Structural equation modeling for the effects of family dysfunctions and communication on perceived mental health status among under/graduate students in the U.S.

BACKGROUND: Many of the college students expressed experiencing moderate or severe psychological distress. In their emergence as adults, college students encounter significant periods of drastic change. Family functions play a crucial role in determining individuals' mental health status. OBJECTIVES: The first objective of this study was to investigate whether family communication mediates the relationships between family dysfunctions and perceived mental health status among under/graduate students. The second objective was to investigate whether the mediation effects of family communication on the relationships between family dysfunctions and perceived mental health status differ by gender. METHODS: The current study applied Minuchin's Structural Family Theory with under/graduate students (N = 348) in Ohio. Structural Equation Modeling was conducted to examine the effects of family dysfunctions and communication on perceived mental health status among under/graduate students. RESULTS: Disengaged family function significantly influenced family communication, which, in turn, significantly impacted perceived mental health (mediation effect). Enmeshed family function did not show a significant relationship with family communication, whereas family communication had a significant impact on perceived mental health (no mediation effect). The model comparison test indicated that there were differences between males and females: the structural weights of the current path models were consistent with the full models, and there was a significant difference in the effect of parents' marital status on perceived mental health, with males being significantly impacted in both models. CONCLUSIONS: Practitioners should recognize that improving positive communication skills within the family unit can be a realistic approach to supporting the perceived mental health of under/graduate students. Colleges/universities should offer regular education programs to promote an understanding of the relationship between family communication strategies and the mental health of under/graduate students.

Comparing symptom clusters in cancer survivors by cancer diagnosis: A latent class profile analysis.

PURPOSE: Research on symptom clusters in oncology is progressing, but knowledge gaps remain. One question is whether the number and types of symptom subgroups (i.e., latent classes) differ based on cancer diagnosis. The purpose of this study was to: (1) identify and compare latent class subgroups based on four highly prevalent symptoms (pain, fatigue, sleep disturbance, and depression), and (2) examine the differences in sociodemographic and clinical factors in the identified latent classes across the seven cancer types (i.e., prostate, non-small cell lung, non-Hodgkin's lymphoma, breast, uterine, cervical, and colorectal cancer). METHODS: This study is a cross-sectional secondary analysis of data obtained from the My-Health study in partnership with four Surveillance, Epidemiology, and End Results (SEER) cancer registries located in California (two), Louisiana, and New Jersey. The sample included 4,762 cancer survivors 6-13 months following diagnosis of one of the seven cancer types mentioned. Latent class profile analysis was used. RESULTS: Subjects were primarily young (59% age 21-64 years), Caucasian (41%), married/cohabitating (58%) and unemployed (55%). The number and types of symptom subgroups varied across these seven cancer populations: four-subgroups were the common in prostate, lung, non-Hodgkin's lymphoma, and breast cancer survivors. Unmarried, low education, and unemployment status were associated with high risk of symptom burden across the cancer types. CONCLUSION: Identifying symptom subgroups by cancer diagnosis has the potential to develop innovative and effective targeted interventions in cancer survivors. Further research is needed to establish extensive knowledge in symptom clustering between treatment regimens, and short-term and long-term cancer survivors.

Nature-based virtual reality intervention to manage stress in family caregivers of allogeneic hematopoietic stem cell transplant recipients: a two-phase pilot study protocol.

