This study examined whether cultural values and gender moderate the association between mother-adolescent communication about sex and adolescents’ sexual behavior/intention to engage in sex and condom use attitudes. One hundred and fifty Latino adolescents completed an anonymous survey that measured sexual health outcomes, mother-child communication, and cultural factors. In bivariate analyses, adolescents with a higher sense of familismo had a more positive attitude towards using condoms and more acculturated Latino adolescents were less likely to speak to their mothers about pre-coital or coital sexual topics. Females spoke more about sex with their mother, compared to males. Traditional gender roles moderated the relation between mother-adolescent communication about sex and condom use attitudes. Acculturation, familismo nor gender significantly moderated the relationship between communication about sex and sexual health outcomes. Further research should explore whether certain cultural factors influence parents to talk to their adolescent about specific topics related to sex.

The current study evaluated the development and acceptability of a social marketing campaign to improve emerging adults’ fruit and vegetable (FV) intake. A social marketing campaign was developed through focus groups with 24 college students. Materials were implemented in two dining locations at Virginia Commonwealth University. Sales of carrots, apples, and chips were collected in three phases: baseline, implementation of the campaign, and washout. In addition, surveys were collected from 303 diners across all phases and locations. Results indicated an increase in carrot sales, decrease in sales of chips sold with a meal, and mixed findings regarding sales of apples and chips sold alone. Intercept surveys indicated the marketing materials were perceived positively, and clearly understood. Statistical analysis of self-report measures revealed that perceptions of one’s health status and autonomy were associated with fruit and vegetable (FV) intake and overall nutrition knowledge. The implementation of a social marketing campaign to encourage FV intake appeared to influence sales of both healthy and non-healthy food items. It is vital for future campaigns and policies to highlight autonomy for health behavior decision-making.

Estimated rates of obesity are notably high in the United States and pose a significant public health concern. A number of deleterious physical and psychosocial conditions are associated with pediatric obesity and the cost of its treatment is considerable. Accordingly, the number of weight management treatments has increased to meet this growing public health challenge. Unfortunately, insufficient participation in weight management treatment, namely low adherence and high attrition, often impede the effectiveness of these programs. Although the barriers associated with inadequate adherence and elevated rates of attrition are documented, there is a dearth of research on the predictors of the low participation in pediatric weight management. To address this gap in the literature, the current study examined whether psychosocial (e.g., motivation, mindfulness, depression), biological (e.g., anthropometric, biochemical), and demographic variables predicted adherence and attrition. A series of backward elimination regressions were modeled to identify the biopsychosocial factors that best predicted adherence and attrition in a pediatric weight management program. The study utilized a sample of parent-adolescent dyads (N = 143) from the T.E.E.N.S. program, a multidisciplinary weight management treatment involving behavioral, nutrition, and exercise components for adolescents with obesity. Several demographic characteristics were associated with lower adherence. Parent basic psychological need fulfillment was also significantly associated with six-month attrition. This finding underscores the importance of the parents’ role in the successful completion of a pediatric weight management program. This study contributes to an increased understanding of the factors related to participation in weight management programs, and can inform the refinements of interventions, such as T.E.E.N.S. and related programs.

This cross-sectional study examined if heterosexist experiences (harassment/rejection, workplace/school discrimination, other) were associated with suicidality (suicidal ideation, suicide attempts) and symptoms of anxiety/depression, and if symptoms of anxiety/depression were associated with suicidality in a national sample of sexual minority men (SMM; N = 89). The study also examined if depression mediated the relationship between heterosexist events and suicidal ideation and whether active and disengaged coping styles moderated this relationship. All associations were significant and positive, with harassment/rejection and symptoms of depression generally independently associated with outcome variables. Symptoms of depression were a significant mediator of the harassment/rejection-suicidal ideation relationship; however, neither disengaged nor active coping moderated the mediation. Clinical research could focus on reducing symptoms of depression associated with heterosexist events in order to influence suicidal ideation in SMM. Other implications are discussed.

