The purpose of this study was to investigate the experience of uncertainty in illness for couples in the post-treatment phase of a cancer diagnosis. More specifically, the study sought to determine if lower levels of cancer uncertainty could lead to higher satisfaction with life, lower depression, and lower anxiety for both members of the couple. The additional influence of coping skill usage and relationship satisfaction was also examined in the context of the couple relationship. Symbolic interactionism was the theoretical framework guiding this study. Data was collected through the Midwestern Site of the Cancer Treatment Centers of America and their volunteer participant program called Cancer Fighters as well as through Facebook recruitment. Data analyses involved using the Actor-Partner Interdependence Model (APIM) as well as path analysis using AMOS (Arbukle, 2006) software to examine the hypotheses. Results indicated a direct relationship between partners uncertainty and depression, anxiety, and satisfaction with life. Survivors results indicated a direct relationship between their uncertainty and anxiety. Finally, a direct relationship was indicated from partner's uncertainty to survivor's depression and anxiety. These findings suggest that a partner's level of uncertainty during the survivorship stage can function as the most influential aspect of the adjustment to post-treatment life. Implications for researchers and practitioners are discussed. / A Dissertation submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Fall Semester, 2013. / November 1, 2013. / Cancer, Couples, Survivorship, Uncertainty / Includes bibliographical references. / Wayne Denton, Professor Directing Dissertation; Mary Gerend, University Representative; Lenore McWey, Committee Member; Carol Darling, Committee Member.

Disproportionate rates of prostate cancer and high-mortality rates from prostate cancer among African American (AA) men have provided the impetus to examine factors which influence prostate cancer screening (PCS) in the AA male population. This study focused on prostate cancer screening, which included the digital rectal exam (DRE) and the prostate specific antigen (PSA) test as the outcome variables. Literature has indicated an association between intrapersonal, interpersonal, and community factors and prostate cancer screening. In addition, the independent variable of intention was examined as a mediator that links the various factors to the outcome variable of the PSA test. Based on the social ecological model and the theory of planned behavior, I hypothesized that: 1) AA men who were over 50 years old, with a college degree, had higher levels of income, a perceived better health-status ranking had higher, positive rates for receiving prostate cancer screening; 2) AA men who were married, and had the presence of marital support, and family support had higher rates of receiving positive prostate cancer screening; 3) higher rates of church attendance, more church member support, and better access to health care would be associated with higher levels of prostate cancer screening; 4) the intrapersonal, interpersonal, and community factors were combined to be associated with the likelihood of AA men receiving prostate cancer screening; and 5) these factors were associated with the likelihood of prostate cancer screening though intention to have a PSA test. Using data from the Center of Disease Control and Prevention's 2007-2008 National Health and Nutrition Examination Survey (NHANES), results from logistic regression suggested that 1) intrapersonal factors were significant and associated with receiving prostate cancer screening ; 2) the interpersonal factors were not significant or associated with AA men receiving prostate cancer screening; 3) community factors were significant and associated with receiving prostate cancer screening; 4) the additive effective of intrapersonal, interpersonal and community factors were significant and associated with prostate cancer screening; and 5) there was no evidence of mediation by intention to receive a PSA test. The study adds to the literature on AA men and prostate cancer screening by separately examining three groups of factors that interact with AA men on a personal, social and environmental level. The findings suggested the importance of several factors (age, income, church attendance, and access to health care) that could provide useful information for designing interventions to promote prostate cancer screening among AA men. / A Dissertation submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Fall Semester, 2013. / August 21, 2013. / African American men, Digital rectal exam, Prostate Cancer, Prostate cancer screening, Prostate specific antigen test / Includes bibliographical references. / Ming Cui, Professor Directing Dissertation; James Whyte, IV, University Representative; Lenore McWey, Committee Member; Penny Ralston, Committee Member.

