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Purpose (1) To test the short-term impact of Helping Us Heal (HUSH), a telephone-delivered counseling program for spouse caregivers of women with breast cancer. (2) To compare outcomes from HUSH with outcomes from a historical control group which received the same program in-person. Methods Two-group quasi-experimental design using both within- and between-group analyses with 78 study participants, 26 in the within-group and 52 in the between-group analyses. Spouse caregivers were eligible if the wife was diagnosed within 8 months with stage 0–III breast cancer and were English-speaking. After obtaining signed informed consent and baseline data, 5 fully scripted telephone intervention sessions were delivered at 2-week intervals by patient educators. Spouses and diagnosed wives were assessed on standardized measures of adjustment at baseline and immediately after the final intervention session. Results Within-group analyses revealed that spouses and wives in HUSH significantly improved on depressed mood and anxiety; spouses improved on self-efficacy and their skills in supporting their wife. Additionally, wives’ appraisal of spousal support significantly improved. Between-group analyses revealed that outcomes from HUSH were comparable or larger in magnitude to outcomes achieved by the in-person delivered program. Conclusions A manualized telephone-delivered intervention given directly to spouse caregivers can potentially improve adjustment in both spouses and diagnosed wives but study outcomes must be interpreted with caution. Given the small samples in the pilot studies and the absence of randomization, further testing is needed with a more rigorous experimental design with a larger study sample.

Objectives The concept analysis of environmental enrichment aims to clarify the meaning of the term contributing to a shared understanding of its use in healthcare and future research studies. Environmental enrichment has implications in health promotion in children's development and healthy aging in the general population. Methods A literature search using PubMed and CINAHL databases on environmental enrichment was conducted to identify the uses of the term from various disciplines. The keywords are "environmental enrichment", "socialization", "physical activity", "cognitive stimulation", and "experience-dependent". Human studies from 2000 to 2020 were included in the search. Results Availability of green spaces, neighborhood safety, walkability to community centers, and accessibility of community resources are antecedents of environmental enrichment. Defining attributes are positive stimulation, interpersonal interaction, and physical engagement. The consequences of environmental enrichment are improved cognitive functioning in children, decline in memory impairment, and reduced risk of developing dementia in the elderly. Conclusion Engaging and counseling patients, family members, and the community in adverse effects of a deprived environment and the benefits of an enriched environment is a vital tenet of the nursing discipline. Understanding the optimum amount of positive stimulation, interpersonal interaction duration, and frequency are needed in future research.

Background: Despite an awareness that parents experience distress and heightened uncertainty at the end of their adolescent’s treatment for cancer, little is known about the specific challenges and concerns parents hold for their adolescent survivors or how they manage these challenges. This study described challenges parents experience in the first year after their adolescent’s cancer treatment and what parents did to manage those challenges. Method: Single occasion semistructured interviews were conducted with parents and were transcribed verbatim. Data were coded using inductive content analysis methods adapted from grounded theory. Results: Participants were 30 parents of adolescent survivors (13-18 years) who were in the first year following treatment completion. The core construct, “Walking on Eggshells,” explained the processes and experiences parents faced once treatment was complete. Two additional domains captured how parents managed posttreatment challenges (“Doing What We Can”) and the ways parents helped their adolescents adjust (“Balancing”). Conclusion: Study results suggest that services and materials are needed to help parents know common struggles that arise after treatment and ways to mitigate the severity of distress parents experience.

Objective The purpose of this study was to evaluate the feasibility of a home-based educational skill building program to support exclusive breastfeeding for mothers in the early postpartum period. Specific aims were to: (1) evaluate the effectiveness of the study’s recruitment strategy, comparing the use of an intermediary with a direct approach, (2) examine intervention fidelity, (3) examine program adherence, and (4) assess the acceptability of the intervention to participants. Design and Sample A mixed methods within-group, three-occasion descriptive design, delivered to 14 dyads of breastfeeding mothers and their full-term singleton infants. Intervention The program was implemented during three, 60-90 minute educational training sessions in the home, delivered at 6, 13, and 27 days postpartum. Results Mothers who adhered to the intervention protocol correctly attributed their infant’s crying behavior to factors other than the adequacy of the mother’s milk supply. All participants were recruited through direct approach. The program was delivered as planned with high fidelity, a high retention rate, and with a high rate of acceptability. Conclusions A fully scripted, at-home, nurse-delivered educational skill building program can be delivered with efficiency to breastfeeding mothers with full-term singleton infants; intervention fidelity, retention, and acceptability were high.

