Agents of change: pathways through which mentoring relationships influence adolescents' academic adjustment.

A conceptual model was tested in which the effects of mentoring relationships on adolescents' academic outcomes were hypothesized to be mediated partially through improvements in parental relationships. The parameters of the model were compared with those of an alternative, in which improved parental relationships were treated as an outcome variable rather than a mediator. The study included 959 young adolescents (M age = 12.25 years), all of whom applied to Big Brothers Big Sisters programs. The adolescents were randomly assigned to either the treatment or control group and administered questions at baseline and 18 months later. The hypothesized model provided a significantly better explanation of the data than the alternative. In addition to improvements in parental relationships, mentoring led to reductions in unexcused absences and improvements in perceived scholastic competence. Direct effects of mentoring on global self-worth, school value, and grades were not detected but were instead mediated through improved parental relationships and scholastic competence. Implications of the findings for theory and research are discussed.

Black-white differences in factors influencing mammography use among employed female health maintenance organization members.

OBJECTIVE: This study examined racial differences in knowledge, attitudes and practices related to breast cancer screening of black and white women health maintenance organization members over age 40 who are employed at 75 worksites in Pennsylvania and New Jersey in the US. DESIGN: Data are from telephone interviews of 1677 women (20% black). The interviews queried background factors and concepts from the Health Belief Model. RESULTS: Compared to whites blacks were younger and less likely to be married or to have family history of breast cancer. They were also more likely to underestimate their cancer risk and to fear radiation, and less likely to have a doctor advise them to get mammograms. Black and white women did not differ in terms of self-reported mammography use. The results of multivariate modeling suggest that different set of knowledge and belief variables may explain mammography adherence among black and white women. CONCLUSION: These findings have implications for clinical prevention and for patient and community health education in minority populations.

Quitting motives and barriers among older smokers. The 1986 Adult Use of Tobacco Survey revisited.

BACKGROUND: Adults aged 50-74 years comprise more than 20% of the population and more than 22% of all smokers. Smoking is a risk factor for 7 of the 14 major causes of death for older adults, including cancer, heart disease, and lung disease. Moreover, older smokers can experience significant dramatic health benefits from quitting, including improvements in circulation and pulmonary function and declines in risks for heart disease, heart attacks, and stroke. METHODS: Smoking patterns, quitting motives, and barriers among older smokers were examined by comparing responses of older smokers (aged 50-74 years) and younger smokers (aged 21-49 years) who took part in the 1986 Adult Use of Tobacco Survey. RESULTS: Older and younger smokers differed little in current smoking patterns or in past quit attempts, motives, and methods. Survey results show that older smokers are far less likely to accept smoking health harms and more likely to view smoking as a beneficial coping and weight control tactic. CONCLUSIONS: Motivational strategies should be tailored to the unique health beliefs and cultural history of older smokers.

Use of transdermal nicotine in a state-level prescription plan for the elderly. A first look at 'real-world' patch users.

OBJECTIVE: To assess transdermal nicotine use patterns and outcomes in a population of low-income older smokers. DESIGN: A 6-month telephone follow-up survey of smokers filling prescriptions for transdermal nicotine in the first 3 months of 1992. SETTING: Pennsylvania's Pharmaceutical Assistance Plan for the Elderly, the nation's largest state-level prescription plan for the elderly. POPULATION: A total of 1070 noninstitutionalized male and female smokers aged 65 through 74 years. MAIN OUTCOME MEASURES: Self-reported physician/pharmacist advice and adjunctive treatments, concomitant smoking, and 6-month smoking abstinence. RESULTS: Respondents were predominantly long-term heavy smokers. They used nicotine patches for an average of 5 weeks, with few reporting use beyond 3 months or recalling bothersome side effects. Most of those with previous quit attempts rated quitting with the patch "easier." The 29% self-reported 6-month quit rate observed is encouraging. However, compliance with patch use guidelines was far from ideal in this high-risk population: only 54% of respondents received any initial advice or materials from their physicians or pharmacists, fewer than 2% took part in a formal clinic or one-to-one treatment program, and almost half (47%) smoked while using the patch, including 20% who smoked every day. Concomitant smoking was strongly associated with failure to achieve abstinence (P < .001). More frequent contact with physicians and/or pharmacists was associated with less concomitant smoking (P < .001) and higher quit rates (P = .005). CONCLUSIONS: This survey offers an important first look at problems and prospects for nicotine patch therapy in older adults, with implications for other groups as well. Prospective studies are needed to clarify optimal treatment regimens and adjuncts.

Does tailoring matter? The impact of a tailored guide on ratings and short-term smoking-related outcomes for older smokers.

