Stress and Trauma Among Nurses in Development (STAND): A Descriptive Study.

BACKGROUND: Mental health conditions related to traumatic stress exposure are common in practicing nurses. Less is known about the impact of trauma on nursing students and how it affects their transition to practice. OBJECTIVES: The purpose of this study is to understand the experience of trauma exposure and resulting symptoms in undergraduate nursing students. DESIGN: This is an analysis of baseline data from a longitudinal study. Students in an undergraduate nursing program completed a survey with validated instruments to measure trauma exposure, risk and protective factors, and trauma symptoms. SETTINGS: The study took place in an undergraduate nursing program in the United States. PARTICIPANTS: A total of 248 nursing students participated in the study. RESULTS: The nursing students reported a higher number of adverse childhood experiences and post-traumatic stress disorder (PTSD) symptoms than the general population. Additionally, mental health symptoms and burnout symptoms increased over time. CONCLUSIONS: Nursing students are at high risk for PTSD and other mental health conditions due to cumulative trauma. Interventions are needed to address trauma in developing nurses.

Using narratives to correct politically charged health misinformation and address affective belief echoes.

BACKGROUND: In May 2020, news outlets reported misinformation about the Centers for Disease Control (CDC) related to COVID-19. Correcting misinformation about outbreaks and politics is particularly challenging. Affective belief echoes continue to influence audiences even after successful correction. Narrative and emotional flow scholarship suggest that a narrative corrective with a positive ending could reduce belief echoes. Therefore, this study investigated the efficacy of a narrative corrective with a relief ending for correcting misinformation about the CDC. METHODS: Between 29 May and 4 June 2020, we tested the effectiveness of a narrative to correct this misinformation. Participants in the United States (N = 469) were enrolled via Qualtrics panels in an online message experiment and randomized to receive a narrative corrective, a didactic corrective or no corrective. RESULTS: The narrative corrective resulted in lower endorsement of the misinformation compared with the control and the didactic corrective. The narrative corrective had a positive indirect effect on perceived CDC competence and mask wearing intentions for politically moderate and conservative participants via relief. CONCLUSIONS: Public health institutions, such as the CDC, should consider utilizing narrative messaging with positive emotion endings to correct misinformation. Narratives better address affective belief echoes, particularly for counter-attitudinal audiences.

Political Party Collective Norms, Perceived Norms, and Mask Wearing Behavior: A Test of the Theory of Normative Social Behavior.

The theory of normative social behavior (TNSB) postulates that people are influenced by others' behaviors, which they observe from messages and experience. In addition to focusing on perceived (i.e., descriptive and injunctive) norms, the TNSB was expanded to include collective norms, which represent what people actually do. Testing this expanded theoretical model, the current study examined whether two types of collective norms - collective political norms and collective regional norms - interacted with descriptive norms to influence pandemic mask wearing behavior expectations among U.S. adults (N = 444). The interaction was statistically significant for collective political norms (ß = -.74, p = .009) but not collective regional norms (ß = -.16, p = .85). Specifically, descriptive norms were related to increased mask wearing expectation for all values of political party collective norms, but the effects were stronger when political party collective norms were low (i.e., low mask wearing behavior was normative). The findings support the inclusion of collective norms in the TNSB, clarify the relationships among different types of norms, and provide insights for norms-based interventions.

Framing COVID-19 Preprint Research as Uncertain: A Mixed-Method Study of Public Reactions.

During the COVID-19 pandemic, journalists were encouraged to convey uncertainty surrounding preliminary scientific evidence, including mentioning when research is unpublished or unverified by peer review. To understand how public audiences interpret this information, we conducted a mixed method study with U.S. adults. Participants read a news article about preprint COVID-19 vaccine research in early April 2021, just as the vaccine was becoming widely available to the U.S. public. We modified the article to test two ways of conveying uncertainty (hedging of scientific claims and mention of preprint status) in a 2 × 2 between-participants factorial design. To complement this, we collected open-ended data to assess participants' understanding of the concept of a scientific preprint. In all, participants who read hedged (vs. unhedged) versions of the article reported less favorable vaccine attitudes and intentions and found the scientists and news reporting less trustworthy. These effects were moderated by participants' epistemic beliefs and their preference for information about scientific uncertainty. However, there was no impact of describing the study as a preprint, and participants' qualitative responses indicated a limited understanding of the concept. We discuss implications of these findings for communicating initial scientific evidence to the public and we outline important next steps for research and theory-building.

