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The Impact of NORTH STAR on Suicidality, Substance Problems, Intimate Partner Violence, and Child Abuse

Smith Slep, Amy M; Heyman, Richard E; Lorber, Michael F; Linkh, David J
INTRODUCTION/BACKGROUND:We evaluated the effectiveness of New Orientation for Reducing Threats to Health from Secretive-problems That Affect Readiness (NORTH STAR), a community assessment, planning, and action framework to reduce the prevalence of suicidality, substance problems, intimate partner violence, and child abuse. MATERIALS AND METHODS/METHODS:One-third of U.S. Air Force bases worldwide were randomly assigned to NORTH STAR (n = 12) or an assessment-and-feedback-only condition (n = 12). Two Air Force-wide, cross-sectional, anonymous, web-based surveys were conducted of randomly selected samples assessing risk/protective factors and outcomes. This study was reviewed and approved by the institutional review board at the investigators' university and by the institutional review board at Fort Detrick. RESULTS:NORTH STAR, relative to control, bases experienced a 33% absolute risk reduction in hazardous drinking rates and cumulative risk, although, given the small number of bases, these effects were not statistically significant. CONCLUSIONS:Given its relatively low cost, use of empirically supported light-touch interventions, and emphasis on sustainability with existing resources, NORTH STAR may be a useful system for prevention of a range of adult behavioral health problems that are difficult to impact.
PMID: 33169138
ISSN: 1930-613x
CID: 4676322

High sensitivity and specificity screening for clinically significant intimate partner violence

Heyman, Richard E; Baucom, Katherine J W; Xu, Shu; Slep, Amy M Smith; Snarr, Jeffery D; Foran, Heather M; Lorber, Michael F; Wojda, Alexandra K; Linkh, David J
The U.S. Preventive Services Task Force has recommended that clinicians screen patients for intimate partner violence (IPV). This article aims to develop and test the first screeners for clinically significant physical and psychological IPV (i.e., acts meeting criteria in the International Classification of Diseases (11th ed.; ICD-11; World Health Organization, 2019) and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). The goal was to derive screeners that (1) are maximally brief, while still achieving high sensitivity and specificity; (2) assess perpetration and victimization when either men or women are reporting; and (3) use ICD-11/DSM-5 criteria as the reference standard. Random samples of active duty service members at 82 installations worldwide were obtained via e-mail invitation (2006: N = 54,543; 2008: N = 48,909); their response rates were excellent for long general population surveys with no payment (2006: 44.7%, 2008: 49.0%). The population of spouses at the participating installation was invited by mailed postcard (2006: N = 19,722; 2008: N = 12,127; response rates-2006: 12.3%, 2008: 10.8%). Clinically significant physical intimate partner violence can be effectively screened with as few as four items, with sensitivities > 90% and specificities > 95%; clinically significant psychological intimate partner violence can be screened with two items. Men and women can be screened with equivalent accuracy, as can those committing the violence and those victimized by it. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
PMID: 32673030
ISSN: 1939-1293
CID: 4532952

Predicting Marital Health From Adverse Childhood Experiences Among United States Air Force Active-Duty Personnel

Cigrang, Jeff; Balderrama-Durbin, Christina; Snyder, Douglas K.; Parsons, Aleja M.; Lorko, Kelsey; Gupta, Avantika; Slep, Amy M.Smith; Heyman, Richard E.; Mitnick, Danielle M.; Wijdenes, Kati L.; Yahle, Courtney
Marital dysfunction in military samples demands special scrutiny because of its concurrent and prospective linkages with a broad spectrum of mental and physical health disorders, as well as its demonstrated adverse impact on military readiness. Although previous research has shown higher risk for marital distress and divorce among female service members (SMs), particularly at the enlisted ranks, contributing factors to this elevated risk remain largely undetermined. The present study examined the antecedent contributing influence of exposure to adverse childhood experiences (ACEs) on current marital health in a sample of 373 early-career active-duty Airmen, aswell as the potential moderating effect of sex on the magnitude of adverse impact. Results indicated higher prevalence of ACEs for this military sample compared with a community sample and higher prevalence of ACEs for female SMs compared with their male counterparts. Moreover, findings revealed the relatively greater adverse impact of childhood abuse or neglect for female SMs in increasing their likelihood of both IPV perpetration and victimization. Overall, these findings indicate the importance of screening for both antecedent and concurrent indicators of marital health in military settings and developing brief intervention protocols targeting relationship distress and its comorbid conditions in this population.
ISSN: 2160-4096
CID: 5060582

Patient Experience and Expression of Unpleasant Emotions During Health Care Encounters

