Pre-existing parental stress and youth internalizing symptoms predict parent-reported COVID-related stress in military families.

Understanding the extent to which youth and families experienced COVID-related stress requires accounting for prior levels of stress and other associated factors. This is especially important for military families, which experience unique stressors and may be reluctant to seek outside help. In this prospective study, we examined the role of pre-pandemic family factors in predicting parent and youth stress during the COVID-19 pandemic. Participants were 234 families with at least one active-duty parent and a 3rd or 5th-grade child. Findings revealed that preexisting factors predicted youth and family COVID-related stress. Specifically, heightened pre-pandemic parental stress and youth internalizing symptoms were significant predictors of COVID-related stress. Implications for mental health professionals and other organizations supporting military parents and families during the COVID-19 pandemic as well as other times of upheaval are discussed.

Considering context: Current relationship satisfaction in a second-generation model of men's physical intimate partner violence.

Despite a half-century of scholarship devoted to explicating and disrupting the intergenerational transmission of family violence, it remains a prominent and destructive social force in the United States. Theoretical models have posited a variety of historical and concurrent risk and protective factors implicated in the trajectory from childhood violence exposure to adult perpetration. Using a second-generation model of intimate partner violence (IPV), we integrated social learning and attachment conceptualizations to examine pathways from family-of-origin violence to IPV perpetration among adult men. A sample of mixed-sex couples (N = 233) completed self-report measures related to social learning and attachment-based factors (e.g., violence in past relationships, child exposure, IPV attitudes, adult attachment) and participated in a 10-min conversation about a desired area for change in their relationship. Following, each partner participated in a video-mediated-recall procedure assessing their anger volatility and eliciting attributions of their partners' behavior. We tested mediation pathways (consistent with social learning and attachment theories) between violence in men's families of origin and their adult IPV perpetration as a function of relationship satisfaction. The proposed model fit the data well (CFI = 0.95) but had notable modifications from the hypothesized model. Generally, social-learning pathways were more consistent with the data. Relationship satisfaction interacted with some parameters. Results support theoretical advances in understanding IPV. Although exposure to violence in men's family of origin confers risk for later IPV, and a social learning developmental pathway is consistent with results, some of these effects are altered by relationship context.

Scoping Review of Postvention for Mental Health Providers Following Patient Suicide.

INTRODUCTION: As suicides among military personnel continue to climb, we sought to determine best practices for supporting military mental health clinicians following patient suicide loss (i.e., postvention). MATERIALS AND METHODS: We conducted a scoping review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Our initial search of academic databases generated 2,374 studies, of which 122 were included in our final review. We categorized postvention recommendations based on the socioecological model (i.e., recommendations at the individual provider, supervisory/managerial, organizational, and discipline levels) and analyzed them using a narrative synthesizing approach. RESULTS: Extracted recommendations (N = 358) comprised those at the provider (n = 94), supervisory/managerial (n = 90), organization (n = 105), and discipline (n = 69) levels. CONCLUSIONS: The literature converges on the need for formal postvention protocols that prioritize (1) training and education and (2) emotional and instrumental support for the clinician. Based on the scoped literature, we propose a simple postvention model for military mental health clinicians and recommend a controlled trial testing of its effectiveness.

Leveraging technology to increase the disseminability of evidence-based treatment of dental fear: An uncontrolled pilot study.

OBJECTIVES: U.S. and global estimates indicate that over 30% of adults fear receiving dental care, including over 20% who have visited a dentist in the last year, leading to avoidance and degraded oral and systemic health. Although evidence-based cognitive-behavioral treatments for dental fear (CBT-DF) exist, they have little impact on the millions who seek dental care annually because they are not disseminable (6 h of in-chair time, delivered only in person at a few sites). We developed a disseminable CBT-DF stepped-care treatment comprising (Step 1) a mobile-health application and, for those who remain fearful, (Step 2) a 1-h, one-on-one psychological treatment session that allows practice during exposure to the patient's most-feared stimuli. We hypothesized that the treatment would (a) be rated highly on usability and credibility and (b) result in clinically consequential (i.e., lowering fear into the 0-3 "no/low fear" zone) and statistically significant changes in global dental fear. METHOD: Racially/ethnically diverse patients (N = 48) with moderate to severe dental fear were recruited; all completed Step 1, and n = 16 completed Step 2. RESULTS: As hypothesized, users found the stepped-care treatment highly usable, credible, and helpful. Critically, this stepped-care approach produced reductions in patients' dental fear that were both clinically consequential (with half no longer fearful) and statistically significant (d = 1.11). CONCLUSIONS: This usable, credible, stepped-care approach to dental fear treatment holds promise for liberating evidence-based CBT-DF from specialty clinics, allowing broad dissemination.

