Distal Health Outcomes Research Articles

Developing Measures for and Testing the Theory of Communicative Disenfranchisement (TCD) in the Context of Chronic Pain

ABSTRACT The post-positivist articulation of the theory of communicative disenfranchisement (TCD) asserts that people subjected to disenfranchising talk (DT; talk that discredits, silences, and stereotypes) experience proximal consequences (PCs; reduced agency, perceived credibility, and ability to exercise rights and privileges) and make negative inferences about others’ future interactional goals (negative goal inferences [NGIs]). Through the mediators of PCs and NGIs, DT is theorized to lead to more distal health and well-being outcomes. This article developed measures of DT, PCs, and NGIs to test the TCD’s post-positivist model in the context of chronic pain. Items were developed and refined in a pilot study. Then, in two validation studies, exploratory and confirmatory factor analyses were conducted and health and well-being outcomes were assessed. Findings offer initial empirical support for the reliability and convergent, divergent, and predictive validity of the DT, PCs, and NGIs measures, as well as the model proposed in the post-positivist articulation of the TCD.

Activity and Participation Are Associated With Future Falls, Hospitalizations, and Emergency Visits in Community-Dwelling Older Adults.

Activity and participation are important for older adults as they are associated with well-being and quality of life. Falls, emergency department (ED) visits, and hospitalizations are adverse health outcomes that impact older adults. Limited research has investigated whether measurement of activity and participation are related to adverse health events in community dwelling older adults. This study sought to examine the association between activity and participation with falls, ED visits, and hospitalization over 1year in community dwelling older adults. A secondary analysis of a longitudinal clinical trial of 341 community dwelling older adults was conducted. The sample mean age was 80.9 (SD = 7.7) years and 83% were female. One-year risk of falls was associated with baseline Late Life Function and Disability Instrument (LLFDI) components of overall function and disability (frequency and limitations dimensions). Incident rate ratios (IRRs) and 95% CIs were calculated. For each five-point higher score (clinically meaningful difference) in activity as measured by LLFDI-overall function (adjusted for age, race, sex, comorbidities and fall history), there was an 18% lower rate of falls (IRR = 0.82, 95% CI = 0.74-0.92), 12% reduction in hospitalizations (IRR = 0.88; 95% CI = 0.77-0.99), and 11% lower rate of emergency room visits (IRR = 0.89, 95% CI = 0.81-0.98). Greater participation as measured by the LLFDI limitations dimension was related to fewer falls (IRR = 0.93, 95% CI = 0.87-1.00) and hospitalizations (IRR = 0.91, 95% CI = 0.83-0.99). Greater activity and participation are associated with a lower incidence of falls, ED visits, and hospitalizations representing an important consideration for targeted physical therapist interventions. Physical therapists are uniquely positioned to identify and address reduced activity and participation. If activity and participation are specifically targeted and improved through physical therapy, undesirable distal health outcomes might be prevented or minimized. Greater activity and participation were found to be related to lower rate of falls, ED visits, and hospitalizations in a sample of 341 older adults who lived in the community.

The Effect of Digital Mental Health Literacy Interventions on Mental Health: Systematic Review and Meta-Analysis.

