psychological distress was interdependent between cancer survivors and their informal caregivers over the 6 months of observation. Caregivers experienced greater depression, anxiety, and stress to the extent that the survivors reported such distress, and vice versa. These effects held, even when controlling for nature of the survivor-caregiver relationship (married to each other or not), education, and the dyads' baseline similarity on distress. However, there was no such evidence of interdependence on indicators of physical distress. Conclusions: These findings are consistent with emotional contagion processes by which psychological distress is transmitted over time between cancer survivors and their informal caregivers. Latina cancer survivors are a particularly vulnerable population due to health disparities, linguistic barriers, and socioeconomic challenges. Management of psychological distress is of particular concern in this population. These findings point to the potential importance of caregiver well-being for the welfare of Latina breast cancer survivors.

Psychological Distress and Social Support Availability in Different Family Caregivers of Latinas With Breast Cancer

Introduction: Latinas with breast cancer draw on a diverse range of family members for informal care. Latin cultures typically prescribe high levels of support and care for an ill family member that leave caregivers vulnerable to compromised well-being. Method: In this cross-sectional survey study, 258 family caregivers of Latinas with breast cancer completed reports of psychological distress, availability of social support, and acculturation. Results: Mothers who provide care to a daughter with breast cancer experience higher levels of psychological distress and report lower availability of informational support than most other types of family caregivers. Mothers’ lower levels of acculturation may at least partially explain these reductions in well-being. Discussion: This study highlights the diverse range of family and fictive kin who participate in family caregiving for Latina breast cancer survivors. Spousal caregivers may not represent a unique population, whereas mothers as caregivers are indeed distinct for their higher distress levels.

Parent- and Child-Reported Asthma Responsibility in School-Age Children: Examining Agreement, Disagreement, and Family Functioning

INTRODUCTION

The school-age years represent a critical time for children to begin assuming shared asthma management responsibility. This study aimed to describe parent- and child-reported asthma responsibility, examine agreement and disagreement, and explore family functioning as a predictor of agreement/disagreement.

METHODS

Twenty children (age range = 6-11 years) and one of their parents participated in this cross-sectional study. Parent-child dyads independently reported on their asthma management responsibility and asthma control. Parents also completed family functioning and demographic questionnaires.

RESULTS

There was a significant difference between parent and child asthma responsibility scores (t(19) = 2.46, p < .05), indicating that children saw themselves as assuming greater responsibilities than their parents did. A regression analysis showed that collectively, family functioning predicted 74% of the variance in parent-child disagreement (F(6,15) = 4.17, p < .05).

DISCUSSION

Family functioning may be an important factor in promoting shared management of asthma in school-age children.

Trajectories of Depression and Anxiety in Latina Breast Cancer Survivors

OBJECTIVES

To identify subgroups of Latina breast cancer survivors with unique trajectories of depression and anxiety and examine predictors associated with these subgroups.

SAMPLE & SETTING

Secondary analysis of Latina breast cancer survivors (N = 293) from three psychosocial intervention studies.

METHODS & VARIABLES

Depression and anxiety were assessed at intake and at weeks 8 and 16. Group-based growth mixture modeling was used to identify subgroups who followed distinct trajectories of depression and anxiety. Multinomial logistic regression models were used to identify predictors of trajectory-based subgroup membership.

RESULTS

Three trajectories emerged for depression.

IMPLICATIONS FOR NURSING

Latina women treated for breast cancer are at an elevated risk for depression and anxiety and follow distinct trajectories of these symptoms. Psychosocial interventions are needed to manage these symptoms, particularly for subgroups in which depression and anxiety persist or worsen.

Cognitively-Based Compassion Training versus cancer health education to improve health-related quality of life in survivors of solid tumor cancers and their informal caregivers: study protocol for a randomized controlled pilot trial

Background

Cancer survivors and their informal caregivers (family members, close friends) often experience significant impairments in health-related quality of life (HRQOL), including disruptions in psychological, physical, social, and spiritual well-being both during and after primary cancer treatment. The purpose of this in-progress pilot trial is to determine acceptability and preliminary efficacy (as reflected by effect sizes) of CBCT® (Cognitively-Based Compassion Training) compared with a cancer health education (CHE) attention control to improve the primary outcome of depressive symptoms and secondary outcomes of other HRQOL domains (e.g., anxiety, fatigue), biomarkers of inflammation and diurnal cortisol rhythm, and healthcare utilization-related outcomes in both cancer survivors and informal caregivers.