Communicating scientific uncertainty in the early stages of the COVID-19 pandemic: A message experiment.

The World Health Organization (WHO) officially declared COVID-19 a pandemic on March 11, 2020. It was a time of significant uncertainty as experts were not yet certain whether social distancing behaviors were necessary to slow the spread of the virus. Some public communicators opted to acknowledge uncertainty based on the limited evidence, whereas others downplayed uncertainty. This situation provided researchers with an opportunity to advance theory by explicating and testing cognitive responses to message uncertainty. Immediately following the WHO declaration (March 13-19, 2020), U.S. adults (N = 1186) were randomly assigned to one of six conditions in a 2 (message uncertainty: low, high) × 3 (argument support: expert, threat, precedent) between-participants experiment. Overall, perceived uncertainty negatively mediated the impact of message uncertainty on intentions. However, participant education was a key moderator. For those with more than a high school education, uncertain messages were related to higher intentions to social distance through increased critical reflection. For those with a high school education or less, uncertain messages were related to lower intentions through decreased message credibility.

The Role of Coping and Posttraumatic Stress in Fostering Posttraumatic Growth and Quality of Life Among Women with Breast Cancer.

Tedeschi & Calhoun's model of posttraumatic growth (PTG) suggests that intrusive thoughts about a traumatic event, in combination with helpful coping strategies, facilitates PTG. This manuscript applies this model to a sample of breast cancer survivors, augments it to conceptualize coping strategies as "active" or "avoidant," and extends it to include health-related quality of life (HRQOL). This is a secondary analysis of a subset of breast cancer patients (N = 123) in a randomized clinical trial of Tibetan yoga, which examines the associations of coping at study entry with PTG, PTSS (i.e., intrusive thoughts and avoidance), and HRQOL (physical (PCS) and mental (MCS) component scales) reported 9 and 15 months later. Mediation analyses revealed that higher baseline active coping predicted higher 9-month PTG, which in turn predicted higher 15-month PCS [effect = .46, 95% CI (.06, 1.07)]. Exploratory moderated mediation analyses revealed that higher baseline intrusive thoughts about cancer predicted lower 9-month PTG, which in turn predicted lower 15-month PCS, but only for those reporting low active coping [effect = - .06, 95% CI (- .16, - .003)]. Active coping may play a critical role of fostering PTG and improving subsequent HRQOL in the presence of rumination about cancer.

Examining ways to score the Epidemic-Pandemic Impacts Inventory in parents of young children.

The Epidemic-Pandemic Impacts Inventory (EPII) is a 92-item measure developed to assess tangible impacts of the pandemic including both negative (work, home, social, and health) and positive changes. The EPII has been used in a variety of studies, but a standard scoring system has not been determined. Parents of young children (N = 216) completed the EPII, Perceived Stress Scale, Parenting Stress Scale, Positive and Negative Affect Scale (PANAS-PA and PANAS-NA), and COVID-19 Stress Scale (CSS) online September 2021-May 2022. The EPII was scored in three ways represented in the literature to examine which scoring method accounted for the greatest amount of variance in parents' stress and mood, independent of demographic factors and CSS. Hierarchical linear regression results revealed that one EPII scoring method consistently accounted for the greatest amount of variance in each outcome variable (largest R2) compared to the other two scoring methods. Additionally, number of negative and positive pandemic impacts accounted for more variance (larger ß coefficient) in each outcome compared to demographic factors and CSS, with the exception that negative pandemic impacts were not associated with PANAS-PA. One method of scoring the EPII may maximize the measures' potential to account for variance in stress and mood among parents of young children. The EPII may be a valuable measure to include in studies examining the impact of the pandemic on parents' well-being even beyond the peak of the pandemic, as its association with stress and mood appears to be long-lasting and independent of demographic factors and COVID-19 stress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Tailored visuals, implementation interventions, and sun safe behavior: A longitudinal message experiment.

