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This study tested the plausibility of a theoretical model of change for the Penn Resiliency Program (PRP), a cognitive-behavioral (CB) depression prevention program for adolescents. Middle school students (N = 697) were randomized to PRP, an assessment-only control condition (CON), or a placebo-control condition (PLA). Explanatory style and depressive symptoms were evaluated over 24 months of follow-up. Relative to both CON and PLA, there were significant indirect effects of PRP on 12-month levels of depressive symptoms through improvements in explanatory style in two of three participating schools. Within a third school, where PRP was not effective in targeting depressive symptoms (Gillham et al., 2007), there was no evidence of group differences in growth in explanatory style or indirect effects. When effective, PRP's CB training provides incremental value over non-specific components and there are indirect effects on depressive symptoms through improvements in explanatory style.
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This study examined how social support seeking and rumination interacted to predict depression and anxiety symptoms six months later in early adolescents (N = 118; 11 - 14 yrs at baseline). We expected social support seeking would be more helpful for adolescents engaging in low rather than high levels of rumination. Adolescents self-reported on all measures at baseline, and on depression and anxiety symptoms six months later. Social support seeking predicted fewer symptoms of depression and anxiety at low rumination levels, but lost its adaptive effects as rumination increased. For depression symptoms, social support seeking led to more symptoms at high rumination levels. Results were stronger for emotion-focused than problem-focused support seeking, and for depression compared to anxiety symptoms. These findings suggest that cognitive risk factors like rumination may explain some inconsistencies in previous social support literature, and highlight the importance of a nuanced approach to studying social support seeking.
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This study investigates the impact of seeking information about the prostate-specific antigen (PSA) test on men's PSA test use during a period of conflicting recommendations. Analyses used longitudinal survey data collected in 2005 and 2006 from a nationally representative sample of U.S. males aged 40-70 years (n = 777). Cross-sectionally, nonmedical information seeking was significantly associated with increased odds of having a PSA test in the past year (Time 1 odds ratio [OR] = 9.74, p < .01, 95% confidence interval [CI] = 4.37, 21.70; Time 2 OR = 5.78, p < .01, 95% CI = 3.17, 10.55). However, lagged analyses showed that among men who had a PSA at Time 1, active seeking is associated with reduced odds of later having a PSA test (OR = 0.33, p < .05, 95% CI = 0.13, 0.85). Participants who had not had a PSA test in the past year very rarely sought information about PSA tests. Information acquisition in an environment of conflicting recommendations may influence adoption of cancer screening behaviors.
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Conducta en la Búsqueda de Información , Antígeno Prostático Específico , Neoplasias de la Próstata/diagnóstico , Adulto , Anciano , Detección Precoz del Cáncer , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
Previous research suggests positive effects of health information seeking on prevention behaviors such as diet, exercise, and fruit and vegetable consumption. The present study builds upon this research and strengthens causal claims from it by examining the lagged effect of patient-clinician information engagement on fruit and vegetable consumption as well as the indirect effect on the outcome through seeking information from nonmedical channels. The results are based on data collected from a randomly drawn sample of breast, prostate, and colorectal cancer patients from the Pennsylvania Cancer Registry who completed mail surveys in the Fall of 2006 and 2007. There was a 65% response rate for baseline subjects (resulting n = 2,013); of those, 1,293 were interviewed 1 year later, and 1,257 were available for our analyses. Results show a positive lagged main effect of patient-clinician information engagement at baseline on fruit and vegetable consumption at follow-up (B = 0.26, SE = 0.10, p = .01). The mediation analysis shows that patient-clinician information engagement leads to increased fruit and vegetable consumption among cancer patients, in part through patients' information seeking from nonmedical channels. Implications of these findings for the cancer patient population and for physicians are discussed.
