Association Between Cannabis Use and Sexual Risk Behavior Among Young Heterosexual Adults

To study the association between cannabis use and frequent sexual risk behavior, we tested the hypothesis of a situational influence of cannabis use in sexual encounters using a combination of global association study and event-level analysis and examined possible mediator variables, including the personality trait of hedonism/risk preference, psychosocial stress, and HIV-related beliefs, using mediation models. The results of a computer-assisted telephone interview of a random sample of 2790 heterosexual men and women aged 16–24 years showed that risky sexual behavior was more frequent in cannabis-using men and women than in non-using persons. The results did not support a situational effect of cannabis intoxication on sexual risk behavior. The more frequent sexual risk behavior among cannabis users was mediated by decreased intentions to use HIV protection, by lower HIV-self-efficacy, and higher risk preference/hedonism. Only among women psychosocial stress was a partial mediator. The findings show that HIV prevention programs for cannabis-using young adults should emphasize the role of person variables instead of situation variables.     

The Theory of Planned Behavior and Safer Sex Behaviors of Gay Men

Determinants of performance of 11 safer sex behaviors were examined within the framework of the theory of planned behavior in a sample of gay men. The theory of planned behavior proposes that intentions and perceived control over behavior contribute to the prediction of behavioral performance. It also theorizes that perceived control, attitudes, and subjective norm predict intentions. Results indicated that control did not contribute significantly to the prediction of any of a range of safer sex behaviors in the sample of gay men, over and above the predictive power of intentions. Control measures were, however, predictive of some safer sex intentions, together with attitudes and subjective norms. Moreover, AIDS-preventive behavioral skills (e.g., how effectively one believed he could enact the behavior), as opposed to difficulty of performing safer sex behaviors (e.g., the ease or difficulty of enacting the behavior), proved to be the control component that was most strongly related to intention. Discussion focuses on the relevance of the findings for safer sex interventions with gay men and for the theory of planned behavior.     

Differences and similarities of physical activity determinants between older adults who have and have not experienced a fall: Testing an extended health belief model

PurposeExperiencing a fall can be a detrimental experience for older adults and may affect an individual’s beliefs about participating in future physical activity (PA) behavior. The purpose of this study was to identify if determinants of PA differ between older adults who have a history of a fall (HF) and those with no history of a fall (NHF) within the Health Belief Model (HBM), expanded through the constructs of intention and habit.Materials and MethodsParticipants (N = 667) were community-dwelling older adults who completed online measures of original HBM determinants (beliefs, barriers, self-efficacy, cues, and perceived threat variables) related to participating in PA in addition to past PA behavior and intention.ResultsNovel findings include perceived barriers significantly predicted intention to participate in PA among those with a HF but not among those with NHF, and past PA behavior predicted decreased perceived threat of falling among both groups. The model also supported cues to predict physical activity habit.ConclusionsPerceived barriers (time constraints and bodily pain) deterred PA intentions among those with a HF, suggesting the importance of intervention planning to reduce/resolve these barriers for this group. Past PA was negatively associated with perceived threat of falling, which signposts the importance of providing a safe environment for older adults to engage in PA. The study also provides formative notes for interpreting and further investigating perceived threat and its antecedents (susceptibility and seriousness) in addition to cues, which generally have been omitted in previous studies that employ the HBM.     

Ethnic differences in stressors, resources, and psychological outcomes of family caregiving: a meta-analysis

PURPOSE: We investigated ethnic differences in caregiver background variables, objective stressors, filial obligations beliefs, psychological and social resources, coping processes, and psychological and physical health. DESIGN AND METHODS: We used a meta-analysis to integrate the results of 116 empirical studies. RESULTS: Ethnic minority caregivers had a lower socioeconomic status, were younger, were less likely to be a spouse, and more likely to receive informal support. They provided more care than White caregivers and had stronger filial obligations beliefs than White caregivers. Asian-American caregivers, but not African-American and Hispanic caregivers, used less formal support than non-Hispanic White caregivers. Whereas African-American caregivers had lower levels of caregiver burden and depression than White caregivers, we found that Hispanic and Asian-American caregivers were more depressed than their White non-Hispanic peers. However, all groups of ethnic minority caregivers reported worse physical health than Whites. Observed ethnic differences in burden and depression were influenced by study characteristics, such as the type of illness of the care recipient and the representativeness of the sample. IMPLICATIONS: The results suggest that more specific theories are needed to explain differential effects of ethnic minority groups of caregivers. Intervention needs vary, in part, between ethnic groups of caregivers.     