Accelerated by technological advancements and the recent global pandemic, there is burgeoning interest in digital mental health literacy (DMHL) interventions that can positively affect mental health. However, existing work remains inconclusive regarding the effectiveness of DMHL interventions. This systematic review and meta-analysis investigated the components and modes of DMHL interventions, their moderating factors, and their long-term impacts on mental health literacy and mental health. We used a random-effects model to conduct meta-analyses and meta-regressions on moderating effects of DMHL interventions on mental health. Using 144 interventions with 206 effect sizes, we found a moderate effect of DMHL interventions in enhancing distal mental health outcomes (standardized mean difference=0.42, 95% CI -0.10 to 0.73; P<.001) and a large effect in increasing proximal mental health literacy outcomes (standardized mean difference=0.65, 95% CI 0.59-0.74; P<.001). Uptake of DMHL interventions was comparable with that of control conditions, and uptake of DMHL interventions did not moderate the effects on both proximal mental health literacy outcomes and distal mental health outcomes. DMHL interventions were as effective as face-to-face interventions and did not differ by platform type or dosage. DMHL plus interventions (DMHL psychoeducation coupled with other active treatment) produced large effects in bolstering mental health, were more effective than DMHL only interventions (self-help DMHL psychoeducation), and were comparable with non-DMHL interventions (treatment as usual). DMHL interventions demonstrated positive effects on mental health that were sustained over follow-up assessments and were most effective in enhancing the mental health of emerging and older adults. For theory building, our review and meta-analysis found that DMHL interventions are as effective as face-to-face interventions. DMHL interventions confer optimal effects on mental health when DMHL psychoeducation is combined with informal, nonprofessional active treatment components such as skills training and peer support, which demonstrate comparable effectiveness with that of treatment as usual (client-professional interactions and therapies). These effects, which did not differ by platform type or dosage, were sustained over time. Additionally, most DMHL interventions are found in Western cultural contexts, especially in high-income countries (Global North) such as Australia, the United States, and the United Kingdom, and limited research is conducted in low-income countries in Asia and in South American and African countries. Most of the DMHL studies did not report information on the racial or ethnic makeup of the samples. Future work on DMHL interventions that target racial or ethnic minority groups, particularly the design, adoption, and evaluation of the effects of culturally adaptive DMHL interventions on uptake and mental health functioning, is needed. Such evidence can drive the adoption and implementation of DMHL interventions at scale, which represents a key foundation for practice-changing impact in the provision of mental health resources for individuals and the community. PROSPERO International Prospective Register of Systematic Reviews CRD42023363995; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023363995.

LGBT sexuality and gender minority experiences of minority stress: a comparison of models and theories

Compelling evidence demonstrates that Lesbian, Gay, and Bisexual (LGB) populations have a higher prevalence of mental disorders compared to their heterosexual peers (Meyer in Psychol Bull 129(5):674–697, 2003). This has been attributed to minority stressors in the minority stress model. Since this model was established in 2003, there have been significant socio-political events that discriminate against SGM LGBTQ+ individuals. There have also been rival hypotheses, including rejection sensitivity (Feinstein in Arch Sex Behav 49(7):2247–2258, 2020) and ‘misperceiving of neutral events’ (Bailey in Arch Sex Behav 49(7):2265–2268, 2019). Examine SGM perspectives and investigate how well they align with Meyers model (2003). 16 qualitative studies capturing SGM minority stress experiences were extracted from scientific databases and, thematically analysed deductively using Meyer’s minority stress model, in addition to generating original subthemes. This systematic review thematically analysed 16 eligible studies, which generated 6 superordinate themes (Discrimination, Lack of representation, Navigation, Harassment, Depersonalization and Mental Health Outcomes) and 18 sub-themes. These themes were then situated in categories from Meyer’s Minority Stress Model (2003) (Circumstances, Minority Status, Distal stressors, Proximal stressors, and Mental health outcomes). SGM-specific stress experiences integrated into the Minority Stress Model (circumstances, navigation, distal, proximal, and mental health outcomes). The collected data elaborated the model with sub-themes such as discrimination, lack of representation, vigilance, depression, body image and positive coping in sum, this study offers support for and updates Meyer’s minority stress model whilst rejecting competing theories (Bailey 2019; Feinstein 2019).

Menu labeling and portion size control to improve the out‐of‐home food environment: A scoping review

