Family-Focused Facilitated Fitness: Feasibility and Acceptability of a Couple-Based Physical Activity Intervention for Hematopoietic Cell Transplant Recipients and Their Caregiving Partners.

Reductions in physical activity (PA) are common among patients following hematopoietic cell transplantation, and a risk factor for poor physical functioning. PA among spouses/cohabiting partners, who frequently serve as the patient's primary caregiver, may also be reduced due to caregiving demands and limited bandwidth for self-care. In addition, the patient-caregiver relationship can be compromised, and communication patterns disrupted. All PA interventions in the hematopoietic cell transplantation setting have focused entirely on patients, ignoring an opportunity to synergistically engage and benefit the caregiver as well. We sought to test feasibility and acceptability of a couple-based intervention entitled Family-Focused Facilitated Fitness (FFFF), designed to improve PA as assessed by daily step counts among both patients undergoing hematopoietic cell transplantation and their caregivers. Guided by interdependence and communal coping perspectives, FFFF is an 8-week, remotely-delivered intervention that provides training in communication skills and joint problem-solving to help patients and caregivers support one another in PA. Participants are also given a Fitbit to track their steps and weekly individualized step prescription based on the 75th percentile ranked value of their last 7 recorded daily step counts. A priori benchmarks for feasibility and acceptability in this single-arm pilot were as follows: 50% of eligible couples would agree to participate, 70% of couples would attend all 8 sessions, 80% of participants would provide valid Fitbit wear data 4/7 days/ week, and among sessions reviewed for treatment fidelity, 85% of treatment protocol elements would be covered. Couples were recruited prior to transplant. Among 26 couples approached and deemed eligible, 17 enrolled (65% agreement) and completed baseline assessment. Three couples later withdrew after transplantation but prior to receiving the intervention, resulting in 14 couples commencing the intervention, on average 21 days post-transplant. Four couples subsequently discontinued due to medical complications (n = 3) or caregiver schedule (n = 1). Among the 10 couples who completed the intervention, the percentage of participants meeting our benchmark of valid Fitbit wear at least 4 days per week was 85% in week 1, 90% in weeks 2 to 7, and 80% in week 8. Treatment fidelity was 95% on average across 24 sessions reviewed (3 cases). Treatment satisfaction scores were uniformly high across multiple dimensions, with all means above 4 on the 1 to 5 scale. Daily step counts among those attending all 8 intervention sessions increased from 2249 ± 302 steps/day in week 1 to 4975 ± 1377 steps/day in week 8 among patients, and from 8676 ± 3760 steps/day in week 1 to 9838 ± 3723 steps/day in week 8 among caregivers. Qualitative feedback indicated perceived mental and physical health benefits of the program. Participants also offered suggestions for adaptations to accommodate medical setbacks and constraints. All a priori feasibility benchmarks were met or exceeded. Results offer promise for utility of the program to engage and leverage patient-caregiver dyads to increase PA following transplant. An investigation using a randomized controlled design will be necessary to adequately examine change over time relative to control and its possible impact on clinical and patient-reported outcomes.

Couples communication and cancer: Sequences and trajectories of behavioral affective processes in relation to intimacy.

Cancer poses a set of physical and emotional challenges to the patient, spouse, and their relationship. One challenge for couples is discussing cancer-related concerns in a manner that facilitates intimacy. Current couple-based interventions have been shown to have mixed efficacy, and little is known about how they bring about improvements. This study aims to expand our understanding of dyadic communication and intimacy to adapt and/or develop more effective interventions for couples coping with cancer. To accomplish this goal, the present study examined affective and behavioral processes associated with intimacy using the valence-affective-connection (VAC) framework and observational coding methods. Participants were 134 couples in which a patient was diagnosed with breast, colorectal, or lung cancer. Couples completed a battery of questionnaires, including a self-report measure of intimacy. Couples also completed a 15-min videotaped interaction about a cancer topic of their choosing, which was observationally coded for communication behavior and affective expression. Couples coping with cancer who reported higher versus lower intimacy engaged in qualitatively different levels, types, and patterns of communication behavior and affective expression. Specifically, couples who reported lower relationship intimacy used negative approach behavior and hard negative affect more frequently and for longer periods of time and were more likely to use avoidance-based communication. Higher intimacy couples were less likely to sustain the use of negative behavior and affect and displayed more reciprocity of positive joining affect. The study highlights important considerations for couple-based interventions and research in the context of cancer. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Assessment of financial screening and navigation capabilities at National Cancer Institute community oncology clinics.

