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Item Characterizing Burden, Role Strains and Psychological Distress of Husbands of Breast Cancer Patients During Treatment and Beyond(Wolters Kluwer, 2011) Wagner, Christina D.; Das, Lala Tanmoy; Bigatti, Silvia M.; Storniolo, Anna MariaBackground: Husbands, as the primary providers of support for women with breast cancer, can experience significant burden and role strain, but also perceive positive aspects to the caregiving. Little is known about the specific caregiving tasks husbands perform, for how long, or how burden and positive aspects relate to later psychological distress. Objective: Our primary aim was to better characterize the caregiving responsibilities and role strains of husbands during active cancer treatment and 1 year later. We also evaluated positive aspects during active treatment. Our second aim was to determine which of these predicted psychological distress 1 year later. Methods: Husbands of women undergoing chemotherapy for breast cancer completed a battery of surveys during the time of wives' treatment and again 1 year later. Results: Husbands performed a variety of caregiving tasks for wives during and after breast cancer treatment and also reported benefits associated with caregiving. Breast cancer-related worries were high at both time points. At 1 year after treatment, role strains improved in the social domain but worsened in the domestic domain. Domestic strains during active treatment were the strongest predictor of 1-year distress. Conclusions: Husbands who report persistent domestic role strain are at high risk for continued psychological distress following their wives' breast cancer treatment. Implications for practice: Health care providers should monitor husbands' caregiver burden regularly. Providing couples with resources to reduce domestic role strain (such as social support and communication training) may prevent or alleviate psychological distress in these husbands.Item Trajectory of Change in Pain, Depression, and Physical Functioning after Physical Activity Adoption in Fibromyalgia(Sage, 2015) Steiner, Jennifer L.; Bigatti, Silvia M.; Ang, DennisFibromyalgia (FM) is associated with widespread pain, depression, and declines in physical functioning. The study purpose was to examine the trajectory of these symptoms over time related to physical activity adoption and maintenance via Motivational Interviewing versus Education, to increase physical activity. There were no treatment group differences, we divided the sample (n = 184) based on changes in physical activity. Repeated measures analyses demonstrated differential patterns in depression, pain, and physical functioning at 24 and 36 weeks. Findings suggest increased physical activity may serve as a multiple-target intervention that provides moderate to large, long-lasting benefits for individuals with FM.Item Depression in Husbands of Breast Cancer Patients: Relationships to Coping and Social Support(Springer, 2011) Bigatti, Silvia M.; Wagner, Christina D.; Lydon, Jennifer R.; Steiner, Jennifer L.; Miller, Kathy D.PURPOSE: The purpose of the present study was to examine depression in husbands of women with breast cancer, as depression is typically as high in husbands as in patients, and impacts functioning in both. METHODS: We compared husbands of patients to husbands of women without chronic illness on depressive symptoms with the Center for Epidemiological Studies Depression Scale, social support with the Interpersonal Support Evaluation List, and coping with the Ways of Coping Questionnaire. Using the stress and coping model, we examined whether coping mediated social support and depression differently by group, as has been found in the literature. RESULTS: Husbands of patients reported higher scores on the measure of depression and lower use of problem-focused coping, while groups reported equivalent social support. Escape-avoidance coping emerged as a full mediator between social support and depression in husbands of patients, but only a partial mediator in comparison husbands. Accepting responsibility coping partially mediated social support and depression in both groups. Low social support appears particularly detrimental in husbands of patients as it is associated with ineffective coping and depression. CONCLUSIONS: Findings suggest that among husbands of patients, social support relates to depression only through its relationship with coping, indicating healthcare providers should direct attention and intervention to the coping strategies employed by husbands with low social support.Item Rates of Depression and Anxiety in Cancer Patients: A Review of Cross-National Findings(Pabst Publishers, 2012) Bigatti, Silvia M.; Steiner, Jennifer L.; Cronan, Terry A.Cancer is the leading cause of death worldwide. In this paper, we examine the similarities and differences between the United States (US) and the European Union (EU-27) in the incidences, deaths, types of screening, and screening rates for breast, cervical, colorectal, prostate, and lung cancers. We highlight the differences between the health care, economic, and sociopolitical systems in the US and EU-27 that result in different types of coverage, access to health care, and cancer screening. Finally, we discuss patient-directed, provider-directed, community-directed, and system-directed interventions