Managing children's asthma: what role do caregivers' mental representations of trigger and symptom management behaviors play?

OBJECTIVE: Pediatric asthma management is challenging for parents and guardians (hereafter caregivers). We examined (1) how caregivers mentally represent trigger and symptom management strategies, and (2) how those mental representations are associated with actual management behavior. METHODS: In an online survey, N = 431 caregivers of children with asthma rated 20 trigger management behaviors and 20 symptom management behaviors across 15 characteristics, and indicated how often they engaged in each behavior. RESULTS: Principal components analysis indicated 4 dimensions for trigger management behaviors and 3 for symptom management behaviors. Bayesian mixed-effects models indicated that engagement in trigger management behavior was more likely for behaviors rated as affirming caregiver activities. However, trigger management behavior did not depend on how highly the behavior was rated as challenging for caregiver, burdensome on child, or routine caregiving. Engagement in symptom management behavior was more likely for behaviors rated as affirming and common and harmless to the child, but was unrelated to how highly a behavior was rated as challenging for caregivers. CONCLUSION: These results suggest that interventions might be particularly useful if they focus on the affirming nature of asthma management behaviors. However, such interventions should acknowledge structural factors (e.g. poverty) that constrain caregivers' ability to act.

Daily aggression domains differentially relate to daily affect and self-esteem.

How do daily fluctuations in aggression relate to daily variability in affect and self-esteem? Although research has examined how trait aggression relates to affect and self-esteem, state aggression has received little attention. To this end, we had 120 US undergraduates participate in a 14-day daily diary study where they responded to state-level measures of aggression, affect, and self-esteem. Crucially, we used multifaceted state measures of both aggression (anger, hostility, verbal aggression, physical aggression) and affect (positive vs. negative, activated vs. deactivated). Multilevel models revealed that daily anger and hostility related positively to daily negative affect and negatively to daily positive affect. Similarly, daily anger and hostility related negatively to daily self-esteem. In contrast, daily verbal and physical aggression were largely unrelated to daily affect and self-esteem; however, unexpectedly, daily physical aggression related positively to daily positive activated affect, but only when controlling for the other daily aggression domains. Overall, daily attitudinal aggression measures-anger and hostility-related to daily affect and self-esteem in theoretically consistent ways, whereas daily behavioral aggression measures-verbal and physical aggression-did not. Our findings support expanding the General Aggression Model to incorporate state-level processes.

How are mental representations of asthma triggers and symptoms related to interpersonal risk perceptions? A psychometric investigation of caregivers of children with asthma.

OBJECTIVE: Parents and guardians (hereafter caregivers) make decisions for their children's medical care. However, many caregivers of children with asthma struggle to understand their child's illness. We used the psychometric paradigm to investigate how caregivers conceptualize, or mentally represent, asthma triggers and symptoms and how these representations are linked to perceived asthma exacerbation risk. METHODS: We asked 377 caregivers of children with asthma across the U.S. to rate 20 triggers or 20 symptoms along 15 characteristics. Caregivers also indicated their perceived risk of their child having an asthma exacerbation (hereafter interpersonal risk perceptions). Using principal components analysis, we extracted key dimensions underlying caregivers' ratings on the characteristics. Then we related the triggers' and symptoms' scores on the dimensions to caregivers' interpersonal risk perceptions. RESULTS: Interpersonal risk perceptions were higher for triggers with high ratings for the dimensions severe and relevant, and negative affect-yet manageable, but not chronic-yet unpredictable. Risk perceptions were also higher for symptoms with high ratings for the dimensions severe and unpredictable, and relevant and common, but not self-blame or manageable despite unknown cause. CONCLUSION: By identifying key dimensions underlying caregivers' mental representations of asthma triggers and symptoms, these findings can inform a new approach to asthma education.

Delay Discounting for HIV/STI Testing.

