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Item 80. Disparities in Perceived Vulnerability to COVID-19 Consequences Among U.S. Adolescents and Young Adults: Findings from a Nationally Representative Survey(Elsevier, 2021-02) Hensel, Devon J.; Rosenberg, Molly; Luetke, Maya; Herbenick, Debby; Pediatrics, School of MedicinePurpose: Global research has documented the adverse impact of COVID-19 on the health and well-being of adolescents and young adults (AYA). Pandemic conditions can increase AYA vulnerability to COVID-19-related health (e.g. getting sick or missing medical appointments), social (e.g. not having enough to eat) and economic (e.g. job loss) consequences. Structural inequalities may further exacerbate exposure to these outcomes. We used nationally representative data to examine AYA perceived vulnerability to health/social outcomes early in the COVID-19 pandemic. Methods: Data were the 2020 National Survey of Sexual and Reproductive Health during COVID-19 (Ipsos Research: Menlo Park, CA, USA), an online, nationally representative survey of COVID-19 experiences and knowledge among noninstitutionalized adults in the United States (all 50 states and District of Columbia). Of all individuals recruited (N=1632; 18-94 years), 1010 (62%) completed the survey. We retained a subsample of participants 18-25 years of age (N=106; 10.1% of the larger study) for our current analytic sample. Participants rated the next 12-week occurrence likelihood of eight COVID consequences (all dichotomized for analsis: no chance + low chance – 25% vs. medium chance – 25% to 75% + high chance - >75%). Illness consequences were: being exposed to COVID-19, getting an infection from COVID-19, being hospitalized from COVID-19, knowing someone with COVID-19, knowing someone who has died from COVID-19. Social/economic consequences were: losing job, partner/spouse losing job, not having enough to eat, parent(s) losing their job, missing important healthcare appointments/treatments. Structural variables were: gender (male/female), age (18-21/22-25), sexual identity (heterosexual/sexual minority [SM]) and race/ethnicity (White/BIPOC). We evaluated the prevalence heterogeneity across structural variables using nonparametric McNemar tests. All estimates were adjusted using Ipsos provided weights to account for sampling differences and/or nonresponse. Results: The majority of AYA in the United States (85%) believed they were vulnerable to 2+ health or social/economic consequences. Significantly more SM (36.4%-57.5%) than heterosexual (23.2%-37.0%; p<.001 both) AYA perceived vulnerability to being exposed to and/or getting an infection from COVID-19. A significantly greater number of BIPOC (16.2%-38.7%) than White (11.4%-18.8%; p<.001 both) believed they were vulnerable to COVID19-associated hospitalization or job loss. More SM (26.4%) than heterosexual (22.4%; p<.001) AYA estimated a medium-to high likelihood they would know someone who died of COVID-19. Significantly more BIPOC than White AYA felt high vulnerability to personal job loss (38.7% vs. 18.8%; p=.015), parent job loss (19.0% vs. 16.3%; p<.001) and not having enough to eat (16.3% vs. 10.0%; p<.001). Conclusions: Nationally, many AYA – particularly sexual minority and BIOPC youth – believe they are highly vulnerability to COVID-19 associated consequences. Professionals who work with youth may consider including screening for COVID-19 worries during clinical/educational interactions as a means of both understanding and normalizing AYA’s experiences, as well as helping them devise support or coping mechanisms, during this unprecedented time. These “check-ins” may be particularly where long-term worry about COVID-19 could exacerbate existing disparities in mental and physical health among marginalized AYA.Item A Brief Report on Living Arrangements Following Gray Divorce(Oxford University Press, 2023) Brown, Susan L.; Lin, I-Fen; Mellencamp, Kagan A.; Pediatrics, School of MedicineObjectives: We offer new insights on how older adults in the United States navigate the aftermath of gray divorce (i.e., divorce that occurs among adults aged 50+) by describing their living arrangements upon divorce and tracking the stability of these configurations over time. Living arrangements are important to decipher because they are linked to health, well-being, and longevity. Methods: Using data from the 1998-2014 Health and Retirement Study, we uncovered patterns of U.S. older adult living arrangements upon divorce (N = 1,057), distinguishing among those who lived alone, lived with others, and lived with a new partner. Multinomial logistic regression models were estimated to assess how individual characteristics (demographics, marital biography, economic resources, health, and social ties) were associated with these configurations. Cumulative survival probabilities gauged the relative stability of these 3 living arrangements. Results: About half of U.S. adults lived alone upon gray divorce, another one-third lived with others, and the remaining 14% lived with a new partner. Adults living with a new partner tended to exhibit the most advantaged sociodemographic profiles, whereas those living solo or with others were largely comparable. More