Efficacy of a Stress Management Intervention for Mothers of Children with Cancer.

OBJECTIVE: Mothers of children with cancer confront life stress that can impact their psychological and physical health and, in turn, the health of the family. Recommendations advocate preemptive stress-management interventions; however, few studies have investigated their efficacy. Here, we report results of a parallel randomized pilot trial examining health benefits of a stress management intervention designed to teach coping skills. METHODS: One hundred twenty mothers (age 36 ± 8 years) of children newly diagnosed with cancer were randomized to a 12-session stress management intervention (n = 60) or usual care (n = 60). Sessions took place in the inpatient or outpatient setting of a children's hospital. Primary outcome variables included psychological function and physical health assessed preintervention and postintervention and at 6-month follow-up (∼12 months postdiagnosis). RESULTS: Enrollment, retention, and satisfaction data supported feasibility and acceptability. Latent change score models showed the intervention reduced perceived stress (d = -0.37, p = 0.03), anxiety symptoms (ds = -0.38 and -0.56, ps < .03) and, a nonsignificant effect for depressive symptoms (d = -0.29, p = .11) across the 6 months following diagnosis. Intervention participants also endorsed fewer depressive symptoms than controls ∼12 months after diagnosis. The intervention improved stress management skills, which associated with the psychological benefits of participation. There were no intervention-related changes in perceived health or markers of inflammation. CONCLUSION: Intervention-related improvements in stress management skills may result in better psychological health in the face of caring for a child with cancer. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02022449.

Exploring the Overlap Between Sexual Victimization and Offending Among Young Women Across Neighborhoods: Does the Type of Force and Type of Offending Matter?

The relationship between victimization and subsequent maladaptive behaviors such as offending is well established. To a lesser degree, a contextual lens has been used to examine how neighborhood characteristics influence the overlap between victimization and offending. The existing literature has yet to explore how the neighborhood context moderates the victim-offender overlap among young women, specifically, or whether the type of force used during sexual victimization or offending matters. This study uses data from The National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine whether concentrated disadvantage moderates the impact of sexual victimization on subsequent offending for women. Results indicate that young women who experience sexual victimization are more likely to engage in general offending regardless of neighborhood type. However, closer examination reveals that, when taking into account the type of force used in sexual victimization (physical or coerced) and the type of offending (violent, property, drug use), the overlap does indeed vary across neighborhoods. Specifically, results indicate that only coerced sexual victimization significantly affects property offending in neighborhoods with high levels of concentrated disadvantage. Related to violent offending, physical sexual victimization has a strong positive impact in less disadvantaged neighborhoods. Finally, coerced sexual victimization is significantly associated with an increased likelihood for drug use, and this relationship is consistent across neighborhoods. The findings suggest that nuances in the nature of victimization and offending need to be taken into account to fully understand the victim-offender overlap across neighborhood context.

Broken (windows) theory: A meta-analysis of the evidence for the pathways from neighborhood disorder to resident health outcomes and behaviors.

The criminological "broken windows" theory (BWT) has inspired public health researchers to test the impact of neighborhood disorder on an array of resident health behaviors and outcomes. This paper identifies and meta-analyzes the evidence for three mechanisms (pathways) by which neighborhood disorder is argued to impact health, accounting for methodological inconsistencies across studies. A search identified 198 studies (152 with sufficient data for meta-analysis) testing any of the three pathways or downstream, general health outcomes. The meta-analysis found that perceived disorder was consistently associated with mental health outcomes, as well as substance abuse, and measures of overall health. This supported the psychosocial model of disadvantage, in which stressful contexts impact mental health and related sequelae. There was no consistent evidence for disorder's impact on physical health or risky behavior. Further examination revealed that support for BWT-related hypotheses has been overstated owing to data censoring and the failure to consistently include critical covariates, like socioeconomic status and collective efficacy. Even where there is evidence that BWT impacts outcomes, it is driven by studies that measured disorder as the perceptions of the focal individual, potentially conflating pessimism about the neighborhood with mental health.

Violent Lives: Pathways Linking Exposure to Violence To Suicidal Behavior in a National Sample.

