Inconsistent, uncoordinated, and reactive: The current state of sibling psychosocial care.

BACKGROUND: Although providing sibling psychosocial services is a standard of care in pediatric oncology, initial survey research suggests that this standard is rarely achieved and siblings' support needs remain unmet. Which sibling psychosocial services are available and how centers provide such services is unknown. To identify targetable services gaps, this qualitative study characterizes current sibling psychosocial care practices at select pediatric cancer centers across the United States. PROCEDURE: Semi-structured interviews were conducted with a purposive sample of psychosocial care providers (N = 27) working across the United States in pediatric oncology centers of varied sizes. Interviews queried providers regarding sibling-focused parent psychoeducation, psychosocial screening, comprehensive assessment, and psychosocial support offerings. Interview data were analyzed using Applied Thematic Analysis. RESULTS: Across cancer centers, sibling care practices did not align with consensus-based recommendations. The nature and availability of sibling-focused psychoeducation, screening, assessment, and support were variable between and within centers. Siblings themselves were largely absent from sibling psychosocial care, and care was rarely sibling-specific. The flow of information about siblings was discontinuous and uncoordinated across the care continuum, resulting in psychosocial care provided reactively, typically in response to parental concerns. CONCLUSIONS: Sibling psychosocial care provision falls short of established care recommendations, leaving sibling psychosocial needs unmet. Findings highlight the need for tools and strategies to facilitate the implementation of sibling psychosocial care across the care continuum, to support siblings' psychosocial functioning across the life course.

Psychosocial care providers' perspectives: Barriers to implementing services for siblings of children with cancer.

BACKGROUND: Siblings of children with cancer are at increased risk for poor long-term psychosocial outcomes. The standard of psychosocial care in pediatric oncology calling for sibling support is not routinely implemented, often leaving siblings with unmet psychosocial needs. Barriers to implementing the sibling standard may exist at multiple levels. This study addresses research gaps regarding multilevel barriers to supporting siblings at the health care system, oncology center, and family levels. PROCEDURE: Qualitative interviews were conducted with psychosocial care providers (N = 27; 18 psychologists, five social workers, three psychiatrists, and one child life specialist) employed at oncology centers within hospitals across the United States, varying in extent of sibling programming and center size. Interviews included questions about providers' roles, oncology center characteristics, existing psychosocial sibling services, barriers to providing systematic sibling assessment, and ideas about how to overcome barriers. Data were analyzed using applied thematic analysis. RESULTS: Qualitative analysis revealed (a) barriers to providing sibling services occur at multiple levels (health care system, oncology center, family); (b) barriers at multiple levels frequently interact with one another; and (c) interacting barriers maintain a cycle: barriers to providing services contribute to limited provision of services, low service provision leads to limited utilization of existing services and underprioritization of siblings, and together this leads to siblings being off the radar, which further limits sibling service provision. CONCLUSION: Addressing health care system and oncology center barriers to implementing sibling assessment and support may be important potential targets for interventions to help ensure that siblings receive needed psychosocial assessment and support.

Effect of Electronic Nicotine Delivery Systems on Cigarette Abstinence in Smokers With No Plans to Quit: Exploratory Analysis of a Randomized Placebo-Controlled Trial.

INTRODUCTION: The extent to which use of electronic nicotine delivery systems (ENDS) for smoking reduction leads to cigarette abstinence in smokers with no plans to quit smoking is unclear. This exploratory analysis examined the effects of ENDS delivering different amounts of nicotine on cigarette abstinence up to 24-week follow-up, in comparison to placebo or a behavioral substitute. METHODS: This four-arm parallel-group, randomized, placebo-controlled trial took place at two academic medical centers in the United States (Penn State Hershey and Virginia Commonwealth University). Participants were current adult smokers (N = 520) interested in reducing but not planning to quit. They received brief advice and were randomized to one of four 24-week conditions, receiving either an eGo-style ENDS paired with 0, 8, or 36 mg/ml nicotine liquid (double-blind) or a cigarette-shaped tube, as a cigarette substitute (CS). Self-reported daily cigarette consumption and exhaled carbon monoxide (CO) were measured at all study visits. Outcomes included intent-to-treat, self-reported 7-day cigarette abstinence, biochemically confirmed by exhaled CO at 24 weeks after randomization. RESULTS: At 24 weeks, significantly more participants in the 36 mg/ml condition (14/130, 10.8%) than in the 0 mg/ml condition (1/130, 0.8%) and the CS condition (4/130, 3.1%) were abstinent (relative risk = 14 [95% CI = 1.9-104.9] and 3.5 [95% CI = 1.2-10.4], respectively). The abstinence rate in the 8 mg/ml condition was 4.6% (6/130). CONCLUSIONS: When smokers seeking to reduce smoking tried ENDS, few quit smoking in the short term. However, if smokers continued to use an ENDS with cigarette-like nicotine delivery, a greater proportion completely switched to ENDS, as compared with placebo or a cigarette substitute. IMPLICATIONS: The extent to which use of electronic nicotine delivery systems (ENDS) for smoking reduction leads to cigarette abstinence in smokers with no plans to quit smoking was unclear. This randomized trial found that ENDS with nicotine delivery approaching that of a cigarette are more effective in helping ambivalent smokers to quit cigarette smoking.

