Daily Telephone Interviews Research Articles

The Costs of Concern: Health Implications of Worries about Aging Parents and Adult Children

As their parents age and their children enter adulthood, midlife adults need to manage their worries and concerns about both generations. In midlife, worries about aging parents’ health and emerging needs for support co-occur alongside worries about adult children’s relationships and prolonged need for support. Research reveals links between midlife adults’ worry and sleep quality, underscoring how worries compromise health and well-being. In addition to compromising sleep, worries may also contribute to poor health behaviors, such as emotional eating. Emotional eating, where individuals eat in response to stressors and negative emotions, is a significant risk factor for overeating and obesity. Less is known; however, about how midlife adults’ worries contribute to poor health behaviors. To address this gap, the current study considers how midlife adults’ concurrent and previous day’s daily worries about aging parents and adult children are associated with daily well-being and health behaviors. Respondents are midlife adults (40-60 years) from Wave II of the Family Exchanges Study (Fingerman et al., 2009). During 7 days of daily telephone interviews, respondents indicated if they worried about their adult children and their aging parent(s), if they ate food for comfort, and their daily negative mood. Controlling for demographics, on days when midlife adults worried about their adult child(ren), they reported more negative emotions than on days without these worries (p <.05). Respondents engaged in more eating for comfort the day after they reported worrying about their mother (p < .05). Implications for aging families will be discussed.

Affective Vulnerability to Short Sleep Predicts 10-Year Changes in Chronic Health Conditions

We examined daily affective vulnerability to short sleep (i.e., individual differences in the extent that sleeping ≤6h predicts next-day affect) as a risk factor for developing chronic conditions 10 years later. Participants (N=1945, ages 35-85, 57% women) from the National Study of Daily Experiences reported sleep duration and affect in daily diary telephone interviews. Chronic conditions were assessed with a 39-item checklist (e.g., arthritis, hypertension, diabetes). Multilevel structural equation models revealed that individuals with heightened negative affect following short sleep had an increased number of chronic conditions after 10 years (Est.=1.20, SE=.48, p<.01). Positive affective vulnerability (i.e., greater declines in positive affect following shorter sleep vs. longer sleep) was marginally associated with 10-year chronic conditions (Est.=-.72, SE=.40, p=.07). Adding to the well-established connections between sleep duration and well-being across adulthood, these findings suggest that affective vulnerability to short sleep represents a unique risk factor for long-term health as people age.

Longitudinal trajectories of subjective care stressors: the role of personal, dyadic, and family resources

ABSTRACTObjectives: Stressors are critical to the caregiver stress process, yet little work has examined resources that contribute to longitudinal changes in subjective stressors. The present study examines a variety of factors that contribute to changes in subjective stressors across time. Method: Dementia caregivers (N = 153) completed an in-person interview and eight daily telephone interviews at baseline, and follow up interviews at 6 and 12 months. Growth curve analyses examine how care- and non-care stressors, respite, dyadic relationship quality, family support/conflict and care transitions (e.g. nursing home placement) are associated with changes in role overload and role captivity across 12 months. Results: Caregivers who transitioned out of their role had higher overload and captivity at baseline. Among caregivers who transitioned out of caregiving, higher captivity at baseline was associated with declines in captivity and overload; more non-care stressors at baseline was linked to increased captivity and greater overload across time. Adult day service use and family support were associated with lesser captivity over time; taking more breaks from caregiving was linked to lower overload. Higher dyadic relationship quality was associated with lower captivity and overload. Conclusion: Findings contribute to caregiver intervention efforts by highlighting important resources associated with subjective stressors across time.

Spillover between interparental conflict and parent-child conflict within and across days.

The present study used a daily reporting design to examine the bidirectional spillover in conflict and conflict strategies between the interparental relationship and the parent-child relationship. Participants were 60 parents with a preadolescent child at risk for aggressive behavior. Parents reported on their experience of interparental and parent-child conflict and their use of constructive and destructive conflict strategies through daily telephone interviews over 7 days. Each day was divided into 3 equal time periods roughly corresponding to early morning, daytime, and evening. Time-lagged analyses investigated the spillover in conflict within and across days. Results revealed that the presence of interparental conflict significantly predicted the presence of parent-child conflict 1 time period later and 1 full day later. Likewise, the presence of parent-child conflict significantly predicted the presence of interparental conflict 1 full day later. In terms of conflict strategy use, results revealed that parents who engaged in constructive patterns of interparental conflict were more likely to engage in constructive patterns of parent-child conflict 1 time period later and 1 full day later. Reciprocal effects for constructive parent-child conflict predicting subsequent interparental conflict were significant across all 3 time lags assessed. There were no significant, bidirectional effects for the spillover in destructive conflict. Findings have important clinical implications. (PsycINFO Database Record

A Pilot Study Evaluating the Safety of Intravenously Administered Human Amnion Epithelial Cells for the Treatment of Hepatic Fibrosis.

