A pragmatic randomized trial of mailed fecal immunochemical testing to increase colorectal cancer screening among low-income and minoritized populations.

BACKGROUND: Colorectal cancer (CRC) screening is underused, particularly among low-income and minoritized populations, for whom the coronavirus disease 2019 (COVID-19) pandemic has challenged progress in achieving equity. METHODS: A hub-and-spoke model was used. The hub was a nonacademic organization and the spokes were three community health center (CHC) systems overseeing numerous clinic sites. Via a cluster-randomized trial design, nine clinic sites were randomized to intervention and 16 clinic sites were randomized to usual care. Patient-level interventions included invitation letters, mailed fecal immunochemical tests (FITs), and call/text-based reminders. Year 1 intervention impact, which took place during the COVID-19 pandemic, was assessed as the proportion completing screening among individuals not up to date at baseline, which compared intervention and nonintervention clinics accounting for intraclinic cluster variation; confidence intervals (CIs) around differences not including 0 were interpreted as statistically significant. RESULTS: Among 26,736 patients who met eligibility criteria, approximately 58% were female, 55% were Hispanic individuals, and 44% were Spanish speaking. The proportion completing screening was 11.5 percentage points (ppts) (95% CI, 6.1-16.9 ppts) higher in intervention versus usual care clinics. Variation in differences between intervention and usual care clinics was observed by sex (12.6 ppts [95% CI, 7.2-18.0 ppts] for females; 8.8 ppts [95% CI, 4.7-13.9 ppts] for males) and by racial and ethnic group (13.8 ppts [95% CI, 7.0-20.6 ppts] for Hispanic individuals; 13.0 ppts [95% CI, 3.6-22.4 ppts] for Asian individuals; 11.3 ppts [95% CI, 5.8-16.8 ppts] for non-Hispanic White individuals; 6.1 ppts [95% CI, 0.8-10.4 ppts] for Black individuals). CONCLUSIONS: A regional mailed FIT intervention was effective for increasing CRC screening rates across CHC systems serving diverse, low-income populations.

Greater subjective cognitive decline severity is associated with worse memory performance and lower entorhinal cerebral blood flow in healthy older adults.

OBJECTIVE: Subjective cognitive decline (SCD) is a potential early risk marker for Alzheimer's disease (AD), but its utility may vary across individuals. We investigated the relationship of SCD severity with memory function and cerebral blood flow (CBF) in areas of the middle temporal lobe (MTL) in a cognitively normal and overall healthy sample of older adults. Exploratory analyses examined if the association of SCD severity with memory and MTL CBF was different in those with lower and higher cardiovascular disease (CVD) risk status. METHODS: Fifty-two community-dwelling older adults underwent magnetic resonance imaging, neuropsychological testing, and were administered the Everyday Cognition Scale (ECog) to measure SCD. Regression models investigated whether ECog scores were associated with memory performance and MTL CBF, followed by similar exploratory regressions stratified by CVD risk status (i.e., lower vs higher stroke risk). RESULTS: Higher ECog scores were associated with lower objective memory performance and lower entorhinal cortex CBF after adjusting for demographics and mood. In exploratory stratified analyses, these associations remained significant in the higher stroke risk group only. CONCLUSIONS: Our preliminary findings suggest that SCD severity is associated with cognition and brain markers of preclinical AD in otherwise healthy older adults with overall low CVD burden and that this relationship may be stronger for individuals with higher stroke risk, although larger studies with more diverse samples are needed to confirm these findings. Our results shed light on individual characteristics that may increase the utility of SCD as an early risk marker of cognitive decline.

Measurement equivalence of the English and French versions of the self-efficacy to manage chronic disease scale: a Scleroderma Patient-Centered Intervention Network (SPIN) study.

