A pilot study of experiencing racial microaggressions, obsessive-compulsive symptoms, and the role of psychological flexibility.

BACKGROUND: Experiencing racial microaggressions has clear effects on physical and psychological health, including obsessive-compulsive disorder symptoms (OCS). More research is needed to examine this link. Psychological flexibility is an important process to examine in this work. AIMS: This study aimed to examine if, while controlling for depression and anxiety, experiences of microaggressions and psychological flexibility helped explain OCD symptoms within a university-affiliated sample (undergraduate, graduate and law students). This was a pilot exploration of the relationships across themes. METHOD: Initial baseline data from a longitudinal study of psychological flexibility, OCD symptoms, depression, anxiety and experience of microaggressions was utilized. Correlations and regressions were utilized to examine which OCD symptom dimensions were associated with experiencing racial microaggressions in addition to anxiety and depression, and the added role of psychological flexibility was examined. RESULTS: OCD symptoms, experiences of microaggressions and psychological flexibility were correlated. Experiences of racial microaggressions explained responsibility for harm and contamination OCD symptoms above and beyond psychological distress. Exploratory results support the relevance of psychological flexibility. CONCLUSION: Results support other work that experiences of racial microaggressions help explain OCS and they add some support for psychological flexibility as a relevant risk or protective factor for mental health in marginalized populations. These topics should be studied longitudinally with continued consideration of all OCD themes, larger sample sizes, intersecting identities, clinical samples, and continued exploration of psychological flexibility and mindfulness and values-based treatments.

Educational stakeholders' attitudes and knowledge about nonsuicidal self-injury among university students: A cross-national study.

Nonsuicidal self-injury (NSSI) is a commonly occurring, yet historically poorly understood, mental health concern among post-secondary students. The present study sought to identify the current knowledge needs of university stakeholders to inform training efforts around effective NSSI response and student support on university campuses.Participants were 1,762 university students, staff, and student-staff (77% female) from seven universities in Canada, the USA, New Zealand, and Australia.Participants completed an online survey about their attitudes and knowledge of both general mental health and NSSI.University stakeholders reported significantly greater stigma toward NSSI than mental illness in general. Student-staff reported greater perceived knowledge and comfort, and demonstrated greater knowledge of NSSI, than students and staff.Findings underscore the need for additional training and resources to reduce stigma and increase knowledge about NSSI on university campuses internationally.

Media guidelines for the responsible reporting and depicting of non-suicidal self-injury.

Media coverage of non-suicidal self-injury (NSSI) ranges from providing helpful education to displaying graphic images. We offer the first research-informed, consensus-based guidelines for the responsible reporting and depicting of NSSI in the media, while also advising on ideas for dissemination and collaboration between media professionals and healthcare experts.

Advocacy for improved response to self-injury in schools: A call to action for school psychologists.

Over the past several years, nonsuicidal self-injury (NSSI) has emerged as a widespread concern in school settings worldwide. However, despite significant strides in NSSI research, there remains a substantial knowledge gap with respect to what school staff know. Unfortunately, this can contribute to stigma and ineffective responding when working with students who self-injure. In light of its high rates and the risks with which NSSI associates, including death by suicide, this is worrisome. Accordingly, there is a pressing need for advocacy in schools to ensure that NSSI is prioritized and for proper knowledge and training be offered to school staff. The current article serves as a call to action for school psychologists as leaders and advocates in meeting these needs. We begin by articulating the central issues pertinent to low NSSI literacy and high NSSI stigma in schools, followed by a series of research-informed recommendations for timely and effective advocacy. By virtue of undertaking these initiatives, school staff will be better able to respond to the needs of youth who self-injure and advocate for them. This, in turn, can foster an enhanced school climate and greater student well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Addressing Self-Injury in Schools, Part 1: Understanding Nonsuicidal Self-Injury and the Importance of Respectful Curiosity in Supporting Youth Who Engage in Self-Injury.

Nonsuicidal self-injury (NSSI) is defined as the deliberate, self-inflicted damage of body tissue without suicidal intent and for purposes not socially or culturally sanctioned. School nurses are often a first point of contact for young people experiencing mental health challenges, and yet they often report they lack knowledge and training to provide care for persons who engage in NSSI. In the first of two parts, this article provides school nurses with a better understanding of NSSI and the distinctions between NSSI and suicidal behaviors, discusses the role of nurses' knowledge and attitudes on their ability to care for their patients' mental health needs, and discusses approaches for developing a respectful, empathic manner for working with and supporting youth who engage in self-injury. Part 2 will offer a strategy for brief assessment of NSSI and reflect on two case studies and their implications for school nursing practice.

