Smoking cessation in adolescents: the role of nicotine dependence, stress, and coping methods

OBJECTIVES: To compare perceived reasons for continued smoking and withdrawal symptoms between current smokers and quitters in an inner-city adolescent population. To examine the relationship of nicotine dependence, stress, and coping methods between smokers and quitters and, using the Transtheoretical Model of Change, among adjacent smoking cessation stages. DESIGN: A cross-sectional study using a self-administered questionnaire. PARTICIPANTS: The study comprised 354 clinic patients between the ages of 12 and 21 years who reported past or present smoking. MAIN OUTCOME MEASURES: Demographic characteristics, smoking status, perceived reasons for continued smoking, attempts to quit, and withdrawal symptoms, as well as standardized scales assessing nicotine dependence, stress, and coping methods. RESULTS: The overall prevalence of smoking in this population was 26%. Smokers were significantly more likely to report smoking more cigarettes per day as well as higher levels of physical addiction (P<.01), greater levels of perceived stress (P<.02), and less use of cognitive coping methods (P<.02) than quitters (P<.005). However, comparison of consecutive stages revealed a significant difference only between precontemplation and contemplation in cognitive coping methods (P<.01). Three of 20 withdrawal symptoms (cravings, difficulty dealing with stress, and anger) were reported more frequently among current smokers who had attempted to quit in the last 6 months than among former smokers (P<.01). CONCLUSION: Interventions for inner-city adolescents who smoke should be designed to target those with the highest levels of nicotine dependence, stress, and decreased use of cognitive coping methods because they are the least likely to quit on their own, rather than developing stage-specific models.     

A qualitative study exploring parental accounts of feeding pre‐school children in two low‐income populations in the UK

Good nutrition in the early years of life is essential, yet the diets of many pre‐school children in the UK are known to be poor. Understanding the decisions parents make when feeding young children is very important in determining what type and nature of interventional support may be developed to promote good nutrition. The aim of this study was to explore using qualitative methods, parental perceptions of feeding their children in order to inform the development of a nutrition intervention. Focus groups (n = 33) and individual interviews (n = 6) were undertaken with parents, most of whom were attending children's centres in two deprived populations from one urban (Islington, north London) and one rural (Cornwall) location in England. Accounts of feeding pre‐school children were primarily concerned with dealing with the practicalities of modern life, in particular the cost of food and the need to manage on a restricted household budget. Time pressures, a lack of perceived knowledge and confidence in preparing food and managing conflict over food choices between family members were also strong themes. Parents commonly reported differences between how they would like to feed their children and the reality of what they were able to do in their circumstances. These findings suggest that the poor eating habits of many pre‐school children may be less a case of parental ignorance but rather the product of a range of coping strategies. Designing an intervention, which helps parents to build their confidence and self‐efficacy, may enable them to make positive changes to their children's diets.     

Parent Stress Levels During Children’s Hospital Recovery After Congenital Heart Surgery

The hospitalization of a child for cardiac surgery is known to be a stressful experience for parents. However, little is known about the time course or the relationships between parental stress and the child’s actual or perceived recovery. This research aimed to investigate pre- and postoperative parental stress and to examine some of the influencing factors during the postoperative period for children undergoing elective cardiac surgery. Parents of 211 children completed questionnaires and structured interviews preoperatively and on postoperative days 3, 5, 8, and 15. The stress of the parents remained moderate to high throughout their children’s hospitalization regardless of the severity of illness. Parents’ perceptions of their children’s level of illness correlated with an objective measure of postoperative morbidity. There were few differences between mothers’ and fathers’ stress or their perceptions of their children’s illness. Parents in more deprived communities and mothers born outside the UK had higher stress levels. These findings indicate the negative impact of children’s surgery and intensive care hospitalization on parents. Better identification of parents at risk for high stress and specific interventions to improve parental support and coping are needed.     

Influence of parental stress and social support on the behavioral adjustment of children with transposition of the great arteries

The joint role of parent stress and social support in the emotional adjustment of children was examined prospectively in a group of children with d-transposition of the great arteries (d-TGA). Questionnaires on parent perceptions of stress and social support were administered when children were 1 and 4 years of age (n = 143-153). Parent ratings of child behavior problems were collected at 4 years (n = 152). The findings indicate a favorable outcome for parents and children with congenital heart disease (CHD). Compared with normative samples, parents experienced less stress and more social support, and they rated children as showing fewer behavior problems. Parents with more stress at both ages reported more behavior problems. Families with less social support reported more stress at both 1 and 4 years. Social support, however, did not moderate the relationship between stress and child behavior problems. Early detection of distressed families may assist in alleviating stress and reducing behavior problems.     

