Effects of Parent Training on Callous-Unemotional Traits, Effortful Control, and Conduct Problems: Mediation by Parenting.

Callous-unemotional (CU) traits and effortful control (EC) are personality and temperament traits implicated in early-onset antisocial trajectories. This secondary analysis of Hitkashrut's randomized controlled trial first tested parent training's effects on EC and CU traits while controlling for more general treatment effects on conduct problems (CP), and subsequently tested mediation by parenting. Prekindergarten teachers in three Israeli cities identified 209 3-5 year-old (163 boys; 46 girls) preschoolers with subclinical-clinical range conduct problems. All participants were Jewish ranging from ultra-orthodox to secular. They were assigned to 14-session co-parent training groups (n = 140 couples), or to minimal intervention control groups with referral to local services as necessary (n = 69 couples). We employed averaged indices of pre- and post-intervention questionnaires completed by both parents. The testing of all hypothesized models controlled for treatment effects on CP in order to strengthen the robustness of the analyses. We found significant concurrent treatment effects on CP and on either CU traits or EC. All effects were mediated by ineffective parenting (IP): a latent variable that was indicated by negative/inconsistent practices and perceived parenting inefficacy. This is the first demonstration of parenting mediated treatment effects on both EC and CU traits in a randomized controlled study conducted in everyday practice contexts. This finding supports a disruption model of change: the reduction of IP facilitates a caregiving environment that affects children's behavior and developing personality. The changing of personality and temperament characteristics implicated in early-onset pathways suggests an innovative prevention strategy for disruptive behavior disorders.

Supervisor support: does supervisor support buffer or exacerbate the adverse effects of supervisor undermining?

Empirical investigations concerning the interplay between supervisor support and supervisor undermining behaviors and their effects on employees yielded contradictory findings, with some studies suggesting that support buffers the adverse effects of undermining, and others suggesting that support exacerbates these adverse effects. Seeking to explain such contradictory findings, we integrate uncertainty-management perspectives with coping theory to posit that relational uncertainty is inherent in the mixture of supervisor support and undermining. Hence, whether supervisor support buffers or exacerbates the adverse effects of supervisor undermining on employee health and well-being depends on factors pertaining to employee ability to resolve and manage such relational uncertainty. Specifically, we hypothesize a buffering effect for employees with high self-esteem and high quality of work life, and an exacerbating effect for employees with low self-esteem and low quality of work life. Analyses of 2-wave data collected from a probability stratified sample of U.S. Air Force personnel supported our predictions. Two supplementary studies of the U.S. military replicated our core findings and demonstrated its practical significance.

The reciprocal relationship between vigor and insomnia: a three-wave prospective study of employed adults.

Vigor is a positive affect experienced at work. It refers to feelings of possessing physical strength, emotional energy, and cognitive liveliness. Accumulated evidence suggests that vigor has a protective effect on health, but the mechanisms of this link remain to be discovered. This study focused on sleep quality as one possible mechanism. We used a full-panel, longitudinal design to investigate the hypothesis that changes in vigor over time have inverse effects on insomnia and vice versa. The study was conducted on a multi-occupational sample of working adults (N = 1,414, 70 % men) at three time points (T1, T2, and T3), over a period of about 3 years. Vigor was assessed by the Shirom-Melamed Vigor Measure, while insomnia was assessed by the Brief Athens Insomnia Scale. Results of SEM-analyses, controlling for neuroticism, and other potential confounding variables, offered a strong support for the study hypotheses, indicating cross-lagged reciprocal inverse relationships between vigor and insomnia. The results suggest that vigor has a protective effect on sleep quality and that vigor might positively influence health through this pathway.

Sensitivity Analysis and Bounding of Causal Effects With Alternative Identifying Assumptions.