OBJECTIVE: One way to communicate skin cancer risk is through ultraviolet (UV) photographs, which can depict the target person (tailored visual) or someone else (stock visual). There is a need for more longitudinal research examining the relative impact of tailored UV photographs compared with other message interventions that could increase sun safe behaviors. METHOD: Students 14-18 years of age (N = 654) at eleven high schools in Utah were recruited to participate in a longitudinal experiment (assessments: pretest, posttest, 1 month follow-up) comparing the relative persuasive impact of receiving either (a) stock and tailored UV photographs or (b) stock UV photographs and an implementation intervention on outdoor tanning behavior. Participants completed measures of fear, appearance norms and benefits, threat susceptibility/severity, self-efficacy, response efficacy, freedom threat, reactance, and outdoor tanning behavior. RESULTS: Compared with the implementation intervention, participants in the tailored UV condition reported increased fear and freedom threat and decreased appearance norms and benefits of tanning immediately following exposure to the intervention and decreased outdoor tanning 1 month after the intervention. Indirect effects also emerged with tailored UV exposure decreasing outdoor tanning via appearance benefits and increasing outdoor tanning when immediate fear triggered psychological reactance. CONCLUSIONS: The results contribute to research on lay reactions to tailored visuals, implementation interventions, and theorizing the indirect effects of affect and cognition across time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

How the public evaluates media representations of uncertain science: An integrated explanatory framework.

Understanding how to portray uncertain science to the public is a pressing goal for science communication. This study compared US public audience reactions to a news article depicting a novel discovery in neurogenomics as certain or uncertain, with statements of (un)certainty attributed to either affiliated or unaffiliated scientists. The uncertainty disclosure had no main effect on perceived news article credibility, scientist trustworthiness, objectivity of the scientists' depiction, or willingness to participate in genomic research. However, news credibility and scientist objectivity ratings were higher for uncertainty disclosure attributed to the affiliated scientists. Participants with greater preference for information about uncertainty found the scientists more trustworthy, their depictions more balanced, and the news article more credible when the research was described as uncertain, and these effects were stronger for affiliated scientist attribution. Findings underscore the important roles of disclosure source and audience characteristics in public reactions to media representations of scientific uncertainty.

Validating Cross-Modal Measures for Comparative Research: Message Veracity, Novelty, and Memorability.

Marketing researchers are interested in the relative persuasiveness of different message modes, such as narratives and arguments. A desire to explicate and compare underlying mechanisms is central to this research, yet progress is hindered by a dearth of measures that can be used meaningfully across modes. In the current project, we identify and validate three cross-modal message perceptions - veracity, novelty, and memorability - that can mediate the relationship between different modes and outcomes. Three studies (Study 1: N = 105; Study 2: N = 322; Study 3: N = 248) confirmed the factor structure, discriminant validity, and cross-modal (narrative vs. argument) value of all three message perceptions. The results of this study provide researchers with three cross-modal measures to support comparative message effects research.

Feasibility, Acceptability, and Efficacy of Mindfulness Training in People With Upper Motor Neuron Disorders: A Systematic Review.

OBJECTIVES: This systematic review aims to gain a comprehensive understanding of the feasibility, acceptability, and efficacy of mindfulness-based interventions (MBIs) on depression, anxiety, fatigue, and health-related quality of life among individuals with upper motor neuron disorders (UMNDs). DATA SOURCES: PubMed, PsycINFO, Excerpta Medica Database, and Cumulative Index to Nursing and Allied Health Literature were searched for relevant studies published between January 2001 and June 2021. STUDY SELECTION: Clinical trials published in English evaluating MBIs in adults with the 4 most common UMNDs (multiple sclerosis, brain injury including stroke, spinal cord injury, amyotrophic lateral sclerosis) were included. DATA EXTRACTION: Two reviewers independently performed the risk of bias assessment using standardized tools and extracted desired data electronically. DATA SYNTHESIS: A total of 44 studies were included: 26 randomized controlled trials, 10 nonrandomized controlled trials, and 8 pre-post intervention studies. The average ± SD duration of MBIs was 8±2 weeks. On average, 85%±14% of participants completed the MBI, and the retention rate at follow-up was 80%±16%. Only 14% of the studies delivered MBIs virtually, and feasibility metrics were similar to in-person studies. Among studies reporting acceptability data, most participants reported satisfaction with the MBI. Randomized controlled trials that evaluated the effects of MBI on depression, anxiety, fatigue, and quality of life revealed greater relative improvement in these outcomes among MBI participants compared with controls, with differences greater when compared with passive control than active control participants. None of the studies included in this review studied dose response. CONCLUSIONS: Based on current data, MBIs are feasible and offer a promising approach to address the biopsychosocial needs of individuals with UMNDs. MBIs are associated with a high acceptance rate among participants, with notable improvements in depression, anxiety, fatigue, and quality of life post intervention. Future studies are needed to evaluate alternate models of delivery of MBIs and the dose-response relationship.

