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The family environment is essential but underused for promoting sexual and reproductive health protective behaviors (SHPB). However, previous literature had no consistent findings regarding how families can efficiently provide sex education and what aspects of family communication may facilitate SHPB. Based on family communication patterns theory (FCPT) and new research that segments family conformity orientation into four sub-dimensions (i.e., respecting parental authority, experiencing parental control, adopting parents' values, and questioning parents' beliefs), we explored the roles that family communication patterns (FCP) and parents' (direct and indirect) sexual communication play in influencing adult daughters' intentions to engage in SHPB. Using survey data from 234 female participants, path analysis suggested that daughters' SHPB intentions were associated with more direct and indirect sexual communication, higher conversation orientation, higher parental control, and less adoption of parental values. Also, parents' direct sexual communication mediated the impact of conversation orientation on SHPB intentions. Additionally, parents' indirect sexual communication mediated the path from parental value adoption to SHPB intentions, mitigating the negative direct impact of parental value adoption. Theoretical and practical implications are discussed. [ABSTRACT FROM AUTHOR]

Objectives This study examined the extent to which multiple relationship-specific attachment schemas (general, parent-child, and romantic) are interrelated and relate to depressive symptoms among older adults living with early-stage dementia and their adult children, a context likely to activate the attachment system. Methods The study consisted of 150 early-stage cognitively impaired parents and one child. Both self-reported general, parent-child, and romantic attachment anxiety as well as avoidance and depressive symptoms. Parents' cognitive and functional impairment were assessed. Results Most attachment variables were interrelated for individuals, except that the child's parent-child-specific avoidance was not associated with their general or romantic avoidance. The parent's worse functional, but not cognitive, impairment was associated with the child's greater parent-child-specific attachment anxiety. Using Actor Partner Interdependence Models, general attachment anxiety was associated with greater depressive symptoms (actor effects). When both dyad members were high in general avoidance, depressive symptoms were greatest (actor × partner effect). A parent had the greatest depressive symptoms when they were avoidantly attached to their child (role × actor effect) and their child was high in anxiety and low in avoidance toward them (role × partner effects). A child had the greatest depressive symptoms when they were low in avoidance toward the parent (role × actor effect) and the parent was low in anxiety and high in avoidance toward the child (role × partner effects). Romantic anxiety was associated with greater depressive symptoms (actor effects). Discussion Psychosocial interventions that incorporate attachment theory as a framework may benefit parent-child dyads coping with dementia. [ABSTRACT FROM AUTHOR]

Objectives Informal care provided by adult children is of great importance for older adults' well-being in China. This paper investigates and compares the functional transitions among older adults living in rural areas who receive care from daughters' and from sons' families. Methods This study utilizes the "Well-being of Elderly Survey in Anhui Province" (WESAP) from 2001 to 2021. Our sample included 2,797 individuals aged 60 years or older. Functional status was based on the activities of daily living and the instrumental activities of daily living. We employed a random-effects ordered logit model to examine the functional transitions among the older adults. Results Receiving care from daughters' families is significantly associated with a lower likelihood of functional decline compared to receiving care from sons' families in rural China. The advantage associated with daughter care becomes more pronounced among older individuals with a severe functional difficulty compared to those with a mild or moderate functional difficulty. The difference is prevalent among older adults aged 75 and older, with less wealth or multiple chronic diseases, or who live alone. Furthermore, among those with severe functional difficulties, the daughter advantage is more significant for fathers as compared to mothers. Discussion Nowadays, daughters' families can provide high-quality informal care, often surpassing that offered by sons' families. This daughter advantage becomes even more significant among older adults who have a higher need for family care, such as those with severe disabilities and limited financial resources. [ABSTRACT FROM AUTHOR]

Despite the incredible challenges of caring for a family member with Alzheimer's disease or a related dementia, many dementia family caregivers exhibit resilience. Framed by the communication theory of resilience, this study examines how resilience processes unfold within dementia caregivers' relationships with their family member, and dementia caregivers' experiences of resilience. Analysis of 27 interviews with adult children and spousal caregivers revealed acknowledging dementia as an actor in the relationship as a central facilitating mechanism that enabled caregivers to enact other communicative resilience processes within their relationship. Resilience processes were enacted through shifting blame to dementia, accommodating dementia, and relying on memories. Caregivers experienced resilience through personal growth, enhanced relational closeness, and ambivalent resilience. We discuss implications for dementia caregiver resilience and forward facilitating mechanisms as an extension of communication resilience theorizing. [ABSTRACT FROM AUTHOR]

Objectives: To examine the influence of sociodemographic factors on employment changes among adult children following onset of parental Alzheimer's disease and related dementia (ADRD). Methods: We used Health and Retirement Study (2010–2018; N = 20,110) data to examine adult child (ages 50–70) changes in employment and work hours at onset of parental ADRD and potential variation by gender, age, race, ethnicity, and education. Results: Parental ADRD onset was not associated with changes in adult child employment overall, although associations differed substantially across subpopulations defined by education level. Sons with the lowest education were least likely to cease employment, while daughters with the lowest education were most likely to reduce work hours. Sons at older ages were increasingly likely to reduce work hours or end employment following parental ADRD onset. Discussion: The potential impact of parental ADRD on adult child employment is complex and should be considered in the context of sociodemographic factors. [ABSTRACT FROM AUTHOR]

Objectives Adult child socioeconomic status (SES) has been identified as a predictor of older parents' cognitive aging. However, studies have primarily relied on educational attainment as the sole measure of adult child SES. We evaluated the relationship between adult children's financial disadvantage and cognitive outcomes of older parents in the United States. Methods We used data from U.S. Health and Retirement Study (2000–2014, n = 15,053 respondents ≥51 years with at least 1 adult child). Adult child financial disadvantage was measured with 3 indicators of extremely low income, unemployment, and lack of homeownership. We used linear mixed models to estimate the association between adult child financial disadvantage and the rate of decline in verbal memory scores, controlling for respondents' sociodemographic characteristics. Results Having at least 1 adult child (vs no adult children) with extremely low income was found to be associated with lower verbal memory (b = −0.041, 95% confidence interval [CI]: −0.043, −0.039) at baseline. There was a small but significant association with the rate of decline in verbal memory z -scores (b = 0.004, 95% CI: 0.000, 0.008) and some evidence of heterogeneity by parent gender, marital status, and SES. Discussion Offspring financial disadvantage may be influential for older parents' initial level of memory function, although evidence of associations with memory decline was weak. Public policy interventions aimed at improving the economic conditions of adult children may indirectly benefit the cognitive performance of disadvantaged parents in their later life. [ABSTRACT FROM AUTHOR]