Introduction: Wait time in healthcare is an important barrier to HIV/STI testing. Using a delay discounting approach, the current study examined a systematic reduction in testing likelihood as a function of delay (wait time) until testing. Methods: In Study 1 (N = 421; data collected in 2019), participants were randomly assigned to either a chlamydia/gonorrhea group or HIV group. A delay discounting task asked them to report how likely they would get tested for the assigned STI if they had to wait for the test (the delay durations varied within persons). In Study 2 (N = 392; data collected in 2020), we added a smaller, sooner outcome (consultation without testing) and tested whether the effect of delay was mediated by perceived severity of the STIs. Results: In both studies, the subjective value of a delayed STI test was discounted. That is, people were less likely to undergo STI testing as the delay to STI testing increased. The chlamydia/gonorrhea group discounted delayed testing more than the HIV group (i.e., the effect of delay on testing decisions was stronger for the former). This effect was statistically mediated by perceived severity. Conclusions: We found evidence for delay discounting for HIV/STI testing and that testing decisions were more susceptible to delay when the test was for relatively mild STIs. Policy Implications: Even mild STIs can cause serious health damage if left untreated. The findings provide strong argument for policies aimed to reduce wait times in healthcare, especially for relatively mild STIs.

Linking cognitive and affective heuristic cues to interpersonal risk perceptions and behavior.

People often use cognitive and affective heuristics when judging the likelihood of a health outcome and making health decisions. However, little research has examined how heuristics shape risk perceptions and behavior among people who make decisions on behalf of another person. We examined associations between heuristic cues and caregivers' perceptions of their child's asthma risk, the frequency of caregivers' asthma management behaviors, and child health outcomes. We used Ipsos KnowledgePanel to recruit 814 U.S. adult caregivers of children with asthma of the age <18 years. Participants completed a survey at baseline (T1) and 3 months later (T2). Caregivers who, at T1, reported greater negative affect about their child's asthma (affect heuristic cue), greater ease of imagining their child experiencing asthma symptoms (availability heuristic cue), and greater perceived similarity between their child and a child who has ever experienced asthma symptoms (representativeness heuristic cue) reported statistically significantly (p < 0.05) higher interpersonal perceived risk of their child having an exacerbation or uncontrolled asthma at T1. They also indicated at T2 that their child had poorer asthma control and more frequent exacerbations. Greater T1 negative affect was associated with more frequent T2 actions to reduce inflammation, manage triggers, and manage symptoms, and with poorer T2 child health outcomes. Heuristic cues are likely important for interpersonal-not just personal-risk perceptions. However, the interrelationship between caregivers' ratings of heuristic cues (in particular, negative affect) and risk judgments may signify a struggle with managing their child's asthma and need for extra support from health care providers or systems.

Psychometric properties and predictive validity of the PP-ACT.

OBJECTIVE: The Parent Proxy Asthma Control Test (PP-ACT) is a self-report measure of asthma control completed by caregivers on behalf of a child. We examined the psychometric properties and the reliability and predictive validity of the PP-ACT. METHODS: We conducted two studies (one cross-sectional, one longitudinal over three months) that surveyed caregivers (N = 1622) of children with asthma. Caregivers completed the PP-ACT and a variety of other measures, including child health outcomes. RESULTS: We found clear evidence that the five-item PP-ACT assesses two distinct constructs: Items 1-4 (which we call the PP-ACT4) assess symptoms, impairment, and use of a short acting beta-2 blocker (albuterol); Item 5 assesses caregivers' global subjective assessment of their child's asthma control. In addition, the two constructs function as unique predictors of asthma outcomes. Both the PP-ACT4 and Item 5 predicted unique variance in ED visits, the number of symptom-free days, and child quality of life. Only the PP-ACT4 predicted frequency of ICS use and only at Time 1 in Study 1. Conversely, Item 5 predicted exacerbation frequency whereas the PP-ACT4 did not. CONCLUSION: Our findings suggest that researchers and clinicians should treat the PP-ACT4 and Item 5 as distinct indicators of asthma control because they differentially predict asthma outcomes and likely have distinct meanings to caregivers.Supplemental data for this article is available online at https://doi.org/10.1080/02770903.2022.2036755 .

Maternal Functioning and Psychological Distress During the COVID-19 Pandemic.