and the outcomes of these approaches.Item Matched and Mismatched Cognitive Appraisals in Patients with Breast Cancer and their Partners: Implications for Psychological Distress(Wiley, 2011) Bigatti, Silvia M.; Steiner, Jennifer L.; Makinabakan, Nermin; Hernandez, Ann Marie; Johnston, Erica; Storniolo, Anna MariaThe present study sought to identify couples’ cognitive appraisals of breast cancer and the extent to which matched or mismatched appraisals within a couple contribute to distress. Women with breast cancer (n = 57) and their partners completed the Cognitive Appraisals of Health Scale along with two self-report measures of distress, the Profile of Mood States and the Impact of Events Scale. Four groups were created based on their cognitive appraisals. Couples where both patient and partner scored highest on challenge or benign appraisals formed the positive outlook group (P+S+); when both scored highest on threat or harm/loss they formed the negative outlook group (P-S-). In the mismatched groups the patient had a positive outlook and their partner had a negative outlook (P+S-), or vice versa (P-S+). In general, lower distress was related to participants’ own positive outlook. Higher distress for patients was found in the matched group P-S-; for partners it was found in the mismatched group P+S-. These findings suggest partner effects for both patients and partners. When the patient had a negative outlook, a partner negative outlook was associated with the highest psychological distress. When the partner had a negative outlook, a patient positive outlook was associated with the highest psychological distress. There are several possible explanations for these findings, each with different implications for clinical practice. Future research with different groups of cancer patients and longitudinal, mixed methods designs may clarify their meaning.Item Cancer Screening in the United States and Europe(2012) Cronan, Terry A.; Santoro, Maya; Van Liew, Charles; Bigatti, Silvia M.Item Eficacia del programa de control y prevención deenfermedades crónicas "Pasos Adelante" en una comunidad enla frontera de EE. UU. y México, 2005-2008(Centers for Disease Control and Prevention, 2012) Staten, Lisa K.; Cutshaw, Christina A.; Davidson, Christopher; Reinschmidt, Kerstin; Stewart, Rosie; Roe, Denise J.Introducción "Pasos Adelante" es un programa de intervención sobre hábitos saludables facilitado por trabajadores de salud comunitaria o"promotores de salud" destinado a prevenir y controlar enfermedades crónicas en mexicoamericanos. Los estudios iniciales de"Pasos Adelante" mostraron mejoras significativas en la alimentación y la actividad física autorreportadas por los participantes.Este estudio evaluó si los habitantes de una comunidad en la frontera estadounidense que participaron en el programa mostraronmejorías en determinados valores fisiológicos y si los cambios se mantuvieron en el seguimiento a los 3 meses. Métodos El programa se llevó a cabo en sesiones de 12 semanas de enero del 2005 a mayo del 2008 e incluyó grupos de caminata y clases denutrición y actividad física. Se realizaron cuestionarios, mediciones antropométricas y pruebas de laboratorio al inicio delprograma (n = 305), al final (n = 254) y en el seguimiento a los 3 meses (n = 221). Resultados Al compararse los datos iniciales de referencia con los del final del programa, los participantes mostraron reducciones en su índicede masa corporal (P= .04), circunferencia de cintura y cadera (P< .001), presión arterial diastólica y sistólica (P< .001) y colesterol total (P= .008). Ningún valor empeoró significativamente entre la conclusión del programa y el seguimiento, aexcepción de la presión arterial sistólica. Los niveles de glucosa mejoraron entre la finalización y el seguimiento del programa (P=.01). Conclusión Estos resultados sustentan los hallazgos iniciales referidos a la mejoría autorreportada por los participantes en relación conpatrones de alimentación y actividad física al mostrar cambios en medidas objetivas. Este programa basado en la evidenciademuestra el potencial de los programas de control y prevención de enfermedades crónicas llevados a cabo por promotores desalud para mejorar la salud física abordando la prevención primaria y secundaria en organizaciones y comunidades hispanas.Item From Program to Policy: Expanding the Role of Community Coalitions(Centers for Disease Control and Prevention, 2007) Hill, Anne; De Zapien, Jill Guernsey; Staten, Lisa K.; McClelland, Deborah Jean; Garza, Rebecca; Moore-Monroy, Martha; Elenes, JoJean; Steinfelt, Victoria; Tittelbaugh, Ila; Whitmer, Evelyn; Meister, Joel S.Background Diabetes mortality at the United States–Mexico border is twice the national average. Type 2 diabetes mellitus is increasingly diagnosed among children and adolescents. Fragmented services and scarce resources further restrict access to health care. Increased awareness of the incidence of disease and poor health outcomes became a catalyst for creating community-based coalitions and partnerships with the University of Arizona that focused on diabetes. Context Five partnerships between the communities and the University of Arizona were formed to address these health issues. They began with health promotion as their goal and were challenged to add policy and environmental change to their objectives. Understanding the meaning of policy