Cultural stressors, acculturation processes, and mental health among adolescents in Korean multicultural families.

OBJECTIVES: To ascertain, among a sample of Korean multicultural adolescents, the longitudinal predictive effects of acculturative stress and parent-adolescent conflict on depressive symptoms and life satisfaction, both (a) directly and (b) indirectly through Korean and heritage cultural practices and identifications. METHOD: We analyzed longitudinal data from the nationally representative Korean Multicultural Adolescents Panel Study (MAPS; 2011-2016). The sample consisted of 1,433 households at Wave 3 (the first timepoint used in the present analyses), and 92.7% of families were retained until the end of the study. Adolescents completed measures of acculturative stress and parent-adolescent conflict at Timepoint 1, heritage and Korean cultural practices and identifications at Timepoints 2 and 3, and depressive symptoms and life satisfaction at Timepoint 4. RESULTS: Acculturative stress at Timepoint 1 predicted both depressive symptoms and life satisfaction at Timepoint 4 indirectly through Korean cultural practices and identifications. Parent-adolescent conflict at Timepoint 1 directly predicted depressive symptoms at Timepoint 4 and predicted life satisfaction indirectly through heritage-cultural practices and identifications. These links were invariant across adolescent sex. CONCLUSIONS: Among Korean multicultural adolescents, acculturative stressors inhibit engagement in Korean cultural practices and identification as Korean, whereas conflict with parents inhibits engagement in heritage cultural practices and identification with the foreign-born parent's cultural heritage. Decreased Korean and heritage cultural practices and cultural identifications predict increased depressive symptoms and lowered life satisfaction. These findings suggest that culturally stressful experiences can impair psychological functioning among Korean multicultural adolescents by undermining acculturation to both Korean and heritage cultural systems. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Screening for Adolescent Risk Behaviors: Preliminary Evidence for a Family Functioning Tool.

BACKGROUND: Family functioning is associated with adolescent drug use, alcohol use, cigarette use, and sexual risk behaviors. Assessing adolescents for family functioning, commonly associated with multiple risk behaviors, may help identify adolescents at risk for adverse health outcomes. This study examined whether a latent family functioning construct, encompassing multiple dimensions of family functioning, was associated with adolescents' substance use and sexual risk behaviors. METHOD: This study used data harmonization with three intervention trials, including data from 1451 adolescents (M = 13.6, SD = 1.0), to perform a full-information item bifactor analysis on 46 family functioning items from five pre-existing family functioning measures. Regression analysis was used to examine the association between the identified subset of items and the following outcomes: cigarette use, alcohol use, drug use, and condom use. RESULTS: Bifactor analysis identified a 26-item latent family functioning construct. Regression analysis indicated that a 26-item latent family functioning construct was associated negatively with lifetime and past 90-day cigarette use, alcohol use, and drug use. CONCLUSION: In sum, the multi-dimensional latent family functioning construct may target specific barriers to risk screening in adolescent populations, including time constraint, hesitancy in discussing sensitive health topics, and use culturally appropriate and age-appropriate assessments.

Functions of Resiliency Traits and Processes in Differential Effects of CBSM on Quality of Life in Breast Cancer Survivors: A Moderated Mediation Model.

BACKGROUND: Although there is evidence that cognitive behavioral therapy (CBT)-based group interventions can improve quality of life (QoL) in women undergoing treatment for breast cancer (BC) little is known about factors that mediate and moderate these effects. We examined a) the mediating role of benefit finding on QoL changes after a Cognitive Behavioral Stress Management (CBSM) intervention, and b) whether this mediation effect differed based on baseline optimism in the first year following surgery for BC. METHODS: We used data from a prior CBSM trial in 240 women with stage 0-3 BC who completed measures of benefit finding (Benefit Finding Scale, BFS), QoL (Functional Assessment of Cancer Treatment, FACT-G), and optimism (Life Orientation Test-Revised) at baseline (2 - 10 weeks post-surgery), 6-months and 12-months after randomization. CBSM-related changes and mediation and moderation effects were assessed using latent growth curve models. RESULTS: We found CBSM increased benefit finding (b = 2.65, p < 0.01), emotional (b = 0.53, p < 0.01), and functional QoL (b = 0.71, p < 0.05) over time. CBSM-related changes in emotional QoL were mediated by increased benefit finding (indirect effect = 0.68, 95% bootstrapped CI: 0.17, 1.56) but only among participants with low to moderate optimism at baseline. CONCLUSION: CBSM intervention improved emotional QoL over the first year of breast cancer treatment by increasing benefit finding among women who reported low trait optimism suggesting those who will most likely benefit from improving benefit finding during this stressful period.