OBJECTIVE: The purpose of this study was to examine the feasibility and short-term impact of a 5-session fully manualized, group-delivered cancer parenting education program to diagnosed parents or surrogate parents with a school-age child. DESIGN: Single group, pre-post-test design with intent to treat analysis. SAMPLE: A total of 16 parents completed the program who were diagnosed within 12 months with non-metastatic cancer of any type (Stages 0-III), read and wrote English, had a child 5–17 years old who knew the parent’s diagnosis. METHODS: Assessments occurred at baseline and at 2 months post-baseline on standardized measures of parental depressed mood, anxiety, parenting self-efficacy, parenting quality, parenting skills and child behavioral-emotional adjustment. FINDINGS/RESULTS: The program was feasible and well accepted: 16/18 (89%) of the enrolled participants were included in the intent to treat analysis. Program staff were consistently positive and enthusiastic about the demonstrated skills they observed in group attendees during the group-delivered sessions, including the emergence of support between attendees. Outcomes on all measures improved between baseline and post-intervention; changes were statistically significant on measures of parents’ anxiety, parents’ self-efficacy, parents’ skills, and parenting quality. CONCLUSIONS: The Enhancing Connections-Group delivered cancer parenting program has potential to improve behavioral-emotional outcomes on standardized measures of skills and emotional adjustment in parents, parent-surrogates and children. Future testing is warranted. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS: After a brief training, a fully manualized cancer parenting program can enhance parenting competencies and parent-reported child outcomes.

Objective The objective of this study was to test the short-term efficacy of a brief, fully manualized marital communication and interpersonal support intervention for couples facing recently diagnosed breast cancer. Methods A total of 322 women diagnosed within 6 months with stages 0 to III breast cancer and their 322 spouse caregivers were enrolled. Spouses in the experimental group received five 30- to 60-minute intervention sessions at 2-week intervals by master's-prepared patient educators; controls received the booklet, "What's Happening to the Woman I Love?" Outcomes were assessed at 3, 6, and 9 months using the linear mixed models within an intent-to-treat analysis. Results Compared with controls, at 3 months, spouse caregivers significantly improved on standardized measures of depressed mood, anxiety, cancer-related marital communication, interpersonal support, and self-care. All differences except depressed mood and anxiety were sustained at 9 months. Wives significantly improved at 3 months on marital communication and positive appraisal of spouses' interpersonal support; gains remained significant at 9 months. Compared with controls on chemotherapy, wives in the experimental group additionally improved on depressed mood and tended to improve on anxiety. Conclusions A brief, fully manualized intervention delivered directly to spouse caregivers early in the course of their wives' medical treatment improves caregivers' self-care and behavioral-emotional adjustment and wives' positive view of their spouses' support and communication. The brevity and manualized structure of the intervention argue strongly for its scalability, use in cost-sensitive settings, and its potential dissemination through e-health channels.

African American adults experience a disproportionate burden and increased mortality for most solid tumor cancers and their adolescent children are negatively impacted by the illness experience. The purpose of this randomized clinical trial is to evaluate the efficacy of a culturally sensitive family-based intervention program developed for African American families coping with solid tumor parental cancer using an intention-to-treat approach. Primary outcome is adolescent depressive symptoms at end of treatment. A sample of 172 African American families will be enrolled from two diverse oncology centers (Helen Graham Cancer Center in Newark, DE, and Kimmel Cancer Center in Philadelphia, PA). Eligible families will be randomized either to a 5-session intervention Families Fighting Cancer Together (FFCT) or a 5-session parent-only psycho-educational (PED) program. Assessments will occur at weeks 0 (baseline), 8 (end-of-treatment), 24, and 52. Treatments to help African American adolescents cope with the impact of parental cancer are scarce and urgently needed. If successful, this proposed research will change the nature of intervention support options available to African Americans, who are overrepresented and underserved by existing services or programs. This project is registered with ClinicalTrials.gov (Protocol #: NCT03567330).

