Healthy Eating for Life English as a second language curriculum: applying the RE-AIM framework to evaluate a nutrition education intervention targeting cancer risk reduction.

Medically underserved US immigrants are at an increased risk for death from preventable or curable cancers due to economic, cultural, and/or linguistic barriers to medical care. The purpose of this study was to describe the evaluation of the pilot study of the Healthy Eating for Life (HE4L) English as a second language curriculum. The Reach, Effectiveness Adoption, Implementation, Maintenance (RE-AIM) model was used to design a mixed-methods approach to the evaluation of the HE4L curriculum. Successful implementation was dependent upon enthusiastic teacher and manager support of the curriculum, teachers' ability to flexibly apply the curriculum to meet student needs, and researcher provision of curriculum workbooks. HE4L can be implemented successfully in various adult education settings to teach healthy eating behaviors and English language principles. Scale-up of HE4L may depend on the development of an online version of the curriculum to avoid the costs associated with printing and distributing curriculum materials.

The effects of message framing and ethnic targeting on mammography use among low-income women.

The authors examined the effects that differently framed and targeted health messages have on persuading low-income women to obtain screening mammograms. The authors recruited 752 women over 40 years of age from community health clinics and public housing developments and assigned the women randomly to view videos that were either gain or loss framed and either targeted specifically to their ethnic groups or multicultural. Loss-framed, multicultural messages were most persuasive. The advantage of loss-framed, multicultural messages was especially apparent for Anglo women and Latinas but not for African American women. These effects were stronger after 6 months than after 12 months.

Abstract and concrete self-evaluative goals.

Assuming that people often hold the abstract goal of acquiring accurate feedback but recognize that acquiring favorable feedback can make the self-evaluative process more comfortable, the authors posited that low-level construals (of how action is performed) would elicit greater self-enhancement motivation than would high-level construals (of why action is performed). Individuals chronically using low-level construals had greater interest in downward social comparison (DSC) and less interest in negative feedback (NF; Studies 1 and 3). Decreases in temporal distance (which foster low-level construals) also elicited greater interest in DSC and less interest in NF (Studies 2 and 4). The latter effect was explained by participants' aversion to inconvenience (Study 5) and not by approach-avoidance conflict (Study 6). These results suggest that the level of abstraction at which people construe self-evaluative situations can influence their feedback preferences.

Emotional intelligence as a standard intelligence.

The authors have claimed that emotional intelligence (EI) meets traditional standards for an intelligence (J. D. Mayer, D. R. Caruso, & P. Salovey, 1999). R. D. Roberts, M. Zeidner, and G. Matthews (2001) questioned whether that claim was warranted. The central issue raised by Roberts et al. concerning Mayer et al. (1999) is whether there are correct answers to questions on tests purporting to measure EI as a set of abilities. To address this issue (and others), the present authors briefly restate their view of intelligence, emotion, and EI. They then present arguments for the reasonableness of measuring EI as an ability, indicate that correct answers exist, and summarize recent data suggesting that such measures are, indeed, reliable.

The Yale Interpersonal Stressor (YIPS): affective, physiological, and behavioral responses to a novel interpersonal rejection paradigm.

Given links between interpersonal functioning and health as well as the dearth of truly interpersonal laboratory stressors, we present a live rejection paradigm, the Yale Interpersonal Stressor (YIPS), and examine its effects on mood, eating behavior, blood pressure, and cortisol in two experiments. The YIPS involves one or more interaction(s) between the participant and two same-sex confederates in which the participant is made to feel excluded and isolated. In Experiment 1, 50 female undergraduates were randomly assigned to the YIPS or a control condition. Participants in the YIPS condition experienced greater negative affect and less positive affect than did those in the control condition. Further, restrained eaters ate more following the YIPS than did nonrestrained eaters. In Experiment 2, 25 male and female undergraduates completed the YIPS. The YIPS induced significant increases in tension, systolic blood pressure (SBP), and diastolic blood pressure (DBP) from baseline, while significantly decreasing positive affect. The YIPS appeared particularly relevant for women, resulting in significantly greater increases in cortisol and SBP for women compared to men. The YIPS, then, provides an alternative to traditional, achievement-oriented laboratory stressors and may allow for the identification of individuals most vulnerable to interpersonal stress.

