Promising Directions: A Systematic Review of Psychosocial and Behavioral Interventions with Cultural Incorporation for Advanced and Metastatic Cancer.

BACKGROUND: Improving quality of life (QOL) in advanced and metastatic cancer is a priority with increasing survivorship. This systematic review synthesizes psychosocial and behavioral interventions incorporating culture with the goal of examining their benefit for understudied and medically underserved populations with advanced and metastatic cancer. METHOD: Reports were systematically screened for (1) a focus on advanced and metastatic cancer survivors, (2) psychosocial or behavioral intervention intended to improve QOL, (3) evidence of incorporating the culture(s) of understudied/underserved populations, and (4) availability in English. Bias was evaluated using the JBI Critical Appraisal Checklist and the Methodological index for non-randomized studies. Qualitative synthesis and quantitative meta-analyses were completed. RESULTS: Eighty-six reports containing 5981 participants' data were examined. Qualitative synthesis of 23 studies identified four overarching themes relevant for incorporating culture in interventions. Meta-analysis of 19 RCTs and 4 quasi-experimental studies containing considerable heterogeneity indicated greater improvements in QOL (g = 0.84), eudaimonic well-being (g = 0.53), distress (g = -0.49), and anxiety (g = -0.37) for main intervention conditions compared to controls. Meta-analysis of 10 single-arm trials containing minimal to moderate heterogeneity found benefit for anxiety (g = -0.54), physical symptoms (g = -0.39), and depression (g = -0.38). CONCLUSION: Psychosocial and behavioral interventions with cultural incorporation appear beneficial for improving QOL-related outcomes in advanced and metastatic cancer. Studies incorporating culture in psychosocial or behavioral interventions offer noteworthy insight and suggestions for future efforts such as attending to deep cultural structure.

Maternal blood pressure and birth weight associations in U.S.-born and foreign-born Latinas.

OBJECTIVES: Research suggests that acculturating to the United States is detrimental for immigrants' health. Consistent with this pattern, higher levels of U.S. acculturation among Latina-American women have been associated with giving birth to lower birth weight babies. The mechanisms that shape this shift in pregnancy health are not clear, but researchers have begun to consider the role of physiological systems that are sensitive to social experience. The present study examined the association of cultural orientation with blood pressure (BP) trajectories over the course of pregnancy. METHOD: In a study of 1,011 U.S.- and foreign-born Latina-American women, cultural orientation was assessed and multiple BP measures were collected throughout pregnancy. Postpregnancy data, including gestational age-adjusted birth weight, were extracted from medical records. Bayesian structural equation models examined average BP and slopes of BP change during pregnancy while accounting for psychosocial stress, support, and pregnancy health-related factors (e.g., maternal age, smoking). RESULTS: We found evidence that greater U.S. orientation was associated with higher diastolic blood pressure (DBP) and steeper increases in DBP, which was associated with less fetal growth. CONCLUSIONS: This is the first evidence that BP may mediate the association between cultural orientation and pregnancy outcomes in Latina-American women. These findings advance our understanding of the biopsychosocial pathways through which acculturation to the U.S. links with health. As scholars seek to better understand the influence of U.S. acculturation on health, focusing on the cardiovascular system and other physiological systems that are sensitive to social experience is warranted and likely to prove valuable. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Culturally adapting relational savoring: A therapeutic approach to improve relationship quality.

Relational savoring (RS) is a brief, strengths-based approach to heightening attentional focus to moments of positive connectedness within relationships. RS can be administered preventatively or within an intervention context when a therapist aspires to foster more optimal relational functioning. Typically administered within a one-on-one therapy setting, RS has demonstrated efficacy in enhancing intra- and interpersonal outcomes. To increase access to mental health services, the developers of RS are committed to engaging in an iterative approach of enhancing the cultural congruence and accessibility of this intervention within various cultural contexts, beginning with Latine groups in Southern California. In this article, we describe relational savoring and its theoretical and empirical support, including the process of culturally adapting the intervention within the context of three major studies, each with a distinct focus on Latine groups, a community that is underserved in mental health care settings. We then provide a vision for future research to improve upon the intervention's compatibility for Latine families and other populations.

