The impact of health anxiety on perceptions of personal and children's health in parents with Lynch syndrome.

This study examined the differences in perceptions of one's health and one's child's health between parents with Lynch syndrome (LS) characterized with high versus low health anxiety. Twenty-one parents completed semistructured telephone interviews about their perceptions of their own health and the health of their children. Qualitative content analysis using a template coding approach examined the differences between parents with high and low health anxiety. Findings revealed that the most prevalent difference emerged on perceptions of personal health, showing individuals with high health anxiety reported more extreme worries, were more hypervigilant about physical symptoms, experienced the emotional and psychological consequences of LS as more negative and severe, and engaged in more dysfunctional coping strategies than those with low health anxiety. Unexpectedly, with regards to perceptions of their children, parents in the high and low health anxiety groups exhibited similar worries. However, high health anxiety parents reported using dysfunctional coping about their children's health more frequently than those with low health anxiety. The findings suggest that health anxiety is of clinical significance for individuals with LS. Accurately identifying and treating health anxiety among this population may be one avenue to reduce the distress experienced by LS carriers.

Health care provider attitudes and beliefs about people living with HIV: Initial validation of the Health Care Provider HIV/AIDS Stigma Scale (HPASS).

HIV stigma is a pressing concern for people living with HIV, and particularly when it is perpetuated by health care providers, as it may affect quality of life and access to health care services. The current study describes the development and initial validation of a contextually appropriate HIV stigma scale for health care providers in North America. A ground-up qualitative approach was used to develop the scale, and it was assessed psychometrically with health care trainees across Canada. The measure demonstrates excellent internal consistency reliability and test-retest reliability, as well as convergent and divergent validity. The study supports a tripartite model of HIV stigma consisting of stereotyping, prejudice and discrimination. The scale provides a new tool to assess HIV stigma in health care providers and can be used to inform training, intervention and self-evaluation of stigmatizing attitudes, beliefs and behaviors among providers.

Examining Evidence for Autonomy and Relatedness in Urban Inuit Parenting.

Inuit have experienced significant lifestyle changes in the past 50 years. Most recently, urbanization has resulted in greater numbers of Inuit living in urban centres in southern Canada. Little is known about Inuit parenting, and nothing has been published on Inuit parenting in an urban context. The present study sought to address this gap by describing the parenting of Inuit living in a large Canadian city and examining emergent themes for evidence of autonomy and relatedness. In partnership with the Tungasuvvingat Inuit Family Resource Centre, 39 Inuit parents completed an interview about their parenting experiences. Based on interviews, major parenting themes included: child characteristics; parenting behaviours and beliefs; affection and love; stressors; and responsive and respectful parenting. The majority of parenting themes linked to relatedness, although there was evidence of autonomy in both parenting behaviours and child characteristics. Results are interpreted in light of the autonomy-relatedness framework and theoretical implications of findings are discussed.

Ready to make nice: parental socialization of young sons' and daughters' prosocial behaviors with peers.

In this study, the authors examined the extent to which maternal and paternal parenting styles, cognitions, and behaviors were associated with young girls' and boys' more compassionate (prototypically feminine) and more agentic (prototypically masculine) prosocial behaviors with peers. Parents of 133 preschool-aged children reported on their authoritative parenting style, attributions for children's prosocial behavior, and responses to children's prosocial behavior. Approximately 6 months later, children's more feminine and more masculine prosocial behaviors were observed during interactions with unfamiliar peers and reported on by their preschool teachers. Boys and girls did not differ in the observed and teacher-reported measures of prosocial behavior. Compared to other parents, fathers of boys were less likely to express affection or respond directly to children's prosocial behavior. Mothers' authoritative style, internal attributions for prosocial behavior, and positive responses to prosocial behavior predicted girls' displays of more feminine prosocial actions and boys' displays of more masculine prosocial actions toward peers. Relations were similar but weaker for fathers' parenting, and after accounting for mother' scores, fathers' scores accounted for unique variance in only one analysis: Teachers reported more masculine prosocial behavior in boys of fathers who discussed prosocial behavior. Overall, the results support a model of parental socialization of sex-typed prosocial behavior and indicate that mothers contribute more strongly than do fathers to both daughters' and sons' prosocial development.