Emotional states and physical health.

Positive emotional states may promote healthy perceptions, beliefs, and physical well-being itself. To explore potential mechanisms linking pleasant feelings and good health, the authors consider several lines of research, including (a) direct effects of positive affect on physiology, especially the immune system, (b) the information value of emotional experiences, (c) the psychological resources engendered by positive feeling states, (d) the ways in which mood can motivate health-relevant behaviors, and (e) the elicitation of social support. As anticipated by the Greek physician Hippocrates, positive emotions and healthy outcomes may be linked through multiple pathways.

Static, dynamic, and causative bipolarity of affect.

In what sense are pleasant and unpleasant moods "bipolar"? One must differentiate three types of affective bipolarity: static bipolarity (the zero-order correlation between measures of pleasant and unpleasant affect, net of distortions due to measurement error, tends to be strongly negative), dynamic bipolarity (pleasant and unpleasant feelings generally change in opposite directions and to approximately the same extent), and causative bipolarity (the influence of pleasant and unpleasant affect on other variables is approximately equal and opposite). It is argued that static bipolarity is often attenuated by measurement error, dynamic bipolarity can be masked by asymmetrical scaling artifacts, and causative bipolarity is often obscured by both. The experience and influence of pleasant and unpleasant affect may occur along bipolar lines even if the sources of these feelings are understood as physiologically separable systems with distinct neurological loci.

Message framing and sunscreen use: gain-framed messages motivate beach-goers.

Prospect theory suggests that people respond differentially to factually equivalent messages depending on how these messages are framed (A. Tversky & D. Kahneman, 1981). A. J. Rothman and P. Salovey (1997) relied on prospect theory to predict that messages highlighting potential "gains" should promote prevention behaviors such as sunscreen use best. This experiment compared the effectiveness of 4 differently framed messages (2 highlighting gains, 2 highlighting losses) to persuade 217 beach-goers to obtain and use sunscreen. Attitudes and intentions were measured before and immediately following the delivery of the framed information, and after completing the questionnaire participants were given a coupon redeemable for a small bottle of sunscreen later that same day. People who read either of the 2 gain-framed brochures, compared with those who read either of the 2 loss-framed brochures, were significantly more likely to (a) request sunscreen, (b) intend to repeatedly apply sunscreen while at the beach, and (c) intend to use sunscreen with a sun protection factor of 15 or higher.

Persuasion for the purpose of cancer risk reduction: a discussion.

We comment on the preceding papers by Gerrard and Vernon concerning persuasion, perceived risk, and cancer-relevant behavior. Our purpose is to highlight several challenges for future investigators. First, relations between health cognition and health behavior (such as the link between perceived vulnerability and protective behaviors) are likely to be moderated by other variables, including individual differences and situational contexts. Second, we encourage health communication researchers to consider how persuasion is contextualized in social relationships and to employ mechanisms from the literature on social influence when promoting cancer prevention and early detection behaviors. Finally, we emphasize the importance of current feelings and anticipated emotions as motivators of salubrious actions.

Predictors of social support and psychological distress in women with breast cancer.

This investigation sought to understand previous well-cited and worrisome findings that women treated for breast cancer with breast-conserving surgery compared to mastectomy experience less social support and more mood disturbance, and that social support from significant others erodes over time. Ninety-three women with breast cancer and a subset of their partners completed assessments at the time of surgical treatment and at 3 and 13 months post-treatment. Contrary to the previous findings, type of surgical treatment was not related to perceptions of social support or psychological functioning. Perceptions of social support and psychological distress decreased over time, and the discrepancy between recipients' and providers' judgments of available support increased over time. Low levels of physical functioning led to relative increases in social support, whereas high levels of psychological distress led to relative decreases in social support. Social support as rated by patients (but not their partners) was a significant predictor of changes in psychological distress.

Elementary school-age children's developmental understanding of the causes of cancer.