What predicts interdependence with family? The relative contributions of ethnicity/race and social class.

OBJECTIVE: Interdependence with family is considered a core element of collectivistic cultures, and it is routinely endorsed by people of ethnic/racial minority backgrounds in the United States. In contrast, a preference for independence from family is characteristic of individualistic cultures, and of European Americans, who are considered prototypical of cultural individualism. Scholars have also theorized that socioeconomic factors play a role in shaping these patterns. We hypothesized and tested the possibility of a more nuanced and interactive pattern. Drawing from long-standing research on U.S. ethnic-minority cultures and recent research on social class, we expected that lower income would be least associated with family interdependence in foreign-born Latino/a Americans and most strongly associated with higher family interdependence in European Americans. METHOD AND RESULTS: In a prospective community study of a diverse sample of U.S. adults (N = 2,466), income interacted with ethnic/racial group to predict interdependence with family. In line with our predictions, income was not associated with family interdependence for foreign-born Latino/a Americans or African Americans, but lower income was significantly associated with higher interdependence with family in European Americans and, to a lesser extent, in U.S.-born Latino/a Americans. CONCLUSIONS: These findings provide novel evidence for the relevance of both ethnicity/race and social class-two aspects of culture-for family interdependence. They highlight the centrality of interdependence with family among foreign-born Latino/a Americans while showing that European Americans, a group considered most representative of cultural individualism, can also highly value interdependence with family. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Is Receiving Social Support Costly for Those Higher in Subjective Socioeconomic Status?

BACKGROUND: Although social support is generally thought to have positive consequences, this is not always the case. Receiving social support may threaten independence, which research has shown is more highly valued among those higher in socioeconomic status. As a result, support may be less strongly associated with positive outcomes for those higher in socioeconomic status (SES). Conversely, those lower in SES are more interdependent (Kraus, Piff, Mendoza-Denton, Rheinschmidt, & Keltner, 2012; Stephens, Markus, & Phillips, 2014) and may, therefore, be less threatened when receiving social support. This study examined SES as a moderator of how daily received support (within and between persons) predicted both daily psychological stressor appraisals and diurnal cortisol. METHOD: Healthy undergraduate students (N = 128) participated in a 3-day study. Participants completed one or more evening diaries the first day of the study and additional questionnaires upon awakening, throughout the day, and at bedtime during the following 2 days. Support was measured each evening and stressor appraisals and cortisol were measured throughout the day. RESULTS: As expected, for those who reported higher subjective SES, receiving more support than usual (within-person support) was associated with a flatter pattern of diurnal cortisol the next day. Although SES did not moderate the association of either within- or between-person support with stressor appraisals, the receipt of more support on average (between-person support) was associated with higher reported resources to cope. CONCLUSION: The findings demonstrate that there may be physiological costs-but not psychological costs-associated with the receipt of support for those higher in socioeconomic status.

Measurement of a Latino cultural value: The Simpatía scale.

OBJECTIVE: Simpatía, a term that captures the tendency to prefer and create social interactions characterized by warmth and emotional positivity while also avoiding conflict and/or overt negativity, is a cultural factor relevant to Latinos. The goal of this article was to develop a scale that measures this cultural value. METHOD: A self-report scale measure of simpatía was developed and administered to a combined sample of Latinos (N = 296) drawn from 3 larger studies. The scale's factor structure was explored, and its internal consistency and validity were tested. RESULTS: Exploratory factor analysis supported an 18-item scale and indicated 2 factors: simpatía-related positivity/warmth and simpatía-related negativity/conflict avoidance. Cronbach's alphas for the overall scale and subscales showed internal consistency. Validity analyses revealed that across subscales, simpatía was positively associated with positive emotion expressivity and dispositional positive emotion. The simpatía-related positivity/warmth subscale was also positively associated with an orientation toward Latino culture. CONCLUSIONS: The Simpatía Scale, which captures dual aspects of simpatía that emphasize the positive and avoid the negative, provides a new tool for advancing the study of Latino culture. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Do cultural values have a role in health equity? A study of Latina mothers and daughters.

