Social Outcomes Among Emerging Adults With Juvenile Idiopathic Arthritis

This longitudinal study examined social outcomes among young adults with juvenile idiopathic arthritis (JIA) and matched peers during the transition from adolescence to emerging adulthood. Participants included 45 participants with JIA (M = 12.64 years post diagnosis), 46 peers, and their parents. Young adults in both groups were similar on a variety of outcomes, including social self-concept, social competence, family relationships, friendships, and romantic relationships. In general, disease factors were not associated with adjustment. Interventions to assist social functioning may not be necessary for all children with JIA, but additional research is needed to identify potential subgroups at risk for difficulties.     

Coping Skills Among African-American Breast Cancer Survivors

Women with a diagnosis of breast cancer, particularly African-American women, face multiple barriers to survival. Although research exists regarding the unique barriers faced by African-American breast cancer survivors, there has been little research into the various coping needs or coping strategies used among African-American women. The purpose of this article is to provide information from an exploratory study of data investigating the coping skills of 30 African-American women diagnosed and treated for breast cancer. Quantitative data was collected via a self-report questionnaire based on the pretest of the Breast Cancer Survivors Toolbox. The study sample was evaluated to determine overall coping skills followed by an analysis of individual categories of coping skills (e.g., communication, information seeking, negotiating, social support systems, cultural norms). Although limited by the non-random sampling technique and self-report, the results of the study support the need for further research regarding the use of interventions and strategies tailored to improve coping skills used by this population.     

Dietary Quality,Caloric Intake,and Adiposity of Childhood Cancer Survivors and Their Siblings: An Analysis from the Cardiac Risk Factors in Childhood Cancer Survivors Study

Childhood cancer survivors are at increased risk of cardiovascular disease, in part because of adiposity. Whether survivors have healthy diets and whether dietary quality is associated with adiposity among survivors are not known. Survivors and siblings from the Cardiac Risk Factors in Childhood Cancer Survivors Study completed 3-day food records that were used to estimate daily caloric intake relative to recommended and dietary quality using the Healthy Eating Index-2005 (HEI). Medical records were reviewed for cancer therapies. Body composition was measured by dual-energy x-ray absorptiometry. Of 91 childhood cancer survivors and 30 sibling controls, there were no marked differences in mean daily caloric intakes (98% vs. 100% of recommended) or HEI total scores (55.5 vs. 53.3), respectively, with both groups scoring worst for the consumption of dark green vegetables and whole grains. Survivors exposed to cranial irradiation had lower total HEI scores (?6.4, P = 0.01). Among survivors, better dietary quality, as reflected by the total HEI score, was associated with decreasing percent body fat (β = ?0.19, P = 0.04). Survivors consume diets similar to their siblings although these diets are only moderately adherent to current guidelines. Decreased dietary quality is associated with higher body fat and receipt of cranial irradiation in survivors.     

Obesity in Childhood Cancer Survivors: Call for Early Weight Management

A high prevalence of obesity and cardiometabolic conditions has been increasingly recognized in childhood cancer survivors. In particular, survivors of pediatric acute lymphoblastic leukemia have been found to be at risk of becoming overweight or obese early in treatment, with increases in weight maintained throughout treatment and beyond. Nutrition plays an important role in the etiology of obesity and cardiometabolic conditions and is among the few modifiable factors that can prevent or delay the early onset of these chronic conditions. However, nutritional intake in childhood cancer survivors has not been adequately examined and the evidence is built on data from small cohorts of survivors. In addition, the long-term impact of cancer diagnosis and treatment on survivors’ nutritional intake as well as how survivors’ nutritional intake is associated with chronic health conditions have not been well quantified in large-scale studies. Promoting family-based healthy lifestyles, preferably at a sensitive window of unhealthy weight gain, is a priority for preventing the early onset of obesity and cardiometabolic conditions in childhood cancer survivors.     

