Chronic psychological stressis a risk factor formultiple diseases of aging. Accelerated cellular aging as indexed by short telomere length has emerged as a potential common biological mechanism linking various forms of psychological stress and diseases of aging. Stress appraisals determine the degree and type of biological stress responses and altered stress appraisals may be a common psychological mechanism linking psychological stress and diseases of aging. However, no previous studies have examined the relationship between stress appraisals and telomere length. We exposed chronically stressed female caregivers and non-caregiving controls (N= 50; M age = 62.14±6.10) to a standardized acute laboratory stressor and measured their anticipatory and retrospective threat and challenge appraisals of the stressor. We hypothesized that threat and challenge appraisals would be associated with shorter and longer telomere length respectively, and that chronic care giving stress would influence telomere length through altered stress appraisals. Higher anticipatory threat appraisals were associated with shorter age-adjusted telomere length (β = −.32, p = .03), but challenge appraisals and retrospective threat appraisals showed no independent association with telomere length. Caregivers reported significantly higher anticipatory (β = −.36, p = .006)and retrospective (β = −.29, p = .03) threat appraisals than controls, but similar challenge appraisals. Although there was no significant main effect of caregiver status on telomere length, care giving had a significant indirect effect on telomere length through anticipatory threat appraisals. Exaggerated anticipatory threat appraisals may be a common and modifiable psychological mechanism of psychological stress effects on cellular aging.
cellular aging; challenge; chronic stress; stress appraisals; threat; telomere length
To evaluate the prospective relation between dispositional traits of optimism and pessimism and IVF treatment failure among women seeking medical intervention for infertility.
Among 198 women (ages 24-45, M=35.1[4.1]; 77% white), the outcome of each participant’s first IVF treatment cycle was examined. Treatment outcome was classified as being successful (vs. failed) if the woman either delivered a baby or was pregnant as a result of the cycle by the end of the 18-month study period. At baseline, optimism and pessimism were measured as a single bipolar dimension and as separate unipolar dimensions according to the Life Orientation Test (LOT) total score and the optimism and pessimism subscale scores, respectively.
Optimism/pessimism, measured as a single bipolar dimension, predicted IVF treatment failure initially (B = -.09; p = .02; OR = 0.917; 95% CI = 0.851 – 0.988), but this association attenuated following statistical control for trait negative affect (B = -.06; p = .13; OR = 0.938; 95% CI = 0.863 – 1.020). When examined as separate unipolar dimensions, pessimism (B = .14; p = .04; OR = 1.146; 95% CI = 1.008 – 1.303), but not optimism (B = -.09; p = .12; OR = 0.912; 95% CI = 0.813 – 1.023), predicted IVF treatment failure independently of risk factors for poor IVF treatment response as well as trait negative affect.
Being pessimistic may be a risk factor for IVF treatment failure. Future research should attempt to delineate the biological and behavioral mechanisms by which pessimism may negatively affect treatment outcomes.
optimism; pessimism; trait negative affect; infertility; in vitro fertilization
Physically active individuals have lower rates of morbidity and mortality, and recent evidence indicates that physical activity may be particularly beneficial to those experiencing chronic stress. The tendency to ruminate increases and prolongs physiological stress responses, including hypothalamic-pituitary adrenal (HPA) axis responses as indexed by cortisol reactivity to stressful experiences. We examined the association between ruminating in response to a laboratory stressor task and HPA axis reactivity and recovery, and whether a physically active lifestyle moderates the associations between rumination and cortisol output trajectories.
Forty-six post-menopausal women underwent the Trier Social Stress Test while salivary cortisol was repeatedly measured. Twenty-five minutes after the end of the stressor, participants reported level of rumination in response to the stress.
Findings indicate that physical activity moderated the initial rate (B = −.10, SE = .04, p < .05) and curvature (B = −.03, SE = .01, p = .06) of the relationship between rumination and log-transformed cortisol trajectory. Among sedentary participants, those who responded to the stressor with higher levels of rumination had a more rapid initial increase in cortisol (0.26 vs 0.21, p < .001), a later peak (56 vs. 39 minutes), and a delayed recovery (curvature −0.07 vs. −0.08, p < .001) compared to those with lower levels of rumination. In active participants, cortisol trajectories were equivalent, regardless of level of rumination.