Background Despite knowing the potential medical consequences of cancer treatment, little is known about how adolescents cognitively and emotionally frame, process, and manage in the early survivorship period. Objective The specific aims were to describe the worries, perceived challenges, and ways of dealing with these issues for adolescent cancer survivors in the early period of survivorship. Methods Twenty-nine adolescent survivors (12-18 years) completed a semistructured interview. Inductive coding methods adapted from grounded theory were used to analyze the data. Results Seven domains and 18 categories organized the adolescent's experience with early posttreatment survivorship. The domains included getting back to school; relationships with parents, siblings, friends; feeling changed by the experience; and concerns about relapse. Conclusions This study contributes to our understanding of survivors' relationships with parents, siblings, and friends and survivors' models of the illness. Future studies are needed to understand how parents can help adolescents assume greater responsibility for their care, to understand what it is like for friends to have a peer with cancer and what behaviors by healthcare providers contribute to feelings of abandonment later in survivorship, and to better understand adolescent survivors' models of the illness and survivorship. Implications for practice Study results suggest that nurses are in an ideal position to begin and to continue discussions with adolescent survivors about the adolescent's view of medical follow- up, its purpose and importance, and ways in which the adolescent can begin, early on, to engage in planning their own health during survivorship.

The purpose of this study is to examine the feasibility and short-term impact of a fully manualized, telephone-delivered intervention for spouse caregivers, Taking Care of Her (TCH). A total of 12 study participants from the Pacific NW were enrolled whose wife was diagnosed with Stage III ovarian cancer within 8 months. Feasibility was confirmed by rates of recruitment and retention; the quality of delivery of the intervention by telephone; and through data obtained on program acceptability during follow up exit interviews. Outcomes from the within-group analysis revealed improvements on standardized measures of spouses’ and patients’ depressed mood and anxiety; marital communication about the cancer; caregivers’ skills and confidence to manage the emotional toll of the illness on themselves and wives; and wives’ positive appraisal of spousal support. Study results suggest that the TCH Program has the potential to positively affect both spouse caregiver and patients’ adjustment to recently diagnosed advanced ovarian cancer. Telephone delivery holds promise for sustainability. A future clinical trial with a larger study sample is warranted.

One-on-one peer coaching/support programs hold promise in promoting healthy outcomes among women at risk for and surviving with breast cancer, with the potential to bridge gaps in “whole person care.” Although popularly cited for their benefits, emerging evidence is mixed and suggests that peer support program impacts may be attenuated by individual- and community-specific factors. We evaluated a national not-for-profit breast cancer organization’s peer support program outcomes (2015–2018) serving women from predominantly Jewish backgrounds to examine program engagement, facilitation, and satisfaction. Of the N = 392 women sampled, 37% utilized the peer support program: the majority were referred by a family member/friend (40%) or had connected with the program online (34%). Logistic regression modeling revealed that mothers (odds ratio [OR] = 1.82; 95% confidence interval [CI] = 1.04 to 3.19), women at increased genetic risk for breast cancer (OR = 2.07; 95% CI = 1.08 to 3.94), and those who connected with the organization through a family member/friend (OR = 1.97; 95% CI = 1.23 to 3.15) were significantly more likely to utilize peer support (all p’s < .05). Satisfaction with peer support was high and reliably measured (M = 42.8 out of possible 50; α = .95). These findings emphasize opportunities for peer support programs to serve a range of needs among breast cancer previvors and survivors and increase health care’s organizational capacity to reach and impact this community through trusted and well-trained lay coaches.

Background Maternal breast cancer has a significant impact on the well-being of school-aged children, but we know very little about the concerns these children attribute to their mother's illness. Objective The aim of this study was to describe child-reported illness-related concerns experienced in the initial 6 months of their mother's diagnosis and to identify any differences by age and gender of the child. Methods Data were obtained from 140 school-aged children (7-12 years) within 6 months of their mother diagnosis with stage 0 to III breast cancer. Children's written responses to an open-ended question were analyzed: "Think about a situation that has bothered you during the last month that had to do with your mom's breast cancer." Inductive content analysis was used to analyze the data using methods adapted from grounded theory. Trustworthiness of results was protected by coding to consensus, formal peer debriefing, and maintaining an audit trail. Results "Losing Her", the core construct, was identified and organized the children's concerns in 4 domains: (1) her being away from me, (2) worrying about her, (3) seeing my mother be different, and (4) changing how things work. Conclusion All children reported illness-related concerns about which they were bothered. Even seemingly short-term treatment-related absences from the child were interpreted as difficult. Implication for practice Findings from the current study add to nurses' awareness and knowledge about the concerns of school-aged children during their mother's initial treatment of breast cancer. Nurses are in a key position to provide services directly to the child or through the mother.