Psychosocial Antecedents of Unprotected Sex by Drug-Using Men and Women

Using the AIDS risk reduction model as a conceptual framework, we conducted a multivariate prospective test of psychosocial antecedents of unprotected sex by 155 female and 134 male heterosexual injection drug users. For both women and men, stronger intentions to use condoms predicted subsequent reductions in unprotected sex. For women, but not men, higher perceived self-efficacy also led to reductions in unprotected sex. These results suggest that explicit formation of risk-reduction intentions is an important antecedent to sexual behavior change by drug users of either gender and that change by drug-using women is also influenced by their perceived control over sexual risk-taking.     

农村老年人照料者的社会文化理念

目的探讨农村地区老年人照料者的社会文化理念特征,比较配偶与子女照料者的社会文化理念。方法采用照料文化理由量表对199位60岁以上老人的长期照料者进行评估,包括79位配偶照料者和99位子女照料者。结果配偶与子女照料老人的社会文化理念包括义务与榜样作用、家庭责任与互惠、宗教与精神信仰三个维度,配偶和子女照料者在照料老人过程中所持有的社会文化理念无显著差异。回归分析表明,受教育程度与义务与榜样作用因子评分密切相关。结论我国农村地区家庭在老人照料中配偶与子女秉承相似的社会文化理念,受教育程度与义务与榜样作用的文化理念有关。     

Is training for informal caregivers and their older persons helpful? A systematic review

BackgroundThe steady increase in the number of people suffering from chronic diseases and increasing life expectancy raises new demands on health care. At the same time, the need for informal caregivers is increasing. This study aims to perform a systematic review of the methodologies used to identify effect of different types of training on informal caregivers and their older persons.MethodsMEDLINE (PubMed), CINAHL and Ovid were searched from December 2016 and April 2017. The following keywords were used; "informal caregiver", "training" "elderly", older persons". Identified publications were screened by using the following inclusion criteria; systematic reviews, randomized controlled trials, prospective cohort and multicentre studies, English language full text journals, samples or interventions that included caregivers of older persons and published in last 10 years.ResultsTwenty four studies (12 randomised control trials, 8 intervention studies and 4 systematic reviews) were included. Most of the randomized controlled trials involved both caregivers and elderly. Pretests and post-tests were used in intervention studies (5 out of the 8 studies). ICT-based, psychosocial interventions on family caregivers' education program for caregivers were applied. Caregivers following a supportive educative learning had a significantly better quality of life.ConclusionsThe findings of this systematic review suggest that support interventions for caregivers can be effective in reducing caregivers' stress, with a consequent improvement of the quality of care. However, results are based on relatively small studies, reporting somewhat controversial findings supporting the need to perform further research in this field.     

Can culture help explain the physical health effects of caregiving over time among African American caregivers?

OBJECTIVES: The purposes of this study were to longitudinally examine the health outcomes of 107 African American caregivers who provided care to their elderly dependent family members and to determine the role of culture in predicting health outcomes. METHODS: With use of the stress and coping model of Pearlin and colleagues (1990) as a guide, the direct effects of background characteristics and stressors and the direct and mediating effects of resources (including culture) on two caregiver health outcomes (i.e., psychosocial health and physical functioning) were analyzed with hierarchical multiple regression analyses. RESULTS: Similar to other studies, we found that combinations of caregiver background characteristics, stressors, and resources at wave 1 had direct effects on African American caregivers' health outcomes at wave 3. Unlike previous studies, where culture was not measured, we found that cultural beliefs and values did help to explain health outcomes for African American caregivers. Specifically, culture justifications for caregiving, baseline psychosocial health, and caregiving mastery predicted wave 3 psychosocial health. Caregiver education, number of morbidities, and physical functioning at wave 1 were associated with physical functioning at wave 3. DISCUSSION: The findings from this study have implications for future studies, particularly in regard to cultural beliefs and values among African American caregivers.     