ABSTRACT In the past, the majority of infant caregiving has been done by mothers or other female care-givers (Bailey, 1994; Hossain, Field, Pickens, Malphurs, & Del Valle, 1997). Yet, most fathers (91%) were involved with the mother at the time of the babies' birth (Gottman, Gottman & Shapiro, 2010). Fathers who had "close physical contact" interacted more with their infants (Park & Swain, 1977). In addition, fathers who saw infant caregiving activities demonstrated mirrored these behaviors with their own infants (Parke, Hymel, Power, & Tinsely, 1980; Harrison et al., 1996). Fathers who were present and active in the lives of their children provided support contributing to the emotional development of their children by being emotionally and physically available and engaged (Parke, 1996; Parke & Brott, 1999). Infant massage increased parental competency, frequency, and quality of caregiving activities by fathers with their infants (Cullen et al., 2000; Scholz & Samuels, 1992). This study aimed to explore the experiences, attitudes, and perspectives of fathers massaging their infants. Five fathers and five infants participated in an exploratory pilot case study to determine what, if any, perceived benefits existed or accrued for fathers who massaged their infants. In this three week study fathers provided infant massage to their infants every night before bedtime and recorded their activities in diaries. Initial and final interviews and videorecordings captured the fathers massaging their infants, their attitudes and perceptions of their experiences. This data was analyzed using Atlas.ti and qualitative process coding. The findings were that father's enjoyed massaging their infants and believed that their infants enjoyed being massaged. Fathers reported: they desired opportunities to spend time with their infants; feelings of contributing to their infants' comfort; competence and confidence in their interactions with their infants; and provided the mothers temporary relief from their child care activities. Additionally, the data demonstrated the attachment constructs of awareness, emotional expression, engagement cues, motivation, relationship, sensitivity supporting attachment theory as an appropriate theoretical framework to study the father child dyad. / A Dissertation submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Fall Semester, 2013. / September 16, 2013. / Atlas.ti, Attachment theory, Father, Fathering, Infant Massage, Qualitative / Includes bibliographical references. / Marsha Rehm, Professor Directing Dissertation; Mary Frances Hanline, University Representative; Wayne Denton, Committee Member; Ming Cui, Committee Member.

Twelve married couples fostering special needs children completed a 6-month, weekly, individualized marital strengthening intervention based on Gottman's Sound Marital House model. 66% (8 couples) were located three to seven years later and interviewed about what they have found useful in that experience. The interview was semi-structured and non-directive and informed a grounded theory approach. The findings indicate that, for this sample, some curricular concepts were experienced as important. However, the findings also suggested that family science researchers and program evaluators should consider not just curricular particulars but the entire process of enrolling and participating in such a program, namely, generic therapeutic aspects of participation. / A Dissertation submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Fall Semester, 2013. / October 21, 2013. / Adoption, Marriage education / Includes bibliographical references. / Robert E. Lee, Professor Directing Dissertation; David Gussak, University Representative; Christine A. Readdick, Committee Member.