State Rehabilitation Services Tailored to Employment Status Among Cancer Survivors

Purpose. Previous analyses of vocational rehabilitation services for unemployed cancer survivors indicated that counseling and guidance, job search assistance, and job placement services are significantly associated with increased odds for employment. However, many cancer survivors with jobs to return to may require vocational interventions that are different from unemployed cancer survivors. It is unclear whether the public rehabilitation system provides vocational services that are based on the work status of cancer survivors rather than providing the same set of services for all cancer survivors. This study examined whether differences in the types of services were indeed based on the employment status of those with a history of cancer at the time of application. Methods. Administrative data on 1,460 cancer survivors were obtained through the US Rehabilitation Services Administration Case Service Report (RSA-911) dataset for fiscal year 2007. Data on demographic characteristics and vocational service patterns were extracted and analyzed. Multiple discriminant analysis was used to identify differential services received by cancer survivors based on employment status at time of application for vocational rehabilitation services. Results. Results of the multiple discriminant analysis indicated one significant canonical discriminant function, with Wilks’s λ = .92, χ ²(19, N = 1,456) = 114.87, p < .001. The correlations between the discriminating variables and the significant canonical discriminant function were highest for diagnoses and treatment (?.526), job placement (.487), transportation (.419), job search (.403), vocational training (.384), job readiness (.344), university training (.307), and rehabilitation technology (?.287). The group centroids along the significant discriminant function (the distance of each group from the center of the canonical function) indicated that the employed applicant group (?.542) and the unemployed applicant group (.153) can be differentiated based on vocational rehabilitation services received, with the employed applicant group receiving primarily diagnostic and treatment services and rehabilitation technology/job accommodation services, while the unemployed applicant group received more vocational training, job seeking skills training, and job placement services. Conclusions. Employed cancer survivors who are at risk of losing their job and unemployed cancer survivors who are looking for a job receive different vocational services tailored to needs, suggesting that state vocational rehabilitation services for cancer survivors is responsive to individual client needs.     

Functional Impairments and Work-Related Outcomes in Breast Cancer Survivors: A Systematic Review

Purpose Work participation after breast cancer treatment is generally negatively affected. Occupational health professionals might improve work-related outcomes by bridging the gap between sick-listed employees’ levels of functioning and work demands. To aid them in this task, this review explored the association between functional impairments and work-related outcomes in breast cancer survivors. Methods Publications from January 2000–March 2016 were identified through five online databases (i.e. Pubmed, EMBASE, PsycINFO, CINAHL and the Cochrane Library). Quantitative and qualitative studies were included if they focused on functional impairments and work-related outcomes in breast cancer survivors. Two reviewers independently selected studies, extracted data and performed quality assessment. Results The search identified 998 studies, of which 20 studies met eligibility criteria. Impairments in physical functioning negatively affected return to work (RTW) and work ability in quantitative and qualitative studies. Studies measuring cognitive functioning with tests found no association with work-related outcomes, whereas the results of studies using self-reported measures were ambiguous. Social functioning was less commonly investigated and findings differed across work-related outcomes. Emotional functioning was not associated with work-related outcomes in quantitative studies, while in qualitative studies feelings such as insecurity were described as influencing RTW. Conclusions Functional impairments can severely hamper work participation in breast cancer survivors. This provides important opportunities for occupational health professionals to enhance RTW in breast cancer survivors, such as adequately addressing illness perceptions and work expectations. Ongoing research is warranted to aid occupational health professionals in providing effective vocational guidance and improve work-related outcomes in breast cancer survivors.     

Factors Related to Depressive Symptoms Among Long-Term Survivors of Cervical Cancer

In this article we describe depressive symptoms among survivors of cervical cancer. Study participants were previously diagnosed and treated with cervical cancer 5 to 25 years prior to the completion of a telephone survey. Through a population-based survey of women identified via a state tumor registry in southern New England, the investigators learned that depressive symptoms are prevalent among a subgroup of long-term survivors long after diagnosis and treatment. The at-risk participants included those who were at a lower economic status and whose marital status and ability to work had changed, and who continued to experience pain and diarrhea caused by radiotherapy. Findings from this study warrant additional research with this potentially vulnerable group of women.     

