Risk and protective factors among youth offenders.

This exploratory study examined the risk and protective factors of youth offenders and their relation to recidivism. The sample consisted of 76 male and female juvenile probationers within a large metropolitan area. Archival records on probationers provided data on prior offenses, personal characteristics, familial conditions, drug use, peer selection, school performance, role models, and activities and hobbies. It was found that protective factors, specifically personal characteristics, familial conditions, and peer selection, differentiated nonrepeat offenders and repeat offenders. The present body of findings supports the adaptive model of resiliency and reinforces the importance of enhancing protective factors in youth offenders as a means of deterring delinquent behavior.

Relationship of mothers' perceptions and behaviors to the duration of breastfeeding.

The relationship between duration of breastfeeding in the first 12 weeks after birth, characteristics of mothers' and infants' behaviors, and the mother's perception of her infant were studied in primiparous mothers and their low-risk newborn infants. 50 women completed questionnaires on infants' temperament, caregiving flexibility, and perception of breastfeeding in their third trimester of pregnancy and again when their infants were 12 weeks old. 30 of the 50 women and their infants were observed for two hours on each of three different occasions at their homes when infants were 2, 6, and 12 wk. of age. Higher rates of mothers' interactive behaviors with their infants, mothers' self-reported perceptions that their infants had "easy" temperaments, and mothers' self-reported flexibility of caregiving were directly correlated with longer duration of breastfeeding and later weaning from the breast.

A randomized controlled evaluation of a psychosocial intervention in adults with chronic lung disease.

The effect of a stress management program on morbidity and psychosocial and physical function in patients with chronic lung disease was assessed. Adults attending either a VA pulmonary clinic or university hospital pulmonary rehabilitation clinic who met criteria for obstructive or restrictive pulmonary disease were randomly assigned to receive the intervention or to a control group. The intervention was provided by a nurse and included one to three teaching sessions, reading material, audiotapes, and telephone follow-up. The program focused on stress management techniques such as cognitive restructuring, progressive relaxation, breathing exercises, and visual imagery. The 45 experimental subjects were similar to the 49 controls with respect to baseline characteristics. Experimental and control subjects had similar rates of mortality, hospital days, bed-disability days, restricted-activity days, and physician visits during the 12-month follow-up. There were no differences between the two groups in physical or psychosocial function at six months or in levels of stressful life changes, social supports, and self-esteem at six and 12 months. Intervention recipients had better function at 12 months, suggesting a possible benefit of the intervention.

The association of health with stressful life changes, social supports, and coping.

Cross-sectional associations of social stressors, social supports, and coping strategies with health status were explored in a self-selected sample of 157 white adults. Using a mailed questionnaire, stressful life changes were assessed by a 40-item version of the Social Readjustment Rating Scale, social supports were measured by a 13-item index, and health status was assessed by the 63-item Duke-UNC Health Profile (DUHP). Responses to a recent stressful event were categorized by method of coping and by focus of coping. In a multivariate analysis controlling for the effects of age, gender, and education level, higher 12 month life change score was related to lower composite DUHP score. The use of active-cognitive coping was directly associated and the use of avoidance-coping was inversely associated with health status. When interaction terms were included in the multivariate analysis, avoidance-coping potentiated the adverse health effect of stressors and weak social supports potentiated the harmful effect of avoidance-coping on health. The findings suggest that the propensity to engage in avoidant behavior in response to a stressful experience is associated with health impairment, particularly when social supports are weak.

A randomized controlled evaluation of an educational program in adults with high psychosocial risk of morbidity.

This clinical trial tested the efficacy of a psychosocial intervention in a panel of white adults with a high level of recent stressful life changes and weak social supports. One hundred seventy users of three family practices were randomly assigned to receive a six-month educational program provided by a nurse practitioner or to a control group. Outcome variables were assessed over a 12-month follow-up period by mailed questionnaires and validated when possible by review of medical records. During the six months immediately following the intervention, recipients had a lower rate of restricted-activity days than controls. During the follow-up period, symptom experience, physical function, social function, and emotional function were similar in the two groups. While the overall improvement in social supports was not significantly better at the completion of the intervention for recipients than for controls, those recipients who developed strong supports had fewer restricted-activity days than those who continued to have weak supports. This educational program may provide temporary benefit to adults with high psychosocial risk for health impairment.

The reliability and validity of a ten-item measure of functional status.

The accurate assessment of functional status is an important clinical activity in family practice. Many of the measures of function developed for research purposes, however, have questionable applicability to primary care practices. The Duke-UNC Health Profile (DUHP) is a 63-item instrument that assesses four dimensions of function: symptom experiences, physical function, social function, and emotional function. The reliability and validity of a ten-item subset (the mini-DUHP) of the DUHP was examined for 71 white adults with a profile of high stressful life changes and weak social supports. These subjects completed the DUHP on two occasions and provided personal morbidity data by monthly mailed questionnaire for an intervening six-month period. On both administrations of the instrument, mini-DUHP scores were strongly correlated with composite DUHP scores (r = .81 and .84) and moderately correlated with each of the four functional dimension scores. The mini-DUHP demonstrated good temporal stability (r = .58). Mini-DUHP scores, determined both before and after the six-month period, were correlated with cumulative self-reported hospital days, bed disability days, restricted activity days, and physician utilization. Responses to the mini-DUHP strongly predicted bed disability, restricted activity, and physician visits after controlling for the effects of sociodemographic characteristics by multivariate analysis. This ten-item scale may be useful and practical in the assessment and monitoring of function in a primary care setting.

Evaluation of a health status measure in adults with high psychosocial risk.

The 63-item Duke UNC Health Profile assesses four dimensions of health status: presence of symptoms, physical function, social function, and emotional function. This instrument was developed for use in primary care research. We have tested its value in a primary care setting among individuals with suspected increased risk of health problems. In a group of 65 white adults with high life changes and weak social supports, this scale produced relatively stable functional status scores over fifteen months. In addition, functional status scores derived from this instrument were strongly correlated with cumulative six-month self-reported morbidity. These findings suggest that the Duke-UNC Health Profile is an acceptably reliable and valid measure of health status for adults with high psychosocial risk of health impairment.