Indiana University-Purdue University Indianapolis (IUPUI) / Little research has explored the degree to which specific intervention components predict improved health outcomes for cancer patients and their family caregivers. The present study examined relations of intervention components (i.e., coping skills) to symptoms in a telephone symptom management (TSM) intervention delivered concurrently to symptomatic lung cancer patients and their family caregivers. Guided by Social Cognitive Theory (SCT) and cognitive behavioral therapy (CBT) frameworks, patient-caregiver dyads were taught coping skills including: a mindfulness exercise (i.e., noticing sounds and thoughts), pursed lips breathing, guided imagery, cognitive restructuring, and assertive communication. Symptom measures were administered at baseline and 2 and 6 weeks post-intervention. The measures assessed patient and caregiver depressive and anxiety symptoms as well as patient pain severity, distress related to breathlessness, and fatigue interference. Data were examined from patient-caregiver dyads enrolled in TSM (N = 51 dyads). Patients and caregivers were predominantly female (55% and 73%, respectively) and Caucasian (87%). The average patient was 63 years of age (SD = 8) and the average caregiver was 56 years of age (SD = 14). Seven autoregressive panel models tested relations of coping skills to symptoms. All models had at least adequate fit to the data (χ2 ps > 0.05, RMSEA values < 0.06). For patients, more assertive communication practice during the intervention was related to less pain severity, fatigue interference, and depressive and anxiety symptoms at 6 weeks post-intervention. Additionally, more guided imagery practice during the intervention was related to less fatigue interference and anxiety at 6 weeks post-intervention. In contrast, more cognitive restructuring practice during the intervention was related to more distress related to breathlessness and depressive and anxiety symptoms at 6 weeks post-intervention. Similarly, more practice of a mindfulness exercise during the intervention was related to more fatigue interference and anxiety at 6 weeks post-intervention. For caregivers, more guided imagery practice was related to more anxiety at 2 weeks post-intervention. All other pathways from coping skills to symptoms at 2 and 6 weeks post-intervention were non-significant for both patients and caregivers. Findings suggest intervention effectiveness may have been reduced by competing effects of certain coping skills. For lung cancer patients, future studies should consider focusing on assertive communication and guided imagery, as these two coping skills were most consistently associated with reduced symptoms. However, more studies are needed to better understand these findings and particular caution should be used when applying CBT-based interventions that have not been validated in lung cancer populations.

This dissertation contributes to research on social isolation in older adults aged 65 years and above through three essays that expand our understanding of the social determinants of health and identify the social and interpersonal factors that contribute to elderly wellbeing. This dissertation examines the significant factors contributing to the problem of social isolation, and how the availability of interest-based, low-cost engagement resources in the community can alleviate social isolation and foster healthy aging. Essay 1 is a systematic literature review with implications for future research that explores how technological skills and training based on user intention and availability of resources can alleviate social isolation. Essay 2 is a qualitative study that evaluates the effectiveness of a unique community-based senior exercise program in fostering social integration and in reducing social isolation. Essay 3 is a quantitative study that examines the magnitude and direction of the correlated relationships among the determinants of social inclusion and the impact of social and interpersonal processes on senior wellbeing. These three essays provide insight into the social isolation phenomenon that negatively impacts senior wellbeing and recommends solutions derived from a data driven examination of the problem that is especially applicable to economically disadvantaged senior communities. Moreover, this research provides community partners and gatekeepers a foundation for future research on the social isolation phenomenon and strategies for developing digital confidence and mobility program strategies that foster social inclusion and reduce social isolation for older adults.

O aumento da demanda interna por etanol de cana-de-açúcar e o crescente interesse de outros países em criar parcerias com o governo brasileiro voltadas à exportação do biocombustível, já evidenciam no Estado de São Paulo - responsável por cerca de 60% da produção de cana-de-açúcar no país - prováveis impactos relacionados com os aspectos sociais, ambientais e econômicos. Do ponto de vista do gerenciamento ambiental dessas questões, percebe-se que grande parte dos aspectos e impactos ambientais provenientes da produção de etanol de cana-de-açúcar está diretamente nas mãos da agroindústria canavieira, mas que o governo, enquanto ator representante do coletivo, tem papel fundamental na estratégia e aplicação de mecanismos ambientais para gestão da qualidade ambiental. Portanto, o trabalho se propôs a entender como o setor alcooleiro está respondendo, em forma de postura ambiental adotada, aos vários estímulos que o circundam, principalmente, aos estímulos impostos pelo poder governamental e dessa forma: às empresas, servir de orientação para um gerenciamento da produção objetivando tornar sustentável e sustentada sua cadeia produtiva; ao Estado, servir de apoio à (re)formulação de políticas públicas para o setor; e à sociedade civil, dispor subsídios que permitam uma melhor compreensão das questões ambientais do complexo setor alcooleiro permitindo uma consciência coletiva e ações daí coerentes. Através da aplicação de questionários estruturados com 15 grupos corporativos de usinas e entrevistas com os outros atores do processo produtivo do etanol (órgãos governamentais, especialistas, ONGs e associações de produtores) os principais resultados encontrados foram: os mecanismos de intervenção governamental têm influência direta e positiva na postura ambiental tomada pela agroindústria canavieira, sendo um dos principais fatores motivadores para uma postura ambiental responsável do setor; as empresas respondem de forma diferente, em forma de adoção de postura ambiental, para os diferentes instrumentos governamentais utilizados, ou seja, alguns instrumentos têm melhores respostas que outros para o setor; novos instrumentos de intervenção governamental, principalmente instrumentos econômicos, poderiam auxiliar, de forma mais eficiente, a mudança de postura ambiental da agroindústria alcooleira do Brasil. / Increased domestic demand for sugarcane ethanol and the growing interest of other countries to build partnerships with the brazilian government\'s export-oriented biofuel, show in the State of Sao Paulo - responsible for 60% of the sugarcane production in the country - likely impacts related to social, environmental and economic. From the standpoint of environmental management of these issues, we can see that most of the environmental aspects and impacts from the sugarcane ethanol production are directly in the hands of industrial sugarcane, but the government, as representative of the collective players plays a fundamental role in the strategy and implementation mechanisms for environmental management of environmental quality. Therefore, the research was to understand how the alcohol industry is responding, in the form of environmental attitude adopted, to various stimulus that surround it, mainly to stimulus imposed by government policies and thus: for companies, serve as guidelines for managing a production chain aiming to become sustainable and sustainable production chain, the state used to support the (re) formulation of public policies for the sector, and civil society, provide subsidies to enable a better understanding of complex environmental issues of the ethanol production industry allowing a collective consciousness actions to be taken. Through structured questionnaires with 15 corporate owners of production plants and interviews with other players in the ethanol production chain (government agencies, experts, NGOs and producer organizations) and the main results were: the mechanisms of government intervention have a direct and positive environmental attitude taken by the sugarcane agro-industry, one of the main motivating factors for a responsible environmental attitude of the sector; firms respond differently to the different government instruments, meaning that some instruments provide better answers to attitude of the sector; new instruments of government intervention, especially economic instruments could help in more efficient ways, the change of the brazilian ethanol agribusiness towards a better environmental attitude.

