How have people who have stopped or reduced their alcohol consumption incorporated this into their social rituals?

Objective: Limiting alcohol consumption is beneficial for health, but can be challenging given the role alcohol plays in the rituals of many social occasions. We examined how people who stopped or reduced their alcohol consumption incorporated this change within their social rituals.

Design: We conducted 16 semi-structured one-on-one interviews with adults aged 25–65 years, who lived in Australia and had stopped or significantly reduced their alcohol consumption in the previous year.

Results: Through thematic analysis, we identified four approaches to adapting drinking rituals: replacing alcohol with other drinks, replacing drinking with other social activities, changing the meaning of drinking rituals and replacing drinking occasions with activities that achieve different goals. These approaches varied in the extent to which they reflected a low or high change in the meanings and/or behaviours attached to the ritual. Approaches involving little change, such as using alternative drinks, were more readily accepted by participants’ social companions than approaches involving more substantial changes such as replacing drinking with activities achieving different goals.

Conclusions: Considering both the role and meaning alcohol carries in social interactions, and how else these might be achieved, may assist people to stop or reduce their drinking, without sacrificing their social lives.     

Self-reported overeating and attributions for food intake

Objective: We examined whether people’s attributions for their eating behaviour differ according to whether they believe they have eaten more, less or about the same as they normally would.

Design: Participants were served a small or large portion of pasta for lunch. Afterwards, they were asked to compare how much they ate in the study to how much they normally eat for lunch, resulting in three intake-evaluation categories: ‘ate less’, ‘ate about the same’ or ‘ate more’.

Main outcome measures: How much participants ate; the extent to which they attributed their food intake to an internal cue (i.e. hunger) and an external cue (i.e. the amount of food served).

Results: Participants served a large portion ate more than those served a small portion, but the magnitude of the portion-size effect did not vary across intake-evaluation categories. Furthermore, although participants in all groups indicated that their hunger influenced how much they ate, only those in the ‘ate more’ group indicated that the amount of food available influenced how much they ate.

Conclusion: People appear to be willing to explain their food intake in terms of an external cue only when they believe that they have eaten more than they normally would.     

Successes and failures in resisting cigarettes affect partner support for smoking cessation

Objective: Potential support providers may rely on observable behaviours (e.g. resisting a cigarette vs. smoking) to determine how much and what kind of support to provide. We evaluated the effect of smokers’ salient behaviour on partners’ likelihood of providing positive and negative support.

Design: Partners of smokers (N = 131) were randomly assigned to recall a time when their partner either successfully resisted a cigarette, failed to resist a cigarette or a control condition (no recall). All participants reported the likelihood of providing positive and negative support to their partner. Perceived commitment to quitting smoking was measured as a potential mediator.

Main Outcome Measures: The main outcome was intention to provide support for a quit attempt.

Results: Participants who recalled their partners’ past failures reported more intentions to engage in negative support and smaller ratios of positive to negative intended support than did participants in the success or control condition. These effects were partially mediated by perception of commitment to quitting.

Conclusion: Lapses in a quit attempt may change the nature of the support quitters receive. Interventions to improve communication between partners about the smoker’s commitment to quitting and experienced challenges may result in better support.     

Physical and mental health trajectories of cancer patients and caregivers across the year post-diagnosis: a dyadic investigation

Objective: Evidence suggests interdependence between cancer patients’ and their caregivers’ physical and mental health. However, the extent to which caregivers’ health relates to their patients’ recovery, or patients’ health affects their caregivers’ outcomes, is largely unknown. This dyadic investigation reports the relations between cancer patients’ and their caregivers’ physical and mental health trajectories during the year following diagnosis.

Design: Ninety-two colorectal cancer patient–caregiver dyads completed questionnaires at 2, 6 and 12 months post-diagnosis.

Outcome measures: Self-reported physical and mental health using the Medical Outcomes Study Short Form Health Survey-12.

Results: Patients reported improved physical health over the year following their diagnosis, whereas caregivers reported declining physical health. Patients with lower mental health at diagnosis had stagnated physical health recovery. Caregivers’ physical health declined most noticeably among those reporting low mental health at diagnosis and whose patients reported low physical health at diagnosis.

