Birth Doula Care in California During COVID-19: The Impacts of Social Distancing on a High-Touch Helping Profession.

Birth doulas were deemed "non-essential" personnel during the COVID-19 pandemic and were generally excluded from attending hospital births in person. This study documents the impacts of pandemic-related contextual factors on birth doula care in the San Francisco Bay Area, examines how doulas adapted their services, and explores implications for policy and practice. We employed a contextually bound qualitative case study methodology driven by social action theory and conducted interviews with 15 birth doulas. The pandemic disrupted physical settings, the social environment, communication modalities, contractual arrangements, and organizational level factors. The historical context also amplified awareness of institutionalized racism in birth settings and highlighted birth doulas' advocacy role. Striking deficits exist in birth doulas' integration into US healthcare systems; this made their services uniquely vulnerable to the pandemic circumstances. Birth doulas' value ought to be more formally recognized within health policy, health insurance, and hospital systems as complementary care to that provided by medical providers to improve access to high-quality perinatal care.

The need for cultural adaptations to health interventions for African American women: A qualitative analysis.

OBJECTIVE: Binge eating disorder (BED) is associated with obesity and psychological distress. Although rates in African American (AA) and White women are similar, AA women report more severity of symptoms and higher frequency of binge eating episodes. However, few AA women seek help due to a lack of acknowledgment of sociocultural influences that shape experiences and behaviors related to BED in currently available interventions. Culturally adapted interventions are an important way to acknowledge these sociocultural factors and produce expected outcomes within a specific group. This qualitative study begins the process of culturally adapting evidence-based treatment for AA women to reduce BED. METHOD: Sixteen AA women with BED participated in focus groups to determine the need for adaptations to an evidence-based intervention. Thematic content analysis was used to analyze data from focus groups. RESULTS: The unique experiences of AA women including lack of awareness of BED, cultural deviation from the "thin ideal," influence of family on eating practices, social meanings of food, role of religion, binge eating as coping, skepticism about weight standards, and the importance of motivation to change are highlighted. CONCLUSION: This research adds to the current discourse on the importance of culturally adapting interventions for more targeted use and helps to expand what is known about AA women with BED and associated obesity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

"I feel like their relationship is based on the media": Relationship Between Media Representation and Adolescents' Relationship Knowledge and Expectations.

Teen dating violence (TDV) is a serious public health issue associated with negative physical and behavior outcomes that disproportionately impact African-American adolescents. Despite the emergence of effective TDV prevention strategies, more knowledge is needed about how African American adolescents understand healthy and unhealthy relationships. Adolescents' analysis of media representations can provide important insight into social norms around adolescent romantic relationships, which can inform the development of TDV prevention strategies. We conducted nine focus groups (n = 86) to explore perceptions of healthy and unhealthy relationships and the influence of media representations on romantic relationships. We transcribed focus group interviews verbatim and coded them line by line. Participants were primarily African American (90%), female (67%), and high school aged (13-17 years). Consistent with other studies, participants reported significant engagement across traditional and social media platforms that exposed them to a wide variety of fictional, celebrity, and peer relationships. A modified constructivist grounded theory analytic approach produced four major relationship themes: commitment, authenticity, privacy, and maturity. These themes captured participants' reflections about romantic relationships and how the media interact with relationship processes and perceptions. Results show that adolescents are using media representations of romantic couples to clarify their own romantic relationship expectations and desires. Future prevention strategies should support youths' use of critical thinking, perspective taking, and analysis to help align their relationship choices and expectations with their own values and preferences.

Associations between meal patterns, binge eating, and weight for Latinas.

Establishing a regular pattern of eating is a core element of treatment for binge eating, yet no research to date has examined meal patterns of Latina women. OBJECTIVE: Compare eating patterns of Latinas who binge eat and those who do not, and examine associations between meal patterns and binge episodes, associated distress and concerns, and body mass index (BMI). METHOD: One-hundred fifty-five Latinas [65 Binge Eating Disorder (BED), 22 Bulimia Nervosa (BN), 68 with no eating disorder] were assessed with the Eating Disorder Examination. RESULTS: There were no significant differences in eating patterns between groups. Breakfast was the least and dinner the most consumed meal. For the BED group: greater frequency of lunch consumption was associated with higher BMI while more frequent evening snacking was associated with lower BMI and with less weight importance; more frequent breakfast consumption, mid-morning snack consumption and total meals were associated with greater distress regarding binge eating. For the BN group, evening snack frequency was associated with less dietary restriction and more weight and shape concern; total snack frequency was associated with more weight concern. Regular meal eaters reported more episodes of binge eating than those who did not eat meals regularly. DISCUSSION: Associations with meal patterns differed by eating disorder diagnosis. Study findings mostly are not consistent with results from prior research on primarily White women. CBT treatments may need to be tailored to address the association between binge eating and regular meal consumption for Latinas. Culturally, appropriate modifications that address traditional eating patterns should be considered. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:32-39).