Background: Our objective was to understand maternal functioning and psychological distress among mothers of young children in the United States during April/May 2020, early in the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: Participants were 862 moms of children aged 0-3 years old who completed an online survey. We examined maternal functioning (maternal competency and self-care subscales from the Barkin Index of Maternal Functioning) and psychological distress (depression, anxiety, and stress subscales of the DASS-21), and then examined interaction effects of COVID-19 impact and socioeconomic status (SES; represented by income and education). Results: Mothers' reports of higher maternal functioning correlated with lower psychological distress and both sets of factors varied substantially by SES and COVID-19 Impact. Higher COVID-19 Impact was associated with lower functioning and greater distress. Higher income and education were associated with better maternal self-care, but not maternal competency. Although we expected high SES to buffer mothers from a higher impact of COVID-19, we found that mothers with high SES reported a lower level of maternal competence and more stress than low-SES mothers. Interactions between COVID-19 impact and SES predicting maternal functioning and psychological distress revealed that when COVID-19 impact was low, high SES was associated with high functioning scores and less distress. Conclusions: This work challenges the assumptions that a stressful event will be uniformly experienced by mothers of young children as well as the stress-buffering role of higher SES. This study highlights the importance of considering SES when characterizing maternal functioning and psychological distress during times of high stress. Further research is needed to examine the processes contributing to these discrepancies.

I don't know my child's asthma risk: evidence against satisficing as an explanation for 'don't know' responses.

Several studies suggest that "don't know" (DK) responses to risk perception items may represent meaningful expressions of uncertainty about disease risk. However, researchers are often discouraged from including a DK response option in survey items due to concerns about respondents overusing it to minimize cognitive effort-a phenomenon often referred to as satisficing. Our objective was to investigate whether patterns of DK responses to risk perception survey items were consistent with satisficing behavior. We conducted a secondary analysis of survey data from 814 parents and guardians (hereafter caregivers) of children with asthma. Caregivers answered 18 items assessing their perceived risk of their child experiencing two types of poor asthma outcomes: asthma exacerbation, and low asthma control. We examined differences in the frequency and distribution of DK responses across all 18 items and by type of risk perception item (i.e., 2 vs. 5 response options, absolute vs. comparative risk). We found that 32% (n=548) of respondents marked DK at least once. Of the 266 caregivers who provided any DK response, most did so for only 1 or 2 items (51.9%, n=138), and only 6% (n=15) answered DK to more than half of the items. Using random coefficient Poisson models, we found more DK responding for dichotomous absolute (30.1%) than ordinal absolute items (5.3%), b=1.72, p<.001. We also found fewer DK responses to the ordinal absolute items than the comparative items (8.2%), b=-0.49, p<.001. Using Chi-square tests, we found that inattentive responding was not associated with responding DK. Our findings suggest that satisficing is unlikely to completely explain DK responding to perceived risk survey items. Researchers who exclude DK response options from risk perception survey items may obtain an incomplete understanding of their study sample's beliefs about risk.

Caregiver Perceptions of Change in Pediatric Asthma Control During the COVID-19 Pandemic.

Purpose: Although several indicators suggest that pediatric asthma control in the United States improved early in the pandemic, other indicators suggest not. Missing are reports from caregivers of the experiences of their children with asthma early in the pandemic. Methods: Using the PP-ACT and other measures that we specifically constructed for our research, we conducted a cross-sectional national survey of US caregivers of children with asthma (N=595) to examine perceived change in their child's asthma control and changes in reports of ED visits and use of emergency relief medicine and controller medicine pre-pandemic (January to March 2020) versus early-pandemic (June to September 2020). Results: Caregivers fell into three groups: most caregivers perceived that their child's asthma control was improved (50.3%) or unchanged (41.2%), and few reported worse control (8.5%). Surprisingly, all three groups of caregivers reported similar frequencies of early-pandemic and pre-pandemic ED visits and use of emergency relief medicine. Also surprising, caregivers who perceived their child's asthma as more controlled (compared with the other two groups) reported more frequent ED visits and use of emergency relief medicine, yet also more use of controller medicine at both early-pandemic and pre-pandemic. Conclusion: The mismatch between caregivers' perceptions of their child's early-pandemic asthma control and their reports of ED visits and use of emergency relief medicine suggests that caregivers may rely on a gist (a global evaluation that can include nonbiomedical evidence) when estimating their child's asthma control. Caregivers and their families could benefit from help from clinicians in understanding the discrepancy between subjective asthma control and asthma control indicators and in understanding what well-controlled asthma looks and feels like.