Is the theory of planned behavior a useful framework for understanding exercise adherence during phase II cardiac rehabilitation?

PURPOSE: This study evaluated the theory of planned behavior (TPB) as a framework for understanding exercise adherence during phase II cardiac rehabilitation (CR). METHODS: A total of 215 patients completed a baseline questionnaire that included the TPB constructs and past exercise. Exercise adherence was measured via program attendance during phase II CR. RESULTS: Hierarchic regression analyses indicated that attitude, subjective norm, and perceived behavioral control (PBC) explained 30% of the variance in exercise intention, with attitude, subjective norm, and PBC each making significant unique contributions to intention. Furthermore, exercise intention explained 12% of the variance in exercise adherence. Finally, the behavioral, normative, and control beliefs provided novel information concerning why patients in phase II CR hold certain attitudes, subjective norms, PBC, and exercise intentions. CONCLUSION: Results of the present study provide evidence that the TPB is a useful framework for understanding exercise intentions and adherence during phase II CR.     

Condom use intentions mediate the relationships between psychosocial constructs and HIV sexual risk behavior in young Black men who have sex with men

HIV prevention interventions that reduce sexual risk behaviors among young Black men who have sex with men (YBMSM), the most severely affected population in the United States, are critical for reducing disparities in HIV infection. However, there are few theory-based sexual risk reduction interventions designed specifically for YBMSM. This study tested the applicability of the Integrated Behavioral Model (IBM), which theorizes that behavioral intentions mediate the relationship between psychosocial constructs and health behavior on condomless anal intercourse (CAI) among YBMSM. To test key constructs of the IBM, analyses were conducted with baseline data from the HealthMpowerment (HMP) randomized controlled trial. Logistic regression was used to examine the relationships between condom use self-efficacy, norms, attitudes, intentions, and environmental constraints, and CAI. Mediation analysis was conducted to determine if condom use intentions mediated the relationship between psychosocial constructs (i.e., condom use self-efficacy, norms, and attitudes) and CAI. Overall 55.7% reported one or more acts of CAI with a male partner in the past 3 months. Those who reported CAI in the 3 months prior to the baseline survey reported lower self-efficacy for condom use, lower condom use norms, more negative attitudes toward condom use, and lower condom use intentions at baseline than those who reported no CAI. In mediation analysis, the relationships between CAI and self-efficacy for condom use (estimated indirect effect?=??0.004 (SE?=?0.002)), condom use norms (?0.002 (SE?=?0.001)) and attitudes toward condom use (?0.005 (SE?=?0.002)) were mediated by condom use intentions. This study applied the IBM to sexual risk behavior among a sample of YBMSM. Results indicate that the relationships between condom use self-efficacy, norms, and attitudes, and CAI were mediated by condom use intentions. Future theory-informed interventions should focus on increasing self-efficacy for condom use, condom use norms, attitudes toward condom use, and condom use intentions to reduce CAI among YBMSM.     

Drug Use Among Gay and Bisexual Men at Weekend Dance Parties: The Role of Intentions and Perceptions of Peers’ Behaviors

Substance use is high among gay and bisexual men attending weekend dance events, yet little research has investigated motivations for drug use and contextual factors influencing use in these settings. We hypothesized that beliefs about peer drug use interact with individuals’ own drug use intentions to predict use. 489 men attending weekend dance events completed an anonymous assessment asking about their own and their beliefs about other attendants’ drug use intentions—47 % completed a follow-up assessment after the event. Forty-four percent reported intending to use ecstasy at the event; intentions to use GHB, marijuana, cocaine, unprescribed erectile dysfunction drugs, and poppers were also high. Perceptions about other attendant’s drug use predicted use among those intending and those not intending to use drugs. Normative beliefs are important predictors of drug use at weekend dance events; event-specific prevention strategies should encompass messages that correct misperceptions of drug use among party attendants.     