PURPOSE: The Self-Efficacy to Manage Chronic Disease (SEMCD) scale is widely used, including in systemic sclerosis (SSc). The SEMCD has been validated in SSc, but the metric equivalence of the English and French versions has not been assessed (i.e., whether psychometric properties are equivalent across English and French). METHODS: Participants were adults from the Scleroderma Patient-Centered Intervention Network (SPIN) Cohort (N = 2159) who completed baseline measures in English (n = 1473) or French (n = 686) between May 2014 to July 2020. Analyses assessed internal consistency reliability via Cronbach's alpha and McDonald's omega, convergent validity via Pearson's correlations, structural validity via confirmatory factor analysis (CFA), and differential item functioning via the Multiple-Indicator Multiple-Cause (MIMIC) model. RESULTS: Internal consistency reliability was high in English (α = .93, ω = .93) and French (α = .92, ω = .93). All correlations between the SEMCD and measures of health outcomes were moderate to large, statistically significant, and in the hypothesized direction in both languages. The CFA demonstrated that the one-factor model of self-efficacy, overall, fit reasonably well (CFI = .96, TLI = .93, SRMR = .03, RMSEA = .14). Standardized factor loadings were large (.76 to .88). Three items displayed statistically significant uniform DIF and all six displayed nonuniform DIF; all DIF was of minimal magnitude. Comparison of unadjusted and DIF-adjusted models indicated that DIF did not meaningfully impact total score (ICC = 0.999, r = 0.999). CONCLUSION: Scores from English- and French-speaking adults with SSc can be combined for analysis or compared.

Neighborhood environments and psychological distress 6-years later: results from the San Diego HCHS/SOL community and surrounding areas study.

PURPOSE: The current study examined associations of social and built features of neighborhood environments with psychological distress 6 years later and whether these associations were explained by stress and social factors, among Hispanic/Latino adults from the HCHS/SOL and SOL CASAS Ancillary Study. METHODS: In the SOL CASAS Ancillary Study, HCHS/SOL San Diego participants' baseline (2008-2011) home addresses were geocoded, neighborhoods were defined using 800 m radial buffers, and variables representing neighborhood socioeconomic deprivation, social disorder, walkability, and greenness were created. Psychological distress (anxiety and depression symptoms) and proposed pathway variables chronic stress, social support, and family cohesion were assessed at HCHS/SOL Visit 2 (2014-2017). RESULTS: On average, the population (n = 2785) was 39.47 years old, 53.3% were women, and 92.3% were of Mexican heritage. In complex survey regression analyses that accounted for sociodemographic covariates, the complex sampling design, and sample weights, greater baseline neighborhood socioeconomic deprivation predicted lower family cohesion at Visit 2 (B = -0.99, 95% CI [-1.97, -0.06]). Path models showed indirect associations of baseline neighborhood socioeconomic deprivation with Visit 2 psychological distress through family cohesion (MacKinnon's 95% CI depression [0.001, 0.026]; 3.9% of the variance accounted for; anxiety [0.00071, 0.019] 3.0% of the variance accounted for). CONCLUSIONS: Among adults of mostly Mexican heritage from the San Diego, CA area, neighborhood deprivation indirectly predicted later psychological distress through family cohesion. No other effects of neighborhood variables were observed.

Moderators of Loneliness Trajectories in People with Systemic Sclerosis During the COVID-19 Pandemic: A SPIN COVID-19 Cohort Longitudinal Study.

BACKGROUND: Many individuals with systemic sclerosis (SSc) are at heightened risk for COVID-19 related morbidity and isolation due to interstitial lung disease, frailty, and immunosuppressant use. Minimal research has explored loneliness predictors in individuals with chronic illnesses during COVID-19. This study evaluated moderators of loneliness trajectories in individuals with SSc during COVID-19. METHODS: Longitudinal data were analyzed across 30 timepoints from April 2020 to May 2022 from 775 adults in the Scleroderma Patient-centered Intervention Network (SPIN) COVID-19 Cohort. Hierarchical linear modeling evaluated cross-level moderators of loneliness trajectories, including marital status, baseline number of household members, number of virtual or telephone one-on-one or virtual group conversations, number of hours spent enjoying in-person household conversations or activities, and satisfaction with quality of in-person household conversations (all in the past week). Level-1 moderation analyses assessed effects of conversation, activity, and satisfaction means and slopes over time. RESULTS: Baseline values were not statistically significant moderators of loneliness trajectories. Higher mean (averaged over time) virtual or telephone one-on-one and in-person household conversations, in-person household activity, and in-person household conversation satisfaction were associated with lower loneliness trajectories (ps < .05). The relationship between in-person household conversation satisfaction and loneliness trajectory was statistically significantly but minimally attenuated over time (p < .001). CONCLUSIONS: For people with SSc, higher mean conversation, activity, and satisfaction variables were associated with lower levels of loneliness during the pandemic, but changes in these social variables were generally not predictive of changes in loneliness.

