Self-Care Adherence and Psychological Functioning of Older Patients with Type 2 Diabetes: Effects of Persuasion, Social Pressure, and Self-Efficacy.

This cross-sectional study examined the role of family members' use of persuasion versus pressure as distinct forms of social control by which family members attempt to encourage better diabetes management among older adults with type 2 diabetes mellitus (T2DM). The study also examined how self-efficacy might moderate the relationship between persuasion/pressure, psychological functioning, and self-care adherence. Participants were 96 men and 103 women with T2DM, with a mean age of 63.3 years. Regression results show that neither persuasion nor pressure was significantly related to self-care adherence, but persuasion and pressure were associated in complex ways with diabetes-related emotional distress and depressive symptoms for which significant interaction effects were found. Patients with lower self-efficacy benefited from persuasion, but were adversely affected by pressure. In contrast, patients with higher self-efficacy were adversely affected by persuasion, but were less negatively affected by pressure. Findings highlight the importance of reducing pressure-based social control, considering patients' self-efficacy when family members seek to influence patients' self-care behaviors, and targeting patient-family interactions in future interventions.

Media exposure and smoking intention in adolescents: a moderated mediation analysis from a cultivation perspective.

The study tested a moderated mediation model to examine the mechanisms underlying the link between media exposure and adolescent smoking intention by utilizing a modification of cultivation theory. A total of 12,586 non-current smoker adolescents in California were included in the analysis. Results showed that media exposure was positively related to smoking intention via perceived prevalence of peer smoking when friend disapproval of cigarette use was low. This study contributes to a better understanding of the mechanisms regarding the media effects on smoking intention, but the findings should be interpreted with caution due to the small effect size.

The effects of connectedness on health-promoting and health-compromising behaviors in adolescents: evidence from a statewide survey.

Using a social ecological perspective, we examined the effects of connectedness in multiple domains on health-promoting and health-compromising behaviors among Asian American (AA), Pacific Islander (PI), and Caucasian/White American (WA) adolescents in California. After adjusting for age, gender, and socioeconomic status, the following consistent results emerged across the three ethnic groups: (a) community connectedness increased the odds of physical activity; (b) internal, family, and school connectedness decreased, whereas friend connectedness increased, the odds of substance use; and (c) internal and family connectedness decreased the odds of violent behavior. We also found specific ethnic variations pertaining to the effects of connectedness. Friend connectedness increased the odds of violent behavior for AAs and WAs, but not for PIs. Meanwhile, community connectedness increased the odds of substance use and violent behavior for AAs and PIs, but decreased the odds of these behaviors for WAs. Findings for healthy dietary behavior were inconsistent across ethnic groups and connectedness domains. Our overall findings suggest that the effects of connectedness were more salient for health-compromising behaviors than for health-promoting behaviors. Health prevention and intervention efforts in adolescents could target the role of their connectedness to their multiple social domains.

Psychosocial correlates of cigarette smoking among Asian American and Pacific Islander adolescents.

Despite the growing body of research in adolescent cigarette smoking, there is a lack of research on Asian American and Pacific Islander (AAPI) adolescents. This study examined the prevalence and psychosocial correlates of the past 30-day cigarette smoking in Asian American (AA) and Pacific Islander (PI) adolescents by utilizing a multi-systemic theory-the problem behavior theory. Using the 2006-07 High School Questionnaire of California Healthy Kids Survey, variables such as cigarette smoking, individual characteristics and external influences were assessed. Chi-square tests and generalized estimating equations were used in the analyses. PIs had higher past 30-day cigarette smoking rates than AAs. In the whole AAPI population, significant correlates of cigarette smoking included: positive and negative attitudes toward cigarettes, perceived harm of cigarettes, perceived prevalence of peer cigarette smoking, friend disapproval of cigarette use, previous drug use, truancy, and academic performance. Interaction results showed that truancy increased the odds of cigarette use for AAs only. The study found differential prevalence and correlate of cigarette smoking in addition to common psychosocial correlates in AAs and PIs. It sheds light on the importance of studying AAs and PIs separately and further exploring other potential variables that contribute to the prevalence discrepancy.

Factors associated with primary care clinicians' choice of a watchful waiting approach to managing depression.

OBJECTIVES: Watchful waiting to manage depression in primary care may be an appropriate management approach for some patients who present with less severe depression. This study examined factors associated with primary care clinicians' choice of a watchful waiting approach to care management for depression. METHODS: Secondary data were analyzed from Partners in Care, which examined dissemination of best practices for depression in primary care. Primary care clinicians' decisions regarding watchful waiting were examined by using the baseline survey data from Partners in Care completed by clinicians and patients from February 1996 to March 1997. Participants were 167 primary care clinicians from 46 practices of seven managed care organizations across the United States and their 1,187 patients with depression. Primary care clinicians' proclivity for watchful waiting was examined by using a brief scenario describing a patient with major depressive disorder. RESULTS: Thirty-four clinicians (20 percent) reported a strong proclivity to use watchful waiting for the patient in the scenario. The proclivity was significantly associated with clinicians' reports of the proportion of their actual patients with whom they used this approach. Clinicians were significantly more likely to choose watchful waiting for their actual patients if they had more psychotherapy knowledge (p=.035) or perceived that the need to treat the patient's medical illness was more important than the need to treat his or her mental illness (p=.046) and were less likely to choose a watchful waiting approach if they perceived the lack of availability of mental health professionals as a barrier (p=.050). CONCLUSIONS: Primary care clinicians' knowledge of treatment and perception of barriers influence their proclivity for watchful waiting. Clinician education to promote appropriate use of watchful waiting on the basis of clinical need is recommended.

Intergenerational communication of race-related trauma by Japanese American former internees.

The present study investigated the intergenerational communications between Japanese Americans who were unjustly ordered into U.S. concentration camps during World War II and their offspring born after the war. Survey data were collected from 450 2nd-generation (Nisei) Japanese American former internees to assess patterns of communication with their children about the internment. The study and its results are discussed in relation to racial socialization and the influence of ethnicity on reactions to traumatic stress.