OBJECTIVES: Recently, there has been a call to better understand Latino health and arrive at effective approaches for achieving health equity via research focusing on the association between cultural factors and health. This study examined whether familism, a cultural value that emphasizes warm and close family relationships, would attenuate the negative effects that perceived stress, a psychological process that can worsen health, can have on two physical health indicators- number of health conditions and bodily pain. METHOD: Latina mothers (n = 85, Mage = 52.68, SD = 6.60) with Type 2 diabetes and their daughters (n = 86, Mage = 27.69, SD = 7.61) whose weight put them at risk for also developing the condition were recruited to take part in a larger intervention study aimed at improving weight loss/dietary intake. Participants completed measures of familism, perceived stress, health conditions, and bodily pain. RESULTS: Results indicated that in the daughters, familism and perceived stress interacted to predict health conditions and bodily pain. As familism decreased, stress was associated with more health conditions and more bodily pain. These interactions were not significant for the mothers. CONCLUSIONS: First, familism has the potential to buffer the negative effect of stress in ways that are protective for health among Latinas at risk for diabetes. Second, this buffering effect has boundary conditions, suggesting that a better understanding is needed of how, for whom, and under what circumstances familism can be beneficial for health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Discrimination and the HPA axis: current evidence and future directions.

Numerous studies suggest that discrimination is associated with poor physical and mental health outcomes. Whereas the cardiovascular system has been extensively studied as a potential pathway linking discrimination with disease, the role of the hypothalamic-pituitary-adrenal (HPA) axis remains understudied. We conducted a systematic review of research on discrimination and related constructs as predictors and correlates of HPA axis activity. Twenty seven studies (10 experimental, 17 observational) met inclusion criteria. Studies suggest that discrimination is associated with alterations in HPA axis activity and that the direction of this association depends on the timing and chronicity of the discrimination experience. There is also evidence of important modulating variables (race, socioeconomic status) and contextual confounders (emotional, situational) that warrant further study. Accounting for the HPA axis in addition to the cardiovascular system will contribute to a more comprehensive understanding of the biobehavioral pathways contributing to physical and mental health inequities related to discrimination.

Community-based participatory research: an innovative approach for improving perioperative care of underserved children.

Pediatric disparities disproportionately affect Latino youth undergoing surgery and their families. As such, there is a critical need for culturally relevant frameworks that can advance perioperative intervention approaches in this population and reduce these disparities. In the following article, we first describe the methodological process of community-based participatory research (CBPR) and next report the results of the CBPR process that was conducted in this population. An interdisciplinary group of investigators, Latina mothers, and various other stakeholders met for a series of CBPR-based structured meetings. Qualitative data collection and analyses of the CBPR process were guided by principles of grounded theory that employs inductive techniques and constant comparison analyses until reaching saturation of data. Barriers identified in the process can be grouped within the following domains: child-related factors, family-related factors, health care provider factors, and hospital system factors. Family system factors category (coded references = 136) had the highest number of coded references; this category was found to be best described by the value of familismo or familism, including a duty to help family members when in need. The health care provider category (coded references = 42) was ranked second by frequency. Within this category, two major themes surfaced: health care provider cultural competence and overestimating health literacy. All barriers identified will be next incorporated in an innovative behavioral intervention that is currently being developed. We conclude that the model of CBPR can be used within the context of perioperative care of children and their families.

Postoperative pain management in Latino families: parent beliefs about analgesics predict analgesic doses provided to children.