This study served as an initial evaluation of integrated psychology services within a clinic designed to serve uninsured patients with complex medical concerns and high utilization histories at the Medical College of Virginia in Richmond, Virginia. The current study evaluates patient outcomes, and more specifically, it further quantifies and describes the role that psychologists play in the primary care setting and their impact on utilization of medical care and in improved health outcomes. Additionally, the study evaluates psychologists’ success at treating mental and behavioral health conditions within the primary care model. The present study demonstrates that patients with complex medical and mental health needs can be effectively managed and treated in an integrated ambulatory care clinic. Care within this clinic resulted in significant improvements in depression, anxiety, HbA1c, cholesterol, and blood pressure. The findings suggested possible improvements in behavioral health outcomes such as insomnia as well, but more structured follow-up data are needed in future research to explore this relationship. Additionally it is possible that reductions in BMI may be significant if followed over a longer period of time. Utilization outcomes were more mixed, and contrary to the expectation that integrated services and improvements in health would be related to decreased utilization. Given the shift in health outcomes over the follow-up period, it is possible that early increases in utilization at the six-month mark, may shift to reductions in utilization and cost if the window of observation is expanded.

O objetivo deste estudo foi caracterizar os pacientes que foram encaminhados por profissionais do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) ao Ambulatório de Psicologia, localizado dentro do Serviço de Psicologia da instituição. Durante o período de 2013 a 2016 o Ambulatório de Psicologia recebeu o total de 189 pacientes, que passaram pelo atendimento de triagem psicológica para a avaliação da elegibilidade do caso, ou seja, se a demanda apresentada pelo paciente e os sintomas psicológicos estavam de acordo com os critérios de inclusão estabelecidos pelo Ambulatório. Dos 110 pacientes que foram aceitos no Ambulatório, 58 estavam de acordo com os critérios de inclusão desta pesquisa. Para a caracterização sóciodemográfica utilizou-se a Entrevista de Anamnese Padrão do Ambulatório de Psicologia. Para a avaliação dos aspectos psicológicos e comportamentais utilizou-se o Inventário de Ansiedade de Beck (BAI), o Inventário de Depressão de Beck (BDI), Inventário de Sintomas de Estresse para Adultos de Lipp (ISSL), Inventário de Habilidades Sociais (IHS) e para avaliar a qualidade de vida utilizou-se o World Health Organization Quality of Life (WHOQoL-Bref). As análises foram conduzidas no software Statistical Package for the Social Science 20.0 (SPSS 20.0), foram realizados testes para verificar a existência de associação entre as variáveis sociodemográficas e os resultados obtidos nos instrumentos. A caracterização sociodemográfica identificou que 81% dos pacientes são mulheres, 46,6% possuem de 18 a 58 anos, 58,6% são procedentes de Ribeirão Preto, 58% possuem companheiro, 39,7% possuem de 10 a 14 anos de estudo e 62,% trabalham. As principais fontes de encaminhamento foram da Psicologia (22%) e das especialidades voltadas ao cuidado da saúde da mulher (19%). Em relação ao desfecho do atendimento psicológico, 54% ocorreram devido à alta por falta ou desistência do paciente. Quanto aos aspectos psicológicos e comportamentais, 46,6% apresentaram sintomas de ansiedade moderado e grave e 55,2% sintomas de depressão moderado e grave 55,2% e 89,7% possuem estresse. Houve o predomínio de déficit nas habilidades sociais nos fatores avaliados no IHS e a autossatisfação com a qualidade de vida foi avaliada como ruim por 43% dos pacientes. Esta pesquisa obteve dados relevantes para a melhoria no funcionamento do Ambulatório de Psicologia do HCFMRP/USP e por se tratar de um centro de atendimento de grande porte, que forma profissionais especializados, torna-se importante a produção e divulgação de conhecimentos na área. / The purpose of this study was to characterize those who were referred by professionals from the Clinic Hospital of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP) to the Ambulatory of Psychology, located within the Psychology Department of the institution. During the period from 2013 to 2016, the Ambulatory of Psychology received a total of 189 patients, who underwent psychological screening to assess the eligibility of the case, in other words, whether the patient\'s demand and the psychological symptoms were in agreement with the inclusion criteria established by the Ambulatory. Out of the 110 patients who were admitted to the outpatient clinic, 58 were in agreement with the inclusion criteria of this study. For the sociodemographic characterization the Interview of Standard Anamnesis of the Ambulatory of Psychology was used. For the evaluation of the psychological and behavioral aspects the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Lipp´s Inventory of Stress Symptoms for Adults (ISSL), Social Skills Inventory (IHS) were used, and to evaluate the quality of life the World Health Organization of Life (WHOQoL-Bref) was used. The analyzes were conducted in the Statistical Package for Social Science 20.0 (SPSS 20.0) software, and tests were carried out to verify the existence of an association between sociodemographic variables and the results obtained in the instruments. The sociodemographic characterization identified that 81% of the patients are women, 46.6% are 18 to 58 years old, 58.6% are from Ribeirão Preto, 58% have a partner, 39.7% have 10 to 14 years of study and 62,% work. The main sources of referrals were from Psychology (22%) and specialties focused on women\'s healthcare (19%). Regarding to the outcome of psychological care, 54% occurred because of discharge due to lacks or patient\'s abandonment. Concerning the psychological and behavioral factors, 46.6% had symptoms of moderate and severe anxiety and 55.2% had moderate and severe depression symptoms, 55.2% and 89.7% had stress. There was an absolute predominance of deficit in social skills factors evaluated in the IHS, and self-satisfaction with quality of life was evaluated as \'poor\' by 43% of the patients. This research obtained relevant data for the improvement in the functioning of the Ambulatory of Psychology of HCFMRP/USP and because it is a large service center, which forms specialized professionals, it becomes important to produce and disseminate knowledge in the area.

