Stress-coping-support in rural communities: A model for primary prevention

Conclusion Because of the relatively small and homogeneous population in rural communities, community-wide prevention efforts are often more manageable than in urban areas. Community needs and resources can be identified more easily, and the feasibility of different interventions can be assessed more readily.To guide the rural prevention agent in developing community programs, the stress-coping-support framework has been proposed here. The value of this model is that it delineates the aspects of community life that must be assessed, and it outlines several different intervention goals. The model in its most general form proposes that prevention activities should reduce stress, increase coping, and build support. While this model can be applied to any community or target group, the framework has been elaborated here to address the unique physical, occupational, and societal characteristics of rural communities.Although some of the issues in applying this model to rural, as opposed to urban, areas have been pointed out here, the variation among rural communities has not been addressed fully. The different types of rural communities, e.g., the mining town, the isolated farmlands, the Indian reservation, have unique characteristics which may determine whether a proposed prevention program is needed, feasible, and effective.It is hoped that rural practitioners, long sensitive to the need for prevention, will use this model to devise additional prevention directions and to generate useful and culturally syntonic programs for their communities.     

Sickle cell disease: primary stroke prevention

Stroke is an important and common complication of sickle cell disease (SCD), affecting children as well as adults. Clinically evident stroke, usually brain infarction, is usually associated with stenosis or occlusion of the intracranial arteries of the Circle of Willis, sometimes with formation of moyamoya (a Japanese word for "hazy" or "like a puff of smoke" that describes the appearance of a abnormal microvasculature on angiography believed secondary to internal carotid artery stenosis or occlusion and the resultant extensive collateralization). Several types of intracranial hemorrhage are observed but usually in older children and adults. Cerebrovascular diseases restricted to small vessels may go unrecognized but is associated with cognitive and learning problems. Prevention of recurrent stroke has been accomplished with chronic blood transfusion. A primary prevention strategy for clinical stroke, based on the Stroke Prevention in Sickle Cell Anemia Trial, has been tested in a randomized clinical trial. Over 2,000 young children with SCD were screened with transcranial Doppler ultrasound (TCD) to detect elevated blood flow velocity indicative of vessel disease and high risk of future stroke. Those randomized to standard care (no transfusion) had a 10%/year risk of stroke, which was reduced >90% with chronic transfusion. This approach is the only primary stroke prevention strategy so far tested in SCD in a randomized controlled trial. Silent lesions on magnetic resonance imaging are associated with an approximately 1.5%/year risk of clinical stroke and a trial is now starting in children with these lesions who do not meet Stroke Prevention in Sickle Cell Anemia Trial criteria for transfusion based on TCD. A controlled trial, based on intervention for nocturnal hypoxemia, is also underway. Hydroxyurea, bone marrow transplantation, antiplatelet, and antithrombotic agents may work but have not been tested in primary prevention in a systematic way. If early and repeated, TCD screening of children, as recommended by National Heart Lung and Blood Institute and the American Stroke Association, were implemented broadly the incidence of new strokes could be greatly reduced in these children.     

A moral vision for the presidential election

The essay celebrates the “Mirror of Princes” writing of political philosophy that appeared in Augustine's City of God, the history of Western political philosophy and in the political thought of ancient China. It upholds the tradition of the good ruler while noting the ambiguities of morality in politics. It notes the political power of the American president in the current global context. While emphasizing the need for the good ruler to love the people he serves it focuses on the need for reform in health care, education, and race relations.     

Structural characteristics of the macroeconomy and mental health: Implications for primary prevention research

Recent research on the impact of economics on mental and physical health has raised fundamental questions about structural elements in the macro-economy. Specifically, five characteristics of our current economic system: instability in the business cycle, unemployment, inequality in income distribution, capital mobility, and fragmentation of the work process, appear to play some pathogenic role in the incidence of behavioral and physical disorders. These macroeconomic elements require intervention at the social policy level since they seem to be more powerful than the individual coping mechanisms of some demographic subgroups. Psychologists can play an important role in policy decisions by providing data on the relative impact of structural economic variables on human functioning. Examples of structural research are presented and the implications for primary prevention are discussed.     

Counselling and primary prevention

Counsellors/therapists have much to contribute to preventionists concerning the social causes of individual distress. Such insights will lead to efforts to change society to reduce the environmental stresses, including racism, sexism, ageism and homophobia that lead to emotional problems in members of groups at risk. Political efforts by conservatives stress the medical model argument that all mental disorders are diseases or dejects of the brain and/or genes, thereby making social changes unnecessary. An alliance between counsellors and preventionists is necessary to oppose this personal defect position. The struggle for a more just and equalitarian society goes on. We must work together in this struggle.     