BACKGROUND: Cancer-related financial hardship is a side effect of cancer diagnosis and treatment, and affects both patients and caregivers. Although many oncology clinics have increased financial navigation services, few have resources to proactively provide financial counseling and assistance to families affected by cancer before financial hardship occurs. As part of an ongoing randomized study testing a proactive financial navigation intervention, S1912CD, among sites of the National Cancer Institute Community Oncology Research Program (NCORP), we conducted a baseline survey to learn more about existing financial resources available to patients and caregivers. METHODS: The NCORP sites participating in the S1912CD study completed a required 10-question survey about their available financial resources and an optional 5-question survey that focused on financial screening and navigation workflow and challenges prior to starting recruitment. The proportion of NCORP sites offering financial navigation services was calculated and responses to the optional survey were reviewed to determine current screening and navigation practices and identify any challenges. RESULTS: Most sites (96%) reported offering financial navigation for cancer patients. Sites primarily identified patients needing financial assistance through social work evaluations (78%) or distress screening tools (76%). Sites revealed challenges in addressing financial needs at the outset and through diagnosis, including lack of proactive screening and referral to financial navigation services as well as staffing challenges. CONCLUSIONS: Although most participating NCORP sites offer some form of financial assistance, the survey data enabled identification of gaps and challenges in providing services. Utilizing community partners to deliver comprehensive financial navigation guidance to cancer patients and caregivers may help meet needs while reducing site burden.

Concurrent and Prospective Associations Between Communicated Emotional Arousal and Adjustment Among Couples Coping With Cancer.

BACKGROUND: The experience of cancer can create considerable emotional distress for patients and their committed partners. How couples communicate about cancer-related concerns can have important implications for adjustment. However, past research has primarily utilized cross-sectional designs and retrospective self-reports of couple communication. While informative, little is known about how patients and partners express emotion during conversations about cancer, and how these emotional patterns predict individual and relational adjustment. PURPOSE: The current investigation examined how patterns of emotional arousal within couples' communication about cancer was associated with concurrent and prospective individual psychological and relational adjustment. METHODS: At baseline, 133 patients with stage II- breast, lung, or colorectal cancer and their partners completed a conversation about a cancer-related concern. Vocally expressed emotional arousal (f0) was extracted from recorded conversations. Couples completed self-report measures of individual psychological and relational adjustment at baseline and at 4, 8, and 12 months later. RESULTS: Couples who started the conversation higher in f0 (i.e., greater emotional arousal) reported better individual and relational adjustment at baseline. If the non-cancer partner had lower f0 relative to patients, this predicted worse individual adjustment across follow-up. Additionally, couples who maintained their level of f0 rather than decreasing later in the conversation reported improvements in individual adjustment across follow-up. CONCLUSIONS: Elevated emotional arousal within a cancer-related conversation may be adaptive for adjustment, as it may reflect greater emotional engagement and processing of an important topic. These results may suggest ways for therapists to guide emotional engagement to enhance resilience in couples experiencing cancer.

Cancer is a stressful experience for patients and their partners. We know that how couples communicate about cancer is important, but we do not know much about how couples express emotion during cancer conversations and how those emotional expressions affect well-being. Our study looked at how couples' emotional arousal within cancer conversations relate to individual and relationship well-being. At the beginning of the study, cancer patients and their partners had a conversation about cancer. Within these conversations, we tracked the emotional arousal expressed in their voices. Couples also completed surveys about their well-being at the beginning of the study and later in time (4, 8, and 12 months later). We found that couples who started the conversation with higher emotional arousal had better initial well-being. Couples who remained higher in arousal later in the conversation improved in their individual well-being over time. We also found that if the non-cancer partner was low in arousal compared with patients, this predicted worse well-being over time. More research is needed, but these findings suggest that being emotionally aroused during conversations about important topics like cancer might be helpful for well-being, potentially because couples are discussing concerns and not backing off when it feels challenging.