Stigma Toward Consensual Non-Monogamy: Thematic Analysis and Minority Stress.

Consensually non-monogamous (CNM) romantic and sexual relationships tend to be stigmatized. The present research examined this stigma across two studies. First, we qualitatively explored the specific ways that people in CNM relationships report experiencing stigma using thematic analysis and identified the following four themes: Expressions of discomfort/disapproval of CNM, Loss of resources/threatening behaviors, Character devaluation, and Relationship devaluation (Study 1; N = 372). Second, we examined the relationship between experienced stigma and psychological well-being for people in CNM relationships, using the framework of minority stress theory. We found that experienced stigma was positively associated with psychological distress and that this association was partially statistically mediated by anticipated stigma and internalized stigma (Study 2; N = 383). Overall, this research strives to achieve a better understanding of the processes and potential consequences of stigma toward CNM relationships and individuals.

Causal Modeling of Descriptive Social Norms from Twitter and the Physical World on Expressed Attitudes Change: A Case Study of COVID-19 Vaccination.

The high infection rate of SARS-CoV-2 makes it urgent to promote vaccination among the public. Previous studies found that people tend to follow the behaviors desired in descriptive social norms, which exist in both social media (e.g., Twitter) and physical-world communities. However, it remains unclear whether and to what extent the descriptive social norms from the cyber and physical communities affect people's attitude change. This study, focusing on COVID-19 vaccination, developed a Directed Acyclic Graphs model to investigate the causal effects of the descriptive social norms of (i) Twitterverse and (ii) physical-world communities on people's attitude change as well as the temporal scales of the effects. It used a Long Short-Term Memory classifier to extract expressed attitudes and changes from relevant tweets posted by 843 sample users. We found that a people's attitude change toward the vaccination receives a more significant impact from Twitter-based descriptive social norms over the prior week, whereas the norms in the physical-world communities tend to be less influential but still notable with the time gap between 2 weeks and 1 month. The findings revealed the potential of using online social norm approaches to proactively motivate behavioral changes toward a culture of health.

Interpersonal comparison among caregivers of children with asthma.

Objective: We examined the extent to which caregivers of children with asthma used interpersonal comparisons-a novel comparison process that parallels social comparison and temporal comparison-to form judgments about their child. Methods & Measures: Using semi-structured interviews adapted from the McGill Illness Narrative Interview, we examined the interpersonal comparisons that caregivers of a child with asthma (n = 41) made regarding their child. Results: Interpersonal comparisons influenced caregiver thoughts, feelings, and behavior. They helped caregivers distinguish asthma from other breathing problems, evaluate the severity of the asthma, and understand their child's experience. However, they also created uncertainty by highlighting the complex, unpredictable nature of asthma. Interpersonal comparisons were a source of gratitude and hope, but also worry and frustration. Finally, interpersonal comparisons influenced caregivers' decisions and actions, resulting in decisions that aligned with and, at times, ran counter to biomedical models of asthma care. In some instances, caregivers used interpersonal comparisons to motivate their child's behavior. Conclusion: The interpersonal comparisons served as a source of information for caregivers trying to understand and manage their child's asthma. Investigating these comparisons also expands how we think about other comparison theories.

Adult Romantic Attachment, Electronic Messaging, and Relationship Quality.

The present study examined associations among adult romantic attachment, relationship quality, and electronic messaging frequency/preferences in 302 romantically partnered undergraduates. Anxious people desired more frequent messages than they received, whereas avoidant people desired less frequent messages than they received. Anxious people received fewer messages from their partners, whereas avoidant people sent fewer messages to their partners. Additionally, anxious people took less time to respond to their partner than their partners took to respond to them, whereas avoidant people took more time to respond to their partner than their partners did to respond to them. Finally, the relation between message frequency satisfaction and relationship quality was stronger for more anxious people. These results suggest that individual differences in attachment dimensions related to differences in romantic messaging behavior in theoretically consistent ways.