This study examines children's conceptual understanding and factual knowledge of the causes of cancer. Using a standardized, developmentally based, semistructured interview (ASK [AIDS (acquired immunodeficiency syndrome) Survey for Kids]), 784 children (43% black, 38% white, and 18% Hispanic; 48% female) in kindergarten through sixth grade attending six public elementary/middle schools in New Haven, Connecticut, were asked open-ended questions about the causes of cancer and, for comparison, the causes of colds and AIDS. Responses were scored for level of conceptual understanding and coded for factual content and factual accuracy. The level of conceptual understanding for causality of cancer increased consistently as grade level increased. When comparisons were made among the illnesses, children's level of conceptual understanding was significantly lower for the causes of cancer than for the causes of colds (p < .0001), but not significantly different from that of AIDS. Although the single most frequent cause of cancer mentioned was cigarettes/smoking (24%), more than one in five students stated that casual contact or contagion was a cause of cancer. More children cited causal contact/contagion than cited the following factually accurate or logically contributory causes combined: poor diet, air/water pollution or overexposure to sun, alcohol, and old age. Slightly more than one half of students in kindergarten through sixth grade worried about getting cancer, and the vast majority (80%) knew that cancer could be fatal. Children have a less sophisticated conceptual understanding of cancer than of colds and a very limited factual knowledge base for cancer, and thus they have the capacity to increase both their understanding and knowledge. These results have implications for the creation of developmentally appropriate cancer prevention curricula for elementary school-age children.

Patient participation in treatment decision making and the psychological consequences of breast cancer surgery.

Women in the early stages of breast cancer can be treated effectively with either modified radical mastectomy or tumor excision plus postoperative radiation therapy. Thus, breast cancer patients may be given a choice between these two modes of treatment. In some states, physician disclosure of such treatment alternatives for breast cancer is mandated by law. Despite the belief that patient participation in decision making is beneficial, the evidence is preliminary, although generally supportive. This study examined the extent to which patient participation in the choice of surgical options was related to psychological functioning, fear of cancer recurrence, and aspects of treatment satisfaction 3 and 13 months postoperatively. Few associations with degree of participation in treatment decision making or type of surgical treatment emerged after 3 months. After 13 months, however, women with greater levels of input into their treatment plan were more satisfied with their medical care, although they were not better off in terms of psychological functioning or fear of cancer recurrence. The positive effects of shared treatment decision making may be more closely related to aspects of longer term treatment satisfaction rather than a buffer against psychological distress resulting from breast cancer.

Affect in electoral politics.

Recent U.S. history provides vivid illustrations of the importance of politicians' emotional displays in subsequent judgments of them. Yet, a review of empirical research on the role of affect (emotion, mood, and evaluation) in electoral politics reveals little work that has focused on the impact of candidates' emotional expression on voters' preferences for them. A theoretical framework is proposed to identify psychological mechanisms by which a target's displays of emotion influence judgments of that target. Findings from the emerging literature on emotions and politics challenge the traditional assumption of political science that voters make decisions based solely on the cold consideration of nonaffectively charged information. The affect and politics literature, although somewhat unfocused and broad, represents an interdisciplinary domain of study that contributes to the understanding of both electoral politics and social interaction more generally.

Shaping perceptions to motivate healthy behavior: the role of message framing.

Health-relevant communications can be framed in terms of the benefits (gains) or costs (losses) associated with a particular behavior, and the framing of such persuasive messages influences health decision making. Although to ask people to consider a health issue in terms of associated costs is considered an effective way to motivate behavior, empirical findings are inconsistent. In evaluating the effectiveness of framed health messages, investigators must appreciate the context in which health-related decisions are made. The influence of framed information on decision making is contingent on people, first, internalizing the advocated frame and, then, on the degree to which performing a health behavior is perceived as risky. The relative effectiveness of gain-framed or loss-framed appeals depends, in part, on whether a behavior serves an illness-detecting or a health-affirming function. Finally, the authors discuss the cognitive and affective processes that may mediate the influence of framed information on judgment and behavior.

Beliefs about mood moderate the relationship of stress to illness and symptom reporting.