Conclusion: Findings suggest targeting health interventions to cancer patients and caregivers reporting poor mental health at diagnosis may mitigate their long-term physical morbidity. Limited evidence of dyadic interdependence between patients’ and caregivers’ physical and mental health trajectories suggests future studies are warranted to identify psychosocial and medical characteristics moderating the relations between patients’ and caregivers’ health.     

Care of the transgender or gender-nonconforming patient undergoing in vitro fertilization

Background: Assisted reproductive technologies, including in vitro fertilization (IVF), can be utilized for fertility preservation and family building in the transgender and gender-nonconforming population.

Methods: This is a retrospective case series from an academic tertiary care center.

Results: We present three couples with a transgender or gender-nonconforming member who pursued IVF to build their families. The first case involves a transgender man who suspends hormone therapy to undergo IVF. The second involves a transgender woman who uses her previously banked sperm to undergo IVF with her wife. The third involves a gender nonbinary patient and their cisgender wife who create and transfer embryos from both partners.

Conclusion: IVF can provide unique family-building opportunities to transgender and gender-nonconforming patients, and providers should seek to broaden their clinical experience with this population.     

To stay or to leave? Decision rules for partner species relocation in two symbiotic pairs of desert beetles

Four nocturnal Kalahari desert tenebrionid beetles live in closely associated species pairs. The larger member of each pair, Parastizopus and Gonopus, are the primary burrowers while their smaller associates, Eremostibes and Herpiscius, inhabit the burrows with them and feed on detritus the larger beetles carry in. During summer drought, the two large species have different emergence times, surface activity patterns (vagilities) and different probabilities that burrows will be reoccupied before sunrise or remain empty for longer periods. Because their partners leave the burrows, the smaller species must make a decision either to stay in the expectation of a burrow being reinhabited, or leave and locate a new partner. The vagility and burrow fidelity of the associating species were studied using marked individuals in free-living populations. Field inclusion/exclusion experiments to test what influences the decision process showed that neither continual partner presence nor food induced the smaller beetles to remain. Different percentages, depending on species, left overnight. For both associates, these proportions corresponded exactly to the probability that the burrow would not be inhabited by their partner species the next day. Neither species predicted the probability of burrow reoccupation after a short vacancy and adopted a “waiting” strategy. Received: 13 January 1998 / Accepted after revision: 20 May 1998     

The theory of agency and breastfeeding

Objective: In this paper, we apply psychological agency theory to women’s interviews of their breastfeeding experiences to understand the role of agency in relation to breastfeeding initiation, maintenance and duration.

Design: Qualitative, video interviews were collected from 49 women in the UK from a wide range of ethnic, religious, educational and employment backgrounds about their breastfeeding experiences. We undertook secondary analysis of the data focusing on their accounts of vulnerability and agency.

Findings: Women’s agency was impacted by a variety of factors including their own vulnerability, knowledge, expectations and experience, the feeding environment and the support of health professionals in sharing decision-making and dealing with uncertainty.

Conclusion: Health professionals as co-agents with women are well positioned to maintain, enhance or restore women’s sense of agency. Breastfeeding goals should be included in women’s birth plans. Training related to agency, continuity of care, and staffing and workload management supported by national breastfeeding policies could improve breastfeeding rates and experiences.     

‘I think a little bit of a kick is sometimes what you need’: Women’s accounts of whole-body scanning and likely impact on health-related behaviours

Objective: This study was designed to investigate whether whole-body scanning might promote healthy eating and physical activity in women, and to explore the effects of scanning on body image.

Design: Fourteen women aged 22–45 years without histories of eating disorders or whole-body scanning took part in semi-structured interviews before and after scanning. Data were analysed using inductive thematic analysis.

Results: Scans did not look as expected, and participants expressed ‘surprise’ and ‘shock’. Participants focused on perceived negative aspects of their bodies as revealed in scan images, and agreed that women with body concerns would find scans too ‘real’ and ‘raw’. Eleven women who met UK Government physical activity and healthy eating guidelines reported that the scan provided additional motivation to maintain, and in nine cases to increase, those behaviours. Two women who neither exercised nor ate healthily would not increase physical activity or change their diets significantly following scanning.