In sum, individuals who maintain a physically active lifestyle may be protected against the effects of rumination on HPA axis reactivity to and recovery from acute stress.
acute stress; rumination; physical activity; mixed modeling; cortisol reactivity
As the prevalence of childhood obesity has risen in past decades, more attention has been given to how the neighborhood food environment affects children’s health outcomes.
This exploratory study examined the relationship between the presence of neighborhood food stores within a girl’s neighborhood and 3-year risk of overweight/obesity and change in BMI, in girls aged 6 or 7 years at baseline.
A longitudinal analysis of participants in the Cohort Study of Young Girls’ Nutrition, Environment and Transitions (CYGNET) was conducted from 2005–2008. Neighborhood food stores were identified from a commercial database and classified according to industry codes in 2006. Generalized linear and logistic models were used to examine how availability of food stores within 0.25-mile and 1.0-mile network buffers of a girl’s residence were associated with BMI z-score change and risk of overweight or obesity, adjusting for baseline BMI/weight and family sociodemographic characteristics. Data were analyzed in 2010.
Availability of convenience stores within a 0.25-mile network buffer of a girl’s residence was associated with greater risk of overweight/obesity (OR 3.38, 95% CI 1.07, 10.68) and an increase in BMI z-score (β=0.13, 95% CI 0.00, 0.25). Availability of produce vendors/farmer’s markets within a 1.0-mile network buffer of a girl’s residence was inversely associated with overweight/ obesity (OR 0.22, 95% CI 0.05, 1.06). A significant trend was observed between availability of produce vendors/farmer’s markets and lower risk of overweight/obesity after 3 years.
Although food store inventories were not assessed and food store indices were not created, the availability of neighborhood food stores may affect a young girl’s weight trajectory over time.
The authors investigated use of the internet-based patient portal, kp.org, among a well-characterized population of adults with diabetes in Northern California. Among 14 102 diverse patients, 5671 (40%) requested a password for the patient portal. Of these, 4311 (76%) activated their accounts, and 3922 (69%), logged on to the patient portal one or more times; 2990 (53%) participants viewed laboratory results, 2132 (38%) requested medication refills, 2093 (37%) sent email messages, and 835 (15%) made medical appointments. After adjustment for age, gender, race/ethnicity, immigration status, educational attainment, and employment status, compared to non-Hispanic Caucasians, African–Americans and Latinos had higher odds of never logging on (OR 2.6 (2.3 to 2.9); OR 2.3 (1.9 to 2.6)), as did those without an educational degree (OR compared to college graduates, 2.3 (1.9 to 2.7)). Those most at risk for poor diabetes outcomes may fall further behind as health systems increasingly rely on the internet and limit current modes of access and communication.
National surveys have found the percentage of female adolescents who report condom use at last sex differs by age group. Using longitudinal data, the authors examined whether there are longitudinal changes in condom use and whether these longitudinal changes are due in part to developmental changes in the types of sexual relationships in which young women are involved.
A clinic sample of 298 African American females aged 14 to 19 years at enrollment were interviewed every 6 months for 36 months. At each interview, participants were asked to name all their recent sex partners, to classify each partner as main or casual and to report whether or not a condom was used at last sex with each of these partners. Hierarchical generalized linear modeling was used to analyze repeated measures within individuals.
On average, there was no statistically significant change in condom use over time. The odds of having a single main partner increased by 4% for each six months spent in the study (OR: 1.04, 95%CI: 1.02, 1.05). Stratifying females by longitudinal relationship patterns resulted in three distinct condom use trajectories.
Data suggest that longitudinal changes in condom use are a function of developmental changes in relationships, whereby young women trend toward monogamous relationships. As condoms are abandoned within these monogamous relationships, lowering infection rates in sex partners through broader STI screening or through community-level interventions aimed at sex networks may prove to be a more effective approach to reduce STI risk in young women.
To characterize the backgrounds of women who have repeat abortions.
In a cross-sectional study of 259 women (M=35.2±5.6 years), the relation between adverse experiences in childhood and risk of having 2+ abortions versus 0 or 1 abortion was examined. Self-reported adverse events occurring between ages 0-12 were summed.