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Información de Salud al Consumidor , Dieta/estadística & datos numéricos , Frutas , Conducta en la Búsqueda de Información , Neoplasias , Relaciones Médico-Paciente , Verduras , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama , Neoplasias Colorrectales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pennsylvania , Neoplasias de la Próstata , Sistema de RegistrosRESUMEN
The current study tested the prospective relations (six month lag) between three aspects of the parent-child relationship at Time 1 (T1) and adolescents' explanatory styles at Time 2 (T2): caregiving behaviors, parents' explanatory style for their own negative events, and parents' explanatory style for their children's negative events. The sample included 129 adolescents aged 11 to 14 years at baseline and their parents. Adolescents reported on their own explanatory style and their parents' caregiving behaviors; parents self-reported on their caregiving behaviors and their explanatory style for their own and their children's events. Regression analyses identified maternal acceptance as a significant predictor of T2 adolescents' explanatory style. Marginal effects emerged for fathers' psychological control and fathers' explanatory style for their children's events. Findings suggest that the ways parents - especially mothers - interact with their children may play a role in adolescents' cognitive vulnerability to depression.
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Research on health information exposure focuses primarily on deliberate information-seeking behavior and its effects on health. By contrast, this study explores the complementary and perhaps more influential role of health information acquired through exposure to routinely used sources, called scanning. The authors hypothesized that scanning from nonmedical sources, both mediated and interpersonal, affects cancer screening and prevention decisions. The authors used a nationally representative longitudinal survey of 2,489 adults 40 to 70 years of age to analyze the effects of scanning on 3 cancer screening behaviors (mammography, prostate-specific antigen [PSA], and colonoscopy) and 3 prevention behaviors (exercising, eating fruits and vegetables, and dieting to lose weight). After adjustment for baseline behaviors and covariates, scanning at baseline predicted weekly exercise days 1 year later as well as daily fruit and vegetable servings 1 year later for those whose consumption of fruits and vegetables was already higher at baseline. Also, among those reporting timely screening mammogram behavior at baseline, scanning predicted repeat mammography. Scanning was marginally predictive of PSA uptake among those not reporting a PSA at baseline. Although there were strong cross-sectional associations, scanning did not predict dieting or colonoscopy uptake in longitudinal analyses. These analyses provide substantial support for a claim that routine exposure to health content from nonmedical sources affects specific health behaviors.
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Información de Salud al Consumidor/estadística & datos numéricos , Detección Precoz del Cáncer/estadística & datos numéricos , Conductas Relacionadas con la Salud , Conducta en la Búsqueda de Información , Adulto , Anciano , Recolección de Datos , Dieta/psicología , Dieta/estadística & datos numéricos , Ejercicio Físico/psicología , Femenino , Frutas , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estados Unidos , VerdurasRESUMEN
The amount of cancer-related information available to the general population continues to grow; yet, its effects are unclear. This study extends previous cross-sectional research establishing that cancer information seeking across a variety of sources is extensive and positively associated with engaging in health-related behaviors. The authors studied how active information seeking about cancer prevention influenced three healthy lifestyle behaviors using a 2-round nationally representative sample of adults ages 40-70 years (n = 1,795), using propensity scoring to control for potential confounders including baseline behavior. The adjusted odds of dieting at follow-up were 1.51 (95% CI: 1.05, 2.19) times higher for those who reported baseline seeking from media and interpersonal sources relative to nonseekers. Baseline seekers ate 0.59 (95% CI: 0.28, 0.91) more fruits and vegetable servings per day and exercised 0.36 (95% CI: 0.12, 0.60) more days per week at 1-year follow-up compared with nonseekers. The effects of seeking from media and friends/family on eating fruits and vegetables and exercising were independent of seeking from physicians. The authors offer several explanations for why information seeking predicts healthy lifestyle behaviors: information obtained motivates these behaviors; information sought teaches specific techniques; and the act of information seeking may reinforce a psychological commitment to dieting, eating fruits and vegetables, and exercising.
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Dieta/psicología , Ejercicio Físico/psicología , Conducta en la Búsqueda de Información , Relaciones Interpersonales , Estilo de Vida , Medios de Comunicación de Masas/estadística & datos numéricos , Neoplasias/prevención & control , Adulto , Anciano , Estudios Transversales , Dieta/estadística & datos numéricos , Familia , Femenino , Estudios de Seguimiento , Amigos , Frutas , Humanos , Masculino , Persona de Mediana Edad , Relaciones Médico-Paciente , VerdurasRESUMEN
This article shares an in-depth summary of a formative evaluation that used quantitative data to inform the development and selection of promotional ads for the antismoking communication component of a social marketing campaign. A foundational survey provided cross-sectional data to identify beliefs about quitting smoking that campaign messages should target, as well as beliefs to avoid. Pretesting draft ads against quantitative indicators of message effectiveness further facilitated the selection and rejection of final campaign ads. Finally, we consider lessons learned from the process of balancing quantitative methods and judgment to make formative decisions about more and less promising persuasive messages for campaigns.