Self-Esteem in 60 Seconds: The Six-Item State Self-Esteem Scale (SSES-6).

With 20 items, the State Self-Esteem Scale (SSES) can be cumbersome in settings that demand efficiency. The present research created an efficient six-item version of the SSES that preserves score reliability and validity and its three-dimensional structure: social, appearance, and performance self-esteem. Item response theory and confirmatory factor analyses identified the "best" six items-two from each dimension (Study 1). Participants completed the SSES four times at 2-week intervals (Studies 2 and 3). The six-item SSES' scores showed adequate test-retest reliability, explained substantial variance in trait-relevant measures, and showed convergent validity with related self-esteem measures. Participants completed the SSES and a laboratory experiment where they received negative feedback on an essay they had written and could retaliate against their evaluator by allocating hot sauce for them to consume (Study 4). The six-item SSES interacted with self-esteem instability in expected ways to predict hot sauce allocated.

The Rise, Demise, and Reprise of the Increasingly Protracted APA Journal Article?

Are APA journal articles getting longer or shorter over time? Earlier work that examined changes over time in article length in 24 APA journals (1986-2005) found that pages per article increased over time for the average journal, peaking around 2001, and then plateaued thereafter. But have these trends continued during the past 14 years? The current research extends prior work by adding additional years (1986-2019) and four additional journals (28 journals, 34 years, and 865 total observations). Multilevel growth curve analyses revealed a cubic effect of time on average article length, showing an increase in the 1980s and 1990s, a plateau or slight decline in the 2000s, and a slight increase again in the 2010s. Journal impact factors (JIFs) moderated linear growth over time; journals with higher JIFs had larger linear increases in article length. Exploratory multilevel interrupted time-series analyses suggested that the average linear increase in pages per article over time was greater after the start of psychology's credibility crisis (2012-2019) than before it (1986-2011), which may relate to an increased emphasis on reporting details and transparency. We discuss implications for article length in the contexts of publishing and psychology's ongoing credibility crisis.

Predictors of Face and Body Visibility in Online Dating Applications Among Young Men Who Have Sex with Men.

In this study, we explored the factors relating to face and body visibility in young men who have sex with men (YMSM) from online dating applications. Research on visual self-presentation in online dating applications, especially in YMSM, remains scarce. The sample consisted of 339 young men (ages 18-24 years) who had casual sex with one or more male partners from online dating applications. Participants completed an online survey asking how visible their face and body were on their profile pictures. For body visibility, participants rated the visibility of their upper and lower body separately. We also computed difference scores between face and body visibility to measure face visibility in relation to body visibility (e.g., showing more-visible face compared to body). Predictors included self-rated attractiveness, fear of being identified on the applications, and motives for application use. Participant age and duration of application use were statistically controlled in all analyses. Results showed that higher perceived attractiveness related to higher upper- and lower-body visibility on profile pictures. Greater fear of being identified related to lower face visibility and less-visible face relative to upper- and lower-body visibility. Having a relationship motive was associated with higher face visibility. Older age and longer duration of application use were associated with more-visible face relative to lower body. The findings contribute to the literature on visual self-presentation in online dating applications in young and vulnerable sexual minorities.

It's The "Why": Links between (Non)autonomous Sexual Motives, Sexual Assertiveness, and Women's Orgasm in Casual Sex.

Existing literature shows conflicting and inconclusive evidence regarding women's sexual experiences in casual sex. Some studies have found negative sexual outcomes (e.g., fewer orgasms), while others have found positive sexual outcomes (e.g., more orgasms, higher sexual satisfaction) when women had casual sex. According to self-determination theory (Deci & Ryan, 1985), people's needs are fulfilled when their choice and behavior are self-motivated and reflect their intrinsic values. We hypothesized that women's autonomous motivation to have casual sex would be associated with higher orgasmic function, whereas nonautonomous motivation would be associated with lower orgasmic function in casual sex. We also hypothesized that sexual assertiveness would mediate the relationship between sexual motives and orgasmic function in casual sex. Participants in this study were women (N = 401) aged 18-59 years who reported having had casual sex in the past 12 months. Participants completed an online survey reporting their motives to have casual sex, sexual assertiveness, and orgasmic function (e.g., orgasm frequency, satisfaction with orgasm) in casual sex. We focused on two motives: (a) pleasure motive and (b) insecurity (i.e., self-esteem boost and pressure) motive. Results showed that greater pleasure (autonomous) motives related to higher sexual assertiveness, which in turn related to higher orgasmic function in casual sex. In contrast, greater insecurity (nonautonomous) motives related to lower sexual assertiveness, which in turn related to lower orgasmic function in casual sex. The findings support self-determination theory, suggesting that autonomous motives are important for women's sexual experience in casual sex.