Neural mechanisms of intimate partner aggression.

People sometimes hurt those they profess to love; yet our understanding of intimate partner aggression (IPA) and its causes remains incomplete. We examined brain activity using functional magnetic resonance imaging (fMRI) in an ethnically and racially diverse sample of 50 female-male, monogamous romantic couples as they completed an aggression task against their intimate partner, a close friend, and a different-sex stranger. Laboratory and real-world IPA were uniquely associated with altered activity within and connectivity between cortical midline structures that subserve social cognition and the computation of value. Men's IPA most corresponded to lower posterior cingulate reactivity during provocation and women's IPA most corresponded to lower ventromedial prefrontal cortex activity during IPA itself. Actor-partner independence modeling suggested women's IPA may correspond to their male partner's neural reactivity to provocation. Broadly, these findings highlight the importance of self-regulatory functions of the medial cortex and away from effortful inhibition subserved by dorsolateral cortices.

Acceptability and feasibility of the online delivery of hatha yoga: A systematic review of the literature.

OBJECTIVES: Hatha yoga has dramatically increased in popularity in the United States and a growing body of evidence points to yoga's ability to successfully manage both physical and mental health conditions. Concurrently, the delivery of telehealth interventions also continues to rise. The online-delivery of yoga lies at this intersection, and to date, no study has systematically reviewed the existing literature of empirical studies involving the online delivery of yoga. DESIGN: This study systematically reviews the literature for evidence on the feasibility and acceptability of online yoga interventions and provides a qualitative synthesis. A total of 10 articles which represent eight unique empirical studies were included in the final review. RESULTS: Across the eight studies, participants expressed overall satisfaction with an online yoga intervention. Online yoga was found to be feasible, based on attendance and practice rates, and acceptable. Although groups vary in degree of initial engagement. Results also found preliminary evidence that online yoga can help manage symptoms associated with a range of disorders. CONCLUSIONS: Understanding this innovative approach to delivering yoga interventions will allow future research to include online yoga as a lower-cost, non-invasive intervention for a wide variety of physical and mental health disorders, as well as provide preliminary evidence to support the integration of online yoga interventions into routine clinical care.

"Think it. Mix it. Vape it.": A Content Analysis on E-Cigarette Radio Advertisements.

BACKGROUND: E-cigarette (EC) use is increasing rapidly across the United States, especially among youth. EC advertisements are one likely contributor to this increase, as they currently have few marketing restrictions. Radio advertising reaches most of the U.S. population and may be particularly influential in this regard. OBJECTIVES: The purpose of the current study was to examine content themes and spending data from EC radio advertisements. METHODS: Competitrack, a marketing tracking firm, gathered 19 advertisements from four different EC brands across the United States from 2015 to 2016, which were coded by two individuals and analyzed for main content themes. Additionally, spending data were analyzed by identified EC brand. RESULTS: Logic was the most common EC brand advertised on the radio and included themes potentially appealing to youth, such as humor and sound effects. Of the 28 analyzed content themes, references to "taste" were the most popular, followed by highlighting benefits of using ECs, presence of music, and comparison to other EC brands. Only Logic advertisements (n = 7) included health disclaimers and age restriction messages, yet frequently included themes that were attractive to youth. Conclusions/Importance: As these radio advertisements are exposing youth and other vulnerable populations to ECs, regulations, similar to those made for conventional cigarette advertising, are necessary for prevention efforts.