Adult siblings without disabilities play important roles in relation to their brothers and sisters with intellectual disabilities. This study reviewed knowledge about adult sibling relationships in Chinese societies, where one sibling has intellectual disability. Five English and two Chinese databases were searched for publications published up to 2022. Findings, based on 14 identified articles show that sibling relationships are considered in the context of parent-child relationships. Little attention is given to the nature of sibling relationships per se. Rather, research in Chinese societies generally frames sibling relationships as one-way caregiving, and where siblings' caregiving responsibilities are inherited from parents, increase as parents age and are organised according to gender and birth order. These findings contrast to Western studies where increasingly perspectives of adults with intellectual disabilities are sought and the reciprocal nature of sibling relationships is highlighted. Future research in Chinese societies may benefit from exploring aspects of relationships beyond caregiving. [ABSTRACT FROM AUTHOR]

The objectives of the present analyses are to examine the frequency, nature, and correlates of nonfatal gun use in incidents of conflict between adult children and their parents, to which police were summoned. A cross-sectional study design was used with all cases of domestic violence to which police were called between adult children and their parents, in Philadelphia, PA, in 2013 (N = 6,248). Data were drawn from forms required to be completed by police when responding to domestic violence calls for assistance. A series of multivariate logistic regression models were estimated. Of the 6,248 incidents, 5,486 involved no weapon, 522 involved a bodily weapon, 190 involved a non-gun external weapon, and 50 involved a gun. Guns were most often used to threaten victims (66%), with guns less often fired (6%) or used to pistol whip victims (4%). Compared to incidents involving a bodily weapon, when guns were involved, offenders were less likely to have pushed, grabbed, or punched the victim and victims were less likely to have visible injuries; however, offenders were more likely to have threatened victims and victims were more likely to be observed as frightened. Police officers intervened similarly to incidents involving guns vs. bodily weapons. This is the first study we are aware of to focus on nonfatal gun use between family members who are not intimate partners, with the results extending much of what is known regarding nonfatal gun use among intimate partners to nonfatal gun use among adult children and parents. [ABSTRACT FROM AUTHOR]

Objectives: In this study, the researchers examined adult children's experience during and after their parents' late‐life divorce. The study applies a familial/dyadic perspective. Family systems theory is used heuristically. Background: Late‐life divorce is rising due to increased social legitimacy of divorce and life‐expectancy. As parents age, their adult children become more involved in their parents' lives. Accordingly, adult children are expected to fulfill roles in their parents' life transitions such as late‐life divorce. However, adult children's experiences regarding their parents late‐life divorce is not as available in previous studies, especially from a dyadic/familial perspective. Method: Semistructured in‐depth qualitative‐interviews were conducted separately with 51 participants (28 adult children, 23 parents) composed of seven family units (n = 33) and nine parent–child‐dyads (n = 18). Thematic analysis and dyadic interview analysis were used. Results: During the divorce, adult children experienced meaningful roles supporting their parents, mediating between them, or pushing them to finalize the divorce. Some avoided involvement. Parents described roles they assigned to their adult children and their consequences. After divorce, adult children continued supporting their parents, experiencing role reversal earlier than expected. Their new roles included relieving loneliness and worry and providing care. Conclusion: The roles adult children experience reveals unique challenges for adult‐child–parent relationships after parents' late‐life divorce, influencing the family system. Implications: Conceptualizing adult children's roles and the implications for family systems contributes to theoretical knowledge. Family counselors should provide families with relevant tools to deal with these consequences. Policy makers and training programs for family therapy should address the consequences of late‐life divorce. [ABSTRACT FROM AUTHOR]

This article presents a survey of literature written on the concepts of estrangement and cut‐off, comparing the similarities of the two concepts and distinguishing significant differences in the scope and theoretical underpinnings of the ideas. Lucy Blake's review of the research studies on estrangement available in 2017 found no common agreement on the concept of estrangement. Quantitative research focused on the amount of contact and qualitative research on the quality of the contact. Susan Forward's approach to rifts between adult children and their parents, which is reflected in the work of the Standalone organisation in Britain, is that parents who are critical or non‐affirming of their adult child are toxic. These traits are thought to create difficulties in the life of the adult child, who is advised to sever contact as a step towards self‐actualisation. On the other hand, Joshua Coleman and Karl Pillemer focus on estrangement as the outcome of the tension between the parent and child, both of whom play a part in the rift, advocating that each side moderate their reactivity, blame and expectations. Kylie Agllias's research utilises concepts from family systems theory, recommending the effort to self‐regulate and to understand one's contribution to the reactivity as integral to reconciliation. Murray Bowen conceptualised the family as a multigenerational family system with varying mechanisms, including cut‐off, to handle tension as the family unit adapts to stressors over time. Cut‐off is an outcome of the family's level of anxiety and the capacity of the family for differentiation, their thoughtful collaboration with one another to address the challenges they face. The effort to bridge cut‐off is one aspect of an individual's effort to be a more thoughtful, connected presence in the family system as work on differentiation of self. [ABSTRACT FROM AUTHOR]

Previous research has not considered how digital communication fits with the established intergenerational solidarity paradigm, although the paradigm has undergone other refinements over time. Consequently, less is known about how the use of digital communication creates new types of intergenerational solidarity between parents and adult children, and how they are associated with their well‐being. With this foundation, we aimed to identify new dyadic patterns of intergenerational solidarity between parents and adult children during the COVID‐19 pandemic in South Korea, with an emphasis on digital communication (texting, video call, and social media interaction), its intersection with other dimensions of solidarity, and its association with parents' and children's well‐being (depressive symptoms, self‐esteem, and life satisfaction). Using an online survey method, we collected data from 407 parent–adult child dyads between April and June 2022 from the Seoul Metropolitan area in South Korea. Three‐step latent class analysis was used for data analysis. We identified four classes describing intergenerational solidarity between parents and adult children (tight‐knit, distant‐but‐digitally‐connected, conflictual, and independent). We found that among dyads of parents and adult children who had tight‐knit and distant‐but‐digitally‐connected relationships with each other, parents reported better well‐being on all three outcomes, and children reported better life satisfaction compared to dyads who had conflictual relationships. Our findings suggest that incorporating digital communication into the intergenerational solidarity paradigm is useful to better understand the multidimensional characteristics of intergenerational relationships between older parents and their adult children. [ABSTRACT FROM AUTHOR]

