Barbara Curbow

The prevalence of psychological distress by cancer site

The goal of this project was to determine the prevalence of psychological distress among a large sample of cancer patients (n=4496). In addition, variations in distress among 14 cancer diagnoses were examined.

Personal changes, dispositional optimism, and psychological adjustment to bone marrow transplantation.

We investigated the number and direction of personal changes experienced by long-term survivors of bone marrow transplantation (BMT) and the relationships of those changes and dispositional optimism to psychological adjustment (current and future life satisfaction and mood). Surveys were returned by 86.0% (N=135) of all eligible long-term survivors; respondents primarily were young males who were 6 to 149 months post-BMT. Subjects reported more positive changes in the relationship and existential/psychological domains and more negative changes in the physical health domain; there was no difference on the plans/activities domain. Negative changes were more strongly related to adjustment than were positive changes. The number of negative changes reported was significantly related to current and future life satisfaction and negative mood after controlling for demographic and illness variables and dispositional optimism. The interaction term for negative and positive changes was significantly related to future life satisfaction after controlling for all other variables.

Harm Perception of Nicotine Products in College Freshmen

This study examined the association of sociodemographic characteristics and smoking behaviors (i.e., cigarette, cigar, and waterpipe) with nicotine product harm perception in college freshmen. Students were asked to compare the perceived harmfulness of 11 nicotine-delivering products with that of a regular cigarette. Data were from a cross-sectional Internet survey conducted during the spring 2004 semester at a private university (N = 411). Binomial logistic regression was used to determine the association between sociodemographic and behavioral factors with nicotine product harm perception. A statistically significant association was found between nicotine product harm perception and sex, race, income, citizenship, and smoking behavior (p< or =.05). Regarding the three medicinal nicotine replacement therapies, 19.6% of respondents incorrectly perceived the nicotine patch to be as harmful as or more harmful than a regular cigarette; corresponding values were 24.1% for nicotine gum and 52.9% for nicotine inhaler. Respondents incorrectly perceived the following smoked tobacco products to be less harmful than regular cigarettes: ultra-light cigarettes (40.4%), waterpipe (37%), light cigarettes (35.2%), cigarillos (17.4%), and cigars (16.9%). Regarding smokeless nicotine products, 89.3% of respondents incorrectly perceived dip and chew to be as harmful as or more harmful than regular cigarettes; corresponding values were 36.2% for nicotine lollipops and 35.2% for nicotine water. Our findings reveal misperceptions about nicotine product harmfulness and underscore the importance of developing a science base to inform policies and educate consumers about these products.

Health, Functional Status, and Employment of Adult Survivors of Bone Marrow Transplantation

OBJECTIVE To determine the health, functional ability, and employment status of adults who survive bone marrow transplantation. DESIGN Inception cohort study. SETTING Patients who received transplants at a single referral-based center. PATIENTS Adults of 18 years of age or older who had received bone marrow transplants at least 6 months previously and who were not in a life-threatening relapse were surveyed a mean of 47 months after transplant (median, 37 months; range, 6 to 149 months). Of 171 eligible patients, 157 were contacted and 135 (86%) responded. MEASUREMENTS AND MAIN RESULTS Patients completed a mailed survey. Medical records were also reviewed. Most patients (93%) reported they could do normal activities with minor or no physical problems (Karnofsky scores, greater than or equal to 80%). Global health was described as good to excellent by 67% of subjects. Most perceived social activities (80%) or physical functional abilities (67%) to be unimpaired or only slightly affected. Moderate or severe pain was uncommon (13%). Sixty-five percent had returned to full- or part-time employment, and one third of those who were not employed were attending school. Job discrimination and problems in obtaining insurance were reported by 23% and 39%, respectively. Among those who had been employed before illness, loss of employment was associated with lower social functioning, chronic graft-versus-host disease, greater job discrimination, and female gender using multivariate logistic regression. CONCLUSIONS Most subjects surviving bone marrow transplant reported good to excellent health and functional ability. Three fourths were employed or enrolled in school. These outcomes are comparable to outcomes in survivors of cancer who received less intensive treatments.

Development of the Child Care Worker Job Stress Inventory.

Abstract After a series of instrument development studies, a mail survey was conducted with 196 randomly selected family day care providers (FDCPs) and child care center workers (CCCWs) residing in the state of Maryland (response rates were 76.6% and 70.5%, respectively). Embedded in the instrument were three job stress scales, specific to child care workers, measuring job demands, job control, and job resources. Extensive psychometric testing of the three 17-item instruments demonstrated several areas of strength. The job demands scale, because of its breadth of stressors covered, fared slightly worse on indicators of reliability (alpha = 0.77; mean interitem correlation [MIC] = 0.17; item-to-total correlations [ITCs] = 0.14 to 0.49) than did job control (alpha = 0.88; MIC = 0.31; ITCs = 0.26 to 0.69) and job resources (alpha = 0.89; MIC = 0.35; ITCs = 0.32 to 0.70). Known groups validity was demonstrated through a conceptually meaningful pattern of differences between FDCPs and CCCWs. Construct validity for all three scales was demonstrated by a pattern of stronger correlations with conceptually similar versus dissimilar instruments. Average correlations with similar versus dissimilar instruments were: job demands, 0.54 versus 0.24; job control, 0.74 versus 0.30; and job resources, −0.53 versus 0.30. Similar to the reliability analysis, results of factor analysis were stronger for job control and job resources than for job demands.

