Correlates of household smoking bans in low-income families of children with and without asthma

Exposure to secondhand smoke (SHS) harms all children's health, especially children with asthma. Yet, children with asthma are as likely to live with smokers as healthy children. Household smoking bans are being advocated to reduce children's harm from SHS. To measure the effect of household smoking bans on child SHS exposure and to examine correlates of strict smoking bans in a low-income, diverse sample, 91 children with asthma were matched to 91 healthy children. All had at least one smoker living in their homes. Nicotine dosimeters, child cotinine assays, and maternal reports quantified child SHS exposures. Maternal reports of household smoking rules, behaviors, and beliefs, and other family characteristics were also gathered. The presence of a strict household smoking ban vastly reduced children's SHS exposures and was associated with fewer cigarettes smoked by the mother and by other family members, the belief that SHS was a personal health risk, having children with asthma, and living in a single-family home. Many children are exposed to high levels of SHS at home. Strict household smoking bans greatly decrease, but do not eliminate children's SHS exposure. Even in disadvantaged families, mutable factors were associated with strict smoking bans. Increased dissemination and use of established public health strategies are needed to reduce children's SHS exposures.     

Treating body dysmorphic disorder with medication: evidence, misconceptions, and a suggested approach

Body dysmorphic disorder (BDD) is a relatively common and often disabling disorder with high morbidity and mortality. Both psychotropic medication and cognitive behavioral therapy (CBT) are considered first-line treatments for BDD, and medication treatment is often essential for more severely ill and suicidal patients. In this practical overview of the pharmacotherapy of BDD, we briefly describe BDD's clinical features, associated morbidity, and how to recognize and diagnose BDD. We describe the importance of forming a therapeutic alliance with the patient, the need for psychoeducation, and other essential groundwork for successful treatment of BDD. We review available pharmacotherapy research, with a focus on serotonin-reuptake inhibitors (SSRIs, or SRIs), which are currently considered the medication of choice for BDD. Many patients have substantial improvement in core BDD symptoms, psychosocial functioning, quality of life, suicidality, and other aspects of BDD when treated with appropriate pharmacotherapy that targets BDD symptoms. We also discuss practical issues such as dosing, length of treatment, and potential side effects associated with the use of SRIs. In addition, we discuss pharmacotherapy approaches that can be tried if SRI treatment alone is not adequately helpful. Finally, some misconceptions about pharmacotherapy, gaps in knowledge about BDD's treatment, and the need for additional research are discussed.     

A National Survey on Multicultural Competence for Professional Counselors: A Replication Study

The purpose of this investigation was to replicate findings from Holcomb‐McCoy and Myers's ( 1999 ) study, which assessed the multicultural competence of professional counselors. Factor analysis was conducted to determine the components of multicultural competence (N = 171). Differences existed between multicultural competence and race/ethnicity, F(2, 168) = 4.86, p = .009, Wilks's Λ = .95, partial η² = .06, and education level, F(2, 167) = 8.95, p < .001, Wilks's Λ = .82, partial η² = .10.     

Connectedness: A Review of the Literature With Implications for Counseling,Assessment, and Research

In this article, the authors review the current conceptual and empirical literature from a variety of disciplines dealing with the construct of connectedness. A working definition of connectedness is provided along with a discussion of its multidimensional nature and major characteristics. Its relationship with a variety of other variables is also presented. Particular attention is given to gender and cultural considerations in the experience and operationalization of connectedness. Recommendations for counseling, assessment, and research related to connectedness are provided.     

Linking sounds to meanings: Infant statistical learning in a natural language

The processes of infant word segmentation and infant word learning have largely been studied separately. However, the ease with which potential word forms are segmented from fluent speech seems likely to influence subsequent mappings between words and their referents. To explore this process, we tested the link between the statistical coherence of sequences presented in fluent speech and infants’ subsequent use of those sequences as labels for novel objects. Notably, the materials were drawn from a natural language unfamiliar to the infants (Italian). The results of three experiments suggest that there is a close relationship between the statistics of the speech stream and subsequent mapping of labels to referents. Mapping was facilitated when the labels contained high transitional probabilities in the forward and/or backward direction (Experiment 1). When no transitional probability information was available (Experiment 2), or when the internal transitional probabilities of the labels were low in both directions (Experiment 3), infants failed to link the labels to their referents. Word learning appears to be strongly influenced by infants’ prior experience with the distribution of sounds that make up words in natural languages.     

Relationship Distress as a Mediator of Adverse Childhood Experiences and Health: Implications for Clinical Practice with Economically Vulnerable Racial and Ethnic Minorities

Adverse childhood experiences (ACE) are interpersonal sources of distress negatively correlated with physical and mental health, as well as maladaptive intimate partner conflict strategies in adulthood. Economically vulnerable racial and ethnic minorities report the greatest disparities in exposure to ACE, as well as relationship distress and health. Yet, little is known about the connections between ACE, relationship distress, and health. We therefore tested a theoretical model for the mediating role of relationship distress to explain the ACE‐health connection with a sample (N = 96) predominantly racial/ethnic minorities (87%) with low income. We applied partial least squares structural equation modeling with bootstrapping (N = 500). Relationship distress strengthened the predictive relationship between ACE and health, and accounted for 42% of the variance in health. The results provide preliminary support for relationship distress as a social determinant of health disparities with implications for interdisciplinary health intervention.     

Self-esteem in body dysmorphic disorder

Although studies indicate that poor body image is associated with poor self-esteem, few investigations have examined self-esteem in a clinical sample of individuals with body dysmorphic disorder (BDD). The present study examined self-esteem in 93 BDD patients and change in self-esteem with pharmacotherapy. Subjects completed the Rosenberg Self-Esteem Scale (RSES) and were assessed with other measures. Participants in a placebo-controlled fluoxetine trial completed measures at baseline and endpoint. The mean RSES score was approximately 1.5 SD units lower than means reported for nonclinical samples. Although poorer self-esteem was associated with more severe BDD and depression, as well as greater delusionality, the relationship between self-esteem and BDD severity was largely mediated by depressive symptoms. Self-esteem did not improve significantly more with fluoxetine than placebo, although it improved significantly more in fluoxetine responders than in nonresponders. It is unclear whether poor self-esteem predisposes to BDD and/or is a consequence of the disorder.