Liver cirrhosis is the 6th leading cause of death in adults aged 15–59 years in high-income countries. For many who progress to cirrhosis, the only prospect for survival is liver transplantation. While there is some indication that mesenchymal stem cells may be useful in reversing established liver fibrosis, there are limitations to their widespread use – namely their rarity, the need for extensive serial passaging and the associated potential for genomic instability and cellular senescence. To this end, we propose the use of allogeneic amnion epithelial cells. This clinical trial will assess the safety of intravenously delivered allogeneic human amnion epithelial cells (hAECs) in patients with compensated liver cirrhosis. This will also provide clinical data that will inform phases 2 and 3 clinical trials with the ultimate goal of developing hAECs as a therapeutic option for patients with cirrhosis who are at significant risk of disease progression. We will recruit 12 patients with compensated cirrhosis, based on their hepatic venous pressure gradient, for a dose escalation study. Patients will be closely monitored in the first 24 h post-infusion, then via daily telephone interviews until clinical assessment on day 5. Long term follow up will include standard liver tests, transient elastography and hepatic ultrasound. Ethics approval was obtained from Monash Health for this trial 16052A, “A Pilot Study Evaluating the Safety of Intravenously Administered Human Amnion Epithelial Cells for the Treatment of Liver Fibrosis, A First in Adult Human Study.” The trial will be conducted in accordance to Monash Health Human Ethics guidelines. Outcomes from this study will be disseminated in the form of conference presentations and submission to a peer reviewed journal. This trial has been registered on the Australian and New Zealand Clinical Trials Registry ACTRN12616000437460.

Immediate and Lagged Effects of Daily Stress and Affect on Caregivers' Daily Pain Experience.

We examined the effect of daily stress, affect, and adult day service (ADS) use on the daily pain experience among caregivers of individuals with dementia (IWD). Participants were interviewed for 8 consecutive days. Caregivers utilized an ADS program on some days and provided care at home on other days. We hypothesized ADS use, care-related and noncare-related subjective stress, and affect would significantly influence and interact in ways to exacerbate or buffer the experience of daily pain. Participants were 173 family caregivers of IWDs using ADS more than 2 days per week. Participants with IWDs diagnosed with "mild cognitive impairment" were excluded. Daily telephone interviews assessed stress, affect, and pain. Multilevel models were used to examine the relation between daily stress and daily pain and interaction effects of other daily experiences within the context of ADS use. Multilevel models revealed a significant relation between care-related subjective stress and daily bodily pain as well as an interaction between noncare-related subjective stress and daily bodily pain. ADS use and affect did not predict daily pain. Lagged effects revealed a significant interaction between yesterday's ADS use and today's positive affect on today's bodily pain. Findings suggest that further studies are warranted for understanding and controlling pain among caregivers. Addressing the physical health needs through pain management interventions, positive affect maximization, and ADS use may improve the overall wellbeing of caregiving dyads.

Relation of Health Literacy to Exceeding the Labeled Maximum Daily Dose of Acetaminophen.

Acetaminophen is a commonly used analgesic/antipyretic; overdoses can lead to liver damage. Little is known about the relationship of health literacy to exceeding the recommended maximum daily dose (4 g). Subjects were recruited at 23 U.S. malls in 2011. Health literacy was measured by Rapid Estimate of Adult Literacy in Medicine (REALM), classified as very low (VLL, score <45); low (LL, 45-60); or adequate (AL, >60). Participants completed a 7-day acetaminophen use diary by daily telephone interview; an exit interview covered demographics, physical/mental health, medical history, medication label reading, and medication-taking knowledge/attitudes. Acetaminophen products were identified from a comprehensive list; subjects were not required to know their medications contained acetaminophen. Seven hundred fifty-six subjects aged ≥18 years had taken acetaminophen in the past 30 days and completed 7 diary days with ≥1 day of acetaminophen use, plus the exit survey. Analysis was conducted in 2012-2014. VLL were more likely than AL individuals to exceed 4 g on ≥1 day (OR [95% CI]=3.8 [1.5, 9.6]; 4.0 [1.3, 12] after controlling for five REALM score-related factors). On usage days, VLL individuals were also more likely to exceed 4 g (3.3 [1.1, 10], by generalized estimating equations; 2.4 [0.9, 6.6], direct effect after accounting for mediation by other deviations from label recommendations). VLL individuals exceed the recommended maximum acetaminophen dose more often than AL individuals. Other identified characteristics related to health literacy do not explain this, but it is partly mediated by increased frequency of other label deviations.