A Meta-Review to Guide Military Screening and Treatment of Gambling Problems.

INTRODUCTION: Excessive gambling can cause substantial biopsychosocial problems (e.g., difficulties with finances, relationships, mental, and physical health). For military Service Members, it can also result in security clearance denial or revocation, failure to achieve promotions, and premature career termination. Recent congressional mandates have obligated the U.S. Department of Defense to screen for problematic gambling, the predictive values of which are a function of (i) problem prevalence and (ii) tool sensitivity and specificity. This meta-review (i.e., systematic review of systematic reviews) on the screening properties of gambling assessment tools and the effectiveness of treatments for gambling disorder is to inform military services on responding to Service Members' gambling problems. MATERIALS AND METHODS: EBSCO Discovery Service, PubMed, PsycINFO, Ovid Medline, Social Care Online, Epistemonikos, International Health Technology Assessment, and the Cochrane Central Register of Controlled Trials electronic databases were searched up to December 2022 for systematic reviews and meta-analyses on measurements of adult subclinical or gambling, and interventions targeting individuals with GD. Three and four studies were included in each section of the current meta-review (i.e., assessment tools and treatment). For review 1, the estimated risk of bias was assessed using the Risk of Bias in Systematic Reviews. RESULTS: Thirty-one tools were identified through the three systematic reviews. All had modest sensitivities and specificities; combined with low prevalences in the general SM population, positive results would be incorrect 64-99% of the time. However, if screening were conducted with SMs referred for alcohol problems, a positive result on the best screening tools would be correct 76% of the time. Several commonly used treatment approaches had demonstrated efficacy for GD. CONCLUSIONS: The combination of low prevalence of GD and subclinical gambling problems in the general population, coupled with modest sensitivity and specificity, makes screening unfeasible in the general SM population. However, dual-phase screening in higher-prevalence subpopulations (i.e., SMs already identified with substance-abuse or mental-health problems) would be viable. Regarding treatment, several interventions-already used in military healthcare-with extensive empirical track records have been successfully used to treat adults with GD.

Leadership perspectives on facilitators and barriers to sustaining evidence-based prevention interventions in the United States Military.

The U.S. Department of Defense (DoD) aims to prevent suicide, harassment, sexual assault, and partner and child maltreatment by implementing evidence-based behavioral health interventions (EBIs). However, sustaining EBI implementation over time and with fidelity to result in meaningful impacts is a tremendous challenge. We interviewed 35 military leaders in positions to observe, and possibly hinder, the erosions of EBI implementations to learn what distinguishes EBIs that sustain in the military from those that fade away. Thematic analysis identified barriers and supports to EBI sustainment consistent with the Consolidated Framework for Implementation Research, reflecting the domains: outer setting, inner setting, individuals, and innovation. Participants described how factors at different levels of the social ecology interact with each other and emphasized how aspects of military culture (e.g., hierarchical structure, frequent moves, mission focus) can both support and challenge implementing and sustaining behavioral-health EBIs. EBI implementation in the military differs from most civilian settings in that service member participation in certain preventative programs is mandated. The results indicate how policy and practice can strengthen sustained EBI implementation to reduce harm and support service members.

Revisiting "ill will versus poor skill": Relationship dissatisfaction, intimate partner violence, and observed "communication skills deficits".

For decades, researchers, interventionists, and the lay public have subscribed to the notion that couples low in relationship satisfaction and/or experiencing psychological, physical, or sexual intimate partner violence (IPV) have communication skills deficits. In contrast, experimental studies of communication have concluded that differences were more likely due to partners' "ill will than poor skill." We revisited this debate by recruiting a fairly generalizable sample of couples (N = 291) via random-digit dialing and asking them to discuss two top conflict areas ("at your best" and "as you typically do"), thus measuring will-conscious inhibition of hostility and negative reciprocity and production of positivity (i.e., the "conflict triad"). The conflict triad was observed with the Rapid Marital Interaction Coding System, Second Generation. We found partial support for the hypotheses grounded in Finkel's I3 meta-model. Frequency of hostility was associated with a complicated satisfaction × IPV-extent × conversation type × gender interaction, indicating that couples' communication skills are multi-determined. Unhappier couples showed almost no change in positivity when at their best, whereas happier couples nearly doubled their positivity despite their considerably higher typical positivity mean. Negative reciprocity was associated with satisfaction and IPV-extent but not conversation type, implying that immediate instigation combined with risk factors overwhelms conscious inhibition. Intervention implications are discussed.

