Making sense of poor adherence in PTSD treatment from the perspectives of veterans and their therapists.

OBJECTIVE: Dropout rates from trauma-focused PTSD treatments (TFTs) in VA clinics are particularly high. We conducted in-depth qualitative interviews with 29 veterans and their therapists to better understand this phenomenon. METHOD: Participants were part of a multisite, mixed-methods study of TFT adherence in VA clinics. Veterans were eligible for interviews if they exhibited poor TFT adherence and screened positive for PTSD in follow-up surveys. Interviews were analyzed using qualitative dyadic analysis approaches. RESULTS: Therapists relied on stereotypes of poor adherence to understand veterans' experiences and were missing information critical to helping veterans succeed. Veterans misunderstood aspects of the therapy and struggled in ways they inadequately expressed to therapists. Therapist attempts at course corrections were poorly matched to veterans' needs. Many dyads reported difficulties in their therapeutic relationships. Veterans reported invalidating experiences that were not prominent in therapists' interviews. CONCLUSIONS: Future work is needed to test hypotheses generated and find effective ways to help veterans fully engage in TFTs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Veterans with poor PTSD treatment adherence: Exploring their loved ones' experience of PTSD and understanding of PTSD treatment.

Trauma-focused psychotherapies such as cognitive processing therapy (CPT) and prolonged exposure (PE) are some of the most effective treatments available for posttraumatic stress disorder (PTSD). These treatments have been widely disseminated and promoted throughout the VA Health care System. However, adherence to and completion of these protocols among veterans is often poor, resulting in diminished impact. "Support persons" (SPs) such as relatives and close friends may provide a source of emotional or practical support in treatment, but little is known about how SPs are involved in or exposed to treatment principles and activities. The primary goal of the current research was to examine the experience of SPs of veterans who had poor adherence to treatment. We were interested in SPs' knowledge about the treatment, their level of involvement in treatment activities or sessions, and their potential interest in more participation or education. Qualitative analyses were used to examine data collected from interviews with 19 SPs of veterans who had an unsuccessful course of CPT or PE. Results indicated generally very low levels of knowledge and treatment participation. However, among most SPs there was substantial interest in the possibility of more treatment involvement, particularly in order to receive guidance from the clinician about how to respond to the veteran's symptoms. We suggest that it is possible and desirable to incorporate loved ones more formally into such protocols. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Plot and irony in childbirth narratives of middle-class Brazilian women.

Brazil's rate of cesarean deliveries is among the highest in the world and constitutes the majority of childbirths in private hospitals. This study examines ways middle-class Brazilian women are exercising agency in this context. It draws from sociolinguistics to examine narrative structure and dramatic properties of 120 childbirth narratives of 68 low- to high-income women. Surgical delivery constituted 62% of the total. I focus on 20 young middle-class women, of whom 17 had C-sections. Doctors determined mode of childbirth pre-emptively or appeared to accommodate women's wishes, while framing the scenario as necessitating surgical delivery. The women strove to imbue C-section deliveries with value and meaning through staging, filming, familial presence, attempting induced labor, or humanized childbirth. Their stories indicate that class privilege does not lead to choice over childbirth mode. The women nonetheless struggle over the significance of their agency in childbirth.

Life events, perceived stress and depressive symptoms in a physical activity intervention with young adult women.

OBJECTIVE: Examine interactive effects of life events, perceived stress and depressive symptoms during a randomized controlled aerobics intervention among women (aged 18-30) in the urban U.S. Midwest, 2006-2009. METHOD: Participants [n=372 at baseline and n=303 at follow up] completed perceived stress, depressive symptoms and life events scales at baseline and 5-6 month follow-up. Life events were correlated with perceived stress and depressive symptoms scales using Pearson correlation. Multivariate linear regression tested the relationship between the 20 most common life events with perceived stress and depressive symptoms. Regression models explored relationships between life events, perceived stress and depressive symptoms and the intervention effect. RESULTS: Higher levels of perceived stress and depressive symptoms correlated with more life events. At baseline, for every additional life event, depressive symptoms were higher; follow-up showed marginal significance with depressive symptoms, but a strong positive association with perceived stress. In the stratified model, for every life event at follow up, the perceived stress scale increased by 0.68 in the exercise group, but not in the controls. For every life event at follow-up, depressive symptoms were higher in controls, but not in the exercise group. CONCLUSION: Perceived stress and depressive symptoms co-occurred with life events at baseline and follow-up for participants. At follow up, perceived stress increased significantly among exercisers; depressive symptoms were significantly higher among controls. Findings suggest that new participation in structured physical activity entails a change in daily life that may buffer against depressive symptoms in relation to life events but not perceived stress.