Validating a Pragmatic Measure of Evidence-Based Practice (EBP) Delivery: Therapist Reports of EBP Strategy Delivery and Associations with Child Outcome Trajectories.

Pragmatic measures of evidence-based practice (EBP) implementation can support and evaluate implementation efforts. We examined the predictive validity of therapist reports of EBP strategy delivery for children's mental health outcomes. Data were obtained from 1,380 sessions with 248 children delivered by 76 therapists in two county systems. Children (Mage=11.8 years, SD = 3.7) presented with internalizing (52%), externalizing (27%), trauma (16%), and other (5%) concerns. Therapists reported their delivery of EBP strategies on a revised version of the EBP Concordant Care Assessment (ECCA; Brookman-Frazee, et al., Administration and Policy in Mental Health and Mental Health Services Research, 48, 155-170, 2021) that included 25 content (e.g., parenting, cognitive behavioral) and 12 technique strategies (e.g., modeling, practice/role-play). On average, 5.6 ECCA session reports (SD = 2.3) were obtained for each client, and caregivers reported symptoms on the Brief Problem Checklist (Chorpita, et al., Journal of Consulting and Clinical Psychology, 78(4), 526-536, 2010) at baseline, weekly over two months, and again at four months. Multilevel models examined whether the mean extensiveness of each EBP strategy predicted trajectories of child outcomes. More individual technique (6 of 12) than content strategies (1 of 25) were associated with outcome trajectories. For techniques, more extensive use of Performance Feedback and Live Coaching and less extensive use of Addressing Barriers were associated with greater declines in total symptoms, and more extensive use of Establishing/Reviewing Goals, Tracking/Reviewing Progress, and Assigning/Reviewing Homework was associated with declines in externalizing symptoms. For content, more extensive use of Cognitive Restructuring was associated with declines in total symptoms. In addition, higher average extensiveness ratings of the top content strategy across sessions was associated with greater declines in total and externalizing symptoms. Therapist-reported delivery of some EBP strategies showed evidence of predictive validity and may hold utility in indexing quality of care.

Mi Puente (My Bridge) Care Transitions Program for Hispanic/Latino Adults with Multimorbidity: Results of a Randomized Controlled Trial.

BACKGROUND: Multimorbidity frequently co-occurs with behavioral health concerns and leads to increased healthcare costs and reduced quality and quantity of life. Unplanned readmissions are a primary driver of high healthcare costs. OBJECTIVE: We tested the effectiveness of a culturally appropriate care transitions program for Latino adults with multiple cardiometabolic conditions and behavioral health concerns in reducing hospital utilization and improving patient-reported outcomes. DESIGN: Randomized, controlled, single-blind parallel-groups. PARTICIPANTS: Hispanic/Latino adults (N=536; 75% of those screened and eligible; M=62.3 years (SD=13.9); 48% women; 73% born in Mexico) with multiple chronic cardiometabolic conditions and at least one behavioral health concern (e.g., depression symptoms, alcohol misuse) hospitalized at a hospital that serves a large, mostly Hispanic/Latino, low-income population. INTERVENTIONS: Usual care (UC) involved best-practice discharge processes (e.g., discharge instructions, assistance with appointments). Mi Puente ("My Bridge"; MP) was a culturally appropriate program of UC plus inpatient and telephone encounters with a behavioral health nurse and community mentor team who addressed participants' social, medical, and behavioral health needs. MAIN MEASURES: The primary outcome was 30- and 180-day readmissions (inpatient, emergency, and observation visits). Patient-reported outcomes (quality of life, patient activation) and healthcare use were also examined. KEY RESULTS: In intention-to-treat models, the MP group evidenced a higher rate of recurrent hospitalization (15.9%) versus UC (9.4%) (OR=1.91 (95% CI 1.09, 3.33)), and a greater number of recurrent hospitalizations (M=0.20 (SD=0.49) MP versus 0.12 (SD=0.45) UC; P=0.02) at 30 days. Similar trends were observed at 180 days. Both groups showed improved patient-reported outcomes, with no advantage in the Mi Puente group. Results were similar in per protocol analyses. CONCLUSIONS: In this at-risk population, the MP group experienced increased hospital utilization and did not demonstrate an advantage in improved patient-reported outcomes, relative to UC. Possible reasons for these unexpected findings are discussed. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02723019. Registered on 30 March 2016.