Despite the current emphasis on person centred, holistic care in health, the concept of spirituality has been discussed very little in the field of speech and language therapy (SLT). The nursing spirituality literature has proliferated in the last twenty years but, by contrast, very few SLT studies exist which mention the spiritual needs of patients with communication problems and how they express them. Individuals experiencing severe, life-changing events, such as a stroke, may need to engage with and discuss their spiritual needs, in order to make sense of what has happened to them. The aim of this study was to discover what it is like to express spiritual issues when one has an acquired communication impairment (aphasia). I also wanted to discover what it is like to be a healthcare professional working with people with communication impairment expressing their spirituality. I used a phenomenological approach in order to interview eight people with aphasia about their spirituality. Participants with aphasia used a variety of strategies to express these ideas, which included employing non-verbal communication techniques, such as gesture, writing key words, intonation and artefacts. I also interviewed five members of the multidisciplinary stroke team (MDT) about what it is like to work holistically with people with aphasia. Each interview resulted in a participant story. People with aphasia talked about religious themes, such as visions and prayer, but also non-religious life meaning-makers, such as gardening and art. MDT members discussed themes such as spirituality as part of their remit and giving the patient time to communicate. The stories were then explored through the interpretive lens of some concepts propounded by Merleau-Ponty (2002), namely ambiguity, lived body, language and thought, and wonder. Frank’s illness narratives (chaos, restitution and quest) were also considered in order to analyse the participants’ stroke journey in relation to expressing spirituality. People with aphasia can and do discuss their spiritual concerns, particularly when they are entering a quest phase of their illness narrative. They employ many non-verbal mosaics in order to convey spiritual issues, and are helped by the listener employing a phenomenological attitude of openness and attentiveness. Healthcare professionals expressed their willingness to listen to their patients’ spiritual stories, in the interests of holistic practice. Being able to express spiritual needs can enhance wellbeing, help foster therapeutic rapport, and enable people to engage more fully in the rehabilitation process.

