Health-risk Behaviors and Type 1 Diabetes Outcomes in the Transition from Late Adolescence to Early Emerging Adulthood.

This study examined within- and between-person associations between health-risk behaviors (smoking, drinking, insulin withholding) and type 1 diabetes (T1D) outcomes (adherence and HbA1c) during the high-risk transition from late adolescence to early emerging adulthood utilizing a 2-year longitudinal study. Beginning in the senior year of high school, participants (n = 197) with T1D completed measures of health-risk behaviors, adherence, and HbA1c annually at three time points. Health-risk behaviors were associated with poorer diabetes outcomes during the transition from late adolescence to early emerging adulthood. These results highlight the importance of monitoring health-risk behaviors regularly and intervening to reduce health-risk behaviors during this important developmental transition.

Translating self-persuasion into an adolescent HPV vaccine promotion intervention for parents attending safety-net clinics.

OBJECTIVE: Self-persuasion is an effective behavior change strategy, but has not been translated for low-income, less educated, uninsured populations attending safety-net clinics or to promote human papillomavirus (HPV) vaccination. We developed a tablet-based application (in English and Spanish) to elicit parental self-persuasion for adolescent HPV vaccination and evaluated its feasibility in a safety-net population. METHODS: Parents (N=45) of age-eligible adolescents used the self-persuasion application. Then, during cognitive interviews, staff gathered quantitative and qualitative feedback on the self-persuasion tasks including parental decision stage. RESULTS: The self-persuasion tasks were rated as easy to complete and helpful. We identified six question prompts rated as uniformly helpful, not difficult to answer, and generated non-redundant responses from participants. Among the 33 parents with unvaccinated adolescents, 27 (81.8%) reported deciding to get their adolescent vaccinated after completing the self-persuasion tasks. CONCLUSIONS: The self-persuasion application was feasible and resulted in a change in parents' decision stage. Future studies can now test the efficacy of the tablet-based application on HPV vaccination. PRACTICE IMPLICATIONS: The self-persuasion application facilitates verbalization of reasons for HPV vaccination in low literacy, safety-net settings. This self-administered application has the potential to be more easily incorporated into clinical practice than other patient education approaches.

Developing a Tablet-Based Self-Persuasion Intervention Promoting Adolescent HPV Vaccination: Protocol for a Three-Stage Mixed-Methods Study.

BACKGROUND: Human papillomavirus (HPV)-related cancers are a significant burden on the US health care system that can be prevented through adolescent HPV vaccination. Despite guidelines recommending vaccination, coverage among US adolescents is suboptimal particularly among underserved patients (uninsured, low income, racial, and ethnic minorities) seen in safety-net health care settings. Many parents are ambivalent about the vaccine and delay making a decision or talking with a provider about it. Self-persuasion-generating one's own arguments for a health behavior-may be particularly effective for parents who are undecided or not motivated to make a vaccine decision. OBJECTIVE: Through a 3-stage mixed-methods protocol, we will identify an optimal and feasible self-persuasion intervention strategy to promote adolescent HPV vaccination in safety-net clinics. METHODS: In Stage 1, we will define content for a tablet-based self-persuasion app by characterizing (1) parents' self-generated arguments through cognitive interviews conducted with parents (n=50) of patients and (2) parent-provider HPV vaccine discussions through audio recordings of clinic visits (n=50). In Stage 2, we will compare the effects of the four self-persuasion intervention conditions that vary by cognitive processing level (parents verbalize vs listen to arguments) and choice of argument topics (parents choose vs are assigned topics) on parental vaccine intentions in a 2 × 2 factorial design randomized controlled trial (n=160). This proof-of-concept trial design will identify which intervention condition is optimal by quantitatively examining basic self-persuasion mechanisms (cognitive processing and choice) and qualitatively exploring parent experiences with intervention tasks. In Stage 3, we will conduct a pilot trial (n=90) in the safety-net clinics to assess feasibility of the optimal intervention condition identified in Stage 2. We will also assess its impact on parent-provider discussions. RESULTS: This paper describes the study protocol and activities to date. Currently, we have developed the initial prototype of the tablet app for English- and Spanish-speaking populations, and completed Stage 1 data collection. CONCLUSIONS: Our systematic collaboration between basic and applied behavioral scientists accelerates translation of promising basic psychological research into innovative interventions suitable for underserved, safety-net populations. At project's end, we plan to have a feasible and acceptable self-persuasion intervention that can affect key cancer disparities in the United States through prevention of HPV-related cancers. TRIAL REGISTRATION: ClinicalTrials.gov http://clinicaltrials.gov/ct2/show/NCT02537756 and http://clinicaltrials.gov/ct2/show/NCT02535845 (Archived by WebCite at http://www.webcitation.org/6e5XcOGXz and http://www.webcitation.org/6e5XfHoic, respectively).