HIV-Related Stigma and Overlapping Stigmas Towards People Living With HIV Among Health Care Trainees in Canada.

HIV continues to be a stigmatized disease, despite significant advances in care and concerted effort to reduce discrimination, stereotypes, and prejudice. Living with HIV is often associated with a multitude of overlapping and intersecting experiences which can, in and of themselves, also be stigmatized, and which may exacerbate HIV-related stigma. The consequences of these stigmatizing experiences are particularly impactful when the stigmatizing individual is a health care provider, as this can influence access to and quality of care. The current study empirically investigates a model of overlapping stigmas (homophobia, racism, sexism, stigma against injection drug use and stigma against sex work) potentially held by health care provider trainees in Canada to determine how these constructs overlap and intersect, and to assess whether HIV-related stigma may have unique attributes. Understanding overlapping stigmas can help inform targeted, stigma-informed training for health care trainees in order to provide effective, compassionate care for people living with HIV.

Guiding health promotion efforts with urban Inuit: a community-specific perspective on health information sources and dissemination strategies.

OBJECTIVE: To develop a community-specific perspective of health information sources and dissemination strategies of urban Inuit to better guide health promotion efforts. METHODS: Through a collaborative partnership with the Tungasuvvingat Inuit Family Resource Centre, a series of key informant interviews and focus groups were conducted to gather information on specific sources of health information, strategies of health information dissemination, and overall themes in health information processes. FINDINGS: Distinct patterns of health information sources and dissemination strategies emerged from the data. Major themes included: the importance of visual learning, community Elders, and cultural interpreters; community cohesion; and the Inuit and non-Inuit distinction. The core sources of health information are family members and sources from within the Inuit community. The principal dissemination strategy for health information was direct communication, either through one-on-one interactions or in groups. CONCLUSION: This community-specific perspective of health information sources and dissemination strategies shows substantial differences from current mainstream models of health promotion and knowledge translation. Health promotion efforts need to acknowledge the distinct health information processes of this community, and should strive to integrate existing health information sources and strategies of dissemination with those of the community.

A Systematic Review on the Effectiveness of Brief Interventions for Alcohol Misuse among Adults in Emergency Departments.

Given the frequency with which individuals seek treatment for alcohol-related consequences in emergency departments (EDs), they may be the optimal setting to deliver brief interventions (BIs) for alcohol misuse. Studies examining the effectiveness of BIs for alcohol misuse conducted in EDs have yielded mixed results, and new articles have been published since the last review in 2008. The aim of this study was to provide an updated systematic review on the effectiveness of BIs for alcohol misuse delivered to adults in EDs. Articles published in June 2014 and earlier were identified from online databases (PsycInfo, Healthstar, CINAHL, Medline, Nursing and Allied Health). Search terms included (1) alcohol, (2) "alcohol screening", "brief intervention", "brief alcohol intervention" or feedback and (3) "emergency department" or "emergency room". Once duplicates were removed, 171 abstracts were identified for review. Thirty-four studies were included in the systematic review. All studies reported a significant reduction in alcohol consumption at 3 months post-BI, with some studies finding significant differences between the BI and control groups, and other studies finding significant decreases in both conditions but no between-groups differences. The majority of studies did not find significant between-group differences at 6 and 12 months post-BI with regard to decreases in alcohol consumption. Individuals who received a BI were significantly less likely to have an alcohol-related injury at 6 or 12 months post-BI than individuals who did not receive a BI. BIs are unlikely to reduce subsequent hospitalizations however, they may be effective in reducing risky driving and motor vehicle crashes associated with alcohol use, which can result in hospitalization. Beyond the effects generated by visiting EDs, BIs delivered in EDs may not be effective in reducing alcohol consumption, or in reducing subsequent hospitalizations. BIs may be effective in reducing some alcohol-related consequences. Future studies ought to investigate for whom BIs are most effective, and the processes that lead to decreases in alcohol consumption and alcohol-related consequences.