Unplanned pregnancy is prevalent in the United States and has been linked to challenges for both mothers and their children over time. However, existing literature is limited by unrepresentative samples, retrospective reports of pregnancy intention, and lack of theoretical guidance. Studies have not yet identified mechanisms through which pregnancy intention is associated with children's outcomes, to sufficiently inform clinical practice. This current study addressed these limitations through inclusion of an at-risk sample of 224 first-time mothers from the Predicting and Preventing Neglect in Teen Mothers Study, assessing pregnancy intention during the third trimester of pregnancy, and testing mechanisms in the association between pregnancy intention and children's outcomes which were hypothesized by Family Systems Theory. The study also examined reciprocal associations among hypothesized mediators, including maternal depressive symptoms, parenting stress, and coparenting satisfaction. Mediation analyses revealed that both parenting stress and coparenting satisfaction when children were 24 months old served as mechanisms in the association between unplanned pregnancy and children's social-emotional competence at 36 months. Additionally, a cross-lagged longitudinal model suggested multiple pathways through which unplanned pregnancy was associated with children's externalizing, internalizing, dysregulation, and social-emotional competence at 36 months. Maternal depressive symptoms tended to predict later parenting stress which, in turn, was associated with later coparenting satisfaction and children's behavioral outcomes. Implications for future research are discussed, including collection of data from multiple respondents and assessment of pregnancy intention prospectively. Clinical implications for work with at-risk parents are also outlined. Specifically, the results suggest that early intervention with mothers experiencing unplanned pregnancies to specifically address depressive symptoms, parenting stress, and coparenting may serve to promote healthy outcomes among their children over time. / A Dissertation submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester, 2014. / May 20, 2014. / At-Risk Families, Children, Coparenting, Depression, Parenting, Pregnancy Intention / Includes bibliographical references. / Lenore M. McWey, Professor Directing Dissertation; Sally Karioth, University Representative; Ming Cui, Committee Member; Kendal Holtrop, Committee Member.

A six-group randomized experimental study was used to investigate the factors that are associated with a marriage and family therapist's decision to work with clients individually or as a couple when they present with intimate partner violence (IPV). Investigated factors included the type of IPV experienced by the clients, the therapist's accuracy in identifying the type of violence experienced by clients, and the therapist's experience with IPV in their own romantic relationships, as moderated by levels of differentiation. Participants included 275 members of the American Association for Marriage and Family Therapy. A chi square test revealed that participants who received vignettes portraying situational couple violence were more likely to endorse couples treatment as the preferred treatment modality than participants who received vignettes portraying intimate terrorism. Additional chi square tests revealed that among participants who received vignettes portraying situational couple violence, those who were accurately able to identify the type of violence portrayed in the vignette were more likely to endorse couples treatment as the preferred treatment modality than those who did not accurately identify the type of violence. Additional analyses, however, suggest that accurate identification and appropriate treatment choice may be more difficult in situations in which intimate terrorism is taking place, especially when women are the perpetrators of this abuse. Logistic regression indicated that there was not a significant relationship between therapists' personal experience with IPV and endorsement of treatment type. In addition, differentiation did not moderate the relationship between IPV experienced in participants' own romantic relationships and their endorsement of couples treatment. The current study indicates that marriage and family therapists are likely to make IPV treatment choices primarily based on the type of violence experienced by the couple. It appears that IPV treatment choice is not influenced by personal experience with IPV, but rather by the therapist's accurate identification of IPV type and the gender of the perpetrator of abuse. These findings ultimately highlight the need continued education on IPV, IPV types, gender biases with regards to IPV, and the importance of taking safety into consideration when making treatment decisions. / A Dissertation submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester, 2014. / July 7, 2014. / Counseling, Differentiation, Domestic Violence, Family Violence, Intimate Partner Violence, Marriage and Family Therapy / Includes bibliographical references. / Frank Fincham, Professor Directing Dissertation; Dina Wilke, University Representative; Wayne Denton, Committee Member; Lenore McWey, Committee Member.