than 70% of adults experienced a subsequent living arrangement transition if they lived with others upon divorce, versus just 50% of those living alone and only 30% of those with a new partner. Discussion: After divorce, older adults reside in a range of living arrangements, some of which are more stable than others. Future work should address whether and how these arrangements and their durability are related to postdivorce adjustment.Item Barriers and Facilitators of Health and Well-Being in Informal Caregivers of Dementia Patients: A Qualitative Study(MDPI, 2023-02-28) Duplantier, Sally C.; Williamson, Francesca A.; Pediatrics, School of MedicineBackground: Given the dramatic projected increase in Alzheimer's disease globally and the increased risk of morbidity and mortality for family caregivers of these patients, there is an urgent need to provide more targeted, timely resources to support the health and well-being of these informal caregivers. Few studies have investigated the barriers to health and well-being and potential strategies to facilitate better self-care from the unique perspective of the caregivers themselves. Purpose: This qualitative study aimed to identify barriers and facilitators to health and well-being for informal caregivers of family members with Alzheimer's. Method: We conducted semi-structured interviews with eight informal caregivers, including daughters, wives, and one husband, ages 32 to 83. Using Reflexive Thematic Analysis, we identified three main themes and subthemes across caregivers' experiences. Findings: We found that caregivers (1) prioritized mental and social well-being over physical health or health behaviors; (2) characterized the subjective burden of caregiving as a "mantle of responsibility" that could not easily be shed due to the complex subjective burden of loss, grief, guilt, resentment, isolation, loneliness, and lack of agency; (3) sought to be recognized as "additional patients", instead of being viewed as invisible patients, with support services tailored to their life stage and challenges. Conclusions: The findings suggest that the subjective burden of strain experienced by family caregivers of Alzheimer's patients has a profound impact on their health and well-being, even more so than the objective burden of strain that is the result of their day-to-day caregiving activities.Item Cognitive function prior to systemic therapy and subsequent well-being in older breast cancer survivors: longitudinal findings from the Thinking and Living with Cancer Study(Wiley, 2020-06) Kobayashi, Lindsay C.; Cohen, Harvey Jay; Zhai, Wanting; Zhou, Xingtao; Small, Brent J.; Luta, George; Hurria, Arti; Carroll, Judith; Tometich, Danielle; McDonald, Brenna C.; Graham, Deena; Jim, Heather S.L.; Jacobsen, Paul; Root, James C.; Saykin, Andrew J.; Ahles, Tim A.; Mandelblatt, Jeanne; Radiology and Imaging Sciences, School of MedicineObjective: To investigate the relationships between self-reported and objectively measured cognitive function prior to systemic therapy and subsequent well-being outcomes over 24 months in older breast cancer survivors. Methods: Data were from 397 women aged 60 to 98 diagnosed with non-metastatic breast cancer in the Thinking and Living with Cancer Study recruited from 2010-2016. Cognitive function was measured at baseline (following surgery, prior to systemic therapy) using neuropsychological assessments of attention, processing speed, and executive function (APE), learning and memory (LM), and the self-reported FACT-Cog scale. Well-being was measured using the FACT-G functional, physical, social, and emotional well-being domain scales at baseline and 12 and 24 months later, scaled from 0 (low) to 100 (high). Linear mixed-effects models assessed the relationships between each of baseline APE, LM, and FACT-Cog quartiles with well-being scores over 24 months, adjusted for confounding variables. Results: At baseline, older survivors in the lowest APE, LM, and FACT-Cog score quartiles experienced poorer global well-being than those in the highest quartiles. At 24 months, older survivors tended to improve in well-being, and there were no differences according to baseline APE or LM scores. At 24 months, mean global well-being was 80.3 (95% CI: 76.2-84.3) among those in the lowest vs 86.6 (95% CI: 83.1-90.1) in the highest FACT-cog quartile, a clinically meaningful difference of 6.3 points (95% CI: 1.5-11.1). Conclusions: Among older breast cancer survivors, self-reported, but not objective cognitive impairments, were associated with lower global well-being over the first 2 years of survivorship.Item Differential Links Between Expressive Suppression and Well-Being Among Chinese and Mexican American College Students(American Psychological Association, 2015-03) Su, Jenny C.; Park, Irene J.K.; Chang, Janet; Kim, Su Yeong; Dezutter, Jessie; Seol, Kyoung Ok; Lee, Richard M.; Soto, José A.; Zamboanga, Byron L.; Ham, Lindsay S.; Hurley, Eric A.; Brown, Elissa; Psychiatry, School of MedicinePrevious research on culture and emotion regulation has focused primarily on comparing participants from individualistic and collectivistic backgrounds (e.g., European Americans vs. Asians/Asian Americans). However, ethnic groups that