Sun protection behaviour of children and their parents at the beach

Abstract

The present study observed the sun protection behaviour of 8–12 year old children and their parents on the beach. Interviews with children and parents were then conducted to examine possible influences on sun protection and the relationship between observed and self reported behaviour.

The sample consisted of 50 children and 68 parents. All 50 children were observed and interviewed. All the parents were observed and 33 were interviewed. Indices of sun protection cover were computed as a sum of clothing and sunscreen cover. Most parents and children were inadequately covered against the sun. Factors related to children's sun protection included parent's cover and the child's tan level. The relationship between attitude to sun protection and observed behaviour could not be examined as all children and parents indicated they thought it was important to protect their skin against the sun.

Inconsistencies between observed and self-reported sun protection were found for children who were not protecting themselves. The possibility that self-report may overestimate actual protective behaviour is discussed.     

The regulation of subjective well-being in cancer patients: An analysis of coping effectiveness

Abstract

The hypothesis that individual coping efforts affect subjective well-being in the face of severe chronic disease is examined with questionnaire data from N=332 cancer patients in a one-year longitudinal study. After depicting conceptual and methodological requirements for the analysis of coping effectiveness, the following five coping modes were investigated in the sample: Rumination, search for affiliation, threat minimization, search for information and search for meaning in religion. Results from a series of hierarchical regression analyses yielded findings that questioned the underlying assumption of a general uniform causal direction within coping-adjustment relationships. Threat minimization proved to be the only coping mode that obviously was “effective” in well-being regulation, that is, was revealed to be predictive of well-being changes over time and to be unaffected by prior levels of well-being. It is argued that the problem of causal directionality has to be carefully examined in future studies on coping effectiveness since interindividual differences in coping behaviors might be a consequence rather than the cause of differences in adjustment status.     

‘Use what God has given me’: Difference and disparity in breast reconstruction

African-American women are significantly less likely to undergo postmastectomy breast reconstruction compared to white women in the USA. These observed differences have been interpreted as evidence of a healthcare disparity. The current study examines breast reconstruction decision-making among African-American women, locating reconstruction decisions in a context of culture, racial inequality and biomedicalisation. Semi-structured interviews were conducted with 27 African-American women who underwent mastectomy for breast cancer to add patient-centred perspectives to existing conceptualisations of racial/ethnic differences in reconstruction. Participants were socio-demographically diverse, and resided in the New York metropolitan area. Data analysis was informed by grounded theory. Spiritually and culturally informed body ethics often guided surgery decisions. Participants expressed reservations about breast implants, preferring autologous procedures that use ‘what God has given’. For some, breast reconstruction restored a sense of normalcy after cancer; others challenged an imperative to reconstruct. Several participants redirected our focus on access to reconstruction toward access to alternatives, noting the low reimbursement for prostheses, or their unavailability in patients’ skin tones. We suggest that a framework of ‘stratified biomedicalization’ better addresses the complexities of race, class and gender that inform preference, access and recommendations for breast reconstruction, and focuses attention on access to high and low-tech interventions.     

Gender role conflict and emotional approach coping in men with cancer

The utility of emotional approach coping (EAC), or expressing and processing emotions, has been equivocal for men. Gender role conflict, or the negative cognitive, emotional and behavioural consequences associated with male gender role socialisation, likely shape coping responses and may negatively affect the efficacy of men's emotion-directed coping efforts and adjustment to cancer. Perceptions of receptiveness of one's interpersonal environment may be particularly important to the effectiveness of EAC. This study examined the relationships among EAC, gender role conflict, and distress in a group of 183 men with cancer. Structural equation modelling revealed that higher gender role conflict was associated with lower emotional expression, which in turn was associated with greater distress. Gender role conflict was not related to emotional processing. Higher gender role conflict also was associated directly with more distress. In subsequent analyses, social constraints and age were examined as possible moderators of EAC. Emotional expression was related to more psychological distress for those in highly constrained environments; and emotional processing was associated with more distress with younger age. Emotional expression may be particularly affected by social influences related to gender and social receptivity. More research is needed to better distinguish constructive and unconstructive emotional processing.     

The structure of adversarial growth in a sample of cancer patients 8 years post-diagnosis: a revision of the SLQ-38

Stressful and traumatic events may trigger positive life changes, so-called adversarial growth. Despite growing interest in this topic, the structure and dimensionality of this concept has not been established. Recently, empirical reviews have suggested that the factors underlying this construct are highly related. Currently, the use of confirmatory factor analysis to test this hypothesis is advocated. Using data from cancer patients (n = 206), this study investigated the dimensionality of a Dutch translated version of the Silver Lining Questionnaire (SLQ-38). A 16-item SLQ (SLQ-16), with three subscales or first-order factors (enhanced personal relationships, changes in life philosophy and changes within the self) loading on a second-order general adversarial growth factor, was a good fitting model. In conclusion, the SLQ-16 may prove useful in the assessment of adversarial growth following illness.     