Methods

Forty dyads consisting of solid tumor survivors who have completed primary treatments (chemotherapy, radiation, surgery) and their informal caregivers, with at least one dyad member with ≥ mild depressive symptoms or anxiety, will be recruited from Tucson, Arizona, USA. Survivor-caregiver dyads will be randomized together to complete either CBCT or CHE. CBCT is a manualized, 8-week, group meditation-based intervention that starts with attention and mindfulness and builds to contemplative practices aimed at cultivating compassion to the self and others. The goal of CBCT is to challenge unexamined assumptions about feelings and behaviors, with a focus on generating spontaneous self-compassion and increased empathic responsiveness and compassion for others. CHE is an 8-week, manualized group intervention that provides cancer-specific education on various topics (e.g., cancer advocacy, survivorship wellness). Patient-reported HRQOL outcomes will be assessed before, immediately after (week 9), and 1 month after CBCT or CHE (week 13). At the same time points, stress-related biomarkers of inflammation (e.g., plasma interleukin-6) and saliva cortisol relevant for survivor and informal caregiver wellness and healthcare utilization will be measured.

Discussion

If CBCT shows acceptability, a larger trial will be warranted and appropriately powered to formally test the efficacy of this dyadic intervention. Interventions such as CBCT directed toward both survivors and caregivers may eventually fill a gap in supportive oncology care programs to improve HRQOL and healthcare utilization in both dyad members.

Trial registration

Clinicaltrials.gov, NCT03459781. Prospectively registered on 9 March 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3320-9) contains supplementary material, which is available to authorized users.

Indirect Effects of Social Skills on Health Through Stress and Loneliness

The social skills deficit vulnerability model predicts that people with inadequate social skills are at risk for a range of psychosocial problems, especially when confronted with stress. People with poor social skills often experience stress and loneliness and these two constructs were tested as potential pathways by which the poor social skills confer a risk for compromised mental and physical health. An online survey was completed by 775 adults, aged 18-91. The sample matched national demographics for race/ethnicity and age, among those over 18. Structural equation modeling revealed indirect effects of social skills on both mental and physical health through both stress and loneliness. The models showed that poor social skills were associated with poor mental and physical health through elevated stress and increased loneliness. The findings reveal that social skills deficits are associated with physical as well as mental health problems.

Examining the Role of Expressed Emotion in the Intergenerational Transmission of Mental Health Problems

Introduction: The aim of this study was to test a model of the intergenerational transmission of mental health problems (indicated by depression, anxiety, and loneliness) in which expressed emotion (indicated by criticism and emotional involvement) was specified as a mediator of mental health problems over multiple family generations.

Method: The sample consisted of three generations of grandmothers, mothers, and daughters (N = 242 family triads), wherein participants completed online surveys in which they self-reported on their own mental health problems and perceptions of their mothers’ expressed emotion.

Results: Results revealed only modest evidence of direct effects for the intergenerational transmission of mental health problems. However, there were a number of significant indirect effects, with all of these effects occurring through the criticism component of expressed emotion.

Discussion: This research identified expressed emotion as both a risk factor for offspring's mental health problems as well as a behavior typical of parents with mental health problems. Specifically, the results revealed that mental health problems are intergenerationally transmitted via critical parent-child interactions.

Transitional Instability Predicts Polymorphous Distress in Emerging Adults

The primary aim of this investigation is to determine the extent to which transitional instability can predict diverse markers of distress in emerging adults. Participants were 210 emerging adults, aged 18-25 who completed measures of distress that included loneliness, stress, problem drinking, and prescription medication use. One year later, they returned to complete these same measures of distress along with a measure of significant life transitions that they encountered during the past year in such domains as education, employment, residence, and relationships. Results of a structural equation modeling analysis showed that even after controlling for the potential reciprocal association between transitional instability and distress, the more transitional instability emerging adults experienced over the year, the higher their distress was at time 2. The results are consistent with models of transitional instability as a precipitant of distress in emerging adulthood.

