Faculty Bibliography

PURPOSE/OBJECTIVES/OBJECTIVE:A patient-centered care (PCC) paradigm undergirds modern dental education. PCC is particularly relevant in the management of patient dental fear. The aims of this study were three-fold: (a) to examine the preliminary psychometric properties of an author-designed survey administered to explore dental fear knowledge and perceptions, (b) to assess how 4th-year dental students regard dental fear, (c) and to investigate the relationship between students' knowledge and perceptions of dental fear and their clinical behavior. METHODS:In 2022, 4th-year dental students (N = 453) participated in a cross-sectional study. Participants completed a 16-item survey that assessed (a) knowledge and perceptions about dental fear, (b) common biases in patient fear assessment, and (c) patient management behaviors when fear is encountered. Exploratory factor analysis, descriptive statistics, and logistic regressions were run to address the study's aims. RESULTS:Exploratory factor analysis revealed three factors, with the two strongest factors pertaining to beliefs about the importance of dental fear (α = 0.87) and self-efficacy in managing fear (α = 0.74). Participants indicated that it is important to assess for dental fear and rated their self-efficacy in ability managing it as high. Ratings on both factors slightly increased the odds of engaging in routine patient screening for dental fear. Students also displayed assessment biases commonly seen among practicing dentists. CONCLUSION(S)/CONCLUSIONS:Results indicate educational gaps within the current behavioral-science training for dental students. Changes to improve advanced dental students' appreciation of their patients' dental fear are warranted.

For decades, researchers, interventionists, and the lay public have subscribed to the notion that couples low in relationship satisfaction and/or experiencing psychological, physical, or sexual intimate partner violence (IPV) have communication skills deficits. In contrast, experimental studies of communication have concluded that differences were more likely due to partners' "ill will than poor skill." We revisited this debate by recruiting a fairly generalizable sample of couples (N = 291) via random-digit dialing and asking them to discuss two top conflict areas ("at your best" and "as you typically do"), thus measuring will-conscious inhibition of hostility and negative reciprocity and production of positivity (i.e., the "conflict triad"). The conflict triad was observed with the Rapid Marital Interaction Coding System, Second Generation. We found partial support for the hypotheses grounded in Finkel's I³ meta-model. Frequency of hostility was associated with a complicated satisfaction × IPV-extent × conversation type × gender interaction, indicating that couples' communication skills are multi-determined. Unhappier couples showed almost no change in positivity when at their best, whereas happier couples nearly doubled their positivity despite their considerably higher typical positivity mean. Negative reciprocity was associated with satisfaction and IPV-extent but not conversation type, implying that immediate instigation combined with risk factors overwhelms conscious inhibition. Intervention implications are discussed.

INTRODUCTION/BACKGROUND:Psychological problems and family maltreatment are significant public health problems. Although research focuses almost exclusively on either individual psychological problems or family maltreatment, there is substantial co-occurrence of these problems. Similarly, intervention services are often "siloed": individuals with mental health needs are referred for mental health services, individuals with family conflict are referred for family-based treatment, etc. These treatment "silos" may miss the larger picture of the co-occurrence of risk, promotion, and the problems themselves. In a previous paper, we used latent class analysis to identify subgroups of individuals with crosscutting patterns (i.e., classes) of psychological and family maltreatment problems. In this study, we explored the predictors of these latent classes. MATERIALS AND METHODS/METHODS:Participants consisted of two large population samples of U.S. Air Force active duty members (ns = 27,895 and 30,841) who were married or cohabiting and had one or more children living in their household. Participants completed an anonymous community assessment survey, which included questionnaire items tapping personal, family, and community problems and well-being. Assessments were conducted in 2008 and 2011. All study procedures were approved by the authors' Institutional Review Board. We used exploratory factor analysis and latent class analysis to (1) identify higher-order factors of risk and promotive variables and (2) examine them as predictors of our previously identified latent classes. RESULTS:Findings indicated that individuals who reported better physical well-being as well as personal and family coping, relationship satisfaction, and support were more likely to be in the lowest-risk subgroup. Notably, individuals in the subgroup most at risk for serious violence and suicide, evidencing disinhibitory psychopathology, endorsed lower risk and higher promotive factors than those individuals in other high-risk subgroups who fell along the internalizing/externalizing continuum. CONCLUSIONS:These findings reinforce the need for integrated prevention and treatment of psychological and family maltreatment problems. Not only do these problems often co-occur, but their risk and promotive factors also tend to be intertwined. The unique (i.e., not on the continuum of the other five classes) problem profile of participants evidencing disinhibitory psychopathology is matched by a unique risk/promotive factor profile, and they will thus likely require a unique intervention approach.

Coercive conflicts between parents and children and between couples are implicated in the pathogenesis of a variety of psychological and physical health problems. Despite its seeming importance to population health, there are no widely available, easy-to-use methods with demonstrated efficacy to engage coercive conflict and reduce it. Identifying and testing potentially efficacious and disseminable micro-interventions (i.e., interventions that can be delivered in under 15 minutes via computer or paraprofessional) for targets with cross-cutting health implications, such as coercive conflict, is the focus of the National Institutes of Health Science of Behavior Change initiative. We experimentally tested four micro-interventions targeting coercive conflict in couple and parent-child dyads in a within-between design. There were mixed but supportive findings for the efficacy of most of the micro-interventions. Attributional reframing, implementation intentions, and evaluative conditioning all reduced coercive conflict as assessed by some but not all measures of observed coercion. No findings indicated any iatrogenic effects. Interpretation bias modification treatment improved at least one measure of coercive conflict for couples, but not for parents and children; additionally, it increased self-reported coercive conflict. Overall, these results are encouraging and suggest that very brief and highly disseminable micro-interventions for coercive conflict are a fruitful direction for inquiry. Optimizing micro-interventions and deploying them across the health care infrastructure could tremendously enhance family functioning and, in turn, health behaviors and health (ClinicalTrials.gov IDs: NCT03163082, NCT03162822).