A realist review of family-based interventions for children of substance abusing parents.

BACKGROUND: Millions of children across North America and Europe live in families with alcohol or drug abusing parents. These children are at risk for a number of negative social, emotional and developmental outcomes, including an increased likelihood of developing a substance use disorder later in life. Family-based intervention programs for children with substance abusing parents can yield positive outcomes. This study is a realist review of evaluations of family-based interventions aimed at improving psychosocial outcomes for children of substance abusing parents (COSAPs). The primary objectives were to uncover patterns of contextual factors and mechanisms that generate program outcomes, and advance program theory in this field. METHODS: Realist review methodology was chosen as the most appropriate method of systematic review because it is a theory-driven approach that seeks to explore mechanisms underlying program effectiveness (or lack thereof). A systematic and comprehensive search of academic and grey literature uncovered 32 documents spanning 7 different intervention programs. Data was extracted from the included documents using abstraction templates designed to code for contexts, mechanisms and outcomes of each program. Two candidate program theories of family addiction were used to guide data analysis: the family disease model and the family prevention model. Data analysis was undertaken by a research team using an iterative process of comparison and checking with original documents to determine patterns within the data. RESULTS: Programs originating in both the family disease model and the family prevention model were uncovered, along with hybrid programs that successfully included components from each candidate program theory. Four demi-regularities were found to account for the effectiveness of programs included in this review: (1) opportunities for positive parent-child interactions, (2) supportive peer-to-peer relationships, (3) the power of knowledge, and (4) engaging hard to reach families using strategies that are responsive to socio-economic needs and matching services to client lived experience. CONCLUSIONS: This review yielded new findings that had not otherwise been explored in COSAP program research and are discussed in order to help expand program theory. Implications for practice and evaluation are further discussed.

A realist review of brief interventions for alcohol misuse delivered in emergency departments.

BACKGROUND: Brief interventions (BIs) involve screening for alcohol misuse and providing feedback to patients about their use, with the aim of reducing alcohol consumption and related consequences. BIs have been implemented in various healthcare settings, including emergency departments (ED), where they have been found to contribute mixed results in their ability to address alcohol misuse among adults. Mechanisms through which BIs work and contextual factors impacting BI effectiveness are not clear. The purpose of this review was to understand how, for whom, and under what circumstances BIs work for adults misusing alcohol and who have been admitted to an ED. A realist review was chosen to answer these questions as realist reviews create context-mechanism-outcome configurations, leading to the development of comprehensive and detailed theories; in this case explaining how and for whom BIs work. METHODS: Databases including PsycINFO, Healthstar, CINAHL, Medline, and Nursing and Allied Health were searched for articles published until December 2013. The search strategy focused on studies examining BIs that targeted alcohol misuse among adults admitted into the ED. The search identified 145 relevant abstracts, of which 36 were included in the review. The literature was synthesized qualitatively (immersion/crystallization). RESULTS: Four mechanisms were found within reviewed studies, including engagement in/retention of BI materials, resolving ambivalence, increased awareness/insight into consequences of drinking, and increased self-efficacy/empowerment to use skills for change. The following contexts were found to impact mechanisms: emotional state, injury attributed to alcohol use, severity of alcohol use, and baseline stage of change. CONCLUSIONS: This realist review provides advances in theories regarding which mechanisms to target during a BI and which contexts create the most favorable conditions for these mechanisms to occur, ultimately leading to optimal BI outcomes. These results can inform future clinical decision-making when delivering BIs in ED settings. Future research should conduct quantitative examination to confirm these findings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42013006549.

The role of relevancy in normative feedback for university students' drinking patterns.