Indirect Effects of Loneliness on Substance Use through Stress

Loneliness is associated with a range of physical health problems, and health behaviors (e.g., alcohol use) have been specified as one factor that explains the compromised health of lonely people. Accordingly, in this investigation, we sought to test direct and indirect (through stress) effects of loneliness on substance use (i.e., alcohol consumption, drinking problems, and prescription medication use) over the course of 1 year in a 2-wave longitudinal study. These effects were tested in a sample of 210 young adults who completed self-report measures of loneliness and substance use at time 1 and then completed measures of stress and substance use at time 2. The results showed that loneliness did not have prospective direct effects on substance use, but that it did have significant indirect effects, through increased stress, on all indicators of substance use. These findings highlight the important role of stress in potentially compromising the health of lonely people by increasing their propensity to engage in health risk behaviors.

A dyadic analysis of stress processes in Latinas with breast cancer and their family caregivers

OBJECTIVE

Breast cancer diagnosis and treatment negatively affect quality of life for survivors and their family caregivers. The stress process model has been useful for describing the cascade of social and psychological experiences that culminate in degraded quality of life for both survivors and their family caregivers. This study is designed to test theoretically specified predictors of negative psychosocial outcomes in a dyadic context.

METHODS

Participants were 230 dyads composed of Latinas recently diagnosed with breast cancer and their primary family caregiver, who completed measures of socioeconomic status, stress, family conflict, depression, and anxiety. Data were analyzed following the Actor-Partner Interdependence Mediation Model in structural equation modeling.

RESULTS

For both survivors and caregivers, there were significant direct and indirect actor effects (through family conflict) of perceived stress on depression and anxiety. Several indirect partner effects were also evident in this sample. Specifically, caregivers' stress was predictive of survivors' depression and anxiety through survivors' increased perceptions of family conflict.

CONCLUSIONS

As predicted by the stress process model, stress and family conflict were predictive of psychological distress in breast cancer survivors and their family caregivers. Significant partner effects in the Actor-Partner Interdependence Mediation Model suggest that there are some dyadic influences, particularly from caregivers' stress to survivors' perceptions of exacerbated family conflict. These findings show how strained family relationships can aggravate the well-being of cancer survivors and their family caregivers through this challenging experience.

Association of Asthma Illness Representations and Reported Controller Medication Adherence Among School-Aged Children and Their Parents

This study examined the relationship between asthma illness representations and reported controller medication adherence of school-aged children (6-11 years) with persistent asthma and their parents. Thirty-four parent-child dyads independently reported on asthma controller medication adherence and asthma illness representations. Hierarchical regression analyses were used to test parent and child illness representation domain variables as predictors of reported medication adherence. Parent beliefs about medication necessity versus concerns was a significant predictor of parent-reported adherence (β = .55, p < .01), and child treatment control was also a significant predictor of parent-reported adherence (β = -.50, p < .01). Child beliefs about medication necessity versus concerns was a significant predictor of child-reported adherence (β = .50, p < .01), and no parent variables reached significance. Although there are similarities between parent and child asthma illness representations, findings indicate that school-aged children develop illness representations somewhat independently from their parents and, therefore, are critical participants in both asthma care and research.

Co-Rumination of Fat Talk and Weight Control Practices: An Application of Confirmation Theory

Grounded in confirmation theory, the current research sought to explore the relationship between co-rumination of fat talk and weight control practices (i.e., binging and purging, exercising, and healthy eating behaviors), with a particular interest in whether perceptions of friends' responses during these interactions exacerbate or mitigate this relationship. Female friendship dyads completed online questionnaires at three time points across 2 weeks. Multilevel modeling analyses revealed that (a) co-rumination was positively associated with binging and purging and exercising, (b) women who perceived their friends as accepting reported less binging and purging, more exercising, and more healthy eating behaviors,

Intergenerational transmission of disordered eating: Direct and indirect maternal communication among grandmothers, mothers, and daughters

The current study explored disordered eating (i.e., dieting, bulimia and food preoccupation, and oral control) among grandmothers, their daughters, and their granddaughters, and also explored specific direct (i.e., maternal commentary) and indirect (i.e., maternal modeling) communication behaviors as mechanisms by which disordered eating is intergenerationally transmitted. A sample of 242 grandmother-mother-daughter triads provided self-reports of their own disordered eating and perceptions of their mothers' weight-related behaviors. Results revealed that only mothers' and daughters' reports of disordered eating were related, but not grandmothers' and mothers' nor grandmothers' and daughters'. However, a number of indirect effects were observed through maternal commentary and maternal modeling, including an indirect effect of grandmothers' reports of maternal communication on their granddaughters' disordered eating. Data from three generations of women illustrate the intergenerational transmission of disordered eating within families, specific communication variables that may propagate this relationship, and possible cohort and age effects within the sample.