Development and Initial Feasibility of a Hospital-Based Acceptance and Commitment Therapy Intervention to Improve Retention in Care for Out-of-Care Persons with HIV: Lessons Learned from an Open Pilot Trial.

Roughly 40% of persons with HIV (PWH) are not consistently involved in HIV care in the US. Finding out-of-care PWH is difficult, but hospitalization is common and presents an opportunity to re-engage PWH in outpatient care. The aims of this study were to (1) develop an Acceptance and Commitment Therapy (ACT)-based intervention for hospitalized, out-of-care PWH who endorse avoidance-coping to improve HIV treatment engagement; (2) examine the intervention's initial feasibility and acceptability; and (3) to revise the study protocol (including the intervention), based on stakeholder feedback, in preparation for a randomized controlled trial (RCT) comparing ACT to treatment as usual. Therapists and HIV care experts developed a four-session ACT-based intervention to be delivered during hospitalization. Fifteen hospitalized patients with poorly controlled HIV enrolled in the open trial, eight completed four sessions, two completed three sessions, and seven provided qualitative feedback. Patients universally liked the intervention and the holistic approach to mental health and HIV care. Refinements included repeating key concepts, including representative graphics, and translating to Spanish. Among the patients who attended ≥3 ACT sessions, 5/10 attended a HIV-care follow-up visit and 5/7 who had labs had a viral load <20 2-months post-intervention. Next steps include conducting a randomized clinical trial exploring the impact of the refined intervention to treatment as usual on retention in care and viral load. ClinicalTrials.gov Identifier: NCT04481373.

Associations between disordered eating and body focused repetitive behaviors in college students.

Objective: College students with disordered eating (DE) are at increased risk of body focused repetitive behaviors (BFRBs). Both DE and BFRBs are described as impulsive and compulsive. However, the associations of impulsive DE with impulsive BFRBs and compulsive DE with compulsive BFRBs have not been examined.Methods: 191 college-aged students completed a survey of BFRBs and DE.Results: Participants who reported hair pulling were twice as likely to report clinically significant DE than those who denied hair pulling (p = .022). Participants who endorsed distressing hair pulling (p = .026), skin picking (p = .052), and nail biting (p = .094) were twice as likely to report clinically significant DE than those who were not distressed by these behaviors. Evidence did not support the association of BFRBs and DE along an impulsive/compulsive continuum.Conclusions: Results suggest that BFRBs and DE often co-occur, and the role of impulsivity and compulsivity in these behaviors is complex.

Potentially morally injurious events as a mediator of the association of gratitude and mindfulness with distress.

OBJECTIVE: Potentially morally injurious events (PMIEs) are events that contradict one's own personal ethics and may promote a deep sense of violation, leading to psychological distress. Individuals with greater trait gratitude and mindfulness may be less likely to perceive events as being morally injurious and may, in turn, be less likely to experience subsequent distress. The current study seeks to examine (a) PMIE rates in a multioccupational first responder sample and (b) the indirect effect of trait gratitude and mindfulness on psychological distress via fewer perceived PMIEs. METHOD: 293 first responders from agencies/departments within southeastern Texas (in-person) and nationwide (online) completed a survey assessing PMIEs, PTSD symptoms (PCL-C), anxiety (GAD-7), depression (PHQ-8), gratitude (GRAT-S), and mindfulness (MAAS). RESULTS: PMIEs were common (61% witnessed a transgression; 21% committed a transgression; 40% felt betrayed by others). Gratitude was indirectly associated with fewer PTSD [-.09, 95% CI (-.13, -.05)], anxiety [-.03, 95% CI (-.04, -.01)], and depression [-.03, 95% CI (-.05, -.01)] symptoms via lower PMIEs. Similarly, mindfulness was indirectly associated with fewer PTSD [-.92, 95% CI (-1.55, -.38)], anxiety [-.20, 95% CI (-.42, .02)], and depression [-.26, 95% CI (-.48, -.06)] symptoms via lower PMIEs. CONCLUSIONS: PMIEs were common in this first responder sample and associated with increased distress. Trait gratitude and mindfulness may protect first responders from perceiving events as morally injurious, which may lead to improved mental health. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sleep moderates the effects of Tibetan yoga for women with breast cancer undergoing chemotherapy.