The Role of Intervention Fidelity, Culture, and Individual-Level Factors on Health-Related Outcomes Among Hispanic Adolescents with Unhealthy Weight: Findings from a Longitudinal Intervention Trial.

Previous studies have suggested the impact of intervention fidelity on the management and prevention of chronic diseases; however, little is known about the effect of the contributing determinants (at multiple levels of influence) that can impact health-related interventions intending to improve the health status of Hispanic adolescents with overweight or obesity. The current study aimed to assess whether fidelity (i.e., dosage and quality of the program delivery), acculturation (i.e., orientation to the American culture, retention of Hispanic cultural values), and individual-level socio-demographic characteristics (i.e., income, education) predict changes in family processes (e.g., parent control), which in turn may affect adolescent health-related outcomes including body mass index (BMI), physical activity, dietary intake, and adolescents' health-related quality of life. A pathway analysis model was utilized to explore the study variables among 140 Hispanic parent-adolescent dyads randomized to Familias Unidas Health and Wellness (FUHW) intervention. Results indicated that fidelity was significantly associated with changes in parent-adolescent communication, parent monitoring, limit-setting, and control. Parents' education was associated with changes in parent limit-setting, and parent Hispanicism was associated with changes in parent limit-setting and discipline. The examination between family processes and adolescent health outcomes revealed that parents' higher discipline and improved communication with their adolescents were significantly associated with improved adolescents' quality of life, and parent control was positively associated with physical activity and negatively associated with BMI in adolescents. Our findings demonstrated the significant contribution of intervention fidelity and participants' characteristics in parenting strategies leading to adolescents' health outcomes to prevent obesity-related chronic diseases. Future research is needed to investigate the effect of environmental and organizational factors on the delivery of the intervention materials.

Family Functioning in Hispanic Parents of Adolescents: Who Benefits Most from a Family-Based HIV and Substance Use Preventive Intervention?

To understand which families are likely to benefit most from resource-intensive family-based, evidence-based interventions (EBIs), we must examine the key, modifiable determinant of family functioning. The purpose of this study was to (1) identify whether there are subgroups of Hispanic parents that differ meaningfully based on their family functioning at baseline, (2) test whether the Familias Unidas preventive intervention was differentially effective across the baseline family functioning subgroups, and (3) understand the mechanisms of intervention effectiveness within each baseline family functioning subgroup. On a pooled data set of 4 completed efficacy and effectiveness trials of Familias Unidas (n = 1445 low-income, Hispanic immigrant origin, parents and their adolescent between the ages of 12-17), we conducted a series of secondary data analyses. Latent profile analyses revealed four significantly different profiles: (1) low family functioning (n = 210, 14.55%), (2) low-to-moderate family functioning (n = 554, 38.39%), (3) moderate-to-high family functioning (n = 490, 33.96%), and (4) high family functioning (n = 189, 13.10%). A structural equation modeling approach found there were significant differences in intervention effectiveness between the subgroups. The low family functioning subgroup experienced gains in family functioning, and in turn, lower levels of adolescent substance use, internalizing, and externalizing symptoms. The high family functioning subgroup showed significant direct effects of the intervention on adolescent substance use, internalizing, and externalizing symptoms, but no indirect effects through improvements in family functioning. Implications for screening, targeting, and adapting interventions are discussed.

Distinct co-occurrence patterns of acculturation and perceived context of reception between weekdays and weekends among Hispanic college students.

