Women infected with HIV are at an increased risk for infection of Human Papillomavirus (HPV), developing cervical lesions, and developing cervical cancer. Prior research has suggested disruptions in the immune system as well as circulating levels of stress and gonadal hormones as possible explanations for the increase of HPV infection in women with HIV. Additionally, psychosocial factors such as symptoms of depression and distress have also been associated with HPV infection, as well as disruptions in immune and endocrinologial systems, suggesting a psychoneuroimmunological pathway to disease progression. It was hypothesized that HIV+HPV+ women assigned to a Cognitive Behavioral Stress Management (CBSM) intervention will experience improvements in disease status, immune markers, circulating stress hormones, and reductions of depression and distress symptoms. An exploratory investigation of the effects of CBSM in levels circulating reproductive hormones was also tested. Follow-up hypotheses tested whether CBSM effects on immune variables were explained by reductions in symptoms of depression, distress, NE, cortisol, and increases of DHEA-S. Additionally, it was hypothesized that CBSM effects on stress hormones would be mediated by reductions in distress and depression symptoms. Finally, it was hypothesized that improvements in immune parameters would be correlated with decreases in risk of cervical dysplasia at a 9 month follow-up. Participants were 71 women co-infected with HIV and HPV that were mostly of African American, Haitian, Latina, and Caribbean descent. Hierarchical regression analyses were performed and showed a significant CBSM effect in decreases on BDI somatic depression subscale scores and increases in NK cell counts. Additionally, there was a marginally significant effect of CBSM on increases in CD4+ T-cells and decreases in urinary NE output. The bootstrapping method evidenced a mediation model, where the relationship between group assignment and CD4+ cell counts was explained by lower BDI somatic scores. More research is necessary to fully elucidate the psychobiological trajectories of disease as immunological changes in our sample did not explain the reduced odds of dysplasia in the women assigned to the CBSM group.

Breast cancer is a devastating disease that affects thousands of women every year influencing their psychological and physical well-being for many years after being diagnosed. The goal of the current study was to determine if there are distinct trajectories of functioning among breast cancer patients in the domains of negative psychological adjustment, positive psychological adjustment, and physical adjustment. This was accomplished using growth mixture modeling. Another goal of this study was to determine whether demographic, medical, and psychosocial variables were able to distinguish among the trajectories. The study combined women from two samples spanning 10 years providing a sample size of 376 women diagnosed and treated for breast cancer. These women were recruited to participate in a 10-week cognitive behavioral stress management intervention and were either randomized to the 10-week experimental condition or a one-day control group. It was hypothesized that distinct trajectories would emerge for each of the domains and that psychosocial variables (i.e., social support, benefit finding, and emotional approach coping) would distinguish among the trajectories. This study was able to statistically identify multiple classes or trajectories of adjustment, consistent with findings reported by Helgeson and colleagues (2004) and Donovan and colleagues (2007). It is difficult to say, however, whether these classes differ in clinically significant ways. The present study also provides a cautionary note to researchers who intend to use growth mixture modeling to identify different trajectories of functioning and the limitations associated with this statistical technique. First, it is important to start this process with strong empirical or theoretical support for the possibility of different classes or trajectories. Without this foundation it becomes difficult to justify why a certain number of classes were chosen. Another limitation of this statistical approach is that there is not a standard method for determining the best number of classes. There are conflicting opinions among researchers in the field about the best fit index to use when the multiple fit indices do not converge. A serious issue related to this is the fact that classes are used for interpreting results and drawing conclusions and inferences. Therefore, clinicians using GMM must be careful when deciding on the number of classes and the clinical inferences drawn from these analyses. Further research needs to be conducted validating these statistical techniques.

The concept of sickness behavior offers a framework to view both the neurovegetative and psychological symptoms that accompany illness as a common entity that results from increased inflammatory activation. Despite the prevalence of sickness behavior in medical populations, to our knowledge this study provides the first attempt to develop a standardized measure to assess sickness behavior using standard self-report questionnaires commonly used with cancer patients. The set of items included in the measure match theoretical conceptualizations of sickness behavior and target symptoms that comprise anhedonia, depressed mood, cognitive dysfunction, social disinterest, fatigue, low libido, poor appetite, somnolence, sensitivity to pain, and malaise. The measure showed high internal consistency, adequate test-retest reliability, and good convergent validity with both psychological and biological correlates. A confirmatory factor analysis also determined that a two-factor, rather than a single-factor measurement model, encompassing a physical and a psychological sickness symptom dimension, accounted for sickness behavior. Future psychometric work is still needed to further validate this new practical assessment tool. Descriptive analyses revealed relatively low levels of sickness behavior symptoms in the sample as a whole with both physical and psychological sickness behavior symptoms exhibiting a significant linear decrease over time. As expected, both physical and psychological sickness behavior symptoms showed associations with two pro-inflammatory cytokine markers, IL6 and TNF-alpha and a neuroendocrine marker, cortisol. Longitudinal associations suggest that higher levels of the pro-inflammatory cytokine TNF-alpha may impact the progressive decline of physical sickness symptoms over time with symptoms taking longer to disappear. Because cortisol was associated with more rather than less physical sickness symptoms, results raise the question of whether the anti-inflammatory neuroendocrine activity may be dysregulated in breast cancer survivors. The mechanistic basis for these associations requires further examination. In this study it was also evaluated whether a cognitive behavioral stress management intervention and relaxation training intervention could reduce sickness symptoms over time. Breast cancer survivors were assessed at baseline and then randomly assigned to a 10-week cognitive behavioral stress management intervention (N = 70) or a 1-day control condition (N = 55). Psychosocial measures, urine, and blood were obtained from participants at 3 months, 6 months, and 12 months post-intervention to assess relevant behavioral, endocrine and immune variables. Relative to the control group, the experimental group showed marginally more prevalence of physical sickness behavior symptoms in the short term (post-intervention, 3-months; p = .08) and a steadier decline of symptoms in the long-term (15-month follow-up period). The adaptive nature of sickness behavior as a motivational strategy that helps restore homeostatic balance in the long run may be one possible interpretation of these results. Whether these intervention effects on sickness behavior were mediated by changes in pro-inflammatory cytokines or cortisol was examined but not supported by these data and needs to be further examined in future studies.