Independent of confounding factors, women who experienced more abuse, personal safety, and total adverse events in childhood were more likely to have 2+ versus 0 abortions (OR=2.56, 95% CI=1.15-5.71; OR=2.74, 95% CI=1.29-5.82; OR=1.59, 95% CI=1.21-2.09) and versus 1 abortion (OR=5.83, 95% CI=1.71-19.89; OR=2.23, 95% CI=1.03-4.81; OR=1.37, 95% CI=1.04-1.81). Women who experienced more family disruption events in childhood were more likely to have 2+ versus 0 abortions (OR=1.75, 95% CI=1.14-2.69) but not versus 1 abortion (OR=1.16, 95% CI=0.79-1.70).
Women who have repeat abortions are more likely to have experienced childhood adversity than those having 0 or 1 abortion.
contraception; early adversity; life events; repeat abortions
To assess the the association of limited English proficiency (LEP) and physician language concordance with patient reports of clinical interactions.
Cross-sectional survey of 8,638 Kaiser Permanente Northern California patients with diabetes. Patient responses were used to define English proficiency and physician language concordance. Quality of clinical interactions was based on 5 questions drawn from validated scales on communication, 2 on trust, and 3 on discrimination.
Respondents included 8,116 English-proficient and 522 LEP patients. Among LEP patients, 210 were language concordant and 153 were language discordant. In fully-adjusted models, LEP patients were more likely than English-proficient patients to report suboptimal interactions on 3 out of 10 outcomes, including 1 communication and 2 discrimination items. In separate analyses, LEP-discordant patients were more likely than English-proficient patients to report suboptimal clinician-patient interactions on 7 out of 10 outcomes, including 2 communication, 2 trust, and 3 discrimination items. In contrast, LEP-concordant patients reported similar interactions to English-proficient patients.
Reports of suboptimal interactions among patients with LEP were more common among those with language discordant physicians.
Expanding access to language concordant physicians may improve clinical interactions among patients with LEP. Quality and performance assessments should consider physician-patient language concordance.
We studied a prospective cohort of 434 couples in Northern California and found that 13% did not pursue any form of infertility treatment after their initial consultation. While age, education, and financial concerns remain important for patients in choosing whether to pursue infertility treatment, depressive symptoms may also be a barrier to achieving reproductive goals.
The studies reported here examines stress-related psychobiological processes that might account for the high, disproportionate rates of dental caries, the most common chronic disease of childhood, among children growing up in low socioeconomic status (SES) families. In two 2004 – 2006 studies of kindergarten children from varying socioeconomic backgrounds in the San Francisco Bay Area of California (Ns = 94 and 38), we performed detailed dental examinations to count decayed, missing or filled dental surfaces and microtomography to assess the thickness and density of microanatomic dental compartments in exfoliated, deciduous teeth (i.e., the shed, primary dentition). Cross-sectional, multivariate associations were examined between these measures and SES-related risk factors, including household education, financial stressors, basal and reactive salivary cortisol secretion, and the number of oral cariogenic bacteria. We hypothesized that family stressors and stress-related changes in oral biology might explain, fully or in part, the known socioeconomic disparities in dental health. We found that nearly half of the five-year-old children studied had dental caries. Low SES, higher basal salivary cortisol secretion, and larger numbers of cariogenic bacteria were each significantly and independently associated with caries, and higher salivary cortisol reactivity was associated with thinner, softer enamel surfaces in exfoliated teeth. The highest rates of dental pathology were found among children with the combination of elevated salivary cortisol expression and high counts of cariogenic bacteria. The socioeconomic partitioning of childhood dental caries may thus involve social and psychobiological pathways through which lower SES is associated with higher numbers of cariogenic bacteria and higher levels of stress-associated salivary cortisol. This convergence of psychosocial, infectious and stress-related biological processes appears to be implicated in the production of greater cariogenic bacterial growth and in the conferral of an increased physical vulnerability of the developing dentition.