Millions of family members and/or friends in the U.S. serve as unpaid caregivers for individuals with chronic conditions, such as cancer. Caregiving for someone undergoing an intense allogeneic hematopoietic stem cell transplant (HSCT) is particularly demanding, with accompanying physical and psychological stress. Increased stress and stress-related symptoms could make it difficult for caregivers to fulfill their roles and could negatively impact the health status and quality of life of themselves and the recipients. Virtual reality (VR) is a promising technology increasingly used for treatment and wellness in various medical settings. There is growing evidence that studies have reported the positive effects of the VR intervention in managing and reducing stress among diverse populations in various clinical scenarios; however, no published studies have focused on family caregivers of patients with cancer. The study aims to assess the feasibility and acceptability of a four-week nature-based VR intervention and to examine the effectiveness of the VR intervention on stress in HSCT caregivers. This study comprises two phases. Phase I of the study will be a single-arm pre-post design focused on assessing the feasibility and acceptability of the VR intervention. Phase II of the study will be a prospective randomized controlled group design to examine the effectiveness of the VR intervention on perceived stress. Adults (≥ 18 years) who serve as primary caregivers for a person who will undergo an allogeneic HSCT will be recruited. Fifteen participants will be enrolled for Phase I and 94 participants for Phase II (Active VR arm N=47; Sham VR arm N=47). The nature-based immersive VR program contains 360° high-definition videos of nature scenes along with nature sounds through a head-mounted display (HMD) for 20 minutes every day for four weeks. Primary outcome is perceived stress measured by the Perceived Stress Scale. Secondary/exploratory outcomes are stress-related symptoms (e.g., fatigue, sleep disturbance) and physiological biomarkers (e.g., cortisol, alpha-amylase). The importance and innovativeness of this study consist of using a first-of-its-kind, immersive VR technology to target stress and investigating the health outcomes assessed by validated objective biomarkers as well as self-report measures of the nature-based intervention in the caregiver population. Clinical trial registration: ClinicalTrials.gov, identifier NCT05909202.

Latent class symptom profiles of colorectal cancer survivors with cancer-related cognitive impairment.

PURPOSE: Colorectal cancer (CRC) survivors experience cancer-related cognitive impairment and co-occurring symptoms after cancer treatments. There has been little data to inform the risk factors of complex symptom phenotypes in CRC survivors. OBJECTIVES: To determine if subgroups of CRC survivors after cancer treatments could be identified based on the cognitive impairment and common co-occurring symptoms (depression, anxiety, sleep disturbance, fatigue, and pain); and to explore risk factors (sociodemographic and clinical characteristics, perceived stress, and social support) of these subgroups. METHODS: Latent class profile analysis (LCPA) was used to identify subgroups based on self-reported symptoms in 64 CRC survivors. Cognitive impairment was measured by assessing subjective cognitive function using the Patient-Reported Outcome Measurement Information System (PROMIS) measure. The Kruskal-Wallis test and regression analyses were performed. RESULTS: Three distinct latent classes were identified (Class 1: All Low '28.1%'; Class 2: High Psychological Symptoms (depression/anxiety) '25%'; Class 3: High Somatic Symptoms (fatigue, sleep disturbance, and pain) with High Cognitive Impairment'46.9%'). The pain was the most distinguishable symptom across the latent classes. The high symptom burden group was associated with less time since cancer diagnosis, higher perceived stress levels, and poor emotional social support. CONCLUSION: Our study adds to the information on interindividual variability in symptom experience of CRC survivors with cognitive impairment. Findings suggest a need for increased attention to screening for co-occurring symptoms (e.g., high pain) and future interventions focused on stress management and social support.

Patterns of health-promoting behaviors and associated factors in family caregivers of people receiving cancer treatment: A latent class profile analysis.

OBJECTIVE: Family caregivers tend to neglect their health while prioritizing the needs of their care recipients. Identifying subgroups of caregivers based on the patterns of health-promoting behaviors (HPBs) may help develop tailored interventions for them, yet little is known. The purpose of this study was: (1) to identify latent classes with distinct patterns of HPBs in family caregivers of people with cancer; and (2) to investigate factors associated with the latent class membership. METHODS: We performed a cross-sectional data analysis using the baseline dataset from a longitudinal survey study that assessed HPBs of family caregivers of individuals who received cancer treatment at a national research hospital (N = 124). Latent class profile analysis was conducted to identify latent classes based on the subdomains of the Health-Promoting Lifestyle Profile II, followed by multinomial logistic regression analysis to investigate factors associated with the latent class membership. RESULTS: Three latent classes were identified: a high level of HPB (Class 1, 25.8%); a moderate level of HPB (Class 2, 53.2%); and a low level of HPB (Class 3, 21.0%) of HPBs. Controlling for caregiver age and sex, caregiver burden due to lack of family support, perceived stress, self-efficacy and body mass index were factors associated with the latent class membership. CONCLUSIONS: HPBs of our caregiver sample appeared in relatively stable patterns at different levels. Higher caregiver burden and perceived stress and lower self-efficacy were associated with the lower practice of HPBs overall. Our findings may serve as a reference for screening caregivers who need support and developing person-centered interventions.