The Desire for Children and Fertility Issues Among Young German Cancer Survivors

PurposeFor young cancer patients, family planning is not always completed at the time of cancer diagnosis. This study investigated young cancer patients' desire to have children, its intensity, and their discussion with oncologists and fertility specialists about fertility. Furthermore, gender differences, differences between childless patients and patients with children, and correlations with psychological distress were analyzed.MethodsA total of 149 cancer patients (range, 18–45 years of age) answered a self-developed questionnaire. Psychological distress was measured with the Patient Health Questionnaire.ResultsSeventy-four percent of patients had a desire to have children at the time of diagnosis. Whereas the intensity of the desire for children increased pre- to post-treatment in childless patients, it decreased in patients who already had children. A total of 55 patients who wanted a child (50%) needed supportive care concerning this issue; 60% of the total sample had discussed fertility aspects with their oncologists and 20% with fertility specialists. Patients reported higher levels of satisfaction with their discussions with fertility specialists than with their discussions with oncologists. Men (56%) underwent fertility preservation more often than did women (31%). Female sex was the only variable predicting psychological distress, whereas parenthood, fertility preservation, and desire for children had no significant impact.ConclusionsThe desire to have children and the fertility issues involved are important for young cancer patients. Reasons for not discussing fertility aspects with oncologists and the cause of low referral rates to fertility specialists should be explored in future studies. The implementation of structured psychosocial supportive care might address the needs of highly fertility-distressed patients.     

Racial/Ethnic Disparities in Health Care Receipt Among Male Cancer Survivors

Objectives. We examined racial/ethnic disparities in health care receipt among a nationally representative sample of male cancer survivors.Methods. We identified men aged 18 years and older from the 2006–2010 National Health Interview Survey who reported a history of cancer. We assessed health care receipt in 4 self-reported measures: primary care visit, specialist visit, flu vaccination, and pneumococcal vaccination. We used hierarchical logistic regression modeling, stratified by age (< 65 years vs ≥ 65 years).Results. In adjusted models, older African American and Hispanic survivors were approximately twice as likely as were non-Hispanic Whites to not see a specialist (odds ratio [OR] = 1.78; 95% confidence interval [CI] = 1.19, 2.68 and OR = 2.09; 95% CI = 1.18, 3.70, respectively), not receive the flu vaccine (OR = 2.21; 95% CI = 1.45, 3.37 and OR = 2.20; 95% CI = 1.21, 4.01, respectively), and not receive the pneumococcal vaccine (OR = 2.24; 95% CI = 1.54, 3.24 and OR = 3.10; 95% CI = 1.75, 5.51, respectively).Conclusions. Racial/ethnic disparities in health care receipt are evident among older, but not younger, cancer survivors, despite access to Medicare. These survivors may be less likely to see specialists, including oncologists, and receive basic preventive care.Gender and racial/ethnic disparities in health care utilization are prevalent. Men are less likely than are women to use health care services, including physician office visits and preventive care visits.1,2 Minorities are also less likely to use health care services than are non-Hispanic Whites.3–6 Contributors to these disparities include low socioeconomic status7–10 and lack of health insurance.7,8,11,12 Even after controlling for socioeconomic status and health insurance coverage, racial/ethnic disparities in health care utilization persist.4 These disparities are associated with poorer health and higher mortality rates among minorities and have important implications for survival and well-being for men with serious and chronic health conditions such as cancer.5Although numerous studies have documented racial/ethnic disparities in cancer screening, diagnosis, treatment, and mortality,10,13–18 little is known about how racial/ethnic disparities in health care among posttreatment cancer survivors influence follow-up care. Such care includes monitoring and managing late and long-term effects and follow-up tests to monitor for recurrence and detect second cancers. Management of noncancer comorbidities (e.g., diabetes) and preventive health care19 (e.g., vaccinations) are also recommended for cancer survivors.20–22 Follow-up care may include visits to both primary care and specialist providers.13,23–25 It is strongly recommended that cancer survivors receive lifelong follow-up care because of increased risk of recurrence, morbidity, and mortality.19Prior studies have used administrative data to explore this issue,13,24,26,27 but few of these studies have focused on male cancer survivors and none included younger survivors who are not covered by Medicare. Additionally, it is not known how patterns of health care receipt might differ among men with and without a history of cancer.We assessed racial/ethnic disparities in health care receipt among adult male cancer survivors and men without cancer using the National Health Interview Survey (NHIS).28 We first wanted to compare cancer survivors to a noncancer group to shed light on whether the disparities are specific to cancer or reflect underlying disparities. We explored (1) racial/ethnic disparities in health care receipt among cancer survivors compared with men with no cancer history, (2) racial/ethnic disparities in cancer survivors, and (3) the extent to which predisposing, enabling, and need factors explain racial/ethnic disparities in health care receipt among male cancer survivors.     