There is new evidence that smokers of all ages benefit from cessation of smoking. Although most older smokers, like younger smokers, prefer to quit on their own, at the time this project was started, there were no materials or programs targeted to older smokers. Using the literature, focus groups with older smokers and a national survey of older smokers, we created Clear Horizons, a self-help guide for older smokers, and a telephone counseling protocol tailored to the needs of older smokers (age 50-74). Smokers were recruited from around the United States and assigned randomly to a control guide, Clearing the Air, Clear Horizons alone or Clear Horizons and two counselor calls. Follow-up of nearly 2000 smokers was conducted by telephone 3, 6, 12 and 24 months after delivery of the self-help guides. This report focuses primarily on results at 3 months because that was the measurement for reactions to the interventions. At the 3 month interview, those in the tailored interventions rated their guides more highly than did those in the control group. They also read more of their guides and were more likely to reread them. Quit rates were significantly higher among smokers who received a combination of the tailored guide and telephone counseling. At 3 months, the combination of the guide and telephone counseling was most effective in helping smokers to quit. By 12 months, both the tailored guide alone and the tailored guide and calls groups had higher quit rates than the control guide but were not statistically different from one another.

Communication between patients with breast cancer and health care providers. Determinants and implications.

BACKGROUND: This study evaluated the perceptions of patients with breast cancer of their medical interactions with providers. The determinants and psychological consequences of communication problems also were examined. METHODS: Ninety-seven patients with Stage I or II breast cancer completed a set of validated questionnaires before initiating postoperative therapy. Data on psychological distress were collected at baseline and 3-month follow-up, and multivariate models were fit to explain the relationship between pretreatment communication problems and subsequent psychological distress. Data on clinical variables were abstracted from medical records. RESULTS: A substantial proportion of patients (84%) reported difficulties communicating with the medical team. Communication problems were more common among patients who were less optimistic about their disease and had less assertive coping styles. Patient-reported communication problems were associated with increased anxiety, depression anger, and confusion at the 3-month follow-up. The association between communication problems and mood disturbance remained significant, although small, after adjusting for baseline mood disturbance, demographic, clinical, and coping style variables. CONCLUSION: Interventions that enhance communication between patients with breast cancer and their providers may improve patients' psychological adjustment to treatment. Conversely, interventions that lower distress and modify coping style may enhance communication.

Impact of elderly mother's death on middle age daughters.

Daughters' responses to an elderly mother's death are found to be multidimensional. In the first six months of bereavement many daughters experience themes of both holding on and letting go. Measured were depression, grief, somatic reactions, as well as impact on the sense of self, degree of acceptance of the death, and ways in which the tie with the mother endures. Though many of these reactions are intercorrelated, they are differentially associated with characteristics of the daughter, mother, and the quality of their relationship. Relatively sudden deaths were associated with more intense grief, less acceptance, and more thoughts of reunion than deaths that occurred in a nursing home.

Breast cancer screening practices among retirement community women.

BACKGROUND: The purposes of this study were (a) to learn more about the existing breast cancer screening practices of women age 65 and older and (b) to identify factors related to breast cancer screening. METHOD: A random sample of 752 women age 65 and older residing in independent living apartments in eight retirement communities was selected to participate in a survey of breast cancer screening practices and related factors. A total of 616 surveys were complete, yielding a response rate of 82%; of those, 571 of the surveys were administered by telephone, with the remaining 45 administered in person. RESULTS: Thirty-eight percent of the women reported having had a mammogram within the past year, 53% had a clinical breast exam, and 39% reported performing monthly breast self-examination. The percentage of women reporting either annual clinical breast examinations or mammography decreased with increasing age. Results of a logistic regression analysis found that having discussed mammography with a physician, believing in the need for mammography, having no mammography-related concerns, and the combination of personal experience with breast cancer and having had a clinical breast examination in the past year were all independently related to having had a mammogram within the past year (P < 0.05). CONCLUSION: In order to increase older women's participation in screening, particularly in mammography, educational interventions need to be developed and directed both to older women and to their physicians.

Factors associated with adherence to breast cancer screening among working women.

This study identified sociodemographic, knowledge, attitude, and social influence correlates of obtaining mammograms among employed women age 40 and over. Telephone interviews were conducted with 798 women who worked at 39 different work sites. Eighty-four percent of respondents had ever had a mammogram, and 72% had had one at the recommended interval for their age group. The only personal characteristic that was associated with past mammography use was having a co-worker, friend, or relative with a history of breast cancer. Logistic regression analyses indicated that a doctor's advice to have a mammogram, knowledge of screening guidelines, knowing someone with breast cancer, and the beliefs that mammography is effective and that mammography is necessary in the absence of symptoms were associated independently with past use of mammography. Three factors contributed independently to explaining adherence to mammography guidelines: younger age, knowledge of guidelines for one's own age group, and the belief that breast cancer is curable. The findings suggest that emphasizing the recommended guidelines, the need for and benefits of mammography in educational programs, and offering low-cost or free mammography at the workplace, can further increase appropriate utilization among working women.

