Family Stress Research Articles

Families of austerity: benefit cutbacks and family stress in the UK

Abstract Benefit cutbacks have been prominent after the Great Recession. The Family Economic Stress Model (FESM) theorizes how financial losses such as those spurred by cutbacks might adversely affect parental and child well-being. Yet, few links with policy have been established. We extend current knowledge by comprehensively assessing how benefits cutbacks may affect parents and their adolescent children. We rely on the first ten waves of the UK Household Longitudinal Study (2009–2019) and an event-study approach to examine the aftermath of an exceptional raft of benefit cutbacks. We find that mothers with lower incomes and single mothers accumulated losses equal to 20–30 percent of their household benefit income. Mothers could not fully compensate for such benefit income losses via their extra earnings, despite increased workforce participation. Financial worries, some forms of material hardship, and mental health worsened among mothers with lower incomes and single mothers exposed to cutbacks. Adolescent socio-emotional difficulties also increased in the period. We find little evidence, though, that cutbacks disrupted parenting. Parents thus display more agency than that accorded by the FESM. Nonetheless, findings point to deepening socioeconomic divides in financial and mental well-being, questioning the rationale for cutbacks.

Progressive Muscle Relaxation on Family Anxiety with Hypertension

Since hypertension is a chronic condition, long-term care is required. Anxiety within the family is one of the ways that long-term care and the possibility of complications impact the loving family. Extended family stress may lead to subpar treatment for hypertensive individuals, which will impact their pulse. The purpose of this study was to examine what increasing muscle relaxation meant for the anxiety levels of hypertensive families. Analytical methods are utilized in this kind of quasi-experimental study. All households with family members who experience the ill effects of hypertension are the target population. samples from 35 participants in the control group and another 35 participants in the experimental group. The HARS questionnaire was the tool used to gauge the level of anxiety. Using the SPSS software, data management employed the Wilcoxon Signed Ranks Test at a significance threshold of <α (0.05). The outcomes demonstrated that gradual muscle relaxation had an impact on the anxiety levels of the experimental group's families with hypertension. ρ = 0.000 (0.000 <0.05) was the result of the Wilcoxon sign rank test at a significance level of 0.05. The control group's Wilcoxon sign rank test result, at a significance level of 0.05, was ρ = 1.000 (1.000 > 0.05), indicating no effect of progressive muscle relaxation on anxiety. According to the study's findings, gradual muscular relaxation can diminish anxiety. To bring down anxiety levels, this technique can be utilized as a non-pharmacological therapy.

Resilience of Family Caregivers of People With Dementia in South Korea: A Scoping Review.

Due to rapid increases in the number of Korean people with dementia, dementia has become a priority health issue in South Korea. Likewise, the well-being of family caregivers of people with dementia has also become an issue of concern. However, little is known about the resilience of Korean family caregivers because there is a lack of review studies from a Korean cultural perspective about the resilience of family caregivers of people with dementia. The purpose of this scoping review was to investigate quantitative studies related to resilience theories, measurement instruments, correlates and resilience interventions for family caregivers of people with dementia. This review was conducted according to the Joanna Briggs Institute based on Arksey and O'Malley. Nine databases were searched to retrieve evidence published in English or Korean between January 2000 and September 2022. Studies with a quantitative research design reporting the resilience of family caregivers of people with dementia based on a resilience theory framework were included. A total of 13 studies were included in this review. All studies used either a modified McCubbin and McCubbin's family stress, adjustment and adaptation model or Walsh's family resilience model. All resilience instruments were used without cross-cultural adaptation. Family adaptation, social support, life satisfaction, family (di)stress and caregiver burden were associated with resilience among family caregivers. A few family resilience-enhancing programmes showed a positive effect on caregiver resilience. This review noted that all the resilience measures documented in this study need to test for cultural adaptation in a Korean context. Further research is required to develop and implement family-based, culturally tailored interventions to effectively enhance Korean resilience for family caregivers of people with dementia. Gerontological nurses should include Korean family caregivers in their nursing care and assess whether family caregivers have depression or suicidal thoughts to promote better health outcomes for caregivers and their family members.