Background: In 2018, >75,000 children were newly affected by the diagnosis of advanced cancer in a parent. Unfortunately, few programs exist to help parents and their children manage the impact of advanced disease together as a family. The Enhancing Connections-Palliative Care (EC-PC) parenting program was developed in response to this gap. Objective: (1) Assess the feasibility of the EC-PC parenting program (recruitment, enrollment, and retention); (2) test the short-term impact of the program on changes in parent and child outcomes; and (3) explore the relationship between parents' physical and psychological symptoms with program outcomes. Design: Quasi-experimental two-group design employing both within- and between-subjects analyses to examine change over time and change relative to historical controls. Parents participated in five telephone-delivered and fully manualized behavioral intervention sessions at two-week intervals, delivered by trained nurses. Behavioral assessments were obtained at baseline and at three months on parents' depressed mood, anxiety, parenting skills, parenting self-efficacy, and symptom distress as well as children's behavioral-emotional adjustment (internalizing, externalizing, and anxiety/depression). Subjects: Parents diagnosed with advanced or metastatic cancer and receiving noncurative treatment were eligible for the trial provided they had one or more children aged 5-17 living at home, were able to read, write, and speak English, and were not enrolled in a hospice program. Results: Of those enrolled, 62% completed all intervention sessions and post-intervention assessments. Within-group analyses showed significant improvements in parents' self-efficacy in helping their children manage pressures from the parent's cancer; parents' skills to elicit children's cancer-related concerns; and parents' skills to help their children cope with the cancer. Between-group analyses revealed comparable improvements with historical controls on parents' anxiety, depressed mood, self-efficacy, parenting skills, and children's behavioral-emotional adjustment. Conclusion: The EC-PC parenting program shows promise in significantly improving parents' skills and confidence in supporting their child about the cancer. Further testing of the program is warranted.

PURPOSE: United States Hispanics are more likely to be diagnosed with advanced cancer as parents than their non-Hispanic white counterparts but little is known about Hispanic parents’ willingness to discuss a terminal cancer diagnosis with dependent children, potentially resulting in suboptimal child coping. Therefore, we investigated Hispanic mothers’ willingness to communicate with dependent children about her actual or hypothetical advanced cancer diagnosis. METHODS: Two focus groups (n = 6 participants) and three, one-on-one interviews (n=3), were conducted among adult, Mexican-American mothers with a current cancer diagnosis of any stage residing in U.S.-Mexico border communities. Participants reported their perceived concerns, parenting challenges and openness to discussing an incurable cancer diagnosis with a dependent child. Audio files were transcribed into English and qualitatively coded using content analysis. RESULTS: Participants, most with breast cancer, ranged in age from 25–47. Five had considered the possibility of their own death from advanced cancer and three had previously discussed this with their children. While many expected their children would carry on well without them, seven expressed concern for the emotional/spiritual well-being of their children. Mothers anticipated physical and time-based parenting challenges but wanted the opportunity to focus on themselves and their children in advance of death. All but one would be willing to discuss an advance cancer diagnosis with dependent children; four expressed the value of doing so or the potential harm of abdicating this responsibility. CONCLUSIONS: If faced with an advanced cancer diagnosis, Mexican-American mothers are open to communicating with dependent children.

The purposes of the study were to (1) test the short-term impact of a telephone-delivered cancer parenting education program, the Enhancing Connections-Telephone (EC-T) Program, on maternal anxiety, depressed mood, parenting competencies, and child behavioral-emotional adjustment and (2) compare those outcomes with outcomes achieved from an in-person delivery of the same program (EC). Thirty-two mothers comprised the sample for the within-group design and 77 mothers for the between-group design. Mothers were eligible if they had one or more dependent children and were recently diagnosed with stages 0–III breast cancer. Mothers in both groups received five intervention sessions at 2-week intervals from a patient educator using a fully scripted intervention manual. Outcomes from the within-group analysis revealed significant improvements on maternal anxiety, parenting competencies, and the child’s behavioral-emotional functioning. Outcomes from the between-group analysis showed the EC-T did as well or better than EC in positively affecting maternal anxiety, depressed mood, parenting competencies, and the child’s behavioral-emotional adjustment. Furthermore, the EC-T had a significantly greater impact than the EC on maternal confidence in helping their family and themselves manage the cancer’s impact and in staying calm during emotionally charged conversations about the breast cancer with their child. Regardless of the channel of delivery, the Enhancing Connections Program has the potential to positively affect parenting competencies and behavioral-emotional adjustment in mothers and dependent children in the first year of stages 0–III maternal breast cancer. Its positive impact from telephone delivery holds promise for sustainability.

