Feeling of Parental Caring Predict Health Status in Midlife: A 35-Year Follow-up of the Harvard Mastery of Stress Study

In the early 1950s, multiple-choice scores reflecting feelings of warmth and closeness with parents were obtained from a sample of healthy, undergraduate Harvard men who participated in the Harvard Mastery of Stress Study. Thirty-five years later, detailed medical and psychological histories and medical records were obtained. Ninety-one percent of participants who did not perceive themselves to have had a warm relationship with their mothers (assessed during college) had diagnosed diseases in midlife (including coronary artery disease, hypertension, duodenal ulcer, and alcoholism), as compared to 45% of participants who perceived themselves to have had a warm relationship with their mothers. A similar association between perceived warmth and closeness and future illness was obtained for fathers. Since parents are usually the most meaningful source of social support in early life, the perception of parental love and caring may have important effects on biological and psychological health and illness throughout life.     

Illness centrality and well-being among male and female early adolescents with diabetes

OBJECTIVE: We examined the implications of illness centrality for psychological and physical health among male and female early adolescents with type 1 diabetes. METHODS: We interviewed 132 adolescents before or after a routine clinic appointment. We measured the extent to which they defined themselves in terms of their illness, their views of the illness, psychological well-being, self-care behavior, and metabolic control. RESULTS: Females scored higher on illness centrality than males. Illness centrality was related to poor psychological well-being when the illness was perceived in negative terms, but only for females. For males, illness centrality was unrelated to psychological well-being. Illness centrality was related to poor metabolic control. CONCLUSIONS: The extent to which adolescent females define themselves in terms of their illness is most problematic when the illness is perceived in highly negative terms. Future research should examine how illness centrality and views of illness change over the course of adolescence.     

Health behaviors among unaffected participants following receipt of variants of uncertain significance in cardiomyopathy-associated genes

PurposeStudies on returning variants of uncertain significance (VUS) results have predominantly included patients with a personal or family history of cancer and cancer-associated gene VUS. This study examined health behaviors among participants with cardiomyopathy-associated gene VUS, but without a personal history of cardiomyopathy.MethodsSixty-eight eligible participants without apparent cardiomyopathy but with VUS in cardiomyopathy-associated genes completed a survey of health behaviors, disclosure, distress, uncertainty, positive experiences, decisional conflict, and perceived value. The medical records of participants who reported cardiac testing because of their VUS were reviewed for testing indication(s).ResultsTwo participants had cardiac testing due to their VUS alone. Four had cardiac testing because of their VUS and other clinical indications. Twelve changed health behaviors, including one participant who was subsequently diagnosed with cardiomyopathy. Distress, uncertainty, and decisional conflict were low (means = 1.2, 4.2, and 24.5 (scale ranges = 0–30, 0–45, and 15–75), respectively), and positive experiences and perceived value were moderate (means = 12.4 and 14.4 (scale ranges = 0–20 and 4–20), respectively). Greater perceived value was associated with greater likelihood to engage in health behaviors (P = 0.04).ConclusionPositive VUS results can be returned to apparently unaffected individuals with modest use of healthcare resources, minimal behavioral changes, and favorable psychological reactions.     

Effects of narrative persuasion in promoting influenza vaccination in Hong Kong: A randomized controlled trial

ObjectivesThe study examined the effectiveness of narrative persuasion in promoting influenza vaccination in Hong Kong.MethodsThe study conducted a randomized controlled trial with a sample of 440 Hong Kong adults who were either at high risk or had a high-risk family member. The participants were randomly assigned to watch a narrative video, an informational video, or no message, and were assessed for perceived threats, perceived efficacy, and vaccination intent, and were followed up three months later for actual vaccination.ResultsExperimental conditions produced significant differences on perceived threats of influenza but not on perceived efficacy, vaccination intent, and actual vaccination. When compared to informational messages delivered containing equivalent amount of information, narrative messages were more persuasive in promoting perceptions about influenza, equally effective in enhancing vaccination intention and actual behaviors, and equally ineffective in changing efficacy beliefs. The persuasiveness of narratives in promoting threat perceptions was found to work better for individuals with lower literacy levels.ConclusionsIncorporating authentic sociocultural beliefs and experiences in message design can effectively enhance threats perceptions related to influenza.Practice implications: Narratives presented in short-video stories could be an effective tool for promoting health threats especially among high-risk individuals with limited health literacy.     