Relationship Functioning and Gut Microbiota Composition among Older Adult Couples.

An emerging area of research extends work on couple functioning and physical health to gut health, a critical marker of general health and known to diminish with age. As a foray into this area, we conducted a pilot study to (1) determine the feasibility of remote data collection, including a fecal sample, from older adult couples, (2) examine within-couple concordance in gut microbiota composition, and (3) examine associations between relationship functioning and gut microbiota composition. Couples (N = 30) were recruited from the community. The participants' demographic characteristics were as follows: M (SD) age = 66.6 (4.8), 53% female, 92% White, and 2% Hispanic. Two of the couples were same-sex. All 60 participants completed self-report measures and supplied a fecal sample for microbiome analysis. Microbial DNA was extracted from the samples, and the 16S rRNA gene V4 region was amplified and sequenced. The results indicated that individuals shared more similar gut microbial composition with their partners than with others in the sample, p < 0.0001. In addition, individuals with better relationship quality (greater relationship satisfaction and intimacy and less avoidant communication) had greater microbial diversity, p < 0.05, a sign of healthier gut microbiota. Further research with a larger and more diverse sample is warranted to elucidate mechanisms.

Attachment in Couples Coping with Cancer: Associations with Observed Communication and Long-Term Health.

Cancer poses a threat to well-being that may activate the attachment system and influence interpersonal dynamics, such as communication. Research indicates that avoidant and anxious attachment, as well as communication, are independently associated with poorer psychosocial well-being, yet studies examining links between attachment, communication, and long-term physical well-being are lacking. We examined (a) associations between patient and partner attachment (measured with the adult attachment scale [AAS-Revised]) and observed communication (across affect [the Relational Affective Topography System (RATS) coding system] and behavior [the Asymmetric Behavior Coding System (ABCS) coding system]) and (b) the extent to which attachment and communication independently predicted long-term physical well-being (measured by the Functional Assessment of Cancer Therapy-General Population [FACT-GP]). Participants were 134 couples [mean age 53.9 (SD = 13.4), 86.2% Caucasian, 66% of patients, 36% of partners female]. Patient participants had either breast, colorectal, or lung cancer. Couples individually completed self-report measures of attachment (baseline) and physical well-being (baseline and 4, 8, and 12 months later). At baseline, couples engaged in a 15 min videorecorded cancer-related conversation coded for communication behavior and affective expression. Patients and partners with higher anxious and avoidant attachment exhibited more negative affect and negative approach behaviors. A greater avoidant attachment was associated with less positive affective expression. Attachment insecurity and affective expression were prospectively linked with physical well-being. Findings indicate that attachment is associated with overt communication behaviors and that insecure attachment and affective expression may be risk factors for poorer health outcomes.

Prevalence of and Factors Associated with Marital Distress among Hematopoietic Cell Transplantation Survivors: Results from a Large Cross-Sectional Study.

The medical and psychological sequelae of hematopoietic cell transplantation (HCT) are well established, but less is known about the impact on intimate relationships. We sought to describe the prevalence of relationship distress among married HCT survivors and to identify factors associated with relationship distress. The study was cross-sectional. HCT survivors treated at a National Cancer Institute-designated cancer center completed a survey that included measures of psychological and relationship distress (Revised Dyadic Adjustment Scale [RDAS]), demographic, and medical factors. A total of 1047 respondents reported being married and completed the RDAS. Sample characteristics were a mean age of 58 years (range, 22 to 83 years), a mean interval post-HCT of 12.3 years (range, <1 to 43 years), 42% female, and 89% non-Hispanic white. RDAS total adjustment scores were comparable to published community sample values. Nineteen percent of the respondents were classified as relationship-distressed. Three factors were associated with greater odds of relationship distress: cancer and treatment distress (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.09 to 2.31); depression (OR, 1.44; 95% CI, 1.17 to 1.76), and time post-transplantation (OR, 1.03; 95% CI, 1.01 to 1.04). These findings were qualified by sex-stratified analyses. Depression was associated with relationship distress among females; the other 2 variables were associated with relationship distress among males. Our results paint an overall picture of positive long-term marital functioning among HCT survivors, with a subset reporting relationship distress. Screening is warranted to identify survivors at risk for relationship distress and to inform targeted intervention.