Counselling and primary prevention

Counsellors and counselling services are frequently involved in primary prevention work. Increasingly these services are required to help immediately after major disasters, an implicit assumption being made that normal social support networks will be unable to cope. A review of the literature suggests extensive participation of counsellors in primary prevention activities despite difficulties in definition, training and funding, and evidence that some interventions may be ineffective or harmful. It is suggested that counsellors providing primary prevention services should be aware of the complex practice and philosophy issues surrounding such efforts, and should be rigorous in assessing the real effects of primary prevention activity.     

A general systems approach to suicide prevention: lessons from cardiac prevention and control

The pathology of cardiac disease includes genetic, physical, biochemical, psychological, social, and environmental vectors. Factors contributing to suicide have been identified in these same areas. Survival from an acute cardiac event requires a systematized and multisectoral response. Communities that do not have systematized response capabilities to acute cardiac events have poorer survival outcomes. Suicide prevention and control may also be responsive to an integrated community response system. This paper examines the development of a community cardiac care model, explores potential parallels for a community suicide prevention and control model, and outlines a general systems theory framework for a suicide prevention and control system.     

Regulatory concerns and appraisal efficiency: the general impact of promotion and prevention

It was hypothesized that people's appraisals both of themselves and of other objects in the world are more efficient when the emotional dimension underlying their appraisals fits their regulatory concerns. Regulatory focus theory distinguishes 2 such fundamental concerns: promotion concerns with accomplishment that relate to cheerfulness- and dejection-related emotions, and prevention concerns with security that relate to quiescence- and agitation-related emotions. Five studies found that individuals with stronger promotion concerns were faster in appraising how cheerful or dejected the object made them feel, whereas individuals with stronger prevention concerns were faster in appraising how quiescent or agitated the object made them feel. These greater appraisal efficiencies were found for both chronic and situationally induced promotion and prevention concerns and were independent of both the valence and the extremity of the appraisals.     

Evaluating a primary prevention program for children of divorce

The effectiveness of a primary prevention program for children of divorce is evaluated. Subjects included 82 mother-child pairs. Mothers had been separated for 33 months or less and did not have prior histories of using mental health services. Subjects were assigned to one of four conditions: (a) the Children's Support Group alone (CSG), (b) the CSG and the Single Parents' Support Group (SPSG), (c) the SPSG alone, or (d) a no-treatment control group. Data collected before, after, and 5 months following intervention, were analyzed using analyses of covariance with preintervention scores as covariates and pre-post and post-follow-up difference scores as dependent measures. Children in the CSG-alone condition improved most in self-concept and parents in the SPSG-alone condition improved the most in adjustment. Improvements were either maintained or did not change differentially across groups at follow up. Adaptive social skills of CSG-alone children compared to children in the CSG/SPSG groups showed significant post-to-follow-up improvements.     

The child parent drop-in center: Community based primary prevention

A community supported child-parent drop-in program that provides services to families with few financial resources or to those who may not seek help from other service agencies is described. Services are provided free or at a minimal cost. The family oriented program provides short-term, respite care for children from birth to kindergarten age, educational programs and social opportunities for parents, short-term crisis counseling, referral to other community resources, and volunteer opportunities and training. Three centers are housed in facilities that donate the space. The centers recruit, train and actively involve parents, students, senior citizens and other volunteers to work in the program. Service groups and businesses aid in fund-raising and human service agencies provide consultation, act as referral resources and help with program operation. Each center is individualized to meet the needs of the community it serves.     

Depression secondary prevention in primary care

In order to analyse efficacy, effectiveness and efficiency of several depression secondary prevention programs, three group interventions were developed in Primary Care Centres: cognitive-behavioral therapy, promotion of one's coping resources therapy (just paying attention to abilities, without training) and social support. The sample was composed by 60 people with from-mild-to-moderate depressive symptoms, who were randomly assigned either to any of the treatments or to a control group (waiting list). Psychopathology, quality of life and attendance to mental health services variables were assessed at pretest, posttest and two follow-up evaluations, 6 and 12 months afterwards. Outcomes: both therapies had more efficacy, effectiveness and efficiency compared to the social support group, and this one was better than the waiting list.     

Philosophy of mathematics: Prospects for the 1990s

For some time now, academic philosophers of mathematics have concentrated on intramural debates, the most conspicuous of which has centered on Benacerraf's epistemological challenge. By the late 1980s, something of a consensus had developed on how best to respond to this challenge. But answering Benacerraf leaves untouched the more advanced epistemological question of how the axioms are justified, a question that bears on actual practice in the foundations of set theory. I suggest that the time is ripe for philosophers of mathematics to turn outward, to take on a problem of real importance for mathematics itself.     