Daily mood and sleep: reciprocal relations and links with adjustment problems.

Children's sleep problems are common and associated with increased risk for adjustment problems. We examined daily links between children's sleep and mood, using a daily diary method and actigraphy. We also tested children's daily mood as a mediator of relations among sleep and children's broader internalizing and externalizing symptoms. A community sample of 142 children (mean age = 10.69 years; 57% girls; 69% European American, 31% African American) and their parents participated. For 1 week, children wore actigraphs and parents completed a daily telephone interview about their child's mood. Following the week of actigraphy, mothers and fathers reported on their child's adjustment. Multi-level models indicated within-person relations between children's mood and subsequent sleep fragmentation (indicated by increased activity) and sleep latency, and between-person relations between sleep latency and subsequent mood on the next day. Significant indirect effects were found such that a more negative daily mood (aggregated across diary days) mediated relations between poor sleep efficiency and longer sleep latency and parent-reported internalizing and externalizing symptoms. Findings extend previous research by highlighting disruptions to children's daily mood as a potential mechanism linking sleep problems to children's mental health.

Assessment of the cost-effectiveness and clinical outcomes of a fourth-generation synchronous telehealth program for the management of chronic cardiovascular disease.

BackgroundTelehealth programs are a growing field in the care of patients. The evolution of information technology has resulted in telehealth becoming a fourth-generation synchronous program. However, long-term outcomes and cost-effectiveness analysis of fourth-generation telehealth programs have not been reported in patients with chronic cardiovascular diseases.ObjectiveWe conducted this study to assess the clinical outcomes and cost-effectiveness of a fourth-generation synchronous telehealth program for patients with chronic cardiovascular diseases.MethodsWe retrospectively analyzed 575 patients who had joined a telehealth program and compared them with 1178 patients matched for sex, age, and Charlson comorbidity index. The program included: (1) instant transmission of biometric data, (2) daily telephone interview, and (3) continuous decision-making support. Data on hospitalization, emergency department (ED) visits, and medical costs were collected from the hospital’s database and were adjusted to the follow-up months.ResultsThe mean age was 64.5 years (SD 16.0). The mean number of monthly ED visits (mean 0.06 SD 0.13 vs mean 0.09 SD 0.23, P<.001), hospitalizations (mean 0.05 SD 0.12 vs mean 0.11 SD 0.21, P<.001), length of hospitalization (mean 0.77 days SD 2.78 vs mean 1.4 SD 3.6, P<.001), and intensive care unit admissions (mean 0.01 SD 0.07 vs mean 0.036 SD 0.14, P<.001) were lower in the telehealth group. The monthly mean costs of ED visits (mean US$20.90 SD 66.60 vs mean US$37.30 SD 126.20, P<.001), hospitalizations (mean US$386.30 SD 1424.30 vs mean US$878.20 SD 2697.20, P<.001), and all medical costs (mean US$587.60 SD 1497.80 vs mean US$1163.60 SD 3036.60, P<.001) were lower in the telehealth group. The intervention costs per patient were US$224.80 per month. Multivariate analyses revealed that age, telehealth care, and Charlson index were the independent factors for ED visits, hospitalizations, and length of hospitalization. A bootstrap method revealed the dominant cost-effectiveness of telehealth care over usual care.ConclusionsBetter cost-effectiveness and clinical outcomes were noted with the use of a fourth-generation synchronous telehealth program in patients with chronic cardiovascular diseases. The intervention costs of this new generation of telehealth program do not increase the total costs for patient care.