The ConNECT Framework: a model for advancing behavioral medicine science and practice to foster health equity.

Health disparities persist despite ongoing efforts. Given the United States' rapidly changing demography and socio-cultural diversity, a paradigm shift in behavioral medicine is needed to advance research and interventions focused on health equity. This paper introduces the ConNECT Framework as a model to link the sciences of behavioral medicine and health equity with the goal of achieving equitable health and outcomes in the twenty-first century. We first evaluate the state of health equity efforts in behavioral medicine science and identify key opportunities to advance the field. We then discuss and present actionable recommendations related to ConNECT's five broad and synergistic principles: (1) Integrating Context; (2) Fostering a Norm of Inclusion; (3) Ensuring Equitable Diffusion of Innovations; (4) Harnessing Communication Technology; and (5) Prioritizing Specialized Training. The framework holds significant promise for furthering health equity and ushering in a new and refreshing era of behavioral medicine science and practice.

Building Community Capacity and Fostering Disaster Resilience.

OBJECTIVE: To describe, within an ecologically grounded framework, key principles, and recommendations for community-level intervention to build community capacity and promote disaster resilience. METHOD: Using an ecological framework, this article describes community resilience and related constructs and key principles for community-level disaster preparedness and response. RESULTS: Current research suggests the importance of focusing on bolstering resources that promote wellness and facilitate individual and community resilience in the face of disaster. CONCLUSION: We advocate for using an ecological framework grounded in such values as collaboration, social justice, empowerment, and an appreciation of diversity to guide disaster work with communities. We highlight the need to: (a) focus on building community-specific capacity for disaster preparedness, response, and recovery; (b) emphasize increasing the capacity and supportive potential of community members' natural settings to promote wellness; (c) address power and resource inequities; and (d) enhance capacity to ensure contextually and culturally appropriate structures, methods, and interventions.

Mental- and physical-health effects of acute exposure to media images of the September 11, 2001, attacks and the Iraq War.

Millions of people witnessed early, repeated television coverage of the September 11 (9/11), 2001, terrorist attacks and were subsequently exposed to graphic media images of the Iraq War. In the present study, we examined psychological- and physical-health impacts of exposure to these collective traumas. A U.S. national sample (N = 2,189) completed Web-based surveys 1 to 3 weeks after 9/11; a subsample (n = 1,322) also completed surveys at the initiation of the Iraq War. These surveys measured media exposure and acute stress responses. Posttraumatic stress symptoms related to 9/11 and physician-diagnosed health ailments were assessed annually for 3 years. Early 9/11- and Iraq War-related television exposure and frequency of exposure to war images predicted increased posttraumatic stress symptoms 2 to 3 years after 9/11. Exposure to 4 or more hr daily of early 9/11-related television and cumulative acute stress predicted increased incidence of health ailments 2 to 3 years later. These findings suggest that exposure to graphic media images may result in physical and psychological effects previously assumed to require direct trauma exposure.

Cyberaggression victimization on anxiety and depression in college students: the role of emotion regulation, social media, social support, and biological sex.

Objective: To test a conceptual model by which emotion dysregulation mediates the association between cyberaggression victimization (CAV) and symptoms of depression and anxiety among college students. Participants: Undergraduate students (N = 459) aged 18 to 29 years. Methods: Participants responded to an online questionnaire assessing CAV and distress associated with these experiences. Participants reported on emotion dysregulation, social media use integration, social support, and depression and anxiety symptoms. Results: As expected, emotion dysregulation mediated the relationship between CAV and depressive and anxiety symptoms. Contrary to expectations, biological sex and social media integration did not moderate the relationship between CAV and emotion dysregulation. Social support reduced the negative effects of emotion dysregulation on depressive and anxiety symptoms. Conclusion: These findings point to the need for colleges to invest in prevention and intervention efforts to reduce exposure to CAV and the impact of those experiences on the health and well-being of students.