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This study reports secondary outcome analyses from a past study of the Penn Resiliency Program (PRP), a cognitive-behavioral depression prevention program for middle-school aged children. Middle school students (N = 697) were randomly assigned to PRP, PEP (an alternate intervention), or control conditions. Gillham et al., (2007) reported analyses examining PRP's effects on average and clinical levels of depression symptoms. We examine PRP's effects on parent-, teacher-, and self-reports of adolescents' externalizing and broader internalizing (depression/anxiety, somatic complaints, and social withdrawal) symptoms over three years of follow-up. Relative to no intervention control, PRP reduced parent-reports of adolescents' internalizing symptoms beginning at the first assessment after the intervention and persisting for most of the follow-up assessments. PRP also reduced parent-reported conduct problems relative to no-intervention. There was no evidence that the PRP program produced an effect on teacher- or self-report of adolescents' symptoms. Overall, PRP did not reduce symptoms relative to the alternate intervention, although there is a suggestion of a delayed effect for conduct problems. These findings are discussed with attention to developmental trajectories and the importance of interventions that address common risk factors for diverse forms of negative outcomes.
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Depression is a common psychological problem in adolescence. Recent research suggests that group cognitive-behavioral interventions can reduce and prevent symptoms of depression in youth. Few studies have tested the effectiveness of such interventions when delivered by school teachers and counselors (as opposed to research team staff). We evaluated the effectiveness of the Penn Resiliency Program for adolescents (PRP-A), a school-based group intervention that targets cognitive behavioral risk factors for depression. We randomly assigned 408 middle school students (ages 10-15) to one of three conditions: PRP-A, PRP-AP (in which adolescents participated in PRP-A and parents were invited to attend a parent intervention component), or a school-as-usual control. Adolescents completed measures of depression and anxiety symptoms, cognitive style, and coping at baseline, immediately after the intervention, and at 6-month follow-up. PRP-A reduced depression symptoms relative to the school as usual control. Baseline levels of hopelessness moderated intervention effects. Among participants with average and high levels of hopelessness, PRP (A and AP) significantly improved depression symptoms, anxiety symptoms, hopelessness, and active coping relative to control. Among participants with low baseline hopelessness, we found no intervention effects. PRP-AP was not more effective than PRP-A alone. We found no intervention effects on clinical levels of depression or anxiety. These findings suggest that cognitive-behavioral interventions can be beneficial when delivered by school teachers and counselors. These interventions may be most helpful to students with elevated hopelessness.
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Terapia Cognitivo-Conductual/métodos , Depresión/prevención & control , Trastorno Depresivo/prevención & control , Adolescente , Niño , Depresión/psicología , Trastorno Depresivo/psicología , Femenino , Humanos , Masculino , Padres/psicología , Factores de Riesgo , Estudiantes/psicología , Resultado del TratamientoRESUMEN
In this paper, we consider a full likelihood method to analyze continuous longitudinal responses with non-ignorable non-monotone missing data. We consider a transition probability model for the missingness mechanism. A first-order Markov dependence structure is assumed for both the missingness mechanism and observed data. This process fits the natural data structure in the longitudinal framework. Our main interest is in estimating the parameters of the marginal model and evaluating the missing-at-random assumption in the Effects of Public Information Study, a cancer-related study recently conducted at the University of Pennsylvania. We also present a simulation study to assess the performance of the model.
