Affective dynamics in mother-adolescent dyads: links to mental health and relationship quality.

Current research in developmental psychopathology has emphasised how emotion dynamics, such as affective variability, relate to psychosocial functioning. In this brief article, we examined mean differences in mothers' and adolescents' affective intensity and lability in positive and negative emotions and explored how these emotion dynamics related to depressive symptoms and mother-adolescent relationship quality. We administered individual surveys each day for one week to mother-adolescent dyads (N = 109) that inquired about positive and negative affective states. Affective intensity was measured by the mean across the week and lability by the standard deviation. Participants also reported on their depressive symptoms and adolescents reported on relationship quality. Results showed that positive affect was more intense and more variable than negative affect, and adolescents experienced more intense negative affective and less intense positive affect than mothers. Greater mother and adolescent negative affect intensity and less maternal positive affect intensity related to more depressive symptoms. Affective intensity in mothers and adolescents and affective lability in mothers related to mother-adolescent relationship quality. These findings extend the growing body of knowledge on individuals' affective intensity and variability by considering family dynamics.

A qualitative exploration of the health needs and goals of urban women to inform the tailoring and adaptation of Strong Hearts Healthy Communities: a community-based cardiovascular disease prevention intervention.

BACKGROUND: In the United States, cardiovascular diseases (CVD) are the leading cause of death and disability in women. CVD-modifiable risk factors, including poor diet quality and inadequate physical activity, can be addressed through evidence-based interventions (EBIs). Strong Hearts Healthy Communities (SHHC) is an EBI that has demonstrated effectiveness in reducing CVD risk and improving health outcomes among rural white women. The aims of this study were to understand the general health, diet, and physical activity-related needs and goals of women living in an urban community, to inform the tailoring and adaptation of the SHHC EBI to an urban setting and more diverse population. METHODS: Focus groups (FGs) were conducted with African American/Black and Hispanic/Latinx women in the Dallas metropolitan area who had a BMI ≥ 25 kg/m2 and engaged in ≤ 150 min per week of moderate physical activity. The data were coded using a team-based, deductive, and thematic analysis approach, that included multiple coders and in-depth discussions. RESULTS: Four FGs with a total of 18 participants (79% Black and 21% Latinx) were conducted, and three themes were developed: (1) participants had adequate knowledge and positive attitudes towards healthy living but faced many barriers to practicing healthy behaviors; (2) culturally-based beliefs and community practices exerted a strong influence on behaviors related to food and stress, revealing barriers to healthy eating and generational differences in stress and stress management; (3) participants desired a more individualized approach to nutrition and physical activity interventions that included familiar and enjoyable activities and social support centered around shared health goals. CONCLUSIONS: The SHHC intervention and similar health programs for Black/African American and Hispanic/Latinx women in urban settings should emphasize individualized nutrition and practical skills for healthy eating with accessible, familiar, and enjoyable exercises. Additionally, stress management strategies should be culturally and generationally sensitive and social support, whether through family, friends, or other program participants, should be based on shared health goals.

Household chaos and mother-adolescent communication.

Household chaos creates unpredictability and stress in families' lives compromising the quality of family interaction and communication. This study examined how mother and adolescent perceptions of daily household chaos relate to adolescent disclosure of information to mothers. We also explored indirect effects through mother and adolescent responsiveness. Participants included 109 mother-adolescent dyads who completed a 7-day diary study (adolescent age 14-18 years, 49% female, 38% White, 25% Asian, 17% Hispanic, 7% Black, 13% multiple/other ethnicities). Multilevel models revealed that on days when adolescents reported more household chaos than usual, they were more likely to disclose information to their mothers. On days when mothers and adolescents perceived more household chaos, they perceived their relationship partner as less responsive, and on days when mothers and adolescents perceived less responsiveness from their relationship partner, they reported less adolescent disclosure. There was a significant indirect effect among mothers' reports at the daily level, such that on days when mothers reported more household chaos than usual, they reported their adolescents as less responsive, and in turn, as disclosing less information to them. Averages across the week showed that mothers who reported higher average levels of household chaos compared to other families reported less adolescent disclosure. Mothers and adolescents who reported more household chaos compared to other families perceived their relationship partner as less responsive, and less adolescent responsiveness predicted less adolescent-reported and mother-reported adolescent disclosure on average compared to other families. Findings are discussed in terms of relational disengagement in chaotic home environments. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Patient Navigation Increases Linkage to Care and Receipt of Direct-acting Antiviral Therapy in Patients with Hepatitis C.

