PROMPTING ONE LOW-FAT,HIGH-FIBER SELECTION IN A FAST-FOOD RESTAURANT

Evidence increasingly links a high-fat, low-fiber diet to coronary heart disease and certain site cancers, indicating a need for large-scale dietary change. Studies showing the effectiveness of particular procedures in specific settings are important at this point. The present study, using an A-B-A-B design and sales data from computerized cash registers, replicated and extended previous work by showing that inexpensive prompts (i.e., signs and fliers) in a national fast-food restaurant could increase the sales of salads, a low-fat, high-fiber menu selection. Suggestions also are made pertinent to more widespread use of the procedures.     

Sur l'omniprésence du mensonge dans le discours

Three levels are proposed to explain lying as a process in discourse production, to characterize different types of lies and to distinguish them from mistakes, ignorance and forgetting as well fr from ill-timed or irrelevant utterances.

     

Genetics and adoption: Forming a partnership

Genetic issues are demanding more attention in the area of public health. Adoption agencies and policymakers are beginning to address these issues where they relate to the adoption process and to the many families involved in adoption in this country. Genetic counselors need to play an active role as both educators of and consultants for adoption professionals and the families with whom they work. To facilitate a partnership between genetics and adoption we have developed a workshop intended to educate adoption professionals about the lifelong implications of genetic conditions on the adoption triad.     

The health needs of the majority versus the health needs of the individual: The reorganization of medical education in Colombia

The challenge of excellence in community health services has been taken up by medical educators in Colombia. Confronted with a nation where the primary indicators of disease mortality and morbidity (cardiovascular disease and infant mortality) were characteristic of First and Third World patterns, respectively, the Ministry of Health and La Asociacion Colombiana de Facultades de Medicina (ASCOFAME), representatives of institutions of medical education, have collaborated to conduct a needs assessment of the country's health needs and devised an implementation plan designed to better address the needs of the majority of that nation's people.As a model, the Colombian reorganization of medical education is an example which could be emulated by the U.S. where policy makers are struggling with troublesome questions of cost, equity and quality.     

INCREASING APPOINTMENT KEEPING BY REDUCING THE CALL-APPOINTMENT INTERVAL

We examined the effect of reducing the interval between a patient's call for an appointment and the appointment itself. In Experiment 1, patients calling a family planning unit of a public health department were assigned appointments within either 1 or 3 weeks of their call. Data on patient “shows” and “no-shows” were recorded weekly for 6 weeks. Show rates for those in the 1-week appointment group were significantly higher than those in the 3-week group. In Experiment 2, patients were assigned to appointment dates either the next operating clinic day (next-day group) or 2 weeks from the call date (2-week group). Show rates for those in the next-day group were significantly better than show rates for patients in the 2-week group. Clinic productivity, time spent with patients, and consumer satisfaction were also assessed. Implications for appointment scheduling are discussed.     

Depressed mood and environmental mastery as potential pathways linking family relationship quality and disease self-management for African Americans with hypertension

African Americans are at significantly greater risk of hypertension and worse cardiovascular outcomes than other racialized groups, yet hypertension intervention effects remain limited. Thus, it is necessary to understand the potential mechanisms whereby interventions may be more effectively targeted to improve health. Supported by prior research evidence and guided by the Biobehavioral Family Model, this study examined associations between family relationship quality, psychological wellbeing, and self-management behaviors for African Americans with hypertension. Data were pooled from three Midlife Development in the U.S. projects, resulting in a sample of 317 African Americans (63.4% female, M_age = 53.32) with self-reported high blood pressure in the past 12 months. We tested four cross-sectional multiple mediator models, with depressed mood and environmental mastery mediating associations between family strain and exercise, smoking, problematic alcohol use, and stress-eating. Environmental mastery mediated the association between greater family strain and decreased odds of achieving recommended exercise levels; greater odds of reporting problematic alcohol use; and greater stress-eating. Though family strain was associated with depressed mood in each model, this variable did not serve as an indirect pathway to self-management behaviors. Family strain, and the potential pathway identified via environmental mastery, may be a meaningful predictor of disease self-management for African Americans with hypertension. Longitudinal studies are needed to examine directionality and to support intervention trials for improving self-management and hypertension outcomes.     

A Model for Adapting Evidence-Based Interventions to Be LGBQ-Affirmative: Putting Minority Stress Principles and Case Conceptualization Into Clinical Research and Practice

The mental health field now possesses clinical trials attesting to the efficacy of affirmative practice with sexual minority individuals. With the goal of efficiently moving the results of these clinical trials into real-world clinical practice, this paper offers a model for adapting existing evidence-based practices originally developed for the general population to be lesbian, gay, bisexual, and queer (LGBQ)-affirmative. The adaptation model presented here guides clinicians to incorporate six LGBQ-affirmative transtheoretical principles of change into practice. These principles facilitate raising awareness of the impact of minority stress on sexual minority clients’ mental health and on client self-evaluation while drawing upon sexual minority resilience and intersectional experiences to build empowering coping skills and validating relationships. The adaptation model also provides a transtheoretical approach to case conceptualization that directs clinicians to consider the role of early and ongoing minority stress on sexual minority clients’ cognitive, affective, motivational, behavioral, and self-evaluative experiences that maintain current distress. This case conceptualization approach highlights common associations among these experiences, suggesting clear routes of interventions for many sexual minority client presentations. Case examples from recent clinical trials of LGBQ-affirmative cognitive-behavioral therapy illustrate how these principles and this case conceptualization can be effectively utilized in practice. While the principles and case conceptualization are meant to be transtheoretical and therefore applicable across therapeutic techniques, to date they have been tested only in clinical trials for cognitive-behavioral treatments. Therefore, this paper concludes with a call for future research to determine the effectiveness of implementing this adaptation model across diverse therapeutic modalities and client presentations.     

Affection deprivation is more aversive than excessive affection: A test of affection exchange theory

Affection exchange theory predicts that both excessive affection and affection deprivation are associated with poorer health, compared with receiving the level of affectionate communication that one desires. A similar yet-untested prediction is that affection deprivation is more aversive than excessive affection. This preregistered study tested both hypotheses on a battery of mental and physical health outcomes, including depression, loneliness, stress, physical pain, frequency of nightmares, and sleep quality, using a Census-matched sample of U.S. American adults (N = 827). As hypothesized, receiving the right amount of affection was associated with more health-supportive scores on all outcomes than either excessive or deficient affection. Similarly, excessive affection was associated with lower depression, loneliness, stress, and pain, and higher sleep quality, than affection deprivation.     

Does authenticity always breed mental health? A cross-cultural comparison between the United States and China

Numerous studies on Western cultures have suggested a strong linkage between authenticity and mental health. However, little is known about whether such an association can be generalized to Eastern cultures. This study aimed to conduct a cross-cultural comparison on the association between three dimensions of authenticity (authentic living, self-alienation, and accepting external influence) and two factors of mental health (negative and positive) across Western and Eastern cultures. Measurement invariance tests were carried out and multigroup structural regression models developed on two college samples from the US (n = 392) and China (n = 281). Results suggested that the associations between authenticity and the negative factor of mental health were consistent across cultures, where both self-alienation and accepting external influence were positively associated with anxiety. However, the associations between authenticity and the positive factor of mental health were different in the US and Chinese samples. Specifically, both authentic living and accepting external influence were significantly associated with life satisfaction in the US sample but not in the Chinese sample. Findings stress that having a nondistorted perception of the true self is critically related to lower levels of anxiety across cultures and highlighted the need to identify culture-specific promotive factors for life satisfaction.