Child Life through the Lens of Family Stress Theory and Family Systems Theory

Certified Child Life Specialists (CCLS) are an integral part of the healthcare team, who address children and families’ psychosocial needs and help children and families cope throughout their healthcare experiences. The history of child life, description of the interventions provided by Certified Child Life Specialists, and educational preparation needed for child life certification will be discussed. Certified Child Life Specialists use family science theories in their interventions with patients and families. Two of the family science theories that influence assessments and interventions are family stress theory (Boss, 1988; Hill, 1949; McCubbin & Patterson, 1983) and family systems theory (Smith & Hamon, 2022). Certified Child Life Specialists utilize these theories to provide support to families and create resources for positive coping and adjustment to their hospital experience. These theories will be discussed, and case studies will be examined to illustrate how Certified Child Life Specialists integrate these theories into their practice.

Healthcare Provider's Preferences on Open Versus Restricted Visiting Hours in Surgical Intensive Care Unit.

The increasing consideration of open visiting hours in intensive care units (ICUs) has presented implementation challenges. Recognizing the invaluable insights of healthcare providers, this study aimed to assess their perspectives on the potential impact of altering ICU visiting policies on patient care. In a single-institution, cross-sectional study, a five-point Likert survey was administered to healthcare providers working in a surgical ICU to assess their perceptions of open and restricted visiting hours. Descriptive statistics were used to analyze the responses. Ninety-three healthcare providers participated, including nurses (53%), resident physicians (23%), and other healthcare professionals. The majority (81%) did not believe that open ICU visiting hours would enhance patient-centered care. Providers expressed concerns that open visitation could lead to increased provider stress (89%), physical barriers to patient access (80%), disruption in workflow (90%), and provider burnout (76%). Conversely, they perceived that restricted visitation would preserve patient privacy (87%), promote better healing for patients (64%), reduce provider stress (81%), and improve workflow (95%). Nurses were more likely than resident physicians to perceive that open ICU hours would alleviate familial stress (p=0.022). Additionally, both nurses and other healthcare providers recognized the potential for open ICU hours to improve communication between patient families and healthcare teams (p<0.05). Notably, there were no significant differences among providers in perceptions of the impact of open versus restricted visitation on provider stress, workflow, or other factors (p>0.05). This survey reveals a negative perception of open ICU visiting hours among healthcare providers in a surgical ICU, with concerns that such a change could increase stress for both patients and providers. These findings underscore the potential challenges and negative impacts of implementing open visiting hours in this setting, emphasizing the need for careful consideration and further research to inform policy decisions and visitation practices.

Could a Growth Mindset Attenuate the Link Between Family Socioeconomic Status and Depressive Symptoms? Evidence from Chinese Adolescents.

The alleviating effects of a growth mindset on depression are promising. However, whether a growth mindset can attenuate the effect of low family socioeconomic status (SES) on depressive symptoms among adolescents remains unknown. Based on the Family Stress Model, the current study explores whether a growth mindset could moderate the associations between family SES, interparental conflict, and adolescent depressive symptoms. The participants were 1572 Chinese adolescents (Mage = 13.35 years, SD = 1.16, 51.84% female). They completed the family SES questionnaire, Children's Perceptions of Interparental Conflict scale, Growth Mindset scale, and Center for Epidemiologic Studies Depression scale. We tested the moderation, mediation, and moderated mediation models using the SPSS macro program PROCESS. A growth mindset moderated the association between family SES and depressive symptoms. Family SES was significantly related to depressive symptoms in adolescents with a lower growth mindset, but not in those with a higher growth mindset. After incorporating the mediating effect of interparental conflict, the growth mindset did not exert a significant moderating influence on the direct path; however, it significantly moderated the mediating effect of interparental conflict on depressive symptoms. Specifically, while a lower growth mindset in adolescents was associated with an increased risk of depressive symptoms due to interparental conflict, those with a higher growth mindset showed a less pronounced effect. A growth mindset attenuates the link between family SES and depressive symptoms among adolescents. These findings highlight the benefits of a growth mindset on mental health, especially for low-SES adolescents.

