Faculty Bibliography

Relationship behaviors contribute to compromised health or resilience. Everyday communication between intimate partners represents the vast majority of their interactions. When intimate partners take on new roles as patients and caregivers, everyday communication takes on a new and important role in managing both the transition and the adaptation to the change in health status. However, everyday communication and its relation to health has been little studied, likely due to barriers in collecting and processing this kind of data. The goal of this paper is to describe deterrents to capturing naturalistic, day-in-the-life communication data and share how technological advances have helped surmount them. We provide examples from a current study and describe how we anticipate technology will further change research capabilities.

This phase of the NIH Science of Behavior Change program emphasizes an "experimental medicine approach to behavior change," that seeks to identify targets related to stress reactivity, self-regulation, and social processes for maximal effects on multiple health outcomes. Within this framework, our project focuses on interpersonal processes associated with health: coercive couple and parent-child conflict. Diabetes and poor oral health portend pain, distress, expense, loss of productivity, and even mortality. They share overlapping medical regimens, are driven by overlapping proximal health behaviors, and affect a wide developmental span, from early childhood to late adulthood. Coercive couple and parent-child conflict constitute potent and destructive influences on a wide range of adult and child health outcomes. Such interaction patterns give rise to disturbed environmental stress reactivity (e.g., disrupted sympathetic nervous and parasympathetic nervous systems) and a wide range of adverse health outcomes in children and adults, including dental caries, obesity, and diabetes-related metabolic markers. In this work, we seek to identify/develop/validate assays assessing coercion, identify/develop and test brief interventions to reduce coercion, and test whether changes in coercion trigger changes in health behaviors.

Over 1 in 5 dental patients report moderate to severe dental fear. Although the efficacy of cognitive-behavioral treatment (CBT) for dental fear has been examined in over 20 randomized controlled trials-with 2 meta-analyses finding strong average effect sizes ( d > 1)-CBT has received almost no dissemination beyond the specialty clinics that tested it. The challenge, then, is not how to treat dental fear but how to disseminate and implement such an evidence-based treatment in a way that recognizes the rewards and barriers in the US health care system. This mixed-method study investigated the potential of disseminating CBT through care from a mental health provider from within the dental home, a practice known as evidence-based collaborative care (EBCC). Two preadoption studies were conducted with practicing dentists drawn from a self-organized Practice-Based Research Network in the New York City metropolitan area. The first comprised 3 focus groups ( N = 17), and the second involved the administration of a survey ( N = 46). Focus group participants agreed that CBT for dental fear is worthy of consideration but identified several concerns regarding its appeal, feasibility, and application in community dental practices. Survey participants indicated endorsement of factors promoting the use of EBCC as a mechanism for CBT dissemination, with no factors receiving less than 50% support. Taken together, these findings indicate that EBCC may be a useful framework through which an evidence-based treatment for dental fear treatment can be delivered.

The longitudinal course of the psychological health (PH) of United States Air Force (USAF) base communities in relation to risk and demographic factors was studied over a 5-year period. PH (clinically significant hazardous drinking, prescription drug misuse, depressive symptoms, suicidal thoughts and behaviors, intimate partner violence [IPV] and child abuse) and risk (personal and family adjustment, workplace adjustment, broader community adjustment) and demographic factors (age and gender distribution) were operationalized at the aggregate level for bases (N = 77) as measured in three large scale surveys of USAF active duty members. Bases whose members collectively exhibited greater levels of risk collectively experienced greater initial problems with alcohol and drug use, depression, suicidality, and physical IPV. Hazardous drinking more quickly increased at bases whose members were younger and more male, and at those with poorer initial aggregate personal adjustment and workplace adjustment. The challenges of studying the community-level course of PH are highlighted.

This study explored the use of dynamical systems modeling techniques to evaluate self- and co-regulation of affect in couples' interactions before and after the transition to parenthood, and the impact of the Family Foundations program on these processes. Thirty-four heterosexual couples, randomized to intervention and control conditions, participated in videotaped dyadic interaction tasks at pretest (during pregnancy) and posttest (1 year after birth). Husbands' and wives' positivity and negativity were micro-coded throughout interactions. Individual negativity set-points, self-regulation, and partner co-regulatory processes during interactions were examined using a coupled oscillators model. Regarding self-regulatory processes, men exhibited amplification of negativity at the prenatal assessment that did not change at the postnatal assessment; women demonstrated no significant damping or amplification at pretest and a marginally significant change towards greater amplification at the postnatal assessment. In terms of partner-influenced regulatory dynamics, men's positive behaviors changed from damping to amplifying women's negative behaviors in the control group following the transition to parenthood, but exerted an even stronger damping effect on women's negative behaviors in the intervention group. The study highlights the advantages of dynamic modeling approaches in testing specific hypotheses in the study of self- and co-regulatory couple dynamics and demonstrates the potential of studying dynamic processes to further understanding of developmental and intervention-related change mechanisms.

