Pediatric asthma disproportionately affects racial/ethnic minority children and children living in low-income, urban areas. Many families living in low-income, urban areas experience a number of stressors that can place children/adolescents at risk for worse asthma outcomes. This study examined the impact of a cumulative risk model of stressors (e.g., ED visits, quick-relief medication use, lung function, asthma control, QOL) in urban children (7-12 years) with persistent asthma. This study further aimed to examine both the original cumulative risk model and an adolescent-specific cumulative risk model as predictors of asthma outcomes in a sample of 60 adolescents (13-17 years). Asthma-related caregiver support was examined as a potential buffer in the association between stress and asthma outcomes. Secondary data analyses were completed on sixty-one caregiver and child dyads (7-12 years old). Data were collected from a separate sample of 60 urban families of adolescents with asthma (13-17 years old). The two cohorts were also combined for analyses. The original cumulative risk model developed for the younger children (7-12 years) was a predictor of child QOL in the younger cohort, and QOL and asthma control in the adolescent cohort. However, this finding in the younger cohort (7-12 years) was not supported in pooled data analyses. The original cumulative risk model predicted QOL, asthma control, and quick-relief medication use in the combined cohort analyses (children 7-17 years). The adolescent-specific cumulative risk model was a significant predictor of adolescent QOL and asthma control. Asthma-related caregiver support was only a significant moderator of the association between cumulative risk and asthma control among adolescents. Child age did not moderate associations between cumulative risk and asthma outcomes in the combined cohort. Overall, findings suggest that the accumulation of stress can have a negative impact on asthma outcomes, especially for urban adolescents with asthma. Further research is needed to determine the most central sources of stress that urban school-aged children with asthma experience and to replicate findings for adolescent with asthma. The buffering role of asthma-related caregiver support in the association between cumulative stress and asthma outcomes needs to be examined further in children and adolescents with asthma.

Pediatric obesity is a major public health epidemic with serious physical and psychological consequences. Difficulty engaging families in treatment is a significant obstacle in addressing pediatric obesity, especially among underserved populations. Motivational interviewing (MI) is a collaborative, person-centered communication style that has been shown to reduce attrition, increase attendance, and improve patient treatment adherence; however, little is known about the process of MI and how it improves treatment engagement. This study examined clinician and parent language in a pre-treatment MI session that increased initial engagement in a parent- focused pediatric obesity intervention (N= 81). Results showed that increased parent change talk, and preparatory language in particular, was positively related to the likelihood of initial attendance at baseline. Additionally, certain types of MI consistent clinician strategies were positively associated with parent change talk. Complex positive reflections were correlated with preparatory language and overall change talk, suggesting this might be a particularly important MI skill. Findings have implications for better understanding the process of MI and mechanisms through which MI can improve treatment engagement.

A study of the available literature on Psychological WellQBeing and Positive Organisational Scholarship revealed that enormous potential existed for further research. This is a relatively new field with limited literature and research evidence available. It became very clear from the beginning that the relationships between these constructs could successfully be researched. It was therefore decided to embark on an academic research journey in order to contribute to the existing knowledge available on these constructs within the South African Private Healthcare Industry. This quantitative research was used to obtain more clarity about the relationships between the two constructs and to gather the responses from the research population. The research sample consisted of 152 nursing staff. Two questionnaires were integrated to develop the Nursing Psychological WellQBeing Questionnaire and consisted of i) PsyCap Questionnaire developed by Luthans, Youssef and Avolio2007, and ii) Psychological WellQBeing Questionnaire developed by Ryff 2000. A total of 152 nursing staff responded to an 87–item paperQbased questionnaire. Four research questions were formulated and covered the following: •The content, validity and portability of the measuring instruments; •The configuration of the various constructs; • Relationships between some of the variables . The content and the structure of the measuring instruments were assessed by means of Confirmatory Factor Analysis (CFA) and) Exploratory Factor Analyses (EFA). These assessments showed that the original measuring instruments are not portable to a culture which is different to the one where they were originally developed. The relationship between dimensions of Psychological WellQBeing and PsyCap sense of achievement and optimism is a significant finding. The significance of the findings of this study and the contribution that it makes to the existing theory is seen in the importance of the portability of measuring instruments. Recommendations in this regard have been made in Chapter 5. Various findings have also highlighted the relationships between Psychological WellQBeing and PsyCap. The importance of future research topics has been recommended.

Despite a rise in the number of studies looking at the relationship of psychosocial factors (coping style, personality type, and social support) on HIV/AIDS severity, there remains a lack of conclusive answers about the specific association between these factors. This study used a meta-analytic method of analysis to address these issues in the post anti-retroviral treatment modality world. A systematic search of major psychology and medical computerized databases led to 110 studies used in the meta-analysis. Social support was found to have the strongest relationship with HIV progression. Structural social support had greater protective effect on HIV progression than functional social support. A significant relationship between coping type and HIV severity was found, with a greater protective benefit seen in studies that utilized CD4 count as the outcome variable. Positive coping had a beneficial effect on HIV progression while passive and negative coping had a detrimental effect on disease progression. Among studies of personality, a weak relationship was found between personality type and HIV severity. In conclusion, the meta-analytical review found significant associations between psychosocial factors and HIV severity that could be used to refine individual treatment plans for people living with HIV/AIDS.

