Relationship Between Food Security Status in a Caregiver's Family of Origin and Current Feeding Practices Among Low-Income, Single, Female Primary Caregivers.

A child's familial environment is paramount to the formation and maintenance of their health behaviors. Factors that influence a child's health behaviors include parental modeling, types of available food, timing of food availability, and characteristics of the home environment. Previous research has demonstrated an association between a caregiver's current food security status and feeding practices, but no studies have explored the association between food security in the caregiver's childhood and their current feeding practices. This study investigates the relationship between parental food insecurity (both current and childhood) and child feeding practices. The US Household Food Security Survey and the Child Feeding Questionnaire were completed by 103 low-income, single, female primary caregivers. Results indicated that caregivers who reported current food insecurity expressed greater tendency to pressure their children to eat. Caregivers who reported food insecurity during their childhood also expressed greater tendency to pressure their children to eat and a greater concern about their child's weight. These findings can serve in both research and clinical efforts as an early screening tool to indicate families most in need of accessible resources. Findings also help to highlight the transgenerational nature of food insecurity, including its residual effects on health behaviors.

Development of an Extended-Reality (XR)-Based Intervention to Treat Adolescent Obesity.

Public health policies aimed at obesity reduction are more often directed toward adults than children. This is alarming given that rates of childhood obesity have been steadily increasing, and, if not treated early, adolescents with obesity may develop comorbidities into adulthood. Lifestyle-based interventions are the cornerstone of childhood obesity treatment. Recently, extended-reality (XR)-based interventions have been incorporated into the treatment of obesity, and parents and adolescents perceive virtual reality (VR) interventions as a promising approach to increasing physical activity levels and improving eating habits. VR is a tool that fits perfectly with contemporary adolescent culture, which is radically different from that of just two generations ago. It is plausible that an XR-based intervention for treating adolescents with obesity could have a profound influence on obesity management over the long-term. An understanding of adolescents' preferences, wants, and needs must be considered in the development of new interventions. We suggest that VR interventions can provide a new approach to weight management for children and adolescents and provide recommendations to assess adolescents', caregivers', and primary care providers' needs. These needs could then be used for the development of an XR-based intervention aimed at inducing sustained lifestyle changes in adolescents with obesity.

Promoting Healthy Eating and Regular Physical Activity in Low-Income Families Through Family-Centered Programs: Implications for Practice.

Research concerning children who are overweight has historically focused on providing services to the affected individuals, and limited attention has been paid to their families. Further, childhood obesity prevention and clinical programs continue to be impacted by contextual factors that increase the likelihood of attrition when targeting underserved populations. This paper provides data with relevance for interventions aimed at promoting healthy eating and regular physical activity with low-income families. Participants in a childhood obesity exploratory study provided recommendations to improve programs by reflecting on specific family and contextual issues related to children who are overweight and obese. Following a thematic analysis approach, we conducted semi-structured interviews with 16 low-income, single, female parents. All participants had, at the time of the interview, at least one overweight or obese child between the ages of 3 and 8. We report the critical role of context in the etiology and challenges of childhood obesity among disadvantaged populations. Findings also highlight the need for interventions to be culturally relevant and sensitive and to create opportunities to address and discuss participant experiences of discrimination, cultural factors, and family of origin influences. Interventions that do not address these contextual factors run the risk of being unsuccessful. Our findings are important for mental and public health professionals who are interested in the direct provision of services using a combination of social determinants of systemic perspectives.

Risk and Protective Factors Associated with Childhood Obesity in a Sample of Low-Income, Single Female, Parent/Guardian Households: Implications for Family Therapists.

The United States is in the midst of a childhood obesity epidemic that disproportionately impacts underserved and diverse populations. In this study, in-depth qualitative interviews were conducted with 16 low-income, single, female, parent/guardians of an overweight or obese 3- to 8-year-old from socioeconomically disadvantaged backgrounds. Following the tenets of the thematic analysis approach, interviews focused on identifying risk and protective factors influencing parental and child health behaviors associated with child weight status. Results from the interviews are organized according to the Socioecological Framework to help identify risk and protective factors at various system levels. Findings from this investigation have relevance for family therapists as they can inform clinical and advocacy-focused interventions with disadvantaged families affected by childhood obesity.