Role retention and quality of life of bone marrow transplant survivors.

Bone marrow transplantation (BMT) offers the potential for survival of 50% or more for selected patients with malignant disease not controlled by other means. However, BMT introduces risks for psychological, social, and physical impairment and the potential for significant loss in ones ability to retain important role relationships. While there has been a sharp increase in the performance of BMTs in the past decade, there has been little research on its effects on long-term survivors. This paper presents the results of a follow-up survey of 135 survivors of BMT at the Johns Hopkins Oncology center. The ability of the survivors to maintain valued social roles is examined as this affects perceived quality of life. The main hypothesis of the paper, that role retention is significantly related to higher quality of life, is supported by significant correlations of role retention with quality of life as measured by the Satisfaction with Life Domains Scale, current and future life satisfaction on Cantril Self-Anchoring Ladders, and by the Bradburn Positive Affect Scale. While the Bradburn Negative Affect Scale was not significantly related to role retention, total negative mood as measured by the Profile of Mood States was inversely related to role retention at a statistically significant level.

Multiple Chemical Sensitivities Syndrome: Toward a Working Case Definition

A study was conducted to identify clinical diagnostic criteria that experts regarded as major for categorizing patients as having multiple chemical sensitivities (MCS) syndrome. A cross-sectional survey of 148 medical practitioners with an interest in, or familiarity with, the condition was performed scoreable questionnaires were returned by 60.1% of those surveyed. The following five criteria, all based on self-reports, were selected as major for diagnosing the syndrome by more than 50% of the respondents: (1) symptoms are reproducible with exposure; (2) condition is chronic; (3) low levels of exposure result in manifestations of the syndrome; (4) symptoms resolve with removal of incitants; and (5) responses occur to multiple, chemically unrelated substances. It is proposed that the major criteria accepted by the majority of survey respondents be used provisionally as the basis for categorizing cases in investigations of MCS syndrome.

Water Pipe Tobacco Smoking Among Middle and High School Students

OBJECTIVES We examined prevalence rates of water pipe tobacco smoking among young people as a first step in assessing the health implications of this form of tobacco use. METHODS We examined water pipe use with data from the 2007 Florida Youth Tobacco Survey, which assessed tobacco-related beliefs, attitudes, and behaviors among the states middle and high school students. RESULTS Four percent of middle school students and 11% of high school students reported ever having used a water pipe. Adolescent boys were significantly more likely than adolescent girls to use water pipes, and African American adolescents were significantly less likely than adolescents from other racial/ethnic backgrounds to do so. Those who indicated ever having tried cigarettes and those who reported positive attitudes toward the social nature of cigarette use were more likely to have tried water pipes. CONCLUSIONS Water pipe use appears to be widespread among middle and high school students. Further research is needed to assess the health risks associated with water pipe tobacco smoking as well as young peoples attitudes toward this form of tobacco use.

Sociocultural and developmental influences on body dissatisfaction and disordered eating attitudes and behaviors of Asian women.

This study is an examination of the influence of sociocultural and developmental factors on body dissatisfaction and disordered eating attitudes and behaviors in two Asian populations: 298 Taiwanese-American (TA) women undergoing acculturating changes and 347 Taiwanese (T) women undergoing modernizing changes. Contrary to the initial hypothesis, body dissatisfaction rates and disordered eating attitudes and behaviors were found to be significantly higher in the T group. Subjects in the T group had higher Taiwanese ethnic identity scores but also lower perceptions of maternal control. Body dissatisfaction was found to be a moderating variable between ethnic identity and disordered eating attitudes and behaviors for the TA group only. The “girl next door” hypothesis, based on the social comparison theory, was set forth to help explain why this result was found only in the TA group. In the T group, ethnic identity and body dissatisfaction were independently associated with disordered eating. Results failed to support a link between parental control and the development of an eating disorder, and implications from a cross-cultural perspective are addressed.

Self-concept and cancer in adults: Theoretical and methodological issues

Research and theory development on the self-concept have increased dramatically over the last decade. Investigators of the psychosocial aspects of cancer have utilized the self-concept as both an independent and dependent variable. This article discusses quantitative adult studies from the self-concept and cancer literature in terms of their correspondence with current conceptualizations of the self-concept in psychology. The wide gap between recent empirical work and self-concept theorizing is discussed and strategies for future investigations of the self-concept/cancer relationship are outlined.