Addressing Self-Injury in Schools, Part 2: How School Nurses Can Help With Supporting Assessment, Ongoing Care, and Referral for Treatment.

Nonsuicidal self-injury (NSSI) is defined as the deliberate, self-inflicted damage of body tissue without suicidal intent and for purposes not socially or culturally sanctioned. School nurses are often a first point of contact for young people experiencing mental health challenges, and yet they often report they lack knowledge and training to provide care for persons who engage in NSSI. In the second of two parts, this article offers a strategy for brief assessment of NSSI, as well as reflection on two case studies and how to offer support, ongoing care, and referral for treatment to youth who engage in self-injury.

Parental Secondary Stress: The Often Hidden Consequences of Nonsuicidal Self-Injury in Youth.

OBJECTIVE: This study aims to deepen understanding of the effects on parents of having a self-injuring child by (a) analyzing differences in dimensions of caregiver strain between caregivers of youth with nonsuicidal self-injury (NSSI+) and parents of youth with no known mental health history (MH-); (b) identifying factors that contribute to caregiver strain; and (c) examining parent outcome expectancies. METHOD: Participants were 196 NSSI+ parents and 57 MH- parents. Quantitative measures of psychosocial variables, parent mental health and support variables, and child self-injury characteristics were assessed in relation to caregiver strain, and NSSI+ parental expectancies were assessed via mixed methods. RESULTS: Parents with a NSSI+ youth were more likely to exhibit all forms of objective and subjective strain than parents of youth with no mental health challenges. Despite this, many parents expressed beliefs that their child would experience personal growth as a result of their NSSI experience. CONCLUSION: Findings reveal the important role of mindful parenting practices and informal social support.

Sex differences in biological response to peer rejection and performance challenge across development: A pilot study.

A pilot study of sex differences in biological response to peer rejection and performance challenges across development was conducted. Participants were 59 typically-developing children (ages 8-17; 58% girls); 59 children completed one challenge: 37 completed both challenges. Following a habituation session, participants completed peer rejection (exclusion challenges) and/or performance (speech, arithmetic, tracing) stress sessions. Saliva cortisol and alpha amylase (AA) were measured throughout. Post-pubertal girls showed increased AA and equivalent cortisol output in response to rejection vs. performance; pre-pubertal girls showed heightened cortisol and AA response to performance vs. rejection. Boys showed similar biological responses across puberty, with pre- and post-pubertal boys demonstrating heightened cortisol, but equivalent AA output in response to performance vs. rejection stressors. Although results are preliminary, they suggest increases in relative sensitivity to rejection vs. performance stressors and malleability of stress response across development in girls, but stability of stress response across development in boys. Future, larger-scale, longitudinal studies are needed.

The Influence of Social Support on Smoking Cessation Treatment Adherence Among HIV+ Smokers.

INTRODUCTION: The high prevalence of smoking among people living with HIV is a significant problem. Nonadherence to smoking cessation pharmacotherapy is a barrier for successfully quitting. The current study investigated the extent to which social support variables impact adherence and cessation. METHODS: Participants were 444 HIV+ smokers who provided data on nicotine patch adherence, social support, and smoking. We conducted a path analysis to estimate (1) the effects of six social support indicators at baseline on nicotine patch adherence; (2) the effect of patch adherence on 7-day point prevalence smoking at 6-month follow-up; and (3) the indirect effects of social support indicators on 7-day point prevalence smoking at 6-month follow-up via patch adherence. RESULTS: The tested model demonstrated good fit as indicated by the comparative fit index, root mean square error of approximation, and weighted root mean square residual (0.94, 0.02, and 0.51, respectively). Path analysis results indicated greater social support network contact was associated with higher levels of nicotine patch adherence (ß = .13, P = .02), greater patch adherence was associated with a lower probability of 7-day point prevalence smoking at 6-month follow-up (ß = -.47, P < .001) and greater social support network contact (ß = -.06, P = .03) had a significant indirect effect on 7-day point prevalence smoking at 6-month follow-up via patch adherence. CONCLUSIONS: Findings have implications for smoking cessation interventions that seek to capitalize on the beneficial effects of social support. Such efforts should account for the role that frequency of contact may have on nicotine patch use and other treatment-related mechanisms.