Contributions of biomass/solid fuel burning to blood pressure modification in women: A systematic review and meta-analysis.

OBJECTIVES: Approximately 2½ billion people worldwide rely on solid/biomass fuel as fuel for cooking/heating the home. Environmental exposure to the smoke associated with biomass fuel burning has been associated respiratory diseases, cardiac disorders, and altered blood pressure. Therefore, a systematic review and meta-analysis was conducted to study this relationship across multiple studies. METHODS: Searches were performed using PRISMA guidelines for articles using Web of Science, PubMed, Toxline, and Web of Science of peer reviewed papers with no beginning time restriction until February 2017. The search yielded 10 manuscripts after application of inclusion criteria, which encompassed 93 724 participants. Outcomes included (a) the proportion of people with a clinical diagnosis of hypertension in an exposed (vs. unexposed) population or (b) correlation coefficients examining degree of exposure and systolic/diastolic blood pressure. RESULTS: The four studies reporting effect sizes for hypertension (N = 92 042) had a weighted mean effect size of r = .12 [-0.02, 0.27], z = 1.66, p = 0.097. The six studies reporting effect sizes for systolic and diastolic blood pressure (N = 1682) had weighted mean effect sizes of r = .15 [0.06, 0.24], p = 0.001, and r = .09 [0.03, 0.15], p = 0.002, respectively. CONCLUSION: These analyses revealed that there is a small-but-significant relationship between biomass fuel exposure and an increase in both systolic and diastolic blood pressure, but the relationship between biomass fuel and hypertension specifically remains unclear.

Examining commonsense epidemiology: The case of asthma.

Commonsense epidemiology-how lay people think about diseases and their causes and consequences-can influence how people respond. We examined three lay epidemiological beliefs about 20 triggers and 19 symptoms among 349 caregivers of children with asthma. Our findings contradicted the prevalence-seriousness hypothesis (perceived prevalence and seriousness correlate negatively). The data partially supported the prevalence-control hypothesis (perceived prevalence and asthma control correlate negatively). We found weak support for the seriousness-control hypothesis (perceived seriousness and asthma control correlate negatively). These findings suggest boundary conditions on the application of commonsense epidemiological beliefs.

American psychology is becoming more international, but too slowly: Comment on Thalmayer et al. (2020).

Commenting on Thalmayer, Toscanelli, and Arnett (2020), we provide broader analysis of the national institutional affiliations of authors (2,978), editors (286), and consulting editors (2,652) from seven (vs. six) American Psychological Association (APA) journals that span over 40 (vs. 30) years. Using multilevel models, results showed that percentages of lead authors at American institutions decreased linearly and significantly and over time. Predicted mean percentages of American authors were 86% in 1978 versus 54% in 2018, a decrease of 37%. Percentages of editors and consulting editors at American institutions also decreased significantly; however, the effect for consulting editors was also quadratic-the linear decline accelerated over time. Predicted mean percentages of American consulting editors at 10-year intervals (1980-2020) were 94%, 92%, 89%, 80%, and 69%. Our 2020 predicted mean of 69% American consulting editors was notably lower than Thalmayer et al.'s (2020) 2018 mean of 82%. In addition, higher-impact journals had more pronounced quadratic declines in the percentages of American consulting editors over time. American psychology continues to become more international, but not quickly enough. We concur with Thalmayer et al.'s (2020) policy proposals, especially that APA journals and their editors should actively pursue non-American associate and consulting editors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).