Objectives: This paper has two objectives. First, it assesses whether the existing informal care provided by adult children has an impact on older people's propensity to demand community care services. Second, it compares the different statuses of sons and daughters in the formal/informal support trade‐off. Methods: The paper is based on an analysis of data from the 2018 wave of the China Longitudinal Ageing Social Survey, within the framework of a revised version of Andersen's model, and applies multilevel models to analyse the effects of adult children's gender, numbers and the quality of their support, on older people's willingness to purchase community care services. Results: Older people who had sons as well as daughters demanded fewer services, while the number of sons increased service demand. Regarding sons, community care services compensated for economic support, daily life care and spiritual consolation, but did so only in respect of daily life care from daughters. Conclusions: Many families have only one son or one daughter as a result of the one‐child policy and therefore often require support from formal care services. Moreover, there is a distinct gender division and an influential filial culture governing the impact of services on the support provided by adult children. Because ageing in place depends on both informal family support and formal services, this key policy goal is at risk if the latter provides insufficient support to the former. [ABSTRACT FROM AUTHOR]

The growing body of evidence linking intergenerational education and late-life cognitive decline is almost exclusively from high-income countries, despite rapid intergenerational changes in education in low- and middle-income countries (LMICs). We used data from the Mexican Health and Aging Study (n  = 8,822), a cohort study of Mexican adults aged ≥50 years (2001–2018), to evaluate whether parental education (none vs. any formal schooling), one's own education (less than primary school vs. completion of primary school), or an adult child's education (less than high school vs. completion of high school) was associated with verbal memory z scores. We used linear mixed models with inverse probability of attrition weights. Educational attainment in all 3 generations was associated with baseline verbal memory scores, independent of the prior generation's education. Lower parental (β = −0.005, 95% confidence interval: −0.009, −0.002) and respondent (β = −0.013, 95% confidence interval: −0.017, −0.010) educational level were associated with faster decline in delayed (but not immediate) verbal memory z scores. Associations between adult child's education and respondent's verbal memory decline varied by exposure specification. The educational attainment of parents and adult children may influence the cognitive aging of middle-aged and older adults in LMICs. These results have important implications given recent structural shifts in educational attainment in many LMICs. [ABSTRACT FROM AUTHOR]

Adult child to parent violence is a growing international social problem that needs to be better understood to develop clinical interventions. An exploratory study on the antecedents of early life adversity on adult child to parent violence/elder mistreatment was carried out using secondary analysis. Directed content analysis was used based on life course theory with a data set of older mothers all > 57 years old (J. R. Smith 2021, 2022). Measurement of instances of child abuse, domestic violence, and birth trauma among abused older mothers was conducted. All the older women had reported being negatively affected by their adult children's problems and 56% reported being physically attacked. A case example is presented to illustrate how repeated incidents of abuse or neglect in early life might explain an older woman's inability to take actions for her own safety. [ABSTRACT FROM AUTHOR]

Family values operate in both immediate (i.e., familial) and broader social contexts. This study used a mixed methods approach to examine both forms of family values in the Australian context. A convenience sample of 856 people completed a measure of family values about both their own values and their perceived values of one of their parents, and a measure of familism. Using a story completion approach, a majority of the sample also responded to three story stems focused on the perceived values held by fictional families. Quantitative findings identified relationships between participant and perceived parent values in terms of gender. Participants reported high levels of familism, predicted by religiosity, age, and being a parent. Qualitative findings suggested that some participants were mindful of discrimination faced by the fictional families, but many participants also provided deficit accounts. [ABSTRACT FROM AUTHOR]

The aim of the current integrative review was to achieve a better understanding of the associations between the grandparent-grandchild relationship and early adult grandchildren's psychological and health outcomes. The current article examines the grandparent's role in view of different aspects of the grandparent-grandchild relationship by analyzing two themes that emerged in the reviewed studies: the general grandparent-grandchild relationship and the relationship with a grandparent with an impairment. Gaps in the research literature, implications for practice and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Adult children with siblings can share caring for older parents but adult only children face this responsibility alone. Given increased longevity and reliance on informal care-giving, as well as an increase in one-child families, there is a need to investigate only children's care-giving further. Using data from three large-scale British birth cohorts, this paper investigates patterns of parent-care, care intensity and wellbeing at ages 38 and 42 (N = 17,255, N = 16,703; born 1970), 50 and 55 (N = 12,775, N = 11,339; born 1958) and 63 (N = 2,364; born 1946), how sibling composition intersects with gender in relation to care-giving and whether different care-giving patterns are associated with wellbeing. Only children are more likely to provide parent-care and the pattern is consistent with an interpretation that differences by sibling status might increase with age. Provision is gendered, and the sibling group composition matters for involvement. Although care-giving is related to wellbeing, we found no evidence that this differs between only children and those with siblings. The literature on only children has hitherto focused largely on childhood, suggesting that on some outcomes they benefit from a concentration of parental resources. Our results suggest that in middle adulthood parental care needs may instead be concentrated for the only child without the 'resource' of siblings. This indicates a need to develop further our understanding of this growing demographic subgroup. [ABSTRACT FROM AUTHOR]

Although the literature on informal care-giving for older parents shows that daughters have a higher tendency to provide care compared with sons, only a few studies have focused on the gender composition of all children or parents' entire range of care options. Our study examines the effect of children's gender composition on informal and formal care types, as well as the informal care network. Using data from the 2015 Survey of Health, Ageing and Retirement in Europe (N = 40,312), we found that parents with daughters tended to use less formal care because daughters take on additional informal care-giving responsibilities. Daughters were the main care-givers among parents' informal care networks. Further analysis indicated that daughters-in-law play an important role in the care-giving process when parents have only sons. We concluded that the presence of a daughter among the children reduces the use of formal care. The results indicated that children's gender composition is an important factor in explaining the allocation of informal care to parents. [ABSTRACT FROM AUTHOR]