O aumento da demanda interna por etanol de cana-de-açúcar e o crescente interesse de outros países em criar parcerias com o governo brasileiro voltadas à exportação do biocombustível, já evidenciam no Estado de São Paulo - responsável por cerca de 60% da produção de cana-de-açúcar no país - prováveis impactos relacionados com os aspectos sociais, ambientais e econômicos. Do ponto de vista do gerenciamento ambiental dessas questões, percebe-se que grande parte dos aspectos e impactos ambientais provenientes da produção de etanol de cana-de-açúcar está diretamente nas mãos da agroindústria canavieira, mas que o governo, enquanto ator representante do coletivo, tem papel fundamental na estratégia e aplicação de mecanismos ambientais para gestão da qualidade ambiental. Portanto, o trabalho se propôs a entender como o setor alcooleiro está respondendo, em forma de postura ambiental adotada, aos vários estímulos que o circundam, principalmente, aos estímulos impostos pelo poder governamental e dessa forma: às empresas, servir de orientação para um gerenciamento da produção objetivando tornar sustentável e sustentada sua cadeia produtiva; ao Estado, servir de apoio à (re)formulação de políticas públicas para o setor; e à sociedade civil, dispor subsídios que permitam uma melhor compreensão das questões ambientais do complexo setor alcooleiro permitindo uma consciência coletiva e ações daí coerentes. Através da aplicação de questionários estruturados com 15 grupos corporativos de usinas e entrevistas com os outros atores do processo produtivo do etanol (órgãos governamentais, especialistas, ONGs e associações de produtores) os principais resultados encontrados foram: os mecanismos de intervenção governamental têm influência direta e positiva na postura ambiental tomada pela agroindústria canavieira, sendo um dos principais fatores motivadores para uma postura ambiental responsável do setor; as empresas respondem de forma diferente, em forma de adoção de postura ambiental, para os diferentes instrumentos governamentais utilizados, ou seja, alguns instrumentos têm melhores respostas que outros para o setor; novos instrumentos de intervenção governamental, principalmente instrumentos econômicos, poderiam auxiliar, de forma mais eficiente, a mudança de postura ambiental da agroindústria alcooleira do Brasil. / Increased domestic demand for sugarcane ethanol and the growing interest of other countries to build partnerships with the brazilian government\'s export-oriented biofuel, show in the State of Sao Paulo - responsible for 60% of the sugarcane production in the country - likely impacts related to social, environmental and economic. From the standpoint of environmental management of these issues, we can see that most of the environmental aspects and impacts from the sugarcane ethanol production are directly in the hands of industrial sugarcane, but the government, as representative of the collective players plays a fundamental role in the strategy and implementation mechanisms for environmental management of environmental quality. Therefore, the research was to understand how the alcohol industry is responding, in the form of environmental attitude adopted, to various stimulus that surround it, mainly to stimulus imposed by government policies and thus: for companies, serve as guidelines for managing a production chain aiming to become sustainable and sustainable production chain, the state used to support the (re) formulation of public policies for the sector, and civil society, provide subsidies to enable a better understanding of complex environmental issues of the ethanol production industry allowing a collective consciousness actions to be taken. Through structured questionnaires with 15 corporate owners of production plants and interviews with other players in the ethanol production chain (government agencies, experts, NGOs and producer organizations) and the main results were: the mechanisms of government intervention have a direct and positive environmental attitude taken by the sugarcane agro-industry, one of the main motivating factors for a responsible environmental attitude of the sector; firms respond differently to the different government instruments, meaning that some instruments provide better answers to attitude of the sector; new instruments of government intervention, especially economic instruments could help in more efficient ways, the change of the brazilian ethanol agribusiness towards a better environmental attitude.