Parental Response to Only Children: Breaking the Stereotypes.

While much has been written about the relationship between only child status and parents' behavior toward children, and consequent personality and intelligence, little is known about the relationship between only child status, parental response to illness, and subsequent child illness behavior. In this study, 227 mothers of 342 children completed measures designed to assess: (a) their children's school attendance, (b) their own psychological status, and (c) their own responses to their children's expressions of stomach pain. Parents of only children were more likely to minimize their children's gastrointestinal symptoms than were parents of children with at least one sibling. In addition, only children were less likely to miss school. Parental protectiveness did not differ as a function of only child status. These findings are somewhat discrepant with commonly held beliefs about parents' patterns of responding to only children.

Recruitment and retention of underrepresented and vulnerable populations to research.

Per principles outlined in the Belmont Report, research involving human subjects should minimize risks to participants and maximize benefits to participants and society. Recruitment of participants should be equitable. Once enrolled, participants have the right to withdraw at any point. Researchers must balance these principles with pressures to meet enrollment goals and, in the context of repeated-measures designs, retain participants across time. The purpose of this perspective is to describe the approach and corresponding activities for recruiting and retaining underrepresented and vulnerable populations that are the focus of a transdisciplinary academic research center. To this effort, we offer diverse disciplinary backgrounds, experience working with a wide range of populations (from infants to older adults and across multiple health conditions), and spanning a variety of research designs. Effective strategies offered include partnering with community entities, approaching potential participants where they are and at a time of readiness, using population-appropriate modes of communication and data collection, conducting study activities in familiar settings and at convenient times, maintaining frequent contact, and offering meaningful incentives. These strategies are consistent with population-specific reports found in the extant literature and underscore their cross-cutting nature, with adaptations based on participant and community partner needs and preferences.

Physical Activity Among Predominantly White Middle-Aged and Older US Adults During the SARS-CoV-2 Pandemic: Results From a National Longitudinal Survey.

Background: The first COVID-19 case in the US was diagnosed late January 2020. In the subsequent months, cases grew exponentially. By March 2020, SARS-CoV-2 (the novel coronavirus that causes COVID-19) was a global pandemic and the US declared a national emergency. To mitigate transmission, federal guidelines were established for social and physical distancing. These events disrupted daily routines of individuals around the world, including Americans. The impact of the pandemic on PA patterns of Americans is largely unknown, especially among those at greater risk for severe COVID-19 outcomes. The aim of this study was to assess levels of PA over time during the pandemic among US adults aged >50 years. Methods: Data were collected as part of a web-based, longitudinal, 3-wave study examining health and well-being among adults aged > 50. PA data were collected at Waves 2 and 3 using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). At Wave 2 (conducted mid-May to early June, 2020), participants completed the IPAQ-SF twice, once in reference to a typical 7-day period before the pandemic, and again in reference to the past 7 days. At Wave 3 (conducted mid-June to early July 2020), participants completed the IPAQ-SF once, with reference to the past 7 days. Potential predictors of PA change were collected using items from previously established surveys and included demographic characteristics, pre-pandemic PA levels, perceived COVID-19 threat, self-rated general health, and number of chronic disease conditions. Results: Respondents (N = 589) had a mean age of 63 ± 7.39 years and were mostly female (88%) and non-Hispanic White (96%). Mean MET-min/week across the three time-referents were 2,904 (pre-pandemic), 1,682 (Wave 2 past 7-days), and 2,001 (Wave 3 past 7-days), with PA declining between the first and second time referents (d = -0.45, p < 0.001) and remaining below pre-pandemic levels at the third (d = -0.34, p < 0.001). Changes over time were predicted by pre-pandemic PA and self-rated general health (p's < .05). Conclusions: Effective strategies are needed to promote safe and socially-distanced PA among adults aged >50 years until the risk of contracting COVID-19 subsides. In the post-pandemic era, PA programming will be imperative to address pandemic-associated declines in PA.