AbstractBackgroundMenu labeling and portion size control interventions may be effective strategies to mitigate the health risks posed by the out‐of‐home food environment. We conducted this scoping review to map the body of evidence (BoE) addressing the effects of menu labeling and portion size control interventions in the out‐of‐home food environment and to summarize the research gaps in this evidence base.MethodsWe searched PubMed, Embase, Epistemonikos, and PROSPERO in phase 1 for systematic reviews (SRs) and PubMed and Embase in phase 2 for primary studies in areas with insufficient SR evidence. We used a comprehensive search strategy without any restrictions on publication date, language, study population characteristics or outcomes. We screened all titles independently and in duplicate. We mapped the number of systematic reviews providing evidence per intervention‐setting combination in a matrix. The gaps in the matrix informed the searches for primary studies in phase 2. For the included SR protocols and primary studies, we charted the population, intervention, comparator, outcome, period, and study design to facilitate their evaluation and inclusion in future evidence syntheses.ResultsWe included 69 completed SRs; 37 on menu labeling, 9 on portion size control, and 23 on both. The types of menu labeling interventions studied were quantitative nutrient information (74%), interpretational guidance (48%), or contextual guidance (13%). Most reviews were from the United States, United Kingdom, and Canada. Most SRs included studies in establishments like cafeterias (51%) or restaurants (39%) and measured change in the quantity of food offered/ordered/consumed (96%). Phase 2 search yielded 24 primary studies; 16 experimental, 6 quasi‐experimental, and 2 observational studies.ConclusionThe BoE on the effectiveness of menu labeling and portion size control is predominantly from the developed world, on nutrient information labeling and reporting impact on consumer food choice. There is a need for studies in the online environment and reporting distal health outcomes.

Problems Regarding Polypharmacy in Elderly in Indian Population

Among the general population, various international studies have shown that poly pharmacy is common in the older adults but those adults who were residing in nursing homes took the maximum number of drugs. It has also be shown that nearly half of the older adult population take one or more medications that are not medically necessary as per their conditions. According to various research, it has been clearly established that there is a strong association between multiple drug use and negative clinical consequences. In addition to that, conducting well-designed inter-professional intervention studies, which often include clinical pharmacists, that focus on enrolling high-risk older patients taking multiple medications with mixed results on distal health outcomes can improve the effectiveness of enhancing the overall quality of prescribing medications. It is critical to do research on poly pharmacy in a nation like India or other low to medium income countries. Poly pharmacy is induced by a multitude of variables at the levels of health-seeking, prescription, distribution, and usage. Society-based issues such as a lack of education and access to adequate healthcare in both rural and urban regions, as well as a general lack of health knowledge and passion, further aggravate the situation. Poly pharmacy is a key challenge in senior care. The senior population frequently has several medical diseases and may possibly suffer from cancer, which necessitates the use of multiple drugs for therapy. Multiple drugs used by an aged person can increase the likelihood of drug-drug interactions, noncompliance with the prescription, adverse drug responses, and reduced patient compliance.

Optimizing a Just-in-Time Adaptive Intervention to Improve Dietary Adherence in Behavioral Obesity Treatment: Protocol for a Microrandomized Trial.

BackgroundBehavioral obesity treatment (BOT) is a gold standard approach to weight loss and reduces the risk of cardiovascular disease. However, frequent lapses from the recommended diet stymie weight loss and prevent individuals from actualizing the health benefits of BOT. There is a need for innovative treatment solutions to improve adherence to the prescribed diet in BOT.ObjectiveThe aim of this study is to optimize a smartphone-based just-in-time adaptive intervention (JITAI) that uses daily surveys to assess triggers for dietary lapses and deliver interventions when the risk of lapse is high. A microrandomized trial design will evaluate the efficacy of any interventions (ie, theory-driven or a generic alert to risk) on the proximal outcome of lapses during BOT, compare the effects of theory-driven interventions with generic risk alerts on the proximal outcome of lapse, and examine contextual moderators of interventions.MethodsAdults with overweight or obesity and cardiovascular disease risk (n=159) will participate in a 6-month web-based BOT while using the JITAI to prevent dietary lapses. Each time the JITAI detects elevated lapse risk, the participant will be randomized to no intervention, a generic risk alert, or 1 of 4 theory-driven interventions (ie, enhanced education, building self-efficacy, fostering motivation, and improving self-regulation). The primary outcome will be the occurrence of lapse in the 2.5 hours following randomization. Contextual moderators of intervention efficacy will also be explored (eg, location and time of day). The data will inform an optimized JITAI that selects the theory-driven approach most likely to prevent lapses in a given moment.ResultsThe recruitment for the microrandomized trial began on April 19, 2021, and is ongoing.ConclusionsThis study will optimize a JITAI for dietary lapses so that it empirically tailors the provision of evidence-based intervention to the individual and context. The finalized JITAI will be evaluated for efficacy in a future randomized controlled trial of distal health outcomes (eg, weight loss).Trial RegistrationClinicalTrials.gov NCT04784585; http://clinicaltrials.gov/ct2/show/NCT04784585International Registered Report Identifier (IRRID)DERR1-10.2196/33568

This job is (literally) killing me: A moderated-mediated model linking work characteristics to mortality.