Death or illness of a family member,violence, interpersonal conflict,and financial difficulties as predictors of sickness absence: longitudinal cohort study on psychological and behavioral links

OBJECTIVE: Although an association between stressful life events and health problems has been demonstrated, the underlying mechanisms have remained unclear. We examined whether psychological problems and health-risk behaviors underpin the health effects of different event categories. METHOD: The initially healthy participants were 2991 (796 men, 2195 women) municipal employees who had taken no sick leave in 1995. In 1997, they completed a questionnaire requesting information on recent life events and psychological and behavioral factors. The outcome was recorded sickness absences in 1998. RESULTS: In men, the death or serious illness of a family member, violence, and financial difficulties increased the risk of later sickness absence. According to structural equation modeling, violence and financial difficulties also induced psychological problems such as anxiety, mental distress, and lowered sense of coherence. Psychological problems were associated with heightened cigarette and alcohol consumption, which in turn increased sickness absence. A corresponding structural model did not fit the data in relation to death or serious illness of a family member. In women, life events were associated with psychological problems and smoking but not sickness absence. CONCLUSIONS: Longitudinal evidence suggests that increased psychological problems and behaviors involving risk to health partially mediate the effect of stressful life events on health, as indicated by sickness absence. This model received support among men and for the event categories of violence and financial difficulties. Women were less affected by stressful life events than men.     

Digital Inequalities of Family Life Information Seeking and Family Well-Being Among Chinese Adults in Hong Kong: A Population Survey

Background

Inequalities in Internet use and health information seeking are well documented, but less is known about information for family life activities.

Objective

We investigated the social determinants of online family life information seeking behaviors and its associations with family well-being among Chinese adults in Hong Kong.

Methods

A probability-based telephone survey was conducted in 2012 to record family life information seeking behaviors, including frequency of seeking and paying attention to family life information, levels of trust, and perceived usefulness of family life information. Family well-being was assessed using 3 single items on perceived family harmony, happiness, and health, with higher scores indicating greater well-being. Adjusted odds ratios for family life information seeking behaviors by socioeconomic characteristics and lifestyle behaviors, and adjusted beta coefficients for family well-being by family life information seeking behaviors were calculated.

Results

Of 1537 respondents, 57.57% (855/1537) had ever and 26.45% (407/1537) sought monthly family life information through the Internet. Lower educational attainment and household income, smoking, and physical inactivity were associated with less frequent seeking and paying attention (all P<.05). Greater perceived family health was associated with more frequent attention (adjusted β=.32, 95% CI.11-.52), greater levels of trust (adjusted β=.28, 95% CI .07-.48), and perceived usefulness (adjusted β=.23, 95% CI .01-.45) of family life information. Frequent attention and higher level of trust were also associated with greater family harmony (adjusted β=.22, 95% CI .002-.41) and happiness (adjusted β=.23, 95% CI .003-.42), respectively.

Conclusions

This is the first study investigating family life information seeking behaviors and suggested inequalities of online family life information seeking behaviors. The association between family life information seeking behavior and family well-being needs to be confirmed in prospective studies.     