Couple Communication in Cancer: Protocol for a Multi-Method Examination.

Cancer and its treatment pose challenges that affect not only patients but also their significant others, including intimate partners. Accumulating evidence suggests that couples' ability to communicate effectively plays a major role in the psychological adjustment of both individuals and the quality of their relationship. Two key conceptual models have been proposed to account for how couple communication impacts psychological and relationship adjustment: the social-cognitive processing (SCP) model and the relationship intimacy (RI) model. These models posit different mechanisms and outcomes, and thus have different implications for intervention. The purpose of this project is to test and compare the utility of these models using comprehensive and methodologically rigorous methods. Aims are: (1) to examine the overall fit of the SCP and RI models in explaining patient and partner psychological and relationship adjustment as they occur on a day-to-day basis and over the course of 1 year; (2) to examine the fit of the models for different subgroups (males vs. females, and patients vs. partners); and (3) to examine the utility of various methods of assessing communication by examining the degree to which baseline indices from different measurement strategies predict self-reported adjustment at 1-year follow up. The study employs a longitudinal, multi-method approach to examining communication processes including: standard self-report questionnaires assessing process and outcome variables collected quarterly over the course of 1 year; smartphone-based ecological momentary assessments to sample participant reports in real time; and laboratory-based couple conversations from which we derive observational measures of communicative behavior and affective expression, as well as vocal indices of emotional arousal. Participants are patients with stage II-IV breast, colon, rectal, or lung cancer and their spouses/partners, recruited from two NCI-designated comprehensive cancer centers. Results will be published in scientific journals, presented at scientific conferences, and conveyed to a larger audience through infographics and social media outlets. Findings will inform theory, measurement, and the design and implementation of efficacious interventions aimed at optimizing both patient and partner well-being.

Sexual Functioning in Long-Term Survivors of Hematopoietic Cell Transplantation.

This investigation characterized sexual activity and sexual function in hematopoietic cell transplantation (HCT) survivors, compared them with norms, and examined factors associated with sexual dysfunction, with the goal of identifying targets for intervention to improve sexual health. Surviving adults from a large transplantation center were asked to complete an annual survey with a core of health questions and a module on sexual activity and function. Participants completed the Sexual Function Questionnaire, Cancer and Treatment Distress form, and Revised Dyadic Adjustment Scale. Clinical data were collected from the transplantation medical database. Multivariate logistic regressions identified factors associated with sexual activity and function. Participating survivors (n = 1742) were a mean of 11.9 years (range, .4 to 43.1 years) after HCT, mean age 57.6 years, and 53% male. Women were more likely than men to report being sexually inactive in the past year (39% versus 27%) and, among those sexually active, to report low sexual function (64% versus 32%). Male and female survivors reported lower rates of sexual activity and function than comparison norms (all P < .01). In regressions, factors associated with being sexually inactive included older age, having <4 years of college education, low performance status, and not being in a committed relationship. Additional factors for men included receipt of nonmyeloablative conditioning and not being employed or in school. Low sexual functioning for men and women was associated with low performance status, and, for women, a committed relationship of lower quality, while for men the association was with older age. Sexual dysfunction is common in both men and women after HCT, regardless of time since treatment. Survivors need routine evaluation and access to multimodal interventions.

Developing an Educational Intervention to Address Financial Hardship in Cancer Patients.

OBJECTIVE: To develop an educational intervention to empower patients to manage their financial health better. PARTICIPANTS AND METHODS: This study was conducted from September 1, 2017, to January 31, 2019. Focus groups were held with social workers, case managers, and patient financial service staff and interviews were conducted with patients and caregivers to inform the content, delivery format, and timing of an intervention for mitigating financial hardship from treatment (phase 1). Based on qualitative data, theories of adult learning, and a review of the literature, we created an educational presentation to be delivered in a classroom setting. Two patient focus groups were then held for feedback on the presentation (phase 2). RESULTS: In phase 1, both patients and allied health care staff providers believed that an educational intervention about financial aspects of care early during treatment would help them cope and plan better. Participants' suggestions for the intervention's content included billing information, insurance, authorization processes, employment policies related to health care and disability benefits, and alternative financial resources. Based on these suggestions, a preliminary educational presentation was developed with 3 main themes: insurance issues, employment issues, and financial health. Phase 2 focus group participants suggested refinement of the presentation, including targeting specific groups, adding graphics, and more information about resources. CONCLUSION: Our study provides the basis for a patient-centered education module for emotional, instrumental, and informational support for financial distress for use in a clinical setting.