Glimpsing the Iceberg: Parent-Child Physical Aggression and Abuse.

Despite evidence that parents' physical aggression abuse has long-lasting negative consequences, information about the true population prevalence of aggression and physical abuse is limited. We have even less information about how parental aggression and abuse vary by child age, parent gender, and how that aggression and abuse might be clustered within families. To address these gaps, an anonymous, computer-based assessment was administered to nearly 40,000 parents of more than 60,000 children in the United States Air Force, which included a detailed assessment on up to four minor children of aggression and its impact. The survey was the largest of its type ever conducted in the United States, allowing for stable, crossvalidated estimation of rates of both corporal punishment and physical abuse. Approximately 39% of children experienced corporal punishment, peaking at three years of age, and 7% experienced physical abuse, peaking at age six. About 45% of parents reported perpetrating corporal punishment and 8% abuse; these rates were higher in multi-child families and most often involved more than one child. Parent gender was not associated with physical aggression or abuse.

Psychological maltreatment: An operationalized definition and path toward application.

Psychological maltreatment (PM) of children has been difficult to define and even more challenging to operationalize consistently. This fact contributes to child PM being under-recognized and under-addressed by professionals that interact with children with mental health, behavioral, and developmental issues; and by systems such as child welfare, clinical and judicial systems. In this paper, we propose a definition of child PM that is both overarching and operationalized in a manner that will support consistent, fair, and unbiased application in applied contexts. The operationalized definition delineates the nature of caregiver acts that can amount to PM, as well as the level of experienced and potential impact of said act (s) that constitute PM. We detail our rationale for the definition. We discuss the need for field trials to establish the utility of the definition. We explain the necessary training and systems that would be required for the definition to be consistently and accurately applied. We believe that this definition has the potential to substantially enhance systems' abilities to recognize and address child PM, and thereby enhance children's and families' wellbeing.

Prevention System Implementation and Reach: Attitudes and Environmental Predictors in a Randomized Controlled Trial of the NORTH STAR Prevention System.

Although many evidence-based interventions are well-established, our understanding of how to effectively implement and sustain those interventions in real-world settings is less well understood. We investigated predictors of implementation and reach in a randomized controlled trial of the NORTH STAR prevention system. One-third of U.S. Air Force (AF) bases worldwide were randomly assigned to NORTH STAR (n = 12) or an assessment-and-feedback-only condition (n = 12). Process data regarding implementation factors were collected from Community Action Team (CAT) members and observations of CAT processes. Results from a series of regression analyses indicated that change in leadership and community support, action planning processes, and perceived approach effectiveness from pre-action planning to follow-up predicted community action plan (CAP) implementation and that changes in barriers to implementation predicted CAP reach. Pre-action planning reports of CAT member self-efficacy and perceived approach effectiveness also predicted CAP implementation at 1-year follow-up. Future directions and practice recommendations are provided.

Evaluating the Relationship Between Intimate Partner Violence-Related Training and Mental Health Professionals' Assessment of Relationship Problems.

Intimate partner violence (IPV) is a serious public health problem associated with increased risk of developing mental health conditions. Assessment of IPV in mental health settings is important for appropriate treatment planning and referral; however, lack of training in how to identify and respond to IPV presents a significant barrier to assessment. To address this issue, the World Health Organization (WHO) advanced a series of evidence-based recommendations for IPV-related training programs. This study examines the relationship between mental health professionals' experiences of IPV-related training, including the degree to which their training resembles WHO training recommendations, and their accuracy in correctly identifying relationship problems. Participants were psychologists and psychiatrists (N = 321) from 24 countries who agreed to participate in an online survey in French, Japanese, or Spanish. They responded to questions regarding their IPV-related training (i.e., components and hours of training) and rated the presence or absence of clinically significant relationship problems and maltreatment (RPM) and mental disorders across four case vignettes. Participants who received IPV-related training, and whose training was more recent and more closely resembled WHO training recommendations, were more likely than those without training to accurately identify RPM when it was present. Clinicians regardless of IPV-related training were equally likely to misclassify normative couple issues as clinically significant RPM. Findings suggest that IPV-related training assists clinicians in making more accurate assessments of patients presenting with clinically significant relationship problems, including IPV. These data inform recommendations for IPV-related training programs and suggest that training should be repeated, multicomponent, and include experiential training exercises, and guidelines for distinguishing normative relationship problems from clinically significant RPM.