Structural Inequity and Pregnancy Desires in Emerging Adulthood

Archives of Sexual Behavior - Public health discourses often claim that delaying pregnancy is associated with social and economic benefits. Yet research suggests that, for young people, structural...     

Childhood Poverty and the Transition to Adulthood

The authors used the Panel Study of Income Dynamics 2007 Transition to Adulthood data in combination with the 2002 Child Development Supplement to examine social class bifurcation in young adulthood. Results indicate that poor youth possibly take on adult roles “too early” at the same time that high‐income youth may be supported for a long period past their 18^th birthday. Although not all evidence is consistent with this bifurcated story, childhood poverty does play a key role. Young adults from poor families establish financial independence early (e.g., contributing to family bills during adolescence, considering themselves fully responsible for their finances as young adults), whereas young adults from more affluent homes are more likely to receive financial transfers from their parents (who often help them pay for college and other expenses). These findings highlight the ways in which socioeconomic inequality in childhood can differentiate youth's experiences of adolescence and young adulthood.     

Exercise Preference Patterns, Resources, and Environment Among Rural Breast Cancer Survivors

ABSTRACT:  Context: Rural breast cancer survivors may be at increased risk for inadequate exercise participation. Purpose: To determine for rural breast cancer survivors: (1) exercise preference "patterns," (2) exercise resources and associated factors, and (3) exercise environment. Methods: A mail survey was sent to rural breast cancer survivors identified through a state cancer registry, and 483 (30%) responded. Findings: The majority (96%) were white, with mean education of 13 (±2.5) years and mean 39.0 (±21.5) months since diagnosis. Most participants (67%) preferred face-to-face counseling from an exercise specialist (27%) or other individual (40%). A third (31%) preferred home-based exercise with non face-to-face counseling from someone other than an exercise specialist. Participants preferring face-to-face counseling were more apt to prefer supervised exercise (38% vs 9%, P < 0.001) at a health club (32% vs 8%, P < 0.001). Home exercise equipment was reported by 63%, with 97% reporting home telephone and 67% reporting Internet access. Age, education, self-efficacy, treatment status, and exercise behavior were associated with exercise resources. The physical environment was often not conducive to exercise but a low crime rate and high trust in neighbors was reported. Conclusions: Rural health education programs encouraging exercise should offer multiple programming options while considering the physical environment and capitalizing on available resources and beneficial social environmental characteristics.     