Daily Stressors and Adult Day Service Use by Family Caregivers: Effects on Depressive Symptoms, Positive Mood, and Dehydroepiandrosterone-Sulfate

This study examines effects of daily use of adult day service (ADS) programs by caregivers of individuals with dementia (IWD) on a salivary biomarker of stress reactivity, dehydroepiandrosterone-sulfate (DHEA-S), and whether these effects on DHEA-S are associated with daily variability in positive mood and depressive symptoms. We used a daily diary design of 8 consecutive days with alternation of intervention (ADS) and nonintervention days to evaluate within- and between-person effects of the intervention. Family caregivers (N= 151) of IWD who were using ADS were interviewed daily by telephone at home. Saliva samples were collected from caregivers five times a day for 8 consecutive days and were assayed for DHEA-S. Daily telephone interviews assessed daily stressors and mood. DHEA-S levels were significantly higher on days after ADS use. Daily DHEA-S levels covaried significantly with daily positive mood but not with depressive symptoms. These results demonstrate an association of ADS use by family caregivers and higher DHEA-S levels on the next day. Prior research has found that higher DHEA-S levels are protective against the physiologic damaging effects of stressor exposure and may reduce risks of illness. Regular use of ADS may help reduce depletion of DHEA-S and allow the body to mount a protective and restorative response to the physiologic demands of caregiving. To our knowledge, this is the first study to examine DHEA-S levels across the day in connection with an intervention that affected daily exposure to stressors.

Short-course Antibiotic Treatment for Community-acquired Alveolar Pneumonia in Ambulatory Children

Studies on short-course treatment of childhood pneumonia in the developed world are lacking. We compared clinical and laboratory outcomes of a 3-day or a 5-day to a 10-day treatment in young children with community-acquired alveolar pneumonia. A double-blind, randomized, placebo-controlled trial was conducted in 2 stages: (1) 3 days versus 10 days and (2) 5 days versus 10 days. Amoxicillin (80 mg/kg/d; divided into 3 daily doses) was used for all arms. Case definition was: age 6-59 months; radiologically confirmed community-acquired alveolar pneumonia; temperature ≥38.5°C; peripheral white blood cell count ≥15,000/mm³; status permitting outpatient treatment. Scheduled visits were on days 4-5 and 10-14 with daily telephone interviews for 30 days. Treatment failure was defined by the need for a rescue treatment or hospitalization. Secondary outcomes were: duration of fever and symptoms and white blood cell and C-reactive protein responses. During Stage 1, 4/10 (40%) and 0/12 (0%) evaluable patients failed in the 3-day and 10-day arms, respectively (P = 0.16). Therefore, the 3-day arm was replaced by a 5-day arm (Stage 2). No failures occurred in the 5-day (n = 56) and 10-day (n = 59) arms. Overall, 4/10 (0%), 0/56 and 0/42 (0%) children failed in the 3-day, 5-day and 10-day arms, respectively (P < 0.001, 3-day versus 5-day or 10-day). Secondary outcomes were similar in the 5-day and 10-day arms. In 6- to 59-month-old outpatients with community-acquired alveolar pneumonia, a 5-day course with high-dose oral amoxicillin was not inferior to a 10-day course. The 3-day regimen may be associated with an unacceptable failure rate.

The Effects of Adult Day Services on Family Caregivers’ Daily Stress, Affect, and Health: Outcomes From the Daily Stress and Health (DaSH) Study

We examine the effects of use of adult day service (ADS) by caregivers of individuals with dementia (IWD) on daily stressors, affect, and health symptoms. Participants were interviewed for 8 consecutive days. On some days, the IWD attended an ADS program and on the other days caregivers provide most or all of the care at home. Participants were 173 family caregivers of IWDs using an ADS program. Daily telephone interviews assessed care-related stressors, noncare stressors, positive events, affect, and health symptoms. Multilevel models with data nested within persons were used to examine effects of ADS use on daily stressor exposure, affect, and health symptoms. Caregivers had lower exposure to care-related stressors on ADS days, more positive experiences, and more noncare stressors. ADS use lowered anger and reduced the impact of noncare stressors on depressive symptoms. The findings demonstrate that stressors on caregivers are partly lowered, and affect is improved on ADS days, which may provide protection against the effects of chronic stress associated with caregiving.

Daily work–family conflict and alcohol use: Testing the cross-level moderation effects of peer drinking norms and social support.