Creating and Testing the Reliability of a Family Maltreatment Severity Classification System.

Child maltreatment and intimate partner abuse determinations often include judgments (e.g., severity) that go beyond whether or not the allegations are founded. Severity ratings inform multiple stakeholders (e.g., researchers, policymakers, clinicians, supervisors) and response pathways (e.g., "differential response" to child maltreatment). However, because severity guidelines typically only provide global direction for raters, these gradations are often of questionable reliability (and thus validity). Extending earlier work developing and implementing reliable and valid family maltreatment substantiation criteria (e.g., Heyman & Slep, 2006, 2009), a classification system for maltreatment severity was created, refined, and field-tested with a sample of clinicians from the largest maltreatment protection agency in the United States The goal was to develop operationalized criteria delineating mild, moderate, and severe maltreatment that could be consistently applied across types of maltreatment, raters, and clinics. To facilitate proper use, a computerized clinical decision support tool for the criteria was created. First, the severity classification system was piloted and refined at four sites throughout the United States. Then, clinicians at these sites (N = 28) and a master reviewer independently rated de-identified cases as part of the clinicians' routine assessments. Agreement between clinicians and the master reviewer was excellent for all types of maltreatment. Implications for practical dissemination are discussed.

Evaluation of Two Approaches for Responding to Allegations of Family Maltreatment in the U.S. Army: Coordinated Community Response Impacts and Costs.

INTRODUCTION: The U.S. Air Force (USAF) conducted a program of research to develop and disseminate reliable and valid criteria for partner and child maltreatment (comprising abuse [physical, emotional/psychological, and sexual] and neglect). These criteria are now used in all branches of the U.S. military. The U.S. Army was the first service outside the USAF to adopt the criteria sets and computerized decision support tool but maintained the original committee composition (the "Case Review Committee" [CRC]) instead of adopting the entire assessment, allegation determination, and treatment planning process (the "Field-tested Assessment, Intervention-planning, and Response" [FAIR] system). The Army commissioned this study to compare the CRC and FAIR processes by testing (1) intra-committee process (i.e., three facets of committee functioning-fidelity to regulations, cohesion and team process, outsized influence of unit representatives); (2) coordinated community response to maltreatment (i.e., perceptions of fairness to alleged offenders and victims, impact on unit representatives, and (3) collaboration between the Family Advocacy Program (FAP, the military's maltreatment response agency) and outside agencies; and (4) the time expended and cost. MATERIALS AND METHODS: New York University's Institutional Review Board approved the study protocol, and the Army's Human Research Protection Office provided permission to collect data. The ten Army garrisons with the most annual maltreatment cases participated. Committee members, FAP social workers, unit commanders, and independent observers completed assessments of individual meetings and of their overall impression of the processes. A test of whether the means significantly differed between phases was then performed separately for each outcome, and 95% CIs of the unstandardized mean difference between phases were estimated. RESULTS: Independent observers rated FAIR meetings as significantly more faithful to regulations. Unit representatives (i.e., commanders and/or first sergeants) perceived the committee to function better during FAIR (although other committee members and independent observers did not perceive differences). Unit representatives not only rated FAIR as significantly more fair to both alleged offenders and victims (ratings from other committee members did not differ), but also were more likely to attend FAIR meetings and, when they did, rated their ability to serve soldiers and families higher during FAIR. However, FAP social workers rated their relationships with units as being better during CRC, and outside agencies rated their relationship with FAP as significantly better during CRC. Costs to the Army were nearly identical in the two committee structures. CONCLUSION: Results indicated that the CRC and FAIR processes cost almost identical amounts to run and that the FAIR system was superior in ways most likely to impact service members: (1) independent observers judged its meetings to be more faithful to Army and DoD Instructions; (2) unit representatives were more likely to attend and believed the FAIR system to be fairer (to both alleged offenders and victims) and better functioning. Care should be taken, however, in nurturing relationships between FAP and (1) unit representatives and (2) outside agencies, which may have weakened during FAIR.

Impact of expectation violation on relationship satisfaction across the transition to parenthood.