Attrition and adherence of young women to aerobic exercise: lessons from the WISER study.

The purpose of this report is to identify factors associated with attrition and adherence of young women to a 16-week randomized aerobic exercise intervention on biomarkers associated with breast cancer risk. The exercise group was prescribed a progressive weight-bearing aerobic exercise program consisting of 30 minute workouts, 5 times/wk for 16 weeks. Adherence was calculated as the average minutes of exercise per week during participation in the study. Of the total of 212 women randomized into the exercise intervention 46 dropped out, of which 82.5% dropped out during the earlier stages of exercise suggesting that reasons for withdrawal may have been related to difficulties with initiating physical activity. Time commitment or lack of time was the primary reason for withdrawal. Drop outs reported lower physical activity at baseline than study completers (p=.0007). Although 78% of the 212 randomized participants completed the exercise intervention, only 4.7% of the participants exercised for at least 150 min/wk during the entire study period. Significant predictors of adherence were self-reported physical activity at baseline and depression scores. We conclude that predictors of adherence to exercise in our population of young women are similar to those reported for older adults. We also found that young women are more likely to exercise at moderate to vigorous intensity for 90 to 120 min rather than 150 min per week, even when participating in a highly structured exercise intervention.

Refugees' perspectives on barriers to communication about trauma histories in primary care.

Objective This study explores refugees' perspectives regarding the nature of communication barriers that impede the exploration of trauma histories in primary care.Method Brief interviews were conducted with 53 refugee patients in a suburban primary care clinic in the Midwest USA. Participants were asked if they or their doctors had initiated conversations about the impact of political conflict in their home countries. Qualitative data analysis was guided by grounded theory. Peer debriefings of refugee healthcare professionals were incorporated into the analysis.Results Two-thirds of refugee patients reported that they never shared how they were affected by political conflict with their doctors and that their doctors never asked them about it. Most refugees stated that they would like to learn more about the impact of trauma on their health and to discuss their experiences with their doctors.Conclusion Refugees are hesitant to initiate conversations with physicians due to cultural norms requiring deference to the doctor's authority. They also lack knowledge about how trauma affects health. Physicians should be educated to inquire directly about trauma histories with refugee patients. Refugees can benefit from education about the effects of trauma on health and about the collaborative nature of the doctor-patient relationship.

Young women's physical activity from one year to the next: What changes? What stays the same?

The Majority of women do not meet recommended physical activity (PA) guidelines. Assessment on changes in PA patterns among young, healthy US women was therefore performed. PA changes were assessed from self-reported PA at baseline (year 1) and follow-up (year 2). Participants [N=127] aged 18-30 years had completed a randomized controlled aerobics trial. A two-sample test of proportions tested the sample changes in PA; a paired t test assessed the within-person changes. A multivariate logistic regression model assessed the demographic predictors of meeting PA levels in year 2 (6 months post-intervention). Women who met the recommended PA used a combination of leisure and lifestyle PA at both timepoints. In year 2, attaining the recommended PA levels through leisure-time PA increased, while work-related and active transit PA decreased. Leisure-time physical activity at moderate and vigorous levels of intensity is recommended to ensure that young women meet the recommended PA levels and obtain health benefits.

Effects of aerobic exercise on premenopausal sex hormone levels: results of the WISER study, a randomized clinical trial in healthy, sedentary, eumenorrheic women.