Estados Unidos está en medio de una epidemia de obesidad infantil que afecta desproporcionadamente a poblaciones diversas y marginadas. En este estudio, se realizaron entrevistas cualitativas detalladas con 16 madres/tutoras solteras de bajos recursos de un niño de entre 3 y 8 años obeso o con sobrepeso de origen socioeconómicamente desfavorecido. Siguiendo los principios del enfoque del análisis temático, las entrevistas se centraron en reconocer los factores de riesgo y de protección que afectan las conductas de salud de los padres y de los niños asociadas con el peso del niño. Los resultados de las entrevistas están organizados de acuerdo con el marco socioecológico para contribuir a identificar los factores de riesgo y de protección en diferentes niveles del sistema. Los resultados de esta investigación tienen relevancia para los terapeutas familiares, ya que pueden explicar las intervenciones clínicas y centradas en el apoyo con familias marginadas afectadas por la obesidad infantil.

Dropout rates of in-person psychosocial substance use disorder treatments: a systematic review and meta-analysis.

BACKGROUND AND AIMS: Relapse rates for psychosocial substance use disorder (SUD) treatments are high, and dropout is a robust predictor of relapse. This study aimed to estimate average dropout rates of in-person psychosocial SUD treatments and to assess predictors of dropout. DESIGN: A comprehensive meta-analysis of dropout rates of studies of in-person psychosocial SUD treatment. Studies included randomized controlled trials (RCTs) and cohort studies. SETTING: Studies conducted anywhere in the world that examined SUD treatment and were published from 1965 to 2016, inclusive. PARTICIPANTS/CASES: One hundred and fifty-one studies, 338 study arms and 299 dropout rates including 26 243 participants. MEASUREMENTS: Databases were searched for studies of SUD treatment that included an in-person psychosocial component. Meta-analyses and meta-regressions were conducted to estimate dropout rates and identify predictors of dropout, including participant characteristics, facilitator characteristics and treatment characteristics. Pooled estimates were calculated with random-effects analyses accounting for the hierarchical structure of study arms nested within studies. FINDINGS: The average dropout rate across all studies and study arms was 30.4% [95% confidence interval (CI) = 27.2-33.8 and 95% prediction interval (PI) = 6.25-74.15], with substantial heterogeneity (I2  = 93.7%, P < 0.0001). Studies including a higher percentage of African Americans and lower-income individuals were associated with higher dropout rates. At intake, more cigarettes/day and a greater percentage of heroin use days were associated with lower dropout rates, whereas heavier cocaine use was associated with higher dropout rates. Dropout rates were highest for studies targeting cocaine, methamphetamines and major stimulants (broadly defined) and lowest for studies targeting alcohol, tobacco and heroin, although there were few studies on methamphetamines, major stimulants and heroin. Programs characterized by more treatment sessions and greater average session length were associated with higher dropout rates. Facilitator characteristics were not significantly associated with dropout. CONCLUSIONS: On average, approximately 30% of participants drop out of in-person psychosocial SUD treatment studies, but there is wide variability. Drop-out rates vary with the treated population, the substance being targeted, and the characteristics of the treatment.

Longitudinal and Reciprocal Relationships Between Psychological Well-Being and Smoking.