When identification of causal effects relies on untestable assumptions regarding nonidentified parameters, sensitivity of causal effect estimates is often questioned. For proper interpretation of causal effect estimates in this situation, deriving bounds on causal parameters or exploring the sensitivity of estimates to scientifically plausible alternative assumptions can be critical. In this paper, we propose a practical way of bounding and sensitivity analysis, where multiple identifying assumptions are combined to construct tighter common bounds. In particular, we focus on the use of competing identifying assumptions that impose different restrictions on the same non-identified parameter. Since these assumptions are connected through the same parameter, direct translation across them is possible. Based on this cross-translatability, various information in the data, carried by alternative assumptions, can be effectively combined to construct tighter bounds on causal effects. Flexibility of the suggested approach is demonstrated focusing on the estimation of the complier average causal effect (CACE) in a randomized job search intervention trial that suffers from noncompliance and subsequent missing outcomes.

Direct and mediated effects of two theoretically based interventions to increase consumption of fruits and vegetables in the Healthy Body Healthy Spirit trial.

This study tested the effects of two theory-based interventions to increase fruit and vegetable intake. Hypothesized intervention mediators included self-efficacy (SE), social support (SS), autonomous motivation (AM), and controlled motivation (CM). At baseline, 1,021 African American adults were recruited from 16 churches randomized to one comparison and two intervention groups: Group 1 (standard educational materials), Group 2 (culturally targeted materials), and Group 3 (culturally targeted materials and telephone-based motivational interviewing). A well-fitted model based on structural equation modeling-χ(2)(df = 541, N = 353, 325) = 864.28, p < .001, normed fit index = .96, nonnormed fit index = .98, comparative fit index = .98, root mean square error of approximation = .042-demonstrated that AM was both a significant mediator and moderator. In the subgroup with low baseline AM, AM mediated 17% of the effect of the Group 3 intervention on fruit and vegetable intake. Conversely, SS, SE, and CM were not significant mediators. Implications related to theory and intervention development are discussed.

Effects of war exposure on air force personnel's mental health, job burnout and other organizational related outcomes.

Longitudinal data from a stratified representative sample of U.S. Air Force personnel (N = 1009) deployed to the wars in Iraq, Afghanistan, and other locations were analyzed in this study. Using structural equation models, we examined the effects of war exposure on traumatic experiences, Post Traumatic Stress (PTS) symptoms, resource loss, and on subsequent functioning, perceived health, and on job and organizationally relevant outcomes. The job and organizational outcomes included job burnout, job involvement, job strain, job satisfaction, work-family conflict, organizational commitment, deployment readiness, and intention to reenlist. We found that deployment to the theater of the war increased risk of exposure to trauma, which in turn, predicted elevated PTS symptoms and resource loss. PTS symptoms predicted later loss of resources and deterioration in perceived health and functioning. In turn, resource loss predicted negative job and organizational outcomes. Exposure to trauma fully mediated the effects of deployment to the theater of war on PTS symptoms and resource loss and had additional significant indirect effects on several job and organizational relevant outcomes. For returning veterans, deployment to the theater of war, exposure to trauma, PTS symptoms, and resource loss represents a "cascading" chain of events that over time results in a decline of health and functioning as well as in adverse job and organizationally relevant outcomes that may affect organizational effectiveness.

The Use of Propensity Scores in Mediation Analysis.

Mediation analysis uses measures of hypothesized mediating variables to test theory for how a treatment achieves effects on outcomes and to improve subsequent treatments by identifying the most efficient treatment components. Most current mediation analysis methods rely on untested distributional and functional form assumptions for valid conclusions, especially regarding the relation between the mediator and outcome variables. Propensity score methods offer an alternative whereby the propensity score is used to compare individuals in the treatment and control groups who would have had the same value of the mediator had they been assigned to the same treatment condition. This article describes the use of propensity score weighting for mediation with a focus on explicating the underlying assumptions. Propensity scores have the potential to offer an alternative estimation procedure for mediation analysis with alternative assumptions from those of standard mediation analysis. The methods are illustrated investigating the mediational effects of an intervention to improve sense of mastery to reduce depression using data from the Job Search Intervention Study (JOBS II). We find significant treatment effects for those individuals who would have improved sense of mastery when in the treatment condition but no effects for those who would not have improved sense of mastery under treatment.