Usability and Acceptability of a Smartphone App to Assess Partner Communication, Closeness, Mood, and Relationship Satisfaction: Mixed Methods Study.

BACKGROUND: Interpersonal communication is critical for a healthy romantic relationship. Emotional disclosure, coupled with perceived partner responsiveness, fosters closeness and adjustment (better mood and relationship satisfaction). On the contrary, holding back from disclosure is associated with increased distress and decreased relationship satisfaction. Prior studies assessing these constructs have been cross-sectional and have utilized global retrospective reports of communication. In addition, studies assessing holding back or perceived partner responsiveness have not taken advantage of smartphone ownership for data collection and have instead required website access or use of a study-provided device. OBJECTIVE: This study aimed to examine the (1) usability and acceptability of a smartphone app designed to assess partner communication, closeness, mood, and relationship satisfaction over 14 days and (2) between-person versus within-person variability of key constructs to inform the utility of their capture via ecological momentary assessment using the participants' own handheld devices. METHODS: Adult community volunteers in a married or cohabiting partnered relationship received 2 smartphone prompts per day, one in the afternoon and one in the evening, for 14 days. In each prompt, participants were asked whether they had conversed with their partner either since awakening (afternoon prompt) or since the last assessment (evening prompt). If yes, a series of items assessed enacted communication, perceived partner communication, closeness, mood, and relationship satisfaction (evening only). Participants were interviewed by phone, 1 week after the end of the 14-day phase, to assess perceptions of the app. Content analysis was employed to identify key themes. RESULTS: Participants (N=27; mean age 36, SD 12 years; 24/27, 89% female; 25/27, 93% white and 2/27, 7% Hispanic) responded to 79.2% (555/701) of the total prompts sent and completed 553 (78.9%) of those assessments. Of the responded prompts, 79.3% (440/555) were characterized by a report of having conversed with one's partner. The app was seen as highly convenient (mean 4.15, SD 0.78, scale: 1-5) and easy to use (mean 4.39, SD 0.70, scale: 1-5). Qualitative analyses indicated that participants found the app generally easy to navigate, but the response window too short (45 min) and the random nature of receiving notifications vexing. With regard to the variability of the app-delivered items, intraclass correlation coefficients were generally <0.40, indicating that the majority of the variability in each measure was at the within-person level. Notable exceptions were enacted disclosure and relationship satisfaction. CONCLUSIONS: The findings of this study support the usability and acceptability of the app, with valuable user input to modify timing windows in future work. The findings also underscore the utility of an intensive repeated-measures approach, given the meaningful day-to-day variation (greater within-person vs between-person variability) in communication and mood.

Attachment Style, Partner Communication, and Physical Well-Being among Couples Coping with Cancer.

Attachment styles may influence interpersonal strategies used to cope with stress. We examined links between attachment style, communicative behaviors, and physical well-being among 166 couples coping with cancer. Results of actor-partner interdependence mediation models indicated that insecure attachment styles were associated with greater self-report of two different and seemingly contradictory communicative behaviors (disclosure and holding back), which in turn were associated with poorer physical well-being. These effects were intrapersonal for both patients and spouses, with the exception of anxious attachment and holding back for spouses. They were also interpersonal in that spouse insecure attachment was associated with poorer patient physical well-being through spouse communication (greater holding back and disclosure). Couple-based communication interventions to support adjustment should consider attachment style.

Psychological Impacts and Ways of Coping Reported by Spousal Caregivers of Hematopoietic Cell Transplant Recipients: A Qualitative Analysis.