Multistrategy health education program to increase mammography use among women ages 65 and older.

Mammography use decreases with age although the risk of breast cancer increases with age. Medicare now provides biennial coverage for screening mammography. This study was designed to simulate the Medicare condition by subsidizing mammography among women in eight retirement communities in the metropolitan Philadelphia area. The study also measured the impact of health education interventions and the presence of a mobile mammography van on increased use of mammography. Retirement communities were assigned randomly to the control (cost subsidy alone) or experimental group (cost subsidy, mammography van, and tailored health education interventions). A total of 412 women ages 65 and older who had not had mammograms in the previous year were surveyed at baseline and 3 months later. Analytic techniques reflected the cluster nature of the randomization. Women in the experimental group were significantly more likely than the control group women to have obtained mammograms. Forty-five percent of the experimental group women compared with 12 percent of the control group women subsequently had mammograms in the 3 months after the baseline interview (P less than .001). Logistic regression analysis for mammography use indicated an odds ratio of 6.1 associated with being in the experimental group. For women in the experimental group, a separate logistic regression for mammography use showed an odds ratio of 7.8 associated with attendance at the educational presentation. The results suggest that Medicare coverage alone will not increase mammography use sufficiently to achieve year 2000 objectives. However, the addition of access enhancing and health education interventions boosts utilization dramatically.

Mental health of caregiving spouses: coping as mediator, moderator, or main effect?

Coping strategies used by 315 persons providing care to a spouse diagnosed with Alzheimer's disease were characterized as either emotion-focused (wishfulness, acceptance, intrapsychic) or problem-focused (instrumental). Models in which coping strategies were postulated as having mediator, moderator, and independent main effects were tested using multiple indexes of mental health. Wishfulness and intrapsychic strategies mediated the relationship between degree of stress and CES-D, Anxiety, and Depression. Wishfulness had a direct effect on Obsessive-Compulsive, Somatization, and Interpersonal Sensitivity; intrapsychic strategies had a direct effect on Obsessive-Compulsive, Somatization, and Interpersonal Sensitivity; and instrumental strategies had a direct effect on Positive Affect. Hierarchical regression analyses indicated that stressors and coping strategies explained between 12% and 40% of the variance on mental health indexes.

The context of change: disorientation following intra-institutional relocation.

Levels of disorientation following either intra-institutional relocation or no relocation were compared for a sample of people resident in a nursing home from April to October, 1983, and a second, independent sample who were either moved or not moved between December 1985 and June 1986. Results of separate logistic regression analyses indicated no differences in disorientation dependent on move status for the first sample, but significant differences for the second group. Among the latter group, nonmovers demonstrated the highest levels of disorientation. Results are interpreted as a function of the larger contexts in which the moves were made. Suggestions are made regarding issues of concern for administrators of long-term care facilities faced with the responsibility of relocating nursing home residents.

Aberrant behaviors and Alzheimer's disease: mental health effects on spouse caregivers.

The relationships between well-being of 262 caregivers of Alzheimer's disease patients and forgetful, asocial, and disoriented behaviors on the part of the impaired spouse were examined using three one-way MANOVAs. Results indicate that asocial and disoriented behaviors have linear relationships with levels of burden, specific mental health problems attributed to caregiving, and the extent to which caregivers sacrificed aspects of their social life. Asocial behaviors were also linearly related to overall level of caregiver depression. Forgetful behaviors, on the other hand, have relationships with burden, specific mental health problems attributed to caregiving, and social change that are nonlinear. Data are interpreted in terms of the predictable course of Alzheimer's disease and associated role expectations.

Husbands and wives as caregivers: antecedents of depression and burden.

Contrasting predictors of depression among 101 men and 214 women providing care to spouses suffering from Alzheimer's Disease indicated that the sole predictor for husbands was ill health, whereas for wives less emotional investment was also predictive. While there were no significant predictors for burden among husbands, for wives, burden was associated with poorer health, less emotional investment, greater spouse impairment, and provision of more assistance with tasks.

Psychometric assessment of the Multidimensional Observation Scale for Elderly Subjects (MOSES).

The factor structure of the MOSES proposed by Helmes et al. (1987) was tested using both exploratory and confirmatory factor analysis procedures. Results indicated that although the number of factors suggested was appropriate, the manifest variables proposed for each latent factor were not stable. A modified 5-factor model using 24 of the original 40 variables was proposed and tested. Confirmation of the modified model suggests factorial invariance across two independent samples. Internal consistency for the five scales measured by coefficient alphas ranged from 0.62 to 0.92. Difficulties in scoring MOSES items are discussed, and solutions offered for alleviating the problems. The 5-factor MOSES model is suggested as a useful research and clinical tool.