BACKGROUND/OBJECTIVES: The present study examined whether parental perceptions of children's pain impacted home-based pain management following outpatient surgery in a sample of Latino families from low socioeconomic backgrounds. METHODS: Latino parents of children (n = 161) who underwent outpatient surgery were recruited for this study and completed measures assessing attitudes on pain and analgesic use (Parental Pain Expression Perceptions and Medication Attitudes Questionnaire) before their child's surgery. Parents also rated their child's pain after their child's surgery using the Parent Postoperative Pain Measure and collected data on the amount of analgesics they gave to their child on the first postoperative day. Hierarchical regression analyses examined whether parental attitudes predicted pain assessment and management at home. RESULTS: A majority of parents reported multiple misconceptions regarding children's pain and fears of side effects as well as avoidance of analgesic use. For example, over 80% reported believing that a child always tells their parents when they are in pain. Hierarchical regression analyses found that more fear and avoidance regarding analgesic use for children's pain predicted parents providing fewer doses of analgesic to their children on the first postoperative day (ß = -0.21, P = 0.028). CONCLUSIONS: Preoperative parents' beliefs regarding analgesics for treatment of children's pain may adversely impact parent postoperative analgesic administration at home in Latino families.

Familism and psychological health: the intervening role of closeness and social support.

Familism, a cultural value that emphasizes warm, close, supportive family relationships and that family be prioritized over self, has been associated with psychological health. The goal of this work was to fill a gap in the literature on how familism contributes to psychological health. Drawing from conceptual links between familism and close relationship processes, we hypothesized that familism contributes to better psychological health by facilitating closeness and social support. A university sample of U.S. women and men of Latino (n = 173), European (n = 257), and Asian (n = 642) cultural backgrounds completed measures of familism, closeness to family members, general perceived social support, and psychological health as indexed by perceived stress, general mental health, and depressive symptoms. Structural equation multiple-group modeling analyses found direct effects of familism on closeness to family members and perceived social support and an indirect effect of familism on better psychological health via greater closeness to family members and greater perceived social support. These effects did not differ by cultural background. Consistent with previous research, however, Latinos reported the highest levels of familism of the three cultural groups, and women reported higher familism and support as well as poorer psychological health than men. Discussion is focused on the implications of these findings for understanding the association of familism with psychological health and the relevance of the familism construct for diverse U.S. groups.

Are the costs of neuroticism inevitable? Evidence of attenuated effects in U.S. Latinas.

Neuroticism is the heritable and stable personality trait defined by the tendency to experience negative emotion, be easily stressed, and slow to soothe. Neuroticism poses a risk for poor social and health outcomes that has been identified as a major public health concern. To date, factors that attenuate neuroticism's costs have not been identified. The goal of this work was to test the hypothesis that the costs of neuroticism would be attenuated in sociocultural contexts that emphasize readily accessible social support, emotional positivity, and physical proximity in interdependent relationships. U.S. Latino culture fits these characteristics. Two studies, an online survey study (Study 1) and a laboratory study (Study 2), tested whether three key costs of high neuroticism-less support (Study 1), more distress (Study 2), and blunted cortisol reactivity (Study 2)-would be attenuated in U.S. Latinas relative to non-Latinas of European and East Asian cultural background. Consistent with previous research, neuroticism was associated with less perceived support, more distress, and blunted cortisol reactivity in non-Latina women of European and East Asian cultural background. For Latina women, however, these effects were attenuated. Latina women who were high in neuroticism continued to feel supported, were not as distressed, and their cortisol reactivity was less blunted. The role of sociocultural context for generating a better understanding of personality processes and the social malleability of neuroticism's costs are discussed.

Perceived neighborhood disorder and type 2 diabetes disparities in Hispanic, Black, and White Americans.