This study examined self-reported and actigraphy-assessed sleep and depression as moderators of the effect of a Tibetan yoga intervention on sleep and depression among women undergoing chemotherapy for breast cancer. This is a secondary analysis of an RCT examining a 4-session Tibetan yoga program (TYP; n = 74) versus stretching program (STP; n = 68) or usual care (UC; n = 85) on self-reported sleep (Pittsburgh Sleep Quality Index (PSQI), actigraphy-assessed sleep efficiency (SE)) and depression (Centers for Epidemiological Studies Depression Scale; CES-D) for women undergoing chemotherapy for breast cancer. Data were collected at baseline and 1-week and 3-month post-intervention. Baseline PSQI, actigraphy-SE, and CES-D were examined as moderators of the effect of group on PSQI, actigraphy-SE, and CES-D 1 week and 3 months after treatment. There was a significant baseline actigraphy-SE × group effect on PSQI at 1 week (p < .001) and 3 months (p = .002) and on CES-D at 3 months (p = .049). Specifically, the negative association of baseline actigraphy-SE with subsequent PSQI and CES-D was buffered for women in the TYP and, to a lesser extent in STP, compared to those in the UC. Baseline PSQI and CES-D were not significant moderators of the effect of group on any outcome. Behaviorally assessed sleep may be a more robust indicator of which patients are most appropriate for a yoga intervention than self-reported sleep quality. Women with poor sleep efficiency may derive the greatest benefit in terms of sleep quality and mood from a yoga intervention.

Are some narratives better than others?: The impact of different narrative forms on adolescents' intentions to text and drive.

Psychological reactance theory posits individuals seek to restore freedom when threatened. Communication scholars have hypothesized persuasive messages can constitute threats to freedom. The current study engages questions about the potential for different forms of narratives in public service announcements (PSAs) to trigger freedom threats by examining responses to a PSA campaign that utilized three forms of narrative (celebrity testimonials, peer testimonials, and accident stories) to decrease adolescent texting and driving intentions. Participants (N = 214) watched anti-texting and driving narratives, and completed measures of threat to freedom, anger, negative cognition, and attitudes/intentions toward texting/driving. Compared to celebrity/peer testimonial PSAs, accident stories triggered increased anger and, indirectly, decreased intentions to drive safely. The results also suggest the need for continued examination of the best way to model psychological reactance theory, and the value of further research explicating anger as a mechanism of message effects.

Risk and protective markers for well-being in Latinx immigrants in removal proceedings.

OBJECTIVES: There are currently 1,308,327 immigrants in removal proceedings, over 80% of whom are Latinx (TRAC, 2021b). This study examined the relation among putative protective markers (i.e. social support, religious support, and legal support) and the emotional and physical well-being of Latinx individuals facing removal proceedings. HYPOTHESES: We hypothesized that increased social support, religious support, and legal support would buffer the negative relations between hopelessness, poor self-efficacy, and well-being measures (depression, anxiety, stress, mental well-being, somatic symptoms, and physical well-being). METHOD: Participants (N = 157; 31.2% men, M age = 33.4 years) had an active immigration court case in Texas and completed a demographic questionnaire, the Beck Hopelessness Scale, General Self-Efficacy Scale, Multidimensional Scale of Perceived Social Support, Multi-Faith Religious Support Scale, Depression, Anxiety, Stress Scale-21, Patient Health Questionnaire-15, and Short Form Health Survey-12. RESULTS: Higher levels of hopelessness and poor self-efficacy were associated with more negative well-being outcomes, while social support was associated with more positive well-being outcomes. Contrary to hypotheses, religious support and legal support served as risk markers independently, while legal support interacted with hopelessness, such that decreased legal support was associated with higher mental well-being at lower levels of hopelessness and interacted with poor self-efficacy, such that increased legal support was associated with poorer mental well-being at lower levels of self-efficacy. All effect sizes were small (rsp2 = .04 to .16). CONCLUSIONS: Targeting hopelessness and poor self-efficacy while promoting social support may help mental health professionals improve the well-being of immigrants in removal proceedings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Impact of Communicating Uncertainty on Public Responses to Precision Medicine Research.