Background: A framework for adolescent and young adult (AYA) survivors that addresses developmental milestones, short and long-term impacts of cancer on relationships is needed to understand the long-term consequences of cancer treatment and why AYAs do not participate in long-term follow-up care. Objectives: Develop a theoretical framework of end-of-treatment and early post-treatment based on a systematic review of the literature and suggest future directions for research that derive from the review. Methods: A systematic review of published research from 1994 to 2014 was conducted using three databases: PubMed, CINAHL, Psych Info using search terms survivors AND end of treatment OR transition* AND cancer. Results: The framework is organized along a time trajectory that includes treatment and post-treatment separated by the critical transition of end-of-treatment. The framework explores links between AYA development; changes in survivor’s relationships with parents, peers, siblings, health care providers; and evidence of issues at end-of-treatment for survivors and parents. Conclusion: Results from the systematic review suggest that end-of-treatment and early post-treatment are particularly challenging for survivors and parents. Five areas of future research are identified: provider behaviors that contribute to AYA’s feelings of abandonment; end-of-treatment and follow-up visits; survivor and parent expectations at end-of-treatment and actual challenges in post-treatment; convergence or discordance between the AYA’s and parent’s concerns and how parents’ concerns may conflict and thwart survivors’ efforts to achieve developmental milestones; and peers’ perceptions and concerns.

Introduction The incidence of unintentional burn injuries provides a natural condition that induces guilt and other emotions, such as blame, in the parents of the inflicted child. Empirical evidence generated has suggested that the consequences of guilt include both prosocial behaviors and antisocial behaviors. Therefore, the effects of guilt on parental behavioral and emotional outcomes have long-term implication. The purposes of this study were to examine guilt and its representation in parental responses to a child’s burn, and to look for the immediate consequences that guilt for parents. Methods Semi-structured interviews were conducted with 20 parents or caregivers in the hospital during their child’s clinical visit in a regional burn center in eastern China. We used a combination of deductive and inductive content analysis to analyze the interview data. Results Parents expressed feelings of guilt using both the word “guilt” or sentences that conveyed the manifest meaning, which reflected the definition of guilt. Analysis of the data produced three conceptual domains of the consequence of guilt. Reappraisal of guilt toward the self included eight categories: regret, blaming myself, thinking about why, not wanting to talk, wanting to be punished, blaming others, having trouble sleeping and feeling irresponsible. Motivational reactions toward the child were sorted into four categories: paying more attention to prevent injuries, feeling sorry for the child, providing the best care, and placating the child. Other reported accompanying emotions included upset, anger and heartache. Conclusions Guilt and its consequences are correlated but have distinct semantic representation. However, guilt and its related emotions were often expressed within one parent’s account of his or her emotional experience. Blaming has been a significant reaction among parents and family caregivers, including self-blaming and blaming others. The results of this study suggest that guilt appears to promote both prosocial and antisocial emotions and behaviors in parents. Applicability of Research to Practice This paper’s findings help to extend our theoretical understanding of the guilt and its effects on the development and persistence of emotional distress in parents facing their child’s unintentional burn injury. What’s more, these results have practical implications for professionals caring for parents or family caregivers who are in greater need of professional mental health support and interventions, given the long-term recovery period in children with moderate to severe burn injury and the meaning and visibility associated with the burn scars. Further research is needed to elucidate the role of guilt in the development and persistence of emotional distress in parents facing their child’s unintentional burn injury.