This study examined associations among indulgent parenting, differentiation, early maladaptive schemas, and romantic disillusionment in an SEM model in a sample of 578 university -students who were partnered or had been in a romantic relationship. Bootstrap tests of indirect effects were examined to rigorously establish mediation. Family-of-origin variables (indulgent parenting and indices of low differentiation) predicted participants' early maladaptive schemas. Early maladaptive schemas predicted perceived partner entitlement, which in turn predicted disillusionment. No differences in model pathways were identified between women and men. The authors provide suggestions for future research and psychotherapy. [ABSTRACT FROM AUTHOR]

The study aims to provide insight into the lives of parents to adult children with drug addiction. We focus on how the parents' social life and interactions were affected by feelings of guilt and shame, and how they dealt with the stigma that often accompanies drug addiction. 32 semi-structured interviews were conducted with parents (age 46–70) of adult children (age 18–47) with drug addiction in Sweden. Three themes emerged (1) Experiences of guilt, shame, and courtesy stigma, (2) Impact on social life and relationships and, (3) Strategies to reduce guilt and shame. Guilt, shame, and courtesy stigma complicated and restricted the parents' social interactions. Many parents applied a selective openness, carried experiences of alienation and in some cases isolated themselves. At the same time, several parents described that they were open about their child's addiction in certain contexts. For some parents, this meant a relief from guilt and shame and an opportunity for increased social interaction. Both informal and professional support for family members of individuals with drug addiction is vital to reduce experiences of guilt, shame, and courtesy stigma. [ABSTRACT FROM AUTHOR]

Objectives Parental differential treatment of children, particularly disfavoritism, has been found to detrimentally affect adult children's psychological well-being in the United States. However, no study has investigated the long-reaching influence of parental disfavoritism in China, where there is an absence of equal treatment norms. Drawing from theories of social comparison, life course, and gender dynamics in China, we tested how perceptions of childhood parental disfavoritism affect midlife and older Chinese adults' depressive symptoms, and how the effects differ by own and parent's gender. Methods Random-intercept models were used based on a sample of 17,682 midlife and older Chinese adults, drawn from 5 waves of China Health and Retirement Longitudinal Study. Results Recollections of childhood parental disfavoritism were associated with higher depressive symptoms among Chinese adults. Perceptions of paternal disfavoritism predicted both men's and women's depressive symptoms, whereas perceptions of maternal disfavoritism predicted women's depressive symptoms only. Paternal disfavoritism was more detrimental than maternal disfavoritism, but only for men. Maternal disfavoritism was more detrimental for women than men. Discussion These findings shed light on the universality of the long-reaching detrimental effect of perceptions of parental disfavoritism across cultures as well as the unique gendered patterns in China shaped by patriarchy. Findings suggest that the implementation of Three-Child Policy in China should be accompanied with parental education programs involving fathers on equal treatment of children. [ABSTRACT FROM AUTHOR]

Background: Losing a parent or spouse in adulthood may result in prolonged grief disorder (PGD) symptoms. PGD levels in parents may affect PGD levels in their adult offspring and the other way around. However, research on transmission of PGD in parent–child dyads is lacking. Consequently, we aimed to examine temporal associations between PGD levels in parent and adult children. Methods: In doing so, we analyzed longitudinal self-report data on PGD levels (using the PG-13) assessed at 2, 11, 18, and 26 months after loss in 257 adult parent–child dyads from Denmark. Cross-lagged panel modeling was used for data-analyses. Results: Changes in PGD levels in parents significantly predicted PGD levels in adult children, but not vice versa. Small through moderate cross-lagged effects (β = 0.05 through 0.07) were found for PGD levels in parents predicting PGD levels in adult children at a subsequent time-point. These cross-lagged effects were found while taking into account the association between PGD levels in parents and adult children at the same time-point as well as the associations between the same construct over time and relevant covariates. Conclusions: Pending replication of these findings in clinical samples and younger families, our findings offer tentative support for expanding our focus in research and treatment of PGD from the individual to the family level. [ABSTRACT FROM AUTHOR]

Background: Adult children provide a large portion of end‐of‐life caregiving for older adults and make up the majority of caregivers for adults with dementia. Yet research has been limited to the hours of care that primary caregivers provide, neglecting the other ways adult children provide caregiving support. This study aims to describe the caregiving support adult children provide to their parents at the end of life and characterize differences by race and ethnicity and dementia status. Methods: We conducted a retrospective study using survey responses from the Health and Retirement Study between 2002 and 2018. The sample population (n = 8040) included decedents aged 65 with at least one living adult child at their time of death. Caregiving support was defined as providing financial support, providing help with basic or instrumental activities of daily living (ADLs or IADLs), or coresiding with the care recipient. Respondents were stratified by self‐identified race and ethnicity as Hispanic, non‐Hispanic White, or non‐Hispanic Black. Respondents were further stratified by dementia and marital status. Results: Black and Hispanic respondents without dementia were more likely to report receiving financial help from (28.0% and 25.9%) or coresiding with their adult children (38.9% and 49.7%) compared to White respondents (15.0% receiving financial help and 23.3% coresiding) (p < 0.05). Among respondents with dementia, 47.1% of both Black and Hispanic respondents reported coresiding with their adult children, compared to only 24.6% of White respondents (p < 0.05). Notably, married Black and Hispanic respondents reported significantly higher rates of all support types compared to married White respondents (p < 0.05). Conclusions: The majority of older adults at the end of life receive some form of care and support from their adult children, with Black and Hispanic older adults receiving particularly high rates of care and support from their adult children regardless of dementia or marital status. [ABSTRACT FROM AUTHOR]

The current study used a grounded theory approach to develop a substantive theory of the process of building resilience in adult children of parents with alcohol use disorder (ACOAs). Seventeen ACOAs selected by purposive sampling underwent in-depth interviews. Results demonstrated that ACOAs' resilience developed in four phases: exposure, awareness, action, and adaptation. The core category of the construction process of ACOAs was accepting reality in the collapse of everyday life and becoming myself. The central phenomenon grounded in the process of developing resilience was trying to maintain my daily life. The current study suggests that appropriate intervention strategies are needed at each phase of development to address the particular needs of ACOAs in that phase. [Journal of Psychosocial Nursing and Mental Health Services, 61(9), 31–39.] [ABSTRACT FROM AUTHOR]

