Developmental, family, and ethnic influences on adolescent alcohol usage: a growth curve approach.

The influence of the developmental process of individuation, family conflict and cohesion, and ethnicity on adolescent alcohol use was examined in a 3-year longitudinal study. Participants included non-Hispanic White, Mexican American, and African American adolescents (n = 6,522) from 6th, 7th, and 8th grades. They were surveyed annually for 3 years. Depending on which aspect of individuation was measured, hierarchical linear modeling indicated that changes in adolescent individuation were related to either increases or decreases in alcohol use over the 3-year period. Separation and family conflict were related to increases in alcohol use, and intergenerational individuation and family cohesion were related to decreases in alcohol use. White and Mexican American adolescents had a faster rate of increase in alcohol use than did African American youth. Separation and family process similarly influenced adolescent alcohol use from different ethnic groups. Implications for prevention and intervention programs are discussed.

Adolescent individuation and alcohol use in multi-ethnic youth.

OBJECTIVE: A structural equation modeling approach is used to assess adolescent alcohol use as a function of two measures of individuation in the context of other family and peer psychosocial factors for adolescents in three ethnic groups. The separation measure captures aspects of individuation related to detachment or rebelliousness. Intergenerational individuation measures increasing self-reliance and control with maintenance of supportive family bonds. METHOD: A sample of 1,200 sixth through eighth grade black, Mexican-American and non-Hispanic white adolescents participated. A structural equation model describing adolescent alcohol use as a function of two measures of individuation, family conflict, communication with mother, stress and peer use of alcohol was tested and compared for the three ethnic groups. RESULTS: Significant direct and indirect paths to adolescent alcohol use were indicated for individuation measures and family use, peer use and stress variables. The proposed model fit for each of the groups, although the way in which separation related to stress was different in the black group. CONCLUSIONS: The findings support the role of individuation as a contributing factor in adolescent alcohol use for each ethnic group. They indicate the importance of family and parent-adolescent relationships in adolescent alcohol use and suggest directions for both family-based and school-based preventive interventions.

Intentions to use alcohol among fifth and sixth graders: the roles of social and stress/coping motives.

This study of children in grades five and six assessed the relationship between social and stress/coping motives and students' intentions to drink in junior high school. Whereas the two motives were not seen as separate by fifth graders, they were differentiated by sixth graders, for whom they were associated--social motives more strongly than stress/coping motives--with intentions to use alcohol. Implications for the design and timing of prevention programs are considered.

Adolescent individuation and alcohol use.

OBJECTIVE: This study evaluates a developmental psychosocial model of adolescent drinking. Specifically, the role of two aspects of adolescent individuation-separation and intergenerational individuation-is examined within the context of family dynamics, stress and peer associations. These measures parallel an ongoing debate regarding the nature of individuation. The separation measure captures aspects of individuation related to detachment or rebelliousness. Intergenerational individuation measures increasing self-reliance and control with maintenance of supportive family bonds. METHOD: A structural equation model describing adolescent alcohol use as a function of two measures of individuation, family conflict, communication with mother, stress and peer use of alcohol was tested in two independent samples. The first included 6th- through 12th-grade adolescents and the second was composed of 6th- through 8th-grade students. RESULTS: In both studies, significant direct and indirect paths were found from individuation measures and family, peer use and stress constructs to adolescent alcohol use. Separation had a stronger relationship to alcohol use than did intergenerational individuation and was associated with higher levels of stress and alcohol use by peers. CONCLUSIONS: The findings support the role of individuation as a contributing factor in adolescent alcohol use. They indicate the importance of family and parent-adolescent relationships in adolescent alcohol use and suggest directions for both family-based and school-based preventive interventions.

Family stress management following acute myocardial infarction: an educational and skills training intervention program.

Although the experience of acute myocardial infarction (AMI) is a family affair, little has been available to guide stress and distress reduction efforts focusing on all members of the family compared to the somewhat larger literature addressing stress management interventions with cardiac patients. This article provides a conceptual background for a specific behavioral therapy approach to family stress management in dealing with the sequelae of AMI for all family members with the goal of reducing morbidity for all family members as they cope with ongoing survivorship issues. The family intervention program is described and its pilot implementation discussed. Evaluation of the pilot suggests that an individually tailored focus for that subset of families at higher risk for elevated persistent distress may be the most cost-effective use of such a family intervention program.

Do fifth graders' attitudes and intentions toward alcohol use predict seventh-grade use?

OBJECTIVE: To examine the relationship among children's perceptions of peer and parental attitudes toward alcohol use, fifth graders' attitudes toward alcohol use and intentions to use alcohol in junior high school, and alcohol use of these same children as seventh graders. METHODS: Subjects completed questionnaires as fifth graders that assessed their perception of parents' and peers' attitudes toward alcohol use, children's attitudes toward alcohol use, and intentions to use alcohol in junior high school. They completed a survey in the seventh grade that assessed alcohol use. RESULTS: Path analyses indicated that perceived peer and parental attitudes were directly related to children's fifth-grade attitudes toward alcohol use. Attitudes, in tum, were related to fifth-grade intentions, which were related to seventh-grade alcohol use. Peer and parental attitudes, and children's attitudes as fifth graders, were not directly related to later alcohol use. CONCLUSIONS: Peer and parental attitudes toward alcohol use among fifth graders exert an indirect, rather than direct, influence on later alcohol use. Similarly, attitudes of fifth graders influence later alcohol use through their influence on intentions to use alcohol. Prevention programs should be targeted toward younger children prior to initiation of alcohol use and should address both peer and parental influences on attitudes and intentions to use alcohol.