Introduction: Approximately 32 million Americans have type 2 diabetes, and that number continues to grow. Higher prevalence rates are observed among certain subgroups, including members of marginalized racial/ethnic groups as well as residents of disordered neighborhoods (i.e., those with more trash and vandalism). Institutionalized discriminatory practices have resulted in disproportionate representation of marginalized racial/ethnic groups in disordered neighborhoods compared to non-Hispanic Whites. These neighborhood disparities may partially contribute to health disparities, given that signs of neighborhood disorder often relate to a general withdrawal from the neighborhood, minimizing opportunities for both physical and social engagement. Yet, research suggests variability across racial/ethnic groups both in reporting rates of neighborhood disorder and in the extent to which neighborhood disorder is interpreted as posing a threat to health and well-being. Methods: Using 2016-2018 Health and Retirement Study data (n = 10,419, mean age = 67 years), a representative sample of older US adults, this study examined the possibility of racial/ethnic differences in associations between perceived neighborhood disorder and type 2 diabetes risk. Participants reported their perceptions of neighborhood disorder and type 2 diabetes status. Weighted logistic regression models predicted type 2 diabetes risk by perceived neighborhood disorder, race/ethnicity, and their interaction. Results: Non-Hispanic Blacks and Hispanics had higher type 2 diabetes risk; these two groups also reported more disorder in their neighborhoods compared to non-Hispanic Whites. Perceiving more neighborhood disorder was associated with increased type 2 diabetes risk, but the interaction between race/ethnicity and disorder was not significant. Discussion: Findings from the current study suggest that the negative effects of perceiving neighborhood disorder, a neighborhood-level stressor, extend to increased type 2 diabetes risk.

What is shared, what is different? Core relational themes and expressive displays of eight positive emotions.

Understanding positive emotions' shared and differentiating features can yield valuable insight into the structure of positive emotion space and identify emotion states, or aspects of emotion states, that are most relevant for particular psychological processes and outcomes. We report two studies that examined core relational themes (Study 1) and expressive displays (Study 2) for eight positive emotion constructs--amusement, awe, contentment, gratitude, interest, joy, love, and pride. Across studies, all eight emotions shared one quality: high positive valence. Distinctive core relational theme and expressive display patterns were found for four emotions--amusement, awe, interest, and pride. Gratitude was associated with a distinct core relational theme but not an expressive display. Joy and love were each associated with a distinct expressive display but their core relational themes also characterised pride and gratitude, respectively. Contentment was associated with a distinct expressive display but not a core relational theme. The implications of this work for the study of positive emotion are discussed.

Well-being: Strengthening and Broadening a Key Psychological Construct.

Park et al.'s (2022) goal of bringing conceptual clarity to the study of psychological aspects of well-being is a good one. We consider their work in terms of its implications for moving towards an understanding of well-being that reflects the full spectrum of human experience, especially the experience of people who remain underrepresented, and poorly accounted for, in psychological science. In our view, there is reason to think that strengthening existing frameworks and broadening in terms of methodologies will be most productive for developing a comprehensive and inclusive understanding of well-being. We describe the distinct strength of the subjective well-being (SWB) construct for this purpose and offer two empirical examples that highlight the value of multiple measures and methods for understanding well-being. We suggest that continued use of the SWB measure, combined with state-of-the-art emotion measurement, and a mix of qualitative and quantitative methodologies be recommended as the way forward.

Displaying pride: Variation by social context, ethnic heritage, and gender?

Pride is universal; however, the complexities linked to its social status functions and implications for social relationships suggest the possibility of variation in its display. Drawing from empirical evidence, this study examined whether displayed pride would vary by social context (i.e., whether the target was a competitor or a loved one), ethnic heritage (i.e., membership in individualistic or collectivistic cultural groups) and by gender. Young adults (N = 145) verbally described a pride experience to an imagined competitor, loved one, stranger or in a no-context control condition. Results showed similarity in displayed pride across the four contexts. However, some ethnic group and gender variations were observed. Latino/a/x Americans displayed less pride verbally than European Americans while women displayed more than men. These findings contribute to a better understanding of how people manage the display of pride and suggest that ethnic and gendered motivations for managing pride displays are relevant to a comprehensive understanding of interpersonal emotion regulation.