In the current study, we conducted daily telephone interviews with a sample of Chinese workers (N = 57) for 5 weeks to examine relationships between daily work-family conflict and alcohol use. Drawn from the tension reduction theory and the stressor-vulnerability model, daily work-family conflict variables were hypothesized to predict employees' daily alcohol use. Further, social variables (i.e., peer drinking norms, family support, and coworker support) were hypothesized to moderate the relationship between work-family conflict and alcohol use. Results showed that daily work-to-family conflict but not family-to-work conflict had a significant within-subject main effect on daily alcohol use. In addition, there was significant between-subject variation in the relationship between work-to-family conflict and alcohol use, which was predicted by peer drinking norms, coworker support, and family support. The current findings shed light on the daily health behavior consequences of work-family conflict and provide important theoretical and practical implications.

DAILY WORK STRESS AND ALCOHOL USE: TESTING THE CROSS‐LEVEL MODERATION EFFECTS OF NEUROTICISM AND JOB INVOLVEMENT

Employee alcohol use has been shown to be prevalent and have potential detrimental effects for both employees' health and work outcomes. In this study, we used a daily telephone interview to investigate the relationships between work stress and alcohol use in a sample of Chinese workers. The results from multilevel modeling showed that daily work stress was significantly related to daily alcohol use and desire to drink. Further, there were significant interindividual variations in the work stress–alcohol use/desire to drink relationships that were predicted by neuroticism and job involvement. Both theoretical and practical implications of this study are discussed.

Psychosocial and Biological Markers of Daily Lives of Midlife Parents of Children with Disabilities

Using daily telephone interviews, 82 midlife parents (mean age = 57.4) of children with disabilities (mean age = 29.9) were compared with a closely matched sample of unaffected parents (N = 82) to elucidate the daily experience of nonnormative parenting. In addition, salivary cortisol samples were obtained to examine whether parents of children with disabilities had dysregulated diurnal rhythms and the extent to which the amount of time spent with children was associated with divergent patterns of cortisol expression. We found that parents of children with disabilities had similar patterns of daily time use and similar likelihood of positive daily events as the comparison group, but they had elevated levels of stress, negative affect, and physical symptoms, all reported on a daily basis. In addition, their diurnal rhythm of cortisol expression differed significantly from the comparison group, a pattern that was strongest for parents of children with disabilities on days when they spent more time with their children.

Accuracy of recall of the items included in disease activity forms of Behçet’s disease: comparison of retrospective questionnaires with a daily telephone interview

The assessment of disease activity in Behçet's disease (BD), either by BD Current Activity Form (BDCAF) or Iranian BD Dynamic Measure (IBDDAM), depends largely on the history of the clinical features. Accuracy of recall of a retrospective questionnaire might influence its reliability to some extent. The aim of this study was to investigate whether patients with BD can recall the items included in both of the disease activity forms accurately. Twenty patients with BD completed a retrospective questionnaire that included BDCAF and IBDDAM, twice, 1 month apart. We made some modifications in the IBDDAM, while the BDCAF (revised 8.5.2002, GL) was applied in its original structure. In contrast to the original application of IBDDAM, in which the history obtained depends on the variable time period, all items of IBDDAM in the present study asked subjects to report their symptoms over the preceding 4 weeks. Furthermore, those IBDDAM items for which the operational definitions are not clearly provided by the developers, as well as the items that depend on the objective examination rather than the history, were not included. Concurrent daily data were collected for 2 months via telephone interview. The level of agreement between the retrospective responses and those extracted from daily recordings were quantified for each item using intraclass correlation coefficient (ICC). The agreement between the recalled and daily reports was good (ICCs>0.60) for the majority of items (oral and genital ulceration, skin lesions, arthralgia, arthritis, and eye involvement) included in BDCAF. Exceptions were gastrointestinal symptoms (ICCs<0.40) and headache (ICCs 0.40-0.50). With regard to the IBDDAM, all of the items examined had good agreement (ICCs>0.60), except for headache, for which the agreement was moderate (ICCs 0.40-0.50) for the first and poor (ICCs<0.40) for the second month. For most of the BD-related features questioned in the disease activity forms, patients provided reasonably accurate reports in comparison to information obtained from daily records. However, it should be kept in mind that the limitations of the study design need to be considered while interpreting the results of the present study. Notably, unlike its original application in which the assessment depends on the variable time period, IBDDAM used in the present study assessed the symptoms present during the month prior to the date of assessment. Therefore, our findings regarding IBDDAM cannot be applied to its original use. Furthermore, lack of patients in some of the symptom groups, as well as possible manipulation of recall with daily questioning, might have influenced our results to some extent.