OBJECTIVE: The present study was designed to examine distinct co-occurrence patterns of acculturation and perceived context of reception between weekdays and weekends among Hispanic college students in Miami and their influences on psychosocial maladaptation. METHODS: We conducted a 12-day diary study with a sample of first- and second-generation Hispanic college students in Miami (n = 864). Depressive symptoms and physically aggressive behaviors were assessed on Days 1 and 12, and acculturation components and perceived negative context of reception were measured using single items on Days 2-11. We examined the overlap between weekday and weekend patterns of acculturation and negative context of reception, as well as links of this overlap with depressive symptoms and with physically aggressive behaviors. RESULTS: Overall, six distinct co-occurrence patterns of acculturation and perceived contexts of reception emerged from the analysis. Four of these appeared to represent stable co-occurrence patterns regardless of weekdays and weekends and two indicated changing co-occurrence patterns between weekdays and weekends. Students in patterns of the Moderate Biculturalism-High Negative Context of Reception regardless of weekdays and weekends reported high depressive symptoms and physically aggressive behaviors. Also, for the two changing co-occurrence patterns, students in patterns of the Changes in both Acculturation and Negative Context of Reception between weekdays and weekends reported high scores on both depressive symptoms and physical aggressive behaviors. CONCLUSION: Both stable and changing patterns in acculturation and context of reception co-occurrences between weekdays and weekends predicted psychosocial maladaptation.

Real-world experience of pembrolizumab and lenvatinib in recurrent endometrial cancer: A multicenter study in Korea.

OBJECTIVE: To investigate the effectiveness and safety of pembrolizumab and lenvatinib (PEMBRO+LEN) for recurrent endometrial cancer (EC) in a real-world setting. METHODS: This multicenter retrospective cohort study included patients with recurrent EC who received PEMBRO+LEN between March 2020 and May 2021 at three tertiary hospitals in Korea. We summarized patient characteristics and evaluated the response rates, survival outcomes, and treatment-related adverse events (AEs). RESULTS: In total, 48 patients were included in the study. The median age of the patients was 62.5 (range, 42-78) years. The most common histologic subtype was endometrioid adenocarcinoma (43.8%), followed by serous adenocarcinoma (25.0%). Most patients (91.7%) had mismatch repair-proficient tumors. Patients received PEMBRO+LEN for a median of 4.5 cycles, during which the best objective response rate and disease control rate were 23.8% (95% CI, 11.9-38.1) and 76.2% (95% CI, 61.9-88.1), respectively. Overall, 56.2% of patients experienced LEN dose reduction once or more and 16.7% experienced LEN interruption. The most common treatment-related AEs were fatigue (18.8%), hypertension (16.7%), and hypothyroidism (14.6%). Total of 8 patients (16.7%) discontinued LEN during the treatment because of treatment-related AEs. Serum CA-125 level was the only prognostic factor for progression-free survival (adjusted hazard ratio, 4.41; 95% confidence interval, 1.19-16.36; p = 0.03). CONCLUSIONS: In our real-world study, Korean patients with recurrent EC who received PEMBRO+LEN showed lower treatment response rate and similar treatment discontinuation rate, compared to clinical trials.

Efficacy of a Family-Based Intervention for HIV Prevention with Hispanic Adolescents with Same Gender Sexual Behaviors.

Despite the availability of efficacious and effective family-based interventions, such interventions are scarce for sexual minority adolescents, particularly among ethnic/racial minorities. Prior to creating an entirely new intervention, a prudent first step may be to determine if existing interventions are efficacious in reducing risk behaviors in sexual minority adolescents. This study assesses the relative efficacy of a general, family-based intervention (Familias Unidas) on improving substance and condom use outcomes among Hispanic adolescents with same gender sexual behaviors (HASGB). Data across five distinct trials of Familias Unidas were synthesized. HASGB were randomized either to an intervention (n = 94) or control condition (n = 100). Mediation analyses tested for intervention efficacy on past 90-day substance (cigarette/alcohol/illicit drug) use and condomless sex at last intercourse in HASGB participants and whether family functioning indicators-parent-adolescent communication, positive parenting, and parental monitoring of peers-mediated the effects. Post hoc analyses explored the moderating role of study target population based on prior risk. Familias Unidas did not impact substance use but significantly reduced condomless sex postintervention relative to the control condition. Hypothesized mediators did not explain this effect. Post hoc analyses indicated that the effect was significant in studies that recruited based on prior risk but not studies that recruited universal samples. Our results suggest that a general, family-based intervention may have positive effects on condom use in HASGB, particularly those with prior indicated risk. Identifying intervention components that drive this effect in addition to developing tailored content for HASGB is needed.