Background Oncology nurses can assist patients in gaining skills and confidence in multiple areas of illness self-management, including parenting skills. Child-rearing parents with cancer are a unique population because they must self-manage their illness and also help their child manage the intrusion of cancer on everyday life. The telephone offers an inexpensive channel for nurses to assist mothers in developing competencies to parent their child. The acceptability and attributed gains from such telephone services are unknown. Objective The aims of this study were to (1) describe the gains child-rearing mothers attribute to participation in a nurse-delivered telephone cancer parenting program and (2) assess mothers' evaluation of the telephone as a channel for delivering the program. Methods Study participants were child-rearing mothers diagnosed with cancer (N = 31) who had completed a manualized telephone-delivered cancer parenting program by a nurse. Mothers were interviewed 1 month after exiting the program by a specially trained interviewer masked on the content of the program. Results Most mothers were white (74%), highly educated, and had breast cancer (93.5%). Mothers attributed gains from the program in 3 areas: (1) being fully present for my child, (2) communicating in new ways, and (3) putting away my assumptions. Conclusions Communication skills learned from nurses can assist mothers to self-manage the impact of the cancer on their own well-being and add to their parenting skills and competencies to help their children. Implications for practice The telephone is an effective and indeed preferred channel for delivering services to child-rearing parents impacted by cancer.

Purpose The purpose of this study is to describe parents' experiences in caring for 2–5-year-old children with juvenile idiopathic arthritis (JIA). Design and methods A qualitative study using single-occasion in-depth interviews was conducted. Nine parents (eight mothers and one father) were interviewed in-person or via telephone. Data were analyzed using inductive content analysis. Methods used to protect the trustworthiness of study results included maintenance of an audit trail, peer debriefing, and member checks. Results The core construct Struggling in the Dark to Help My Child explained parents' experience in six domains: not knowing, trying to reach out in the dark, feeling my child's pain, working out the kinks to stay on top to manage, feeling drained by the whole process, and being hard on the entire household. Parents struggled with the unknown, searched for resources, witnessed their child's suffering without knowing how to help, and tried every possible way to stay on top of the child's illness and treatment, even when they felt drained physically and emotionally. JIA not only consumed their lives, but also affected the entire family, including the siblings and spouse, and the relationships among family members. Conclusion and implications Findings highlight the day-to-day lived challenges parents face when caring for a young child with JIA. Healthcare providers including nurses need to assess the particular needs of an ill child and parents as well as the impact of the illness on the physical and psychosocial health of the entire family so that proper resources can be provided.

Objective Evaluate the feasibility and acceptability of a behaviorally focused intervention designed to increase perceived cardiovascular disease (CVD) and coronary heart disease (CHD) risk in young adults with a family history (FH) of CVD/CHD. Design and Sample Single group, pre-post-test design. Fifteen, mostly female (n = 13, 86.7%), White, young adults (mean age 20.8 years) with a minimum of a high school education with a FH of CVD/CHD. Measures Feasibility examined the recruitment strategy, study procedures, appropriateness and quality of the study instruments, and problems that occurred during delivery of the intervention. Acceptability examined participants’ engagement in the in person sessions and at home exercises and their feedback about the intervention. Intervention Two, in person sessions provided personalized, tailored messages about 10-year and lifetime CHD risk based on risk factors, FH from a three-generation pedigree, lipid levels, blood pressure, and smoking status, and brief counseling about how to engage in a healthy lifestyle to decrease CVD/CHD risk. Results The intervention was feasible and acceptable. Participants requested more information on healthy food choices, including which foods to avoid and which exercises most improve cardiovascular health. Conclusions Although requiring refinement, the intervention has potential public health implications and deserves further testing.

BACKGROUND Lifestyle choices have a significant impact on cardiovascular disease (CVD) risk. Interventions to promote a heart-healthy lifestyle in young adults at long-term high risk for CVD are needed to decrease the burden of CVD. However, few interventions with this purpose have been developed. OBJECTIVE The objective of this study was to examine the effect of a pilot intervention on young adults with a family history of CVD that used 3-generation pedigrees, risk factor information, and counseling on heart disease knowledge, perceived CVD risk, and intention to engage in a heart-healthy lifestyle. METHODS A pretest-posttest design, with within-group analysis, was used to examine the effect of the intervention. Paired t test and Wilcoxon signed rank tests were used to examine the changes in heart disease knowledge, perceived risk, and behavioral intention from baseline to postintervention. The Cohen d was calculated to examine the effect of the intervention on study measures. In addition, Spearman ρ was used to examine the associations between postintervention perceived risk, postintervention behavioral intention, and family history. RESULTS The sample for the pilot study included 15 mostly white and mostly female healthy young adults between the ages of 18 and 25 years. The intervention was effective at increasing CVD knowledge (P = .02) and had a medium effect on perceived risk and intention to engage in a heart-healthy lifestyle (Cohen d, 0.48-0.58). There were significant associations between postintervention perceived risk and postintervention intention to exercise and the participants' family history of coronary heart disease (r = 0.62, P = .014 and r = 0.55, P = .035, respectively). CONCLUSIONS Interventions are needed to increase individuals' awareness of their long-term CVD risk and to improve their ability to make lifestyle changes. Although this intervention was only tested in a small sample, it shows promise to improve heart disease knowledge and perceived lifetime CVD risk and may effect longer-term risk for CVD.

