Voxelotor: A Novel Treatment for Sickle Cell Disease.

OBJECTIVE: To review the pharmacological characteristics, clinical evidence, and place in therapy of voxelotor for the treatment of sickle cell disease (SCD). DATA SOURCES: A comprehensive literature search of PubMed (1966 to April 2020) was conducted. Key search terms included GBT440, sickle cell, and voxelotor. Other sources were derived from bibliographies of articles, product labeling, manufacturer's website, and news releases. ClinicalTrials.gov was searched for additional studies. STUDY SELECTION AND DATA EXTRACTION: All English-language articles identified from the data sources were reviewed and evaluated. Case reports/series and phase 1 through 3 clinical trials were included. DATA SYNTHESIS: SCD is an inherited disorder associated with significant morbidity and early mortality. Three medications approved for SCD reduce SCD-associated complications but do not selectively ameliorate the underlying disease. Voxelotor is a novel agent that targets the pathophysiology of SCD. A phase 3 trial reported an increase in mean Hb level from baseline for voxelotor compared with placebo (1.1 vs -0.1 g/dL; P < 0.001). Voxelotor is generally well tolerated, with common adverse effects including headache, diarrhea, nausea, and arthralgia. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Voxelotor may be considered for patients with SCD who have continued anemia and hemolysis despite being on maximum tolerated dose of hydroxyurea or in those who are hydroxyurea intolerant. Voxelotor is costly; therefore, both cost and benefit should be weighed before prescribing. CONCLUSION: Voxelotor appears to be safe and effective as monotherapy or in combination with hydroxyurea for patients with SCD who are 12 years of age and older.

The Attachment Dynamic: Dyadic Patterns of Anxiety and Avoidance in Relationship Functioning.

Whereas attachment dimensions (i.e., anxiety and avoidance) are generally associated with lower levels of relationship evaluations (e.g., satisfaction, commitment), research has not yet fully incorporated how partner attachment is related to these evaluations, nor how dyadic patterns (actor × partner attachment interactions) are associated with evaluations. Across two dyadic studies (N = 185, 123 dyads), we examine how actor, partner, and actor × partner interactions of attachment anxiety and avoidance are associated with reports of trust, satisfaction, and commitment. Results generally revealed that actor effects of attachment anxiety on lower relationship evaluations were weaker when partners were more anxious and stronger when partners were more avoidant. Moreover, actor effects of attachment avoidance on lower trust and satisfaction were stronger when partners were more anxious. Finally, own avoidance was more strongly negatively related to commitment in the presence of a more avoidant partner. These results suggest that the combination of attachment within relationships is important to consider for both close relationships researchers and clinicians.

Exploring the association between anticipated and actual responses to disclosures of intimate partner violence and sexual assault.

Victims of intimate partner violence (IPV) and sexual assault (SA) commonly disclose their experiences to friends or family members, or within other personal relationships. Disclosure recipients' responses to these disclosures are associated with victims' mental health. Previous research has separately measured both actual responses to IPV/SA and anticipated responses to IPV/SA (e.g., response to a hypothetical scenario) from the perspective of disclosure recipients. Yet, little research has described the association between disclosure recipients' anticipated and actual responses. The aim of the current paper was to use a prospective design to examine the association between disclosure recipients' anticipated and actual responses to IPV/SA, including positive and negative social reactions, perceptions of victim responsibility, empathy, and confusion and ineffectiveness about how to respond. Participants (N = 126 college students aged 18-23; 70.6% women) answered questions about their anticipated responses to a hypothetical IPV/SA disclosure scenario, and then six months later answered the same questions about their actual responses to an actual disclosure of IPV/SA. Although most anticipated and actual responses were significantly associated, associations were moderate in size. Some associations were stronger for participants with a closer relationship to the victim, for participants who had their own victimization history, for women, and for men. Individuals can predict their responses to some degree, but are not totally accurate in doing so.

A dyadic approach to attachment anxiety and avoidance, marital conflict, and drinking.