Trajectories of maternal parenting stress and adolescent behavioral symptoms in unmarried families: The role of family immigration status

BackgroundMaternal parenting stress during childhood may have important influences on offspring internalizing and externalizing behaviors during adolescence in unmarried households, but it is unclear whether effects differ across different trajectory patterns of maternal parenting stress and for native-born vs. immigrant families. MethodsUsing data from the Future of Families and Child Wellbeing Study, we identified trajectory patterns of maternal parenting stress from ages 1–9 years using semi-parametric group-based trajectory modeling. We used negative binomial regression models to estimate associations between maternal parenting stress trajectories and adolescent behavioral symptoms at age fifteen. ResultsFive maternal parenting stress trajectory groups were identified among the 1982 unmarried families included in this study, representing consistently low (9.2 %), consistently mild (54.2 %), moderate and decreasing (14.4 %), moderate and increasing (16.0 %) and consistently high (6.2 %) levels of maternal parenting stress. For adolescent internalizing symptoms, all maternal parenting stress trajectory groups exhibited higher symptoms compared to the consistently low group: IRR for consistently mild: 1.21 (95 % CI: 0.98–1.56); IRR for moderate/decreasing: 1.34 (95 % CI: 1.04–1.74); IRR for moderate/increasing: 1.62 (95 % CI: 1.28–2.13); and IRR for consistently high: 1.74 (95 % CI = 1.29–2.41). Similar results were observed for adolescent externalizing symptoms. Stronger effects of maternal parenting stress trajectories on adolescent externalizing symptoms were observed among native-born vs. immigrant families. LimitationsDifferential attrition and same-source bias may lead to under- or over-estimation of the associations of interest. ConclusionsInterventions targeting unmarried families with elevated maternal parenting stress during childhood may reduce behavioral symptoms in adolescence.

African descent populations in the United States are not monolithic: A scoping review of African immigrants' mental health and coping strategies.

African immigrants in the United States have unique experiences and stressors, resulting in diverse outcomes and disparities. As such, examining the effects of cultural stressors (e.g., discrimination, the negative context of reception, bicultural stress) on immigrant populations' mental health can provide a useful framework for explaining and identifying malleable targets to reduce African immigrants' health disparities. This review mapped conceptual and methodological knowledge of cultural stress in African immigrants by applying the cultural stress theoretical framework to reveal (a) what we currently know about the impact of cultural stressors on African immigrants' mental health and (b) coping strategies African immigrants utilize to persist in achieving positive health outcomes. Conforming to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review guidelines, this scoping review spans five interdisciplinary, health-focused databases and includes peer-reviewed articles published in English since 1980. Covidence software was used to screen 2095 articles, review 129 full-text records, and extract data from the 22 studies that met criteria and focused on mental health. Participant and study characteristics (i.e., country of origin, generation, methodology, duration) are highlighted. The impact of discrimination on African immigrants' mental health was the dominant research focus. Congruent with cultural stress theory, negative context, bicultural stress, and immigration-related familial stress also negatively impact their mental health. Nevertheless, African immigrants utilize various coping strategies to achieve positive outcomes. Mapping the existing evidence of immigrant cultural stress and mental health elucidates gaps for research and demonstrates that culturally relevant interventions ought to address immigration-related stressors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Emotional competences as predictors of psychological wellbeing and quality of life of supplementary grandparents caregivers.

Grandparents are increasingly becoming key figures in the supplementary care of grandchildren. Based on the Resilience Model of Family Stress, Adjustment and Adaptation, the present study aims to analyze the emotional competences that canpl predict higher levels of psychological wellbeing and quality of life in supplementary grandparents caregivers. A sample of 270 supplementary grandparents caregivers living in Spain participated. Most participants were women (71.1%), and the mean age was 67.83 years (SD = 6.26). Most participants were occasional caregivers, that is, they care for less than 10 h per week (76.3%). We conducted hierarchical multiple regression analysis, one for psychological wellbeing and the other for quality of life. The regression model for psychological wellbeing identified that age, management of caregiving stress, self-confidence in the caregiving role, management of work-life balance difficulties and emotional self-regulation explained 32.8% of its variance. The regression model for quality of life showed that age, type of grandparent caregiver, management of caregiving stress, management of work-life balance difficulties and emotional self-regulation explained 31.2% of its variance. This study focuses on supplementary grandparents caregivers, whereas literature has tended to look at primary grandparents caregivers. The results highlight the role of emotional competences as predictors of supplementary grandparents caregivers' psychological wellbeing and quality of life, overcoming the usual tendency in the literature to focus on the negative consequences of grandparents caregiving for grandchildren, and emphasizing the competences that grandparents have to cope with this care in a satisfactory way, which, moreover, can be trained.