Research with adolescents who engage in non-suicidal self-injury: ethical considerations and challenges.

Non-suicidal self-injury (NSSI) has emerged as a significant psychiatric issue among youth. In addition to its high prevalence rates, NSSI is associated with a number of psychiatric issues and confers risk for varying degrees of physical injury. It is also a risk factor for attempted suicide. Thus, youth who engage in NSSI represent a vulnerable and high-risk population and researchers are likely to encounter a variety of ethical challenges when conducting NSSI research. Accordingly, it is critical that researchers be familiar with the major ethical issues involved in NSSI research and how to effectively account for and address them. This is important both prior to obtaining clearance from their Institutional Review Boards and when carrying out their research. To date, there is no consolidated resource to delineate the ethical challenges inherent to NSSI research and how these can be effectively navigated throughout the research process. The goals of this paper are to review international best practices in NSSI research across the various contexts within which it is studied, to offer guidelines for managing these issues, to identify areas in which variation in approaches prohibits decisive recommendations, and to generate questions in need of further consideration among scholars in this field.

Outcomes of a Tailored Intervention for Cigarette Smoking Cessation Among Latinos Living With HIV/AIDS.

INTRODUCTION: Tobacco use has emerged as a leading killer among persons living with HIV, with effective approaches to tobacco treatment still unknown. HIV infection is nearly 3 times as prevalent in Latinos than in non-Latino Whites. This study reports the results of a randomized trial comparing a tailored intervention to brief counseling for smoking cessation among Latino smokers living with HIV (LSLWH). METHODS: LSLWH (N = 302; 36% female, 10% employed full-time, 49% born in United States) were randomized to 4 in-person sessions of a tailored intervention (Aurora) or 2 in-person sessions of brief advice (enhanced standard care [ESC]). Both groups received 8 weeks of nicotine replacement therapy (NRT) patch. Biochemically validated 6- and 12-month 7-day point-prevalence abstinence (PPA) rates were compared, along with secondary outcomes (e.g., reduction to light smoking, NRT adherence). RESULTS: Seven-day PPA rates reached 8% versus 11% at 6 months and 6% versus 7% at 12 months, for Aurora and ESC, respectively, with no between-group differences (p values > .40). Significant changes from baseline to 6 and 12 months among intervention targets were noted (percentage reduction in heavy smoking and dependence; increases in knowledge and self-efficacy). Baseline smoking frequency, older age, and higher intensity of patch use during the trial emerged as significant predictors of abstinence at 6 months. CONCLUSIONS: There was no evidence that the tailored intervention improved cessation rates. Interventions that encourage use of, and adherence to, empirically validated cessation aids require further development to reduce tobacco-related death and disease in this vulnerable population.

Adolescent weight control: an intervention targeting parent communication and modeling compared with minimal parental involvement.

OBJECTIVE: Adolescent weight control interventions demonstrate variable findings, with inconsistent data regarding the appropriate role for parents. The current study examined the efficacy of a standard adolescent behavioral weight control (BWC) intervention that also targeted parent-adolescent communication and parental modeling of healthy behaviors (Standard Behavioral Treatment + Enhanced Parenting; SBT + EP) compared with a standard BWC intervention (SBT). METHODS: 49 obese adolescents (M age = 15.10; SD = 1.33; 76% female; 67.3% non-Hispanic White) and a caregiver were randomly assigned to SBT or SBT + EP. Adolescent and caregiver weight and height, parental modeling, and weight-related communication were obtained at baseline and end of the 16-week intervention. RESULTS: Significant decreases in adolescent weight and increases in parental self-monitoring were observed across both conditions. Analyses of covariance revealed a trend for greater reduction in weight and negative maternal commentary among SBT condition participants. CONCLUSIONS: Contrary to hypotheses, targeting parent-adolescent communication and parental modeling did not lead to better outcomes in adolescent weight control.

Concrete images of the sugar content in sugar-sweetened beverages reduces attraction to and selection of these beverages.