Mental health problems are a major concern in the older population in Sweden, as is the growing number of older adults aging alone in their homes and in need of informal care. Using a linked lives perspective, this study explored if older parents' mental health is related to their children's dual burden of informal caregiving and job strain. Data from a nationally representative Swedish survey, SWEOLD, were used. Mental health problems in older age (mean age 88) were measured with self-reported 'mild' or 'severe' anxiety and depressive symptoms. A primary caregiving adult child was linked to each older parent, and this child's occupation was matched with a job exposure matrix to assess job strain. Logistic regression analyses were conducted with an analytic sample of 334. After adjusting for covariates, caregiving children's lower job control and greater job strain were each associated with mental health problems in their older parents (OR 2.52, p = 0.008 and OR 2.56, p = 0.044, respectively). No association was found between caregiving children's job demands and their older parents' mental health (OR 1.08, p = 0.799). In line with the linked lives perspective, results highlight that the work–life balance of informal caregiving adult children may play a role in their older parent's mental health. [ABSTRACT FROM AUTHOR]

Simple Summary: Breast cancer is a shared experience for diagnosed mothers and their young adult caregiving daughters (YACDs). They struggle to talk about cancer and receive no guidance for navigating challenging but critical care conversations. Daughters in young adulthood also tend to avoid cancer-related talk, which is associated with poorer biopsychosocial outcomes, whereas openness between mothers and daughters is tied to better biopsychosocial outcomes. We sought to determine mothers' and YACDs' most challenging topics as well as their preferred strategies that help them engage in these discussions, while also exploring associations between openness/avoidance and their psychosocial outcomes. Results highlight how mother–daughter communication approaches (i.e., avoidance and openness) intersect with their psychological distress and relational satisfaction. Collectively, findings demonstrate that if we are to promote better psychosocial outcomes for diagnosed mothers and their caregiving daughters, we must recognize the influential role their communication plays in their well-being. For many diagnosed mothers and their daughters, breast cancer is a shared experience. However, they struggle to talk about cancer. This is particularly true when the daughter is in adolescence or young adulthood, as they tend to be more avoidant, which is associated with poorer biopsychosocial outcomes. When daughters are their mother's caregivers, daughters' burden and distress are heightened. Young adult caregiving daughters (YACDs) are the second most common family caregiver and encounter more distress and burden than other caregiver types. Yet, YACDs and their diagnosed mothers receive no guidance on how to talk about cancer. Thirty-nine mother/YACD pairs participated in an online survey to identify challenging topics and strategies for talking about cancer, and to explore associations between openness/avoidance and psychosocial outcomes. YACDs and mothers reported the same challenging topics (death, treatment-related issues, negative emotions, relational challenges, YACDs' disease risk) but differed on why they avoided the topic. YACDs and mothers identified the same helpful approaches to navigate conversations (openness, staying positive, third-party involvement, avoidance). Avoidance was correlated with more distress whereas openness was correlated with better psychosocial outcomes. These results provide a psychosocial map for a mother-YACD communication skills intervention, which is key to promoting healthy outcomes. [ABSTRACT FROM AUTHOR]

The present study explores the transmission of attachment and family functioning across three generations. It is based on a sample of 460 female emerging adults (aged 18–26), their mothers (N = 440), fathers (N = 368), maternal grandmothers (N = 224), and maternal grandfathers (N = 113). Participants self‐assessed their attachment anxiety and avoidance using the Relationship Style Questionnaire and evaluated the functioning of their families of origin using the Family Adaptation and Cohesion Scale–IV. The results reveal two mechanisms, both of which have a small but significant effect on the development of attachment across generations. The first operates via direct trans‐generational transmission of attachment from parent to child, mainly involving the mother–child dyad, while the second operates through primary family functioning, especially balanced family cohesion, but also enmeshment and chaos in the case of attachment avoidance. The findings highlight the importance of including content related to attachment and family functioning in intervention programs. [ABSTRACT FROM AUTHOR]

In a series of two papers, the narrative themes of Intergenerational Trauma (IGT) from both the perspectives of the parent and offspring generation in the Chinese diaspora in Canada are examined. IGT involves parental traumatization, the intergenerational transmission of trauma, and the impact of trauma on subsequent generations. This study focuses on the narratives of the offspring generation and their construction of how their parents' traumas shaped their lives. Narratives of IGT were constructed using a collaborative narrative method. The offspring narratives were centred on their experiences growing up in Canada and how those experiences were influenced by the transmission of their parents' traumas. Narratives were analyzed using Braun and Clarke's (2006) reflexive thematic analysis. The themes developed from the narratives were as follows: (a) silence and disconnection; (b) saving face and conflicting values; (c) discipline and internalization of insecurities; (d) education as necessity; and (e) preservation and reclamation of heritage. The study illustrates how collective and IGT are understood through the mediated narrative lens of subsequent generations. The role of silence and its construction in these narratives is discussed from a cultural standpoint in relation to dominant trauma discourse. The study has implications for understanding Chinese diasporic IGT through narrative and cultural frameworks and invites trauma and IGT discourses as clinical and research considerations for this population. [ABSTRACT FROM AUTHOR]

Aim: To explore the relationship between filial obligation and caregiver depression across cultures. Design: Systematic review and meta‐analysis. Methods: Twelve databases were reviewed for dissertations and peer‐reviewed articles on filial obligation and caregiver depression among adult children, published before January 2020. In total, 476 titles and abstracts were retrieved. Final analysis included six studies; of these, four were included in the meta‐analysis. Results: Fixed‐effects model indicated that a stronger perception of filial obligation was associated with increased depressive symptoms among caregivers across cultures (β = 0.14, 95% CI [0.04, 0.24], p < 0.01, N = 394). However, a non‐significant effect size in the correlation between these two variables was found in samples predominated by Caucasian and mixed‐blood caregivers (r = 0.03, 95% CI [−0.03, 0.10], p > 0.05, N = 880). Therefore, caregivers' perceptions of filial obligation should be clinically assessed and normalised to reduce their depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: Young adults' connectedness with and independence from parents have important implications for both their development and family relationships. Although technology plays an increasingly important role in these dynamics, there are few direct observations of how connectedness and independence unfold in the digital world. Little is known of between- and within-person differences in these dynamics. Purpose: This study uses Screenomics to directly observe smartphone interactions between young adults and their parents, and discover whether and how dimensions of connectedness and independence manifest in these interactions at multiple timescales. Research Design, Study Sample, and Data Collection: Screenshot sequences were collected from 10 ethnically diverse young adult (50% female) participants' smartphones every 5 seconds for up to 1 month (total of 457,905 screenshots). We identified 1413 interaction instances between young adults and their parents (including 359 calls, 1032 messages, and 10 other communication instances). Analysis and Results: Digital ethnographic analysis of screenshots revealed multiple themes related to connectedness (emotional support, logistical and financial support, consistent communication) and independence (parent fostering independence, parent intrusiveness/overinvolvement, and young adults' psychological separation). Quantitative descriptions at different timescales (week, day, hour, moment) revealed within-person and between-person differences in active engagement, reciprocal communication, consistent communication, parent intrusiveness, young adults' reliance on parents' support, and young adults' psychological separation. Conclusion: Findings highlight the need to examine family digital interactions at multiple timescales and the utility of temporally dense and comprehensive Screenomics data in studying social relations. [ABSTRACT FROM AUTHOR]