OBJECTIVE: Intervention studies using normative feedback have reported changes in motivation for changes in alcohol use. The relevancy of the social comparison group of the feedback has not yet been examined. The purpose of this study was to examine whether varying the relevancy of the comparison group would result in greater motivation for changes in alcohol use. METHOD: Participants completed the AUDIT and then read one of three intervention pamphlets: (i) Canadian population drinking patterns; (ii) Canadian university students' drinking patterns; or (iii) American university students' drinking patterns. Afterwards, participants completed the recognition and ambivalence subscales of SOCRATES and rated their overall impressions of the pamphlet. RESULTS: Participants identified as problem drinkers who read the American university students pamphlet reported significantly higher recognition ratings, compared to problem drinkers who read one of the other two pamphlets. CONCLUSIONS: Explanations for the unanticipated findings are discussed. The authors speculate that participants may have relied on their knowledge of perceived drinking patterns as opposed to relevancy of the feedback in making their social comparison.

Evaluation of the acceptability of a CD-Rom as a health promotion tool for Inuit in Ottawa.

BACKGROUND: There are few health promotion tools for urban Inuit, and there is a specific dearth of evaluations on such tools. OBJECTIVE: The current study used a community-specific approach in the evaluation of a health promotion tool, based on an urban Inuit community's preferences of health knowledge sources and distribution strategies. In partnership with the Tungasuvvingat Inuit Family Health Team in Ottawa, a CD-Rom was developed featuring an Inuk Elder presenting prenatal health messages in both Inuktitut and English. Also, relevant evaluation materials were developed. DESIGN: Using a mixed methods approach, 40 participants completed interviews prior to viewing the CD-Rom and participated in a focus group at follow-up. Questionnaires were also completed pre- and post-viewing to assess changes between expectations and reactions in order to document acceptability. RESULTS: Significant increases were found on satisfaction, acceptability of medium and relevance of content ratings. Qualitative findings also included (a) interest, uncertainty and conditional interest prior to viewing; and (b) positive evaluations of the CD-Rom. CONCLUSIONS: This suggests that CD-Rom technology has the potential for health promotion for urban Inuit, and the community-specific evaluation approach yielded useful information.

Parental socialization, vagal regulation, and preschoolers' anxious difficulties: direct mothers and moderated fathers.

Parental supportiveness and protective overcontrol and preschoolers' parasympathetic regulation were examined as predictors of temperamental inhibition, social wariness, and internalizing problems. Lower baseline vagal tone and weaker vagal suppression were expected to mark poorer dispositional self-regulatory capacity, leaving children more susceptible to the influence of parental socialization. Less supportive mothers had preschoolers with more internalizing problems. One interaction between baseline vagal tone and maternal protective overcontrol, predicting social wariness, conformed to the moderation hypothesis. Conversely, vagal suppression moderated several links between paternal socialization and children's anxious difficulties in the expected pattern. There were more links between mothers' self-reported parenting and child outcomes than were noted for direct observations of maternal behavior, whereas the opposite tended to be true for fathers.

Applying the polyvagal theory to children's emotion regulation: Social context, socialization, and adjustment.

Effective emotion regulation is essential for children's positive development. Polyvagal theory provides a framework for understanding how parasympathetic regulation of cardiac activity contributes to children's adaptive versus maladaptive functioning. Maintenance of cardiac respiratory sinus arrhythmia (RSA) under social challenge should support emotion regulation and behavioral adjustment. Children's effective parasympathetic regulation and behavioral adjustment should be supported by appropriate parental socialization. These proposals were evaluated in a short-term longitudinal study of 94 preschool-aged children. Parenting and basal RSA were measured at home, then 6-10 months later behavioral adjustment and RSA in lab baseline and socially challenging contexts were measured. Children with relatively higher RSA in social challenge than at baseline (DeltaRSA) had fewer internalizing problems (IP) and externalizing problems (EP), and better behavioral self-regulation (SR). Mothers who used more negative control had children with lower DeltaRSA, more IP and EP, and less SR. Structural equation modeling showed that vagal regulation mediated associations between maternal negative control and children's adjustment; maternal negative control did not predict EP or SR after accounting for DeltaRSA. Associations were consistent across boys and girls, with one exception: Higher DeltaRSA was significantly associated with fewer EP in boys only. These findings suggest that the practical significance of physiological regulation might be best revealed in ecologically valid procedures, and that children's physiological mechanisms of emotion regulation are shaped by their experiences of parental socialization.