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Sesgo , Información de Salud al Consumidor/métodos , Interpretación Estadística de Datos , Funciones de Verosimilitud , Neoplasias/psicología , Años de Vida Ajustados por Calidad de Vida , Adulto , Anciano , Anciano de 80 o más Años , Simulación por Computador , Información de Salud al Consumidor/normas , Femenino , Humanos , Estudios Longitudinales , Masculino , Cadenas de Markov , Persona de Mediana Edad , Relaciones Profesional-Paciente , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
Given the importance of public information environment in cancer control, it is theoretically and practically important to explore how people's media use to acquire health information influences their beliefs about cancer prevention. In the current research, we focus on the role of the Internet in shaping fatalistic beliefs about cancer prevention (cancer fatalism). To be more specific, we examine the effect of Internet use for health information on changes in cancer fatalism using a 2-wave nationally representative survey. We then investigate whether the effect of Internet use on cancer fatalism is moderated by education and health knowledge. Health-related Internet use reduced cancer fatalism only among those with average and lower than the average levels of education and health knowledge.
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Previous research suggests positive effects of health information seeking on prevention behaviors such as diet, exercise, and fruit and vegetable consumption among the general population. The current study builds upon this research by examining the effect of cancer patients' active information seeking from media and (nonmedical) interpersonal sources on fruit and vegetable consumption. The results of this longitudinal study are based on data collected from a randomly drawn sample from the Pennsylvania Cancer Registry, comprising breast, prostate, and colorectal cancer patients who completed mail surveys in the fall of 2006 and 2007. There was a 65% response rate for baseline subjects (resulting n = 2013); of those, 1,293 were interviewed one year later and 845 were available for final analyses. We used multiple imputation to replace missing data and propensity scoring to adjust for effects of possible confounders. There is a positive effect of information seeking at baseline on fruit and vegetable servings at follow-up; seekers consumed 0.43 (95% CI: 0.28 to 0.58) daily servings more than nonseekers adjusting for baseline consumption and other confounders. Active information seeking from media and interpersonal sources may lead to improved nutrition among the cancer patient population.
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Información de Salud al Consumidor , Dieta , Frutas , Conducta en la Búsqueda de Información , Neoplasias , Verduras , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Familia , Conducta Alimentaria , Femenino , Estudios de Seguimiento , Amigos , Encuestas Epidemiológicas , Humanos , Estudios Longitudinales , Masculino , Medios de Comunicación de Masas , Persona de Mediana Edad , Pennsylvania , Sistema de Registros , Adulto JovenRESUMEN
OBJECTIVE: Examine how patient-clinician information engagement (PCIE) may operate through feeling informed to influence patients' treatment decision satisfaction (TDS). METHODS: Randomly drawn sample (N=2013) from Pennsylvania Cancer Registry, comprised of breast, prostate and colon cancer patients completed mail surveys in the Fall of 2006 (response rate=64%) and Fall of 2007. Of 2013 baseline respondents, 85% agreed to participate in follow-up survey (N=1703). Of those who agreed, 76% (N=1293) completed follow-up surveys. The sample was split between males and females. The majority of participants were White, over the age of 50, married, and with a high school degree. Most reported having been diagnosed with in situ and local cancer. RESULTS: PCIE was related to concurrent TDS (beta=.06) and feeling informed (beta=.15), after confounder adjustments. A mediation analysis was consistent with PCIE affecting TDS through feeling informed. Baseline PCIE predicted feeling informed (beta=.04) measured 1 year later, after adjustments for baseline feeling informed and other confounders. Feeling informed was related to concurrent TDS (beta=.35) after confounder adjustment and follow-up TDS (beta=.13) after baseline TDS and confounder adjustment. CONCLUSION: Results suggest PCIE affects TDS in part through patients' feeling informed. PRACTICE IMPLICATIONS: PCIE may be important in determining patients' level of feeling informed and TDS.
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Neoplasias de la Mama , Neoplasias Colorrectales , Comunicación , Toma de Decisiones , Satisfacción del Paciente , Relaciones Médico-Paciente , Neoplasias de la Próstata , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Sistema de RegistrosRESUMEN
Patients may bring unreliable information to the physician, complicating the physician-patient relationship, or outside information seeking may complement physician information provision, reinforcing patients' responsibility for their health. The current descriptive evidence base is weak and focuses primarily on the Internet's effects on physician-patient relations. This study describes how cancer patients bring information to their physicians from a range of sources and are referred by physicians to these sources; the study also examines explanations for these behaviors. Patients with breast, prostate, and colon cancer diagnosed in 2005 (N = 1,594) were randomly drawn from the Pennsylvania Cancer Registry; participants returned mail surveys in Fall 2006 (response rate = 64%). There is evidence that both bringing information to physicians and being referred to other sources reflects patients' engagement with health information, preference for control in medical decision making, and seeking and scanning for cancer-related information. There is also evidence that patients who bring information from a source are referred back to that source.