We conducted an observational study of a collection of interactive processes known as "demand-withdraw" in relation to adolescent dating aggression. Couples (N = 209) aged 14-18 years participated in a challenging observational laboratory assessment to measure demands (i.e., pressures for a change), as well as demand → partner withdraw and demand → partner avoid sequences. Actor and partner effects were disentangled via dyadic data analyses. The results indicated a fairly consistent pattern in which demand → withdraw and demand → avoid sequences led by either partner were positively associated with both partners' physical and psychological aggression (measured via a dual informant questionnaire method). Further, higher quality demands (i.e., pressures for change that were specific and encouraged both members of the dyad to increase a given behavior) were inversely associated with aggression. Yet, all of the above associations were attenuated to the point of statistical nonsignificance after controlling for hostility. These results suggest two primary possibilities. The associations of demand → withdraw and demand → avoid sequences with dating aggression may be spurious, with the sequences merely markers for hostility, a known correlate of dating aggression. Alternatively, hostility may mediate the relations of demand → withdraw and demand → avoid sequences with dating aggression. Further research is required to test these competing explanations. Implications for preventive intervention are discussed.

In a study of conflict recovery and adolescent dating aggression, 14- to 18-year-old couples (N = 209 dyads) participated in a 1-hr observational assessment. Negative behavior was observed during conflict-evoking "hot" tasks and in a "cooldown" task. Physical and psychological dating aggression were assessed via questionnaires. Negative behavior measured in the cooldown task was not associated with dating aggression after controlling for carryover effects of negativity from the hot to cooldown tasks. Moreover, cooldown negativity moderated the associations of hot task negativity and dating aggression. Actor and partner effects were disentangled via dyadic data analyses. Given the paucity of observational studies of dating aggression, our findings are an important contribution to the literature and in need of replication and extension.

Recent technological advances have made the remote recording of interactions and the automatic extraction of nonverbal, paraverbal, and verbal behavioral cues from the videos possible. The development of computer programs that can replace human observational coders is imminent. The increasing availability of such new technologies, accompanied by their lower costs and greater convenience, is likely to advance behavioral observation research, giving new insight into the fine-grained moment-to-moment interactional processes. We illustrate how couple researchers can use recent technological advances to bring behavioral observation research into the 21st century. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Mixed-gender couples presenting for couple therapy are at 2-3 times higher risk for physical intimate partner violence (IPV) than community couples. However, it is unclear if this elevation of relative risk is the same in the general population because relationship distress and treatment-seeking are often confounded. We used archival data from three representative U.S. civilian samples and one representative U.S. Air Force sample to test the hypothesis that clinically significant relationship distress is associated with increased risk of various forms of IPV. In these community samples, those in mixed-gender distressed relationships were at 2-3 times higher risk than those in nondistressed relationships for any physical IPV during the past year and at 3-6 times higher risk for clinically significant psychological and physical IPV during the past year. Given that the increase in IPV risk is similar for individuals in distressed community relationships and therapy-seeking relationships, the prior findings of the elevated rates of IPV in clinical samples are unlikely to be due to therapy-seeking. Although epidemiological risk involves statistical, not causal, associations, the increased co-occurrence of IPV in distressed mixed-gender couples fits with numerous theories of IPV and has implications for both screening and future research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Despite evidence that parents' physical aggression abuse has long-lasting negative consequences, information about the true population prevalence of aggression and physical abuse is limited. We have even less information about how parental aggression and abuse vary by child age, parent gender, and how that aggression and abuse might be clustered within families. To address these gaps, an anonymous, computer-based assessment was administered to nearly 40,000 parents of more than 60,000 children in the United States Air Force, which included a detailed assessment on up to four minor children of aggression and its impact. The survey was the largest of its type ever conducted in the United States, allowing for stable, crossvalidated estimation of rates of both corporal punishment and physical abuse. Approximately 39% of children experienced corporal punishment, peaking at three years of age, and 7% experienced physical abuse, peaking at age six. About 45% of parents reported perpetrating corporal punishment and 8% abuse; these rates were higher in multi-child families and most often involved more than one child. Parent gender was not associated with physical aggression or abuse.

Although many evidence-based interventions are well-established, our understanding of how to effectively implement and sustain those interventions in real-world settings is less well understood. We investigated predictors of implementation and reach in a randomized controlled trial of the NORTH STAR prevention system. One-third of U.S. Air Force (AF) bases worldwide were randomly assigned to NORTH STAR (n = 12) or an assessment-and-feedback-only condition (n = 12). Process data regarding implementation factors were collected from Community Action Team (CAT) members and observations of CAT processes. Results from a series of regression analyses indicated that change in leadership and community support, action planning processes, and perceived approach effectiveness from pre-action planning to follow-up predicted community action plan (CAP) implementation and that changes in barriers to implementation predicted CAP reach. Pre-action planning reports of CAT member self-efficacy and perceived approach effectiveness also predicted CAP implementation at 1-year follow-up. Future directions and practice recommendations are provided.