Felicitometry: measuring the 'quality' in quality of life.

Following Bernheim,(1) we examine aspects of 'felicitometrics,'(2) the measurement of the 'quality' term in Quality of Life (QOL). Bernheim argued that overall QOL is best captured as the Gestalt(3) of a global self-assessment and suggested that the Anamnestic Comparative Self Assessment (ACSA) approach, in which subjects' memories of the best and worst times of their lives are used to anchor a Visual Analog Scale (VAS), provided a serious answer to the serious question, 'How have you been?' Bernheim compares and contrasts the ACSA to multi-item questionnaire QOL instruments, such as the SF-36, concluding that the ACSA has a number of advantages. His discussion assumes that the use of QOL outcomes in clinical trials is both relevant and appropriate. In the present paper, we document the reasonableness of this latter assumption,(4) contribute to the characterization of the similarities and differences between multi-item and individualized QOL instruments, and point to some other individualized instruments that may be used in clinical trial contexts. These 'other individualized instruments' differ from the ACSA in fundamental ways; but they are individualized in that the subject defines those areas in his/her life that are most important, and these may vary from subject-to-subject.

Patient-staff interactions and mental health in chronic dialysis patients.

Chronic dialysis imposes ongoing stress on patients and staff and engenders recurring contact and long-term relationships. Thus, chronic dialysis units are opportune settings in which to investigate the impact of patients' relationships with staff on patient well-being. The authors designed the present study to examine the degree to which perceptions of open communication between patients and staff affect patient mental health. A one-year, two-wave longitudinal survey assessed patient (N = 109) perceptions of the interpersonal environment and mental health. Assessments included sharing personal information (open disclosure), assisting one another (helping), staff respect for patients (respect), and hierarchical patient-staff relations (formal staff authority). Cross-sectional and longitudinal regression analyses examined how these characteristics of the interpersonal environment relate to depression and subjective well-being among patients. Multivariate analysis showed that open disclosure correlated independently with lower levels of depression at baseline (N = 109) and a predicted significant decrease in depression over time (N = 64). Other interpersonal characteristics did not correlate with depression or subjective well-being at baseline or longitudinally. The interpersonal climate in chronic dialysis units influences patient well-being. Contrary to traditional views, open disclosure in patients' relationships with staff is not detrimental and contributes to well-being.

Work barriers in the context of pathways to the employment of welfare-to-work clients.

The ability of welfare-to-work clients to leave the welfare rolls and stay in the labor force is often limited by the work barriers they face. Using a sample of 1,404 female welfare-to-work clients we first examined the structure of work barriers and then tested their contribution to current work status in the context of a structural equation model that incorporated other central pathways to employment. Whereas work barriers included diverse factors ranging from lack of transportation to low quality jobs, they were shown to constitute a uni-dimensional construct. Furthermore, work barriers had a net adverse effect on employment outcomes, controlling for job search self-efficacy and employment intention. We conclude with discussion of implications for the development of welfare-to-work programs and interventions that target low-income women.

The association of consumer expectations, experiences and satisfaction with newly prescribed medications.

OBJECTIVE: To examine the association between medication expectations and subsequent experience on treatment satisfaction and intention to continue using the medication. METHODS: A longitudinal study with two surveys administered to each patient. Patients prescribed a new medication were recruited in pharmacies within Michigan. Medication-related expectations were evaluated at baseline. Experiences, satisfaction and intent to continue were evaluated a month later. Analyses used included factorial ANOVA models, multiple linear regressions and structural equation modeling (SEM). Impact of satisfaction on intention to continue was evaluated using correlation analysis and SEM. RESULTS: A total of 344 usable responses were obtained. SEM showed that expectation scores were not associated with both experience (path coefficient = 0.10) and satisfaction (path coefficient = 0.02, NS). On the other hand, experience was strongly associated with satisfaction (path coefficient = 0.89) and satisfaction was strongly associated with intent to continue using the new medication (path coefficient = 0.81). CONCLUSIONS: This study empirically supports the value of the patient's experience and its contribution to satisfaction, which in turn is associated with intended continued use mainly due to greater effectiveness of the newly prescribed medication. Satisfied consumers should be more adherent, thus enhancing the probability of positive therapeutic outcomes.