People with psoriasis are known to engage in high levels of unhealthy lifestyle behaviours which may lead to poorer psoriasis outcomes and increase the risk of cardiovascular disease (CVD). Thus, helping individuals with psoriasis understand the link between behaviours and health risks, that is health risk communication, and direct support for lifestyle behaviour change (LBC) are important aspects in optimal management of psoriasis, a long-term inflammatory skin condition. There are two aspects of the literature that remain unclear. First, whether adequate support is given to patients to enable them to understand the links between lifestyle behaviours and health outcomes is part of psoriasis patient management strategies. Second, whether there is agreement around effective health risk communication techniques. This programme of research aimed to examine these gaps in the literature using four related studies. The first study used content analysis to examine general and dermatology-specific healthcare professionals’ core training competencies for evidence of skills relating to LBC. An important finding was the lack of explicit skills relating to LBC and changing understanding of health risks. There was little or no reference to recognised LBC techniques that could be used to support and facilitate LBC with patients. The second study used observational techniques to examine messages about the links between behaviour and health outcomes and LBC signposting (such as leaflets or posters about healthy living) for patients with psoriasis in primary and secondary care patient waiting areas. There was little evidence of psoriasis-specific information about healthy living. Generic information (not specifically about psoriasis) was often of poor quality and was poorly displayed, and did not conform to evidence-based recommendations for effective LBC signposting. The third study combined observational and qualitative techniques to examine how healthcare professionals communicate information about CVD risk to patients and the role of LBC in reducing risk in the context of primary care risk assessments with people with psoriasis. A key finding was that interpretation of risk information was not always linked to specific advice about how to modify each risk factor. Discussion was mostly instructional rather than a shared collaborative discussion about behaviour change and risk reductionThe fourth study used experimental methods to examine the effects of message framing theory as a health risk communication strategy on reported behavioural intentions (BIs) in people with psoriasis. An important finding was that for messages about psoriasis symptom reduction, gain-framed (positively-framed) messages were more effective in increasing BIs for alcohol reduction. Conversely, for messages about CVD risk reduction, loss-framed (negatively-framed) messages were more effective for increasing BIs to reduce alcohol consumption. The body of work presented in this thesis demonstrated that much needs to be done to increase the skill sets of healthcare professionals in order to help people with psoriasis recognise the specific links between their own health behaviours and health outcomes. In addition specific recommendations have been suggested as a way of improving risk communication strategies, such as using theory-based personally-relevant health information for people with psoriasis.

In the health psychology literature there has been a proliferation of research linking forms of self-attention to psychological distress, especially to depression. The broad conclusion that self-attention is harmful, however, challenges the central premise of self-regulation theory - a theory detailing the role of self-attention as the engine of an adaptive regulating system that enables people to achieve their goals. In an attempt to reconcile these perspectives, I conducted two studies to distinguish the forms and states of self-attention that serve an adaptive self-regulation function from those that create a vulnerability to depression. Both studies included a pretest and a daily diary component. Participants were pretested on trait self-attention, trait negative affectivity (Study 1), depression (Study 2), and a goal inventory. Study 2 included a follow-up session where participants again completed the depression inventory. For the diary component, participants described and rated the most negative event they experienced during the rating period (twice daily for 2 weeks in Study 1; once daily for 4 weeks in Study 2). Diary self-report measures of self-attention included: level of rumination (Study 1), initial self-analysis (Study 2), and multi-day-protracted attention (Study 2). After the diaries were completed, participants' event descriptions were coded for goal-relevance and level of self-focused attention (SFA). Consistent with self-regulation theory, participants' goal-related events elicited stronger self-attentional responses (higher levels of SFA, rumination, initial self-analysis, and protracted attention) than did their goal-unrelated events. These within-person effects were not moderated by the pretest measures, nor did they predict levels of emotional distress. Thus, in daily life it appears to be typical and not harmful for people to respond to goal-setbacks by engaging in elevated levels of introspection, self-analysis, and even negative, symptom-focused rumination. With respect to individual differences, people higher in pretest rumination and in chronic daily rumination, initial self-analysis and protracted attention experienced higher levels of emotional distress. Chronic daily levels of initial self-analysis and rumination predicted emotional distress after controlling for pretest levels of distress. Thus, self-attention appears to create a vulnerability to depression only when people have chronic difficulty containing initial levels of self-analysis and rumination in response to negative events. / Arts, Faculty of / Psychology, Department of / Graduate