Development of a risk profile for intentions to use alcohol among fifth and sixth graders.

OBJECTIVE: The relationship between intentions to use alcohol and risk factors was examined among fifth and sixth graders. METHOD: Subjects completed a questionnaire that assessed intentions to use alcohol and eight risk factors. Risk factors included peer and parental use and attitudes toward use, sensation seeking, tolerance of deviance, rejection of parental authority, and family cohesion. RESULTS: Multivariate analyses showed that the risk factors were able to discriminate between those who intended to use alcohol and those who did not. Family factors showed stronger relationships to intentions among fifth graders, and peer factors were more strongly related to intentions among sixth graders. CONCLUSIONS: Risk factors can be used to target preadolescents who may be at risk for early alcohol use, and programs that attempt to prevent early initiation of alcohol use among adolescents can be designed.

Influence of family disharmony and parental alcohol use on adolescent social skills, self-efficacy, and alcohol use.

Deficits in social skills have been found to be related to adolescent substance use. Little effort has been devoted to understanding how family factors influence the acquisition of these skills. This study examined the manner in which family disharmony and parental alcohol use affect adolescent alcohol use through their influence on the acquisition of social skills and self-efficacy regarding one's ability to utilize these skills. It was hypothesized that family disharmony and parental alcohol use directly influenced usage and affected usage indirectly through their influence on acquisition of social skills. Social skills were also hypothesized to affect usage directly and to affect usage indirectly by influencing beliefs regarding one's ability to implement these skills. Results indicated that family disharmony was directly related to adolescent alcohol use and social skills. Parental alcohol use was related only to adolescent usages, not to social skills. Social skills were related to self-efficacy, which was related to alcohol use but was not directly related to usage. Results are discussed in terms of the importance of family influences on adolescent alcohol use, the importance of including families in prevention efforts, and the importance of the acquisition of self-efficacy relative to social skills.

Dispositional optimism, self-efficacy, and health beliefs as predictors of breast self-examination.

This cross-sectional study examined relationships among predictors of breast self-examination (BSE) derived from the Health Belief Model and behavioral self-regulation theory. Subjects were 427 gynecology outpatients. Although 64% indicated that they had practiced BSE at least once during the past year, only 27% indicated they practiced BSE monthly. The majority of the subjects knew about most of the recommended BSE steps. The most frequently endorsed reasons for completing BSE were early detection, recommendation from a doctor, and peace of mind. The most frequently endorsed barrier was forgetting/being too busy. Multivariate analysis showed that several psychological variables--including reasons for doing BSE, self-efficacy, and barriers to doing BSE--were related to frequency of BSE. Overall, the variables in this model accounted for about 37% of the variance in BSE frequency.

Subtypes of psychosocial adjustment to breast cancer.

By means of cluster analytic techniques, four subtypes of psychosocial adjustment were identified in a sample of 122 breast cancer patients who completed the Psychosocial Adjustment to Illness Scale. Internal consistency and internal validity of the derived typology were suggested by the finding that two different hierarchical agglomerative clustering methods (average linkage between groups, Ward's) produced similar solutions. Three of the derived subtypes reported normal affect levels but different patterns of relative strengths and dysfunctions, while the fourth subtype appeared to be highly distressed and globally maladjusted. External validation was demonstrated by differentiating the subtypes on variables of negative affect, avoidance coping, and fighting spirit. The clinical and heuristic implications of these findings are discussed. The findings highlight the need for comprehensive assessment of psychosocial functioning of cancer patients. They demonstrate that even non-emotionally distressed patients can have very different profiles of adjustment and may benefit from correspondingly individually tailored psychosocial interventions.

Relationship among social and intrapersonal risk, alcohol expectancies, and alcohol usage among early adolescents.

Numerous studies have shown that adolescents' expectancies about the effects of alcohol influence usage. Expectancies are described as mediators between social influences (such as peer and parental influences) and alcohol use. The present study examined the relationship between social risk factors (peer influence and parental approval), intrapersonal risk factors (tolerance of deviance and sensation seeking), alcohol expectancies, and alcohol usage in a cohort of seventh graders. It was hypothesized that social risk factors affected alcohol usage indirectly through expectancies, while intrapersonal risk factors influenced usage both directly and indirectly. Structural modeling was used to examine the hypothesized relationships between these four constructs. Results indicated that the hypothesis that expectancies mediate social influences was not supported, and that social influences exerted a direct influence on usage independent of expectancies. Results suggested that the view that expectancies mediate social risk factors may need modification. Suggestions for future research in this area include the need to examine the relationships among these constructs longitudinally and with adolescents over a broader age range.

The relationship of dispositional optimism, daily life stress, and domestic environment to coping methods used by cancer patients.