INTRODUCTION: Smoking cessation treatments currently succeed at a rate of approximately 20%-30%, underscoring the importance of exploring factors that might increase intervention effectiveness. Although negative affect has been studied extensively in relation to smoking cessation, psychological well-being (PWB; eg, life satisfaction, optimism, positive affect, purpose in life) has received little attention. This study tested longitudinal and reciprocal relationships between PWB and smoking status in older adults. METHODS: Panel data were obtained from the biennial, longitudinal Health and Retirement Study. Using structural equation modeling, we developed cross-lagged models to examine the relationships of PWB in 2006 with smoking status in 2010 and of smoking status in 2006 with PWB in 2010 while controlling for covariates (Ns = 2939-4230, 55% women, 89% white, mean age = 64 years, mean years of education = 13, 25% smokers in 2006 and 21% smokers in 2010). Separate cross-lagged models were developed for each of the PWB variables: life satisfaction, optimism, positive affect, and purpose in life. RESULTS: Greater life satisfaction (standardized path coefficient = -0.04), optimism (standardized path coefficient = -0.07), and positive affect (standardized path coefficient = -0.08) in 2006 predicted a reduced likelihood of smoking in 2010. Being a smoker in 2006 predicted lower life satisfaction (standardized path coefficient = -0.25), optimism (standardized path coefficient = -0.10), positive affect (standardized path coefficient = -0.10), and purpose in life (standardized path coefficient = -0.13) in 2010. CONCLUSIONS: Findings warrant further exploration of the relationships between PWB and smoking, and support the incorporation of PWB-boosting components into existing treatments. IMPLICATIONS: Given the relatively low success rate of current smoking cessation treatments, the present results suggest that increasing PWB might promote abstinence and therefore warrant consideration as a focus of future cessation treatment research. Moreover, these results suggest that smoking might inhibit PWB, illuminating a negative consequence of smoking not previously identified. Helping smokers increase their PWB may benefit them beyond promoting cessation and contribute to a flourishing society. These results warrant further investigation of PWB and smoking, and support the continued evaluation of PWB-boosting components in smoking cessation treatments.

Understanding Barriers and Facilitators to the Uptake of Best Practices for the Treatment of Co-Occurring Chronic Pain and Opioid Use Disorder.

Objective: Patients with a combination of chronic pain and opioid use disorder have unique needs and may present a challenge for clinicians and health care systems. The objective of the present study was to use qualitative methods to explore factors influencing the uptake of best practices for co-occurring chronic pain and opioid use disorder in order to inform a quantitative survey assessing primary care provider capacity to appropriately treat this dual diagnosis. Methods: Guided by the Consolidated Framework for Implementation Research (CFIR), semi-structured qualitative interviews were conducted with 11 primary care providers (PCPs) to inform the development of a questionnaire. Interviews were audio-recorded and transcribed verbatim. Fifteen comments from an open-ended question on the questionnaire were added to the analyses as they described factors that were not elucidated in the interviews. Barriers and facilitators were identified and categorized using the CFIR codebook. Results: The most frequently described barriers were cost and inadequate access to appropriate treatments, external policies, and available resources (e.g., risk assessment tools). The most frequently described facilitators were the presence of a network or team, patient-specific needs, and the learning climate. Knowledge and beliefs were frequently described as both barriers and facilitators. Conclusions: While substantial funding has been allocated to initiatives aimed at increasing PCP capacity to treat this population, numerous barriers to adopting appropriate practices still exist. Future research should focus on developing and testing implementation strategies that leverage the facilitators and overcome the barriers illustrated here to improve the uptake of evidence-based recommendations for the treatment of co-occurring chronic pain and opioid use disorder.

The Relationships of Expectancies With E-cigarette Use Among Hospitalized Smokers: A Prospective Longitudinal Study.

Background: Expectancies demonstrate cross-sectional associations with e-cigarette use, but the prospective relationships between expectancies and e-cigarette use are unknown. This study examined the longitudinal associations of expectancies with e-cigarette use among hospitalized tobacco cigarette smokers. Methods: E-cigarette expectancies (e-cigarette-specific Brief Smoking Consequences Questionnaire-Adult [BSCQ-A]), tobacco cigarette expectancies (tobacco-specific BSCQ-A), and number of days used e-cigarettes in the past 30 days were assessed at baseline hospitalization, 6-months post-hospitalization, and 12-months post-hospitalization among 978 hospitalized tobacco cigarette smokers. Expectancy difference scores (e-cigarette-specific expectancies minus tobacco-specific expectancies) were computed for each of the 10 BSCQ-A scales. Cross-lagged panel models tested the relationships between expectancy difference scores and number of days used e-cigarettes in the past 30 days for each of the 10 BSCQ-A scales. Results: Though some models revealed partial associations between expectancies and e-cigarette use, only one yielded results consistent with hypotheses. Greater e-cigarette use at baseline predicted greater expectancies that e-cigarettes taste pleasant as compared to tobacco cigarettes at 6 months, which then predicted greater e-cigarette use at 12 months. To a lesser degree greater expectancies that e-cigarettes taste pleasant as compared to tobacco cigarettes at baseline predicted greater e-cigarette use at 6 months, which then predicted greater expectancies that e-cigarettes taste pleasant as compared to tobacco cigarettes at 12 months. Conclusions: Expectancies that e-cigarettes provide similar or more pleasant taste sensations as compared to tobacco cigarettes may be both a cause and consequence of e-cigarette use. Focusing on the taste experience may prove most effective in modifying e-cigarette use behavior. Implications: The current study offers the first longitudinal examination of expectancies and e-cigarette use. Results suggest expectancies that e-cigarettes provide similar or more pleasant taste sensations relative to tobacco cigarettes are both a cause and consequence of e-cigarette use. Efforts that focus on the e-cigarette taste experience may prove most effective in modifying e-cigarette use behavior.