Effects of Vaccine Literacy, Health Beliefs, and Flu Vaccination on Perceived Physical Health Status among Under/Graduate Students.

Physicians highlight that receiving the flu vaccine is critical, especially during the COVID-19 pandemic period. Younger groups' flu vaccination coverage is very low, and this tendency is potentially related to a lower level of vaccine literacy and perceptions toward vaccination. This study investigated the relationship between flu vaccine literacy, health beliefs, and flu vaccinations (benefit, barrier, severity, and susceptibility) and their impact on perceived health status controlling for socioeconomic factors. It used the Health Belief Model andHealth Literacy Skills Framework with under/graduate students (N = 382) in Ohio, U.S. Path analyses were performed to examine the causal process using SPSS and Amos 23.0. Indicators of CFI, RMSEA, SRMR, and the chi-square/df of the path models were good-acceptable. Vaccine literacy directly impacted on health beliefs and vaccination. Susceptibility belief directly influenced perceived health status. The mediation effects of health beliefs (benefit, barrier) between vaccine literacy and vaccination were confirmed. The study highlights the need for healthcare providers and governments to work together to improve flu vaccine literacy and reduce negative perceptions toward vaccination among younger populations. Educational programs and official communication channels can be used to address concerns and provide accurate information about vaccines to increase flu vaccination rates and protect public health.

Impact of nonpharmacological interventions on cognitive impairment in women with breast cancer: A systematic review and meta-analysis.

Objective: This study aimed to examine the characteristics of research conducted on nonpharmacological interventions for cognitive impairment in patients with breast cancer and identify the primary effects of nonpharmacological interventions through a systematic review and meta-analysis. Methods: Five electronic databases were searched to identify all randomized controlled trial studies until September 30, 2022, using the key terms "breast cancer," "cognitive disorders," and their possible variations. The Cochrane Risk of Bias tool was used to assess risk of bias. The effect sizes were calculated in Hedges' g. Potential moderators influencing the intervention effects were explored. Results: Twenty-three studies were included in the systematic review, and 17 studies were included in the meta-analysis. Among the nonpharmacological interventions for patients with breast cancer, cognitive rehabilitation and physical activity were the most common, followed by cognitive behavioral therapy. The meta-analysis indicated that nonpharmacological interventions had a significant effect on attention (g â€‹= â€‹0.83; 95% CI: 0.14 to 1.52; I 2 â€‹= â€‹76%), immediate recall (g â€‹= â€‹0.33; 95% CI: 0.18 to 0.49; I 2 â€‹= â€‹0%), executive function (g â€‹= â€‹0.25; 95% CI: 0.13 to 0.37; I 2 â€‹= â€‹0%), and processing speed (g â€‹= â€‹0.44; 95% CI: 0.14 to 0.73; I 2 â€‹= â€‹51%) among objective cognitive functions, as well as subjective cognitive function (g â€‹= â€‹0.68; 95% CI: 0.40 to 0.96; I 2 â€‹= â€‹78%). Intervention type and mode of delivery were potential moderators for the effects of nonpharmacological interventions on cognitive functions. Conclusions: Nonpharmacological interventions can improve subjective and objective cognitive functioning among patients with breast cancer undergoing cancer treatment. Therefore, it is necessary to provide nonpharmacological interventions by screening patients at high risk of cancer-related cognitive impairment. Systematic review registration: CRD42021251709.