Within- and between-group heterogeneity in cultural models of emotion among people of European, Asian, and Latino heritage in the United States.

Research on cultural variation in emotion values and beliefs has usually explained this variation in terms of individualism and collectivism, typically comparing European American against East Asian cultural contexts. This study examined emotion model variability across as well as within cultural contexts in a large sample of young adults of Latino heritage along with people of European and East Asian heritage. Using latent class analysis, we characterized and predicted endorsement of emotion models, distinguishing emotion ideals (the emotions one desires) from beliefs about injunctive norms for emotion (the emotions one believes are appropriate). Students from three universities in different regions of the United States (N = 1,618; 490 of European heritage, 463 of Asian heritage, 665 of Latino heritage) provided data on the desirability and appropriateness of experiencing 19 specific emotions in daily life, as well as their U.S. cultural orientation and sociodemographic characteristics. Four distinct classes/models of emotion desirability and four classes/models of emotion appropriateness emerged. Latent class regression demonstrated that endorsement of emotion models was systematically related to heritage group membership and mainstream cultural orientation. Findings suggest meaningful within-group heterogeneity in emotion models and highlight the ways in which emotion models among people of Latino heritage are both similar to and distinct from models among people of European and Asian heritage. By developing a more nuanced understanding of between- and within-group variation in emotion models and highlighting the Latin American form of collectivism as in need of further research, this study advances cultural psychology, affective science, and their integration. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Attachment insecurity, heart rate variability, and perceived social support in a diverse sample of young adults.

Psychological and physical factors are robustly associated with perceived social support. Drawing from the literature on attachment style in adults and psychophysiology, we examined the possibility that the interaction of attachment insecurity and resting heart rate variability (HRV) was associated with perceived social support in a diverse sample of young adults living in the U.S (N = 145, Mage = 20.45) that was majority Latino (n = 77). Analyses revealed three key findings. First, in the overall sample, attachment avoidance and attachment anxiety were negatively associated with perceived social support, but in the Latino sample, only attachment avoidance was negatively associated with perceived social support. Second, HRV was not associated with perceived social support in the overall sample nor in the Latino sample. Third, attachment insecurity and HRV interacted to predict perceived social support only in the Latino sample such that, for those with lower levels of HRV, attachment anxiety was positively associated with perceived social support. This study underscores the importance of examining both psychological and physiological processes with careful consideration of ethnicity/culture in order to better understand perceived social support.

Relational savoring intervention: Positive impacts for mothers and evidence of cultural compatibility for Latinas.

Parenting young children poses numerous emotion regulation challenges, and prevention programs that promote emotion regulation skills can help with this important task of parenthood. Relational savoring (RS), which entails savoring a positive experience of interpersonal connectedness, is a brief manualized intervention program, 4 weeks in length, grounded in positive psychology and attachment theory. In the current longitudinal, randomized, controlled trial, we examined the impacts of RS compared with an active control (personal savoring [PS], defined as savoring a positive individual experience) in a sample of N = 164 mothers of toddlers (Mage = 20.93 months) on outcomes that were assessed immediately postintervention (positive emotion, closeness to child) and at a 3-month follow-up visit (parenting sensitivity, reflective functioning [RF], savoring uptake, and parenting wellness). Compared with mothers assigned to the PS condition, mothers in the RS condition had greater immediate response to the intervention (greater increases in positive emotions [gratitude, pride], closeness to their child) as well as greater increase in sensitivity to toddlers' cues at the three-month follow-up. Neither RS nor PS increased overall parenting wellness at the three-month follow-up. Latina mothers (but not non-Latina mothers) in the RS condition had higher RF and greater savoring uptake than Latina mothers in the PS condition at follow-up. Findings provide preliminary evidence of the efficacy of RS in modifying therapeutic targets and suggest evidence of the cultural congruence of RS for Latina mothers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).