The mediating effects of situational control on social support and mood following a stressor: a prospective study of dementia caregivers in their natural environments

OBJECTIVES: The present study examined, prospectively and within the context of stress experienced in the natural environment, whether situational control served as a mediator between perceived social support and caregiver's mood. METHODS: Data came from baseline assessments of individuals participating in health promotion interventions for women caregivers. Participants were 49 female caregivers of dementia patients who monitored their own acute psychological states during the day. RESULTS: Results revealed that although the occurrence of a situational stressor increased negative mood, greater perceived support reduced the detrimental impact of a stressor on negative mood. Moreover, path analyses revealed that changes in situational control partially mediated the relationship between perceived support and stress-induced negative mood changes. However, changes in control did not serve as a mediator in analyses focused on happiness. DISCUSSION: Results suggest that caregivers with greater perceived support were less emotionally reactive to stress occurring in their natural environments because of, in part, sustained or increased situational control.     

Relative contribution of smoker prototypes in predicting smoking among adolescents: a comparison with factors from the theory of planned behavior

BACKGROUND: It has frequently been suggested that adolescents are more likely to start smoking when they hold favorable social images or prototypes of smoking peers. Although empirical evidence supports the role of smoker prototypes in predicting smoking, little is known about the relative contribution of smoker prototypes, in comparison to more well-established social cognitive factors. Therefore, the present study investigated the relative impact of smoker prototypes, in comparison to factors of the theory of planned behavior, in predicting smoking among adolescents. METHODS: A three-wave prospective study was conducted among 612 Dutch 8th grade students (aged 12-13 years). Questionnaires were administered and adolescents were followed during one year. RESULTS: The results indicate that smoker prototypes are predictive of adolescent smoking behavior. Adolescents who believe that smoking peers are sociable more frequently engage in smoking behavior. Moreover, adolescents who hold the image that smoking peers are rebellious are less inclined to engage in smoking. These prototype factors predict a significant proportion of variance in smoking status, over and above the components of the theory of planned behavior. CONCLUSION: The findings of the present study are interesting because they suggest that intervening on the level of smoker prototypes may contribute to the effectiveness of current programs aiming at the prevention of adolescents' smoking behavior.     

Older adults’ lay theories of abilities predict their willingness to engage in preventive health behaviors

ObjectivesThe present studies examined the linkages between older adults’ lay theories regarding the modifiability of abilities and their intentions to perform preventive health behaviors. The ‘entity theory’ refers to the belief that traits are fixed. The ‘incremental theory’ is the belief that traits are malleable. We hypothesized that older adults who held a stronger incremental theory would perceive more benefits to health behaviors, which in turn would lead to higher intentions to perform those behaviors.MethodData from two independent, cross-sectional studies were analyzed via mediation analyses (Study 1: n = 147, Mean age = 68.62, SD = 5.40; Study 2: n = 152, Mean age = 70.56, SD = 4.98). Data were collected via an online survey and/or during an in-lab session at the university. Community-dwelling older adults completed, among other measures, a questionnaire assessing their lay theories of abilities. Participants also reported their perceptions of the benefits of different health behaviors for slowing the effects of aging, and their intentions to engage in those behaviors.ResultsIn both samples, the more older people believed that abilities are changeable (i.e., endorsed the incremental theory), the more they perceived the benefits of preventive health behaviors (Study 1: b = .22, p = .005; Study 2: b = .11, p = .03), which in turn predicted greater intention to perform such behaviors (Study 1: b = .74, p < .001; Study 2: b = .36, p < .001).DiscussionThese results suggest that entity beliefs may discourage older people from adopting health behaviors.     