In the present research, we offer a novel method for informing consumers about the sugar content in sugar-sweetened beverages (SSBs). With a series of experiments, we present evidence that this method curbs preference for SSBs and leads to more negative attitudes toward SSBs. We propose that people view SSBs more negatively and show less preference for SSBs when they are able to concretely visualize the quantity of sugar in SSBs. For example, we suggest that people might have more negative views toward the idea of consuming 28 sugar cubes (concrete information), compared to consuming "70g" of sugar (abstract information). Indeed, we found that, without any intervention, people struggle to convert sugar grams into a concrete, physical sugar representation (Experiment 1). But, when people are provided ways to convert abstract sugar-nutrition information into a concrete representation, they find SSBs less attractive (Experiment 2) and are less likely to select SSBs in favor of sugar-free beverage options (Experiments 3 and 4). These findings offer direct applications to the design of public-health messages and nutrition-education interventions. Such applications might benefit society in its battle with the obesity epidemic.

Longitudinal associations among change in overweight status, fear of negative evaluation, and weight-related teasing among obese adolescents.

OBJECTIVE: To examine longitudinal bidirectional associations between changes in adolescents' weight status and psychosocial constructs. METHOD: 118 obese adolescents aged 13-16 years participated in a behavioral weight control intervention. Percent overweight (OW), fear of negative evaluation (FNE), and frequency of weight-related teasing (WRT) were collected at baseline, end of intervention, and 12 and 24 months post-randomization. 3 multivariate latent change score models were estimated to examine longitudinal cross-lagged associations between: (1) OW and FNE; (2) OW and WRT; and (3) FNE and WRT. RESULTS: Decreases in OW were prospectively associated with subsequent decreases in both FNE and WRT; however, changes in FNE and WRT were not prospectively associated with subsequent change in OW. Decreases in FNE were prospectively associated with subsequent decreases in WRT. CONCLUSION: Moderate weight loss in the context of a behavioral weight control intervention has positive long-term implications for obese adolescents' peer relations.

Two-year follow-up of an adolescent behavioral weight control intervention.

OBJECTIVE: This study examined the 24-month outcomes of a randomized controlled trial of a group-based behavioral weight control (BWC) program combined with either activity-based peer intervention or aerobic exercise. METHODS: At baseline, 118 obese adolescents (68% female; BMI = 31.41 ± 3.33) ages 13 to 16 years (mean = 14.33; SD = 1.02) were randomized to receive 1 of 2 weight loss interventions. Both interventions received the same 16-week group-based cognitive-behavioral treatment, combined with either aerobic exercise or peer-based adventure therapy. Eighty-nine adolescents (75% of original sample) completed the 24-month follow-up. Anthropometric and psychosocial measures were obtained at baseline, at the end of the 16-week intervention, and at 12 and 24 months following randomization. RESULTS: An intent-to-treat mixed factor analysis of variance indicated a significant effect for time on both percent over 50th percentile BMI for age and gender and standardized BMI score, with no differences by intervention group. Post hoc comparisons showed a significant decrease in percent overweight at 4 months (end of treatment), which was maintained at both 12- and 24-month follow-up visits. Significant improvements on several dimensions of self-concept were noted, with significant effects on physical appearance self-concept that were maintained through 24 months. CONCLUSIONS: Both BWC conditions were effective at maintaining reductions in adolescent obesity and improvements in physical appearance self-concept through 24-month follow-up. This study is one of the first to document long-term outcomes of BWC intervention among adolescents.

Targeting body image schema for smoking cessation among college females: rationale, program description, and pilot study results.

Smoking among young adults is a significant public health problem. Despite the negative health effects, many young women smoke for weight and body image reasons. Understanding the factors that prompt young women to initiate and continue smoking is important for designing smoking cessation interventions. The aim of the current article is to outline a potential pathway for smoking behavior among young women, specifically applying a cognitive bias framework previously used to describe disordered eating behaviors. This article provides the rationale for using two different treatments targeting body image schema among female smokers. The authors describe the development, feasibility, and acceptability of these two treatment approaches among a sample of female college smokers (N = 24). Preliminary pilot data are presented as well as the significance and implications for future clinical interventions.

Associations between parent behavior and adolescent weight control.