Dental caries; socioeconomic status; stress; vulnerability; USA; children; psychobiological
Studies examining associations between racial discrimination and cardiovascular health outcomes have been inconsistent, with some studies finding the highest risk of hypertension among African Americans who report no discrimination. A potential explanation of the latter is that hypertension and other cardiovascular problems are fostered by internalization and denial of racial discrimination. To explore this hypothesis, the current study examines the role of internalized negative racial group attitudes in linking experiences of racial discrimination and history of cardiovascular disease among African American men. We predicted a significant interaction between reported discrimination and internalized negative racial group attitudes in predicting cardiovascular disease. Weighted logistic regression analyses were conducted among 1216 African American men from the National Survey of American Life (NSAL; 2001– 2003). We found no main effect of racial discrimination in predicting history of cardiovascular disease. However, agreeing with negative beliefs about Blacks was positively associated with cardiovascular disease history, and also moderated the effect of racial discrimination. Reporting racial discrimination was associated with higher risk of cardiovascular disease among African American men who disagreed with negative beliefs about Blacks. However, among African American men who endorsed negative beliefs about Blacks, the risk of cardiovascular disease was greatest among those reporting no discrimination. Findings suggest that racial discrimination and the internalization of negative racial group attitudes are both risk factors for cardiovascular disease among African American men. Furthermore, the combination of internalizing negative beliefs about Blacks and the absence of reported racial discrimination appear to be associated with particularly poor cardiovascular health. Steps to address racial discrimination as well as programs aimed at developing a positive racial group identity may help to improve cardiovascular health among African American men.
USA; African American men; cardiovascular disease; racial discrimination; racial identity
We investigated whether, over time, baseline obesity is associated with change in depressive symptoms or if baseline symptoms of depression are associated with change in body mass index (BMI) and waist circumference.
We used latent growth curve modeling to examine data from years 5, 10, 15, and 20 of the Coronary Artery Risk Development in Young Adults study (n = 4643). We assessed depressive symptomatology with the Center for Epidemiological Studies Depression scale.
Respondents who started out with higher levels of depressive symptoms experienced a faster rate of increase in BMI (for Whites only) and waist circumference (for Blacks and Whites) over time than did those who reported fewer symptoms of depression in year 5. Initial BMI and waist circumference did not influence the rate of change in symptoms of depression over time.
Depressive symptomatology likely plays a role in the development of physical health problems, such as cardiovascular disease, through its association with increases in relative weight and abdominal obesity over time.
We examined possible determinants of self-reported health care discrimination.
We examined survey data from the Diabetes Study of Northern California (DISTANCE), a race-stratified sample of Kaiser diabetes patients. Respondents reported perceived discrimination, and regression models examined socioeconomic, acculturative, and psychosocial correlates.
Subjects (n=17,795) included 20% Blacks, 23% Latinos, 13% East Asians, 11% Filipinos, and 27% Whites. Three percent and 20% reported health care and general discrimination. Health care discrimination was more frequently reported by minorities (ORs ranging from 2.0 to 2.9 compared to whites) and those with poorer health literacy (OR=1.10, 95% CI: 1.04-1.16), limited English proficiency (OR=1.91, 95% CI: 1.32-2.78), and depression (OR=1.53, 95% CI: 1.10-2.13).
In addition to race/ethnicity, health literacy and English proficiency may be bases of discrimination. Evaluation is needed to determine whether patients are treated differently or more apt to perceive discrimination, and whether depression fosters and/or follows perceived discrimination.
Race/ethnicity; discrimination; diabetes care; managed care
Internet-based patient portals are intended to improve access and quality, and will play an increasingly important role in health care, especially for diabetes and other chronic diseases. Diabetes patients with limited health literacy have worse health outcomes, and limited health literacy may be a barrier to effectively utilizing internet-based health access services. We investigated use of an internet-based patient portal among a well characterized population of adults with diabetes. We estimated health literacy using three validated self-report items. We explored the independent association between health literacy and use of the internet-based patient portal, adjusted for age, gender, race/ethnicity, educational attainment, and income. Among 14,102 participants (28% non-Hispanic White, 14% Latino, 21% African-American, 9% Asian, 12% Filipino, and 17% multiracial or other ethnicity), 6099 (62%) reported some limitation in health literacy, and 5671 (40%) respondents completed registration for the patient portal registration. In adjusted analyses, those with limited health literacy had higher odds of never signing on to the patient portal (OR 1.7, 1.4 to 1.9) compared with those who did not report any health literacy limitation. Even among those with internet access, the relationship between health literacy and patient portal use persisted (OR 1.4, 95% CI 1.2 to 1.8). Diabetes patients reporting limited health literacy were less likely to both access and navigate an internet-based patient portal than those with adequate health literacy. Although the internet has potential to greatly expand the capacity and reach of health care systems, current use patterns suggest that, in the absence of participatory design efforts involving those with limited health literacy, those most at risk for poor diabetes health outcomes will fall further behind if health systems increasingly rely on internet-based services.