With an aging global population, the number of dementia cases is growing exponentially. To address the upcoming dementia crisis, the World Health Organization and Alzheimer’s Disease International (2012) collaborated on an extensive report, Dementia: A Public Health Priority. In the United Kingdom, Prime Minster David Cameron initiated a national challenge on dementia, forming 3 dementia challenge champion groups aimed at improving health and care, creating dementia-friendly communities, and promoting dementia research. In the U.S., President Obama signed the National Alzheimer’s Project Act, which led to the formation of the Advisory Council on Alzheimer’s Research, Care, and Services and the launch of the first National Plan to Address Alzheimer’s Disease. The term “dementia capable” was introduced in the 2012 Recommendations of the Public Members of the Advisory Council and has since been adopted in both the recommendations and annual updates of the national plan. This paper will first compare and contrast government usage of the concepts dementia friendly and dementia capable, along with another valuable concept, dementia positive, that was added after reviewing the literature. Finally, a new vision statement for the U.S.’ national plan will be proposed and recommendations incorporating these 3 concepts in policy, research, and practice will be made.

Objectives—A three year drowning prevention campaign focused on increasing the use of life vests among children 1‐14 years old. An evaluation was conducted to determine campaign awareness, change in ownership and use of life vests by children, and predictors of life vest use. Setting—King County, Washington. Methods—Four telephone surveys were conducted with parents before, during, and after the campaign. Results—The campaign was recalled by 50% of families surveyed. From before to after the campaign, reported life vest use by children on docks, beaches, or at pools increased from 20% to 29% (p

This study examines the experiences of 48 spouses of wives newly diagnosed with local or regional breast cancer. Their reported experiences were organized into the core construct of Coming to Grips reflected by four domains: (1) Feeling nailed by the breast cancer; (2) Changing us; (3) Taking care of me; and (4) Making things work. Prior studies have underestimated the extent to which the assumptive world and day-to-day lives of spouses are shattered by the diagnosis of breast cancer and the work they do to guess how to be supportive to their wives. Interventions are needed which directly assist spouses add to their ways of managing the intrusion of their wife’s breast cancer in their lives.

Objective—To describe spouses' reported cancer-related demands attributed to their wife's breast cancer and to test the construct and predictive validity of a brief standardized measure of these demands. Methods—Cross-sectional and longitudinal data were obtained from 151 spouses of women newly diagnosed with non-metastatic breast cancer. Descriptive statistics were computed to describe spouses' dominant cancer-related demands and multivariate regression analyses tested the construct and predictive validity of the standardized measure. Results—Five categories of spouses' cancer-related demands were identified, such as concerns about: spouses' own functioning; wife's well being and response to treatment; couples' sexual activities; the family's and children's well-being; and the spouses' role in supporting their wives. A 33-item short version of the standardized measure of cancer demands demonstrated construct and predictive validity that was comparable to a 123-item version of the same questionnaire. Greater numbers of illness demands occurred when spouses were more depressed and had less confidence in their ability to manage the impact of the cancer (F=18.08 (3, 103), p

Despite the high rates of breast cancer in the child-rearing mother, there is extremely limited research on the effects of the illness on the children, marriage, and parent-child relationship. The current study tested an explanatory model of family functioning with breast cancer based on data obtained from standardized questionnaires from 80 diagnosed mothers and partners with young school-age children. Path analysis results for data obtained from both the mothers and the partners revealed a similar pattern. More frequently experienced illness demands were associated with higher levels of parental depressed mood which negatively affected the marriage. When the marriage was less well adjusted, it negatively affected the family's coping behavior. Household functioning was positively affected by heightened coping activity and by higher levels of marital adjustment. Children functioned better when the non-ill parent more frequently interacted with them and their families coped more frequently with their problems.