In this research, we integrate attachment theory and dyadic methodology to examine how attachment anxiety and avoidance might interact with marital conflict to influence alcohol consumption, drinking motives, and alcohol-related problems in a sample of 280 married and cohabiting couples over 3 years. Both husband and wife attachment anxiety were related to higher levels of own drinking to cope and alcohol-related problems. Additionally, both husband and wife reports of marital conflict were associated with own alcohol-related problems. For wives, significant interactions between anxiety and marital conflict suggested that anxiety was more strongly associated with alcohol consumption, coping, and problems at higher levels of conflict. For husbands, significant interactions between avoidance and conflict indicated that avoidance was more strongly associated with coping and problems at lower levels of conflict. This research suggests two main patterns of attachment and alcohol use, both exacerbated by marital conflict and different for husbands and wives.

Drinking motives, cultural orientations, and alcohol use among Hispanic college students at the U.S.-Mexico border.

Hispanic college students at the U.S.-Mexico border are at higher risk for alcohol use and negative drinking consequences relative to their counterparts in non-border areas. Hispanic students at the U.S.-Mexico border (N = 219, Mage = 20.14; 71.2% women) completed an online survey. U.S. orientation was negatively associated with alcohol consumption. Enhancement motives predicted alcohol consumption, whereas coping and conformity motives predicted negative drinking-related consequences. Cultural orientations did not moderate the relations between social motives and alcohol use outcomes. Results highlight the need to consider alcohol-related cognition and to better contextualize U.S. and heritage cultural orientations among Hispanics in the U.S.-Mexico areas.

Personality, coping strategies and emotional adjustment among Chinese cancer patients of different ages.

Literature has documented personality and coping strategies as valuable intrapersonal resources for cancer adjustment among Caucasians. Nevertheless, it remains unclear whether these personal characteristics operate in a similar manner among cancer patients of different ages and cultural backgrounds. This study examined the association between personality traits and affects, their underlying mechanism (i.e. coping strategies) and how these relations differed by age among Chinese cancer survivors, an understudied population. A sample of 234 Chinese cancer survivors in Beijing, China completed the five factor inventory, affect balance scale, ways of coping checklist and medical and demographic information. The results indicated that neuroticism was associated with negative affect, which was explained by avoidance coping strategies. Extraversion and neuroticism were associated with positive affect, and these associations were explained by approach coping strategies. Conditional process (i.e. moderated mediation) analyses demonstrated that conscientiousness was more strongly related to positive affect directly and indirectly through approach coping strategies among older survivors than among younger survivors. The findings highlight the importance of personality traits for emotional adjustment to breast cancer and the critical role of approach coping strategies in explaining the linkage of personality to positive affect for survivors of different age.

Comorbidity of Alcohol and Gambling Problems in Emerging Adults: A Bifactor Model Conceptualization.

Addictive disorders, such as pathological gambling and alcohol use disorders, frequently co-occur at greater than chance levels. Substantive questions stem from this comorbidity regarding the extent to which shared variance between gambling and alcohol use reflects a psychological core of addictive tendencies, and whether this differs as a function of gender. The aims of this study were to differentiate both common and unique variance in alcohol and gambling problems in a bifactor model, examine measurement invariance of this model by gender, and identify substantive correlates of the final bifactor model. Undergraduates (N = 4475) from a large northwestern university completed an online screening questionnaire which included demographics, quantity of money lost and won when gambling, the South Oaks Gambling Screen, the AUDIT, gambling motives, drinking motives, personality, and the Brief Symptom Inventory. Results suggest that the bifactor model fit the data well in the full sample. Although the data suggest configural invariance across gender, factor loadings could not be constrained to be equal between men and women. As such, general and specific factors were examined separately by gender with a more intensive subsample of females and males (n = 264). Correlations with motivational tendencies, personality traits, and mental health symptoms indicated support for the validity of the bifactor model, as well as gender-specific patterns of association. Results suggest informative distinctions between shared and unique attributes related to problematic drinking and gambling.