Conclusion: Whole-body scanning may enable maintenance or even acceleration of physical activity and healthy eating, but is unlikely to be useful in promoting initiation of these behaviours. Participants engaged in unhelpful body critique when viewing scans; scanning needs to be confined to contexts where support is provided, to avoid increasing body-related concerns.     

Book reviews and books received

Colin Murray Parkes and Joan Stevenson-Hinde (eds.): The Place of Attachment in Human Behaviour. London: Tavistock, 1982. £14.50.

A. G. Watts: Education, Unemployment and the Future of Work. Milton Keynes: Open University Press, 1983. £5.95.

Kenneth Roberts: School Leavers and their Prospects: Youth and the Labour Market in the 1980s. Milton Keynes: Open University Press, 1984. £5.95.

Peter Herriot: Down from the Ivory Tower: Graduates and their Jobs. Chichester: Wiley, 1984. £13.25.

Edwin J. Thomas: Designing Interventions for the Helping Professions. London: Sage, 1984. £28.00 (hardback); £14.00 (paperback).

Tony Collins and Terry Bruce: Staff Support and Staff Training. London: Tavistock, 1984. £4.95 (paperback).

Helen C. Masson and Patrick O'Byrne: Applying Family Therapy. Oxford: Pergamon, 1984. £7.95.

Michael Berger, Gregory J. Jurkovic and Associates:Practicing Family Therapy in Diverse Settings. San Francisco: Jossey-Bass, 1984. £19.95.     

Parent Grief 1–13 Months After Death in Neonatal and Pediatric Intensive Care Units

Objective. Describe changes in mothers’ and fathers’ grief from 1 to 13 months after infant or child neonatal or pediatric intensive care unit death and identify factors related to their grief.

Methods. Mothers (n = 130) and fathers (n = 52) of 140 children (newborn–18 years) completed the Hogan Grief Reaction Checklist at 1, 3, 6, and 13 months postdeath.

Results. Grief decreased from 3 to 13 months for mothers and from 3 to 6 months for fathers. Grief was more intense for mothers of deceased adolescents and mothers whose children were declared brain dead.

Conclusion. Mothers’ and fathers’ grief intensity may not coincide, resulting in different needs during the 13 months after infant or child death.     

The use of commitment techniques to support weight loss maintenance in obese adolescents

Objectives: Obesity is a rising problem in adolescents related to unhealthy behaviours. Commitment devises are one type of behavioural intervention that may help people change their behaviours. The current pilot trial tests whether commitment devices delivered via text message help adolescents maintain their recent weight loss.

Methods: During a 12-week pilot trial, adolescents who attended a weight loss camp were randomly assigned to either received text messages that contained only information, i.e. advice, about weight loss management (n = 13) or asked for them to commit to following the same advise (n = 14).

Results: The BMI of the adolescents in the commitment group did not change. In contrast, the BMI of adolescents in the information group increased. A linear regression revealed that group was a significant predictor of BMI change. A logistic regression revealed that adolescents in the information group were nearly eight times more likely to regain weight than those in the commitment group.

Conclusions: This is the first study with adolescents to show weight maintenance using a commitment device. The results suggest that commitment devices can help adolescents maintain their recent weight loss.     

The role of body mass index,weight change desires and depressive symptoms in the health-related quality of life of children living in urban disadvantage: Testing mediation models

Objectives: This study was undertaken to ascertain whether or not the body mass index (BMI) of urban disadvantaged children indirectly affects their health-related quality of life (HRQoL) through weight change desires and depressive symptoms and whether such mediation is conditional upon age and gender.

Design: A total of 255 children aged 7–12 years (50% male) were recruited from 7 schools in urban disadvantaged districts in Ireland using consecutive sampling. A prospective longitudinal design was employed whereby children completed, at two time points, the Kidscreen-27, the Children’s Depression Inventory, and the Health Related Behaviour Questionnaire, and had their BMI measured. The analyses involved multiple-, half-longitudinal- and moderated-mediation.