A model of a virtual psychotherapeutic support group was developed for young-onset dementia (YOD; people with dementia under the age of 65) caregivers; one group for adult children and one for spouses. This pilot study evaluated the impact of support groups on YOD caregivers' psychosocial well-being, coping abilities, and knowledge. At post, psychosocial measures revealed an increase in the number of coping strategies rated as helpful among the 13 spousal and 14 adult children caregivers who completed the study. Adult children were observed to have a reduction in both the negative impact of caregiving and depression scores. Caregivers reported that being able to share experiences with other caregivers in similar circumstances helped them feel supported and less alone. The virtual support groups demonstrated the potential to reduce the negative impact of caregiving, especially among adult children, and showed that the groups could improve knowledge and capacity building for all caregivers. [ABSTRACT FROM AUTHOR]

Increasing longevity has led to a rising number of adult children who are at higher ages when they provide care for their parents. Drawing on the lifecourse approach and exchange theory, the paper addresses similarities and differences in parent care between late middle-aged and older adult children. The study uses the UK Household Longitudinal Study, restricting the analysis sample to individuals aged 50 and older with a living parent or parent-in-law. It presents multivariate models to examine differences between late middle-aged (aged 50–64) and older (aged 65+) children in being a parent carer, providing intensive care, the duration of parent care and providing selected types of help to parents. The involvement in parent care increases among women up to the end of their seventh decade of life and for men up to their eighth decade of life. At higher ages, the proportion of parent carers decreases more strongly for women than men. Older carers have shorter care-giving episodes than younger carers, but there is no significant difference in the type of care provided. Even past retirement age, parent care remains classed and gendered, with women from lower social classes having the highest likelihood of providing intensive parent care in old age. Having dependent children or living in a non-marital union depress the likelihood of caring for a parent even past retirement age. [ABSTRACT FROM AUTHOR]

Although much is known about the harmful consequences of racial microaggressions toward people of color, few studies have examined the factors associated with expressing racial microaggressions. This study investigated the relationship between White young adults' perceptions of family communication environments and their self-reported microaggressive communication toward people of color. Participants (N = 242) reported on conversation and conformity orientations as well as their engagement in four different microaggressive behaviors (i.e. assumptions of inferiority, assumptions of criminality, exoticization, microinvalidations). Results revealed that White young adult children who reported higher levels of both conformity and conversation (i.e. consensual families) orientation reported higher levels of microaggressions whereas those who reported lower levels of conformity orientation and higher levels of conversation orientation (i.e. pluralistic families) reported the lowest levels. Practically, our results offer insight into the family dynamics and potentially promote and mitigate the perpetuation of microaggressions in White families. [ABSTRACT FROM AUTHOR]

Background: The changes in demographic and family structures have weakened the traditional norms of filial piety and intergenerational relationships dramatically. This study aims to examine the dynamic association between financial support of adult children to their parents and informal care provision in China and its differences in household registration, residence arrangement and community-based care services. Methods: Data was derived from the 2008–2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), which is a longitudinal survey of a nationally representative sample of individuals aged 60 and over. Random effects model was used to assess the association between financial support and informal care provision of adult children to their parents. Results: It was found that financial support showed an upward trend while informal care provision showed a download trend from 2008 to 2018. The result indicated a significant and negative association between financial support and informal care provision of adult children to their parents (B = -0.500, 95% confidence interval (CI) = -0.761 to -0.239). And the association was significant among elderly people who were from urban areas (B = -0.628, 95% CI = -0.970 to -0.287), co-resided with adult children (B = -0.596, 95% CI = -0.939 to -0.253), and had community-based services (B = -0.659, 95% CI = -1.004 to -0.315). Conclusion: Financial support was negatively associated with informal care provision of adult children to their parents in China, and the association has differences in household registration, residence arrangement and community-based care services. It is suggested that policymakers should prioritize planning interventions for elderly care services and establish a family caregiver support system. [ABSTRACT FROM AUTHOR]

Using data from China Health and Retirement Longitudinal Study (N = 3864), we examined the relationship between proximity to aging parents and depression among middle-aged (45-64 years) married individuals in China. Our study depicted and explained the declining coresident rate and showed a majority of adult children live separately from their parents. Children living in different households had higher levels of depression than coresident children, including those living adjacently. Furthermore, having a coresident spouse increased the levels of depression of sons living in an adjacent dwelling and in the same city, and reduced the levels of depression of daughters living farther away. More intergenerational economic support increased the levels of depression of daughters living in an adjacent dwelling. These findings may offer a reference for married adult children to reconstruct intergenerational proximity and adjust intergenerational relations. [ABSTRACT FROM AUTHOR]

The purpose of this study is to assess the relationship between adult children's education and older parents' cognitive health, and the extent to which this relationship is moderated by parents' own socio-economic and marital statuses. Data using Waves 5 (2000) to 13 (2016) are drawn from the Health and Retirement Study (HRS), a nationally representative panel survey of individuals age 50 and above in the United States of America (USA). Older parents' cognitive functioning is measured using episodic memory from Waves 5–13. Adult children's education is measured using years of schooling, on average, for all adult children of a respondent. Analyses based on multilevel linear growth curve modelling reveal that parents with well-educated adult children report higher memory score over time compared to their counterparts whose children are not as well-educated. We also find that the positive effect of children's education on parents' cognitive health is moderated by parents' own education, though not by their income, occupation or marital status. Our work contributes to the growing body of research on the 'upward' flow of resources model that assesses the ways in which personal and social assets of the younger generation shape the health and wellbeing of the older generation. Our findings are particularly relevant to the USA given the enduring linkage between socio-economic status and health, and the limited social and economic protection for those of lower social status. [ABSTRACT FROM AUTHOR]