Symptom Clusters in Family Caregivers of Hematopoietic Stem Cell Transplantation Recipients: Loneliness as a Risk Factor.

A symptom cluster is a group of 2 or more symptoms that occur together and are related to each other. Family caregivers of allogeneic hematopoietic stem cell transplantation (HSCT) recipients experience multiple concurrent symptoms, but the majority of symptom research in this population has focused on assessing and managing individual symptoms. The purpose of this analysis was to determine (1) whether clusters of 5 highly prevalent symptoms (fatigue, sleep disturbance, depression, anxiety, and cognitive impairment) in allogeneic HSCT caregivers could be identified and (2) which caregiver and patient characteristics influence membership in the identified symptom cluster groups. Baseline cross-sectional data were collected from allogeneic HSCT caregivers participating in a randomized controlled trial at the National Institutes of Health Clinical Center. Measures included the Caregiver Reaction Assessment (CRA), Health-Promoting Lifestyle Profile II (HPLP-II), Fatigue Symptom Inventory (MFSI), Pittsburgh Sleep Quality Index (PSQI), and Patient-Reported Outcomes Measurement Information System (PROMIS). Cluster analysis was used to identify symptom clusters, and univariate analyses and multiple logistic regression were performed to identify factors that contribute to symptom clusters. The average age of caregivers (n = 44) was 45.20 ± 15.05 years; primarily white (52.3%) and female (88.6%) and often the spouse/partner of the patient (50.0%). Two symptom cluster groups were identified: low symptom burden (n = 24; 54.5%) and high symptom burden (n = 20; 45.5%). Caregivers with higher levels of loneliness (odds ratio, 1.12; 95% confidence interval, 1.04 to 1.22; P = .004) were more likely to be in the high symptom burden group. This study provides evidence that 5 symptoms commonly found in family caregivers-fatigue, sleep disturbance, depression, anxiety, and cognitive impairment-tend to occur in clusters. Therefore, clinicians should be aware that caregivers with 1 or more of these symptoms may be at higher risk for developing the others, and caregivers reporting high levels of loneliness may be at particular risk. Future research is needed to identify novel interventions that target multiple, co-occurring symptoms. Such interventions also might include components that decrease loneliness. © 2022 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

Factors influencing injury or death due to traumatic events in Afghanistan's crisis-affected populations: a cross-sectional nationwide study.

OBJECTIVE: Afghanistan, with one of the world's largest refugee populations, suffers an enormous burden of injury resulting in loss of life. This study aims to identify the epidemiology of injuries or death in the crisis-affected populations across Afghanistan and to investigate factors associated with injuries or deaths due to traumatic events. DESIGN: Cross-sectional study. SETTING: This study analysed Whole Afghanistan Assessment 2019 data. This survey geographically covered all 34 accessible provinces in Afghanistan. PARTICIPANTS: 31 343 displaced and shock-affected households in Afghanistan. PRIMARY AND SECONDARY OUTCOME MEASURES: Injury or death of household members due to traumatic events. RESULTS: 2561 (8.2%) reported at least one household member had been injured or deceased because of a significant conflict or natural disaster in the past year. Households experienced significant events such as active conflict or violence (prevalence ratio, PR=5.575, p<0.001), earthquake (PR=3.118, p=0.004), flood (PR=1.534, p=0.008) and avalanche or heavy snowfall (PR=3.450, p<0.001) were significantly associated with injury or death. The likelihood of injury or death was significantly higher for long-distance households than for households living within a 5 km radius of the nearest healthcare facilities (6-10 km: PR=1.402, p=0.030; >10 km: PR=1.560, p=0.020). CONCLUSION: The study provides an epidemiological profile of injuries or death in crisis-affected populations across Afghanistan. Results also suggest that certain factors place the crisis-affected populations in Afghanistan at high risk for injuries or death, which can inform the development of surveillance and prevention programmes, the monitoring of patterns over time and the formulation of healthcare policies.