BACKGROUND: It is hypothesized that exercise can lead to a decrease in breast cancer risk through several hormonal and nonhormonal mechanisms. The WISER (Women In Steady Exercise Research) study investigated the effects of aerobic exercise on premenopausal sex hormone levels. METHODS: Three hundred ninety-one sedentary, healthy, young eumenorrheic women were randomized either into an exercise intervention of 30 minutes of aerobic exercise 5 times a week for approximately 16 weeks (n = 212) or into a control group (n = 179). Serum levels of estradiol, estrone sulfate, testosterone, and sex hormone-binding globulin (SHBG), all in the midfollicular phase, and of progesterone, in the midluteal phase, were measured at baseline and at the end of the 16-week period. RESULTS: Compared with the controls (n = 153), exercisers (n = 166) experienced significant increases in aerobic fitness, lean body mass, and decreases in percent body fat. There were no significant changes in body weight and menstrual cycle length between or within groups. Progesterone decreased significantly in exercisers; however, this reduction was similar to that of the control group. No significant changes between or within groups were found for any of the other sex hormones or SHBG. CONCLUSIONS: In premenopausal women, 16 weeks of 150 minutes per week of moderate aerobic exercise in young women did not significantly alter sex hormone or SHBG levels. IMPACT: Any favorable effects that moderate aerobic exercise without an associated weight change may have on breast cancer risk in premenopausal women are unlikely to be a consequence of changes in levels of sex hormones or SHBG.

Dual conversations: body talk among young women and their social contacts.

In this article, we explore an area little researched within the literature on body dissatisfaction: the content and functions of body talk. We interviewed 60 diverse, college-educated women aged 18 to 30 in the urban United States about how social contacts talked about their bodies. Half the women, and by their reports, half their contacts (N = 295) endorsed some ideal body, most often the thin model. The other half favored a "healthy," "average" range in body size, shape, and/or appearance. Excepting family members, contacts gave mostly positive comments about women's bodies or appearance, or made no comments. Many critiqued their own bodies, however, as did nearly half the women participants. We suggest that these women exempted others, but not themselves, from critical body surveillance, rendering contestation of the ideal theoretical. We also suggest that the parallel airing of self-criticism repeatedly circulated through speech, if not through practice, the imperative to regulate one's own gendered body toward unattainable normativity.

Adherence to a strength training intervention in adult women.

BACKGROUND: The factors influencing exercise adherence are not well characterized in women in their premenopausal years. METHODS: The purpose of this report is to provide an analysis of demographic factors contributing to women's adherence to a 2-year twice-weekly weight training intervention. Overweight and obese premenopausal women were randomized to a control or intervention group. RESULTS: During the supervised period of the intervention (months 1 to 4), adherence was significantly lower among those with a higher level of education and among unmarried women with children aged 6 to 12 compared with married women without children (F = 4.83, P = .004). Overall adherence during the supervised and unsupervised periods was 95.4% and 64.5%, respectively (unadjusted mean). During year 1, white women were significantly more adherent to the intervention (70.3%) than women of color (48.6%). Non-married women with children 13 years or older were significantly less adherent than married women with children 5 years or younger (36.3% versus 75.4%, respectively, P < .007). Overall adherence was 51.4% in year 2. CONCLUSIONS: Interventions and public health recommendations need to further consider how to engage communities to provide effective support for long-term adherence to fitness center based exercise of all women, regardless of demographics.

Women in Steady Exercise Research (WISER): study design and methods.

PURPOSE: Observational studies have shown that physical activity is inversely associated with breast cancer etiology. WISER is a randomized controlled trial examining the effects of exercise training on oxidative stress, and hormonal and metabolic factors associated with breast cancer risk. METHOD: Subjects were recruited via emails, flyers, and mass media advertising. Inclusion criteria included: sedentary, age 18-30 years, non-smokers, BMI 18-40 kg/m2, not using any hormonal contraceptives. After completion of all baseline measures subjects were randomized into a control group or an exercise intervention for 4 menstrual cycles. The exercise group was asked to complete five 45 min exercise sessions per week. Exercise intensity was set at 65-70% of maximum age- predicted heart rate (max HR) and increased every four weeks. All women provided blood samples four times during the study for measurement of blood F2-isoprostanes, hormones and IGF-axis proteins. In addition, 24-hour urine samples were collected at baseline and follow-up for measurement of estrogen metabolites, as well as 24-hour food records to monitor participants' diets. DISCUSSION: WISER consented 683 women among which 391 enrolled and 319 successfully completed the study. The overall dropout rate was 18.4% (n=72) with a higher number of participants dropping from the exercise group (n=46). No differences were found between dropouts and completers with respect to age, body weight, BMI, and demographic characteristics with the exception of degree of education. Findings from this trial will be useful in understanding the physiologic mechanisms by which exercise possibly contributes to decreased breast cancer risk.