Research in applied psychology has found that job demands affect employee health outcomes. However, less is known about the mechanisms linking job demands to more distal health outcomes, such as death, and how other job characteristics (i.e., job control) and individual differences (i.e., cognitive ability) might buffer these relationships. Accordingly, we drew from theories from the work stress and medical literatures to argue that job control and cognitive ability moderate the positive relationship between job demands and the probability of mortality, via the mediating effects of poor physical (i.e., allostatic load) and mental health (i.e., depression) indicators. We tested our hypotheses using a 20-year time-lagged design in a sample of 3,148 individuals with mental health data (and a subsample of 754 with physical health data) from the Midlife in the United States Survey. We found that job control and cognitive ability buffered the positive relationship between job demands and poor mental health. Unexpectedly, we found that job control, but not cognitive ability, moderated the relationship between job demands and physical health, such that job demands were related to better physical health under conditions of high control, and unrelated to physical health under conditions of low control. In turn, physical and mental health mediated the moderated (by job control and cognitive ability) job demands-mortality relationship. Our findings suggest that job demands relate to death differentially via physical and mental health, and that these relationships are bounded in unique ways by job control and cognitive ability. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Effect of Long-Term Changes in Daily Stress Processes on Prospective Health: An Application of Three-Level SEM

The study of change over time, contexts, cohorts, and people is influenced by the sampling of observations within longitudinal studies. Intensive measurement designs, embedded within long-term longitudinal studies, provide new opportunities to understand changes in dynamic processes, as well as determinants and consequences of these changes over time. The present investigation examined whether short-term dynamic associations accounted for individual differences in prospective health functioning. We used measurement burst data from the National Study of Daily Experiences subsample (N = 2485) embedded within the Midlife in the United States longitudinal study. Two measurement bursts were separated by ten years, with each containing daily measures of stress and affect across eight consecutive days. Functional health was measured by basic and instrumental activities of daily living at three measurement waves spanning 20 years. Three-level structural equation models were fit to simultaneously model short-term within-person associations between stress and affect (i.e., stress reactivity) and long-term changes in these associations over the ten year period. Individual differences in long-term changes of the short-term dynamic association predicted both basic and instrumental activities of daily living at 20 year follow-up (estimate = 5.26, SE = 2.54, p < .01; and estimate = 5.48, SE = 2.81, p < .01, respectively). These effects were present after adjusting for mean levels of both stress and affect. We highlight how characterizing individuals based on the strength of their within-person associations across multiple time scales can be informative in predicting distal health outcomes.

Machine Learning-Based DNA Methylation Score for Fetal Exposure to Maternal Smoking: Development and Validation in Samples Collected from Adolescents and Adults.

Background:Fetal exposure to maternal smoking during pregnancy is associated with the development of noncommunicable diseases in the offspring. Maternal smoking may induce such long-term effects through persistent changes in the DNA methylome, which therefore hold the potential to be used as a biomarker of this early life exposure. With declining costs for measuring DNA methylation, we aimed to develop a DNA methylation score that can be used on adolescent DNA methylation data and thereby generate a score for in utero cigarette smoke exposure.Methods:We used machine learning methods to create a score reflecting exposure to maternal smoking during pregnancy. This score is based on peripheral blood measurements of DNA methylation (Illumina’s Infinium HumanMethylation450K BeadChip). The score was developed and tested in the Raine Study with data from 995 white 17-y-old participants using 10-fold cross-validation. The score was further tested and validated in independent data from the Northern Finland Birth Cohort 1986 (NFBC1986) (16-y-olds) and 1966 (NFBC1966) (31-y-olds). Further, three previously proposed DNA methylation scores were applied for comparison. The final score was developed with 204 CpGs using elastic net regression.Results:Sensitivity and specificity values for the best performing previously developed classifier (“Reese Score”) were 88% and 72% for Raine, 87% and 61% for NFBC1986 and 72% and 70% for NFBC1966, respectively; corresponding figures using the elastic net regression approach were 91% and 76% (Raine), 87% and 75% (NFBC1986), and 72% and 78% for NFBC1966.Conclusion:We have developed a DNA methylation score for exposure to maternal smoking during pregnancy, outperforming the three previously developed scores. One possible application of the current score could be for model adjustment purposes or to assess its association with distal health outcomes where part of the effect can be attributed to maternal smoking. Further, it may provide a biomarker for fetal exposure to maternal smoking. https://doi.org/10.1289/EHP6076