The current prospective study examined how characteristic beliefs about mood affect illness and symptom reporting. Using the Trait Meta-Mood Scale, 134 undergraduate (76 females and 58 males) reported their beliefs about attention to, clarity, and reparability of mood. Self-reported stress, illness, and symptoms were collected at three times following assessment of trait meta-mood, during times of general stress, and immediately prior to a class examination. Results indicate that, at increasing levels of distress, those who believe in greater attention to mood were more likely to report physical symptoms. In addition, those individuals who said that they generally make efforts to maintain positive mood were less likely to report illness than those less likely to engage in mood repair. The findings suggest that a person's general manner of evaluating or appraising mood is an important moderator of the relation between distress and symptom and illness reporting.

Death Attitudes and Self-reported Health- relevant Behaviors.

Two studies are presented investigating the role of attitudes toward death in self- reported health-protective behavior. The Multidimensional Death Attitudes Scale (MDAS), based on three existing measures of death attitudes, was administered to a group of health professionals (N = 348). A principal components analysis revealed five factors, labeled Acceptance, Fear, Death as Passage, Death as Relief and Avoidance. The five- factor structure also was replicated in a second, somewhat different sample (N = 100). Twenty-three items loaded highly on the five factors, and the subscales showed good internal consistency. The relationship between the five death attitudes and self-reported health behaviors was explored. Acceptance of death was associated positively with physical exercise controlling for demographic and psychological variables. Accepting death but not viewing death as relief were associated with self- reported lower levels of drinking and driving.

Psychosocial sequelae of breast cancer and its treatment.

The psychosocial problems associated with breast cancer have commanded more and more attention. Historical developments in medicine and society have altered the context in which breast cancer is diagnosed and treated. There are many new issues for researchers interested in quality-of-life issues surrounding breast cancer, and findings from past research must be evaluated carefully. Accordingly, this article reviews: (a) historical developments affecting the context of breast cancer research, (b) aspects of breast cancer and its treatments that challenge well-being, (c) the literature considering breast cancer's psychosocial sequelae, and (d) variables that may influence the intensity of its impact. In addition, we offer some directions for future research.

Role-relationship models for case formulation.

BACKGROUND: Personality disorders are important because they occur frequently and often complicate psychiatric symptom disorders. They are difficult to diagnose and formulate because unitary core traits and themes are hard to define for individual patients. A multiple-selves approach helps clinicians define core contradictions in belief that are frequently present. METHOD: A configurational system for case formulation was used with an approach of states and person schemas. Transactions and stories involving self and others were observed for recurrent elements of identity, attribution, and action. These elements were systematically arranged as role relationship models for each important state of behavior. Cyclic repetitions of maladaptive interpersonal behavior patterns were then explained in terms of motivations and social events that activate enduring, but erroneous, beliefs. RESULTS: Reliable and valid individualized formulations were derived by means of configurations of role relationship models. Inferring several levels of diverse self and other beliefs clarified the complexity usually found in disorders of personality. CONCLUSIONS: The role relationship models method of formulation is compatible with integrative approaches to treatment planning.

The effects of message framing on mammography utilization.

This experiment compared the effectiveness of gain-versus loss-framed messages to persuade women to obtain mammography screening. One hundred and thirty-three women 40 years and older and not adhering to current guidelines for obtaining mammography screening were assigned randomly to view either gain-framed (emphasizing the benefits of obtaining mammography) or loss-framed (emphasizing the risks of not obtaining mammography) persuasive videos that were factually equivalent. Attitudes and beliefs were measured before and immediately following the intervention. Mammography utilization was assessed 6 and 12 months later. Consistent with predictions based on prospect theory, women who viewed the loss-framed message were more likely to have obtained a mammogram within 12 months of the intervention. These findings suggest that loss-framed messages may have an advantage in the promotion of detection behaviors such as mammography.

Measurement error masks bipolarity in affect ratings.

For years, affect researchers have debated about the true dimensionality of mood. Some have argued that positive and negative moods are largely independent and can be experienced simultaneously. Others claim that mood is bipolar, that joy and sorrow represent opposite ends of a single dimension. The 3 studies presented in this article suggest that the evidence that purportedly shows the independence of seemingly opposite mood states, that is, low correlations between positive and negative moods, may be the result of failures to consider biases due to random and nonrandom response error. When these sources of error are taken into account using multiple methods of mood assessment, a largely bipolar structure for affect emerges. The data herein speak to the importance of a multi-method approach to the measurement of mood.