Shifting motivations: Young women's reflections on physical activity over time and across contexts.

This research analyzes motivations expressed by young, healthy, sedentary women before and after an exercise intervention. Young women (aged 18-30, n = 39) participated in focus groups or interviews during a 4-month exercise intervention. Afterward, 22 of these women and 20 controls completed physical activity diaries for 6 months and were interviewed. For the majority of women (n = 24), obligation to the study prevailed as the motivator during the intervention. Some ( n = 15) became physically active for their own benefit. Afterward, exercisers and controls said they were physically active to feel better and/or healthy (n = 20), for body image and/ or weight loss (n = 20), or both. Women expressed motivations for physical activity in ways that resonated with self-determination theory. Their commentaries expand on theory to include experiencing multiple motivations simultaneously and motivations shifting over time and in differing contexts. Social motivations were compelling, both those associated with societal values (research, health) and cultural trends (body image).

Communicating with local elected officials: lessons learned from clean indoor air ordinance campaigns.

This article describes a study of the effectiveness of communication strategies used to influence policy makers to support local smoke-free laws in the Minneapolis-St. Paul metropolitan region. Twenty-seven of 41 members of three city councils and two county boards of commissioners were individually interviewed as were seven advocates who campaigned for the bans. Officials valued public health and economic data, public opinion polls, personally written e-mails, and dialogue with constituents. Phone banking messages indicated public support but were a nuisance. Officials felt that media ads were a waste of money and leafleting and other personal targeting were unacceptable. Advocates tended not to critically examine their own efforts for strengths and weaknesses and seemed unconcerned by public officials' negative reception to some strategies. This case study suggests the need for reflection on the pros and cons of well-funded, highly orchestrated campaigns for public health policy, as these strategies may clash with the political process of building relationships.

Purposeful exercise and lifestyle physical activity in the lives of young adult women: findings from a diary study.

It is important to know how physical activity is incorporated in women's lives to assess ways they can feasibly attain and maintain lifelong healthy practices. This study aimed to determine whether patterns of activity differed among young women whose physical activity met nationally recommended levels from those who did not. The sample was 42 women (aged 18-30 years) who had completed an exercise intervention (22 from the exercise group, 20 from the control group). Participants recorded pedometer steps and physical activities in diaries including form, duration and perceived exertion during 12 randomly assigned weeks over 26 weeks. We divided the sample into quartiles of moderate to vigorous physical activity to examine the composition of physical activities per quartile. Walking and shopping comprised the majority of physical activity in the lowest quartile of moderate to vigorous physical activity. In the second and third quartiles, walking and household/childcare together comprised more than two-thirds of all activities. Only in the highest quartile was cardio activity (not including walking, shopping and household/childcare) the largest proportion of activity; this category stood alone as varying significantly across quartiles of moderate to vigorous physical activity (p < 0.005). Among these young adult women, self-reported "lifestyle" physical activity was not sufficient to meet recommended levels of moderate to vigorous physical activity. The one-quarter who met recommended levels of moderate to vigorous physical activity did so largely through purposeful physical activities directly associated with exercise. Further research is needed to refine means of more fully measuring physical activities that women frequently perform, with particular attention to household work, childcare and shopping and to differing combinations of activities and levels of exertion by which diverse women can meet the recommended levels. The findings of this small scale study reinforce the ongoing benefit of recommending structured, planned physical activity at moderate and vigorous levels of intensity to young, healthy women to ensure they obtain the health benefits.