Self-efficacy,psychological adjustment and decisional-balance regarding decision making for outpatient chemotherapy in Japanese advanced lung cancer

This study examined the application of the trans-theoretical model (TTM) for readiness for decision-making of outpatient chemotherapy of Japanese advanced lung cancer patients by a cross sectional questionnaire survey. A questionnaire was conducted with 105 Japanese patients diagnosed with advanced lung cancer receiving chemotherapy. We classified them according to the TTM stages, including 4 in precontemplation, 42 in contemplation, 22 in preparation, and 35 in action. The valid model (χ ² (37) = 42.56, p = 0.24; GFI = 0.93; AGFI = 0.88; CFI = 0.98; RMSEA = 0.04; AIC = 100.56) derived from structural equation modeling (SEM) revealed that stage of outpatient chemotherapy was significantly affected mostly by decisional-balance (β = 0.60, p < 0.001) and partially by time from the patient's house to the hospital (β = ?0.15, p < 0.10), and that decisional-balance was significantly affected by self-efficacy (β = 0.48, p < 0.001) and nausea (β = ?0.23, p < 0.01). The findings from our study provided encouraging results for adopting the TTM in decision making for outpatient chemotherapy in Japanese cancer care and several clinical implications were obtained from the results.     

End of living: maintaining a lifeworld during terminal illness

The narrative responses of 32 people with AIDS or cancer with survival prognoses of 6 months to a year to monthly interview questions about their daily lives were analysed with a team-based qualitative methodology. Two groups emerged: (a) a Maintained Lifeworld Group characterised by one or more of the following: continued engagement with family, friends, and community; the ability to relinquish untenable goals and substitute new, realistic ones; engagement in spirituality and a spiritual practice; and, (b) a Lifeworld Interrupted Group characterised by one or more of the following: relocation just before or during the study, cognitive impairment, commitment to untenable goals, ongoing substance abuse. Understanding how people with a terminal illness can maintain a lifeworld and experience well-being while also managing the physical challenges of their illness could help inform the support offered by professional and family caregivers to improve care recipients’ quality of life.     

The relation between hopelessness and psychological and serological outcomes in israeli women with breast-cancer

Abstract

Investigations into the role of hopelessness in cancer-outcomes are gaining importance. This study examined the relations between hopelessness and psychological and serological outcomes among breast-cancer patients. Forty-nine Israeli women with breast-cancer were assessed for background data, hopelessness (helplessness and pessimism), life-changes, post-traumatic stress disorder (PTSD) symptoms and negative-affect (NA). A sub-sample (N= 21) was followed over four months for alterations in the breast-cancer serological marker CA15-3. Hopelessness was significantly correlated with PTSD-symptoms (r=.43) and NA (r= .30). Hopelessness accounted for an additional and significant 17% and 10% of the variances in PTSD-symptoms and NA. respectively, after controlling for effects of cancer-stage, age, time since diagnosis (and life-changes for PTSD). Finally, helplessness (but not pessimism) predicted changes in CA15-3, controlling for cancer-stage (r= .42. p < .05). These results support previous findings concerning the importance of hopelessness in cancer, and extend them to further psychological and serological outcomes.     

Breast cancer: The intention to have a mammography and a clinical breast examination - application of the theory of planned behavior

Abstract

The purpose of these cross sectional studies was to identify the psychosocial factors explaining women's intention to have a mammography within the next two years and their intention to have a clinical breast examination (CBE) by a professional within the next year. Two random samples of women aged 40–69 years (n_a = 354, n_b = 344) completed a self-administered questionnaire that investigated theoretical constructs of the theory of planned behavior. The results of structural equation modeling showed that subjective norms and perceived behavioral control explained 81 % of the variance in intention of having a mammography. Sixty-five percent (65%) of the variance in intention of having a CBE was explained by attitude and perceived behavioral control. In conclusion, women need to be better informed, have better skills to overcome psychological and physical barriers in performing preventive breast behaviors, and promotion of preventive breast cancer methods should consider people significant for women.     

Communicating BRCA1/2 genetic test results within the family: A qualitative analysis

Genetic testing for BRCA1/2 mutations associated with hereditary breast and ovarian cancer reveals significant risk information about one's chances of developing cancer. It is important to study communication processes in families where members are undergoing genetic testing because the information received is crucial not just to the individual concerned but also to other members of the biological family. This study investigates family communication of BRCA1/2 test results from both the informants’ and recipients’ perspectives. A total of 10 female patients and 22 of their relatives were interviewed. Patients’ and their relatives described feelings of responsibility for sharing genetic information within the family to enable others to reduce their risks of developing cancer. However, there were limits to an individuals’ responsibility once key family members had been informed, who then had to take responsibility for continuing dissemination of information. Whilst there was an implicit responsibility to inform the family of a mutation, information was edited or withheld in the best interest of relatives, dependent upon their perceived emotional readiness, resilience and current life stage and circumstances. The pre-existing family culture and the impact previous cancer diagnoses had upon the family also influenced the process of communication. Findings are discussed in relation to extant literature and implications for clinical practice are considered.