Elucidating patient-perceived role in "decision-making" among African Americans receiving lung cancer care through a county safety-net system.

PURPOSE: We explored patient-perceived role in "decision-making" related to active treatment and palliation among African Americans receiving lung cancer care through a county safety-net system. METHODS: Drawing from a cohort of over 100 African Americans treated in a safety-net hospital, we invited a subsample of 13 patient-caregiver dyads to participate in a series of dyadic, ethnographic interviews conducted at the patients' homes. Over 40 h of transcripts were analyzed in an iterative process resulting in reported themes. RESULTS: Findings from ethnographic interviews demonstrated that healthcare communication with physicians is difficult for patients. While caregivers and patients describe a deep engagement in lung cancer care, they expressed a concurrent lack of understanding of their prognosis and outcomes of treatment. Dyads did not discuss their lung cancer experience in terms of decision-making; rather, most articulated their role as following physician guidance. Distinct lack of understanding about disease course, severity, and prognosis may constrain patient perception of the need for informed decision-making over the course of care. CONCLUSIONS: Dyadic interviews detailing safety-net patient experiences of lung cancer care raise important questions about how clinicians, as well as researchers, conceptualize processes of informed decision-making in vulnerable populations. IMPLICATIONS FOR CANCER SURVIVORS: Safety-net patients may not perceive their role as involving informed decision-making and further may lack understanding of disease course and individual prognosis. Safety-net patient dyads expressed high involvement in care and a desire for clarity; clinicians should be prepared to clearly communicate disease stage and prognosis.

Illness perceptions matter: understanding quality of life and advanced illness behaviors in female patients with late-stage cancer.

BACKGROUND: Patients with late-stage cancer are living longer, making it important to understand factors that contribute to maintaining quality of life (QOL) and completing advanced illness behaviors (eg, advance directives). OBJECTIVE: To examine whether illness perceptions-the cognitive beliefs that patients form about their cancer-may be more important guides to adjustment than clinical characteristics of the cancer. METHODS: In a cross-sectional study, 105 female patients diagnosed with stage III (n = 66) or IV (n = 39) breast (n = 44), gynecological (n = 38), or lung (n = 23) cancer completed self-report measures of illness perceptions, QOL, and advanced illness behaviors. Clinical data was obtained from medical records. RESULTS: Despite modest associations, patients' beliefs about the cancer were clearly unique from the clinical characteristics of the cancer. Illness perception variables accounted for a large portion of the variance (PS < .01) for QOL and advanced illness behaviors, whereas clinical characteristics did not. QOL scores were predicted by patients' reports of experiencing more cancer related symptoms (ie, illness identity), believing that their cancer is central to their self-identity, and higher income. Higher completion of advanced illness behaviors was predicted by higher income, the cancer being recurrent, and participants perceiving their cancer as more severe but also more understandable. LIMITATIONS: This study was limited by a cross-sectional design, small sample size, and focus on female patients. CONCLUSION: Addressing patients' beliefs about their cancer diagnosis may provide important targets for intervention to improve QOL and illness behaviors in patients with late-stage cancer.

Intrusion, avoidance, and daily negative affect among couples coping with prostate cancer: a dyadic investigation.

