Exploring the Barriers to Social Support Interactions: A Qualitative Study of Young Adult Cancer Patients and Young Adult Supporters.

This study explores the reasons why young adults (ages 18-39) struggle to provide or avoid providing support to young adult cancer patients. The study also explores young adult cancer patients' perceptions of why they have not received support from individuals who did not provide support. A total of 722 reasons were collected through online surveys and analyzed: 438 were provided by young adults who knew a young adult with cancer (N = 131), and young adult cancer patients (N = 111) provided 284 reasons why they believe they did not receive support. Initially using a previous typology of 16 nonsupport reasons, an abductive thematic analysis yielded a total of 21 barriers to the provision of social support. These barriers were categorized across four higher-order categories: recipient-focused, supporter-focused, relationship-focused, and context-focused. Some reasons provided by young adult supporters were not provided by young adult patients and vice versa, suggesting the potential for discrepancies between why cancer patients believe they did not receive support and nonsupporters' actual reasons for not providing support. These various reasons why people struggled to provide support or avoided providing support can act as a list of barriers that future researchers and practitioners can address through the development of resources and interventions aimed at fostering adequate support provision throughout individuals' cancer experiences. Cancer patients can address the experience of nonsupport by individuals in their lives by being more direct in communicating their support desires and, when unsuccessful, using cognitive reappraisal strategies.

Hope as a Predictor of Anxiety and Depressive Symptoms Following Pediatric Cancer Diagnosis.

Objective: To examine hope and its components of agency and pathways as predictors of anxiety and depressive symptoms in children receiving cancer treatment. Methods: Sixty patients (mean standard deviation age = 13.3 (2.7); 57% male) completed Snyder's Hope Scales, the Children's Depression Inventory, and the State-Trait Anxiety Inventory at diagnosis and 3 month intervals for 1 year following pediatric cancer diagnosis. Parents also completed Snyder's Hope Scales. Linear mixed-effect regression was used to assess hope's role in longitudinal models of symptoms of depression and anxiety. Results: Agency was a significant predictor of between-patient differences and within-patient changes in symptoms of depression and anxiety. Neither patient pathways nor either component of parent hope was predictive of symptoms of depression or anxiety. Patients who were more likely to have depressive symptoms at baseline were older, diagnosed with leukemia, and non-Hispanic White as opposed to Hispanic. Patient demographics were not predictive of anxiety. Conclusions: Patient agency is a potential target for intervention to prevent or reduce anxiety and depressive symptoms following pediatric cancer diagnosis.

Hoping Is Coping: A Guiding Theoretical Framework for Promoting Coping and Adjustment Following Pediatric Cancer Diagnosis.

OBJECTIVE: To determine the pattern of resilience and adjustment following pediatric cancer diagnosis and to evaluate hope as a mediator of adjustment. METHODS: 61 participants with pediatric cancer completed measures of hope, depression, anxiety, and quality of life (QoL) within 4 weeks of cancer diagnosis and every 3 months for 1 year. RESULTS: Participants showed high and increasing levels of hope and QoL, as well as low and decreasing levels of depression and anxiety. Linear mixed-effects regression analyses revealed changes in depression, anxiety, and hope to be significant predictors of changes in QoL. Changes in hope were found to partially mediate the effects of depression and anxiety on QoL. CONCLUSIONS: While a variety of interventions are efficacious for treating anxiety and depression, hope theory provides a framework for choosing interventions that may more globally promote children's ability to maintain good functioning, adjustment, well-being, and QoL following cancer diagnosis.

Ya gotta have friends: social support and self-efficacy predict success following immersion treatment.

OBJECTIVE: This study examined the impact of perceived social support and self-efficacy on predicting success in weight management following immersion treatment of adolescent obesity. METHODS: 198 overweight and obese adolescents (M% overweight = 81.4%; M BMI = 36.0) participated in Wellspring's cognitive-behavioral therapeutic camps for 3-10 weeks during the summer of 2011. The campers and one of their caretakers completed a series of questionnaires at the halfway point during immersion. One year following camp, campers and their parents provided follow-up heights and weights. RESULTS: Multiple regression intent to treat analyses indicated that campers who perceived their friends as supportive, reported confidence in their ability to succeed, and believed that their families functioned well achieved relatively more substantial reductions in percent overweight 1 year after immersion. Perceptions of support anticipated from parents failed to predict success. Campers who more fully engaged in the process of change at camp also achieved somewhat greater success in the long run. CONCLUSIONS: These results suggest that participants in cognitive-behavioral immersion treatment may improve outcomes by nurturing support from their friends, increasing self-efficacy, and having their families consider family therapy if warranted.

Back pain among long-term survivors of childhood leukemia.

BACKGROUND: The objectives of this study are to determine the prevalence and relative risk (RR) of back pain and identify possible mechanisms of back pain among childhood acute lymphoblastic leukemia (ALL) survivors. METHODS: Surveys were mailed to 5 + -year survivors of childhood ALL aged 13 to 25 years. Survivors' siblings were also invited to participate in the study. Prevalence of back pain and hip pain among ALL survivors was determined and compared with siblings. Sex, treatment with radiation therapy, obesity, and physical activity were examined for an association with back pain and hip pain. RESULTS: Forty-four of 99 (44.4%) ALL survivors reported back pain compared with 11 of 52 (21.2%) their siblings (P = 0.007; RR: 2.01; 95% confidence interval = 1.15-3.56). In contrast, 10 of 99 (10.1%) ALL survivors reported experiencing hip pain compared with 1 of 52 (2.0%) siblings experiencing hip pain [P = 0.07; RR: 4.95 (0.65 to 37.57)]. Twenty-six of 43 female survivors reported back pain compared with 18 of 56 male survivors who reported back pain (P = 0.005). Obesity, physical activity, and treatment with radiation therapy were not associated with back pain or hip pain. CONCLUSIONS: This is the first study demonstrating an increased frequency of back pain among survivors of childhood ALL. Future studies are needed to better define the causes of back pain among childhood ALL survivors.