A Dyadic Growth Approach to Partner Regulation Attempts on Changes in Drinking and Negative Alcohol-Related Consequences.

BACKGROUND: Many individuals engage in regulation attempts to manage or reduce their partner's alcohol use. Research on partner social control behaviors has shown that regulation attempts generally factor into negative (i.e., punishing) and positive (i.e., rewarding) dimensions. In the alcohol domain, partner drinking has been associated with poorer relationship functioning through punishment. OBJECTIVES: This research applied a dyadic growth model approach to investigate changes in alcohol consumption and negative alcohol-related consequences over 6 months, and evaluated whether partner regulation attempts (punishment and reward) were influential (i.e., successful) in these changes. METHODS: Married couples (N = 123 dyads) completed web-based measures of partner regulation attempts, alcohol consumption, and alcohol-related consequences three times over a 6-month period. RESULTS: Results from dyadic growth curve analyses showed that partner punishment was significantly associated with increases in alcohol-related consequences-and marginally associated with increases in alcohol consumption-over the 6-month period. Partner reward was associated with decreases in consumption over the study period. These effects were not different for husbands and wives. Conclusion/Importance: Results support previous research demonstrating deleterious impact of partner punishing control strategies and provide important implications for future interventions and treatment.

Racial and Ethnic Differences in Problem Gambling among College Students.

The college years are a formative period where the risk for development of problematic gambling is high. Research examining racial and ethnic differences in gambling behaviors has been limited and inconsistent. The aims of this study were to examine racial and ethnic differences in problem gambling among a large sample of college students. Undergraduates (N = 3058) from a large southern university completed an online screening questionnaire which included demographics, gambling frequency, gambling expenditure (i.e. money lost) in the previous 6 months, and the South Oaks Gambling Screen (SOGS). Negative binomial regression results indicated that Asian participants gambled less frequently than participants who were Caucasian or Hispanic/Latino(a), but spent more money than participants who were African-American (AA)/Black or Hispanic/Latino(a). A significantly larger proportion of Asian students met probable pathological gambling criteria (SOGS 5+; 7.8 %) and at-risk gambling criteria (SOGS 3+; 16.3 %)) than Caucasian (5.2; 10.1 %), AA/Black (3.9; 10.2 %), or Hispanic/Latino(a) (3.6; 9.4 %) students. Additionally, a significantly larger proportion of Asian students endorsed problematic gambling indicators such as lying about losses, feeling guilty about gambling, feeling like they had a gambling problem, being criticized for their gambling, feeling like they couldn't stop gambling, losing time from school or work due to gambling, having a family history of problem gambling, and arguing with close others about their gambling than Caucasian, AA/Black or Hispanic/Latino(a) students. Results suggest that Asian students may be a high-risk sub-group of college gamblers, and that there is a critical need for targeted interventions for this population.

Cultural differences and shame in an expressive writing alcohol intervention.

The present study evaluates the relationships between shame, culture, and drinking behavior in predicting drinking intentions in the context of an expressive writing intervention. Theory and empirical findings have generally found that shame is maladaptive and can lead to anxiety, depression, and problematic alcohol use. However, research on cultural differences suggests that shame may be differentially damaging to individuals of collectivist, Asian cultures. Previous research evaluating expressive writing as a brief alcohol intervention has shown promising results such as reduced drinking intentions and increased readiness to change drinking behavior. The present study tested the hypothesis that feelings of shame after writing about a negative heavy drinking event would be associated with greater alcohol use generally and that this effect would differ for Caucasian compared to Asian individuals. We also explored whether this differed for light and heavy drinkers. Two hundred sixty-four undergraduates (74% female) who drank at least one alcoholic beverage in the past month completed measures of demographics, baseline drinking, event-related shame and guilt, pre- and postwriting affect, and drinking intentions. Results revealed that, independent of affect, social desirability, and event-related guilt, shame was generally negatively associated with drinking intentions for Caucasians and light drinking Asians. However, for heavy drinking Asians, shame was associated with increased drinking intentions. Results suggest that interventions that elicit shame are differentially effective and should be targeted accordingly.