Heyman, Richard E; Baucom, Katherine J W; Giresi, Jill; Isaac, Liza J; Slep, Amy M Smith
To examine the concordance between patients' experience and expression of unpleasant emotions in a health care context, 21 patients presenting to a university dental clinic were observed for expressed unpleasant emotions and patients provided the intensity of their experienced unpleasant emotions. We found low convergence between experience and expression. Most of the time that patients experience unpleasant emotions they do not express them, and 80% of the time patients express unpleasant emotions they are not experiencing them at the time. Providers need to frequently check in with patients regarding their emotional experience during appointments, as it is infrequently accessible to providers.
PMID: 33457530
ISSN: 2374-3735
CID: 4762792

Caring for a spouse with advanced cancer: similarities and differences for male and female caregivers

Ketcher, Dana; Trettevik, Ryan; Vadaparampil, Susan T; Heyman, Richard E; Ellington, Lee; Reblin, Maija
Most caregiving literature has focused on women, who have traditionally taken on caregiving roles. However, more research is needed to clarify the mixed evidence regarding the impact of gender on caregiver/patient psychological outcomes, especially in an advanced cancer context. In this paper, we examine gender differences in caregiver stress, burden, anxiety, depression, and coping styles, as well as how caregiver gender impacts patient outcomes in the context of advanced cancer. Eighty-eight patients with advanced cancer and their caregivers completed psychosocial surveys. All couples were heterosexual and most caregivers were women (71.6%). Female caregivers reported significantly higher levels of perceived stress, depression, anxiety, and social strain compared with male caregivers, and female patients of male caregivers were more likely to use social support as a coping style compared with male patients of female caregivers. These findings highlight the potential differences between male and female caregivers' needs and psychological health.
PMID: 31845168
ISSN: 1573-3521
CID: 4243832

Evaluating the Effectiveness of NORTH STAR: a Community-Based Framework to Reduce Adult Substance Misuse, Intimate Partner Violence, Child Abuse, Suicidality, and Cumulative Risk

Slep, Amy M Smith; Heyman, Richard E; Lorber, Michael F; Baucom, Katherine J W; Linkh, David J
We evaluated the effectiveness of NORTH STAR, a community assessment, planning, and action framework to reduce the prevalence of several secretive adult problems (hazardous drinking, controlled prescription drug misuse, suicidality, and clinically significant intimate partner violence and child abuse [both emotional and physical]) as well as cumulative risk. One-third of US Air Force (AF) bases worldwide were randomly assigned to NORTH STAR (n = 12) or an assessment-and-feedback-only condition (n = 12). Two AF-wide, cross-sectional, anonymous, web-based surveys were conducted of randomly selected samples assessing risk/protective factors and outcomes. Process data regarding attitudes, context, and implementation factors were also collected from Community Action Team members. Analyzed at the level of individuals, NORTH STAR significantly reduced intimate partner emotional abuse, child physical abuse, and suicidality, at sites with supportive conditions for community prevention (i.e., moderation effects). Given its relatively low cost, use of empirically supported light-touch interventions, and emphasis on sustainability with existing resources, NORTH STAR may be a useful framework for the prevention of a range of adult behavioral health problems that are difficult to impact.
PMID: 32827290
ISSN: 1573-6695
CID: 4583772

An Uncontrolled Trial of Flexibly Delivered Relationship Education with Low-Income, Unmarried Perinatal Couples

Heyman, Richard E; Baucom, Katherine J W; Slep, Amy M Smith; Mitnick, Danielle M; Halford, W Kim
Objective/UNASSIGNED:To examine couple and parenting outcomes from an American version of Couple CARE for Parents (CCP) in low-income, unmarried couples. Background/UNASSIGNED:We adapted an evidence-based, flexibly delivered program for use with low-income, unmarried couples, for whom the outcome literature is scarce. Method/UNASSIGNED:= 443) were recruited from maternity units and began CCP. They completed measures before, during, and immediately after the intervention, and 6 months later. Results/UNASSIGNED:Moderate psychological intimate partner violence (IPV) declined and perceived parenting efficacy increased over time; there was no change in severe psychological or physical IPV. Individuals with lower levels of relationship commitment than their partners showed improvement in relationship satisfaction, whereas those with similar or higher levels of commitment maintained their baseline levels despite being in a period of expected satisfaction decline. Conclusion/UNASSIGNED:CCP showed some signs of helping low-income couples during a stressful period and its flexible service delivery model allowed these couples to participate by reducing the impediments of transportation challenges, conflicting work schedules, and overall time poverty. Implications/UNASSIGNED:Practitioners interested in using CCP with low-income couples would likely maximize the impact by (a) focusing on pregnant, first-time parents; (b) integrating CCP within post-natal healthcare; and/or (c) assuming that a considerable minority of couples will avail themselves of only up to two sessions, and thus practitioners should front-load content, making other content optional or just-in-time. In addition, non-psychoeducational elements (e.g., gamification, easy computerized tasks to reduce angry responses, watching couple-themed movies) could enliven preventative offerings for perinatal couples.
PMID: 33542587
ISSN: 0197-6664
CID: 4800022