"Always on parade": Pregnancy experience of active-duty air force members.

Findings are reported from a qualitative study that sought to understand the maternity experience of active-duty women in the context of improved and expanded pregnancy accommodations. Semistructured interviews were conducted with 30 active-duty women serving in the United States Air Force (15 enlisted and 15 commissioned members). Women described experiencing negative pregnancy-related stereotypes and stigma in the workplace. Connotations unique to military culture were unavoidable changes to uniform and physical body shape, cultural expectations of fitness, and uniformity of dress/appearance. Use of necessary pregnancy accommodations led to increased exposure to stereotypes and stigma, such as being perceived as less disciplined, lazy, weak, or receiving unfair advantages/fewer duties at work. Women relied on "covering behaviors" to separate themselves from negative stereotypes. Extreme covering behaviors put pregnant women's health and well-being at risk. Finally, women navigated a shift in priorities from an indoctrinated "service before self" perspective to a prioritization of personal health and well-being during pregnancy. Leadership skills were strengthened through this change in perspective, which were perceived as positively influencing unit morale, cohesion, productivity, and retention. Study findings suggest the military will experience limited success in fully integrating and retaining active-duty women due to an organizational climate that lags behind the recent, progressive improvements in pregnancy policies and accommodations. Organizational culture related to pregnancy within the military must be targeted for change to reduce negative stigma and pregnancy-related bias. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Role of Disordered Eating in Type 2 Diabetes: A Pilot Study.

Rates of type 2 diabetes mellitus continue to rise around the world, largely due to lifestyle factors such as poor diet, overeating, and lack of physical activity. Diet and eating is often the most challenging aspect of management and, when disordered, has been associated with increased risk for diabetes-related complications. Thus, there is a clear need for accessible and evidence-based interventions that address the complex lifestyle behaviors that influence diabetes management. The current study sought to assess the efficacy and acceptability of a pilot lifestyle intervention for women with type 2 diabetes and disordered eating. The intervention followed a cognitive behavioral therapy guided-self-help (CBTgsh) model and included several pillars of lifestyle medicine, including: diet, exercise, stress, and relationships. Ten women completed the 12-week intervention that provided social support, encouraged physical activity, and addressed eating behaviors and cognitions. Results indicate the lifestyle intervention was a feasible treatment for disordered eating behaviors among women with type 2 diabetes and was also associated with improved diabetes-related quality of life. The intervention was also acceptable to participants who reported satisfaction with the program. The current CBTgsh lifestyle intervention is a promising treatment option to reduce disordered eating and improve diabetes management.

Examining predictors of binge eating behaviors among racially and ethnically diverse college men.

Objective: College men may be at risk for binge eating (BE) but are underrepresented in research. This study aimed to examine if body weight/shape concerns, perceived stress, and psychological distress significantly contributed to the likelihood of BE over the past 28 days. Participants: A racially/ethnically diverse sample (N = 873) of college men. Method: An anonymous online survey was administered. Logistic regression analysis was conducted to examine the hypothesized associations for the entire sample, and exploratory analyses were conducted within each racial/ethnic group. Results: The model explained approximately 25% of the variance in BE, with body weight/shape concerns as the only significant predictor in the overall sample and for the White, Black, and Asian subsamples; none of the variables were significant among Latino men. Conclusions: Body weight/shape concerns predict BE among diverse college men. The findings have implications for future research, as well as for prevention and intervention for college men.

Exploring posttraumatic growth in children impacted by Hurricane Katrina: correlates of the phenomenon and developmental considerations.

This study explored posttraumatic growth (PTG), positive change resulting from struggling with trauma, among 7- to 10-year-olds impacted by Hurricane Katrina. Analyses focused on child self-system functioning and cognitive processes, and the caregiving context, in predicting PTG at 2 time points (Time 1 n = 66, Time 2 n = 51). Findings suggest that rumination, both negative, distressing thoughts and constructive, repetitive thinking, plays an important role in PTG. Hypotheses regarding future expectations and perceived competence were not fully supported, and, unexpectedly, coping competency beliefs, realistic control attributions, and perceived caregiver warmth did not contribute to PTG models. With 1 exception (positive reframing coping advice), caregiver-reported variables did not relate to PTG; no caregiver variable reached significance in final models. Relevant theory, developmental considerations, and future directions are discussed.