Cancer affects nearly 15 million Americans, and is the second leading cause of death in the U.S. Persons with cancer, including those in recovery, are at increased risk for mental health difficulties; 15% - 25% experience clinically significant depressive symptoms and approximately 12% meet criteria for an anxiety disorder. Poor mental health may be due to heightened levels of stress related to the illness experience, such as uncertainty about the course of disease or adapting to functional impairments (e.g., cleaning, walking) and illness symptoms (e.g., pain). Lack of predictability regarding symptoms and physical limitations may lead to negative mood states, such as fear, worry, or sadness. However, not all persons living with or recovering from cancer, experience psychological distress, perhaps due to individual-level factors, such as social support. An available network of persons (e.g., friends, family) who can provide emotional (e.g., empathy), instrumental (e.g., health advice), or tangible (e.g., assistance with chores) support may lower levels of perceived stress and, in turn, may reduce the likelihood of experiencing psychological distress. Based on this, we examined the linkage between social support and symptoms of psychopathology, and the mediating role of perceived stress. At the bivariate level, we hypothesized that social support would be negatively related to stress and symptoms of depression and anxiety, and that stress would be positively related to both depressive and anxiety symptoms. At the multivariate level, we hypothesized that stress would mediate the relations between social support and symptoms of anxiety and depression, such that higher levels of social support would be associated with lower levels of perceived stress and, in turn, to fewer symptoms of depression and anxiety. Our sample of persons living with, or in remission from, cancer (N = 236) was primarily White (91.5%; n = 216) and female (64.4%; n = 152). Participants completed self-report measures including the Modified Social Support Survey, Perceived Stress Scale, and Multidimensional Health Profile – Psychosocial Functioning. Bivariate correlations and multivariate analyses, per Hayes (2013), were conducted covarying age, sex, and ethnicity. In bivariate correlations, all variables were significantly related to one another in the hypothesized directions (p < .01). In serial mediation analyses, the total effect of social support on depressive symptoms was significant (t = -5.22, p < .001), and the direct effect was nonsignificant when stress was added to the model (t = -1.72, p = .09), indicating mediation. In the second model, stress also mediated the relation between social support and anxiety symptoms; the total effect was significant (t = -4.56, p < .001), and the direct effect was nonsignificant (t = -1.73, p = .09). Supporting hypotheses, our results suggest that to the extent one has available social support, illness-related stress may be lessened and, in turn, cancer-affected persons may experience fewer symptoms of depression and anxiety. Therapeutic interventions focused on enhancing one’s social support network (e.g., cancer support groups) or lowering perceived stress (e.g., Mindfulness Based Stress Reduction) may reduce experiences of psychological distress among persons living with, or in remission from, cancer.

Depression is regarded as the most common mental problem among young college adults and is associated with numerous health complications and increased mortality. Significant evidence supports a relationship between depression and physical health outcomes, including poorer general health and obesity. The purpose of this study is to examine potential mechanisms underlying this relationship. Specifically, we examined whether three health behaviors – physical activity (PA), fruit and vegetable consumption (FVC), and fast food consumption (FFC) mediated the relationship between depression and three physical health outcomes – self-rated general health, somatic complaints, and body mass index (BMI). A sample of college students (n=723) was recruited through the ETSU Sona system and completed self-report questionnaires via the REDCap survey platform. Linear regression analysis was conducted in order to determine the association between depression, health risk behaviors, and health outcomes. The effects of age, race, gender, income, and year in school were controlled to limit confounding. Depression was found to significantly predict general self-rated health (R2 = .18, F[7, 335] = 10.64, p < .000, β = -.06), BMI (R2 = .13, F[7, 337] = 7.12, p < .01, β = .14), and somatic symptoms (R2 = .40, F[7, 335] = 31.86, p < .000, β = .60). Depression also significantly predicted fast food consumption (R2 = .04, F[7, 336] = 2.04, p < .01, β = .07), although it did not significantly predict fruit and vegetable consumption (R2 = .06, F[7, 335] = 3.00, p = .579, β = -.07) or minutes of physical activity (R2 = .03, F[7, 307] = 1.30, p = .975, β = -.08). No significant predictive relationships were found between the health behaviors in our study (PA, FVC, and FFC) and selected health outcomes (self-rated health, somatic complaints, and BMI). Because the regression results were not significant supporting mediation, a mediation analysis was not performed. The study findings demonstrate that depression is a strong predictor of multiple measures of physical health as well as of fast food consumption. Future research should continue to examine the mechanisms by which depression affects physical health outcomes. Understanding the health determinants that link depressed mood to physical health outcomes will help determine specific public health interventions that can potentially prevent and better manage the prevalence of these coexisting health conditions among college adults.

A sample of 1,031 pregnant women from five prenatal practices participated in Tennessee Intervention for Pregnant Smokers (TIPS), an expanded 5A’s (Ask, Advise, Assess, Assist, Arrange) program. Stress, self-esteem, depressive symptoms, and disordered eating were hypothesized to differ among three groups: pregnant women who never smoked, pregnant women who smoked but quit prior to birth, and pregnant women who smoked and did not quit prior to birth. Smokers who quit were lower in stress and higher in self-esteem than those who did not quit. Non-smokers were lowest in stress and depression, and highest in self-esteem. These findings may lead to improved intervention programs and reduction of adverse health effects in children born to mothers who smoke.

No description available.