OBJECTIVE: Investigate (1) the association of child adiposity with parent-to-child and parent-to-parent hostility, (2) the mediation of these associations by dietary behaviours and (3) moderation by gender. DESIGN: One hundred thirty-five couples with 6- to 14-year-old children completed measures of emotional and physical aggression, overreactive discipline and child diet. Parent-to-parent hostility was also coded from laboratory observations. MAIN OUTCOME MEASURE: Child adiposity was a combination of body mass index and waist-to-hip ratio. RESULTS: Mother-to-child hostility was associated with child adiposity. This association was concentrated in boys and was not significantly explained by child dietary factors. Mother-to-father hostility was not significantly associated with boys' or girls' adiposity. Girls' adiposity was not significantly associated with family hostility. Fathers' hostility was not linked to child adiposity. CONCLUSION: This is the first study to take a family-level approach to understanding the relation of hostility to child adiposity by examining relations among adiposity and both mothers' and fathers' hostility directed toward one another and toward their children. Our findings highlight the potential role played by mothers' emotional hostility in boys' adiposity and suggest that, if this role is further substantiated, mother-son emotional hostility may be a promising target for the prevention of child obesity.

Military deployment can create significant relationship strain. Although most couples navigate the challenges of deployment successfully, this period may render some couples more vulnerable to adverse relationship outcomes such as infidelity due to a convergence of factors including geographic separation and reduced emotional and physical intimacy. Despite anecdotal reports of increased rates of infidelity during deployment, empirical findings are lacking. This study used a prospective design to examine the prevalence and risk factors of infidelity across the deployment cycle including a year-long deployment to Iraq. A total of 63 married male Airmen were assessed both pre- and 6-9 months postdeployment. The rate of sexual infidelity prior to deployment (21%) was commensurate with the lifetime rate of sexual involvement outside the marriage in representative community samples of men. Across the deployment period, the prevalence of sexual infidelity was strikingly high (22.6%) compared with annual community estimates (1.5-4%; Allen et al., 2005). Findings demonstrated that service members with a prior history of separation, steps toward divorce, and relationship distress prior to deployment had elevated risk for infidelity over the deployment cycle. Moreover, roughly 75% of Airmen who experienced infidelity over the deployment cycle divorced by 6-9 months postdeployment whereas only 5% of service members without infidelity divorced during this same time period. Considering well-documented adverse impacts of infidelity and divorce, the current findings may assist in identifying military couples at risk for infidelity and informing targeted prevention or early intervention strategies for these couples prior to or immediately following deployment. (PsycINFO Database Record

Research has garnered support for a systemic view of factors affecting child dental caries that accounts for the influence of social factors such as the family environment. Our previous work has demonstrated the association between mother-to-father emotional aggression and child caries. The present study builds on these results by evaluating pathways that might explain this relation. Families (n = 135) completed a multimethod assessment of mother-to-father emotional aggression, child caries, and several hypothesized mediators (i.e., child cariogenic snack and drink intake, child internalizing behaviors, child salivary cortisol and alpha-amylase reactivity, parental laxness, child oral hygiene maintenance, and parental socialization of child oral hygiene maintenance). Mediation analyses partially supported the role of the child's diet as a mechanism linking mother-to-father emotional aggression and child caries. However, children's neglect of oral hygiene, parental laxness, and child emotional and biological disturbances failed to stand as conduits for this association. Future investigations should expand upon these results to better establish the causal links that could only be suggested by the present cross-sectional findings.

Parents who are overwhelmed by the intensity and aversive nature of child negative affect - those who are experiencing flooding - may be less likely to react effectively and instead may focus on escaping the aversive situation, disciplining either overly permissively or punitively to escape quickly from child negative affect. However, there are no validated self-report measures of the degree to which parents experience flooding, impeding the exploration of these relations. Thus, we created and evaluated the Parent Flooding scale (PFS), assessing the extent to which parents believe their children's negative affect during parent-child conflicts is unexpected, overwhelming and distressing. We studied its factorial validity, reliability, and concurrent validity in a community sample of 453 couples with 3- to 7-year-old children (51.9 % girls) recruited via random digit dialing. Confirmatory factor analyses indicated a one-factor solution with excellent internal consistency. Test-retest stability over an average of 5.6 months was high. Concurrent validity was suggested by the associations of flooding with parents' aggression toward their children, overreactive and lax discipline, parenting satisfaction, and parents' anger, as well as with child externalizing behavior and negative affect. Incrementally concurrent validity analyses indicated that flooding was a unique predictor of mothers' and fathers' overreactive discipline and fathers' parent-child aggression and lax discipline, over and above the contributions of parents' anger and children's negative affect. The present results support the psychometric validity of the PFS.

Although a substantial proportion of service members returning from a combat deployment report individual emotional and behavioral disorders as well as intimate relationship difficulties, previous studies indicate that only a minority actually seek mental health services. Little is known about factors that predict help-seeking in this population. We first review key findings from the literature on help-seeking in military and veteran populations, including mixed findings regarding the role of perceived stigma and attitudes toward mental health treatment. We then present data from a longitudinal study of United States Air Force Security Forces following a year-long high-risk deployment to Iraq-including findings regarding who seeks help, for what problems, and from which providers. We also examine whether these findings differ for Airmen in a married or committed relationship versus nonpartnered Airmen and, for the former group, whether findings differ for those in a distressed versus nondistressed relationship. Finally, we discuss implications of these findings for extending couple-based interventions to service members and veterans, and describe a multitiered "stepped" approach for promoting relationship resiliency.