Association of Positive Affect Instability With All-Cause Mortality in Older Adults in England

There is increasing recognition that positive affective states have a protective association for all-cause mortality. However, positive states of happiness and excitement vary over time, and little is known about the association of fluctuations in positive affect with survival. To investigate the association of positive affect instability, conceptualized as fluctuations in momentary positive affect, with mortality in a population-based sample of older adults in England. This survey study used data from a longitudinal survey collected in wave 2 (2004) of the English Longitudinal Study of Ageing, a nationally representative sample of older men and women living in England, with follow-up continuing until March 2018. Participants included people aged 50 years or older at recruitment. Data were analyzed from September 2019 to April 2020. The main outcome was all-cause mortality. Positive and negative affect were measured at 4 time points over the course of 1 day: soon after waking, 30 minutes after waking, at 7:00 pm, and at bedtime. Data were analyzed from 3834 participants (mean [SD] age at baseline, 64.0 [7.4] years; 2082 [54.3%] women) with a mean (SD) follow-up of 12.25 (2.60) years. Adjusting for demographic characteristics, baseline illness, health behaviors, and mean level and instability in negative affect, Cox proportional hazards regression showed that high positive affect instability was associated with greater mortality, with a hazard ratio of 1.25 (95% CI, 1.04-1.49; P = .02). Associations did not differ by age, suggesting that the increased mortality risk associated with high positive affect instability was not restricted to older ages. These findings suggest that temporal fluctuations in positive affect were associated with mortality risk in older adults. These findings illustrate the value of incorporating dynamic assessments of positive affect in distal health outcomes such as mortality.

Association Between Improved Mobility and Distal Health Outcomes.

We examined the association between improved mobility and distal health outcomes in older adults using secondary analysis of data from a cluster-randomized controlled group exercise trial. Participants were 303 men and women aged ≥65 and older in 32 independent living facilities, senior apartments, and community centers who participated in 12-week group exercise interventions. Included were those who completed ≥1 follow-up phone call regarding outcomes assessment in the following year. Gait speed and 6-minute walk distance (6MWD) were assessed at baseline and immediately after 12-week interventions to determine mobility performance change status. Falls, emergency department (ED) visits, and hospitalizations were assessed monthly for 12 months following the end of interventions via interactive voice response phone calls. Incident rate ratios (IRRs) were calculated to quantify incidence of adverse outcomes with respect to mobility performance change. Each 0.05 m/s increase in gait speed resulted in an 11% reduction in falls (IRR = 0.89; 95% confidence interval [CI], 0.84-0.94; p < .0001); a similar decrease was seen for each 20 m increase in 6MWD (IRR = 0.89; 95% CI, 0.83-0.93; p = .0003). Those who improved gait speed had 61 falls per 1,000 person-months versus 135 in those who had no change/a decline. Those who improved 6MWD had 67 falls per 1,000 person-months versus 110 per 1,000 person-months in those who had no change/a decline. Differences in ED visits and hospitalizations were not statistically significant. Improvements in mobility performance are associated with lower incidence of future falls. Given the exploratory nature of the findings, further investigation is warranted.

Translating Workforce Development Policy Interventions for Community Health Workers: Application of a Policy Research Continuum.