This study explored the extent to which depression, somatic symptoms, and substance use mediated the effects of exposure to violence on suicidal ideation and attempted suicide, and whether these pathways varied across gender, age, and race/ethnicity. Path analysis was conducted on 12,272 adolescents (mean = 15.3 years) from the National Longitudinal Study of Adolescent to Adult Health. The impact of exposure to violence on suicidal ideation was fully mediated, and the impact of exposure to violence on attempted suicide was partially mediated by depression, somatic symptoms, and substance use. Mediating pathways were stronger for females and for younger adolescents. Understanding the impact of exposure to violence on adolescent suicidal behavior requires the consideration of direct, indirect, and conditional indirect effects.

Development of glucocorticoid resistance over one year among mothers of children newly diagnosed with cancer.

Chronic distress associates with peripheral release of cortisol and a parallel upregulation of innate inflammation. Typically, cortisol functions to down-regulate inflammatory processes. However, in the context of chronic stress, it is hypothesized that glucocorticoid receptors within immune cells become less sensitive to the anti-inflammatory effects of cortisol, resulting in increased systemic inflammation. Caring for a child newly diagnosed with cancer is a particularly provocative chronic stressor. Here, we examine evidence for the development of cellular resistance to glucocorticoids among 120 mothers (Aged 18-56 years; 86% Caucasian) across the 12 months following their child's new diagnosis with cancer. Measures of psychological distress, interleukin (IL)-6, and glucocorticoid resistance (GCR) were assessed 1, 6, and 12 months after the diagnosis. A latent factor for distress was derived from the covariation among symptoms of anxiety, depression, and post-traumatic stress. Latent change score models revealed a significant positive association between change in distress and change in GCR from 0 to 6 months, and 6 months-1 year. This finding provides initial evidence for a longitudinal association between change in maternal distress and change in GCR from the onset of a chronic stressor through one year. Although levels of IL-6 increased during the first six months after the child's diagnosis, the magnitude of this change was not related to change in distress or change in GCR. Given the possible health consequences of reduced immune sensitivity to glucocorticoids, future work should further explore this stress response and its clinical significance.

Parents, Peers, Perceived Risk of Harm, and the Neighborhood: Contextualizing Key Influences on Adolescent Substance Use.

Recent research has affirmed the need to examine contextual influences on adolescent substance use in a multilevel framework. This study examined the role of neighborhood opportunities for substance use in promoting adolescent substance use. Data came from two components of the Project on Human Development in Chicago Neighborhoods: the Longitudinal Cohort Study, consisting of interviews with youth and their primary caregivers across three waves of data with an average span of 4.5 years; and a Community Survey of neighborhood residents. Analysis used an Item-Response Theory-based statistical approach on 6556 substance use item responses from 1639 youth (49.0 % female) within 80 neighborhoods to assess the extent to which neighborhood opportunities for substance use had direct and indirect effects on adolescent substance use. Neither direct nor mediated effects of neighborhood opportunities for substance use on adolescent substance use were detected. But, analyses revealed moderating effects such that higher levels of neighborhood opportunities for substance use: (1) amplified the detrimental effects of parental substance use and peer substance use on youth substance use; and (2) attenuated the protective effect of adolescents' perceived harm of substance use on adolescent substance use. The results suggest that the ways in which neighborhood characteristics impact adolescent behavior are nuanced. Rather than impact individual-level outcomes directly, neighborhood context may be particularly relevant by conditioning the effects of salient individual-level risk and protective factors for substance use.

Contextual Determinants of Adolescent Perceived Early Fatality.

Adolescents overestimate their risk for early or premature death. In turn, perceived early fatality is associated with a host of adverse developmental outcomes. Research on the correlates of perceived early fatality is nascent, and an examination of the contextual determinants of perceived early fatality is largely absent from the literature. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), this study examines whether friendship networks and the school climate impact youth's perceptions of premature death. Analysis using hierarchical linear models on 9617 youth (52.0 % female) within 113 middle and high schools across the U.S. assess the extent to which peer and school future orientation climate and friendship network characteristics (network size, density, popularity, and centrality) impact respondents' life expectancy. Consistent with hypotheses: (1) higher levels of life expectancy in respondents' friendship networks and schools are associated with more optimistic expectations about the future among sample respondents; and (2) youth embedded in larger and denser friendship networks report higher levels of life expectancy. The results are consistent with the literature on peer effects, studies documenting the insulating effects of extensive and closely knit peer networks, and research on the contextual effects of the school environment. More generally, the results suggest that adolescent friendship networks and the school climate are key contexts in which youth develop expectations for the future.