Behavior analysis and the primary prevention of occupational injuries

Contemporary cognitive models of obsessive‐compulsive disorder emphasize the importance of various types of dysfunctional beliefs, such as beliefs about inflated responsibility, perfectionism and the importance of controlling one's thoughts. These beliefs have been conceptualized as main effects, each influencing obsessive‐compulsive symptoms independent of the contributions of other beliefs. It is not known whether beliefs interact with one another in their influence on obsessive‐compulsive symptoms. To investigate this issue, data from 248 obsessive‐compulsive disorder patients were analyzed. Dependent variables were the factor scores on the 4 Padua Inventory subscales. Predictor variables were the factor scores from the 3 factors (inflated responsibility, perfectionism and controlling one's thoughts) of the Obsessive Beliefs Questionnaire and their 2‐ and 3‐way interactions. Regression analyses revealed significant main effects; in almost all analyses one or more of inflated responsibility, perfectionism, and controlling one's thoughts factors predicted scores on the Padua factors even after controlling for general distress. There was no evidence that beliefs interact in their effects on obsessive‐compulsive symptoms, thereby providing a relatively unusual instance in which a simpler explanation (main effects only) is just as powerful as a more complex model.     

The ontogenesis of primary prevention: Lengthy strides and subbed toes

Reviews evolution of the concept of primary prevention in the past 40 years and cites progress in overcoming significant early deterrents (e.g., loosely anchored, overinclusive definitions; weak supporting empirical base) to this development. Highlights the growing trend to define the concept specifically around the yoked notions of risk, and the goal of forestalling major psychological dysfunction. This de facto shift in definitional emphasis has obscured primary prevention's early vision of promoting health and wellness. Stresses need for a comprehensive, multilevel, proactive approach targeted systematically toward the enhancement of psychological wellness in all people, from the start. This article is based on the Seymour B Sarason Award talk given at the 103rd annual meeting of the American Psychological Association, New York City, August 12, 1995. Although the spoken and written versions are similar, and their intended bottom lines identical, the two differ in several ways. One is that the talk's many references to Sarason'shighly influential contributions to the field, and his unique, thought-stimulating style, do not appear here. They continue, however to be keenly felt. Those views are a matter official record (see “In Honor of Seymour Sarason,”American Journal of Community Psychology, 1976, Vol. 4, pp. 244–246). A second difference between the talk and the article is that the former was more relaxed, breezier, and less jargonesque. Although I have tried to preserve some of that informality, the article is surely stuffier than the talk.     

A systematic review of primary prevention strategies for sexual violence perpetration

This systematic review examined 140 outcome evaluations of primary prevention strategies for sexual violence perpetration. The review had two goals: 1) to describe and assess the breadth, quality, and evolution of evaluation research in this area; and 2) to summarize the best available research evidence for sexual violence prevention practitioners by categorizing programs with regard to their evidence of effectiveness on sexual violence behavioral outcomes in a rigorous evaluation. The majority of sexual violence prevention strategies in the evaluation literature are brief, psycho-educational programs focused on increasing knowledge or changing attitudes, none of which have shown evidence of effectiveness on sexually violent behavior using a rigorous evaluation design. Based on evaluation studies included in the current review, only three primary prevention strategies have demonstrated significant effects on sexually violent behavior in a rigorous outcome evaluation: Safe Dates (Foshee et al., 2004); Shifting Boundaries (building-level intervention only, Taylor, Stein, Woods, Mumford, & Forum, 2011); and funding associated with the 1994 U.S. Violence Against Women Act (VAWA; Boba & Lilley, 2009). The dearth of effective prevention strategies available to date may reflect a lack of fit between the design of many of the existing programs and the principles of effective prevention identified by Nation et al. (2003).     

Tailoring sex-education programs to adolescents--a strategy for the primary prevention of unwanted adolescent pregnancies

The data for this paper were derived from 88 unstructured interviews conducted with a purposive sample of adolescents from September 1978 through July 1979. We content analyzed all interview abstracts with particular emphasis on the comments and suggestions made by adolescents in regard to sex education in order to ascertain their needs. Three areas in need of immediate revision were identified--curriculum, format, and lecturer. Respondents also provided a variety of suggestions which can be used by educators and planners in developing and implementing sex-education programs; thereby making programs sensitive to the expressed needs and wants of adolescents. This qualitative study supports the findings of many quantitative studies which found that many adolescents do not have, yet want, sensitive sex-education programs.