Associations between children's self-system functioning and depressive and posttraumatic stress symptoms following disaster.

This study examined correlates of posttraumatic stress symptoms (PTSS) and depressive symptoms among 6- to 10-year-olds affected directly by Hurricane Katrina and its aftermath. Research on the sequelae of disaster exposure for children has focused largely on aspects that contribute to increased distress or risk for disorder; fewer studies have investigated influences that may serve a positive function. This study sought to address that gap by examining the association between key children's socioemotional resources reflecting the self-system (perceived competence, future expectations, coping competency beliefs) and postdisaster symptomatology (PTSS, depressive symptoms) at approximately 12 and 22 months posthurricane. Participants included 66 caregiver-child dyads at Time 1 (T1) and 51 at Time 2 (T2), recruited in Louisiana and Mississippi. Study results indicate that higher levels of child self-system resources and self-views were associated with lower symptom levels. Although results were mixed across time points, the study's key findings were: (a) children's T1 levels of coping competency beliefs predicted lower PTSS at T2; and (b) children's positive future expectations at T1 predicted lower levels of depressive symptoms at T2. Results support the value of incorporating child socioemotional resource variables in disaster research and building on children's self-system resources via intervention pre- and postdisaster. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Substance use after residential treatment among individuals with co-occurring disorders: the role of anxiety/depressive symptoms and trauma exposure.

This longitudinal study examined the contribution of anxiety/depressive symptoms and lifetime and recent trauma exposure to substance use after residential substance abuse treatment among individuals with co-occurring disorders. Data were collected from adults at treatment entry and 6 and 12 months later. At treatment entry, nearly all participants reported lifetime trauma exposure, and over one third met criteria for posttraumatic stress disorder (PTSD). Over the follow-up, nearly one third of the participants were exposed to trauma. Lifetime trauma exposure and a diagnosis of PTSD at treatment entry were not associated with substance use over the follow-up. Trauma exposure and anxiety/depressive symptoms over the follow-up were associated with an increased likelihood of substance use. Gender did not moderate the association between trauma exposure and anxiety/depressive symptoms and substance use. These findings highlight the importance of monitoring for trauma exposure and symptoms of anxiety/depression to better target interventions and continuing care approaches to reduce the likelihood of posttreatment substance use in this population.

Finding social benefits after a collective trauma: perceiving societal changes and well-being following 9/11.

Individuals frequently perceive positive changes in themselves following adversity; after a collective trauma, they may perceive such benefits in others or in their society as well. We examined perceived benefits of the September 11, 2001 (9/11) terrorist attacks in a 3-year study of a national sample of adults (N = 1382). Many individuals (57.8%) perceived social benefits of 9/11, including increased prosocial behavior, religiousness, or political engagement. Individuals who found increased national religiosity as a benefit 2 months post-9/11 reported greater positive affect and life satisfaction and lower distress and posttraumatic stress up to 3 years post-9/11. Pre-9/11 religiousness and Republican political affiliation predicted perceiving religion-related social benefits post-9/11. Perceptions of social change are important but understudied responses to stressful events.

Use of the revised Posttraumatic Growth Inventory for Children.

Posttraumatic growth (PTG; positive change resulting from the struggle with trauma) was examined among children impacted by Hurricane Katrina. The revised Posttraumatic Growth Inventory for Children (PTGI-C-R) assessed PTG at two time points, 12 (T1) and 22 months (T2) posthurricane. The PTGI-C-R demonstrated good reliability. Analyses focused on trauma-related variables in predicting PTG. Child-reported subjective responses to the hurricane and posttraumatic stress symptoms (PTSS) correlated with PTG at T1; however, in the regression, only PTSS significantly explained variance in PTG. At follow-up, T1 PTG was the only significant predictor of PTG. Findings suggest that the PTGI-C-R may assist efforts to understand children's responses posttrauma.

Global mental health: A call to action.