Exploring classes of cancer patient navigators and determinants of navigator role retention.

BACKGROUND: In the current nationwide study, the authors used latent class analysis (LCA) to identify classes of cancer patient navigators (CPNs) and examined whether class membership and 12 indicators were related to navigator role retention. METHODS: By using data from 460 CPNs in the United States, LCA identified classes (ie, homogenous subgroups) of CPNs with the following indicators: type of CPN (clinical vs nonclinical), education level, area(s) of the cancer care continuum in which the CPN provided patient navigation, region and urbanity where the CPN provided services, organizational work setting, and patient navigation program funding source. The associations of navigator retention with class membership and each indicator were examined using χ2 tests. RESULTS: LCA identified 3 classes of CPNs. Classes 1 and 3 were conceptualized as distinct, homogeneous subgroups of clinical CPNs that appeared to differ mainly on their likelihood of engagement in outreach, survivorship, palliative care, and end-of-life patient navigation. Class 2 was conceptualized as a nonclinical CPN subgroup that was distinct primarily based on their high endorsement of employment in programs, which are at least partially funded by grants and engagement in earlier stages of patient navigation (eg, early detection). The provision of survivorship and treatment patient navigation was related to navigator role retention, with senior CPNs providing these patient navigation services more than novice CPNs. CONCLUSIONS: The current study highlights 3 distinct classes of CPNs, provides initial information regarding determinants of navigator retention, and makes several recommendations for future patient navigation research.

Neighborhood built environments and Hispanic/Latino adults' physical activity in the U.S.: The Hispanic community health study/study of Latinos community and surrounding areas study.

Despite experiencing health inequities, less is known about neighborhood environments and physical activity among Hispanic/Latino adults compared to other populations. We investigated this topic in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Hispanic/Latino adults in the San Diego, California area of the U.S. completed measures of overall moderate-to-vigorous physical activity (MVPA) via accelerometry and domain-specific MVPA via questionnaire at Visits 1 (2008-2011; n = 4086) and 2 (2014-2017; n = 1776), ~6 years apart. 800-m home neighborhood buffers were used to create objective measures of residential, intersection, and retail density, bus/trolley stops, greenness, parks, and recreation area at Visit 1. Regression models tested the association of each neighborhood feature with MVPA at Visit 1 and over 6 years, adjusting for individual characteristics and neighborhood socioeconomic deprivation. At Visit 1, those in neighborhoods with higher vs. lower retail density or recreation area (+1 vs. -1 standard deviation from the mean) engaged in 10% more overall MVPA and 12-22% more active transportation. Those in neighborhoods with higher vs. lower residential density engaged in 22% more active transportation. Those in neighborhoods with higher vs. lower greenness and park count engaged in 14-16% more recreational MVPA. Neighborhood features were unassociated with changes in MVPA over 6 years. Although changes in MVPA over time were similar across neighborhoods, Hispanic/Latino adults living in neighborhoods with design features supportive of walking and recreational activity (e.g., greater residential and retail density, more parks and recreation facilities) were consistently more active. Improving neighborhood environments appears important for supporting physical activity among Hispanic/Latino adults.

Identification of Youthful Neurocognitive Trajectories in Adults Aging with HIV: A Latent Growth Mixture Model.

Despite the neurocognitive risks of aging with HIV, initial cross-sectional data suggest a subpopulation of older people with HIV (PWH) possess youthful neurocognition (NC) characteristic of SuperAgers (SA). Here we characterize longitudinal NC trajectories of older PWH and their convergent validity with baseline SA status, per established SuperAging criteria in PWH, and baseline biopsychosocial factors. Growth mixture modeling (GMM) identified longitudinal NC classes in 184 older (age ≥ 50-years) PWH with 1-5 years of follow-up. Classes were defined using 'peak-age' global T-scores, which compare performance to a normative sample of 25-year-olds. 3-classes were identified: Class 1Stable Elite (n = 31 [16.8%], high baseline peak-age T-scores with flat trajectory); Class 2Quadratic Average (n = 100 [54.3%], intermediate baseline peak-age T-scores with u-shaped trajectory); Class 3Quadratic Low (n = 53 [28.8%], low baseline peak-age T-scores with u-shaped trajectory). Baseline predictors of Class 1Stable Elite included SA status, younger age, higher cognitive and physiologic reserve, and fewer subjective cognitive difficulties. This GMM analysis supports the construct validity of SuperAging in older PWH through identification of a subgroup with longitudinally-stable, youthful neurocognition and robust biopsychosocial health.