Dementia family caregiver training: affecting beliefs about caregiving and caregiver outcomes

OBJECTIVES: Family caregiving is an integral part of the care system for persons with dementing disorders, such as Alzheimer's disease. This study tested role-training intervention as a way to help family caregivers appreciate and assume a more clinical belief set about caregiving and thereby ameliorate the adverse outcomes associated with caregiving. DESIGN: Training effectiveness was tested in a trial in which family care receiver dyads were randomly assigned to training beginning immediately or were placed in a wait-list control group and assigned to receive training in 5 to 6 months, following completion of data collection. SETTING: A community-based 14-hour training program provided in seven weekly 2-hour sessions. The training program curriculum was built on a stress and coping theory base. Recruitment and randomization were ongoing. Programs were begun every 2 months over a two and one half-year period for a total of 16 programs. PARTICIPANTS: Community health and social service agencies referred primary caregivers and at least one other family member of community-dwelling persons with dementia to participate. MEASUREMENTS: Data reported in this paper were gathered from each participating family at entry to the study and 5 months later. Standard measures of beliefs about caregiving, burden, depression, and reaction to care receiver behavior were administered to caregivers. A standard measure of mental status was administered to the person with dementia and standardized instruments were used to gather information from caregivers concerning care receivers' behavior and abilities to perform activities of daily living (ADLs). RESULTS: Data were analyzed from 94 caregiver/care receiver dyads with complete sets of data. Treatment and control caregivers and care receivers were similar at baseline, and care receivers in both groups declined similarly over the 5-month period. Significant within-group improvements occurred with treatment group caregivers on measures of beliefs about caregiving (P = .044) and reaction to behavior (P = .001). When outcomes were compared, treatment group caregivers were significantly different (in the expected direction) from those in the control group on measures of the stress mediator, beliefs (P = .025), and key outcomes, response to behavior (P = .019), depression (P = .040), and burden (P = .051). There was a significant positive association between the strengthened mediator, the caregivers' having less-emotionally enmeshed beliefs about caregiving roles and responsibilities, and the outcome, namely improvements in burden (P = .019) and depression (P = .007). CONCLUSION: A caregiver training intervention focused on the work of caregiving and targeted at knowledge, skills, and beliefs benefits caregivers in important outcome dimensions. The results suggest the benefits of providing information, linkage, and role coaching to dementia family caregivers.     

The relationship between self-efficacy and cumulative health risk associated with health behavior patterns in female caregivers of elderly relatives with Alzheimer's dementia

OBJECTIVE: To promote caregiver well-being and to help caregivers persevere in their invaluable roles, personal resources that predict increased self-care and reduced health risk behaviors need to be identified. METHOD: This study examined relationships between self-efficacy beliefs in three distinct domains of caregiving and cumulative health risk associated with health behavior patterns. RESULTS: Higher levels of self-efficacy for Obtaining Respite and self-efficacy for Controlling Upsetting Thoughts were found to be related to reduced health risk. DISCUSSION: These findings suggest that caregivers who believe that they can remove themselves from the stresses of caregiving and who can manage the distorted cognitions often associated with caregiving may experience tangible benefits in health behaviors and, ultimately, improved physical health.     

Caring for the caregiver: evaluation of support groups for guardians of orphans and vulnerable children in Kenya