Components of family history associated with women's disease perceptions for cancer: A report from the Family Healthware™ Impact Trial

PurposeTo determine the specific components of family history and personal characteristics related to disease perceptions about breast, colon, and ovarian cancers.MethodsBaseline, cross-sectional data on 2,505 healthy women aged 35–65 years enrolled from 41 primary care practices in the cluster-randomized Family Healthware™ Impact Trial, assessed for detailed family history and perceived risk, perceived severity, worry, and perceived control over getting six common diseases including breast, colon, and ovarian cancers.ResultsParticipants provided family history information on 41,841 total relatives. We found evidence of underreporting of paternal family history and lower perceived breast cancer risk with cancer in the paternal versus maternal lineage. We observed cancer-specific perceived risks and worry for individual family history elements and also found novel “spillover” effects where a family history of one cancer was associated with altered disease perceptions of another. Having a mother with early-onset breast or ovarian cancer was strongly associated with perceived risk of breast cancer. Age, parenthood, and affected lineage were associated with disease perceptions and ran counter to empiric risks.ConclusionsUnderstanding patients' formulation of risk for multiple diseases is important for public health initiatives that seek to inform risk appraisal, influence disease perceptions, or match preventive interventions to existing risk perceptions.     

Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus

BACKGROUND. Physical activity is recommended by physicians to patients with non-insulin-dependent diabetes mellitus (NIDDM), because it increases sensitivity to insulin. Whether physical activity is effective in preventing this disease is not known. METHODS. We used questionnaires to examine patterns of physical activity and other personal characteristics in relation to the subsequent development of NIDDM in 5990 male alumni of the University of Pennsylvania. The disease developed in a total of 202 men during 98,524 man-years of follow-up from 1962 to 1976. RESULTS. Leisure-time physical activity, expressed in kilocalories expended per week in walking, stair climbing, and sports, was inversely related to the development of NIDDM. The incidence rates declined as energy expenditure increased from less than 500 kcal to 3500 kcal. For each 500-kcal increment in energy expenditure, the age-adjusted risk of NIDDM was reduced by 6 percent (relative risk, 0.94; 95 percent confidence interval, 0.90 to 0.98). This association remained the same when the data were adjusted for obesity, hypertension, and a parental history of diabetes. The association was weaker when we considered weight gain between the time of college attendance and 1962 (relative risk, 0.95; 95 percent confidence interval, 0.90 to 1.00). The protective effect of physical activity was strongest in persons at highest risk for NIDDM, defined as those with a high body-mass index, a history of hypertension, or a parental history of diabetes. These factors, in addition to weight gain since college, were also independent predictors of the disease. CONCLUSIONS. Increased physical activity is effective in preventing NIDDM, and the protective benefit is especially pronounced in persons at the highest risk for the disease.     

Parent-reported suicidal behavior and correlates among adolescents in China

BACKGROUND: Suicidal risk begins to increase during adolescence and is associated with multiple biological, psychological, social, and cultural factors. This study examined the prevalence and psychosocial factors of parent-reported suicidal behavior in Chinese adolescents. METHODS: A community sample of 1920 adolescents in China participated in an epidemiological study. Parents completed a structured questionnaire including child suicidal behavior, illness history, mental health problems, family history, parenting, and family environment. Multiple logistic regression was used for data analysis. RESULTS: Overall, 2.4% of the sample talked about suicide in the previous 6 months, 3.2% had deliberately hurt themselves or attempted suicide, and 5.1% had either suicidal talk or self-harm. The rate of suicidal behavior increased as adolescents aged. Multivariate logistic regression indicated that the following factors were significantly associated with elevated risk for suicidal behavior: depressive/anxious symptoms, poor maternal health, family conflict, and physical punishment of parental discipline style. LIMITATIONS: Suicidal behavior was reported by parents. No causal relationships could be made based on cross-sectional data. CONCLUSIONS: The prevalence rate of parent-reported suicidal behavior is markedly lower than self-reported rate in previous research. Depressive/anxious symptoms and multiple family environmental factors are associated with suicidal behavior in Chinese adolescents.     