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Información de Salud al Consumidor/métodos , Neoplasias , Relaciones Médico-Paciente , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama , Neoplasias Colorrectales , Toma de Decisiones , Femenino , Conocimientos, Actitudes y Práctica en Salud , Alfabetización en Salud , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Participación del Paciente , Neoplasias de la Próstata , Factores SocioeconómicosRESUMEN
The authors investigated the effectiveness and specificity of the Penn Resiliency Program (PRP; J. E. Gillham, L. H. Jaycox, K. J. Reivich, M. E. P. Seligman, & T. Silver, 1990), a cognitive-behavioral depression prevention program. Children (N = 697) from 3 middle schools were randomly assigned to PRP, Control (CON), or the Penn Enhancement Program (PEP; K. J. Reivich, 1996; A. J. Shatté, 1997), an alternate intervention that controls for nonspecific intervention ingredients. Children's depressive symptoms were assessed through 3 years of follow-up. There was no intervention effect on average levels of depressive symptoms in the full sample. Findings varied by school. In 2 schools, PRP significantly reduced depressive symptoms across the follow-up relative to both CON and PEP. In the 3rd school, PRP did not prevent depressive symptoms. The authors discuss the findings in relation to previous research on PRP and the dissemination of prevention programs.
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Depresión/prevención & control , Servicios de Salud Mental/organización & administración , Servicios de Salud Escolar/organización & administración , Adolescente , Niño , Depresión/psicología , Depresión/terapia , Femenino , Humanos , Masculino , Sensibilidad y Especificidad , Insuficiencia del TratamientoRESUMEN
This study evaluated the Penn Resiliency Program's effectiveness in preventing depression when delivered by therapists in a primary care setting. Two-hundred and seventy-one 11- and 12-year-olds, with elevated depressive symptoms, were randomized to PRP or usual care. Over the 2-year follow-up, PRP improved explanatory style for positive events. PRP's effects on depressive symptoms and explanatory style for negative events were moderated by sex, with girls benefiting more than boys. Stronger effects were seen in high-fidelity groups than low-fidelity groups. PRP did not significantly prevent depressive disorders but significantly prevented depression, anxiety, and adjustment disorders (when combined) among high-symptom participants. Findings are discussed in relation to previous PRP studies and research on the dissemination of psychological interventions.
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Terapia Cognitivo-Conductual , Trastorno Depresivo/prevención & control , Atención Primaria de Salud , Análisis de Varianza , California , Niño , Trastorno Depresivo/psicología , Femenino , Sistemas Prepagos de Salud , Humanos , Masculino , Cooperación del Paciente , Factores SexualesRESUMEN
Given the dramatic increase in depression that occurs during early adolescence in girls, interventions must address the needs of girls. The authors examined whether a depression prevention program, the Penn Resiliency Program, was more effective for girls in all-girls groups than in co-ed groups. Within co-ed groups, the authors also tested whether there were greater effects for boys than for girls. Participants were 208 11- to 14-year-olds. Girls were randomly assigned to all-girls groups, co-ed groups, or control. Boys were assigned to co-ed groups or control. Students completed questionnaires on depressive symptoms, hopelessness, and explanatory style before and after the intervention. Girls groups were better than co-ed groups in reducing girls'hopelessness and for session attendance rates but were similar to co-ed groups in reducing depressive symptoms. Co-ed groups decreased depressive symptoms, but this did not differ by gender. Findings support prevention programs and suggest additional benefits of girls groups.
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Unipolar depression is a major problem among youth today, with some estimates indicating that more than 20% will experience an episode before age 18. The disorder is often accompanied by academic problems, alcohol abuse, interpersonal difficulties, and physical health problems. The financial burden of depression is also significant. To address the high prevalence and associated costs, our research group developed at 12-session 24-hour cognitive-behavioral therapy based program for administration to middle school aged children. This article describes the content of the program and evidence for the program's efficacy in preventing depressive symptoms in early adolescence.