HIV and AIDS have altered the context in which millions of children in sub-Saharan Africa are raised. Many are under the care of a widowed or ill parent, and others are residing with their extended family. Caregivers of orphans and other vulnerable children (OVC) face a variety of stressors that may adversely affect children. This study explores potential benefits of caregivers' membership in support groups on their own psychosocial wellbeing, and on the treatment and psychosocial well-being of OVC aged 8-14 under their care. A post-test study design comparing members and non-members was applied, drawing upon random samples of current and prospective beneficiaries from a rural community in Kenya. With up to two children per caregiver eligible for study inclusion, the sample comprised 766 caregivers and 1028 children. Three-quarters of children had lost at least one parent. Nearly 90% were cared for by a female, often their natural mother or grandmother. Half of the caregivers were widowed and one-fifth had a chronic illness. Over one-third of caregivers were members of support groups, more commonly female caregivers. Regression analyses assessed the effect of support group membership after controlling for household, caregiver and child characteristics. Members reported less social marginalization, better family functioning and more positive feelings towards the children in their care than nonmembers. Children with caregivers in support groups exhibited fewer behavioral problems, higher rates of prosocial behavior and reported lower incidence of abuse from adults in their household. The psychological state of caregivers, however, was not associated with support group membership. Results underscore that quality care of vulnerable children hinges on interventions that address the psychosocial challenges facing their caregivers.     

Decisional regret in left ventricular assist device patient-caregiver dyads

BackgroundThe objective of this study was to investigate decisional regret among left ventricular assist device (LVAD) patients and their caregivers.MethodsThis study was a single center, cross-sectional survey of patients after LVAD implantation and their caregivers. Subjects were recruited at their outpatient heart failure appointments. Patients and caregivers at least three months from LVAD implantation completed a 5-item, validated decisional regret scale. Summative scores on a 0–100 point scale were determined for patient and caregivers (0 = no regret). Subgroup analysis included gender, LVAD indication (bridge to transplant (BTT) or destination therapy (DT)), time from LVAD implantation, and caregiver relationship. Dyad discordance was defined as a patient-caregiver difference of ≥2 points on any regret scale question.ResultsFifty patients were approached for participation. Thirty-three LVAD patient-caregiver dyads were enrolled in the study (19 male, 14 female patients; 8 male, 25 female caregivers). Patients had a mean age of approximately 50 years. Caregivers had a mean age of approximately 54 years. Patients had a median regret score of 10 (Interquartile range (IQR): 0–30), while caregivers had a median regret score of 20 (IQR: 0–25). Median regret scores of female patients were significantly higher than that of male patients (27.5 vs 0, p = 0.0038). BTT patients had numerically lower regret than DT patients, but this was not statistically significant. Patients who had been implanted for greater than three years had the highest regret scores. Discordance in at least one domain of the regret scale was present in 19 out of 33 (57.6%) dyads.ConclusionsWhile decisional regret was reasonably low in this population, comparatively, there was significantly increased decisional regret among female patients and patients further from LVAD implantation. Differences between patients and caregivers were also observed. These findings highlight the need for robust support and continual attention to expectations before and after LVAD implantation.     

Role of the serotonin transporter gene and family function in adolescent alcohol consumption

BACKGROUND: That the extent to which a particular individual will engage in problematic behaviors such as delinquency, violence, or drug abuse is determined by the way psychosocial, situational, and hereditary factors interact is widely accepted. However, only recently have researchers begun to investigate the interactions between specific genotypes and psychosocial factors in relation to behavior. The purpose of the present study was to investigate possible interactions between a polymorphism in the promoter region of the serotonin transporter (5-HTT) gene and family relations on adolescent alcohol consumption. METHODS: A cross-sectional study with a randomized sample from a total population of 16- and 19-year-old adolescents from a Swedish county was conducted. Eighty-one male and 119 female adolescents, who volunteered to participate after having answered a questionnaire, were randomly selected from quartiles of volunteers representing various degrees of psychosocial risk behavior. RESULTS: 5-HTT genotype (p=0.029) and family relations (p=0.022) predicted alcohol consumption independently as well as through an interaction with one another (p=0.05). The model explained 11% of the variance in alcohol consumption. In a binary logistic model, we found that adolescents with the LS variant of the 5-HTT gene and with family relations being "neutral" or "bad" had a 12- to 14-fold increased risk for high intoxication frequency. CONCLUSIONS: In sum, our results show that a functional polymorphism of the 5-HTT genotype, family relations, and interactions between these variables predict adolescent alcohol consumption in a randomized sample of adolescents.