Blood is thicker than booze: Examining the role of familism and gender in alcohol use and related consequences among Hispanic college students.

The present study evaluated cultural, ethnic, and gender differences in drinking and alcohol-related problems among Hispanic students. Familism protects against negative outcomes in Hispanic populations, thus we expected familism to buffer against alcohol problems. Participants (N = 623; 53% female) completed a battery of measures. Results suggested that familism was protective against drinking. Furthermore, alcohol use mediated the association between familism and alcohol-related problems. In sum, understanding that culture plays an important role in people's behaviors and identifying protective factors is critical to inform culturally sensitive prevention and intervention efforts.

A Personality-Based Latent Class Analysis of Emerging Adult Gamblers.

Increases in access to gambling venues have been accompanied by increased gambling behavior among young adults. The present research examined associations among Five Factor Model personality traits, motives for gambling, and gambling behavior and problems using latent class analysis. College students (N = 220) completed online measures of personality and gambling behavior as part of a larger intervention trial. Agreeableness and conscientiousness were negatively associated with indicators of gambling behavior. Low agreeableness and high neuroticism were associated with gambling-specific motives, particularly for less frequently endorsed motives. Personality-based latent class analyses of emerging adult gamblers revealed support for three distinct groups reflecting a resilient personality group, a normative personality group, and a vulnerable personality group, which were further differentiated by gambling behaviors and gambling-specific motives. Associations between personality traits and gambling-specific motives highlight potential heterogeneity among college students who gamble. Together, findings suggest that the correlational and latent class-based analyses, as well as the personality and motivation analyses, present complementary information with respect to the attributes of college student gamblers. Implications and future research directions are discussed.

Motivational Profiles of Gambling Behavior: Self-determination Theory, Gambling Motives, and Gambling Behavior.

Gambling among young adults occurs at a higher rate than in the general population and is associated with a host of negative consequences. Self-determination theory (SDT) posits that individuals develop general motivational orientations which predict a range of behavioral outcomes. An autonomy orientation portrays a choiceful perspective facilitating personal growth, whereas a controlled orientation represents a chronic proclivity toward external pressures and a general lack of choice. Further, an impersonal orientation is characterized by alack of intention and feeling despondent and ineffective. Controlled orientation has previously been associated with more frequent and problematic gambling. This research was designed to examine gambling motives as mediators of associations between motivational orientations and gambling behaviors. Undergraduates (N = 252) who met 2+ criteria on the South Oaks Gambling Screen participated in a laboratory survey assessing their motivational orientations, gambling motives, and gambling behavior (quantity, frequency, and problems). Mediation analyses suggested that autonomy was negatively associated with gambling problems through lower levels of chasing and escape motives. Further, controlled orientation was associated with more problems through higher levels of chasing and interest motives. Finally, impersonal orientation was negatively associated with amount won through escape motives. Overall, results support exploring gambling behavior and motives using a SDT framework.

Spring break versus spring broken: predictive utility of spring break alcohol intentions and willingness at varying levels of extremity.

Within the domain of risk-related behavior, many times the decision to engage is not a product of premeditation or intention. The prototype willingness model was created to capture and explain the unintended element of risk behavior. The present study aimed to evaluate the importance of willingness versus intention, two important constructs within the prototype willingness model, in relation to spring break drinking behavior when assessed at both high and low extremities. College undergraduates (N = 275) completed questionnaires prior to spring break regarding their anticipated spring break activities. Willingness and intention were assessed for different levels of risk. Specifically, participants indicated the extent to which they intended to (a) get drunk and (b) drink enough to black out or pass out; and the extent to which they were willing to (a) get drunk and (b) drink enough to black out or pass out. When classes resumed following spring break, the students indicated the extent to which they actually (a) got drunk and (b) drank enough to black out or pass out. Results demonstrated that when the health-related risk was lower (i.e., getting drunk), intention was a stronger predictor of behavior than was willingness. However, as the level of risk increased (i.e., getting drunk enough to black out or pass out), willingness more strongly predicted behavior. The present study suggests that willingness and intentions differentially predict spring break alcohol-related behavior depending on the extremity of behavior in question. Implications regarding alcohol interventions are discussed.