'Learn Young, Learn Fair', a stress management program for fifth and sixth graders: longitudinal results from an experimental study

Background:  This study examined the effects of a universal stress management program (Learn Young, Learn Fair) on stress, coping, anxiety and depression in fifth and sixth grade children.
Methods:  Fifty-two schools (1467 children) participated in a clustered randomized controlled trial. Data was collected in the fall of 2002, the spring of 2003, and the winter of 2004. Given the nested structure of the design mixed (multilevel) regression analyses were applied.
Results:  Positive effects were found for emotion-focused coping at posttest ( p  < .01) and increased stress awareness at both time points. At posttest a decrease in problem solving was found ( p  < .01). After correcting for mediation by stress awareness the results showed that the program significantly reduced stress symptoms ( p  = .05) and anxiety ( p =  .01) at posttest. Effect sizes varied from small to large.
Conclusions:  Universal prevention programs that address stress and coping in children are warranted given the high prevalence of stress in children and the relationship between stress, on the one hand, and health complaints and pathology, on the other. Such programs are expected to be particularly salient for children with an increased sensitivity to stress and inadequate coping styles (e.g., diathesis-stress model). The results indicate that the school-based program 'Learn Young, Learn Fair' may be a valuable program for reducing stress in children.     

Influence of caregiver stress and coping on glycemic control of young children with diabetes.

INTRODUCTION: The purpose of this research was to examine the influence of caregiver stress, perceived stress and coping on home management and glycemic control of young children with type 1 diabetes. METHOD: A correlational design of 73 conveniently sampled caregivers of children younger than 9 years of age receiving routine care in an urban hospital diabetes clinic completed the Problem Areas in Diabetes Survey, the Appraisal of Diabetes Scale, the Coping Health Inventory for Parents, and the Diabetes Self-Management Profile. Data were analyzed using Pearson product-moment correlation. RESULTS: Higher caregiver stress was associated with lower Hgb A(1c) levels. Higher levels of home management were associated with lower Hgb A(1c). No significant relationship was noted between caregiver coping and home management. DISCUSSION: Caregivers managing their child's type 1 diabetes rated themselves as having stress, and those able to maintain their child's glycemic control indicated higher levels of perceived stress. It is essential that practitioners assess caregiver stress regardless of the child's apparent glycemic control.     

Children of divorce: recent findings regarding long-term effects and recent studies of joint and sole custody

The 10-year study revealed that the effects of divorce on children are often long lasting. Children are especially affected because divorce occurs within their formative years. What they see and experience during the failing marriage becomes a part of their view of themselves and of society. Although the findings from the study are, in some respects, dismaying, what emerges clearly is that a successfully reestablished family or a successful remarriage can improve the quality of life for both adults and children. The divorce may resolve the family conflict and allow the children to preserve a relationship with both parents. Divorce may also be useful in putting some distance between a child and a disturbed parent. Under these conditions, children may show accelerated maturity and independence. They may also bring to young adulthood a morality that places high value on sustaining relationships and on love, fidelity, and compassion. The results of the longitudinal study, as well as those of the two joint custody studies, indicate that ongoing conflict between divorced parents has especially detrimental effects on the children and that children are particularly at risk when they have frequent and continuing access to both parents who are hostile and uncooperative with each other. Mandated joint custody and frequent visitation in these situations may not be advisable. On the other hand, among children in chronically disturbed and disputing families, there is a wide range of individual coping responses and degrees of resilience. In the final analysis, individual temperaments should be considered and a careful evaluation made of how each child is coping in his or her own particular family environment.     

Coping and attention: implications for child health and pediatric conditions.

Child health and illness are best conceptualized in terms of the interaction of biological, psychological, and social processes. Among the central factors in biopsychosocial models of health and illness are processes of coping and attention in response to stress. As a guide to research on biopsychosocial processes in child health and illness, a dual-process model of responses to stress is described, distinguishing between stress responses that are involuntary/automatic and those responses that are voluntary/controlled. Research on coping with stress is briefly reviewed, along with research on attentional processes in response to stress. The relationships between coping and attention are highlighted, along with the implications of this research for understanding children's health and illness. Throughout the article, examples are drawn from research on pediatric recurrent abdominal pain to illustrate important aspects of coping and attention.     

Effective interviewing and counseling of the adolescent patient

A vast number of successful recommendations are available to physicians who want to learn how to strengthen their interactions with adolescent patients. Understanding that the physician-patient relationship is dynamic is the first step toward building a strong repertoire within this patient sample. Therefore, physicians may assume that adolescent perceptions of the physician-patient relationship and the services provided will change as they change developmentally or as the situation is modified. Finding a balance between family and patient concerns while gaining increased experience with skills less-practiced (eg, communication about sensitive topics) will improve adolescent perceptions of your expertise, knowledge, and abilities. Finally, following up on changes across time in adolescents' concerns, perceptions, abilities, and the physician-patient relationship itself, will help to ensure continued satisfaction and service use by adolescents and their families.     