The relationship of dispositional optimism, daily life stress, and domestic environment to two types of coping methods was examined in a group of 94 cancer patients. As expected, dispositional optimism and domestic environment made significant contributions to the prediction of avoidance coping. Dispositional optimism contributed significantly to the prediction of active-behavioral coping. Specifically, a significant positive relationship was obtained between active-behavioral coping and optimism. A significant positive relationship also was found between avoidance coping and both daily stress and domestic environment. Avoidance coping was negatively related to dispositional optimism. In multivariate analyses, gender and disease-related variables did not make significant contributions to the prediction of coping method. Suggestions for future research were made.

Risk factors and their relation to initiation of alcohol use among early adolescents.

This study examined the relationship between risk factors and initiation of alcohol use over a 15-month period among a cohort of 7th graders who were abstainers at the time of initial testing. The relationship between risk factors and alcohol use was examined using a discriminant function analysis. At the univariate level, rejection of parental authority, deviant behavior, and sensation seeking were statistically significant. The discriminant function retained only three of the risk factors: rejection of parental authority, deviant behavior, and religious commitment. Implications for school-based prevention programs are discussed, particularly the need to target primary prevention programs based upon adolescents' risk.

Attitudes of cancer: psychometric properties of fighting spirit and denial.

Higher rates of recurrence-free survival at 5- and 10-year follow-up have been reported for breast cancer patients who initially responded to cancer with attitudes of "fighting spirit" or denial. We report here a factor analytic attempt, utilizing questionnaire data, to objectify these attitudes. A reliable factor structure replicated in breast and mixed cancer samples, yielding three factors: (1) Fighting Spirit or belief in the ability to fight back, conquer, and recover from cancer; (2) Information-Seeking behavior; and (3) Denial. Adequate 1-month test-retest correlations were obtained for Fighting Spirit and Information Seeking factor scores. A pattern of differential correlations with other measures (affect, coping, and optimism) distinguished Fighting Spirit and Information Seeking. The Denial factor appeared to be less stable and did not correlate significantly with other measures.

Women with breast cancer: perception of family functioning and adjustment to illness.

Fifty-seven women with breast cancer completed measures of family adaptability and cohesion, marital adjustment, and psychosocial adjustment to illness. Using a circumplex model of family systems, we examined whether subjects who perceived their families at moderate levels of cohesion and adaptability reported better psychosocial adjustment than subjects from families with extreme levels of cohesion and adaptability. The results indicated that the patients who reported the best adjustment to breast cancer and in their marriages, also reported the highest levels of family cohesion. There was not a significant relationship between adjustment to illness and adaptability. The implications for the treatment of women with breast cancer and for the families of these patients were discussed.

Psychological approaches to the assessment and treatment of anxiety and depression.

Clinical psychology offers a unique and often complementary approach to assessment and treatment of anxiety and depression. Current practices are examined for their scientific validity and clinical utility.

Stress, coping, family conflict, and adolescent alcohol use.

This study examined alcohol use among seventh graders in relation to life events, daily hassles, the supportive quality of the family environment, coping, and anxiety. Four hundred twenty-five students participated, 228 girls and 197 boys. Stepwise regression and discriminant function analyses indicated that the students reported more alcohol use if they also reported more life events, more daily hassles, and more conflict in the family. A stress-buffering effect of low family conflict on life events could not be substantiated for extent of alcohol use. The results are discussed in the context of the developmental transitions of adolescence.

Alcohol use by adolescents in disrupted families.

Alcohol use increases among adults in response to marital disruption and divorce, but data that are available regarding adolescent alcohol use are inconsistent in the light of whether or not families are intact. To explore this question we obtained measures of frequency and quantity of alcohol use from 2595 junior and senior high school students, together with information about family intactness and parental alcohol use. Adolescents in single and stepparent families reported more alcohol use than adolescents from intact families, for both frequency and quantity of use. This was the case for boys and for girls, as well as for junior high school and for senior high school students. Parents in nonintact families also were reported to be using more alcohol than parents in intact families. Adolescent alcohol use was significantly correlated with parental alcohol use. After adjusting adolescent alcohol use for parental alcohol use as a covariate, the finding of greater alcohol use by adolescents in non-intact families remained.

Inflatable and noninflatable penile prostheses: comparative follow-up evaluation.

This evaluation was conducted with 63 men who were organically impotent and subsequently received either an inflatable penile prosthesis (n = 43), a noninflatable penile prosthesis (n = 14), or both in succession (n = 6). The patient groups were compared for sexual satisfaction, sexual activity, mental status, complications, satisfaction with prosthesis, and relationship changes. The methods of evaluation were the Derogatis Sexual Functioning Inventory and two unstandardized questionnaires. Significant differences were found between the two patient groups: inflatable prosthesis recipients report being more sexually satisfied, more satisfied with their implant, experiencing less psychiatric distress, having a more rapid postsurgical recovery, more sexually active, and experiencing more positive changes in relationships with their partners than do recipients of a noninflatable prosthesis. The data suggest that the inflatable prosthesis may be a more favorable choice for most individuals than noninflatable devices.