Drinking games and contextual factors of 21st birthday drinking.

BACKGROUND: 21st birthday celebrations are among the highest risks for alcohol use throughout emerging adulthood and celebrants often experience a range of alcohol-related consequences. OBJECTIVES: The present research considered what happens when drinking games are paired with an already high-risk event (i.e., 21st birthday celebrations) and how drinking games compare with other contextual factors on 21st birthdays. METHODS: Approximately four days after turning 21, 1124 college students (55% women) completed an online survey assessing alcohol use and related consequences experienced during their birthday celebrations. Participants were also asked whether drinking games and other contextual factors were associated with their celebrations. RESULTS: Overall, 18% of participants reported playing drinking games during their 21st birthday celebrations. These individuals reported consuming more alcohol, had higher estimated BACs, and experienced more negative consequences than those who did not play drinking games. The association between playing drinking games and alcohol use and negative consequences was stronger for men. The effect of drinking games on negative consequences was mediated through elevated BAC levels. Receiving bar specials, having drinks purchased, playing drinking games, and loud music were uniquely and significantly associated with all alcohol outcomes. CONCLUSION: Together, these results suggest that drinking games are part of a larger context of risk contributing to extreme drinking on 21st birthdays. Furthermore, these results will help to facilitate interventions that are more individually tailored to target specific contextual risks, behaviors, and events.

Self-identification as a moderator of the relationship between gambling-related perceived norms and gambling behavior.

This research was designed to evaluate social influences and perceived social norms on gambling behavior among undergraduate students. Furthermore, this research was designed to replicate and extend previous research demonstrating that young adults overestimate the prevalence of gambling among peers, and that the magnitude of overestimation is positively associated with own use (Larimer and Neighbors, Psychol Addict Behav 17:235-243, 2003). We expected that; (1) gambling college students would identify more strongly with other gambling students compared to other students in general; (2) identification with other gambling students would predict gambling behaviors over and above perceived prevalence of gambling; and (3) identification with other gambling students would moderate the association between perceived social norms and gambling behavior. Participants included 1,486 undergraduate students who completed measures assessing gambling quantity and frequency, gambling-related perceived descriptive norms, and identification with groups. Results revealed that perceived norms for gambling were associated with gambling and revealed that students identified more strongly with other students than either gamblers or student gamblers. However, gambling behavior was more strongly associated with identification with gambling students than students in general. There was consistent support for the perspective that social identity moderates the association between perceived norms for gambling and gambling behavior. This research builds on previous examinations of social influences related to gambling and suggests that it may be important to consider the overall prevalence of a given behavior before considering norms-based intervention approaches. Interventions utilizing social norms for gambling may be advised to consider references other than just the typical student.

Differential Treatment Response of Proactive and Reactive Partner Abusive Men: Results from a Laboratory Proximal Change Experiment.

Objective: The current study reexamines data from Babcock et al. (2011) proximal change experiment to discern the differential utility of two communication skills-based interventions for proactive and reactive partner violence offenders. Method: Partner violent men were randomly assigned to the Editing Out the Negative skill, the Accepting Influence skill, or to a placebo/timeout and reengaged in a conflict discussion with their partners. Proactivity was tested as a moderator of immediate intervention outcomes. The ability to learn the communication skills, changes in self-reported affect, observed aggression, and psychophysiological responding were examined as a function of proactivity of violence. Results: Highly proactive men had some difficulty learning the Accepting Influence skill and they responded poorly to this intervention. They responded positively to the Editing Out the Negative technique, with less aggression, more positive affect, and lower heart rates. Low proactive (i.e., reactive) men tended to feel less aggressive, more positive, and less physiologically aroused after completing the Accepting Influence technique. Conclusions: This study lends support for tailoring batterer interventions specific to perpetrator characteristics.