are equally individualistic or collectivistic can still vary notably in cultural norms and practices regarding emotion regulation. The present study examined the association between expressive suppression and well-being in two collectivistic ethnic groups (i.e., Chinese Americans and Mexican Americans). Results indicated that suppression of positive emotions was related to lower hedonic and eudaimonic well-being among Mexican Americans but not among Chinese Americans. Moreover, post hoc analysis revealed that Mexican Americans with a stronger collective identity reported lower eudaimonic well-being when suppressing positive emotions than Mexican Americans with a weaker collective identity. Suppression of negative emotions, by contrast, was unrelated to hedonic and eudaimonic well-being for both ethnic groups. Overall, our findings underscore the importance of taking into account the role that culture and the characteristics of emotion (e.g., valence) may play in the link between emotion regulation and well-being.Item Dyadic influence of hope and optimism on patient marital satisfaction among couples with advanced breast cancer(Springer, 2014-09) Rock, Emily E.; Steiner, Jennifer L.; Rand, Kevin L.; Bigatti, Silvia M.; Department of Psychology, School of SciencePURPOSE: An estimated 10-40 % of breast cancer (BC) patients report negative changes to their partnered relationships. Literature suggests that for these patients, marital satisfaction is related to depression and other quality of life factors which are associated with survivorship and treatment response. However, existing literature does not provide a clear explanation of the factors that strengthen vs. create strain in couples facing cancer. Given the benefits of a satisfying relationship to patient quality of life, it is important to better understand factors that put patients at greater risk for marital difficulties. This study examined the differential and combined roles of hope and optimism among BC patients and their partners on patient marital satisfaction. METHOD: Fifty-six breast cancer patient-partner dyads completed study questionnaires as part of a larger study. Regression analyses were used to examine the main and interaction effects of patient and partner hope and optimism on patient marital satisfaction. RESULTS AND CONCLUSION: Higher patient and partner hope predicted greater patient marital satisfaction, whereas optimism did not. These results are divergent from the literature on optimism and well-being, which shows the importance of studying these two traits concurrently. Interaction effects suggest certain combinations of patient and partner hope and optimism are more beneficial than others for patient marital satisfaction and suggest a dyadic approach is important for investigation of well-being in breast cancer.Item Effectiveness of Occupational Therapy Interventions to Promote Social Participation and Quality of Life in Older Adults: A Rapid Systematic Review(2021-05-05) Adams, Alexa; Horsford, Caitlin; Jones, Paige; Long, Ryane; Pflugradt, Dana; Chase, Anthony; Department of Occupational Therapy, School of Health and Human SciencesThis systematic review discusses the evidence of 24 studies to identify the effectiveness of various evidence-based interventions that could be utilized within the scope of occupational therapy (OT), as they aim to improve social participation and health related quality of life in adults over 60 years of age. Older adults often experience difficulty with social engagement, increasing their risk for social isolation which is correlated to decreases in health-related quality of life, functional mobility, as well as increased loneliness, cognitive declines, or other adverse physical and psychological effects. Social participation can facilitate increased health-related quality of life, mitigate loneliness, as well as slow cognitive decline and other adverse physical and psychological effects related to aging and late life transitions. Overall, this review found strong evidence for the effectiveness of physical activity interventions, moderate evidence for the effectiveness of emotional and personal based interventions, and mixed evidence for external support interventions that aim to improve social participation in older adults. Additional research should be conducted to further identify objective aspects (rather than typical subjective aspects) of evidence-based interventions that clinically correlate to increased health-related quality of life and well-being as related to social participation for therapeutic utilization within the domain of occupational therapy for older adults.Item Effects of Shambhavi Mahamudra Kriya, a Multicomponent Breath-Based Yogic Practice ( Pranayama), on Perceived Stress and General Well-Being(Sage Publications, 2017-10) Peterson, Christine Tara; Bauer, Sarah M.; Chopra, Deepak; Mills, Paul J.; Maturi, Raj K.; Medicine, School of MedicineStress-induced disorders such as anxiety represent the leading causes of adult disability worldwide. Previous studies indicate that yoga and other contemplative practices such as pranayama, or controlled yogic breathing techniques, may be effective in the treatment of mood disorders and stress. In