RESUMEN: A pesar de los riesgos neurocognitivos de envejecer con VIH, datos transversales iniciales sugieren que una subpoblación de personas con VIH (PCV) de edad mayor posee neurocognición (NC) juvenil, característica de los Súper-Ancianos (SA). Aquí nosotros caracterizamos trayectorias longitudinales de NC en PCV mayores y su validez convergente con su status de referencia de SA, según los criterios establecidos en PCV, y factores biopsicosociales en la base de referencia. El modelo de mezclas Gaussianas (GMM) identificó clases longitudinales de NC en 184 PCV mayores (edad ≥ 50-años) con 1­5 años de seguimiento. Las clases fueron definidas utilizando puntuaciones-T (T-scores) globales de "edad pico", que comparan el desempeño con una muestra normativa de personas de 25 años de edad. 3-clases fueron identificadas: Clase 1Élite Estable (n = 31 [16.8%], puntuaciones-T de edad pico de referencia altas con trayectoria plana; Clase 2Promedio Cuadrático (n = 100 [54.3%], puntuaciones-T de edad pico de referencia intermedias con trayectoria en forma de u); Clase 3Cuadrática Baja (n = 53 [28.8%], %], puntuaciones-T de edad pico de referencia bajas con trayectoria en forma de u). Los predictores de referencia de la Clase 1Élite Estable incluyen estatus de SA, edad mas joven, reserva cognitiva y fisiológica superior, y menos dificultades cognitivas subjetivas. Este análisis GMM apoya la validez del constructo de Súper-Envejecimiento en PCV mayores mediante la identificación de un subgrupo longitudinalmente estable, neurocognición juvenil y una robusta salud biopsicosocial.

Confirmatory factor and measurement invariance analyses of the Eating Disorder Examination Questionnaire in sexual minority men and women.

OBJECTIVE: The present study aimed to investigate the factor structure of the Eating Disorder Examination Questionnaire (EDE-Q) in a large sample of cisgender sexual minority men and women, and subsequently, to evaluate measurement invariance by gender. METHOD: The sample consisted of 962 sexual minority adult men (n = 479) and women (n = 483) who completed online self-report surveys. Confirmatory factor analysis was conducted using two previously supported factor structures (Friborg et al.'s four-factor model and Grilo et al.'s brief three-factor model) as well as the original four-factor structure of the EDE-Q. RESULTS: Results indicated that the best fitting models were Friborg et al.'s four-factor model (CFI = .974, RMSEA = .098, SRMR = .0 70) and Grilo et al.'s brief three-factor model (CFI = .999, RMSEA = .049, SRMR = .017). The model fit of both factor structures were nearly identical when examined separately for men and women. The original four-factor structure could not be supported in this sample. Measurement invariance analyses further indicated that the best fitting models were invariant by gender in sexual minority individuals. Internal consistency was adequate for all subscales of Friborg et al.'s and Grilo et al.'s models. DISCUSSION: The present study provides support for the use of the EDE-Q in sexual minority men and women. Additionally, findings demonstrate that the EDE-Q performs similarly in sexual minority men and women. Future research is needed to further evaluate measurement invariance of the EDE-Q by sexual orientation, gender identity, and race.

Relationships of Sleep Duration, Midpoint, and Variability with Physical Activity in the HCHS/SOL Sueño Ancillary Study.