Overload, autonomy, and burnout as predictors of physicians' quality of care.

A model in which perceived overload and burnout mediated the relations of workload and autonomy with physicians' quality of care to their patients was examined. The study was based on data from 890 specialists representing six medical specialties. Including global burnout as well as its three first-order facets of physical fatigue, cognitive weariness, and emotional exhaustion improved the fit between the structural model and the data relative to an alternative model that included only global burnout. Workload (number of work hours) indirectly predicted quality of care through perceived overload. Additionally, the authors found that the paths from the first order factors of emotional exhaustion, physical fatigue, and cognitive weariness predicted quality of care negatively, positively, and nonsignificantly, respectively.

Educational web-based intervention for high school students to increase knowledge and promote positive attitudes toward organ donation.

A sample of 490 high school students from 81 schools in Michigan participated in an experiment in which they were randomly assigned to either a control or an experimental Web site. The experimental Web site provided exposure to educational material about the process of organ donation and organ transplantation. The control Web site provided educational material on methods to avoid the common cold. The pre-and posttests of knowledge of issues related to organ donation and of attitude toward donation demonstrated statistically significant increases for the experimental group compared with the control group. A structural equation path model suggested that these increases in knowledge and prodonation attitude mediated the effects of the experiment on contacting the Michigan donor registry. The increase in knowledge and in prodonation attitude increased the likelihood of contacting the registry. The potential for this and similar other Web interventions to enhance students' health education is discussed.

Arab and Jewish elementary school students' perceptions of fear and school violence: understanding the influence of school context.

This inquiry explores variables that predict elementary school students' fear of attending school due to school violence and their overall judgments of school violence as a problem. Using a nationally representative sample (Israel) of 5,472 elementary-school-aged children, this study tested the hypotheses that: (a) young students' personal fear of attending school due to violence, and (b) students' assessment of a school violence problem, are best understood as separate conceptual constructs. Structural equation modelling was used to test the proposed theoretical model for the sample as a whole and separately for across gender and for Arab and Jewish students. Student fear of attending school due to violence was related directly to experiences of personal victimization on school grounds by students and teachers. Children's judgments of their schools' overall violence problem were influenced directly by the school climate, risky peer-group behaviours, and personal victimization. The findings provide evidence that the proposed theoretical model applies across gender groups and for both Arab and Jewish students. Implications for policy, theory, and future research are highlighted.

Crossover of marital dissatisfaction during military downsizing among Russian army officers and their spouses.

This study examined mechanisms of strain crossover within couples and the moderating role of gender. Data were collected at a time of military downsizing from a sample of 1,250 Russian army officers and their spouses. The authors tested a model that incorporated 3 mechanisms for the crossover of marital dissatisfaction among dual-earner couples. The model provided support for 2 suggested crossover mechanisms: direct reactions of crossover and indirect mediated effects through social undermining. Strong evidence was also provided for gender asymmetry in the crossover process. Marital dissatisfaction crossed over from husbands to wives but not vice versa, and social undermining behavior played a role in the process of crossover of marital dissatisfaction for husbands but not for wives.

The interplay among risk factors for suicidal ideation and suicide: the role of depression, poor health, and loved ones' messages of support and criticism.

When individuals who receive social support are in poor physical or mental health and are criticized or made to feel unwanted, they may perceive themselves as a burden. Poor physical health and depression were hypothesized to exacerbate the harmful effects on suicidal ideation of receiving critical negative messages and of receiving social support. These hypotheses were tested using secondary analyses of data from a sample of 533 unemployed married individuals who were assessed shortly after job loss, and 6 months later. The results of our analyses supported the hypotheses and demonstrated that for participants with poor health or high level of depressive symptoms an increase in critical messages and social support (from Time 1 to Time 2) predicted increased suicidal ideation. This relationship was not observed for non-depressed participants in good health. The results are discussed in terms of their implications for suicide prevention.