Allogeneic hematopoietic cell transplantation (HCT) is a demanding treatment with well-established medical and psychosocial sequelae. Impacts on significant others are tremendous. Using an unfiltered qualitative approach, we asked spouses (n = 15) of HCT recipients to talk about their thoughts and feelings regarding the transplantation and their role as caregiver. Recordings were transcribed and independently coded to identify recurrent patterns. Caregivers mentioned both negative and positive psychological impacts of HCT, but the number of negative impacts was greater: 164 versus 34 instances. The most frequently mentioned negative psychological impacts were anxiety/worry (30 instances), fear (20 instances), feeling overloaded/overwhelmed (19 instances), and uncertainty (17 instances). Other emergent categories were roles/responsibilities (49 instances) such as parenting, work, and treatment-related tasks, and coping strategies (55 instances). The latter included both adaptive and maladaptive strategies (75% and 25%, respectively). Despite the preponderance of negatively toned thoughts and feelings, signs of adjustment emerged, with mentions of positive psychological states, such as optimism and gratitude, and adaptive coping strategies, such as active coping, use of emotional support, and self-care. Interventions intended to facilitate adaptation to the HCT experience should involve strategies to help caregivers manage symptoms of distress and promote adaptive coping.

Relationship of Socioeconomic Status Indicators to Obesity in Hispanic and Non-Hispanic White Middle-Aged Women: A Population Study.

BACKGROUND: Obesity rates differ between Hispanic and White (non-Hispanic) women in the United States, with higher rates among Hispanic women. Socioeconomic processes contribute to this disparity both at the individual and the environmental level. Understanding these complex relationships requires multilevel analyses within cohorts of women that have a shared environment. In population-based samples of Hispanic and White (non-Hispanic) women from the same neighborhoods, we evaluated within each ethnic group a) The association of individual-level socioeconomic status (SES) with body mass index (BMI); and b) The additional contribution of neighborhood-level measures of SES. METHODS: Using population-based multi-stage sampling methods, we oversampled low SES and Hispanic block groups. During household screening, we identified women aged 30 to 50 years. Among White women, we specifically oversampled women with low educational levels. 515 Hispanic and 503 White women completed baseline. Height and weight were measured. Baseline surveys, in Spanish and English, included four measures of SES. Three measures of area-level SES were examined. Analysis of loge BMI on each SES measure used linear mixed models, incorporating design effects. RESULTS: Among White women, low education, social status, and neighborhood SES were associated with higher BMI (p < 0.001, p < 0.0001, and p < 0.05, respectively), independent of other SES measures. Although the highest grouped category of education, income and subjective social status within the Hispanic cohort had the lowest mean estimated BMI, the point estimates across categories were not monotonic, and had wide confidence intervals. As a result, in contrast to the findings among White women, no statistically significant associations were found between BMI and measures of SES among Hispanic women. DISCUSSION: Neighborhood and individual measures of SES operate differently in Hispanic compared with White women. We had assumed the measures we included to be most salient and operate similarly for both groups of women. Rather the salient factors for Hispanic women have yet to be identified. Improved understanding may ultimately inform the design of culturally-relevant multilevel obesity prevention strategies.

The Healthy Homes/Healthy Kids 5-10 Obesity Prevention Trial: 12 and 24-month outcomes.

BACKGROUND: Pediatric primary care is an important setting for addressing obesity prevention. OBJECTIVE: The Healthy Homes/Healthy Kids 5-10 randomized controlled trial evaluated the efficacy of an obesity prevention intervention integrating pediatric primary care provider counseling and parent-targeted phone coaching. METHODS: Children aged 5 to 10 years with a BMI between the 70th and 95th percentile and their parents were recruited from pediatric primary care clinics. Participants received well-child visit provider counseling about obesity and safety/injury prevention and were then randomized to a 14-session phone-based obesity prevention (OP; n = 212) or safety and injury prevention contact control (CC; n = 209) intervention. The primary outcome was 12 and 24-month child BMI percentile. RESULTS: There was no overall significant treatment effect on child BMI percentile. Caloric intake was significantly lower among OP compared with CC participants at 12 months (P < .005). In planned subgroup analyses, OP condition girls had significantly lower BMI percentile (P < .05) and BMI z-score (P < .02) at 12 and 24 months relative to CC girls and were less likely to be overweight (38.0% vs 53.0%, P < .01) or (obese 3.4% vs 8.8%, P < .10) at follow-up. CONCLUSIONS AND RELEVANCE: An obesity prevention intervention integrating brief provider counseling and parent-targeted phone counseling did not impact 12 and 24-month BMI status overall but did have a significant impact on BMI in girls.