Effects of a yoga-based stress reduction intervention on stress, psychological outcomes and cardiometabolic biomarkers in cancer caregivers: A randomized controlled trial.

Caregiving stress is a risk factor for cardiometabolic disease. Therefore, integrating cardiometabolic biomarkers into caregiving research provides a more comprehensive assessment of an individual's health and response to an intervention. The objective of this study was to examine the effects of a yoga-based stress reduction intervention on stress, psychological outcomes, and cardiometabolic biomarkers in cancer caregivers. This prospective randomized controlled trial enrolled family caregivers of adult patients who underwent an allogeneic HSCT at the National Institutes of Health (NIH) Clinical Center. All subjects received usual care education. Participants in the intervention group received an Iyengar yoga intervention self-administered over six weeks using an audio recording file. The primary outcome was perceived stress (measured using the NIH toolbox Perceived Stress). The secondary outcomes were psychological factors (depression and anxiety measured using PROMIS® Depression and Anxiety), and cardiometabolic biomarkers measured by nuclear magnetic resonance spectroscopy. A total of 50 family caregivers (mean [SD] age, 44.9 [15.2] years; 42 [84.0%] women) were randomized, 25 to the intervention group and 25 to the control group. No group differences were noted in stress, depression, and anxiety. Significant interaction effects between group and time were found in large TRL-P (F(1,43) = 10.16, p = 0.003) and LP-IR (F(1,42) = 4.28, p = 0.045). Post-hoc analyses revealed that the levels of large TRL-P (mean difference = 1.68, CI = [0.86, 2.51], p< .001) and LP-IR (mean difference = 5.67, CI = [1.15, 10.18], p = 0.015) significantly increased over time in the control group but while remained stable in the intervention group (mean difference = -0.15, CI = [-0.96, 0.66], p = 0.718; mean difference = -0.81, CI = [-5.22, 3.61], p = 0.714, respectively). Even when perceptions of psychological distress remain unchanged, incorporating gentle yoga poses and breathing exercises may reduce the risk of cardiometabolic disease in caregivers by inhibiting the development of insulin resistance. Standard lipids of cardiometabolic risk do not appear to be robust enough to detect short-term early changes of cardiometabolic risk in caregivers. Trial registration: ClinicalTrials.gov Identifier: NCT02257853.

Caregiving stress and burden associated with cardiometabolic risk in family caregivers of individuals with cancer.

Chronic stress is a well-established risk factor for cardiometabolic disease. Caregiving for individuals with cancer is perceived as a chronic stressor yet research on the risk for cardiometabolic disease in this population, opposed to the elderly and those with Alzheimer's disease, is limited. Additionally, few studies have explored the early physiological changes that occur in family caregivers suggesting an elevated risk for illness. This cross-sectional study was designed to examine levels of cardiometabolic risk biomarkers and their correlates in caregivers of patients with colorectal cancer. Caregivers completed questionnaires that measure exposures to stress and vulnerability factors, psychological distress, and health habits as potential correlates. Traditional lipid and nontraditional lipoprotein particle biomarkers (e.g. concentration and size for all lipoprotein classes) were assayed from blood serum. Caregivers (N = 83, mean age = 49.8, 73% female) displayed levels of cardiometabolic biomarkers that suggest an elevated risk for cardiometabolic disease. Caregivers who were Hispanic, married, highly educated, employed, reported more hours spent caregiving daily, experienced higher caregiver burden associated with the lack of family support and impact on schedule, and psychological distress, demonstrated an elevated risk for cardiometabolic disease; primarily determined by nontraditional lipid biomarkers - large TRL-P, LDL-P, small HDL-P, large HDL-P, TRL-Z, LDL-Z and HDL-Z. These findings suggest that traditional lipid biomarkers may not be robust enough to detect early physiological changes associated with cardiometabolic disease risk in family caregivers. Moreover, findings reiterate the importance of assessing caregiver burden and providing evidence-based interventions to manage caregiving stress with the potential to improve caregivers' cardiometabolic health.