Mental health needs have been recognized as a priority area by the World Health Organization (WHO), and a Comprehensive Mental Health Action Plan (2013) was proposed to address the needs of millions of people around the world. Concerns have been raised about the degree to which current global efforts are appropriate and sufficient for promoting mental health (MH), reducing the risk for common MH disorders, and addressing the needs of individuals experiencing mental illness. This commentary expands on the presentation of the Global Alliance for Behavioral Health and Social Justice's Task Force on Global Mental Health at the 16th Biennial Conference of the Society for Community Research and Action, held in Ottawa, Ontario, Canada June 21-24, 2017, "Building Capacity to Address Mental Illness and Emotional Distress in Low-Resource Settings and Among Refugee Populations." Utilizing a socioecological framework, this commentary offers a call to action in addressing global mental health by emphasizing the need for greater investments in wellness promotion, prevention, treatment, and recovery. Importantly, such efforts need to value local knowledge and culture, harness natural existing resources and assets, and ensure equitable distribution of key resources for MH. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Randomized controlled trial of a culturally-adapted program for Latinas with binge eating.

Binge eating disorder (BED) is the most prevalent eating disorder among Latinas. Furthermore, Latinas report more frequent binge eating and higher levels of associated mental health symptoms as compared with non-Latino White women. Research demonstrates that Latinas' eating problems largely go undetected and untreated and that they face numerous barriers to seeking professional help. Cognitive-behavioral therapy (CBT)-based guided self-help (CBTgsh) for binge eating is a more affordable and disseminable intervention than traditional CBT treatment. In this paper, we present the findings from a randomized controlled trial (RCT) of a culturally adapted CBTgsh program in a sample of overweight and obese Latinas with BED, the first RCT of this type with an ethnic minority population. Study participants (N = 40) diagnosed with BED were randomly assigned to the CBTgsh (n = 21) or waitlist (n = 19) condition. Treatment with the CBTgsh program resulted in significant reductions in frequency of binge eating, depression, and psychological distress and 47.6% of the intention-to-treat CBTgsh group were abstinent from binge eating at follow-up. In contrast, no significant changes were found from pre- to 12-week follow-up assessments for the waitlisted group. Results indicate that CBTgsh can be effective in addressing the needs of Latinas who binge eat and can lead to improvements in symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Society of Behavioral Medicine Position Statement: Congress should protect immigrants seeking health care.

According to the Migration Policy Institute (2019), as of 2017 the USA was home to approximately 44 million immigrants, the largest number of immigrants in the world. Most of these immigrants relocate from Mexico, India, China, the Philippines, El Salvador, Vietnam, Cuba, and the Dominican Republic. Since 2017, there have been increased reports of Immigrations and Customs Enforcement (ICE) interventions toward immigrants, especially at and near previously delineated "safe areas" such as medical facilities, as immigrants sought health care. Currently, health care providers are reporting delays and reductions in health care seeking by immigrants. This increases risks of untreated health problems for the immigrants themselves as well as their communities. To protect the health of immigrants, and the general public, the Society of Behavioral Medicine joins the American College of Physicians (2011) and the American Medical Association (2017) in recommending that Congress impose restrictions on ICE interventions in or around medical facilities.

Facilitating successful reintegration: Attending to the needs of military families.

Subsequent to the wars in Afghanistan and Iraq, the experiences of military service members (MSVMs) and veterans have garnered increasing attention. A growing body of work has begun to shed light on their reintegration, a process that can bring with it transitions and challenges for service members and their families. Although many families adapt effectively, some have difficulty navigating this process, which can lead to a host of short- and long-term negative consequences for families. The literature to date is not well-developed regarding strategies for supporting successful reintegration of MSVMs and veterans in the context of military families. Guided by the ecological framework, this article summarizes selected evidence regarding factors that influence reintegration and puts forth recommendations for research and practice to promote the wellness of military families. Informed by findings regarding the diverse challenges faced by these families and grounded in the ecological framework, the authors highlight the need to assess both proximal and distal factors related to families' reintegration experiences and the need to intervene at multiple levels and across multiple contexts. Of primary importance, the authors recommend strategies to enhance the capacity of families' natural settings and describe selected capacity- and resource- enhancement approaches for families, neighborhoods, schools, and communities that facilitate resilience and promote wellness. Other recommendations include focusing on the accessibility, integration, and coordination of services; considering the long-view and developing strategies for longer-term support; developing mechanisms for family support; and evaluating efforts to address needs of families and promote family resilience. (PsycINFO Database Record