Asking the Experts: Developing and Validating Parental Diaries to Assess Children’s Minor Injuries

The methodological issues involved in parental reporting of events in children’s everyday lives are discussed with reference to the development and validation of an incident diary, collecting concurrent data on minor injuries in a community study of children under eight years old. Eighty-two mothers participated in a comparison over nine days of daily tele-phone interviews and structured incident diaries. Telephone methods resulted in more missing data, and participants in both groups expressed a preference for the diary method. This diary was then validated on a sample of 56 preschool and school-aged children by comparing injury recording by a research health visitor with that of their mothers. Each failed to report some injuries, but there was good agreement overall, and in descriptive data on injuries reported by both. Parental diaries have the potential to provide rich data, of acceptable validity, on minor events in everyday life.

Meniett Clinical Trial: Long-term Follow-up

To delineate 2-year efficacy of Meniett device therapy in people with classic, unilateral, Ménière's disease unresponsive to traditional medical treatment. A 2-year long-term unblinded follow-up after a prior randomized, placebo-controlled, multicenter clinical trial of the Meniett device for Ménière's disease. Follow-up was performed remotely by using diaries and questionnaires mailed to the data coordinating center by the participants. Those who failed to mail their diaries were interviewed by telephone. Sixty-one study participants agreed to use the Meniett device and report their symptoms for 2 years. All had active, unilateral cochleovestibular disease. Outcomes are available for 58 participants; 2 were unavailable for follow-up and 1 was excluded because of a concurrent condition that precluded Meniett device use. Participants were advised to adhere to a low-sodium diet, use the Meniett device 3 times daily, and maintain a patent tympanostomy tube in the affected ear. Diuretic and vestibular suppressant medications were used as needed. Outcomes were based on the participants' daily diary, questionnaires, and telephone interviews. Three different analyses were prepared: tracking of vertigo frequency throughout the study, comparison of vertigo frequency before and at the end of Meniett device use (American Academy of Otolaryngology-Head and Neck Surgery Foundation reporting guideline), and Kaplan-Meier estimates of vertigo remission and recurrence. Vertigo levels gradually improved for most but not all participants. American Academy of Otolaryngology-Head and Neck Surgery Foundation class A (remission) or class B (greatly improved) results occurred in 67% (39/58) of participants, and class F (dropped out to receive surgical therapy) results occurred in 24%. Of the 44 nondropout participants, 39 (89%) had American Academy of Otolaryngology-Head and Neck Surgery Foundation group A or B outcomes. People who went into remission were highly likely (80%) to remain in remission long term; participants who achieved remission (20/43; 47%) did so within the first year of follow-up. Use of the Meniett device was associated with a significant reduction in vertigo frequency in about two thirds of the participants, and this improvement was maintained long term. Therapy with the Meniett device is a safe and effective option for people with substantial vertigo uncontrolled by medical therapy.

Mothers' mastery-oriented involvement in children's homework: Implications for the well-being of children with negative perceptions of competence.

This research examined the idea that parents' mastery-oriented practices while assisting children with homework are particularly beneficial for children with negative perceptions of their academic competence. One hundred fourteen mothers and children (8 to 12 years old) participated in a 2-wave study. At the 1st wave, mothers took part in a daily telephone interview in which they reported on the frequency and nature of their assistance with homework every weekday for 2 weeks. Children reported on multiple dimensions of their psychological functioning at the 1st wave in a daily telephone interview as well as in traditional questionnaires; children completed the questionnaires again 6 months later at the 2nd wave. Mothers' mastery-oriented practices while assisting with homework predicted enhanced psychological functioning both concurrently and longitudinally only among children with negative perceptions of their academic competence.

Chronic stressors and daily hassles: unique and interactive relationships with psychological distress.

Using daily telephone interviews of a U.S. national sample of adults, aged 25-74 (N = 1,031), the present analyses draw from theories of the stress process and recent research to examine how chronic role-related stressors and daily hassles affect psychological distress. Four separate hypotheses are examined. The first explores the association between chronic stressors and daily hassles. The second tests whether daily hassles function as an intervening variable between chronic stressors and psychological distress. The third tests whether a chronic stressor moderates the relationship between daily hassles and psychological distress. The fourth hypothesis tests for cross-domain effects of chronic stressors and daily hassles. Findings indicate that chronic stressors and daily hassles are distinct types of stressors with unique contributions to psychological distress. The study provides support for chronic home stressors functioning as a moderating factor on the relationship between daily hassles and psychological distress both within and across domains.