There is a need for knowledge translation to advance health equity in the prevention and control of cardiovascular disease and type 2 diabetes. One recommended strategy is engaging community health workers (CHWs) to have a central role in related interventions. Despite strong evidence of effectiveness for CHWs, there is limited information examining the impact of state CHW policy interventions. This article describes the application of a policy research continuum to enhance knowledge translation of CHW workforce development policy in the United States. During 2016-2019, a team of public health researchers and practitioners applied the policy research continuum, a multiphased systematic assessment approach that incorporates legal epidemiology to enhance knowledge translation of CHW workforce development policy interventions in the United States. The continuum consists of 5 discrete, yet interconnected, phases including early evidence assessments, policy surveillance, implementation studies, policy ratings, and impact studies. Application of the first 3 phases of the continuum demonstrated (1) how CHW workforce development policy interventions are linked to strong evidence bases, (2) whether existing state CHW laws are evidence-informed, and (3) how different state approaches were implemented. As a knowledge translation tool, the continuum enhances dissemination of timely, useful information to inform decision making and supports the effective implementation and scale-up of science-based policy interventions. When fully implemented, it assists public health practitioners in examining the utility of different policy intervention approaches, the effects of adaptation, and the linkages between policy interventions and more distal public health outcomes.

The Effects of Multi-Component Exercise Training on Cognitive Functioning and Health-Related Quality of Life in Older Adults.

Exercise has been shown to have various proximal and distal benefits among older adults such as improving physical fitness, cognitive functioning, and health-related quality of life (HR-QOL). Despite this evidence, limited research has investigated pathway change of these outcomes. The primary purpose of this study was to test if older adults who improved in physical fitness measures from engaging in multicomponent exercise training for 12 weeks predicted change in proximal (cognitive functioning) and distal (HR-QOL) outcomes, respectively. Participants (n = 110) were healthy, older adults (M = 72, SD = 7.24) that comprised an exercise-intervention and control group. The intervention consisted of exercising in a supervised laboratory setting for 12weeks. Structural equation modeling revealed group type to predict change in physical performance and the maximum walking test with comparable effect sizes. Physical performance in turn predicted improvement in processing speed (β = 0.23, p = 0.013) executive functioning (β = 0.26, p = 0.006), and HR-QOL (β = 0.13, p = 0.031). However, only executive functioning was found to significantly predict HR-QOL (β = 0.49, p < 0.001) over processing speed (p > 0.05). Between two fitness measures, the physical performance test demonstrated better predictive validity in proximal and distal health outcomes. In addition to physical fitness, older adults who engage in multi-component exercise sessions regularly can improve their executive functioning, which in turn enhances their HR-QOL.

Effectiveness of Universal Self-regulation–Based Interventions in Children and Adolescents

Childhood and adolescence self-regulation (SR) is gaining importance as a target of intervention because of mounting evidence of its positive associations with health, social and educational outcomes. To conduct a systematic review and meta-analysis of rigorously evaluated interventions to improve self-regulation in children and adolescents. Keyword searches of the PsycINFO, PubMed, EMBASE, CINAHL Plus, ERIC, British Education Index, Child Development and Adolescent Studies, and CENTRAL were used to identify all studies published through July 2016. To be eligible for this review, studies had to report cluster randomized trials or randomized clinical trials, evaluate universal interventions designed to improve self-regulation in children and adolescents aged 0 to 19 years, include outcomes associated with self-regulation skills, and be published in a peer-reviewed journal with the full text available in English. A total of 14 369 published records were screened, of which 147 were identified for full-text review and 49 studies reporting 50 interventions were included in the final review. Results were summarized by narrative review and meta-analysis. Self-regulation outcomes in children and adolescents. This review identified 17 cluster randomized trials and 32 randomized clinical trials evaluating self-regulation interventions, which included a total of 23 098 participants ranging in age from 2 to 17 years (median age, 6.0 years). Consistent improvement in self-regulation was reported in 16 of 21 curriculum-based interventions (76%), 4 of the 8 mindfulness and yoga interventions (50%), 5 of 9 family-based programs (56%), 4 of 6 exercise-based programs (67%), and 4 of 6 social and personal skills interventions (67%), or a total of 33 of 50 interventions (66%). A meta-analysis evaluating associations of interventions with self-regulation task performance scores showed a positive effect of such interventions with pooled effect size of 0.42 (95% CI, 0.32-0.53). Only 24 studies reported data on distal outcomes (29 outcomes). Positive associations were reported in 11 of 13 studies (85%) on academic achievement, 4 of 5 studies on substance abuse (80%), and in all studies reporting on conduct disorders (n = 3), studies on social skills (n = 2), studies on depression (n = 2), studies on behavioral problems (n = 2), and study on school suspensions (n = 1). No effect was seen on 2 studies reporting on academic achievement, 1 study reporting on substance abuse, and 1 additional study reporting on psychological well-being. A wide range of interventions were successful in improving self-regulation in children and adolescents. There was improvement in distal academic, health, and behavioral outcomes in most intervention groups compared with controls.