Denna studie är en fallstudie av Equmeniakyrkans kampanj Klimatfastan, där de under 40 dagar uppmanade medarbetare och medlemmar att se över sitt klimatavtryck och göra beteendeförändringar utifrån detta. Tidigare forskning visar att religiösa miljöaktioner skiljer sig från sekulära miljöaktioner gällande metoder, fokus och budskap. Studien ämnaratt undersöka hur Klimatfastan genomfördes, vilka effekter kampanjen hade påmedlemmars miljömedvetna beteende samt vilka svårigheter och framgångsfaktorer som kunde identifieras. För attkunna dra slutsatser utifrån ett bredare perspektiv, undersöktes den nationella organisationen och en lokal församling i Equmeniakyrkan. Materialet som användes för att besvara studiens frågeställningar bestod av tre intervjuer med Equmeniakyrkans personal, en enkät riktad till en lokal församling och ett internt dokument. Resultatet visar att Equmeniakyrkansanvändning av resurser förstärktes genom användning av vad Bomberg och Hague (2018) definierar som andliga resursergenom hela processen. Detta identifierades som en framgångsfaktor för kampanjen. En skillnad mellan den nationella organisationen och den lokala församlingen var möjligheten att förutse och hantera hinder för medlemmarnas deltagande i kampanjen. / This is acase study that examines the UnitingChurch in Sweden ́s (UCS) campaign “Klimatfastan” (Climate Fasting), during which members were encouraged to examine their carbon footprints and make lifestyle changes accordingly for40 days. Previous research shows that religious environmental groups differ from secular groups when it comes to methods, focus areas and messages. The aim of this study was to examine how the Climate Fastingwas implemented, which effects the campaign had on members’ pro-environmental behaviour,and which strengths and weaknesses the campaign had. To be able to draw conclusions based on a wider perspective, the campaign was examined through the lens of the national organisation and a local congregation. The material used to answer the study’s research questions consisted of three interviews with staff at UCS, a survey answered bymembers of a local congregation,and an internal document. The results show that UCS ́s use of resources was enhanced by the use of what Bomberg and Hague (2018) define asspiritual resourcesthroughout the campaign. This was identified as a strength. A difference between the national organisation and the local congregation was the ability to identify and counteract barriers for members’ participation in the campaign.

In the summer of 2007, a single neighbourhood in downtown Toronto contributed at least 13 percent of all residential grid???tie solar photovoltaic (PV) systems sold in the Canadian province of Ontario. On average, PV purchaser households produced 37 percent as much electricity as they consumed. This research investigates solar energy adoption in a community case study. Specifically, it investigates why some residents who sign up for a solar resource assessment through a community solar energy initiative (CSEI) decide to purchase, and others decide not to purchase in the short???term. Characteristics and perceptions of potential adopters are analyzed to better understand their motivations and barriers to adoption. Community energy projects became an official public policy goal in Ontario, with the passing of the Green Energy and Green Economy Act in 2009. Approximately 80 percent of Ontario???s anticipated generation capacity will need to be built, replaced or refurbished within 15 years. In this context, the Ontario Ministry of Energy, Ontario Power Authority, and Deloitte (one of Canada???s leading professional services firms), have partnered with a ???green benefit??? fund, the Community Power Fund, to help local community groups access resources to develop and establish renewable energy projects. Understanding solar energy adoption in a community context is therefore important to improve the effectiveness of such policies, including the disbursement of multi???million dollar grant funds. Differences between purchasers and non???purchasers in respect of adoption behaviour were found in this study to cluster around two general themes. The first theme concerns differences in compatibility of both the concept of solar energy systems, and their physical attributes, with characteristics of potential adopter households. Some compatibility issues are straightforward, e.g. availability of roof space with a southern orientation. Others are more complex, involving several interrelated perceptual and socio???demographic factors. For instance, while both purchasers and non???purchasers rated cost as a very important barrier, purchasers rated the motivation of solar energy systems to reduce climate change higher relative to the barrier of high financial costs than did non???purchasers. Purchasers were also more likely to possess a graduate degree, while non???purchasers were more likely to hold a professional degree. The second general theme relates to potential adopters??? trust and stake in the ability of the community???based initiative to reduce barriers in the adoption process. Since two types of solar energy systems are considered in the case study???PV and thermal (hot water)???differences are explored between each of three respondent groups: solar PV purchasers, solar hot water (SHW) purchasers, and non???purchasers. iv Surveys were used to gather data on adopter perceptions and characteristics. A participatory research design helped identify the research topic. Two main bodies of literature???community???based social marketing (CBSM) and diffusion of innovations theory???were drawn upon to conceptualize the adoption process and interpret the survey findings. These include five models of human behaviour that can be used to guide the design of CBSM campaigns. Diffusion theory was used as a basis for discussing ???perceived innovation attributes???. The study takes an integrated approach by considering both social and technical aspects of solar energy adoption, together with the issues of fuel substitution and household electricity demand.