Virtual Reality in Clinical Practice and Research: Viewpoint on Novel Applications for Nursing.

Virtual reality is a novel technology that provides users with an immersive experience in 3D virtual environments. The use of virtual reality is expanding in the medical and nursing settings to support treatment and promote wellness. Nursing has primarily used virtual reality for nursing education, but nurses might incorporate this technology into clinical practice to enhance treatment experience of patients and caregivers. Thus, it is important for nurses to understand what virtual reality and its features are, how this technology has been used in the health care field, and what future efforts are needed in practice and research for this technology to benefit nursing. In this article, we provide a brief orientation to virtual reality, describe the current application of this technology in multiple clinical scenarios, and present implications for future clinical practice and research in nursing.

Psychosocial protective interventions associated with a better quality of life and psychological wellbeing for African American/Black female breast cancer survivors: an integrative review.

PURPOSE: This integrative review provides an overview of current psychosocial interventions and qualitative studies exploring African American Breast Cancer Survivors (AABCS)' psychosocial wellbeing. METHODS: We conducted a search of five databases: PubMed, Academic Search Ultimate, CINAHL, PsycINFO, and Web of Science. Peer-reviewed articles written in English and published from 2011 to May 26, 2021 were included. We critically appraised intervention studies and qualitative studies using established frameworks. RESULTS: Of the 633 unique studies identified, seven interventions and twenty-one qualitative studies were included. Analysis of the interventions revealed the importance of alleviating structural barriers and facilitating peer support for AABCS. Analysis of the qualitative studies revealed seven themes: (1) spirituality/religion, (2) social support, (3) cultural perceptions of BC, (4) lack of representation, (5) negative impacts of treatment, (6) healthcare system experience, and (7) barriers to psychosocial care. CONCLUSIONS: This review highlights the dearth of psychosocial interventions created specifically for AABCS. The qualitative literature in this review elucidates the unique psychosocial challenges that AABCS experience, providing rich data to inform the creation of future culturally competent interventions in this population. IMPLICATIONS FOR CANCER SURVIVORS: This review found spirituality and social support to be protective factors for AABCS' psychosocial wellbeing. Further research using rigorous methodologies is needed to further evaluate how to most effectively alleviate structural barriers that AABCS face in obtaining long-term support.

Professional quality of life, sleep disturbance and health among nurses: A mediation analysis.

AIMS: This study aimed to examine sleep disturbance as a mediator of the relationship between professional quality of life (compassion satisfaction, burnout, secondary traumatic stress) and health (physical and mental health) in nurses. DESIGN: Descriptive, cross-sectional study. METHODS: Three hundred eighteen Registered Nurses completed a web-based survey at the National Institutes of Health Clinical Center in the United States. Mediation analyses were conducted to test hypothesized relationships. RESULTS: Nurses with higher levels of compassion satisfaction reported lower levels of sleep disturbance and better physical/mental health. Burnout and secondary traumatic stress were negatively associated with physical/mental health and positively associated with sleep disturbance. Sleep disturbance fully or partially mediated the relationships between professional quality of life and physical/mental health among nurses.

Acute and chronic fatigue in nurses providing direct patient care and in non-direct care roles: A cross-sectional analysis.