Impact of cancer survivorship care plans (SCPs) on health outcomes and health care delivery: A systematic review.

2 Background: In 2006, the Institute of Medicine recommended that patients at or near completion of active treatment be provided with a SCP (treatment summary, relevant health information, and follow-up care plan) to improve care delivery and outcomes in the post-treatment period. We systematically reviewed published research to determine if SCPs have a positive impact on health outcomes and healthcare delivery. Methods: Randomized and nonrandomized studies evaluating patient-reported outcomes, healthcare utilization, and disease outcomes after delivery of SCPs were identified by searching MEDLINE, Embase, PsycINFO, and Cochrane Library. Data were extracted by independent raters and summarized based on qualitative synthesis. Results: Eleven nonrandomized and 13 randomized studies met inclusion criteria. Variability was evident across studies in cancer diagnoses, timing of SCP delivery in relation to treatment completion, SCP delivery method and recipients, SCP content, SCP-related counseling, and outcomes assessed. Findings from nonrandomized studies yielded descriptive information only on outcomes such as satisfaction with care and reactions to SCPs. Among randomized studies, findings were near uniformly negative for the impact of SCPs on the most commonly assessed outcomes (physical, functional, and psychological well-being); findings were positive in single studies for other outcomes including amount of information received, satisfaction with care, and physician implementation of recommended survivorship care. Conclusions: Existing research provides minimal evidence that SCPs improve quality of life in cancer survivors. Possible explanations include heterogeneity in study designs and the low likelihood that SCP delivery alone would influence distal health outcomes. Findings are very limited but more positive for proximal outcomes (e.g., information received) and for care delivery, especially when SCPs are accompanied by counseling to prepare survivors for future clinical encounters. In light of current findings, future research should focus to a greater extent on evaluating ways to ensure SCP recommendations are subsequently implemented as part of ongoing care.

Impact of Participatory Health Research: A Test of the Community-Based Participatory Research Conceptual Model

Objectives A key challenge in evaluating the impact of community-based participatory research (CBPR) is identifying what mechanisms and pathways are critical for health equity outcomes. Our purpose is to provide an empirical test of the CBPR conceptual model to address this challenge. Methods A three-stage quantitative survey was completed: (1) 294 US CBPR projects with US federal funding were identified; (2) 200 principal investigators completed a questionnaire about project-level details; and (3) 450 community or academic partners and principal investigators completed a questionnaire about perceived contextual, process, and outcome variables. Seven in-depth qualitative case studies were conducted to explore elements of the model not captured in the survey; one is presented due to space limitations. Results We demonstrated support for multiple mechanisms illustrated by the conceptual model using a latent structural equation model. Significant pathways were identified, showing the positive association of context with partnership structures and dynamics. Partnership structures and dynamics showed similar associations with partnership synergy and community involvement in research; both of these had positive associations with intermediate community changes and distal health outcomes. The case study complemented and extended understandings of the mechanisms of how partnerships can improve community conditions. Conclusions The CBPR conceptual model is well suited to explain key relational and structural pathways for impact on health equity outcomes.