This study examined the direct and interactive effects of stress reactivity and family adversity on socio-emotional and cognitive development in 338 five-to-six-year-old children. Neurobiological stress reactivity was measured as respiratory sinus arrhythmia and salivary cortisol responses to social, cognitive, sensory, and emotional challenges. Adaptation was assessed using child, parent, and teacher reports of externalizing symptoms, prosocial behaviors, school engagement, and academic competence. Results revealed significant interactions between reactivity and adversity. High stress reactivity was associated with more maladaptive outcomes in the context of high adversity but with better adaption in the context of low adversity. The findings corroborate a reconceptualization of stress reactivity as biological sensitivity to context by showing that high reactivity can both hinder and promote adaptive functioning.
Little is known about the frequency of significant hypoglycemic events in actual practice. Limited health literacy (HL) is common among patients with type 2 diabetes, may impede diabetes self-management, and thus HL could increase the risk of hypoglycemia.
To determine the proportion of ambulatory, pharmacologically-treated patients with type 2 diabetes reporting ≥1 significant hypoglycemic events in the prior 12 months, and evaluate whether HL is associated with hypoglycemia.
Cross-sectional analysis in an observational cohort, the Diabetes Study of Northern California (DISTANCE).
The subjects comprised 14,357 adults with pharmacologically-treated, type 2 diabetes who are seen at Kaiser Permanente Northern California (KPNC), a non-profit, integrated health care delivery system.
Patient-reported frequency of significant hypoglycemia (losing consciousness or requiring outside assistance); patient-reported health literacy.
At least one significant hypoglycemic episode in the prior 12 months was reported by 11% of patients, with the highest risk for those on insulin (59%). Patients commonly reported limited health literacy: 53% reported problems learning about health, 40% needed help reading health materials, and 32% were not confident filling out medical forms by themselves. After adjustment, problems learning (OR 1.4, CI 1.1-1.7), needing help reading (OR 1.3, CI 1.1-1.6), and lack of confidence with forms (OR 1.3, CI 1.1-1.6) were independently associated with significant hypoglycemia.
Significant hypoglycemia was a frequent complication in this cohort of type 2 diabetes patients using anti-hyperglycemic therapies; those reporting limited HL were especially vulnerable. Efforts to reduce hypoglycemia and promote patient safety may require self-management support that is appropriate for those with limited HL, and consider more vigilant surveillance, conservative glycemic targets or avoidance of the most hypoglycemia-inducing medications.
Electronic supplementary material
The online version of this article (doi:10.1007/s11606-010-1389-7) contains supplementary material, which is available to authorized users.
diabetes; health literacy; hypoglycemia
This paper examines how age at immigration influences the association between adult subjective social status and mental health outcomes. The age when people immigrate shapes the capacity and efficiency at which they learn and use a new language, the opportunities to meet and socialize with a wide range of people, and respond to healthy or stressful environments. We hypothesize that adult subjective social status will be more predictive of health outcomes among immigrants who arrive in the US in mid- to late-adulthood compared with immigrants who arrive earlier. To investigate this hypothesis, data on immigrants are drawn from the US first national survey of mental health among Asian Americans (N = 1451). Logistic regression is used to estimate the relationships between adult subjective social status and mood dysfunction, a composite of anxiety and affective disorder symptoms. As predicted, age at immigration moderated the relationship between adult subjective social status and mood dysfunction. Adult subjective social status was related to health among immigrants arriving when they were 25 years and older, but there was no association between subjective social status and mental health among immigrants arriving before the age of 25 years.