BACKGROUND & AIMS: Patient navigation interventions can improve health outcomes in underserved, low-income, and racial and ethnic minority groups, who often experience health disparities. We examined the effectiveness of patient navigation to improve linkage to hepatitis C virus (HCV) treatment receipt in a socioeconomically disadvantaged, racially diverse patient population. METHODS: We performed a pre-post analysis evaluating the effectiveness of a patient navigation program among baby boomers who tested positive for HCV in a safety-net health system. The usual care group (June 2013 to May 2015) and patient navigation group (January 2016 to December 2017) were balanced using a stabilized inverse probability of treatment weighting approach. We used logistic regression analyses to evaluate associations between patient navigation and linkage to care for HCV treatment evaluation, treatment initiation, and sustained virologic response. RESULTS: Among 1353 patients (62% black, 61% uninsured, 16% homeless), 769 were in the usual care group, and 584 were in the patient navigation group. The patient navigation group had significantly higher odds of linkage to care (odds ratio [OR], 3.7; 95% confidence interval [CI], 2.9-4.8) and treatment initiation (OR, 3.2; 95% CI, 2.3-4.2) within 6 months. The patient navigation group continued to have increased linkage to care (OR, 3.4; 95% CI, 2.7-4.3) and treatment initiation (OR 2.3; 95% CI, 1.7-3.0) at 12 months. However, there was no significant difference in sustained virologic response between the groups (86.9% vs 86.1%; P = .78). CONCLUSIONS: Patient navigation was associated with significantly increased linkage to care and treatment initiation among patients with HCV infection. Patient navigation programs can be used to promote HCV elimination among traditionally difficult-to-reach patient populations.

Evaluation of a civic engagement approach to catalyze built environment change and promote healthy eating and physical activity among rural residents: a cluster (community) randomized controlled trial.

BACKGROUND: Prior studies demonstrate associations between risk factors for obesity and related chronic diseases (e.g., cardiovascular disease) and features of the built environment. This is particularly true for rural populations, who have higher rates of obesity, cancer, and other chronic diseases than urban residents. There is also evidence linking health behaviors and outcomes to social factors such as social support, opposition, and norms. Thus, overlapping social networks that have a high degree of social capital and community cohesion, such as those found in rural communities, may be effective targets for introducing and maintaining healthy behaviors. METHODS: This study will evaluate the effectiveness of the Change Club (CC) intervention, a civic engagement intervention for built environment change to improve health behaviors and outcomes for residents of rural communities. The CC intervention provides small groups of community residents (approximately 10-14 people) with nutrition and physical activity lessons and stepwise built environment change planning workshops delivered by trained extension educators via in-person, virtual, or hybrid methods. We will conduct process, multilevel outcome, and cost evaluations of implementation of the CC intervention in a cluster randomized controlled trial in 10 communities across two states using a two-arm parallel design. Change in the primary outcome, American Heart Association's Life's Simple 7 composite cardiovascular health score, will be evaluated among CC members, their friends and family members, and other community residents and compared to comparable samples in control communities. We will also evaluate changes at the social/collective level (e.g., social cohesion, social trust) and examine costs as well as barriers and facilitators to implementation. DISCUSSION: Our central hypothesis is the CC intervention will improve health behaviors and outcomes among engaged citizens and their family and friends within 24 months. Furthermore, we hypothesize that positive changes will catalyze critical steps in the pathway to improving longer-term health among community residents through improved healthy eating and physical activity opportunities. This study also represents a unique opportunity to evaluate process and cost-related data, which will provide key insights into the viability of this approach for widespread dissemination. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05002660 , Registered 12 August 2021.