Children's responses to daily social stressors: relations with parenting, children's effortful control, and adjustment

Background:  We examined children's coping and involuntary stress responses as mediators of the relations between parenting or children's effortful control (EC) and adjustment.
Method:  Two hundred and forty primarily Mexican American 7- to 12-year-old children reported on their EC, coping, involuntary stress responses, and problem behaviors. Teachers reported on children's academic competence. Parents reported on their reactions to children's negative emotions and on children's EC, problem behaviors, and academic competence.
Results:  There were significant zero-order relations between parents' affective responses to children's negative emotions, children's EC, engagement coping, disengagement coping, involuntary stress responses, and adjustment. Consistent evidence emerged that children's engagement coping and involuntary stress-responses mediate the relations between parenting or EC and adjustment.
Conclusions:  Results highlight the utility of assessing stress responses in a multidimensional manner and have implications for intervention programs.     

The influence of emotional neglect on development

Emotional neglect represents dysfunction of the protective parental relationship on which children depend while they learn the skills needed for safe independence. It affects key developmental foundations, including perceptions of self, which should be acquired through the mirror of attuned parenting, and can have lifelong consequences for stress regulation. In distorting children’s preconceptions of relationships, it has implications for everything that should be learnt through and modelled by others. It influences the development of skills needed to function effectively both independently and through relationships.     

Helping adolescents cope with stress during stressful times

Increasing levels of stress in the daily lives of adolescents is an important health concern. Adolescents experience a variety of stressful situations and use a wide range of coping strategies to help effectively manage stress. Recent research on adolescent coping with stressful situations is reviewed. Findings support an association between coping and adolescent health problems, chronic physical illness, and mental health. More research is needed to investigate the long-term benefits of coping with stress on adolescent health and well-being. Specific recommendations for helping adolescents cope with stressful situations are discussed. Health care providers are encouraged to assess how adolescents cope with acute and chronic stressors and provide adolescents with information about coping with stressful situations.     

The psychological impact of genital anomalies on the parents of affected children

BACKGROUND: There is scarce information on how parents cope with children with genital anomalies. Participants & methods: Twenty-six parents of 25 children with a median age of 0.5 years (r, 5 days-10.8 years) were recruited through the Scottish Genital Anomaly Network and had a quantitative assessment of parenting stress and coping patterns; a qualitative assessment by a semi-structured interview was also performed in19 parents. RESULTS: In five parents, the total stress score was above the 85th centile, denoting clinical levels of stress. Three parents showed reduced coping pattern scores for social support, self-esteem and psychological stability and three showed a reduction in utilization of communication with medical professionals. The scores did not correlate with each other or the extent of genital anomaly in the child. Semi-structured interview analysis revealed parents' need for more knowledge about the imminent surgery, post-operative care and their desire for written information that could complement the time-restricted contact with the clinical team. CONCLUSION: In the majority of cases, parents did not display abnormal levels of stress or coping on quantitative assessment. The semi-structured interview provided further information about the parents' level of coping and potential for stress and highlighted the need for more effective exchange of clinical information at a critical period of the parent-child relationship.     

Using knowledge to cope with stress in the NICU: how parents integrate learning to read the physiologic and behavioral cues of the infant

Parental stress in the NICU has at least a short-term impact on the establishment of the parent-child relationship and potential repercussions on long-term child development outcomes. One way to help parents mitigate stress is to help them learn what they need to know about their infant's condition and care. In this article, we examine how learning to read the infant's physiologic and behavioral cues helps parents cope with stress. We view parental learning as a process in which parents target specific domains of information for learning according to the temporal relevance of the domain to their concerns. It is important that we recognize the fluidity of the process and anticipate what parents need to learn at different times during hospitalization. The NICU staff assumes a crucial role in reducing parental stress by delivering information that is relevant to the parents' needs and by helping parents understand this information.     

Mothers' perceptions of anxiety of their diabetic children

Within the theoretical framework of family dynamics, the anxiety levels expressed by 20 diabetic children, the level of anxiety ascribed to them by their mothers, and the anxiety levels of 20 healthy children were studied. The diabetic children did not form an emotionally deviant group in terms of their expressed anxiety, although their mothers viewed them as significantly more anxious than they judged themselves. The mothers' own anxiety was the best predictor of their perceptions of their children's anxiety. The results are discussed in terms of their effects on communication and coping in the families.     