BACKGROUND: Precision medicine research depends upon recruiting large and diverse participant cohorts to provide genetic, environmental, and lifestyle data. How prospective participants react to information about this research, including depictions of uncertainty, is not well understood. PURPOSE: The current study examined public responses to precision medicine research, focusing on reactions toward (a) uncertainty about the scientific impact of sharing data for research, and (b) uncertainty about the privacy, security, or intended uses of participant data. METHODS: U.S. adults (N = 674; 51.9% male; 50% non-Hispanic white; Mage = 42.23) participated in an online experimental survey. Participants read a manipulated news article about precision medicine research that conveyed either certainty or uncertainty of each type (scientific, data). Participants then rated their attitudes toward the research, trust in the researchers, and willingness to join a cohort. We tested direct and mediated paths between message condition and outcomes and examined individual characteristics as moderators. RESULTS: Overall attitudes were positive and a majority of participants (65%) reported being somewhat or very likely to participate in precision medicine research if invited. Conveying uncertainty of either type had no overall main effect on outcomes. Instead, those who reported perceiving greater uncertainty had lower attitudes, trust, and willingness to join, while those with more tolerance for uncertainty, support for science, and scientific understanding responded favorably to the scientific uncertainty disclosure. CONCLUSIONS: Findings suggest responses to precision medicine research uncertainty are nuanced and that successful cohort enrollment may be well-supported by a transparent approach to communicating with prospective participants.

Theory utilization in current communication of cancer genetic testing research: Identified gaps and opportunities.

BACKGROUND: Effective communication of cancer-related genetic and genomic testing (CGT) with patients and the public is paramount to transforming and managing cancer prevention, detection, and care. Behavioral and social science theories could improve communication effectiveness and, in turn, health outcomes. METHODS: In this study, we characterized the use of theory in recent research on communication about CGT from 2010 to 2017. RESULTS: Of 513 empirical papers focusing on communication about CGT, only 119 (23%) utilized any theory in the study design. Behavior change and health psychology/cognitive representation theories (24.2% and 21.9%, respectively) were the most commonly used with minimal use of communication theories (3%). Theories were primarily used to guide hypotheses or research question development (73.9%), and for selecting measures or codes (68.9%). Approximately half of the papers (48.3%) related their study findings to the referenced theory. Fewer papers (14.3%) discussed implications of the findings for the theory. CONCLUSIONS: While theories are being utilized to inform study design, few discuss their results in the context of theoretical implications and thus decrease potential generalizability. Greater use of theory could help scholars to identify and develop theories suited to this clinical context and inform our understanding of related communication processes more broadly.

Digital Health Engagement in the US Population: Insights From the 2018 Health Information National Trends Survey.

Objectives. To examine prevalence and predictors of digital health engagement among the US population. Methods. We analyzed nationally representative cross-sectional data on 7 digital health engagement behaviors, as well as demographic and socioeconomic predictors, from the Health Information National Trends Survey (HINTS 5, cycle 2, collected in 2018; n = 2698-3504). We fitted multivariable logistic regression models using weighted survey responses to generate population estimates. Results. Digitally seeking health information (70.14%) was relatively common, whereas using health apps (39.53%) and using a digital device to track health metrics (35.37%) or health goal progress (38.99%) were less common. Digitally communicating with one's health care providers (35.58%) was moderate, whereas sharing health data with providers (17.20%) and sharing health information on social media (14.02%) were uncommon. Being female, younger than 65 years, a college graduate, and a smart device owner positively predicted several digital health engagement behaviors (odds ratio range = 0.09-4.21; P value range < .001-.03). Conclusions. Many public health goals depend on a digitally engaged populace. These data highlight potential barriers to 7 key digital engagement behaviors that could be targeted for intervention.