Communicating and Connecting: Associations Between Daily Adolescent Disclosure and Mother-Adolescent Responsiveness.

Adolescents who share information with their parents tend to have more positive parent-adolescent relationships. This brief report examined daily variability in adolescents' disclosure to mothers and mother-adolescent responsiveness. Using a 7-day intensive longitudinal design with 109 mother-adolescent (14-18 years) pairs, multilevel models revealed the amount of information adolescents disclosed to mothers varied day-to-day, according to both adolescent and mother reports. On days when adolescents perceived mothers to be more responsive than usual, adolescents were more likely to disclose. On days when mothers perceived adolescents to be more responsive than usual, mothers perceived more adolescent disclosure. Lastly, more responsive adolescents disclosed more on average across the week according to both adolescent and mother reports of disclosure compared to less responsive adolescents.

Multicenter Randomized Clinical Trial of a Mailed Outreach Strategy for Hepatocellular Carcinoma Surveillance.

BACKGROUND: The effectiveness of hepatocellular carcinoma (HCC) surveillance is mitigated by underuse in clinical practice, highlighting a need for interventions. We evaluated the effectiveness of mailed HCC surveillance outreach to promote HCC surveillance in patients with cirrhosis. METHODS: We conducted a multicenter pragmatic randomized clinical trial comparing mailed outreach for surveillance ultrasound (n = 1436) and usual care with visit-based surveillance (n = 1436) among patients with cirrhosis at 3 health systems (tertiary care referral center, safety net health system, and Veterans Affairs medical center) from April 2018 to December 2019. The primary outcome of this interim analysis was guideline concordant semiannual HCC surveillance over a 12-month period and a secondary outcome was proportion time covered by surveillance. All patients were included in intention-to-screen analyses. RESULTS: Compared with usual care, the outreach arm had significantly higher semiannual surveillance (35.1% vs 21.9%) and lower no-surveillance (29.8% vs 43.5%) (P < .001), resulting in significant increases in the proportion of time covered by surveillance (41.3% vs 31.0%; P < .001). The intervention increased HCC surveillance across most predefined subgroups; however, there were site-level differences in the intervention effect, with significant increases in semiannual surveillance at the Veterans Affairs and safety net health systems but not at the tertiary care referral center. CONCLUSIONS: Mailed outreach significantly increased semiannual HCC surveillance vs usual care in patients with cirrhosis, with a consistent intervention effect across most examined subgroups. Continued follow-up is ongoing to determine if these increases in surveillance translate into improved downstream outcomes includi.ng early HCC detection and curative treatment receipt. (ClinicalTrials.gov, Numbers: NCT02582918 and NCT03756051).

Randomized Clinical Trial of Inreach With or Without Mailed Outreach to Promote Hepatitis C Screening in a Difficult-to-Reach Patient Population.

INTRODUCTION: Hepatitis C virus (HCV) treatment can significantly reduce the risk of liver-related mortality; however, many patients remain unaware of their infection in clinical practice. The aim of this study is to compare the effectiveness of inreach, with and without mailed outreach, to increase HCV screening and follow-up in a large, difficult-to-reach patient population. METHODS: We conducted a pragmatic randomized clinical trial from August 2018 to May 2019 in a large safety-net health system. Patients born between 1945 and 1965 were randomly assigned (1:1) to inreach with an electronic health record reminder to providers (n = 6,195) or inreach plus mailed HCV screening outreach (n = 6,191) to complete HCV antibody screening. Outreach also included processes to promote HCV RNA testing among those with a positive HCV antibody and linkage to care among those with positive HCV RNA. The primary outcome was completion of HCV antibody testing within 3 months of randomization (ClinicalTrials.gov NCT03706742). RESULTS: We included 12,386 eligible patients (median age 60 years; 46.5% Hispanic, 33.0% Black, and 16.0% White). In intent-to-treat analyses, HCV screening completion was significantly higher among inreach-plus-outreach patients than inreach-alone patients at 3 months (14.6% vs 7.4%, P < 0.001) and 6 months (17.4% vs 9.8%, P < 0.001) after randomization. Among those who completed HCV screening within 6 months, a higher proportion of inreach-plus-outreach patients with positive antibody results completed RNA testing within 3 months than inreach-alone patients (81.1% vs 57.1%, respectively, P = 0.02); however, linkage to care within 3 months of HCV infection confirmation did not significantly differ between the 2 groups (48.1% vs 75.0%, respectively, P = 0.24). DISCUSSION: Among difficult-to-reach patients, a combination of inreach and mailed outreach significantly increased HCV screening compared with inreach alone. However, HCV screening completion in both arms remained low, highlighting a need for more intensive interventions.