OBJECTIVE/BACKGROUND: Short and long sleep duration, later sleep midpoint, and greater intra-individual sleep variability are associated with lower physical activity, but previous research lacks objective and concurrent assessment of sleep and physical activity. This cross-sectional study examined whether sleep duration, midpoint, and variability in duration and midpoint were related to wrist actigraphy-measured physical activity. PARTICIPANTS: Participants were 2156 Hispanics/Latinos in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sueño Ancillary Study. METHODS: Participants wore Actiwatch devices to measure sleep and physical activity via the wrist for ≥5 days. Physical activity was defined as minutes/day in the upper quartile of the sampling distribution's non-sleep activity, capturing light to vigorous physical activity. RESULTS: An inverse linear relationship between sleep duration and physical activity was found such that each additional sleep hour related to 29 fewer minutes of physical activity (B = -28.7, SE = 3.8), p < .01). Variability in sleep midpoint was also associated with physical activity; with each 1-hr increase in variability there were 24 more minutes of physical activity (B = 24.2, SE = 5.6, p < .01). In contrast, sleep midpoint and variability in duration were not associated with physical activity. Sensitivity analyses identified an association of short sleep duration and greater variability in sleep duration with greater accelerometry-derived moderate-to-vigorous physical activity measured at the HCHS/SOL baseline (M = 2.1 years before the sleep assessment). CONCLUSIONS: Findings help clarify inconsistent prior research associating short sleep duration and sleep variability with greater health risks but also contribute novel information with simultaneous objective assessments.

Therapist-Observer Concordance in Ratings of EBP Strategy Delivery: Challenges and Targeted Directions in Pursuing Pragmatic Measurement in Children's Mental Health Services.

Pragmatic measures of therapist delivery of evidence-based practice (EBP) are critical to assessing the impact of large-scale, multiple EBP implementation efforts. As an initial step in the development of pragmatic measurement, the current study examined the concordance between therapist and observer ratings of items assessing delivery of EBP strategies considered essential for common child EBP targets. Possible EBP-, session-, and therapist-levels factors associated with concordance were also explored. Therapists and independent observers rated the extensiveness of therapist (n = 103) EBP strategy delivery in 680 community psychotherapy sessions in which six EBPs were used. Concordance between therapist- and observer-report of the extensiveness of therapist EBP strategy use was at least fair (ICC ≥ .40) for approximately half of the items. Greater therapist-observer concordance was observed in sessions where a structured EBP was delivered and in sessions where therapists reported being able to carry out planned activities. Findings highlighted conditions that may improve or hinder therapists' ability to report on their own EBP strategy delivery in a way that is consistent with independent observers. These results can help inform the development of pragmatic therapist-report measures of EBP strategy delivery and implementation efforts more broadly.

Modeling daily and weekly moderate and vigorous physical activity using zero-inflated mixture Poisson distribution.

Recently developed accelerometer devices have been used in large epidemiological studies for continuous and objective monitoring of physical activities. Typically, physical movements are summarized as minutes in light, moderate, and vigorous physical activities in each wearing day. Because of preponderance of zeros, zero-inflated distributions have been used for modeling the daily moderate or higher levels of physical activity. Yet, these models do not fully account for variations in daily physical activity and cannot be extended to model weekly physical activity explicitly, while the weekly physical activity is considered as an indicator for a subject's average level of physical activity. To overcome these limitations, we propose to use a zero-inflated Poisson mixture distribution that can model daily and weekly physical activity in same family of mixture distributions. Under this method, the likelihood of an inactive day and the amount of exercise in an active day are simultaneously modeled by a joint random effects model to incorporate heterogeneity across participants. If needed, the method has the flexibility to include an additional random effect to address extra variations in daily physical activity. Maximum likelihood estimation can be obtained through Gaussian quadrature technique, which is implemented conveniently in an R package GLMMadaptive. Method performances are examined using simulation studies. The method is applied to data from the Hispanic Community Health Study/Study of Latinos to examine the relationship between physical activity and BMI groups and within a participant the difference in physical activity between weekends and weekdays.

Sleep disturbance and cancer-related fatigue symptom cluster in breast cancer patients undergoing chemotherapy.