This study examined how adult children's divorce affected their financial support to older parents in rural China and how that relationship was dependent on children's gender. The sample was from rural Anhui Province and the working sample included 1629 older parents who reported their interactions with 6210 children across six waves of observations in 14 years (2001- 2015). Generalized Estimating Equations showed that divorced sons provided less financial support to their parents than married sons. In contrast, divorced daughters did not necessarily provide less financial support than married daughters. This gender difference was statistically significant. The findings were discussed in the context of changing rural Chinese families, where the norm of filial piety is still strong but patrilineal tradition and gender ideology have experienced desynchronized changes. [ABSTRACT FROM AUTHOR]

Parental mental illness can have long-lasting impacts on a child's life. Although programs exist in supporting the needs of young children, there remains a paucity in programs that address the needs of adult children. A two-round Delphi study with adult children, academics and clinicians who have experience with parental mental illness was employed. A total of 45 and 24 participants participated in rounds one and two respectively. Open-ended questions in round one around program design and content were thematically analysed, and subsequently rated in round two. Adult children specifically identified four topics of need: (i) managing multiple roles, (ii) emotional regulation, (iii) setting relational boundaries and (iv) transition to parenthood. Current results provide the foundation for the development of modular programs that could be pilot tested with adult children who grew up with parents with mental illness. [ABSTRACT FROM AUTHOR]

Autoethnographic research has described the tendency to ascribe blame to mothers for their daughters' disordered eating patterns, but the mechanisms by which these attitudes develop have been insufficiently investigated. The literature on mother-blaming and mothers' roles in the development of women's eating disorders has provided macro-level theoretical explanations for this attribution of blame but lacks depictions of women who subscribe to these macro narratives and yet subsequently attribute blame to their own mothers on the micro level. In this paper, I address these two gaps by conducting a feminist autoethnographic inquiry into my own history of blaming my mother for my anorexia and other disordered eating patterns. I use classical structuralist and post-structuralist theoretical concepts, as well as Althusser's proposed neo-Marxist idea of ideological state apparatuses (ISAs). Results indicate that my mother-blaming behavior was mainly influenced by apparatuses of medicine, church, education, family, and culture. Legal, political, civic, and media apparatuses were less involved in the construction of my perception in this area. All in all, my findings provide richer insight into mother-blaming internalization on the micro level and enlarge the "palette" of feminist approaches to eating disorder analysis. [ABSTRACT FROM AUTHOR]

In this study, we seek to clarify whether the present-day experience of psychological distress among adults whose parents suffered from mental illness is related to their childhood experiences of abuse and neglect and their provision of emotional care for their parents during their school-age years. To this end, a web-based cross-sectional study was conducted. A total of 120 participants over the age of 20 who attended a self-help group responded (50% response rate); of these, 94 had a parent diagnosed with a mental illness, and these participants were included for data analysis purposes. Of the 94 respondents, 65 (69.2%) were highly distressed, as measured by a Kessler (K) 6 measure of ≥5. A logistic regression analysis revealed that the experience of providing emotional care for parents during school-age childhood was significantly related to high levels of distress in adulthood (OR = 3.48; 95% CI 1.21–9.96). For children of parents with mental illnesses, the effects of providing emotional care for parents during childhood may include long-term psychological distress. For this reason, mentally ill parents raising children need visiting community nurses or other professionals to provide emotional care on behalf of their children. [ABSTRACT FROM AUTHOR]

Aim: To synthesize and present the currently available literature on the experiences of spousal and adult child caregivers of stroke patients in transitional care. Design: This is a qualitative systematic review. Data Sources: Eight electronic databases (PubMed, CINAHL, Cochrane, Embase, Web of Science, PsychINFO, ProQuest and Scopus) were searched from September 2020 to April 2022 for relevant literature and grey literature. Qualitative studies exploring the experiences of sspousal or adult child caregivers of stroke survivors up till 1 year after discharge were included. Review Methods: The selection of articles was done by two independent reviewers who screened the titles and the abstracts of studies, and the full texts of selected articles. Quality appraisal and data extraction of selected articles were undertaken by two independent reviewers using Joanna Briggs Institute (JBI) critical appraisal tools. Data synthesis was conducted using a meta‐aggregative approach recommended by JBI. Results: A total of 19 papers were included in this review. A total of three synthesized findings centred around caregivers' experience with healthcare professionals, changes in their life roles and needs, effects of caregiving and how they adapted to their changes were aggregated. Conclusion: Spousal and adult child caregivers faced multiple barriers during transitional care, such as the lack of resources and an inability to cope with changes in their lives. Support and adequate preparation were key facilitators in easing stroke caregivers into their role. Impact The findings from this review can be used to guide future implementations of caregiver education programmes and comprehensive discharge planning for stroke survivors. [ABSTRACT FROM AUTHOR]

Studies on the effects of parental alcoholism on adult children of alcoholics (ACOAs) have been mostly quantitative. To acquire a richer and better understanding of this realm in Malta, while outlining concrete recommendations to further contain this problem, a qualitative study was thus employed. Six participants were selected after meeting all inclusion criteria. Data were analysed following interpretative phenomenological analysis (IPA) guidelines. Semi‐structured interviews were audio‐recorded and transcribed verbatim. Three superordinate themes, namely a) psychosocial impact, b) coping strategies, and c) a sense of identity, were elevated. A number of findings resulting from this study may point at the resilient nature and skills exhibited by ACOAs, who move on to lead successful lives, despite their past hard life. Recommendations for future applications are discussed. Overall, recognition of children of parents who misuse alcohol should be prioritised in service planning to ensure that their needs are not overlooked. [ABSTRACT FROM AUTHOR]

We examine older partnered parents’ time spent with adult children in biological and step families, treating time together as an indication of relationship strength. Using a unique national sample of U.S. time diaries from the Panel Study of Income Dynamics, we investigate time with all adult children combined and with each adult child. We find that time together depends on family structure and parent–adult child dyadic relationship type embedded in family structure. In analyses of all adult children combined, an older parent is more likely to spend time with adult children in biological families than in stepfamilies only when there is no shared biological child in the stepfamily. In dyadic analyses, a parent’s tie with an adult child who is a biological child of both partners is stronger in stepfamilies than in biological families. Moreover, among stepfamilies, ties are not uniformly stronger with biological children relative to stepchildren; differences emerge only in more complex families when each partner has biological children from previous relationships. Our findings challenge the view that ties with older parents are always weaker with stepchildren in stepfamilies and point to the importance of considering parent–child relationships in the broader family context. [ABSTRACT FROM AUTHOR]