Children with chronic illness. The prevention of dysfunction

Children with long-term illnesses are at risk of developing problems in psychological adjustment and in functioning in activities of daily life. Their families face increased risks of marital and economic dysfunction, and siblings too face special tasks living with a chronically ill child. A variety of interventions can help children and families to cope effectively with the tasks of chronic illness. Pediatricians should be alert to effects on the family. Children respond to family stress in very predictable ways. Inasmuch as the stress of chronic illness may affect the marital relationship, there is a likelihood of concurrent behavioral and school problems. Relatively sudden changes in behavior may signal family issues that require professional attention. Drotar et al. maintain that professionals should serve as guides or advocates for children with chronic illness and their families. The relationship that develops between families and professionals is based on trust. They believe that "trust appears to evolve from the following principles: (1) continuity of relationship, (2) active participation by professional caregivers, (3) mutual participation of child and family, (4) advocacy, (5) a focus on coping and competence, (6) a developmental perspective, and (7) a family-centered focus." Cadman et al. identified a similar set of elements that characterizes an efficacious preventive intervention approach. In addition, they propose specific programmatic efforts that are associated with less morbidity. These include ongoing education and counseling for the child, family, and community regarding chronic illness and its management, use of stress management techniques to promote mastery and reduce the impact of stressful life events, and facilitation of social support mechanisms for families with chronically ill children. We have added consideration of the child's performance in school.     

Ruling out the need for antibiotics: are we sending the right message?

OBJECTIVES: To examine the relationships among physician-parent communication practices, physicians' perceptions of parental expectations for antibiotic treatment, and inappropriate antibiotic prescribing for viral upper respiratory tract infections. DESIGN: Cross-sectional study of pediatric encounters motivated by cold symptoms between October 1, 2000, and June 30, 2001. Each encounter was videotaped. Physicians completed a postvisit survey that measured whether they perceived the parent as expecting antibiotics. Coded communication variables were merged with survey variables. Multivariate analyses identified key predictors of parent-physician communication practices, physician perceptions of parents' expectations for antibiotics, and inappropriate antibiotic prescribing for viral conditions. SETTING: Twenty-seven pediatric practices in Los Angeles, Calif. PARTICIPANTS: Thirty-eight pediatricians and 522 consecutively approached parents of children with cold symptoms. MAIN OUTCOME MEASURES: Physicians' perceptions of parental expectations for antibiotics, inappropriate antibiotic prescribing, and parental questioning of nonantibiotic treatments. RESULTS: Physicians were 20.2% more likely to perceive parents as expecting antibiotics when they questioned the physician's treatment plan (P = .004; 95% confidence interval, 6.3%-34.0%). When physicians perceived parents as expecting antibiotics, they were 31.7% more likely to inappropriately prescribe them (P<.001; 95% confidence interval, 16.0%-47.3%). Parents were 24.0% more likely to question the treatment plan when the physician ruled out the need for antibiotics (P = .004; 95% confidence interval, 7.7%-40.3%). CONCLUSIONS: Parental questioning of the treatment plan increases physicians' perceptions that antibiotics are expected and thus increases inappropriate antibiotic prescribing. Treatment plans that focus on what can be done to make a child feel better, rather than on what is not needed, ie, antibiotics, may decrease inappropriate antibiotic prescribing.     

Children's Methods of Coping with Stress: A Twin Study of Genetic and Environmental Influences

The relative importance of environmental and hereditary factors in how children cope with stress was examined. Emotion-focused, problem-focused, and additional coping variables were assessed in 44 monozygotic (MZ) and 30 dizygotic (DZ) twin pairs, aged 9–16 years. The effects of heritability, shared environment, and unshared environment were examined in structural modelling analyses. Genetic factors accounted for a majority of the reliable variance in four of seven coping variables, while effects of twins' shared environment were negligible for all but one coping variable. Environmental factors important to individual differences in coping strategies were primarily unique to each child (unshared between the twins), highlighting the importance of individual experiences in shaping coping behaviors.     

A prospective study of the role of coping and family functioning in health outcomes for adolescents with sickle cell disease

Risk-and-resistance models identify factors that predict psychosocial adjustment to pediatric chronic illness, including sickle cell disease (SCD), but have not been applied to understand health outcomes. The study objectives were to examine prospectively the relationship of coping and family functioning with health outcomes for adolescents with SCD, accounting for sociodemographic and psychosocial risk. Forty-one adolescents and their families (41 primary caregivers, 9 second caregivers, and 15 healthy siblings) completed paper-and-pencil measures of coping and family functioning at a baseline assessment (time 1). At both time 1 and time 2 (1 y later), disease severity, SCD complications, healthcare utilization, and average hemoglobin level were derived from medical file reviews. Time 1 disease-related parenting stress predicted time 2 health outcomes; however, there were no significant associations for coping. Families concordant in reporting lower family functioning had teens with increased disease severity and greater healthcare utilization. Examination of moderation of disease-related parenting stress by a risk index showed main effects for risk and for disease-related parenting stress for time 2 disease severity and time 2 healthcare utilization. Interaction effects were not significant. Efforts to explore specific mechanisms by which adaptive family functioning contributes to health outcomes for adolescents with SCD should continue, with particular attention to addressing the potential role of multiple sociodemographic and psychosocial risk variables.