The use of distraction and imagery with children during painful procedures.

The effectiveness of a pediatric pain management program was examined using a multiple case study design. This study examined both the children's pain experience during cancer treatment, as well as their parents' anxiety and behavioral stress. Fourteen children were videotaped while receiving lumbar punctures during an 8-12 month period. Baseline data were obtained at the first of three visits prior to the introduction of relaxation, imagery, and distraction exercises. Self-ratings of child fear and parent anxiety, videotaped observations of child and parent behavior, and child pain ratings were obtained at all three visits. The children's behavioral responses to the procedure varied considerably, but their fear scores were stable and their reports of pain decreased over time. Parents reported high-trait, low-state anxiety scores that were stable over time. They were observed to be very supportive during the procedures. Implications for further research in this area and recommendations for practice are presented.

Children's medical fears, coping behaviors, and pain perceptions during a lumbar puncture.

This study explored the relationships among medical fears, coping behaviors, and acute pain perceptions in 17 children with cancer who were encountering a painful medical procedure. The children completed the Child Medical Fear Scale (CMFS) before undergoing a lumbar puncture (LP), which was videotaped. The children's coping behaviors during the procedure were rated independently and classified as active or passive behaviors. Immediately following the LP, the children, using a pictorial scale, reported their pain perceptions. Most of the children's scores on the CMFS indicated a moderately low level of fear of medical experiences. A majority of the children perceived a great deal of pain during the LP. During the five phases of the painful medical procedure, more than half of the children exhibited a combination of active and passive behaviors. No significant differences were found between exhibited active or passive coping behaviors and reported medical fear levels; however, children who exhibited passive coping behaviors reported more pain than those who demonstrated active coping behaviors. Implications for practice relate to the need for continual preparation and support of children during a painful procedure.

A theoretical model for smoking prevention studies in preteen children.

The age of the onset of smoking is on a continual decline, with the prime age of tobacco use initiation being 12-14 years. A weakness of the limited research conducted on smoking prevention programs designed for preteen children (ages 10-12) is a well-defined theoretical basis. A theoretical perspective is needed in order to make a meaningful transition from empirical analysis to application of knowledge. Bandura's Social Cognitive Theory (1977, 1986), the Theory of Reasoned Action (Ajzen & Fishbein, 1980), and other literature linking various concepts to smoking behaviors in preteens were used to develop a model that may be useful for smoking prevention studies in preteen children.