The Intergenerational Impact of Adverse Childhood Experiences on Hispanic Families: The Mediational Roles of Parental Depression and Parent-Adolescent Communication.

Parental exposure to adverse childhood experiences (ACEs) has been documented as a strong risk factor for subsequent externalizing behaviors in their youth. Although studies have investigated ACEs and their intergenerational association with youth externalizing behaviors, this association has not been investigated in Hispanic families. Additionally, substantial gaps in the literature exist explaining the mechanisms by which this association occurs. The purpose of this study was to examine whether parent-adolescent communication and parental depressive symptomatology explain the relationship between parent's ACE score and adolescent externalizing behaviors. This secondary data analysis utilized baseline data from an ongoing randomized controlled trial evaluating the relative effectiveness of an online parenting intervention for Hispanic adolescents. The sample consisted of 456 parents and their adolescents between the ages of 12-16. Using path modeling, parental depressive symptomatology and parent-adolescent communication were simultaneously examined as mechanisms that may explain the intergenerational relationship between parental exposure to ACEs and externalizing behaviors in Hispanic youth. Parental depressive symptomatology and parent-adolescent communication both significantly mediated the association between parental exposure to ACEs and adolescent externalizing behaviors. Understanding the mechanisms explaining the intergenerational association between parental exposure to ACEs and adolescent externalizing behaviors may aid future research examining problematic behaviors in Hispanic youth.

La exposición de los padres a las experiencias adversas de la niñez se ha documentado como un factor de riesgo potenciador de comportamientos posteriores de exteriorización en sus hijos. Aunque existen estudios donde se han investigado las experiencias adversas de la niñez y su asociación intergeneracional con las conductas de exteriorización de los jóvenes, esta asociación no se ha investigado en familias hispanas. Además, existen vacíos considerables en la bibliografía sobre la explicación de los mecanismos por los cuales ocurre esta asociación. El propósito de este estudio es analizar si la comunicación entre padres y adolescentes y la sintomatología depresiva de los padres explican la relación entre el puntaje de las experiencias adversas de la niñez de los padres y las conductas de exteriorización de los adolescentes. En este análisis de datos secundarios se utilizaron datos basales de un ensayo controlado aleatorizado en curso que evalúa la eficacia relativa de una intervención virtual sobre la crianza para adolescentes hispanos. La muestra consistió en 456 padres y sus adolescentes de entre 12 y 16 años. Utilizando un modelo de pautas, se analizaron simultáneamente la sintomatología depresiva de los padres y la comunicación entre los padres y los adolescentes como mecanismos que pueden explicar la relación intergeneracional entre la exposición de los padres a experiencias adversas en la niñez y las conductas de exteriorización en los jóvenes hispanos. La sintomatología depresiva de los padres y la comunicación entre los padres y los adolescentes mediaron significativamente la asociación entre la exposición de los padres a experiencias adversas en la niñez y las conductas de exteriorización de los adolescentes. La comprensión de los mecanismos que explican la asociación intergeneracional entre la exposición de los padres a experiencias adversas en la niñez y las conductas de exteriorización de los adolescentes puede ayudar a investigaciones futuras que analicen las conductas problemáticas de los jóvenes hispanos.

The contribution of syndemic conditions to cardiovascular disease risk.