OBJECTIVE: To evaluate associations between parent behaviors (i.e., parent weight change, self-monitoring of their behavior, and feeding practices and attitudes) and changes in adolescent BMI and weight following 16-weeks of behavioral weight control (BWC) intervention. METHOD: Adolescents (N = 86) 13-16 years old and 30-90% overweight (M = 60.54%, SD = 15.10%) who completed BWC intervention and their parents. Adolescents were randomized to 1 of 2 interventions involving 16 consecutive weeks of active treatment with 4 biweekly maintenance sessions. Adolescent weight and BMI were measured at baseline and 16-weeks. Feeding practices were measured at baseline. Parent self-monitoring was measured during the intervention. RESULTS: The only independently significant predictor of adolescent BMI change (p < .01) was parent BMI change. Greater parent self-monitoring (p < .01) predicted greater adolescent weight loss. Greater parent pressure to eat predicted less adolescent weight loss (p < .01). CONCLUSIONS: Findings highlight the potential importance of parent weight-related behaviors and feeding practices in the context of adolescent BWC.

Early patterns of food intake in an adolescent weight loss trial as predictors of BMI change.

PURPOSE: To determine whether baseline intake or initial changes in intake of fruits (F), vegetables (V), snack foods (SF), and reduced-calorie snack foods (RCSF) during standard behavioral weight loss treatment predict BMI reductions among overweight adolescents. Given conflicting messages between child and adult weight loss interventions, the role of RCSF in adolescent weight control was of particular interest. METHODS: Seventy-two adolescents, 13-16 years old, participating in a 16-week behavioral weight loss trial with diet records at baseline and 4 weeks were included. Height and weight were measured at 0 and 16 weeks. Frequency of intake of F, V, SF, and RCSF were obtained from 7-day food records at 0 and 4 weeks. RESULTS: Male gender, higher initial frequency of intake of V and increased frequency of intake of F and RCSF over the first 4 weeks of treatment accounted for 43% of the variance in BMI reduction at 16 weeks (p<.001). CONCLUSIONS: Early changes in eating habits, including increased frequency of intake of F and RCSF may promote greater adolescent BMI reductions.

Behavioral weight control treatment with supervised exercise or peer-enhanced adventure for overweight adolescents.

OBJECTIVE: To evaluate the efficacy of behavioral weight control intervention with a peer-enhanced activity intervention versus structured aerobic exercise in decreasing body mass index (BMI) and z-BMI in overweight adolescents. STUDY DESIGN: Participants were randomized to 1 of 2 group-based treatment conditions: (1) cognitive behavioral treatment with peer-enhanced adventure therapy or (2) cognitive behavioral weight control treatment with supervised aerobic exercise. Participants included 118 overweight adolescents, ages 13 to 16 years, and a primary caregiver. Changes in BMI, standardized BMI, percent over BMI, and waist circumference were examined. RESULTS: Analysis of variance on the basis of intent-to-treat indicated significant decreases in all weight change outcomes at the end of treatment, with significant decreases maintained at the 12-month follow-up. No differences in treatment conditions were observed. Secondary analyses indicated that adherence with attendance and completion of weekly diet records contributed significantly to reductions in BMI. CONCLUSIONS: A cognitive behavioral weight control intervention combined with supervised aerobic exercise or peer-enhanced adventure therapy is equally effective in short-term reduction of BMI and z-BMI in overweight adolescents. Adherence, as measured with session attendance and self-monitoring, is a key dimension of weight change.

Smoking and drinking among college students: "it's a package deal".

BACKGROUND: This paper reports on qualitative research on smoking in contexts associated with drinking among college students. Although a plethora of survey research has shown a positive association between smoking and alcohol use, little attention has been given to the utility functions of these co-occurring behaviors. METHODS: Data are drawn from semi-structured interviews with college freshmen at a large Mid-western university in the U.S. (n=35). In addition, eleven focus groups with fraternity and sorority members were conducted (n=70). Interviews and focus groups focused on a range of issues including current smoking behavior, reasons for smoking, and smoking and drinking. RESULTS: A review of qualitative responses reveals that smoking served multiple utility functions for this population including (1) facilitating social interaction across gender, (2) allowing one to structure time and space at a party, (3) enabling "party" smokers to smoke with fewer negative side effects, and (4) helping to calm one down when drunk. CONCLUSIONS: Whereas smoking was stigmatized during the context of one's everyday life as a student, at parties while consuming alcohol, smoking was viewed as normative and socially acceptable. Preventive interventions are needed on college campus that target co-substance use and address widespread misperceptions about the harm of tobacco use and addiction.