Developmental Disabilities and Socioeconomic Outcomes in Young Adulthood

ObjectiveWe assessed the associations between developmental disabilities and indicators of socioeconomic outcomes (i.e., educational attainment, employment status, occupation type, subjective perception of socioeconomic status [SES], income, and wage rate) among young U.S. adults aged 24–33 years.MethodsWe used data from the National Longitudinal Study of Adolescent Health (n=13,040), a nationally representative study of U.S. adolescents in grades 7–12 during the 1994–1995 school year. Young adult outcomes (i.e., educational attainment, employment status, income, occupation, and subjective SES) were measured in Wave IV (2008 for those aged 24–33 years). Multivariate methods controlled for sociodemographic characteristics and other relevant variables.ResultsNearly 12% of this sample presented with a physical or cognitive disability. Respondents with physical disabilities had lower educational attainment (odds ratio [OR] = 0.69, 95% confidence interval [CI] 0.57, 0.85) and ranked themselves in lower positions on the subjective SES ladder (OR=0.71, 95% CI 0.57, 0.87) than those without a physical disability. Compared with individuals without disabilities, young adults with a cognitive disability also had lower educational attainment (OR=0.41, 95% CI 0.33, 0.52) and, when employed, were less likely to have a professional/managerial occupation (OR=0.50, 95% CI 0.39, 0.64). Young adults with disabilities also earned less annually (–$10,419.05, 95% CI –$4,954.79, –$5,883.37) and hourly (–$5.38, 95% CI –$7.64, –$3.12) than their non-disabled counterparts.ConclusionThis study highlights the importance of considering multiple developmental experiences that may contribute to learning and work achievements through the transition from adolescence to young adulthood.Disabilities are prevalent conditions that result from interactions among health problems, environment, and personal factors, and can impose a large burden on affected individuals, their families, and society. Developmental disabilities, which can be defined as conditions caused by physical or mental impairments occurring by age 22, are of particular interest given their potential long-term impact on well-being.¹Several metrics suggest that the prevalence of disabilities is increasing, by as much as 7 percentage points (11.7% to 18.7%) from 1970 to 2005.² The increasing trend in prevalence is similar across various age groups^1–4 and is partially explained by the aging of the U.S. population.^1,3–5 Other contributing factors include advances in neonatal and pediatric care, which have significantly improved the survival of infants at greater risk of developing a disability, such as very preterm and low birthweight children.^6,7Adulthood is typically characterized by the achievement of specific milestones related to human capital accumulation, such as completing one''s education, getting a full-time job, and getting married or having a child.⁷ The transition into adulthood can be challenging for any adolescent, but for adolescents with disabilities and their families, this transition may be more difficult.⁶ Disabilities can adversely affect multiple socioeconomic outcomes, including educational achievement and attainment, employment, income, and other socioeconomic status (SES) indicators.⁸Education is a key determinant of economic performance that also affects long-term SES and quality of life.⁸ Children and adolescents with physical and cognitive disabilities typically have more limited access to formal education than their non-disabled peers.^9–11 Also, individuals with disabilities have poorer employment outcomes than their non-disabled peers, as reflected in lower-paying jobs, lower occupational status, and higher unemployment rates.^6,7,12,13Differences in learning and work performance for adults with disabilities compared with their non-disabled peers may be decreasing, as suggested by a 2012 review on transition to adulthood.¹⁰ However, the performance of individuals with disabilities on these socioeconomic outcomes continues below ideal levels.^11,12 A better understanding of socioeconomic achievements around the transition to adulthood for individuals who have lived with disabilities is needed to identify policies and early life interventions that can improve the outcomes of affected individuals.⁹Previous research on developmental disabilities has major limitations. First, adolescents and young adults are the least studied age group for any type of disability,¹⁴ and their needs are poorly understood and not adequately considered in educational programs and policies.¹⁵ Longitudinal studies using nationally representative samples to examine the transition of adolescents with disabilities into adulthood are few, and those that do exist have limitations, such as a focus on students in special secondary education and exclusion of individuals with severe disabilities.^2,15–17Using nationally representative data, we examined how early life disabilities are associated with human capital accumulation in young adulthood, focusing on educational attainment, employment status, occupation, income, wage rate, and subjective perception of social status. Given that previous studies have repeatedly reported that individuals with disabilities have worse performance on these outcomes, we hypothesized that (1) young adults with physical and cognitive disabilities would demonstrate lower educational and economic achievements compared with individuals without disabilities and (2) individuals with physical disabilities alone would perform better on these outcomes than individuals with cognitive disabilities. The second hypothesis was stated to allow the discussion on the differences of the impact of cognitive and physical disabilities on one''s life.     