US; Mental health; Subjective social status; Age at immigration; Developmental context; Asians
Telomere length (TL) has been proposed as a marker of
mitotic cell age and as a general index of human organismic aging. Short
absolute leukocyte telomere length has been linked to
cardiovascular-related morbidity and mortality. Our aim was to test
whether the rate of change in leukocyte TL is related to mortality in a
healthy elderly cohort. We examined a subsample of 236 randomly selected
Caucasian participants from the MacArthur Health Aging Study (aged 70 to 79
years). DNA samples from baseline and 2.5 years later were assayed for
mean TL of leukocytes. Percent change in TL was calculated as a measure of
TL change (TLC). Associations between TL and TLC with 12-year overall and
cardiovascular mortality were assessed. Over the 2.5 year period, 46% of
the study participants showed maintenance of mean bulk TL, whereas 30%
showed telomere shortening, and, unexpectedly, 24% showed telomere
lengthening. For women, short baseline TL was related to greater mortality
from cardiovascular disease (OR = 2.3; 95% CI: 1.0 - 5.3). For men, TLC
(specifically shortening), but not baseline TL, was related to greater
cardiovascular mortality, OR = 3.0 (95% CI: 1.1 - 8.2). This is the first
demonstration that rate of telomere length change (TLC) predicts mortality
and thus may be a useful prognostic factor for longevity.
aging; longevity; telomere length; cardiovascular disease; mortality
The cognitive, social, and biological transitions of adolescence suggest that subjective perceptions of social position based on the socioeconomic hierarchy may undergo important changes during this period, yet how such perceptions develop is poorly understood and no studies assess if changes in such perceptions influence adolescents’ health. This study describes adolescents’ subjective perceptions of familial socioeconomic status (SSS), how SSS changes over time, and how age, race, and objective socioeconomic status (SES) indicators influence SSS. In addition, the study determines if SSS independently influences adolescents’ self-rated health, an important predictor of morbidity and health service utilization.
1179 non-Hispanic black and white baseline 7–12th graders from a Midwestern public school district completed a validated, teen-specific measure of SSS annually for 4 consecutive years. A parent provided information on SES. Markov modeling assessed transitions in SSS over time.
SSS declined with age (p=.001) and stabilized among older teens. In addition to age, SES and race, but not gender, were significant correlates of SSS, but the relationships between these factors were complex. In cross-sectional and longitudinal analyses, black teens from families with low parent education had higher SSS than white teens from similarly educated families, while white teens from highly educated families had higher SSS than black teens from highly educated families. Lower SSS and changes in SSS predicted poor self rated health even when adjusting for race and objective SES measures.
Subjective evaluations of socioeconomic status predict adolescents’ global health ratings even when adjusting for the sociodemographic factors which shape them.
socioeconomic status; self-rated health; health disparities
(a) To examine different methods of assessing pregnancy intention; (b) to identify psychosocial differences between those who indicate pregnancy intentions and those who do not; and (c) to examine the relationship between pregnancy intentions and subsequent pregnancy at 6-month follow-up in nonpregnant (at baseline), sexually experienced adolescent females.
Longitudinal cohort study of 354 sexually experienced female adolescents attending either a STD clinic or HMO adolescent medicine clinic in northern California. Student’s t-tests and regressions examined psychosocial differences between females who reported “any” and “no” pregnancy intentions. ANOVAs examined differences among different combinations of pregnancy plans/likelihood. Chi-square analyses assessed associations between baseline pregnancy intentions and subsequent pregnancy.
Adolescents’ reports of their pregnancy plans and their assessments of pregnancy likelihood differed from one another (χ2 = 50.39, df = 1, p < .001). Pregnancy attitudes and baseline contraceptive use differentiated those with inconsistent pregnancy intentions (Not Planning, but Likely) from those with clear pregnancy intentions (Planning and Likely, and Not Planning and Not Likely) (Pregnancy Attitudes: F [2,338] = 68.96, p < .0001; Contraceptive Use: F [2,308] = 14.87, p < .0001). Suspected pregnancies and positive pregnancy test results were associated with baseline pregnancy intentions (Suspected: χ2 = 19.08, df = 2, p < .01; Positive Results: χ2 = 8.84, df = 2, p = .015).
To reduce adolescent childbearing we must assess pregnancy intentions in multiple ways. Information/education might benefit those female adolescents with inconsistent reports of pregnancy intentions.
Pregnancy intentions; Adolescent females; Attitudes; Intentions; Contraceptive use
To identify psychosocial differences between sexually experienced male adolescents who indicate intentions to get someone pregnant and those who do not.