PURPOSE: Sleep disturbance and cancer-related fatigue (CRF) are among the most commonly reported symptoms associated with breast cancer and its treatment. This study identified symptom cluster groups of breast cancer patients based on multidimensional assessment of sleep disturbance and CRF prior to and during chemotherapy. METHODS: Participants were 152 women with stage I-IIIA breast cancer. Data were collected before chemotherapy (T1) and during the final week of the fourth chemotherapy cycle (T2). Latent profile analysis was used to derive groups of patients at each timepoint who scored similarly on percent of the day/night asleep per actigraphy, the Pittsburgh Sleep Quality Index global score, and the five subscales of the Multidimensional Fatigue Symptom Inventory-Short Form. Bivariate logistic regression evaluated if sociodemographic/medical characteristics at T1 were associated with group membership at each timepoint. RESULTS: Three groups (Fatigued with sleep complaints, Average, Minimal symptoms) were identified at T1, and five groups (Severely fatigued with poor sleep, Emotionally fatigued with average sleep, Physically fatigued with average sleep, Average, Minimal symptoms) at T2. The majority of individuals in a group characterized by more severe symptoms at T1 were also in a more severe symptom group at T2. Sociodemographic/medical variables at T1 were significantly associated with group membership at T1 and T2. CONCLUSIONS: This study identified groups of breast cancer patients with differentially severe sleep disturbance and CRF symptom profiles prior to and during chemotherapy. Identifying groups with different symptom management needs and distinguishing groups by baseline sociodemographic/medical variables can identify patients at risk for greater symptom burden.

Psychosocial and neighborhood correlates of health-related quality of life: A multi-level study among Hispanic adults.

OBJECTIVE: Improvement in health-related quality of life (HRQoL) is a public health goal of Healthy People 2020. Hispanics living in the United States are at risk for poor HRQoL, but the causes and correlates of this risk are not well understood. Thus, the present study examined individual-level psychosocial and neighborhood-level built environment correlates of physical and mental HRQoL among Hispanic adults. METHOD: A community sample of Hispanic adults (N = 383) completed self-report health-related questionnaires, and census tract was used to collect data on neighborhood-level built environment variables. Multilevel modeling was used to examine individual-level psychosocial (language preference, religiosity, subjective social status, discrimination, and number of years lived in the United States) and neighborhood-level built-environment (the retail food environment, proximity to alcohol retailers, and tobacco retailer density) correlates of physical and mental HRQoL. RESULTS: Higher subjective social status was significantly associated with better HRQoL, and more experiences with discrimination were significantly associated with lower HRQoL. For physical HRQoL, these relationships were stronger in neighborhoods with a higher density of tobacco retail outlets. CONCLUSIONS: Findings from this study suggest that subjective social status and discrimination play important roles in HRQoL among Hispanics, in particular in neighborhoods with a higher density of tobacco retail outlets. This study highlights the importance of considering neighborhood context, and in particular neighborhood disadvantage, when examining the relationship between social status, discrimination and HRQoL among Hispanics. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Socioeconomic Adversity, Social Resources, and Allostatic Load Among Hispanic/Latino Youth: The Study of Latino Youth.

OBJECTIVE: We examined associations among socioeconomic adversity, social resources, and allostatic load in Hispanic/Latino youth, who are at high risk for obesity and related cardiometabolic risks. METHODS: Participants were 1343 Hispanic/Latino youth (51% male; ages 8-16 years) offspring of Hispanic Community Health Study/Study of Latinos participants. Between 2012 and 2014, youth underwent a fasting blood draw and anthropometric assessment, and youth and their enrolled caregivers provided social and demographic information. A composite indicator of allostatic load represented dysregulation across general metabolism, cardiovascular, glucose metabolism, lipid, and inflammation/hemostatic systems. Socioeconomic adversity was a composite of caregiver education, employment status, economic hardship, family income relative to poverty, family structure, and receipt of food assistance. Social resources were a composite of family functioning, parental closeness, peer support, and parenting style variables. RESULTS: Multivariable regression models that adjusted for sociodemographic factors, design effects (strata and clustering), and sample weights revealed a significant, positive, association between socioeconomic adversity and allostatic load (ß = .10, p = .035), and a significant, inverse association between socioeconomic adversity and social resources (ß = -.10, p = .013). Social resources did not relate to allostatic load and did not moderate or help explain the association of adversity with allostatic load (all p values > .05). CONCLUSIONS: Statistically significant, but small associations of socioeconomic adversity with both allostatic load and social resources were identified. The small effects may partially reflect range restriction given overall high socioeconomic adversity and high social resources in the cohort.

Efficacy of problem-solving therapy for spouses of men with prostate cancer: A randomized controlled trial.