大学生儿童时期成长经历对恋爱的影响

目的探索儿童时期成长经历对大学生恋爱的影响,为有效控制恋爱相关心理问题的产生提供科学依据。方法采用亲密关系经历量表(ECR-R),儿童时期创伤量表(CTQ),青少年父母同伴依恋量表(IPPA)对某大学二年级学生进行问卷调查,所收集的数据应用SPSS 15.0进行统计学分析。结果所有受调查的大学生儿童时期均受过不同程度的情感、躯体忽视,而有轻度或以上情感虐待、躯体虐待、性侵犯经历的大学生分别占调查对象总数的49.6%,29.2%,32.7%;情感虐待经历、青少年时期与母亲的依恋安全性是大学生产生恋爱相关焦虑、逃避心理的主要影响因素,而性别的差异也是产生恋爱相关逃避心理的影响因素之一。结论儿童时期创伤经历与性别、城乡、父母亲文化程度、家庭经济情况、家庭结构完整性相关。恋爱关系中出现依恋焦虑、依恋逃避心理的主要预测因素为性别、儿童时期情感虐待经历、青少年时期与母亲的依恋安全性。     

Perceptions of Health Among Black Women in Emerging Adulthood: Alignment With a Health at Every Size Perspective

ObjectiveTo explore the health perceptions of Black women in emerging adulthood and the degree to which perceptions align with core Health at Every Size (HAES) principles.DesignSemistructured interviews with Black women in emerging adulthood. Data were collected between June and July 2018 as part of a larger, mixed-methods study.SettingSouthern California.ParticipantsForty-one Black women aged 18–24 years were recruited via a combination of convenience and respondent-drive sampling.Phenomenon of InterestHealth perceptions of young Black women and alignment with core HAES principles.AnalysisData were analyzed using principles of inductive thematic analysis. Following analysis, data were further interpreted within the HAES framework.ResultsParticipants’ insights resulted in 3 main themes: (1) health is multidimensional, (2) good health means taking care of yourself, and (3) systemic and environmental disparities affect Black women's health. These themes reflect 3 HAES principles of health enhancement, weight inclusivity, and eating for well-being.Conclusions and ImplicationsFindings provide preliminary support for aligning HAES principles and perceptions and health for Black women in emerging adulthood. Prioritizing holistic well-being, attention to individualized health needs and access to needed information and resources in efforts to improve health outcomes among members of this demographic may be promising.     

Validation of a Milk Consumption Stage of Change Algorithm among Adolescent Survivors of Childhood Cancer

ObjectiveTo assess the construct validity of a milk consumption Stages of Change (SOC) algorithm among adolescent survivors of childhood cancer ages 11 to 21 years (n = 75).MethodsBaseline data from a randomized controlled trial designed to evaluate a health behavior intervention were analyzed. Assessments included a milk consumption SOC algorithm and hypothesized theoretical and behavioral predictors of SOC.ResultsCompared with survivors who expressed no readiness to change, those expressing readiness to change behavior for both 2 and 4 daily servings of milk reported more frequent milk consumption (P < .001), greater dietary calcium intake (P = .006), and were more likely to meet age-specific recommendations for daily calcium intake (P = .01).Conclusions and ImplicationsResults provide support for the construct validity of the milk consumption SOC algorithm relative to behavioral criteria. Research is needed to further examine algorithm validity with respect to theoretical predictors of SOC.