Barriers and motivators for strength training among women of color and Caucasian women.

The present study examined factors associated with adherence to a strength training (ST) intervention in a randomized controlled intervention trial testing whether twice-weekly strength training over 2 years could prevent age-associated increases in body fat in 80 overweight to mildly obese women, aged 25-44 years. Two sets of focus groups (FGs) were conducted with 25 women of color and 24 Caucasian participants, representing 60% of intervention participants. Fifty-five percent of FG participants had low adherence (defined as < or = 80% adherence to twice-weekly gym-based strength training). Demographic data indicated that marital status and childcare responsibilities affected adherence. Participants' perceptions of experiences in the ST intervention did not correspond to adherence levels or vary by race/ethnicity. Major impediments to adherence included competing obligations and related scheduling difficulties; life transitions; and declining or insufficient social motivators.

Food choices of young African-American and Latino adolescents: where do parents fit in?

To gain insight into parents' perceptions of the food preferences of their young adolescents, and their negotiating and decision-making strategies around food purchasing and meals, four focus groups were held with 32 African-American parents and three focus groups with 14 Spanish-dominant, first-generation immigrant Latina mothers. Most participants were of low socioeconomic status and were single parents. Many African-American parents emphasized children's growing appetites and preferences for fast food. Many reported making weekday dinner decisions jointly with the child or allowing the child to eat a lunch-like alternative, and allowing serve-yourself meals on weekends. A few prepared traditional ethnic foods. Latina parents reported that their children liked ethnic foods and fast/junk foods. They emphasized buying foods their children wanted, making no eating restrictions, and preparing traditional ethnic dinners without alternatives. African-American and Latina parents displayed concern over whether to place restrictions on young adolescents' eating. Further research is needed on the ways in which socioeconomic inequalities compound barriers to healthful eating, with particular attention to low income and immigrant populations.

Observations of parent-child co-shoppers in supermarkets: children's involvement in food selections, parental yielding, and refusal strategies.

The study aimed to collect descriptive information on the decision-making processes of adult shoppers around food purchases when young children are present. Anthropological field observations were conducted on adult-child grocery shoppers. Eleven supermarkets in the Minneapolis-St. Paul metropolitan region. A convenience sample (n = 142) of adult-child shoppers at 8 budget and 3 deluxe supermarkets located in diverse urban and suburban areas. Observations registered adult-child interactions over food selections, including parental yielding or refusal strategies and child engagement in shopping. Means and frequencies were calculated for food items considered. In 67 (50.4%) of the total 133 observations, a child initiated a request. Half (55.2%) of the requests were for sweets or snacks. Nearly half (47.8%) of adults yielded to the child's request. Brands and marketing techniques appeared to be a factor in 28.6% of selections. The most frequent adult refusals either provided an explanation or ignored the request. Adults yield to children's requests for sweets and snacks nearly as often as they refuse them. However, effective refusal strategies are used by many adults. Opportunities exist in the grocery store for adults to reinforce young children's interest in food and nutrition.

Nutrition labeling and value size pricing at fast-food restaurants: a consumer perspective.

PURPOSE: This pilot study examined nutrition-related attitudes that may affect food choices at fast-food restaurants, including consumer attitudes toward nutrition labeling of fast foods and elimination of value size pricing. METHODS: A convenience sample of 79 fast-food restaurant patrons aged 16 and above (78.5% white, 55% female, mean age 41.2 [17.1]) selected meals from fast-food restaurant menus that varied as to whether nutrition information was provided and value pricing included and completed a survey and interview on nutrition-related attitudes. RESULTS: Only 57.9% of participants rated nutrition as important when buying fast food. Almost two thirds (62%) supported a law requiring nutrition labeling on restaurant menus. One third (34%) supported a law requiring restaurants to offer lower prices on smaller instead of bigger-sized portions. CONCLUSION: This convenience sample of fast-food patrons supported nutrition labels on menus. More research is needed with larger samples on whether point-of-purchase nutrition labeling at fast-food restaurants raises perceived importance of nutrition when eating out.