This study examined whether violations of partner expectations-and attributions and perceptions of these violations-are associated with relationship satisfaction across the transition to parenthood. First-time parents (N = 99) mixed-sex couples completed mail-in packets during pregnancy (Time 1; T1) and when their babies were 3-5 months old (Time 2; T2). Hypotheses were largely confirmed. Multilevel modeling results indicated a significant T1-to-T2 decrease in relationship satisfaction. Expectation violations significantly predicted change in satisfaction; undermet expectations are associated with decreased satisfaction. T2 perception of expectation confirmation predicted change in satisfaction at T2 and moderated the relationship between expectation violation and relationship satisfaction. Likewise, benign postnatal attributions were significantly associated with the change in satisfaction at T2 and moderated the relationship between expectation violation and relationship satisfaction. Clinical and research implications are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Systematic Review of the Military Career Impact of Mental Health Evaluation and Treatment.

INTRODUCTION: Military leaders are concerned that active duty members' fear of career impact deters mental health (MH) treatment-seeking. To coalesce research on the actual and perceived consequences of MH treatment on service members' careers, this systematic review of literature on the U.S. Military since 2000 has been investigating the following three research questions: (1) is the manner in which U.S. active duty military members seek MH treatment associated with career-affecting recommendations from providers? (2) Does MH treatment-seeking in U.S. active duty military members impact military careers, compared with not seeking treatment? (3) Do U.S. active duty military members perceive that seeking MH treatment is associated with negative career impacts? MATERIALS AND METHODS: A search of academic databases for keywords "military 'career impact' 'mental health'" resulted in 653 studies, and an additional 51 additional studies were identified through other sources; 61 full-text articles were assessed for eligibility. A supplemental search in Medline, PsycInfo, and Google Scholar replacing "career impact" with "stigma" was also conducted; 54 articles (comprising 61 studies) met the inclusion criteria. RESULTS: As stipulated by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies were summarized on the population studied (U.S. Military Service[s]), sample used, intervention type, comparison group employed, outcome variables, and findings. Self-referred, compared with command-directed, service members appear to be less likely to face career-affecting provider recommendations in non-deployed and deployed settings although the data for the latter are not consistent. Of the two studies that tested if MH treatment actually negatively impacts military careers, results showed that those who sought treatment were more likely to be discharged although the casual nature of this relationship cannot be inferred from their design. Last, over one-third of all non-deployed service members, and over half of those who screened positive for psychiatric problems, believe that seeking MH treatments will harm their careers. CONCLUSIONS: Despite considerable efforts to destigmatize MH treatment-seeking, a substantial proportion of service members believe that seeking help will negatively impact their careers. On one hand, these perceptions are somewhat backed by reality, as seeking MH treatment is associated with a higher likelihood of being involuntarily discharged. On the other hand, correlational designs cannot establish causality. Variables that increase both treatment-seeking and discharge could include (1) adverse childhood experiences; (2) elevated psychological problems (including both [a] the often-screened depression, anxiety, and posttraumatic stress problems and [b] problems that can interfere with military service: personality disorders, psychotic disorders, and bipolar disorder, among others); (3) a history of aggressive or behavioral problems; and (4) alcohol use and abuse. In addition, most referrals are self-directed and do not result in any career-affecting provider recommendations. In conclusion, the essential question of this research area-"Does seeking MH treatment, compared with not seeking treatment, cause career harm?"-has not been addressed scientifically. At a minimum, longitudinal studies before treatment initiation are required, with multiple data collection waves comprising symptom measurement, treatment, and other services obtained, and a content-valid measure of career impact.

The role of intimate partner violence and relationship satisfaction in couples' interpersonal emotional arousal.

To inform interpersonal models of intimate partner violence (IPV), the present study examines patterns of vocally encoded emotional arousal during the conversations of mixed-gender couples who reported on the extent of physical and psychological IPV and degree of relationship satisfaction (N = 149). All couples completed two problem-solving discussions. Emotional arousal was measured continuously during each conversation using vocal fundamental frequency. Contrary to expectations, results demonstrated that trajectories of arousal differed based on gender, IPV, and relationship satisfaction. Within conversations, men demonstrated linear increases in arousal at higher levels of IPV, suggesting that men may either struggle to contain their emotions or use heightened emotional expression as a conflict strategy in relationships with more extensive IPV. Conversely, women exhibited different trajectories of arousal depending on the combinations of relationship satisfaction and couple IPV, except at higher levels of their own satisfaction. Specifically, when women reported being highly satisfied in their relationships, they demonstrated similarly shaped trajectories across all levels of IPV and men's satisfaction. Together, this suggests that women's higher relationship satisfaction may buffer their emotional expression, although this may not always be adaptive within the context of relationships with extensive IPV. Overall, this study offers insight into the dynamic interpersonal processes linked with relationship distress and IPV and implies the need for a more nuanced, interpersonal research agenda for IPV research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Impact of NORTH STAR on Suicidality, Substance Problems, Intimate Partner Violence, and Child Abuse.