Correlates of psychosocial well-being among overweight adolescents: the role of the family

An ethnically diverse sample of at-risk-for-overweight and overweight youths (body mass index greater than the 85th percentile for age and gender; n = 667 male participants, and n = 684 female participants) completed a school-based survey measuring family variables (connectedness, mealtime environment, and weight commentary), psychosocial well-being (depressed mood, body satisfaction, and self-esteem), and unhealthy weight-control behaviors; all measures were assessed concurrently. Hierarchical linear regression analyses revealed that measures of general family connectedness, priority of family meals, and positive mealtime environment were significantly positively associated with psychological well-being and inversely associated with depressive symptoms and unhealthy weight-control behaviors. Familial weight commentary (i.e., weight-based teasing and parental encouragement to diet) was associated with many indicators of poor psychological health. The authors conclude that greater psychosocial well-being and fewer unhealthy weight-control behaviors are associated with making family time at meals a priority, creating a positive mealtime atmosphere, and refraining from weight commentary.     

Knowledge,attitudes, and beliefs related to hypertension and hyperlipidemia self-management among African-American men living in the southeastern United States

ObjectivePerceptions of illness affect cardiovascular disease (CVD) self-management. This study explores knowledge, attitudes, and beliefs regarding hypertension and hyperlipidemia management among 34 African-American men with hypertension and/or hyperlipidemia, age 40–65, living in the Southeastern United States.MethodsIn-person focus groups were conducted using semi-structured interview questions informed by the Health Belief Model (HBM).ResultsParticipants had a high level of knowledge about hypertension self-management, but less about cholesterol self-management. Perceived severity of both conditions was acknowledged, though participants perceived hypertension as more severe. Barriers to self-management included medication side effects and unhealthy dietary patterns. Facilitators included social support, positive healthcare experiences, and the value placed on family. Cultural implications highlighted the importance of food in daily life and social settings. Participants expressed how notions of masculinity affected self-management—noting the impact of feelings of vulnerability and perceived lack of control stemming from diagnosis and treatment expectations.ConclusionsThe findings highlight gaps in knowledge of hyperlipidemia versus hypertension, and the impact of cultural context and perceptions on engagement in self-management behaviors.Practice implicationsPublic health practitioners and healthcare providers serving African-American men should address cultural factors and notions of masculinity which can hinder effective disease management among this population.     

Impact of Parental Health Problems on Children: Concepts, Methods, and Unanswered Questions

Described conceptual and methodological issues that arise inthe design and analysis of data from studies of the impact ofparental health problems on children. Researchers should considerhow the functional effects, duration, and type of exposure ofparental health problems affect children's psychological experience.Multiple pathways (e.g., parental modeling, family socializationpractices, and genetic factors) that affect the transmissionof psychological and/or health risk to children need to be considered.Important methodological issues in this area of research includesample selection and bias, confounding factors, and limitedassessment of family influences. Future work should identifyfactors that enhance child and family resilience to the effectsof parental health problems. Studies are also needed to developand test interventions to reduce the psychological morbidityassociated with parental health problems.     

Investigating Self-Reported Health Behaviors in Australian Adults with Mental Illness

To investigate self-reported health behaviors among Australian adults with mental illness, 1,935 Australian adults completed an online survey including the Kessler Psychological Distress Scale and instruments assessing health behaviors in October 2011. Participants with moderate or higher psychological distress reported significantly lower weekly physical activity levels ( p = .024), daily fruit ( p = .001) and vegetable ( p < .001) intakes, and greater regularity of consuming six or more drinks on one occasion ( p = .002) and of smoking within 30 minutes of waking ( p = .001), Participants with very high psychological distress had significantly increased odds ratios for insufficient weekly physical activity (2.38, 95% CI 1.42–4.00), insufficient daily fruit and vegetable intake (1.72, 95% CI 1.03–2.88), and smoking (2.27, 95% CI 1.12–4.60). Australian adults with current mental illness demonstrate significantly poorer health behaviors than those without mental illness.     