Efficacy of a screening procedure to identify potentially disruptive participants in an immersion program for the treatment of adolescent obesity.

BACKGROUND: This study examined the efficacy of the red flag screening procedure, an approach used in a largescale immersion program for the treatment of adolescent obesity (Wellspring Camps). The intention of the red flag screening was to screen out potentially highly disruptive applicants, provide an impetus for additional support when high-risk campers were admitted, and help parents develop appropriate expectations. When compared to non-flagged peers, red-flagged campers who attended camp were expected to be sent home early more frequently. METHODS: Wellspring's admissions coordinators 'red-flagged' potential campers whose enrollment forms showed evidence of a history of psychological distress, major medical challenges, and/or developmental delays; a licensed psychologist then determined whether or not to admit the child after talking with the identified applicant, parents, and health care providers. 554 overweight young people attended three Wellspring Camps in the summer of 2007 (445 females, 109 males, mean age = 15.8 years, mean BMI = 35.6 kg/m(2), mean % overweight = 66.7%). RESULTS: 8.7% of applicants were red-flagged (n = 48), and 8% of all of the campers (n = 44) were dismissed prematurely. As expected, a much higher percentage of red-flagged campers who were admitted to camp were dismissed prematurely (31,3% of the red-flagged campers) than were non-flagged campers (5,1%; p < 0.0005). CONCLUSION: These findings support the efficacy of Wellspring's red flag screening procedure. While further improvements can be made, such a tool may be useful to other immersion programs.

Child and parental self-monitoring as determinants of success in the treatment of morbid obesity in low-income minority children.

OBJECTIVE: To examine self-monitoring by children and parents as related to weight control over 6 months within a long-term multidisciplinary program for low-income minority children with morbid obesity. METHODS: The weight changes of 228 children with obesity were evaluated according to frequency of child and parental self-monitoring. Predictors of self-monitoring were also evaluated. RESULTS: Children who self-monitored on most days lost more weight over 6 months of treatment compared with less-consistent self-monitors. Children whose parents self-monitored were also more likely to self-monitor and lose weight. CONCLUSIONS: Self-monitoring seems just as critical for successful weight control among low-income minority children with obesity as it is in the middle-class populations. Although lower education and higher levels of psychosocial stress may decrease self-monitoring and participation by these families, they might still benefit from targeting highly consistent self-monitoring (by parents and children) as a primary goal in weight-control programs.

Long-term evaluation of multi-disciplinary treatment of morbid obesity in low-income minority adolescents: La Rabida Children's Hospital's FitMatters program.

PURPOSE: Long-term evaluation of an empirically based program for the treatment of morbidly obese, low-income, minority adolescents. METHODS: In the first year, 150 participants received cognitive-behavior therapy, nutritional education, medical monitoring, and structured exercise training. Weights and heights were collected at follow-up. Successful and Less Successful groups were delineated based on change in body mass index z-scores. Medical record review provided weight and height data one year before treatment for a subset of participants (comparison group). Analyses of variance examined differences between groups. Discriminant function analyses examined predictors of success in the domains of socioeconomic status, individual factors and psychological functioning, family factors, and prior weight loss behaviors. Correlates of success were explored. RESULTS: Eighty-three adolescents participated in the follow-up, on average 23 months (SD = 3.8) after initial assessment. Nineteen (23%) participants achieved clinically meaningful weight change (-.70 z-scores or better). Discriminant function analyses, correlations, and direct comparisons showed that the Successful group, compared with the Less Successful group, on average, attended 50% more sessions over 84% more weeks, were heavier initially, had somewhat better critical weight control skills (e.g., self-monitoring) before and during the program, and were somewhat more psychologically and intellectually challenged before treatment. CONCLUSION: Although some of these very high risk adolescents made clinically significant progress, more intensive treatments, like long-term residential treatments and bariatric surgery, may produce even more favorable outcomes.

Treatment of morbid obesity in low-income adolescents: effects of parental self-monitoring.

OBJECTIVE: This study examined the extent to which consistency of self-monitoring by participants and their parents was related to weight control over an initial period of 3 months within the context of a treatment program for morbidly obese low-income minority adolescents. RESEARCH METHODS AND PROCEDURES: Eighty-three obese adolescents (mean age, 13.0 years; 51% boys; 92% African American; mean BMI, 43.0 kg/m2; mean BMI z-score, 6.0) and at least one parent participated in a long-term treatment program that included a very-low-fat dietary focus, weekly group cognitive-behavior therapy, monthly nutrition education classes, a 12-week physical therapy class, and medical monitoring. RESULTS: Participants who self-monitored on the majority of days compared with those who did not self-monitor at all or who self-monitored infrequently attended more sessions and generally lost more weight over the first 3 months. Although parents signed behavioral contracts committing to self-monitor their own eating and exercising over the first month, only 12% did so. Nonetheless, participants whose parents self-monitored were much more likely to self-monitor consistently and lose weight during the first 3 months. DISCUSSION: These results indicate that self-monitoring is a cornerstone of successful weight control even for morbidly obese low-income minority adolescents; targeting consistency of self-monitoring among these high-risk weight controllers and their parents should be just as important as it is for more affluent and less overweight adolescents.