The syndemic conditions of low education, childhood maltreatment, depression, HIV, alcohol and cocaine use, and obesity have been established as independent risk factors for cardiovascular risk, but research examining the association between syndemic conditions and cardiovascular risk in high-risk populations is lacking. A total of N = 503 participants underwent an ultrasound of the carotid artery to assess for atherosclerotic plaque. Participants, HIV-infected (n = 202) and HIV-uninfected (n = 301) with and without a history of cocaine use, were a mean age of 36.13 years (SD = 9.51); 50% were male, and 62% were African-American. Each syndemic condition was associated with 8% greater odds of atherosclerotic plaque (OR = 1.08), 9% greater odds of systolic blood pressure (OR = 1.09), and 10% greater odds of diastolic blood pressure (OR = 1.10). Multilevel research, interventions, and public policy initiatives are needed to activate stakeholders at each level to maximize their impact at a community level among populations with high rates of syndemic conditions.

A Family-Based Healthy Lifestyle Intervention: Crossover Effects on Substance Use and Sexual Risk Behaviors.

This study examined the efficacy of a healthy lifestyle family-based intervention in reducing substance use and sexual risk behaviors compared with prevention as usual over 24 months in Hispanic adolescents. Participants were overweight/obese Hispanic adolescents (N = 280; M age 13.01; SD = .82) in the 7th/8th grade and their primary caregivers. Participants were randomized to either the healthy lifestyle family-based intervention or to the control condition (i.e., referral to community services offered for overweight and/or obese adolescents and their families). Outcomes included adolescent substance use and sexual risk behaviors among adolescents. Intervention effects were found for adolescent alcohol (b = - 0.37, 95% CI = [- 0.49, - 0.26]), marijuana (b = - 1.00, CI = [- 1.22, - 0.78]), and non-prescription drug use (b = - 3.77, CI = [- 6.49, - 1.05]) over 24 months. No significant intervention effects were found for adolescent sexual risk behaviors. Findings suggest that Familias Unidas for Health and Wellness reduces adolescent alcohol, marijuana, and non-prescription drug use across time. ClinicalTrials.gov Identifier: NCT03943628.

How Early Stressful Life Experiences Combine With Adolescents' Conjoint Health Risk Trajectories to Influence Cardiometabolic Disease Risk in Young Adulthood.

Research has primarily focused on additive (unique) associations between early stressful life experiences (specifically, socioeconomic adversity and maltreatment) and young adults' cardiometabolic disease risk without considering multiplicative (synergistic) influences. Furthermore, research has not fully considered the varying patterns of health risk trajectories (e.g., substance use, obesogenic-related behaviors, depressive symptoms) across adolescence and the transition to young adulthood that may link earlier stressful experiences and later cardiometabolic disease risk. This study examined heterogeneity in conjoint health risk trajectories from adolescence to the transition to young adulthood and their additive and multiplicative (synergistic) influences with early stressful life experiences on cardiometabolic disease risk in young adulthood using data from the National Longitudinal Study of Adolescent to Adult Health (n = 9,421; 55.6% female) over a period of 13 years. Four distinct conjoint health risk trajectories were identified considering trajectories of substance use behaviors, obesogenic-related behaviors, and depressive symptoms: (a) overall high-risk, (b) behavioral risks, (c) psycho-obesogenic risks, and (d) overall low-risk. Socioeconomic adversity and maltreatment were additively and multiplicatively associated with cardiometabolic disease risk in young adulthood. Individuals with overall high-risk conjoint trajectories averaged higher cardiometabolic disease risk in young adulthood when they were exposed to early socioeconomic adversity. Implications for personalized interventions for individuals who have experienced multiple forms of health risks are discussed.

The family crisis migration stress framework: A framework to understand the mental health effects of crisis migration on children and families caused by disasters.

Crisis migration refers to displacement of large numbers of individuals and families from their home countries due to wars, dictatorial governments, and other critical hazards (e.g., hurricanes). Although crisis migration can adversely influence direct and indirect effects on the mental health of adults and their children collectively as families, there is a deficiency in theory that addresses family level processes in this crisis migration context. We propose the Family Crisis Migration Stress Framework, which consolidates what is known about the multiple factors affecting mental health outcomes of crisis migrants into one cohesive model. In our article, we synthesize relevant theories and models of disaster, migration, and family resilience in order to create a framework in which to organize the complex processes that occur within families as a result of migration and that affect the mental health of children. We include examples from various national settings to illustrate the tenets of our framework. Future policy and intervention for crisis migrant should focus on the family as a unit, instead of parents and children as individual entities.