Objetivo: El presente estudio reexamina los datos de Babcock et al. (2011) con respecto a un experimento de cambio proximal para discernir la utilidad diferencial de dos intervenciones basadas en habilidades de comunicación para agresores de violencia de pareja proactivos y reactivos. Método: A los agresores se les asignó aleatoriamente a las condiciones habilidad de eliminar lo negativo, habilidad de aceptación de la influencia, o placebo/tiempo fuera y volvieron a participar en una discusión conflictiva con sus parejas. Se evaluó la proactividad como moderadora de los resultados proximales de la intervención. Se examinó la capacidad de aprender habilidades de comunicación, los cambios en el afecto autoinformado, la agresión observada y la respuesta psicofisiológica en función de la proactividad de la violencia. Resultados: Los hombres muy proactivos tuvieron algunas dificultades para aprender la habilidad de aceptación de la influencia y respondieron escasamente a esta intervención. Sin embargo, respondieron positivamente a la técnica de eliminar lo negativo, con menor agresión, más afecto positivo y una frecuencia cardíaca más baja. Los hombres poco proactivos (es decir, reactivos) tendían a sentirse menos agresivos, más positivos y menos activados fisiológicamente después de completar la técnica de aceptación de la influencia. Conclusiones: Este estudio proporciona apoyo a la adaptación de las intervenciones para maltratadores a las características específicas del agresor.

Self-determination theory and romantic relationship processes.

Self-determination theory can be viewed as a theory of optimal relationship development and functioning. We examine the concept of self that is employed in self-determination theory and explain how its unique definition allows an important and novel characterization of investing one's "self" in romantic relationships. A self-determined perspective on romantic relationships integrates several theories on romantic relationship development, but also goes beyond them by explicitly articulating the personality, developmental, and situational factors that facilitate optimal self-investment and relational functioning. Self-determination promotes openness rather than defensiveness and facilitates perspective-taking, authenticity, and support of close others. The dyadic context of romantic relationships affords great opportunity for theoretical development and integration of self-determination theory with current theories of interdependence and relational well-being.

Affection preference, enactment, and relationship satisfaction: A dyadic analysis of love languages.

Despite its popularity, The Five Love Languages relationship self-help book has received little empirical investigation. This may result in a disconnect between clinicians and clients with preconceived notions based on the book. The current research sought to evaluate love languages through the lens of responsiveness by examining if an accurate or biased understanding of partner preferences for different modes of affection were associated with enacted affectionate behavior, the perception of partner behavior, and relationship satisfaction. The results from a sample of 84 couples indicated that individuals tend to have a biased understanding of partner preferences and these biases influenced expressions of affection. In addition, accurately understanding partner preferences was associated with greater relationship satisfaction. The findings suggest that helping clients understand both their own and their partner's preferences for expressions of affection, may reduce bias and lead to more partner-preferred expressions of affection and, ultimately, greater relationship satisfaction.

Longitudinal associations between descriptive and injunctive norms on college drinking.

Perceived norms of drinking prevalence (descriptive norms) and approval (injunctive norms) are among the most robust predictors of college student drinking, but the dynamic fluctuations of these relationships over time are less understood. We examined longitudinal associations of descriptive and injunctive norms on alcohol consumption, disaggregating within-person fluctuations from between-person associations. Participants were 593 heavy drinking college students who completed measures of perceived descriptive and injunctive norms and drinking at baseline, one month, three months, six months, and 12 months. Longitudinal multilevel model analyses revealed that, at the between-person level, only descriptive norms predicted drinking. In contrast, both descriptive and injunctive norms at the within-person level predicted weekly drinking. The findings are the first to examine between- and within-person effects of descriptive and injunctive norms simultaneously on drinking and suggest that future college drinking interventions using normative influence would benefit from recognizing and incorporating within-person fluctuations in perceived norms.