Cross-sectional study of 101 sexually experienced adolescent males recruited from an STD clinic in northern California. Student’s t-tests and regressions examined psychosocial differences between males who reported any intention versus no intention to get someone pregnant in the next six months. ANOVAs examined differences among different combinations of pregnancy plans/likelihood.
Adolescents’ reports of their plans for getting someone pregnant differed from their assessments of the likelihood that they would do so (χ2 = 24.33, df = 1, p < .0001). Attitudes toward pregnancy and participants’ mothers’ educational attainment differentiated those with clear pregnancy intentions (Planning, and Likely) from those with clear intentions to avoid pregnancy (Not Planning & Not Likely)
To reduce the rates of adolescent childbearing, males’ pregnancy intentions must be assessed and asked about in multiple ways.
Adolescent Males; Pregnancy Intentions; Psychosocial Variables
To examine the amount of time adolescents waited to have intercourse with past partners (main and casual), and intentions to delay with future partners. To determine psychosocial factors which predict delay intentions among adolescent males and females with future partners (main and casual).
Adolescent STD clinic attendees were approached before clinical appointments to participate in an interview. Data from 205 participants who had previous experience with both main and casual partners were used in the current study.
Adolescents waited less time to have intercourse with most recent casual than with most recent main partners (χ2 = 31.97, p<.0001). The amount of time waited with past partners was shorter than intended time to wait in future relationships (medians of 1 month vs. 2 months (main) [t=3.47, p<.001]; medians of 2 weeks vs. 1 month (casual), [t=6.14, p<.0001]). Factors influencing intentions to delay intercourse with future main partners differed by gender; males’ were negatively influenced by importance of sex in relationships, while females’ were positively influenced by importance of intimacy in relationships, perceived risk of STDs, and health values.
Implications for designing interventions for adolescent males and females are discussed.
Adolescents; sexual intercourse delay; partner types
Objective To examine the causal effects of doctor-patient relations and the severity of a medical outcome on medical patient perceptions and malpractice intentions in the event of an adverse medical outcome. Design Randomized between-subjects experimental design. Patients were given scenarios depicting interactions between an obstetric patient and her physician throughout the patient's pregnancy, labor, and delivery. Participants One hundred twenty-eight postpartum obstetric patients were approached for participation, of whom 104 completed the study. Main outcome measures Patients' perceptions of physician competence and intentions to file a malpractice claim. Results Positive physician communication behaviors increased patients' perceptions of physician competence and decreased malpractice claim intentions toward both the physician and the hospital. A more severe outcome increased only patients' intentions to sue the hospital. Conclusion These results provide empiric evidence for a direct, causal effect of the doctor-patient relationship on medical patients' treatment perceptions and malpractice claim intentions in the event of an adverse medical outcome.
To examine whether 10-year change in occupational mobility is related to carotid artery intima-media thickness (IMT) 5 years later.
Data were obtained from 2350 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Occupational standing was measured at the Year 5 and 15 CARDIA follow-up exams when participants were 30.2+3.6 and 40.2+3.6 years of age, respectively. IMT (common (CCA), internal (ICA), and bulb) was measured at Year 20. Occupational mobility was defined as the change in occupational standing between Years 5 and 15 using two semi-continuous variables. Analyses controlled for demographics, CARDIA center, employment status, parents’ medical history, own medical history, Year 5 Framingham risk score, physiological risk factors and health behaviors averaged across the follow-up, and sonography reader.
Occupational mobility was unrelated to IMT save for an unexpected association of downward mobility with less CCA-IMT (β= −.04, p=.04). However, associations differed depending on initial standing (Year 5) and sex. For those with lower initial standings upward mobility was associated with less CCA-IMT (β= −.07, p=.003) and downward mobility with greater CCA-IMT and bulb-ICA-IMT (β= .14, p=.01 and β= .14, p=.03, respectively); for those with higher standings, upward mobility was associated with greater CCA-IMT (β= .15, p=.008) but downward mobility was unrelated to either IMT measure (ps>.20). Sex-specific analyses revealed associations of upward mobility with less CCA-IMT and bulb-ICA-IMT among men only (ps<.02).
Occupational mobility may have implications for future cardiovascular health. Effects may differ depending on initial occupational standing and sex.
CARDIA; IMT; occupational mobility; occupational social class; socioeconomic status