Results: Results showed that the depressive symptoms of children wanting to change their weight may have lead, in large part, to poorer HRQoL (specifically psychological well-being when considering longitudinal data) rather than weight status per se. The mediation effect of weight change desires occurred regardless of age or gender.

Conclusions: Childhood obesity programmes that traditionally focus on the negatives of obesity and the need to control weight may need to take a more positive approach to health and well-being by, for example promoting intuitive eating, an active lifestyle, body acceptance and good mental health.     

Change in subjective social status following HIV diagnosis and associated effects on mental and physical health among HIV-positive gay men in Australia

Objective: This study investigates the impact of HIV diagnosis on subjective social status and if changes are linked to health outcomes.

Design: Two measures of subjective social status, socio-economic and standing in the community were examined in 342 Australian HIV-positive gay men in 2014. Participants recalled ratings at diagnosis were compared with current ratings.

Main outcome measures: Self-reported mental (psychological distress, self-esteem, positive mental health and satisfaction with life) and physical health (self-rated health, CD4 count, viral load).

Results: Half of the participants reported improvements in subjective socio-economic status (59%) or standing in the community (52%) since diagnosis, yet one quarter reported socio-economic status (25%) or standing in the community had decreased (23%). Increases in either measure of subjective social status were linked to higher self-esteem, positive mental health, satisfaction with life and better self-rated health. Decreases in subjective social status, however, were strongly linked to poorer outcomes on all mental health measures. Decreases in standing in the community were also associated with poorer physical self-rated health.

Conclusion: Most participants reported their subjective social status were the same or better since diagnosis. Changes in subjective social status following diagnosis were strongly linked to mental health outcomes. Those who reported a decrease in subjective social status were particularly vulnerable to mental health problems.     

Increased cognitive problem reporting after information about chemotherapy-induced cognitive decline: The moderating role of stigma consciousness

Objective: Information about treatment side effects can increase their occurrence; breast cancer (BC) patients showed increased cognitive problem reporting (CPR) and decreased memory performance after information about cognitive side effects. The current study extends previous research on adverse information effects (AIE) by investigating (a) risk factors, (b) underlying mechanisms and (c) an intervention to reduce AIE.

Design: In an online experiment, 175 female BC patients were randomly assigned to one of three conditions. In the two experimental groups, patients were informed about the possible occurrence of cognitive problems after chemotherapy with (intervention group) or without (experimental group) reassuring information that ‘there are still patients who score well on memory tests’. In the control group, no reference to chemotherapy-related cognitive problems was made.

Main outcome measures: Main dependent measure was CPR. Four moderating and five mediating processes were examined.

Results: CPR increased with higher levels of stigma consciousness in the two experimental groups, but not in the no-information control group.

Conclusion: Merely informing patients about cognitive side effects may increase their occurrence, especially among individuals vulnerable to patient stereotypes. Adding reassuring information is not sufficient to reduce AIE.     

Book reviews

Peter E. Hodgkinson and Michael Stewart (1998) A Handbook of Post-Disaster Psychosocial Aftercare, 2nd edn, London: Routledge, $15.99 (pb)

Caroline Garland (ed.) (1998) Understanding Trauma: A Psychoanalytic Approach, London: Duckworth, Tavistock Clinic Series, $14.95 (pb)

Claudio Neri (1998) Group, preface by Parthenope Bion Talamo, foreword by Malcolm Pines, London: Jessica Kingsley, $16.95

Robert L. Perkinson (1997) Chemical Dependency Counseling: A Practical Guide, London: Sage, $24

Mary Turner (1998) Talking with Children and Young People about Death and Dying: A Workbook, illustrated by Bob Thomas, London: Jessica Kingsley, $17.95

Jan Wiener and Mannie Sher (1998) Counselling and Psychotherapy in Primary Health Care: A Psychodynamic Approach, London: Macmillan, $11.99 (pb)

Melanie Hart and James Loader (eds) (1998) Generations: Poems between Fathers, Mothers, Daughters, Sons, London: Penguin, $14.99

David Kennard and Neil Small (eds) (1997) Living Together, London: Quartet, $9.00

Sally Skaife and Val Huet (1998) Art Psychotherapy Groups: Between Pictures and Words, London: Routledge, $47.50 (hb), $15.99 (pb)     

Adjustment modes in the trajectory of progressive multiple sclerosis: a qualitative study and conceptual model

Objective: We examined cognitive and behavioural challenges and adaptations for people with progressive multiple sclerosis (MS) and developed a preliminary conceptual model of changes in adjustment over time.