Exploring the varied effects of occupational and family stress on sleep quality in military personnel on islands: a cross-sectional study in China

Exploring the varied effects of occupational and family stress on sleep quality in military personnel on islands: a cross-sectional study in China

Childhood Family Stress and Women's Health: Parasympathetic Activity as a Risk and Resiliency Factor.

Childhood family stress (CFS) exacerbates risk for physical health problems across the lifespan. Health risks associated with CFS are particularly relevant for women who tend to endorse more CFS than men. Importantly, some evidence suggests that individuals may vary in their susceptibility to CFS. Parasympathetic activity, which helps to regulate automatic bodily activity (e.g., breathing, digestion), has been proposed to represent a marker of plasticity to environmental exposure. However, no research to date has tested whether parasympathetic activity may modulate the impact of early adversity on health. We examined whether parasympathetic activity would moderate the link between CFS and health complaints in a sample of 68 undergraduate women (Mean age = 19.44). Participants self-reported CFS and health complaints. Parasympathetic activity was indexed using high-frequency heart rate variability (HF-HRV) and was evaluated by measuring changes in HF-HRV in response to and following a laboratory-based stress induction. Multiple regression analyses indicated that CFS was significantly associated with more health complaints. Further, HF-HRV in response to stress and during recovery relative to baseline significantly moderated relationship between CFS and health complaints. Specifically, more CFS was significantly associated with more health complaints among women who showed mean or greater decreases in HF-HRV in response to stress. Additionally, lower levels of CFS were associated with fewer health complaints among women who showed mean or greater HF-HRV during recovery relative to baseline. Findings highlight the importance of parasympathetic activity in modulating stress-health links.

Protective effect of social support: A longitudinal application of Family Stress Model

Mothers’ economic hardship is found to be positively associated with maternal depressive symptoms and depressed mothers are more likely to experience more parenting stress. Research shows that social support might be particularly beneficial for these families, however there are competing views on whether protective factors need to demonstrate direct or moderating effects. Thus, we examined whether the association between income-to-needs and mothers’ parenting stress is mediated via economic pressure and maternal depressive symptoms. Then, we tested the potential protective effect of social support, one model with the main effects and another model with moderating effects. The sample included 3001 mothers from the Future of Families and Child Wellbeing Study. Results demonstrated that the association between income-to-needs ratio and parenting stress was significantly and serially mediated by economic pressure and depressive symptoms. Further, the main effects of social support were significant, however none of the interaction effect of social support were significant. The results suggest that the social support has direct positive effects in decreasing maladaptive outcomes, but it did not buffer earlier experiences of risks. Given the important role social support plays in low-income families with mothers who might be depressed and highly stressed, it can be specifically targeted in prevention and intervention programs.

Dynamic self-regulation and coregulation of respiratory sinus arrhythmia in mother-child and father-child interactions: Moderating effects of proximal and distal stressors.

This study examined how proximal and distal familial stressors influenced the real-time, dynamic individual and dyadic regulation of respiratory sinus arrhythmia (RSA) in mother-preschooler and father-preschooler interactions in at-risk families (N = 94, Mage = 3.03 years, 47% males, 77% White, 20% Latinx, data collected 2013-2017). Proximal stressors were operationalized as changing task demands (baseline, challenge, recovery) across a dyadic puzzle task. Distal stressors were measured as parent-reported stressful life events. Multilevel models revealed that greater proximal and distal stressors were related to weaker dynamic self-regulation of RSA in mothers, fathers, and children, and more discordant mother-child and father-child coregulation of RSA. Findings affirm that stress is transmitted across levels and persons to compromise real-time regulatory functioning in early, developmentally formative caregiver-child interactions.