Parental History of Hypertension and Myocardial Infarction Predicts Cardiovascular Responses to Behavioral Stressors in Middle-aged Men and Women

The present study had two objectives: to examine the influence of parental history of hypertension on cardiovascular responses during behavioral stress in middle-aged men and women; and to study the impact of parental history of myocardial infarction on stress responses. Participants were separated into four groups: no parental history of cardiovascular disease; parental history of hypertension only; parental history of myocardial infarction only; or parental history of both hypertension and myocardial infarction. Heart rate and blood pressure were monitored at rest and during serial subtraction, mirror image tracing, and isometric handgrip. Analyses of residualized difference scores showed that like younger, male offspring of hypertensives, middle-aged men and women with a parental history of hypertension exhibited exaggerated diastolic blood pressure responses during all stressors. Men with a parental history of myocardial infarction, with or without a parental history of hypertension, exhibited exaggerated systolic blood pressure responses during all stressors. These data are the first to show that family history of hypertension influences middle-aged men's and women's stress responses, and that family history of myocardial infarction influences men's stress responses. Results suggest the importance of parental history of cardiovascular diseases in understanding acute psychophysiological responses of middle-aged adults.     

Illness perceptions, illness-related problems, subjective health and the role of perceived primal threat: preliminary findings

Many theories suggest that a threatening situation impacts health because it affects core needs. Our assumption was that a set of interdependent ;perceived primal threats' to basic human needs (self-preservation, social integration, personal identity and growth, and positive worldview), which result from the presence of a disease, are related to illness perceptions and subjective health. Participants were 121 chronic medical patients. According to the results, perceived primal threat was strongly associated with illness-related perceptions and problems, as well as perceived psychological and overall self-rated health. Also, perceived primal threat mediated the relationship between illness-related factors and subjective health measures.     

Brief report: illness uncertainty and dispositional self-focus in adolescents and young adults with childhood-onset asthma

OBJECTIVE: To investigate differences in self-focused attention between college students with childhood-onset asthma and a group of healthy controls and to determine whether self-focused attention mediates the relationship between illness uncertainty and psychological distress among individuals with asthma. METHODS: Forty-two adolescent and young adult participants with childhood-onset asthma and 40 age- and gender-matched healthy participants completed measures of self-focused attention, perceived illness uncertainty, psychological distress, and health status. RESULTS: Adolescents and young adults with childhood-onset asthma evidenced an increased tendency to engage in private self-focus compared to age- and gender-matched peers without a chronic illness history. Self-focused attention also mediated the relationship between perceived illness uncertainty and psychological distress among those with asthma. CONCLUSIONS: The need for self-monitoring in asthma management may result in an increased propensity to self-focus, which may result in heightened levels of psychological distress.     

Vulnerability to Stress among Women with in Utero Diethylstilbestrol (DES) Exposed Daughters

Abstract

In utero exposure to diethylstilbestrol (DES) was initially linked to vaginal-cervical cancer and subsequently to reproductive difficulties. These unanticipated and ongoing health risks to female offspring may constitute a chronic source of stress for DES mothers. We interviewed 60 mothers of exposed daughters and 30 acquaintance controls. Two hypotheses were tested in regard to DES mothers: (1) DES discovery and its aftermath have a direct, long-term, negative effect on psychological health and (2) the DES experience intensifies the negative psychological effects of other adverse life circumstances. To operationalize psychological health, we measured symptoms of ?demoralization” and positive health practices—the latter as a behavioral indicator of mastery and personal control. We also measured adversities that may mediate the threat posed by DES, including stressful events, medical problems, and chronic burdens. We found DES history to be associated with poorer psychological health only when mothers encountered other losses and threats to themselves and their families. We concluded that DES mothers may manifest increased vulnerability to subsequent stresses in their lives.     