The purpose of this study was to explore multiple research questions related to foster caregiver protective factors, satisfaction with fostering, and intent to continue fostering. First, the researcher identified what protective factors (i.e., parental resilience, social connections, concrete supports, and nurturing and attachment) foster caregivers report and to what degree. Second, the researcher determined whether there was a significant relationship between the independent variables (protective factors) and the dependent variables (satisfaction with fostering and intent to continue fostering). Next, the researcher examined whether child disruptive behaviors moderated or influenced the nature or strength of the relationship between protective factors and satisfaction as a caregiver. Third, the researcher examined a second model of whether child behaviors moderated or influenced the nature or strength of the relationship between protective factors and intent to continue fostering. The sample consisted of 155 licensed foster caregivers from across the United States. Descriptive statistics (i.e., means, standard deviations, range, internal consistency, skewness, kurtosis, and bivariate correlations), multiple regression, and interaction effects in multiple regression were used to test the various relationships proposed in this model. First, it was found that foster caregivers generally report a high degree of each protective factor. Second, there was a significant relationship between protective factors and two domains of satisfaction (challenging aspects of fostering and confidence and satisfaction). Third, child behaviors served as a significant moderator between some of the protective factors and two domains of satisfaction (challenging aspects of fostering and confidence and satisfaction). Implications for future research, practice, and policy were discussed. / A Dissertation submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester, 2014. / May 13, 2014. / Foster Care, Foster Children, Foster Parents, Protective Factors, Satisfaction / Includes bibliographical references. / Ann K. Mullis, Professor Directing Dissertation; Karen Randolph, University Representative; Lenore McWey, Committee Member; Ming Cui, Committee Member.

The factors that currently impact professional practice in the field of human sexuality are invisible in the available literature. The current study addresses this gap, and also identifies similarities and differences between professions, as well as the role of an ecological systems framework in explaining professionals' experiences. The present study drew on past literature that outlines the historical nature of sexuality education, therapy, and research. The sample was drawn from a previous data set where the author interviewed experts in the field(s) of sexuality education, therapy, and research. Twenty-seven sexuality educators, therapists, and researcher were interviewed using purposive and snowball sampling. Beginning with contacting the membership directors of the American Association of Sexuality Educators, Counselors, and Therapists (AASECT; the predominant professional body for sexuality educators and therapists in North America), and the Society for the Scientific Study of Sexuality (SSSS; the predominant professional body for sexuality researchers in North America), to gain the initial potential participants, a snowball sampling technique was subsequently used to garner the remainder of the respondents. To conduct these interviews, the author contacted each potential participant personally through email. Participants were interviewed through Skype or a telephone conversation typically lasting between 35 to 90 minutes. They were then asked to provide their experiences regarding their joys, challenges, what they would have done differently; areas where the field needs growth; factors to be studied; and suggestions for the future of sexuality education, therapy, and research. The interviews were analyzed using a grounded theoretical (GT) strategy, resulting in the production of themes. Two main themes, as well as many sub-themes, were identified that explain the factors impacting professional practice in human sexuality. Meaningful work and the personal characteristic of diehard determination, both encompassed what a professional must attain and overcome to remain in a sexuality-based career. Meaningful work for sexuality educators was comprised of student epiphanies and the public's desire for accurate information. For therapists, this included the overwhelming trust of clients and the variety of clinical treatments and problems. For researchers, this was represented through the variance of the phenomena studied, and a senses of pioneering. Diehard determination in sexuality educators was seen through confrontation and conflict and maintaining sensitivity. For Therapists, this was represented by insufficient training and clients' beliefs about normality. Sexuality researchers remained determined despite funding being an ever-present challenge, institutional review boards not understanding sexuality research, and work being undervalued. Many unique similarities and differences were observed among professions. Similarities were seen through participants' recommendations for future professionals wishing to enter the field. Themes included: holistic views and a change in sociopolitical ideology. Many differences among the experiences of each profession were observed through professional's perspectives on future directions for sexuality education (such as the need for external collaboration), therapy (e.g., the usefulness of a standardization of certification), and research (e.g., the desire for internal unification among professions). Additionally, an ecological systems framework was helpful in explaining the factors that impact professional practice in human sexuality. This framework was useful in describing the experiences of respondents in the context of natural impacts (such as time), human-behavioral impacts (such as the personal interactions and difficulties in collaboration between sexuality professionals and those in other fields of human science), and human-constructed impacts including regulatory systems (e.g., restrictive funding priorities). Many implications for theory, research, and professional practice were identified. The results of this study noted the extent to which novel methodological, measurement, and theoretical approaches are needed in the field of sexuality. It is particularly important for training and regulatory bodies to work together to create internal consistency among the various professional practices within the field of human sexuality. Professionally, regulation through credentialing standardization could further be researched, with the possibility of increased credibility among professional practices. / A Dissertation submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Spring Semester, 2014. / April 15, 2014. / Impacting Factors, Professional Implications, Sexuality, Sexuality Education, Sexuality Research, Sexuality Therapy / Includes bibliographical references. / Carol A. Darling, Professor Directing Dissertation; Anne Barrett, University Representative; Marsha Rehm, Committee Member; Wayne Denton, Committee Member.