OBJECTIVE: Prostate cancer can have a significant negative impact on patients and their spouses. Problem-solving therapy (PST) has been shown to help reduce distress and improve quality of life among cancer and caregiver populations. This study tested the efficacy of PST for spouses of men with prostate cancer. METHODS: Spouses of men diagnosed with prostate cancer within the past 18 months (N = 164) were randomly assigned to PST (n = 78) or usual psychosocial care (UPC; n = 86). Spouses completed measures of constructive and dysfunctional problem solving, cancer-related distress, mood, physical and mental health, and dyadic adjustment at preintervention and post-intervention and 3-month post-intervention follow-up. RESULTS: Constructive problem solving increased from pre-intervention to post-intervention among spouses receiving PST but not for spouses receiving UPC; this was maintained at follow-up. There was no decrease in dysfunctional problem solving. Spouses receiving PST versus UPC reported less cancer-related distress post-intervention and at follow-up. There were no significant changes in mood or physical and mental health. Dyadic adjustment was significantly better for spouses receiving PST versus UPC at post-intervention but not at follow-up. Improvements in constructive problem solving mediated better mood and dyadic adjustment post-intervention. CONCLUSIONS: Results support the efficacy of PST for improving spouses' constructive problem solving. There was evidence of both direct and mediated positive effects of PST for both individual and dyadic adjustment. PST may be useful for improving individual and dyadic outcomes for spouses of men with prostate cancer.

Extra-familial social factors and obesity in the Hispanic Community Children's Health Study/Study of Latino Youth.

Hispanic/Latino youth are disproportionately affected by obesity. However, how social factors outside of the family relate to Hispanic/Latino youth obesity is not well understood. We examined associations of extra-familial social factors with overweight/obesity prevalence, and their variation by sex and age, in 1444 Study of Latino Youth participants [48.6% female; 43.4% children (8-11 years); 56.6% adolescents (12-16 years)], who were offspring of the Hispanic Community Health Study/Study of Latinos participants. Youth self-reported general social support from friends, dietary-, and physical activity (PA)-specific support from peers, and awareness/internalization of thinness ideals. Overweight/obesity was defined as body mass index ≥ 85th percentile. Logistic regression models assessed effects of social factors and their interactions with age-group and sex, adjusting for potential confounders. Social support from friends interacted with both age and sex in relation to overweight/obesity. Female children who reported lesser (OR 0.60; 95% CI [0.39, 0.91]) and female adolescents who reported greater (OR 1.35; 95% CI [1.06, 1.74]) social support from friends had higher odds of overweight/obesity. Among males, greater awareness/internalization of thinness ideals related to higher odds of overweight/obesity (OR 2.30; 95% CI [1.59, 3.31]). Awareness/internalization of thinness ideals was not associated with overweight/obesity among females. Dietary and PA-specific peer support did not relate to overweight/obesity. Social support from friends and awareness/internalization of thinness ideals were significantly related to odds of overweight/obesity in Hispanic/Latino youth; associations varied by age and sex, and persisted after control for intra-familial factors (overall family support/function; diet and activity specific support).

Child Maltreatment, Relationship with Father, Peer Substance Use, and Adolescent Marijuana Use.

This longitudinal prospective study examined the relationship between child maltreatment as per reports to child protective services (CPS) and adolescent self-reported marijuana use, and the association between relationships with mothers and fathers and use of marijuana. The association between relationships with parents early in childhood (ages 6-8 years) and during adolescence with adolescent marijuana use were also probed. Another aim examined whether relationships with parents moderated the link between child maltreatment and youth marijuana use. The sample included 702 high risk adolescents from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), a consortium of 5 studies related to maltreatment. Children were recruited at age 4 or 6 years together with their primary caregiver. Some were recruited due to their risk for child maltreatment, others were already involved with CPS, and children in one site had been placed in foster care. Logistic regression analysis was performed using youth self-report of marijuana use as the criterion variable and child maltreatment and the relationships with parents as predictor variables, controlling for youths' perceptions of peer substance use and parental monitoring, parental substance use, race/ethnicity, sex and study site. Approximately half the youth had used marijuana. Most of them described quite positive relationships with their mothers and fathers. Participant marijuana Use was associated with a poorer quality of relationship with mother during adolescence, and with peer and parental substance use. A better relationship with father, but not mother, during adolescence attenuated the connection between Child Maltreatment and youth Marijuana Use.