Risk factors associated with headache prevalence among adolescents

Background: Headache prevalence among adolescents has raised growing concerns due to its association with various risk factors in their lifestyle habits. Objective: This literature review aims to identify and analyze the main determinants related to headache prevalence among adolescents. Methods: This study consists of a systematic review of literature published in the last ten years in the Virtual Health Library (BVS) and PubMed, using the descriptors "headache," "adolescent," and "risk factors." The inclusion criteria were articles that address risk factors for headache in adolescents, published in Portuguese or English. Results: A higher prevalence of headache was observed in older adolescents (16-19 years) compared to younger adolescents (12-15 years). This difference may be related to biopsychosocial factors in younger adolescents, such as stress and/or divorce in the family environment. Among headache types, migraine and tension headaches were the most frequent. Tension headaches were more prevalent in females, with women reporting more frequent headache complaints than men. This difference may be associated with hormonal factors. The study also found a significant relationship between excessive technology use and headache occurrence, especially migraine-type headaches. This association can be explained by inadequate posture habits, visual fatigue, and auditory symptoms during the use of electronic devices. Conclusion: This study highlighted a higher prevalence of headache in older adolescents and a lower prevalence among younger ones, possibly due to family stress. Migraine and tension headaches were more common in this group, with tension headaches predominant among girls. Excessive use of digital technologies was associated with headache, especially migraine-type headaches, due to inadequate postures, visual fatigue, and auditory symptoms.

Эмоциональное состояние матерей недоношенных новорожденных детей с внутрижелудочковыми мозговыми кровоизлияниями, находящихся на отделении реанимации и интенсивной терапии

&lt;p&gt;This article presents the results of a study of the emotional state and stress of mothers attending their premature infants with structural intracranial changes at the stage of their stay in the neonatal intensive care unit, sociodemographic characteristics of the family, and the relationship between the studied indicators. &lt;strong&gt;Sample.&lt;/strong&gt; The study included 77 mothers (age M&amp;plusmn;SD=32,1&amp;plusmn;4,7 years) of prematurely born children (gestational age 28,3&amp;plusmn;3,1 weeks; birth weight 1186&amp;plusmn;499 g; 40 boys). &lt;strong&gt;Methods.&lt;/strong&gt; To assess the emotional state and stress of the mothers, the methods of assessing depressive experiences (BDI-II; Beck et al., 1996), anxiety (Spielberger et al., 1983), the Parental Stress Scale (Miles, 1987), and the Heidelberg Family Stress Scale (Sidor et al., 2007) were used. &lt;strong&gt;The results&lt;/strong&gt; of the study indicate that 69,2% of the mothers show a strong level of depressive experiences, 29,3% show a moderate level, and 1,5% show a weak level. 63,5% of mothers are found to have high and 33% have moderate values of reactive anxiety, 42% have high and 52% have moderate values of personality anxiety. About 88% of mothers cite a feeling of helplessness from not being able to protect their child from painful procedures or from not knowing how to help their child during this period of his or her life as a source of stress. Characteristics of emotional state and different types of maternal family stress were shown to be associated with socio-demographic characteristics of the family, but were not significantly associated with indicators of newborn health status and type of treatment.&lt;/p&gt;

Do lifestyle and hormonal variables explain links between health and facial attractiveness?

Facial attractiveness has recently been considered an indicator of underlying immunocompetence. However, studies examining this relationship have yielded mixed findings. Previous research suggested that these discrepant findings could be due to the common influence of lifestyle factors upon both rated facial attractiveness and health. Young men (N = 162) provided standardized facial photos with a neutral expression subsequently rated by eight women for overall attractiveness. Saliva was assayed for immunoglobulin A, testosterone (T) and cortisol (C), and body fat was measured using a skinfold caliper. Self-reports of poor health, and lifestyle factors that could influence health status (age, sleep habits, smoking, drinking alcohol, family stress, and exercising) were collected. Results showed that symptoms of poor health and skinfold negatively predicted facial attractiveness. There was a modest but statistically non-significant T x C interaction where higher T lower C men trended toward having more attractive faces. A sequential mediation model examining the influence of lifestyle showed support for an indirect effect on facial attractiveness. Specifically, skinfold and poor health symptoms mediated the links between exercise, stress, and facial attractiveness. These findings suggest links between facial attractiveness and immunocompetence could be linked to some common lifestyle and hormonal variables, but that more comprehensive research involving lifestyle indicators (such as nutrition) are necessary.