Couples Coping Through Deployment: Findings From a Sample of National Guard Families.

OBJECTIVE: Military families face numerous changes and stresses as they negotiate deployments and other life transitions. How they cope with these events is an important part of their overall well-being and resilience. This longitudinal study on coping in a sample of National Guard couples examined the association between the predeployment coping (active vs. avoidant) of each in the relationship, and their own and their significant others' mental health (anxiety, depression, posttraumatic stress disorder [PTSD]) and family well-being (dyadic adjustment and parenting stress) postdeployment. METHOD: A total of 238 matched couples completed the predeployment survey, 143 matched couples completed the post, with 122 matched couples completing both pre- and postdeployment surveys. RESULTS: While active coping was not significantly associated with any outcomes, predeployment avoidant coping in both soldiers and significant others was associated with increased anxiety, PTSD, and depression post deployment (actor effects). Additionally, soldier avoidant coping predeployment was associated with increased parenting stress for soldiers, while significant other avoidant coping predeployment was associated with increased relationship distress for significant others (actor effects). Finally, significant other avoidant coping predeployment was associated with higher parenting distress for soldiers postdeployment (partner effect). CONCLUSION: Findings suggest that interventions are needed to combat avoidant coping (behavioral disengagement, denial, substance abuse) predeployment because this way of coping is strongly related to negative outcomes. In addition, those who work clinically with these families should work to reduce avoidant coping strategies and any familial dynamics exacerbated by this way of coping.

Withdrawal exposure with withdrawal regulation training for smoking cessation: a randomized controlled pilot trial.

INTRODUCTION: Although withdrawal processes form a key motivational basis for cigarette use, smoking cessation treatments appear to exert only modest effects on withdrawal. One treatment option for further reducing withdrawal severity would be to provide smokers with withdrawal regulation training. The objective of this study was to pilot a smoking cessation intervention comprising withdrawal exposure with withdrawal regulation training. METHODS: Adult smokers (N=80) were randomized to one of two conditions: 1) Withdrawal Exposure with Withdrawal Regulation Training (WT), which included the development and application of individualized withdrawal regulation strategies over four separate sessions that spanned the first four hours of abstinence; 2) or Relaxation Control (RC) training, which controlled for the therapeutic contact of WT. All sessions occurred before the quit date, after which differential treatment was discontinued and all participants received brief counseling, nicotine replacement therapy, and self-help literature. Biochemically-confirmed (CO≤3) seven-day point-prevalence abstinence was assessed at Months 2 and 3 after end-of-treatment. RESULTS: Treatment completion and ratings of credibility and efficacy were high and equivalent across conditions. 22.2% of participants in the WT condition were abstinent at both time points, whereas 0% and 4.2% of participants in the RC condition were abstinent at Months 2 and 3 (Month 3 OR=6.5 [0.73, 59.19]). In-session withdrawal ratings suggested WT improved regulation of withdrawal symptoms, which were in turn associated with abstinence. CONCLUSIONS: This small pilot study suggests that WT promotes abstinence by enhancing withdrawal regulation. Results warrant further investigation of this innovative treatment approach.