Understanding Outcomes in Behavior Change Interventions to Prevent Pediatric Obesity: The Role of Dose and Behavior Change Techniques.

BACKGROUND: Behavioral interventions to prevent pediatric obesity have shown inconsistent results across the field. Studying what happens within the "black box" of these interventions and how differences in implementation lead to different outcomes will help researchers develop more effective interventions. AIM: To compare the implementation of three features of a phone-based intervention for parents (time spent discussing weight-related behaviors, behavior change techniques used in sessions, and intervention activities implemented by parents between sessions) with study outcomes. METHODS: A random selection of 100 parent-child dyads in the intervention arm of a phone-based obesity prevention trial was included in this analysis. Sessions were coded for overall session length, length of time spent discussing specific weight-related behaviors, number of behavior change techniques used during the sessions, and number of intervention-recommended activities implemented by the parents between sessions (e.g., parent-reported implementation of behavioral practice/rehearsal between sessions). The primary study outcome, prevention of unhealthy increase in child body mass index (BMI) percentile, was measured at baseline and 12 months. RESULTS: Overall session length was associated with decreases in child BMI percentile ( b = -0.02, p = .01). There was no association between the number of behavior change techniques used in the sessions and decreases in child BMI percentile ( b = -0.29, p = .27). The number of activities the parents reported implementing between sessions was associated with decreases in child BMI percentile ( b = -1.25, p = .02). DISCUSSION: To improve future interventions, greater attention should be paid to the intended and delivered session length, and efforts should be made to facilitate parents' implementation of intervention-recommended activities between sessions (ClinicalTrials.gov, No. NCT01084590).

Links Between Communication and Relationship Satisfaction Among Patients With Cancer and Their Spouses: Results of a Fourteen-Day Smartphone-Based Ecological Momentary Assessment Study.

Cancer treatment poses significant challenges not just for those diagnosed with the disease but also for their intimate partners. Evidence suggests that couples' communication plays a major role in the adjustment of both individuals and in the quality of their relationship. Most descriptive studies linking communication to adjustment have relied on traditional questionnaire methodologies and cross-sectional designs, limiting external validity and discernment of temporal patterns. Using the systemic-transactional model of dyadic coping as a framework, we examined intra- and inter-personal associations between communication (both enacted and perceived) and relationship satisfaction (RS) among patients with stage II-IV breast or colorectal cancer and their spouses (N = 107 couples). Participants (mean age = 51, 64.5% female patients, and 37.4% female spouses) independently completed twice-daily ecological momentary assessments (EMA) via smartphone for 14 consecutive days. Items assessed RS and communication (expression of feelings, holding back from expression, support and criticism of partner, and parallel ratings of partner behavior). Linear mixed models employing an Actor Partner Interdependence Model were used to examine concurrent, time-lagged, and cross-lagged associations between communication and RS. Expressing one's feelings was unassociated with RS. Holding back from doing so, in contrast, was associated with lower RS for both patients and spouses in concurrent models. These effects were both intrapersonal and interpersonal, meaning that when individuals held back from expressing their feelings, they reported lower RS and so too did their partner. Giving and receiving support were associated with one's own higher RS for both patients and spouses in concurrent models, and for patients in lagged models. Conversely, criticizing one's partner and feeling criticized were maladaptive, associated with lower RS (own and in some cases, partner's). Cross-lagged analyses (evening RS to next-day afternoon communication) yielded virtually no effects, suggesting that communication may have a stronger influence on short-term RS than the reverse. Findings underscore the importance of responsive communication, more so than expression per se, in explaining both concurrent and later relationship adjustment. In addition, a focus on holding back from expressing feelings may enhance the understanding of RS for couples coping with cancer.