Acculturation Trajectories Differ by Youth Age at Arrival and Time in Residency among Latino Immigrant Families in a US Emerging Immigrant Context.

The present study was designed to examine acculturation trajectories of first-generation, Latino immigrant youth and their parents in an emerging immigrant context. We also examined whether acculturation trajectories differed between families with youth who migrated at different stages of development and who have spent differential amounts of time in the United States (US). A community sample of 217 immigrant families in western Oregon was purposely sampled according to youths' age at arrival and time in US residency (TR) and assessed three times over a 3-year period. Families were stratified into three TR groups: TR1 = 2-4 years spent in the US; TR2 = 6-8 years spent in the US; and TR3 = 10-12 years. Parents and youth in each TR group completed measures assessing their acculturation to US American and Latino culture. Results from multiple-group latent growth models showed that acculturation trajectories differed for both youth and parents depending on the TR group. Moreover, both youth and their parents within each TR group differed in their acculturation trajectories. Overall, although youth slowly gravitated toward biculturalism over time, their parents remained relatively separated such that they reported high endorsement of their heritage culture and low endorsement of US culture over time. Findings are discussed in terms of prior research and theory.

Dynamic Transition Patterns in Acculturation Among Hispanic Adolescents.

Acculturation consists of multiple domains (i.e., cultural practices, identifications, and values). However, less is known about how acculturation processes influence each other across multiple domains of acculturation. This study was designed to investigate transition patterns of acculturative processes within and across domains in a sample of 302 recent-immigrant Hispanic adolescents, Mage (SD) = 14.51 years (0.88) at baseline; male = 53%). Adolescents were assessed six times over a 3-year period. Latent profile analyses identified two profiles (high [or increasing] vs. low) for each domain at each timepoint. We found largely stable transition patterns in each domain over six timepoints. Importantly, sequential associations among profiles in acculturation domains were also detected. Implication for acculturation theory and research are discussed.

The effect of male involvement and a prevention of mother-to-child transmission (PMTCT) intervention on depressive symptoms in perinatal HIV-infected rural South African women.

This study investigated perinatal depressive symptoms among HIV-infected women enrolled in a cluster-randomized, controlled trial in South Africa. Women (n = 1370) attending 12 community health centers were consecutively enrolled in a two-phase (phase 1 = without a male partner, phase 2 = with a male partner) and two-condition (experimental or control) prevention of mother-to-child transmission (PMTCT) intervention. Women were enrolled at 8-24 weeks pregnant and followed postpartum at 6 weeks and 6 and 12 months (retention rate = 69.8%). Antenatally, 45.4% of women were above the 12-point Edinburgh Postnatal Depression Scale (EPDS) cutoff, 30.2% were above the cutoff at 6 weeks, and 34.2% and 36.9% at 6 months and 12 months postpartum, respectively. In multilevel regression analyses, depressive symptoms decreased over time among women in phase 2 participating in the intervention condition, but neither condition nor phase alone was associated with a decrease in depression. Greater HIV stigma, increased psychological intimate partner violence, less male involvement, lower education, and non-adherence during pregnancy were associated with increased depressive symptoms over the perinatal period. Results indicated that women participating had high levels of depressive symptoms (> 40% prenatally and > 30% postnatally), and the combination of the multi-session PMTCT intervention plus male partner participation contributed to a reduction in depressive symptoms. Results suggest that interventions targeting the reduction of depressive symptoms in perinatal HIV-positive women by increasing male involvement and decreasing HIV stigma and intimate partner violence are needed to reduce depression in this vulnerable population.

When a Personal HPV Story on a Blog Influences Perceived Social Norms: The Roles of Personal Experience, Framing, Perceived Similarity, and Social Media Metrics.

