Protective Parenting, Relationship Power Equity, and Condom Use Among Rural African American Emerging Adult Women.

Sexually transmitted infections disproportionately affect African Americans, particularly young women. The influence of a set of interrelated protective parenting processes-instrumental and emotional support, sexual risk communication, and encouragement of goals for employment or education-on emerging adult women was examined. Parenting was hypothesized to affect consistent condom use through its association with women's reports of power equity in their intimate relationships. Hypotheses were tested with 135 sexually active women 18 to 21 years of age living in rural southern communities. Structural equation modeling indicated that (a) parenting processes predicted women's self-reported relationship power equity and consistent condom use, and (b) relationship power equity predicted consistent condom use. Limited support emerged for a mediational role of relationship power equity in explaining the influence of parenting on consistent condom use. Parental involvement and young women's establishment of personal control in their intimate relationships are important goals for sexual risk reduction programs.

Reliability and validity of the global assessment of relational functioning (GARF) in a psychiatric family therapy clinic.

The reliability and validity of the Diagnostic and Statistical Manual of Mental Disorders-IV Global Assessment of Relational Functioning (GARF) was evaluated in consenting participants presenting to a family therapy training clinic. The purpose of this study was to (a) assess whether the GARF could be administered quickly in a marriage and family therapy training clinic, (b) assess the inter-rater and internal reliability of GARF ratings of intake sessions, (c) examine the relationship of GARF ratings to established measures of relationship functioning, and (d) compare GARF ratings to a measure of depressive symptoms. Study participants completed the General Functioning Subscale of the Family Assessment Device (GFS/FAD), the Quality of Marriage Index (QMI), and the Center for Epidemiologic Studies-Depression Scale (CES-D). After intake sessions were conducted with study participants, GARF ratings were made by an American Association for Marriage and Family Therapy Approved Supervisor or Supervisor-in-Training, a therapist trainee, and two observing trainees who had observed the session from behind a one-way mirror. Cronbach's coefficient alphas and the average intraclass correlation coefficients were both .82 when ratings of the supervisor and two observers were compared and .78 and .79, respectively, when ratings of the supervisor, two observers, and therapist were evaluated. There was significant agreement between GARF ratings made by the supervisor and therapist (but not observers) and scores on the GFS/FAD, QMI, and CES-D. Results suggest that GARF ratings can be made quickly and reliably, especially among raters with greater clinical experience, and are related to measures of relational functioning and depression. Implications for research and marriage and family therapy training are discussed.

Younger women's perceptions of coping with breast cancer.

Numerous studies have demonstrated an association between coping strategies and better quality of life after breast cancer. Because younger women consistently show greater psychological morbidity than older women after breast cancer diagnosis, there is great interest in the coping strategies of younger women. The present cross-sectional study used quantitative and qualitative methods to examine coping strategies used by 201 women who were aged 50 years or younger at diagnosis and were 6 months to 3.5 years postdiagnosis. Quantitative results from a modified version of the Ways of Coping scale revealed that the most frequently used coping strategies were positive cognitive restructuring, wishful thinking, and making changes. Qualitative analyses based on open-ended questioning of how women best coped with different stressful aspects of their diagnosis showed that women reported finding different strategies useful depending on the stressor. For example, social support was helpful in dealing with anger or depression, whereas positive cognitive restructuring was more helpful for concerns about the future. Analyses also confirmed that most coping strategies cited in commonly administered coping scales were used frequently by these women. However, several coping strategies not generally measured were also deemed valuable, including engaging in physical activity, using medications, and resting. These findings suggest that clinicians should identify patients' particular stressors and help with coping techniques targeting particular concerns.

Addressing behavioral health issues during well child visits by pediatric residents.

The study examined practices by pediatric residents (n = 61) concerning psychosocial care during well child visits. A random sample (n = 719) of well child visits was selected, and a medical record review was conducted. Results suggested that a behavioral health issue was discussed in 38% of the cases. The most frequent type of problem discussed involved a medical component, while problems with mood were rarely discussed (<1%). Residents treated 67% of the cases and referred 20% of the cases with behavioral health concerns. Logistic regression suggested that residents were significantly more likely to treat medically focused problems (P = 0.05), but more likely to refer children with social/environmental or learning problems (P = 0.05). Results suggested the need for further training in recognition of internalizing disorders.

Sexual problems in younger women after breast cancer surgery.

PURPOSE: To examine sexual problems in younger women diagnosed with breast cancer during the first year after surgery and to identify sociodemographic, medical, and psychosocial predictors of sexual problems. PATIENTS AND METHODS: Women diagnosed with breast cancer age < or = 50 years completed surveys at three time points: within 24 weeks after initial surgery (baseline), 6 weeks after baseline, and 6 months later. Survey items included the Medical Outcomes Study Sexual Functioning Scale, satisfaction with sex life, feeling sexually attractive, body image, marital satisfaction, quality of life, medical history, symptoms, and sociodemographics. Prediagnosis sexual problems were retrospectively ascertained at the initial survey. RESULTS: Analyses included 209 women sexually active at baseline (78.6% of total sample). Sexual problems were significantly greater immediately postsurgery compared with retrospective reports before diagnosis (P < .0001). Although problems gradually decreased over time, they were still greater at 1 year postsurgery than before diagnosis. In multivariate analyses controlling for sexual problems at prediagnosis, vaginal dryness, and lower perceived sexual attractiveness were consistently related to greater overall sexual problems. Chemotherapy was related to sexual problems only at baseline except for women who became menopausal as a result of chemotherapy, who continued to have problems. CONCLUSION: Findings substantiate the need to address potential sexual problems related to chemotherapy treatment and menopause among younger breast cancer survivors and to counsel women about possible remedies, particularly for vaginal dryness. Increasing feelings of sexual attractiveness may also help sexual problems, especially among women for whom these feelings were altered by surgery or treatment.