Longitudinal associations between family members' internalizing symptoms across middle childhood.

An individual's internalizing symptoms have been shown to relate to greater symptoms in family members. However, an examination of how family members' symptoms are associated with one another is needed with a model including mothers, fathers, and children. Using 633 families from the National Institutes of Child Health and Human Development Study of Early Child Care and Youth Development, the current study examines relations between different family members' internalizing symptoms over time. In the archival data set, mothers', fathers', and children's internalizing symptoms at first, third, and fifth grades were assessed during home and laboratory visits. We tested a cross-lagged path model to assess transactional associations with family income-to-needs ratio and child gender as covariates. In the model, more maternal internalizing symptoms at first and third grades were associated with greater child symptoms at third and fifth grades. More child symptoms at first and third grades were associated with greater maternal symptoms at third and fifth grades. Additionally, more child symptoms at third grade were associated with greater paternal symptoms at fifth grade. These results highlight the importance of examining how family members' internalizing symptoms are associated longitudinally in understanding family systems processes. (PsycINFO Database Record

Perceived control of anxiety as a moderator in the relationship between anxiety sensitivity and problematic alcohol use among adolescents.

The current study examined perceived control over anxiety as a moderator in the relationship between AS and (1) alcohol use frequency and (2) binge drinking frequency among 80 community-recruited adolescents (Mage = 15.40; 40% female). Eighty-five percent of adolescents reported consuming an alcohol beverage, while 39.5% reported binge drinking. Results indicated significant interactions between AS and perceived control. More specifically, when perceived control was low, higher anxiety sensitivity was related to increased frequency of alcohol use days, but not with binge drinking days. Alternatively, when perceived control over anxiety was high, elevated anxiety sensitivity was associated with a decreased in binge drinking days, but not with alcohol use days. Findings suggest that influence of perceived control over anxiety may be another important, malleable factor that should be considered in future etiological and intervention-oriented work targeting anxiety sensitivity and alcohol misuse among adolescence.

Relations between mothers' daily work, home, and relationship stress with characteristics of mother-child conflict interactions.

This study examined whether daily variations in levels of mothers' work, home, and relationship stress were related to collaborative and oppositional qualities of mother-child conflict interactions across 1 week. Mothers reported on 1 specific conflict interaction with their 5- to 8-year-old child and their work, home, and relationship stress through online surveys each day for 7 consecutive days. Diary data from 142 mothers were analyzed in 6 multilevel models, each including within- and between-family levels of a stressor predicting collaborative or oppositional conflict qualities. Results suggested that families in the sample differed from each other, and also varied during the week, in collaborative and oppositional conflict qualities as well as stress in all 3 domains. Mothers reported a greater degree of oppositional conflict qualities on days characterized by higher perceptions of home chaos. Additionally, mothers who reported higher average levels of negativity in romantic relationships endorsed oppositional conflict qualities to a greater extent than mothers with lower relationship negativity. Two multilevel models including all 3 stressors in relation to collaborative and oppositional conflict revealed that for mothers managing multiple roles, average romantic relationship stress was the most important unique contributor to mother-child conflict qualities and daily relationship stress was particularly influential among mothers with sons compared to those with daughters. Results support the spillover hypothesis of stress within the family system and are discussed in terms of mothers' coping mechanisms and emotional engagement. (PsycINFO Database Record