Nurses are at risk for work-related fatigue, which can impact their health, well-being, and job readiness. The purpose of this study was to examine the levels, types, and factors associated with fatigue in registered nurses (RNs) in direct patient care (DCRNs) and in non-direct patient care (non-DCRNs) roles. A cross-sectional survey was administered to 313 RNs. Measures included: Multidimensional Fatigue Symptom Inventory, Occupational Fatigue Exhaustion Recovery, Brief COPE, PROMIS® Global Sleep Disturbance, and Job Content Questionnaire. Acute fatigue levels in RNs were similar to those in diseased populations, and nearly 50% reported moderate/high levels of chronic fatigue. DCRNs reported higher levels of acute and chronic fatigue than non-DCRNs, but the differences were small and disappeared when accounting for other factors associated with fatigue including sleep disturbance, job strain, workplace support, maladaptive coping, and especially intershift recovery, which accounted for 20%-41% of fatigue variability. This study suggests that it may not be only nurses providing direct patient care who are at risk for acute and chronic fatigue. Intershift recovery may be particularly important in alleviating acute and chronic fatigue in nurses.

Effects of Health Beliefs on Flu Vaccination and Physical Health among Under/Graduate Students in the U.S.: Racial Differences (Whites, African Americans, Hispanics, and Asians).

Physicians highlight that annual flu vaccination is the best strategy for preventing seasonal flu and flu-associated complications and it reduces the burden of infectious diseases. Path analyses were used to understand whether health beliefs (barriers, benefits, susceptibility, severity) influence flu vaccinations, in turn, enhance self-rated health of White, African American, Hispanic, and Asian adults in the U.S. (N = 446). Multiple-group analyses were performed to see whether given paths vary across the four groups. Regardless of race, perceived barriers and benefits significantly influenced flu vaccination. There was a group variance in the path-model of the perceived barriers, flu vaccination, and self-rated health. Although the direct effect of perceived barriers on flu vaccination was shown for all racial groups, the direct effect of perceived barriers on self-rated health was shown only for Asians. Social workers and healthcare providers should be educated to appropriately interpret different meanings of health beliefs of diverse racial groups.

Influenza Vaccination Among U.S. College or University Students: A Systematic Review.

OBJECTIVE: Influenza is one of the major causes of morbidity. This study summarized major components that influence college/university students' use of the vaccination using Ecological System Theory; and evaluated racial differences in key predictors of influenza vaccination/intention. DATA SOURCE: Sixteen engines (e.g., PsycINFO, Academic Search Premier, Science Citation Index) were used to search for cross-sectional studies (2009-2019). STUDY INCLUSION/EXCLUSION CRITERIA: PI/CO criteria were applied (U.S. students, multidimensional ecological system, influenza vaccination/intention). DATA EXTRACTION: 25 cross-sectional studies were included from the initial 810 citations. Four reviewers performed the cross-checking. DATA SYNTHESIS AND RESULTS: Higher SES (e.g., education, vaccine affordability, healthcare resource) were positively associated with vaccination/intention. Under micro levels, both internal factors (e.g., positive beliefs, perceptions, attitudes) and external factors (e.g., supports/recommendations from physicians, families or peers, information, engagement in campus activities) enhanced influenza vaccination/intention of students. Meso level factors (private university, dorm-residence, or student housing) also influenced influenza vaccination/intention. Despite limited information on the effects of race on influenza vaccination, the current study synthesized the racial variances in vaccination behaviors of students. CONCLUSIONS: Enhancing positive beliefs, perceptions, or attitudes toward influenza vaccination with students is critical. Information about the safety and effectiveness of vaccination could be provided for students through official media, medical sources/physicians, campaigns, or internet websites. Family-to-student or peer-to-peer awareness campaigns could facilitate the vaccination of students.

Symptom Clusters and Influencing Factors in Family Caregivers of Individuals With Cancer.