Family history and perceptions about risk and prevention for chronic diseases in primary care: A report from the Family Healthware™ Impact Trial

PurposeTo determine whether family medical history as a risk factor for six common diseases is related to patients' perceptions of risk, worry, and control over getting these diseases.MethodsWe used data from the cluster-randomized, controlled Family Healthware™ Impact Trial (FHITr). At baseline, healthy primary care patients reported their perceptions about coronary heart disease, stroke, diabetes, and breast, ovarian, and colon cancers. Immediately afterward, intervention group participants used Family Healthware™ to record family medical history; this web-based tool stratified familial disease risks. Multivariate and multilevel regression analyses measured the association between familial risk and patient perceptions for each disease, controlling for personal health and demographics.ResultsFor the 2330 participants who used Family Healthware™ immediately after providing baseline data, perceived risk and worry for each disease were strongly associated with family history risk, adjusting for personal risk factors. The magnitude of the effect of family history on perceived risk ranged from 0.35 standard deviation for ovarian cancer to 1.12 standard deviations for colon cancer. Family history was not related to perceived control over developing diseases. Risk perceptions seemed optimistically biased, with 48–79% of participants with increased familial risk for diseases reporting that they were at average risk or below.ConclusionsParticipants' ratings of their risk for developing common diseases, before feedback on familial risk, parallels but is often lower than their calculated risk based on family history. Having a family history of a disease increases its salience and does not change one's perceived ability to prevent the disease.     

Effects of parental history of hypertension and urbanization on blood pressure in zimbabweans

The increasing prevalence of essential hypertension is a growing public health concern for Zimbabwe and other African countries. Two important risk factors for hypertension are urbanization and parental history of hypertension. The relations among parental history of hypertension, urbanization, and blood pressures (BPs) are poorly understood. The objective of this study is to clarify these relations in a population of urbanized. African, young adults. The relation between parental history of hypertension and urbanization on resting BPs and BP responses to a menial arithmetic stressor was examined in a group of normotensive, Black medical students with (n = 36) and without (n = 34) a parental history of high BP.and with (n = 49) and without (n = 19) a parental history of urbanization. Results indicate that those with a positive parental history of high BP had higher resting BPs and greater systolic blood pressure (SBP) increases in response to laboratory stress, when compared to their negative parental history counterparts. Further, those with parents residing in urban areas had higher resting SBPs than those with parents residing in rural areas. However, no reactivity differences were apparent between the urban and rural parent groups. These data suggest that although parental history for hypertension influences both resting and reactivity BPs, parental history of urbanization may influence only resting BP. This study was supported by NIH/Fogarty International Center Grants 5T37TW3041-02, N1H-HL35195. and NIH-HL32738.     

How Is the Suicide Ideation in the Korean Armed Forces Affected by Mental Illness,Traumatic Events,and Social Support?

BackgroundSuicide is one of the leading causes of death in the military as in the general population. To mitigate such a serious public health problem, identifying the risk or protective factors of suicide behaviors is crucial.MethodsWe analyzed the representative data of the 2014 Korean Armed Forces to explore the relationship between past year adverse events (PAE), accumulated lifetime trauma (ALT), mental illness vulnerability, perceived social support, and suicidal ideation in the previous year.ResultsAmong the 6,377 subjects, 3.7% of males and 6.2% of females reported suicidal ideation in the previous year. Multivariate analytic models identified significant associations of PAE and ALT with suicidal ideation with a dose-response pattern. The mental illness vulnerability showed the most significant association with suicidal ideation even after controlling PAE or ALT. We found that perceived social support may be potentially linked with a reduced risk of suicidal ideation.ConclusionThis Korean military representative data demonstrates mental illness vulnerability; PAE; and lifetime trauma as significant risk factors of suicidal ideation, while perceived social support was found as a potential protective factor. Given the importance of the prevention of suicide in the military, those risk and protective factors may be used to screen soldiers at risk of suicide and provide further support on mental health services as needed.