this study, 142 individuals (mean age = 43 years; SD = 13.90) participated in a 3-day retreat program during which they learned Shambhavi Mahamudra kriya, which is a yogic practice that includes both deep breathing and meditation techniques. Participants were instructed to practice the kriya each day for 21 minutes. After 6 weeks of daily practice, participants reported subjectively lower levels of perceived stress (Perceived Stress Scale) and higher levels of general well-being (General Well-Being Scale) compared to baseline. These results support the notion that Shambhavi Mahamudra kriya may represent a natural treatment for stress reduction.Item An Empirical Test of the Dimensionality of Self-Control(2013-08-23) Tunze, Chloe Ann; Rand, Kevin L.; Cyders, Melissa A.; Rexroth, Daniel F.; Stewart, Jesse C.; Ashburn-Nardo, Leslie; Hazer, JohnMinimal attention has been devoted to examining the dimensionality of self-control. The present study tested a multidimensional model of self-control in which dimensions were based on the nature of the behavior required (i.e., persistence, initiation, cessation, or prevention). A total of 336 undergraduates completed measures of self-control and psychological well-being. Seventy-four of these participants completed behavioral self-control tasks representing the proposed subtypes. Participants’ GPAs were obtained from the Registrar. Stop self-control was inversely related to previously-validated measures of persistence (β = -.61, p = .010) and prevention (β = -.56, p = .040) self-control and demonstrated differential predictive ability of persistence and prevention compared to the other proposed subtypes. Initiation self-control was inversely related to life satisfaction (β = -.35, p = .012) and demonstrated differential predictive ability of life satisfaction compared to stop self-control. These results were interpreted with caution due to inadequate power and questionable validity of several of the behavioral self-control tasks. Both handgrip persistence (r = -.25, p = .033) and blinking prevention (r = -.29, p = .023) were associated with depression. These pairwise correlations were not significantly different from each other, suggesting that no conceptual distinction should be made between persistence and prevention self-control. Confirmatory factor analyses of self-report data revealed that items clustered based on domain rather than on type of behavior required for self-control exertion. Thus, the structure of self-control remains unclear. Limitations of the present study and implications for future research are discussed.Item Experiences of Residency Program Directors in Their Roles: Exploring Well-Being Through Burnout and Engagement(2022-11) Robertson, Kyle A.; Byram, Jessica N.; Hayes, Cleveland; Agosto, Elizabeth R.; McNulty, Margaret A.; Organ, Jason M.Recent literature on well-being of physicians in general, and residency program directors (PD) specifically, has demonstrated those meeting the criteria of burnout reaching almost 50% in physicians, and 20-30% in PDs. However, few studies have explored engagement, or the positive or meaningful aspects, in physicians and no studies have explored engagement in the PD and Assistant PD community. Therefore, this study employed a qualitative approach to explore the experiences of PDs and APDs as they encountered burnout, engagement, and every combination in between through their multifaceted, roles, responsibilities, and tasks embedded in their institutional context and personal lives. Phase 1 participants (n=3) included two PDs and one APD from Indiana University School of Medicine (IUSM). Participants in Phase 1 took part in three semi-structured interviews at 6-month intervals, and direct observations in their clinical, administrative, and education roles. Phase 2 participants (n=5) were PDs from IUSM who completed a single semi-structured interview based on preliminary results and exploration of Phase 1 participants’ experiences. Interviews and field notes from observations were analyzed using inductive thematic analysis, followed by a deductive application of Job Demands-Resources (JD-R) theory. Document analysis was incorporated to add context, understanding, and a rich description of the participants’ experiences. This study found multiple sub-themes situated within four major themes: It Takes a Village, Integration of the “Hats” They Wear, Motivation and the Meaning of Their Career, and Coping. Exploring the sub-themes to JD-R theory allowed contextualization of how job demands, job resources, personal resources, absence of resources, job crafting, recovery, self-undermining, and strain, interact to add context, nuance, and broader conceptualization of how PD and APD experienced their multifaceted roles. This study provides a rich description of the experiences of PDs and APDs embedded in their social context of roles, tasks, and responsibilities. These results indicated that understanding how the individual experiences their job demands as they interact with their experiences of job and personal resources, and how the individual proactively engages with their environment through job crafting and recovery enables for a nuanced appreciation of engagement and burnout.