The current study examines how a personal health story on a blog can influence individuals' perceived social norms, adopting the notion that social norms are "group identity-based codes of conduct". For that, we tested the effects of story framing and personal experience on perceived similarity, which interacts with social media metrics in forming perceived social norms. In an online experiment, college students (N = 220) were recruited to read a blogger's story in either a gain-frame (the blogger received the HPV vaccine and, thus, prevented cancer) or a loss-frame (the blogger did not receive the vaccine and, thus, developed cancer) with either high or low social media metrics. Participants reported that they were more similar with the blogger in the gain-framed story than the one in the loss-framed story, especially among those who have received the HPV. This perceived similarity was positively associated with both descriptive and injunctive norms; however, the positive association between similarity and descriptive norms disappeared when the blog had low social media metrics. Theoretical and practical implications are discussed.

The Interplay between Framing and Regulatory Focus in Processing Narratives about HPV Vaccination in Singapore.

This study examined whether regulatory focus changes the effects of gain- and loss-framed narratives on promoting Human Papillomavirus (HPV) vaccination among young females in Singapore. We conducted a quasi-experiment in which participants reported their regulatory focus and then read either a gain- or loss-framed narrative about HPV vaccination. The results showed an overall advantage of a loss frame over a gain frame in producing transportation and self-referent emotions, which in turn led to increased vaccination intentions. This pattern was more pronounced among those high in prevention or promotion focus, with self-referent emotions being the primary mediator transferring the interactive effects onto vaccination intentions. This study contributes to the extant literature on narrative persuasion by addressing the specific mechanisms of the effect of framing employed in narratives.

Marital strain trajectories over a quarter century and spouses' loneliness: Couple-level and individual pathways.

Although research suggests that stressful marital experiences may lead to feelings of loneliness in later life, little is known about the influence of marital strain over an extended period of time on loneliness in later years. Thus, in the present study, drawing from family systems and cognitive theories along with common fate and actor-partner interdependence modeling approaches, we hypothesized a hybrid model comprised of two multilevel pathways explaining the persistent influence of marital strain on loneliness, including: (a) a couple-level pathway and (b) an individual pathway involving within-spouse and between-spouse effects. Specifically, we investigated the influences of individual- and couple-level trajectories of marital strain over a period of 25 years (from 1991 to 2015) on loneliness outcomes in later years with a sample of 257 couples in enduring, long-term (over 40 years) marriages. The results mostly supported both hypothesized pathways. Consistent with the pathway involving a couple-level process, couple-level trajectories of marital strain predicted couples' later-life loneliness as reflected by both spouses' reports of loneliness (shared perceptions). In addition, at the individual level, each spouses' unexplained variances (unique perception) in marital strain trajectories predicted his/her own later-life loneliness outcomes (within-spouse effect or actor effect). Findings are discussed as they relate to intervention and prevention programs focusing on the well-being of married couples in later life.

Sexual risk behavior among HIV-infected women in South Africa at 12-months postpartum.

The postnatal period is a time of increased susceptibility to HIV infection and superinfection for postpartum women, sexual partners, and infants. This study examined the effect of a prevention to mother-to-child transmission of HIV intervention compared to standard care, and factors associated with unprotected last sex and inconsistent condom use at 12-months postpartum. Participants were N = 1399 HIV-infected women 6-30 weeks pregnant (M = 18 weeks (SD = 5.75)) assessed during pregnancy and 12-months postpartum. Women were aged an average of 28 (SD = 5.82); 48% reported 10-11 years of education. Older age (adjusted odds ratio [AOR] = 1.00) and being employed (AOR = 1.51) were associated with greater odds of unprotected sex at 12-month postpartum. Disclosure of HIV status (AOR = 0.64) and greater male involvement during pregnancy (AOR = 0.92) were associated with lower odds of unprotected sex at 12-month postpartum. HIV negative or unknown partner status (AOR = 0.45) and greater depressive symptoms (AOR = 0.97) were associated with lower odds of inconsistent condom use at 12-months postpartum. The intervention was not associated with reduced sexual risk behavior. Future studies should address male involvement and consider measurement of culturally tailored male involvement constructs for men South Africa. Perinatal women may require support for sexual communication and gender equity to reduce sexual risk.