in the community context is the first step in the transition from program to policy. Policy participation brings different groups together, strengthening ties and building trust among community members and community organizations. Methods Data on progress and outcomes were collected from multiple sources. We used the Centers for Disease Control and Prevention’s Racial and Ethnic Approaches to Community Health (REACH) 2010 Community Change Model as the capacity-building and analytic framework for supporting and documenting the transition of coalitions from program to policy. Consequences Over 5 years, the coalitions made the transition, in varying degrees, from a programmatic focus to a policy planning and advocacy focus. The coalitions raised community awareness, built community capacity, encouraged a process of “change in change agents,” and advocated for community environmental and policy shifts to improve health behaviors. Interpretation The five coalitions made environmental and policy impacts by engaging in policy advocacy. These outcomes indicate the successful, if not consistently sustained, transition from program to policy. Whether and how these “changes in change agents” are transferable to the larger community over the long term remains to be seen.Item Depressive Symptoms and Health-Related Quality of Life Among Participants in the Pasos Adelante Chronic Disease Prevention and Control Program, Arizona, 2005-2008(Centers for Disease Control and Prevention, 2012) Cutshaw, Christina A.; Staten, Lisa K.; Reinschmidt, Kerstin M.; Davidson, Christopher; Roe, Denise J.Introduction Chronic diseases are the leading causes of death in the United States and have been associated with depressive symptoms and poor health-related quality of life (HRQOL). This study examined whether depressive symptoms and HRQOL indicators changed among participants in Pasos Adelante, a chronic disease prevention and control program implemented in a US–Mexico border community. Methods Pasos Adelante was a 12-week promotora-led program that included educational sessions and walking groups. We used the Centers for Epidemiologic Studies Depression Scale (CES-D) and the Center for Disease Control’s “Healthy Days” measures to measure depressive symptoms and HRQOL. We used linear mixed-effects models and general estimating equations to analyze changes in CES-D scores and HRQOL indicators from baseline to postprogram and from postprogram to 3-month follow-up. Results At baseline, participants had a mean of 7.1 physically unhealthy days, 7.4 mentally unhealthy days, and 3.9 days of activity limitation. The mean number of physically and mentally unhealthy days declined significantly from baseline to postprogram, but the mean number of activity limitation days did not. At baseline, 42.6% of participants reported their health as fair/poor; 20.8% of participants reported frequent mental distress, and 31.8% had a CES-D score of 16 or more. All 3 proportions declined from baseline to postprogram. No significant changes occurred between postprogram and follow-up. Conclusion Participants in Pasos Adelante showed improvement in depressive symptoms and several HRQOL indicators. Future studies should use an experimental design with a comparison group to determine whether these findings can be replicated and to examine potential mediators and moderators of program effects.Item Effectiveness of the Pasos Adelante Chronic Disease Prevention and Control Program in a US-Mexico Border Community, 2005-2008(Centers for Disease Control and Prevention, 2012) Staten, Lisa K.; Cutshaw, Christina A.; Davidson, Christopher; Reinschmidt, Kerstin; Stewart, Rosie; Roe, Denise J.Introduction Pasos Adelante is a lifestyle intervention program facilitated by community health workers (promotores) targeting chronic disease prevention and control in Mexican Americans. Initial studies of Pasos Adelante indicated significant improvements in self-reported nutrition and physical activity. This study examined whether Pasos Adelante participants living in a US border community showed improvements in selected physiological measures after participating in the program and whether changes were maintained at 3-month follow-up. Methods The program took place in 12-week sessions from January 2005 to May 2008 and included walking groups and education targeting nutrition and physical activity. Questionnaires, anthropometric measures, and laboratory tests were conducted at baseline (n = 305), conclusion of program (n = 254), and 3-month follow-up (n = 221). Results Participants demonstrated decreases in body mass index (P = .04), waist and hip circumference (P < .001), diastolic and systolic blood pressure (P < .001), and total cholesterol (P = .008) from baseline to program conclusion. No values worsened significantly between program conclusion and follow-up, except systolic blood pressure. Glucose levels improved between conclusion and follow-up (P = .01). Conclusion These results support the initial findings of improvements in participants’ self-reported physical activity and nutrition patterns through changes in objective measures. This evidence-based program demonstrates the potential for a promotores-facilitated chronic disease prevention and control program to improve physical health and targets both primary and secondary prevention in Hispanic communities and organizations.