INTRODUCTION: We evaluated the effectiveness of New Orientation for Reducing Threats to Health from Secretive-problems That Affect Readiness (NORTH STAR), a community assessment, planning, and action framework to reduce the prevalence of suicidality, substance problems, intimate partner violence, and child abuse. MATERIALS AND METHODS: One-third of U.S. Air Force bases worldwide were randomly assigned to NORTH STAR (n = 12) or an assessment-and-feedback-only condition (n = 12). Two Air Force-wide, cross-sectional, anonymous, web-based surveys were conducted of randomly selected samples assessing risk/protective factors and outcomes. This study was reviewed and approved by the institutional review board at the investigators' university and by the institutional review board at Fort Detrick. RESULTS: NORTH STAR, relative to control, bases experienced a 33% absolute risk reduction in hazardous drinking rates and cumulative risk, although, given the small number of bases, these effects were not statistically significant. CONCLUSIONS: Given its relatively low cost, use of empirically supported light-touch interventions, and emphasis on sustainability with existing resources, NORTH STAR may be a useful system for prevention of a range of adult behavioral health problems that are difficult to impact.

High sensitivity and specificity screening for clinically significant intimate partner violence.

The U.S. Preventive Services Task Force has recommended that clinicians screen patients for intimate partner violence (IPV). This article aims to develop and test the first screeners for clinically significant physical and psychological IPV (i.e., acts meeting criteria in the International Classification of Diseases (11th ed.; ICD-11; World Health Organization, 2019) and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). The goal was to derive screeners that (1) are maximally brief, while still achieving high sensitivity and specificity; (2) assess perpetration and victimization when either men or women are reporting; and (3) use ICD-11/DSM-5 criteria as the reference standard. Random samples of active duty service members at 82 installations worldwide were obtained via e-mail invitation (2006: N = 54,543; 2008: N = 48,909); their response rates were excellent for long general population surveys with no payment (2006: 44.7%, 2008: 49.0%). The population of spouses at the participating installation was invited by mailed postcard (2006: N = 19,722; 2008: N = 12,127; response rates-2006: 12.3%, 2008: 10.8%). Clinically significant physical intimate partner violence can be effectively screened with as few as four items, with sensitivities > 90% and specificities > 95%; clinically significant psychological intimate partner violence can be screened with two items. Men and women can be screened with equivalent accuracy, as can those committing the violence and those victimized by it. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Associations between self-rated physical Health and relationship satisfaction in couples with children.

The degree to which individual self-rated physical health and concordance of self-rated physical health between partners are associated with relationship satisfaction was examined in a community sample of 399 couples with children. Couples completed self-report assessments of physical health (general health and physical functioning) and relationship satisfaction. Results suggest unique associations between partners' general health and their own relationship satisfaction. Further, higher between-partner concordance in physical functioning was uniquely associated with higher relationship satisfaction in women. Understanding associations between health and relationship processes is crucial and has implications for future research on couple-based interventions to promote physical health.

Evaluating the Effectiveness of NORTH STAR: a Community-Based Framework to Reduce Adult Substance Misuse, Intimate Partner Violence, Child Abuse, Suicidality, and Cumulative Risk.

We evaluated the effectiveness of NORTH STAR, a community assessment, planning, and action framework to reduce the prevalence of several secretive adult problems (hazardous drinking, controlled prescription drug misuse, suicidality, and clinically significant intimate partner violence and child abuse [both emotional and physical]) as well as cumulative risk. One-third of US Air Force (AF) bases worldwide were randomly assigned to NORTH STAR (n = 12) or an assessment-and-feedback-only condition (n = 12). Two AF-wide, cross-sectional, anonymous, web-based surveys were conducted of randomly selected samples assessing risk/protective factors and outcomes. Process data regarding attitudes, context, and implementation factors were also collected from Community Action Team members. Analyzed at the level of individuals, NORTH STAR significantly reduced intimate partner emotional abuse, child physical abuse, and suicidality, at sites with supportive conditions for community prevention (i.e., moderation effects). Given its relatively low cost, use of empirically supported light-touch interventions, and emphasis on sustainability with existing resources, NORTH STAR may be a useful framework for the prevention of a range of adult behavioral health problems that are difficult to impact.