Creating and Testing the Reliability of a Family Maltreatment Severity Classification System

Erlanger, Ann C Eckardt; Heyman, Richard E; Slep, Amy M Smith
Child maltreatment and intimate partner abuse determinations often include judgments (e.g., severity) that go beyond whether or not the allegations are founded. Severity ratings inform multiple stakeholders (e.g., researchers, policymakers, clinicians, supervisors) and response pathways (e.g., "differential response" to child maltreatment). However, because severity guidelines typically only provide global direction for raters, these gradations are often of questionable reliability (and thus validity). Extending earlier work developing and implementing reliable and valid family maltreatment substantiation criteria (e.g., Heyman & Slep, 2006, 2009), a classification system for maltreatment severity was created, refined, and field-tested with a sample of clinicians from the largest maltreatment protection agency in the United States The goal was to develop operationalized criteria delineating mild, moderate, and severe maltreatment that could be consistently applied across types of maltreatment, raters, and clinics. To facilitate proper use, a computerized clinical decision support tool for the criteria was created. First, the severity classification system was piloted and refined at four sites throughout the United States. Then, clinicians at these sites (N = 28) and a master reviewer independently rated de-identified cases as part of the clinicians' routine assessments. Agreement between clinicians and the master reviewer was excellent for all types of maltreatment. Implications for practical dissemination are discussed.
PMID: 32990144
ISSN: 1552-6518
CID: 4799982

Family Influences on Caries in Grenada

Mitnick, Danielle; Dills, Ashley; Smith Slep, Amy M; Heyman, Richard E; Giresi, Jill
If high-conflict family environments are cariogenic across cultures, and can be studied in cultures where both these environments and cariogenic dental practices are particularly prevalent, this would afford the opportunity to examine how these two pathways of risk might interact, laying the stage for culturally competent, integrated prevention efforts. The first investigation involved qualitative data about perceptions of oral health and family stressors in Grenadian families with school-aged children. The second study used a questionnaire and observational data to assess relations among oral health behaviors, relationship satisfaction, parenting, and child behavior; it also included a pilot study of Motivational Interviewing. Most of the themes discussed in focus groups suggested overlap between U.S. and Grenadian parents; possible culture-specific issues were high prevalence of single-parent homes, normativity of physical discipline, less preventive dental care, and more fatalistic view of oral health outcomes. Significant associations were found between parent and child oral health behaviors, between child externalizing and internalizing behaviors, and between family variables (e.g., relationship satisfaction, child behavior) and oral health behaviors (e.g., parent flossing, child brush time). The results strongly support the need for research on the relations between family functioning and oral health to be embedded within culture.
PMID: 32916915
ISSN: 2304-6767
CID: 4590262

In-home conversations of couples with advanced cancer: Support has its costs

Reblin, Maija; Otto, Amy K; Ketcher, Dana; Vadaparampil, Susan T; Ellington, Lee; Heyman, Richard E
OBJECTIVE:The goal of this study was to describe the quality of naturalistic communication between patients with advanced cancer and their spouse caregivers using observational methods. We also assessed the association between patient and caregiver communication behaviors and psychological and physical health using the actor-partner interdependence model. METHODS:Data on 81 dyads were gathered as part of a prospective observational study. Patients with advanced cancer and their spouse caregivers completed demographic, physical health, and emotional well-being questionnaires. Cancer and relationship communication captured in "day-in-the-life" audio recordings were coded using Gottman's Turning System to assess the quality of bids for attention and responses. RESULTS:Bids for attention were most often informational (Low Bids) and responses were mostly positive and effortful (Turn Towards); patients and caregivers did not significantly differ in communication behavior. More effortful bids for attention (High Bids) were associated with more positive and effortful responses. Patient communication behaviors were significantly associated with caregiver emotional well-being, whereas caregiver communication behaviors were significantly associated with their own emotional well-being and patient physical health. CONCLUSIONS:While patients may benefit from caregivers' more positive and engaged communication at home, the emotional labor of focusing on and engaging the patient may take a toll on caregivers' own well-being. This work contributes to the understanding of what everyday communication looks like for patients with advanced cancer and their spouse caregivers and how this communication may impact physical and psychological health. Our findings provide a foundation to develop guidelines for psychosocial couple-based interventions.
PMID: 32419243
ISSN: 1099-1611
CID: 4490372