Empirical knowledge about sibling relationships of youth in foster care is scant. The purpose of this study was to explore sibling relationships of youth in foster care and begin to build a stronger understanding of the potential protective role these relationships can have for youth in an uncertain circumstance. Symbolic interaction was used as the theoretical lens for this mixed methods study. The sample consisted of children who are currently living in foster care and attended a five-day sibling enhancement camp, called Camp To Belong. The results indicated that sibling relationships could be a protective factor for youth in foster care. In a qualitative exploration of the meaning of sibling relationships of youth in foster care, youth reported that their sibling has a positive and protective role. Furthermore, youth reports of greater sibling warmth significantly predicted higher scores of individual resilience, a trait that is associated with overcoming adversity. Another aim of this study was to explore developmental differences of sibling relationships for those in foster care. The results of this study indicated that there were no significant differences between youth in middle childhood and adolescents in how they perceived their sibling relationship quality in terms of sibling warmth and sibling conflict. Lastly, youth in middle childhood and adolescence had a significant decrease in sibling conflict as a result of their participation in Camp To Belong. The results of this study have implications for research, clinical practice, and policy that are discussed. / A Dissertation submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Spring Semester, 2014. / April 2, 2014. / Development, Resilience, Siblings / Includes bibliographical references. / Lenore M. McWey, Professor Directing Dissertation; Kathryn H. Tillman, University Representative; Wayne Denton, Committee Member; Ann K. Mullis, Committee Member.

This study explored the relationship between adolescent mental health, parental depression, and family environment for children and adolescents accessing intensive mental health treatment. The study had two aims. Aim one was to identify the severity of externalizing behaviors versus internalizing behaviors in children and adolescents accessing intensive mental health treatment and to determine the nature of gender differences in such behaviors. Aim two was to explore the relationship between adolescent mental health, parental depression, and family environment. Results indicated that children and adolescents accessing intensive mental health treatment were more likely to exhibit externalizing behaviors than internalizing behaviors, and female adolescents were more likely to exhibit externalizing behaviors than were male adolescents. In relation to the second aim, there was a significant relationship between parental depression and internalizing behaviors in children and adolescents, such that parents who reported more symptoms of depression were more likely to report that their children and adolescents exhibited internalizing behaviors. Family environment and gender had the greatest influence on externalizing behaviors such that families with female adolescents and who reported lower levels of connection within the family were also more likely to report that their children and adolescents exhibited externalizing behaviors. Lastly, parents who perceived that their children and adolescents were exhibiting externalizing behaviors were more likely to report less access to relationships both internally (i.e. their spouse) and externally (i.e. childcare, friends). Conversely, only one of the internalizing behaviors, depression, was related to access to internal and external family relationships. Parents who perceived that their children and adolescents were displaying more depressive symptoms were also more likely to report less access to relationships. Findings from the current study highlight the need to understand the families of children and adolescents who access intensive mental health treatment to better tailor prevention and intervention efforts. / A Dissertation submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Spring Semester, 2014. / March 25, 2014. / Adolescent, Intensive Mental Health Treatment, Parental Depresion / Includes bibliographical references. / Wayne Denton, Professor Directing Dissertation; Michèle Preyde, Professor Directing Dissertation; Joyce L. Carbonell, University Representative; B. Kay Pasley, Committee Member; Ming Cui, Committee Member.