During the novel coronavirus (COVID-19) pandemic, families must communicate to assess and avoid risk. Given the specific threat of COVID-19 to individuals of advanced age, a crisis of this nature may trigger a role reversal for parents and adult children in the family wherein adult children lend emotional and instrumental support to their parents while suppressing their own needs. To understand if and how the COVID-19 pandemic has contributed to the role shifts of adult children, this study provides an analysis of interviews with 17 adult children. The results explain how emotional and instrumental support emerged in these families as a result of the COVID-19 pandemic. The interviews also highlighted adult children's acute need to steer parents toward protective health behaviors, expanding understanding of role shifts and creating a new area of focus for practitioners interested in family communication during a crisis. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACE) are associated with negative psychological consequences later in life, for both the victims and their children. The present study examines the links between parents' ACE and psychological outcomes in their adult children. A sample of 162 participants from 54 intact families with adult children was evaluated for ACE history and current mental health. Results showed that ACE was a predictor of mental health for all the participants, explaining 31.2% of the variance. Furthermore, parents' ACE, negative parenting, and parents' marital satisfaction had a significant influence on their adult children's mental health. The results also showed that fathers' ACE are associated with negative parenting, as well as their adult children's ACE and self-reported psychopathological symptoms. These results point to the importance of examining multiple familial factors in the development of psychopathology in young adults. Limitations of the study are also presented. [ABSTRACT FROM AUTHOR]

Adult children (N = 245, M Age = 50.55 years, 62.0% women, 80.0% European American) reported on their own prosocial goals during typical interactions with their parent, inferences of their parent's prosocial goals, assessment of their parent's future, and general communication satisfaction in their relationship with their parent. Prosocial goals were considered as social support goals and relationship protection goals. The study examined how children's own prosocial goals predicted children's general communication satisfaction, as well as how children's inferences of their parent's goals and future time perspective of their parent moderated these associations. The associations between children's own goals and children's communication satisfaction were positive (1) when children inferred that their parent held the same goals and perceived their parent's future as restricted, or (2) when children inferred that their parent held relatively low levels of the goals and perceived their parent's future as expansive. The study illuminates the contingencies under which children's goals predict children's general communication satisfaction. [ABSTRACT FROM AUTHOR]

Objectives Intergenerational support between aging parents and adult children is important to the well-being of both groups, especially during public health emergencies. However, few previous studies have examined the effects of daily support between parents and children on their well-being during public health emergencies. To fill in this gap, we examined the association between daily support and well-being in mothers and their adult children during the coronavirus disease 2019 pandemic. Methods Seventy-seven pairs of mothers (aged 44–80 years, M = 53.78, SD = 9.57) and adult children (aged 18–54 years, M = 26.61, SD = 9.46; 19% male) in mainland China participated in a 14-day daily diary study during a stay-at-home period. All of the participants reported the daily emotional and instrumental support they had given to and received from their mother/child each day for 14 consecutive days. Their daily positive affect and negative affect were also measured. Results Receiving more support on a given day was associated with providing more support on that day, suggesting a daily reciprocity. This finding was consistent across mothers and children. A lower level of being underbenefitted on a day was associated with better daily well-being of children, but not that of mothers. Providing support, but not receiving support, was positively associated with mothers' daily well-being, whereas receiving support, but not providing support, was positively associated with children's daily well-being. Discussion This study provides evidence of daily intergenerational support during a global public health emergency. The findings shed light on the importance of daily reciprocity and its implications for well-being. [ABSTRACT FROM AUTHOR]

While most studies have attempted to identify the causes and consequences of adult children's estrangement from their parents, this study focuses on a relatively unexplored topic -- factors associated with family relationships in which the adult child and parents reconcile after a period of estrangement. An online survey of 1360 parents who had experienced an estrangement from their adult child provided data concerning three constructs: (a) whether the parents were now still married, remarried, or divorced, (b) secure attachment ratings of self, other parent, and child, from the perspective of the responding parent, and (c) whether the estrangement was continuing or there had been a reconciliation. Parents who were still married described all family members as having a more secure model of attachment than did remarried or divorced parents. Also, continuous ratings of security of attachment by parents in families that had resolved the estrangement were higher than ratings by parents in which the estrangement was continuing. Two exploratory path models tested alternative hypotheses about how marital status and perceived security of attachment combined to differentiate between families in which the adult child reconciled, and families in which the adult child remained estranged. Model A did not find an indirect path leading from attachment security to marital status to reconciliation. Model B found a statistically significant indirect path leading from parents remaining married to higher levels of attachment security in their ratings of family members, to reconciliation rather than continued estrangement of the parent–child relationship. With data obtained at a single point in time, this study represents a first step toward exploring continuity or discontinuity in the relationship between the parents and between the parents and their adult child. Directions for further research and implications for clinical intervention to promote reconciliation are discussed. [ABSTRACT FROM AUTHOR]

Child sexual abuse (CSA) has received much research attention in recent years, leading to the considerable development of services provided for children worldwide. The literature in the field of trauma studies recognizes that responses to trauma are of central importance and mainly discusses the fight-flight-freeze model of automatic responses to traumatic events. For a variety of reasons, research on this specific subject in the field of CSA is sparse. The current study was designed to spotlight the way adults perceive their responses during incidents of CSA. Semistructured interviews were carried out with 20 survivors who described their responses. The results pointed to the irrelevance of "fight or flight" responses in the context of CSA and emphasized compliance, avoidance, and simply surviving the abuse. In addition, the survivors shared the thoughts they had had during the abusive incidents. Specifically, while they understood that what was being done to them was wrong, they also realized that there was little they could do other than try to survive. The survivors' reflections on how their responses to CSA affected their negative self-attributions and on the way they contend with difficult incidents in adulthood suggest the central role played by CSA responses. The findings point to the multifaceted nature of responses to CSA and to the urgent need to further examine them by exploring other relevant contexts and perceptions to develop a theoretical model that will address responses to child abuse and inform both prevention and intervention efforts. [ABSTRACT FROM AUTHOR]