In the present study we examined how husbands' and wives' intrusive thoughts of prostate cancer (i.e., thinking about it when not meaning to) and avoidance (i.e., efforts to not think about cancer) related to their own and each other's average negative affect over a subsequent 14-day period. We examined whether congruence or similarity in intrusion about illness, but not avoidance, would be associated with less negative affect as this response to cancer could potentially facilitate adjustment. Fifty-nine husbands and wives completed measures of intrusion and avoidance after the diagnosis of prostate cancer and reported on their daily negative affect for 14 days. Using the actor-partner interdependence model, both patients and their wives who had high levels of intrusive thoughts experienced less negative affect when the other member of the couple also experienced high levels of intrusive thoughts. Those who had higher levels of avoidance had spouses who had higher levels of negative affect regardless of their own levels of avoidance. Congruence in responses to cancer may be adaptive for intrusion but not avoidance because the use of intrusive thoughts by both husbands and wives can allow couples to process the diagnosis of cancer, facilitating psychological adjustment, whereas avoidance does not. The current investigation adds to our understanding of how people within a marital dyad affect each other as they adjust to a cancer diagnosis.

Affect covariation in marital couples dealing with stressors surrounding prostate cancer.

BACKGROUND: Consistent with a dyadic perspective to coping with chronic illness, couples may experience covariation in their daily affective experiences, particularly as they deal with stressful events surrounding chronic illness, such as prostate cancer. OBJECTIVE: Our purpose was to examine the daily covariation of negative and positive affect among husbands and wives and whether this covariation was enhanced when couples mentioned the same stressful event and reported frequently collaborating. METHODS: Fifty-nine husbands diagnosed as having prostate cancer and their wives participated in a daily diary where they reported on the most stressful event of the day, positive and negative affect, coping strategies and whether their spouse was involved in a collaborative manner. Coders independently made judgments as to whether the stressful event mentioned by husbands and wives was the same. RESULTS: Multivariate hierarchical linear models revealed that on days when wives experienced greater negative affect, husbands did so as well. However, negative affect covariation was only found when spouses mentioned the same daily stressful event. The mean levels of collaborative coping across the 14 days moderated this negative covariation effect for wives, such that negative affect covariation was enhanced when wives reported collaborating more frequently. Positive affect covariation was not found. CONCLUSION: The results reveal that negative affect covariation may be most likely when spouses experience similar stressors and wives perceive frequently collaborating. Partners within close relationships experience similar negative affect as their spouse, pointing to the shared nature of illness in late life.

Late-midlife and older couples' shared possible selves and psychological well-being during times of illness: the role of collaborative problem solving.

We investigated associations between spouses' shared possible selves and well-being as a function of their perceptions of collaboration in 61 late-midlife (M = 60 years) and older (M = 72 years) couples dealing with prostate cancer. Spouses completed assessments of possible selves (with shared selves defined as possible selves portraying a similar goal across spouses), psychological well-being, and enjoyment and frequency of collaboration. Associations between shared selves and better well-being occurred through better enjoyment of collaboration regardless of age (after controlling for marital quality and subjective health). An interaction revealing that shared selves were associated with better well-being only with frequent collaboration was obtained with older couples but was not found in late-midlife couples.

Collaborative coping and daily mood in couples dealing with prostate cancer.

Collaborative coping (i.e., spouses pooling resources and problem solving jointly) may be associated with better daily mood because of heightened perceptions of efficacy in coping with stressful events. The study examined the daily processes of collaborative coping (individuals' perceptions that the spouse collaborated), perceived coping effectiveness (ratings of how well they dealt with the event), and mood (i.e., Positive and Negative Affect Scale) across 14 days in 57 older couples coping with stressors involving the husband's prostate cancer and daily life in general. In hierarchical multivariate linear models, collaborative coping was associated with more positive same-day mood for both husbands and wives and less negative mood for wives only. These associations were partially mediated by heightened perceptions of coping effectiveness. Exploratory analyses revealed that collaborative coping was more frequent among wives who performed more poorly on cognitive tests and couples who reported greater marital satisfaction and more frequently using collaboration to make decisions. The results suggest that older couples may benefit from collaborative coping in dealing with problems surrounding illness.