Design: Using theoretical sampling, 34 semi-structured interviews were conducted with people with MS. Participants were between 41 and 77 years of age. Thirteen were diagnosed with primary progressive MS and 21 with secondary progressive MS. Data were analysed using a grounded theory approach.

Results: Participants described initially bracketing the illness off and carrying on their usual activities but this became problematic as the condition progressed and they employed different adjustment modes to cope with increased disabilities. Some scaled back their activities to live a more comfortable life, others identified new activities or adapted old ones, whereas at times, people disengaged from the adjustment process altogether and resigned to their condition. Relationships with partners, emotional reactions, environment and perception of the environment influenced adjustment, while people were often flexible and shifted among modes.

Conclusions: Adjusting to a progressive condition is a fluid process. Future interventions can be tailored to address modifiable factors at different stages of the condition and may involve addressing emotional reactions concealing/revealing the condition and perceptions of the environment.     

Provider quality and barriers to care for transgender people: An analysis of data from the Wisconsin transgender community health assessment

Background: Transgender people in the United States often lack access to high-quality health care.

Methods: A group of researchers and transgender people came together in a community-based participatory research process to survey transgender Wisconsinites about their health care experiences. A multiple regression analysis of survey data was used to evaluate the association between barriers to health care, gender identity, and quality of medical and mental health care provider.

Results: Seventy-seven respondents were included in this analysis. Transmasculine respondents were more likely than transfeminine respondents to report barriers to high-quality health care, but having a high-quality medical or mental health care provider was associated with reporting fewer barriers to care across the entire sample.

Discussion: This community-based study suggests that health care providers play a key role in facilitating access to care for transgender Wisconsinites in the USA.     

The role of pain behaviour and family caregiver responses in the link between pain catastrophising and pain intensity: A moderated mediation model

Objectives: This study investigated the mediating role of pain behaviours in the association between pain catastrophising and pain intensity and explored the moderating role of family caregivers’ responses to pain in the link between pain behaviours and pain intensity.

Methods: The sample consisted of 154 chronic pain patients and their family caregivers. Patients completed questionnaires regarding pain intensity, pain catastrophising, pain behaviours and their caregivers’ responses to their pain. Family caregivers reported their responses to the patients’ pain.

Results: Pain catastrophising was associated with pain intensity (r = 0.37) and pain behaviours partly mediated this association. The positive association between pain behaviours and pain intensity was significant only if patients reported that their family caregivers showed high levels of solicitous (effect = .49) and distracting responses (effect = .58), and if caregivers reported to show high levels of solicitous responses (effect = .51). No support was found for negative responses as a moderator neither based on patients’ perception of negative responses nor based on caregivers’ perception of negative responses.

Conclusions: The findings are in line with the idea that family caregivers’ solicitous and distracting responses convey to patients that their condition is serious, which may reinforce patients’ pain and pain behaviours, especially in those who catastrophise.     

Interfemale aggression in adult bank voles (Clethrionomys glareolus)

Agonistic interaction may play a large role in shaping the social structure and spatial distribution of rodents such as Clethrionomys glareolus. Aggressive and non-aggressive behaviors of adult bank vole females were investigated with a home cage test during 10 min sessions. The number of attacks was significantly higher in virgin females kept with intact adult males than in singly reared females or those exposed to male urine. Bulbectomy of the tested females completely inhibited the male stimulating effect. This indicates that males influence the behavior of females by activating their olfactory systems. Aggressive behavior in pregnant or lactating females, which is linked to maternal behavior, was also tested. Female bank voles between 11 and 17 days of pregnancy or lactating at 3–4 days or 9–10 days attacked their partners significantly more frequently than virgins did. Females that had direct contact with males, even if they were not fertilized, appeared to be more successful in same-sex competition. Aggr. Behav. 24:53–61, 1998. © 1998 Wiley-Liss, Inc.