Telephone-based mindfulness intervention positively impacts family communication and stress within rural, African American dementia caregiving teams

Objectives The objective of this paper is to explore how telephone-delivered mindfulness training impacts family conflict and communication within the informal dementia caregiving team, including primary caregivers, their care partner, and the care recipient. Method Primary caregivers and their care partners participated in an eight-week telephone-delivered mindfulness-based intervention (MBI). This study used mixed methods and a pre-post design to evaluate the intervention’s effect on family satisfaction, perceived support, and family conflict. Results Both family satisfaction and perceived informational support increased significantly, and qualitative analysis revealed four key themes illustrating how the mindfulness intervention served to positively impact family conflict and communication among participating caregivers. Conclusion This study provides preliminary evidence for the beneficial effects of an MBI on family functioning among rural African American caregivers of people with Alzheimer’s disease and related dementias.

Strength-based strategies for addressing racial stressors in African American families: lessons learned from developing the LEADS health promotion intervention

Recognizing the real-life impact of racial stress on physical and psychological health is vital for creating impactful health promotion interventions among African American families. Despite the known link between racial stress and poor physical health outcomes, no existing intervention to date has targeted stress management strategies to buffer racial stress and build positive health behaviors among African American families. The current study outlines the lessons learned throughout the development of the Linking Exercise for Advancing Daily Stress (LEADS) Management and Resilience program, a 10-week family-based health promotion, stress management, and resilience intervention that aimed to improve physical activity, healthy eating, and well-being among African American adolescents and parents. We highlight the evolution of the LEADS intervention from a health promotion and stress management intervention to a culturally salient health promotion, stress management, and resilience intervention utilizing community-based participatory research strategies. This paper chronicles our systematic journey in making those changes and the lessons we learned along the way. We provide specific recommendations and implications for future health promotion interventions developed for African American families. Overall, we argue for a research orientation that respects cultural and racial contexts, embraces diversity within research teams and self-reflection, recognizes the heterogeneity among African American populations, and applies strength-based approaches.

Momentary autonomic engagement during parent-adolescent conflict: Coping as a moderator of associations with emotions.

Regulatory efforts are hypothesized to affect associations between emotions and physiology (i.e., concordance) to facilitate adaptive functioning. Assessing the role of coping on physiological-emotional concordance during ecologically relevant scenarios can elucidate whether concordance can serve as a biomarker of risk or resilience. The present study assessed self-reported coping as a moderator of minute-to-minute associations between autonomic nervous system activity and emotions (i.e., physiological-emotional concordance) in caregivers (N = 97) and adolescents (N = 97; ages 10-15) during a dyadic conflict task. Models included physiological variables (sympathetic, skin conductance level [SCL]; and parasympathetic, respiratory sinus arrhythmia [RSA]) and their interaction (SCL × RSA) as predictors of emotions, with coping variables as moderators. Caregivers' use of primary control coping (e.g., problem solving and emotional expression) and secondary control coping (e.g., cognitive reappraisal and acceptance) use in response to family stress predicted more positive emotional experiences during the laboratory conflict task. Adolescents' use of secondary control coping moderated the SCL-emotion association, such that increases in momentary SCL were associated with more positive emotion ratings for youth reporting higher secondary control coping. For youth who report more adaptive trait-level coping skills, momentary changes in SCL may reflect active engagement and attentiveness to facilitate more positive emotional experiences. Findings advance our understanding of the interrelationships between physiological responses and psychological experiences during relevant, interactive scenarios. Autonomic responses are differentially related to affective states depending on the coping strategies that adolescents employ, suggesting that concordance may be associated with intervention targets (i.e., coping skills).

Relation of Family Economic Pressure and Racial Stress with Sleep Disturbance among African American College Students: Moderating Effects of Kin Social Support

The investigation examined whether kin social support moderated the association of family economic pressure and race-related stress with sleep disturbance among African American college students. The study is grounded in two theoretical models including the Integrative Model for the Study of Developmental Competence in Minority Children (IM) and the Family Stress Model (FSM), which predict that economic and race-related stress are linked to well-being in families and that the effects of stressful experiences may be moderated by kin social support. Hypotheses were assessed with online questionnaires administered to 152 African American college students (83% female, Mage = 21.7, SDage = 4.6). Economic pressure and race-related stress were significantly associated with sleep disturbance. Interference effects of kin support were evident and revealed that the positive relations of family economic pressure and race-related stress with sleep disturbance were less apparent with increases in kin support. Findings suggest that kinship ties are complex relations with costs and benefits that African American students must manage as they cope with stressful experiences in college.