Providing social support may be more beneficial than receiving it: results from a prospective study of mortality.

This study examines the relative contributions of giving versus receiving support to longevity in a sample of older married adults. Baseline indicators of giving and receiving support were used to predict mortality status over a 5-year period in the Changing Lives of Older Couples sample. Results from logistic regression analyses indicated that mortality was significantly reduced for individuals who reported providing instrumental support to friends, relatives, and neighbors, and individuals who reported providing emotional support to their spouse. Receiving support had no effect on mortality once giving support was taken into consideration. This pattern of findings was obtained after controlling for demographic, personality, health, mental health, and marital-relationship variables. These results have implications for understanding how social contact influences health and longevity.

Internet-based intervention to promote organ donor registry participation and family notification.

BACKGROUND: Little is known regarding the potential of Internet-based educational interventions to increase organ donor registry participation and family notification of donation wishes. We studied the effects of an Internet-based multimedia intervention (www.journey.transweb.org) on donor registry participation and family notification. METHODS: Visitors to a specially designed web site were studied between December 14, 2000, and March 31, 2002. Demographic characteristics were requested, and a pretest was administered to one half of the participants (selected randomly) before web site content exposure. All visitors were offered a posttest. Eight knowledge questions (true/false), three attitude questions (7-point scale), and three behaviors (yes/no) were assessed. RESULTS: A total of 10,884 visitors provided demographic data. Correct answers to knowledge questions increased from 85.1% to 87.0% overall (pretest vs. posttest; P<0.001) and from 80.6% to 82.0% for teenagers (P<0.001). Willingness to donate increased (scores of 6.34 vs. 6.39; P<0.001), as did willingness to join a donor registry (scores of 5.53 vs. 5.67; P<0.001). Willingness measures were less positive among teenagers but increased significantly after exposure to the intervention. Almost 10% of visitors directly linked to an online registry and 2,489 (23%) used the web site facilities to communicate donation wishes. Increases in knowledge were not associated with changes in attitudes, but an increase in pro-donation attitude was a significant predictor of donor registry participation (P<0.001). CONCLUSIONS: Increases in donation attitudes among visitors to an organ donation web site resulted in positive behaviors, such as enrollment in a donor registry and family notification. Future efforts should focus on using Internet-based interventions to improve attitudes toward donation and to facilitate pro-donation behaviors.

School climate, observed risky behaviors, and victimization as predictors of high school students' fear and judgments of school violence as a problem.

The primary aim of this study is to explore how school-related variables predict high school students' subjective judgements of school violence. Using a nationally representative sample (Israel) of 3,518 high school-aged youth, this study tested the hypotheses that (a) students' personal fear of attending school due to violence and (b) students' assessment of a school violence problem are best understood as separate conceptual constructs. The findings support the proposition that student fear of attending school and assessments of school violence as a problem are influenced by different types of school-related variables. Student fear of attending school due to violence was directly related to experiences of personal victimization by students and school staff. In contrast with fear, students'judgements of their schools' overall violence problem were directly associated with the variables of school climate, observed risk behaviors, and personal victimization. Implications for policy, theory, and future research are highlighted.

Links in the chain of adversity following job loss: how financial strain and loss of personal control lead to depression, impaired functioning, and poor health.

The authors tested hypotheses concerning risk mechanisms that follow involuntary job loss resulting in depression and the link between depression and poor health and functioning. A 2-year longitudinal study of 756 people experiencing job loss indicates that the critical mediating mechanisms in the chain of adversity from job loss to poor health and functioning are financial strain (FS) and a reduction in personal control (PC). FS mediates the relationship of job loss with depression and PC, whereas reduced PC mediates the adverse impacts of FS and depression on poor functioning and self-reports of poor health. Results suggest that loss of PC is a pathway through which economic adversity is transformed into chronic problems of poor health and impaired role and emotional functioning.