Smoking remains a leading cause of disability and mortality worldwide. Despite declining rates of smoking in developed countries, smoking prevalence remains high, and there is evidence that it has plateaued in recent years. Individuals with a comorbid psychiatric diagnosis represent a disproportionate percentage of those who continue to smoke and are particularly at-risk given they smoke at higher rates and consume more cigarettes compared to those with no diagnosis. Moreover, these individuals are often excluded from clinical trials of smoking cessation, making it difficult to generalize results of previous intervention studies. In the general literature of smoking cessation, smoking cessation self-efficacy, or one’s confidence in their ability to abstain from smoking, is a consistent predictor of positive abstinence outcomes. The overall purpose of this dissertation was to investigate smoking cessation self-efficacy as a predictor of abstinence outcomes in a population of treatment-seeking smokers with and without a history of psychiatric illness. To accomplish this, articles 1 and 2 investigated the psychometric properties of a multi-item measure of cessation self-efficacy. This entailed comparing the measure to other indices of smoking, and conducting a confirmatory factor analysis to ensure factor invariance and equivalence of the measure regardless of psychiatric status. We found a moderate correlation between our multi-item scale to a single-item measure of confidence to quit, as well as support for both the original two-factor model as well as a three-factor model, which explained 79.3% of the variance. Our results also supported the measure as being factor invariant across psychiatric diagnoses. Next, articles 3 and 4 investigated how this measure of cessation self-efficacy predicted several smoking outcomes (10-, 22- and 52-weeks following target-quit date), and whether this relationship was mediated by concurrent smoking and other interpersonal-indices of smoking cessation (nicotine withdrawal, negative affect). In article 3, we found support for a bidirectional and reciprocal relationship between smoking cessation self-efficacy and smoking status. While changes in concurrent behavior (smoking or abstinent) did impact subsequent evaluations of self-efficacy, the inverse was also true. Moreover, both concurrent smoking and cessation self-efficacy predicted outcomes at week 10. Article 4 built on this framework and investigated this relationship at 22- and 52-weeks post-target quit-date. Our results highlight the robust association between cessation self-efficacy and abstinence. Higher cessation self-efficacy was positively associated with better abstinence outcomes, even after controlling for concurrent smoking, withdrawal, and negative affect. Further, there was evidence that cessation self-efficacy partially mediated the impact of withdrawal and negative affect. In our fully adjusted model (adjusting for demographic characteristics, baseline smoking levels, withdrawal and negative affect), cessation self-efficacy along among the interpersonal-determinants predicted abstinence outcomes (Odds ratio = 1.078, 95% confidence interval (1.068 - 1.089). This was true for those with either a current, past, or no lifetime psychiatric diagnosis, and despite the finding that individuals in the lifetime (current or past diagnosis) category experienced overall lower self-efficacy. Overall, our results support the value of cessation self-efficacy as an important indicator of abstinence outcomes, and particularly highlight its potential utility for at-risk populations of comorbid psychiatric smokers.

Individuals with chronic illness often face the added burden of stigma associated with their chronic conditions. Stigma has been associated with fewer psychosocial resources of social support, self-esteem, and self-compassion, as well as less access and usage of mental and physical healthcare. However, it is unclear whether stigma experiences vary by age of the individuals with chronic illness. It was hypothesized that emerging adults would report more perceived stigma, fewer psychosocial resources and less access to medical treatments. It was additionally hypothesized that perceived stigma would mediate the association between age and outcomes. 197 participants completed an online survey using Survey Monkey. Results of multiple regression analysis testing for mediation did not support hypotheses. In fact, emerging adults reported easier access to treatments than older adults. Post-hoc analyses were conducted and revealed that among emerging adults – but not older adults – perceived stigma was significantly related to less access to medical treatments. Thus, age may moderate the impact of stigma of chronic illness on access to healthcare in individuals with chronic illness, rather than predict more or less stigma of chronic illness. This indicates that in spite of easier access to care for emerging adults, increased stigma might interfere with their seeking of that care. Future studies should examine the impact of stigma on emerging adults’ treatment access.

BACKGROUND: Suicide rates among veterans are disproportionately high compared to rates among the general population. Veterans may experience a number of negative emotions (e.g., anger, self-directed hostility, shame, guilt) during periods of postwar adjustment and reintegration into civilian life that may uniquely confer risk for suicide. Mechanisms of these associations, however, are less well studied. The purpose of the present study was to examine the relationship between negative emotions and suicide risk in veterans through the theoretical framework of the interpersonal theory of suicide. METHODS: A large sample of veterans (N = 541) completed measures assessing their negative emotions, perceived burdensomeness, thwarted belongingness, and suicide risk. RESULTS: Self-directed hostility and shame related indirectly to suicide risk through both perceived burdensomeness and thwarted belongingness. Thwarted belongingness accounted for the association between anger and suicide risk, whereas perceived burdensomeness accounted for the relationship between guilt and suicide risk. LIMITATIONS: This study had a cross-sectional design and relied solely on self-report measures. CONCLUSIONS: These findings provide evidence for the role of negative emotions in conferring risk for suicide in veterans. Clinical implications, limitations, and future research directions are discussed.