BACKGROUND: A symptom cluster is a group of 2 or more symptoms that occur together and are related to each other. Although family caregivers of individuals with cancer experience multiple concurrent symptoms, the majority of symptom research has focused on assessing and managing individual, isolated symptoms. OBJECTIVE: The study purpose was to investigate symptom clusters in cancer caregivers and to explore factors that influence symptom clusters. METHODS: Cluster analysis was performed using cross-sectional survey data from 129 family caregivers of individuals receiving cancer treatment at the National Institutes of Health Clinical Center. PROMIS (Patient-Reported Outcomes Measurement Information System) measures of 5 common symptoms in caregivers (fatigue, sleep disturbance, depression, anxiety, impaired cognition) were used to identify symptom clusters. RESULTS: Two symptom cluster groups were identified: low symptom burden (n = 106, 82.2%) and high symptom burden (n = 23, 17.8%). Individuals who reported higher levels of caregiving burden (impact on health subscale) (ß = 1.31, P = .005) and loneliness (ß = 0.18, P = .024) were significantly more likely to be in the high symptom burden group. CONCLUSIONS: This study provides evidence that 5 key symptoms among cancer caregivers appear to cluster into 2 groups, those with low symptom burden and those with high symptom burden. Caregiving burden (impact of health) and loneliness were significant factors differentiating symptom cluster membership. IMPLICATIONS FOR PRACTICE: Identifying symptom clusters may lead to better prevention and treatment strategies that target symptoms in cancer caregivers. Identifying factors that place a group at high risk of symptom burden can be used to guide individualized and tailored interventions.

Factors That Influence Health-Promoting Behaviors in Cancer Caregivers.

OBJECTIVES: To describe cancer caregivers' participation in health-promoting behaviors and to identify factors influencing participation. SAMPLE & SETTING: 129 informal cancer caregivers at the National Institutes of Health Clinical Center. METHODS & VARIABLES: Cross-sectional survey methodology using Health-Promoting Lifestyle Profile-II (HPLP-II), PROMIS® Global Physical Health, NIH Toolbox Stress and Self-Efficacy, Caregiver Reaction Assessment, and Family Care Inventory Mutuality subscale. RESULTS: Caregivers reported the highest HPLP-II subscale scores for spirituality and interpersonal relationships and the lowest for physical activity. Caregivers who were older, with lower body mass indices, in better physical health, and with higher self-efficacy and mutuality participated in more health-promoting behaviors. Sixty percent of the caregivers reported that they exercised less since becoming a caregiver, and 47% reported that their diet was worse. IMPLICATIONS FOR NURSING: Future research is needed to examine novel interventions to increase health-promoting activities in cancer caregivers, and these interventions might be strengthened by including components that focus on increasing self-efficacy and/or improving the strength of the relationship between the caregiver and care recipient.

Cooking Frequency and Perception of Diet among US Adults Are Associated with US Healthy and Healthy Mediterranean-Style Dietary Related Classes: A Latent Class Profile Analysis.

: Background: Meal habits are associated with overall dietary quality and favorable dietary patterns determined by the Healthy Eating Index (HEI). However, within dietary patterns, complexities of food combinations that are not apparent through composite score determination may occur. Also, explorations of these food combinations with cooking and perceived diet quality (PDQ) remain unknown. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 were utilized to determine the frequency of cooking at home and PDQ, along with sociodemographic variables. Latent class profile analysis was performed to determine person-centered data-driven analysis using the dietary index, HEI-2010, at both the daily and dinner meal-time levels. Multinomial logistic regression analysis was utilized to evaluate the association of dietary patterns with all covariates. RESULTS: For daily HEI, five distinct dietary classes were identified. For dinner HEI, six classes were identified. In comparison to the standard American diet classes, home cooking was positively associated with daily (p < 0.05) and dinner (p < 0.001) dietary classes that had the highest amounts of total vegetable and greens/beans intake. PDQ was positively associated with these classes at the daily level (p < 0.001), but negatively associated with healthier classes at the dinner level (p < 0.001). CONCLUSION: The use of latent class profile analysis at the daily and dinner meal-time levels identified that food choices coalesce into diverse intakes, as shown by identified dietary classes. Home cooking frequency could be considered a positive factor associated with higher vegetable intake, particularly greens/beans, at the daily and dinner levels. At the same time, the perception of diet quality has a positive association only with daily choices.