Criterion and Divergent Validity of the Sexual Minority Adolescent Stress Inventory

Sexual minority adolescents (SMA) consistently report health disparities compared to their heterosexual counterparts, yet the underlying mechanisms of these negative health outcomes remain unclear. The predominant explanatory model is the minority stress theory; however, this model was developed largely with adults, and no valid and comprehensive measure of minority stress has been developed for adolescents. The present study validated a newly developed instrument to measure minority stress among racially and ethnically diverse SMA. A sample of 346 SMA aged 14–17 was recruited and surveyed between February 2015 and July 2016. The focal measure of interest was the 64-item, 11-factor Sexual Minority Adolescent Stress Inventory (SMASI) developed in the initial phase of this study. Criterion validation measures included measures of depressive symptoms, suicidality and self-harm, youth problem behaviors, and substance use; the general Adolescent Stress Questionnaire (ASQ) was included as a measure of divergent validity. Analyses included Pearson and tetrachoric correlations to establish criterion and divergent validity and structural equation modeling to assess the explanatory utility of the SMASI relative to the ASQ. SMASI scores were significantly associated with all outcomes but only moderately associated with the ASQ (r = −0.13 to 0.51). Analyses revealed significant associations of a latent minority stress variable with both proximal and distal health outcomes beyond the variation explained by general stress. Results show that the SMASI is the first instrument to validly measure minority stress among SMA.

Systematic review of effectiveness of universal self-regulation-based interventions and their effects on distal health and social outcomes in children and adolescents: review protocol

BackgroundGrowing evidence suggests that childhood and adolescence self-regulation contributes to multiple health, educational and social outcomes. Considering the potential impact of self-regulation skills on improved life chances in conjunction with evidence suggesting that self-regulation can be modified by interventions, there is a need to identify interventions which are most effective in improving childhood and adolescence self-regulation. The present systematic review was designed to determine the effectiveness of universal interventions focused on enhancing the self-regulation of children and adolescents. As secondary outcomes, we will also examine the effectiveness of such interventions on distal health and social outcomes.MethodsEligible studies include randomised controlled trials (including cluster randomised trials) reporting on universal interventions designed to improve self-regulation in childhood and adolescence (age 0–19 years). The following databases will be searched for peer-reviewed publications using an iterative search strategy: Medline, PsycINFO, EMBASE, ERIC, CINAHL Plus, British Education Index, Child Development & Adolescent Studies and CENTRAL without applying language or date filters. Additionally, reference lists and citations of included studies will be searched for eligible studies. A 10% proportion of the total titles and abstracts will be randomly selected and screened independently by two reviewers (AP and DH). Results will be compared to ensure less than 5% discrepancy, followed by screening of all results by one reviewer (AP). Full-text review and data collection will be independently performed by two reviewers. Any discrepancies will be solved by mutual discussion, and if unresolved, a third reviewer (RV) will be consulted. Meta-analysis will be conducted to quantify trial effects, if the data is sufficiently homogenous to allow quantitative synthesis. Otherwise, results will be described narratively.DiscussionThe evidence derived from the systematic review will strengthen the evidence base to inform planning of effective interventions targeting self-regulation skills in childhood and adolescence. This will benefit policy makers, academicians, researchers, health professionals, and also, young people who will benefit from policy and interventions informed by this review.Systematic review registrationCRD42016047661.

Translating Genetic Research into Preventive Intervention: The Baseline Target Moderated Mediator Design.

In this paper we present and discuss a novel research approach, the baseline target moderated mediation (BTMM) design, that holds substantial promise for advancing our understanding of how genetic research can inform prevention research. We first discuss how genetically informed research on developmental psychopathology can be used to identify potential intervention targets. We then describe the BTMM design, which employs moderated mediation within a longitudinal study to test whether baseline levels of intervention targets moderate the impact of the intervention on change in that target, and whether change in those targets mediates causal impact of preventive or treatment interventions on distal health outcomes. We next discuss how genetically informed BTMM designs can be applied to both microtrials and full-scale prevention trials. We use simulated data to illustrate a BTMM, and end with a discussion of some of the advantages and limitations of this approach.