THE FATHER'S, MOTHER'S, AND ADOLESCENT'S FUNCTIONING WITH BREAST CANCER* Frances Marcus Lewis and Mary A. Hammond" The current study used path analysis to examine the impact of early stage breast cancer on the functioning of families with adolescents. Results revealed that the illness-related demands that the mothers and fathers saw impinging on their family predicted higher levels of maternal depressive mood, poorer marital adjustment, and lower parenting quality. When parenting quality was lower, the adolescent scored lower on self-esteem. Family professionals can help couples gain cognitive behavioral control over their perceived illness-related demands, help husbands avoid transferring illness-related tension onto their appraisal of the marriage, and help adolescents appropriately interpret parenting behavior. Chronic medical illness in a parent has been studied primarily from the perspective of the diagnosed patient, not from the perspective of other household members (Hilton, 1989; Lewis, 1986, 1990; Lindsey, Norbeck, Carrieri, & Perry, 1981; Maguire et al., 1978; Peters-Golden, 1982; Wellisch, Fawzy, Landsverk, Pasnau, & Wolcott, 1983). Research on breast cancer has reflected this same pattern. Even when the window of observation into the family's experience with breast cancer has been expanded to include the spouse/partner (Carter, Carter, & Siliunas, 1993; Gotay, 1984; Lewis & Deal, 1995; Northouse, 1988; Northouse & Peters-Golden, 1993; Northouse & Swain, 1987; Sabo, Brown, & Smith, 1986; Wellisch, 1981; Wellisch, Jamison, & Pasnau, 1978; Zahlis & Shands, 1991, 1993), there has been extremely limited documentation of the child's or adolescent's adjustment to the illness (Armsden & Lewis, 1994; Lewis, 1996). Given that an estimated 184,300 women will be diagnosed with breast cancer in 1996 and an estimated 15 to 30% of them will have one or more children still living in the home, this represents a substantial number of potentially affected children (Parker, Tong, Bolden, & Wingo, 1996). Few researchers have examined the adolescent's response to cancer in a mother. Early clinical evidence of the impact of breast cancer on the adolescent was reported by Grandstaff (1976), who observed that adolescents, particularly males, had a difficult time adjusting to their mothers' breast cancer. More recent research has been data based (Lichtman et al., 1984; Wellisch, Gritz, Schain, Wang, & Siau, 1991, 1992). Wellisch et al.'s study, however, relied on the adult daughter's retrospective report of her response to her mother's breast cancer and aggregated data across children ages 0 to 20 years at the time of the mother's diagnosis. Lichtman's team studied the mother-daughter and mother-son relationship but relied on the mother's report of changes in the relationship that were consequent to the breast cancer (Lichtman et al., 1984). The study was also limited because, like Wellisch's research, it relied on retrospective reports and data were aggregated across a wide age span of children's ages. Not only has prior research given limited attention to the adolescent's experience with breast cancer in the mother, it has also overrelied on the diagnosed mother as the sole reporter for the family. With only one known exception, the father's report of his family's experience with breast cancer has received no attention (Lewis, Woods, Hough, & Bensely, 1989), but results from that prior study were limited to children ages 6 through 12. The purpose of the current study was to test a theoretical model of the impact of the mother's breast cancer in adolescent-rearing households from the mother's, father's, and adolescent's viewpoints. The theoretical model derives from stress and coping, developmental, and family systems theories (Brody, Stoneman, & Burke, 1987; Buckley, 1967; Hill, 1972; Kobak & Sceery, 1988; Kobak, Sudler, & Gamble, 1991; Lazarus & Folkman, 1984; Schwenk & Hughes, 1983). …

The purpose of the current study was to describe the types of coping strategies household families use to manage problems that affect them when the mother has a chronic illness. Data presented are cross-sectional data from first occasion interviews collected as part of a larger longitudinal study of 125 families (Lewis, Woods, & Ellison, 1983) in which the mother has either breast cancer, fibrocystic breast disease or diabetes. The instrument used to collect data on family coping was the Problem Centered Family Coping Interview (Lewis, 1983). Study families reported a mean number of 4.02 coping strategies per family. Using content analysis, 55 mutually exclusive coping strategies were identified from open-ended interview questions. These 55 categories were combined into 10 composite categories by content area for purposes of statistical analysis. The most frequent composite category reported by the study sample was alterations in household management which represented 38% of the types of strategies employed by these families. The type of chronic illness in the mother did not differentiate the families by categories of management strategies.