Catherine Zimmer

Clinical Trials and Medical Care: Defining the Therapeutic Misconception

A key component of informed consent to participate in medical research includes understanding that research is not the same as treatment.

Development and validation of the Infant Feeding Style Questionnaire

This study describes and validates the Infant Feeding Style Questionnaire (IFSQ), a self-report instrument designed to measure feeding beliefs and behaviors among mothers of infants and young children. Categorical confirmatory factor analysis was used to estimate latent factors for five feeding styles, laissez-faire, restrictive, pressuring, responsive and indulgent, and to validate that items hypothesized a priori as measures of each style yielded well-fitting models. Models were tested and iteratively modified to determine the best fitting model for each of 13 feeding style sub-constructs, using a sample of 154 low-income African-American mothers of infants aged 3-20 months in North Carolina. With minor changes, models were confirmed in an independent sample of 150 African-American first-time mothers, yielding a final instrument with 39 questions on maternal beliefs, 24 questions on behaviors and an additional 20 behavioral items pertaining to solid feeding for infants over 6 months of age. Internal reliability measures for the sub-constructs ranged from 0.75 to 0.95. Several sub-constructs, responsive to satiety cues, pressuring with cereal, indulgent pampering and indulgent soothing, were inversely related to infant weight-for-length z-score, providing initial support for the validity of this instrument for assessing maternal feeding beliefs and behaviors that may influence infant weight outcomes.

Occupational Stress, Social Support, and the Buffer Hypothesis

The relationship between occupational stress, social support, and strain was investigated in a series of influential studies in the late 1970s and early 1980s. This continues to provide the most consistent support for the buffer hypothesis in the stress-strain literature. The authors argue that this support is more tenuous than it appears because these studies have theoretical and methodological limitations. When they are corrected, there is, at best, weak support for the buffer hypothesis in this as in other role domains. However, promising developments in the stress-strain model in other role domains can be incorporated into the occupational context.

Discrimination, distrust, and racial/ethnic disparities in antiretroviral therapy adherence among a national sample of HIV-infected patients.

Objective:Although discriminatory health care experiences and health care provider distrust have been shown to be associated with health care disparities, little is known about their contribution to racial/ethnic disparities in antiretroviral therapy adherence. We therefore sought to assess the extent to which discriminatory health care experiences and health care provider distrust influence treatment-related attitudes, beliefs, and self-reported adherence in a national sample of HIV-infected patients. Study Design:This secondary analysis used data from the HIV Cost and Services Utilization Study. We used structural equation modeling to identify pathways from minority status to adherence through discrimination, distrust, and treatment-related attitudes and beliefs. Participants:The sample was the 1886 participants who completed the baseline and 2 follow-up interviews and were prescribed antiretroviral therapy at the second follow-up interview (54% white, 28% black, 14% Hispanic, and 3% others). Results:Minorities were less likely to report perfect adherence than whites (40% vs. 50%, P ≤ 0.001). Over one third (40%) of all participants reporting ever having discriminatory health care experiences since having HIV, and 24% did not completely or almost completely trust their health care providers. The effect of minority status on adherence persisted in the full model. More discrimination predicted greater distrust, weaker treatment benefit beliefs, and, in turn, poorer adherence. Distrust affected adherence by increasing treatment-related psychological distress and weakening treatment benefit beliefs. Conclusions:The relationship between minority status and adherence was not fully explained by patient-level factors. Future studies should consider conceptualizing minority status as a contextual factor rather than predictor.

Studying Race or Ethnic and Sex Segregation at the Establishment Level Methodological Issues and Substantive Opportunities Using EEO-1 Reports

Scholars of employment segregation now recognize that gender, race, and class processes are mutually constitutive. Coupled with new data-collection strategies, understanding of the organization of work and distribution of inequality will improve. The authors explore the strengths and weaknesses of longitudinal establishment data collected by the Equal Employment Opportunity Commission (EEOC), comparing these to other data used to study workplace status processes. Findings both confirm and dispute well-known occupation-based analyses of workplace segregation and lead to similar substantive conclusions. EEOC data are useful for discovering trends in segregation, for locating segregation in spatial, temporal, and industrial contexts, and for combining with organizational data to uncover mechanisms.

Stewardship Practices of U.S. Biobanks

Most U.S. biobanks do not create ongoing relationships with contributors but do practice stewardship over storing and sharing of specimens. Biobanks require new governance models that address their ethical and regulatory challenges. One model relies on stewardship of specimens throughout their life course. Here, we discuss findings from our survey of 456 U.S. biobank managers that addressed whether and how biobanks steward their specimens. The findings reveal that most biobanks do not create ongoing relationships with contributors but do practice stewardship over storing and sharing of specimens. Biobanks now need guidance to fully articulate stewardship practices that ensure respect for contributors while facilitating research.

Patient-health care provider communication among patients with newly diagnosed prostate cancer: findings from a population-based survey.

OBJECTIVE To examine the multidimensional concept of patient-health care provider (HCP) communication, its effects on patient satisfaction with oncology care services, and related racial differences. METHODS The current analysis draws from a population-based survey sample of 1011 African American and 1034 Caucasian American men with newly diagnosed prostate cancer. The variables of satisfaction with health care services, interpersonal treatment, contextual knowledge of the patient, and prostate cancer communication were analyzed using multiple-group structural equation modeling. RESULTS Regardless of race, patient-HCP communication was related positively to interpersonal treatment by the HCP, HCPs contextual knowledge of the patient, and prostate cancer communication. More positive patient-HCP communication was related to more satisfaction with health care services. Racial differences were significant in the relationships between patient-HCP communication and prostate cancer communication. CONCLUSION Content and interpersonal relationships are important aspects of patient-HCP communication and affect patient satisfaction with oncologic care for prostate cancer. PRACTICE IMPLICATIONS HCPs need to integrate the transfer of information with emotional support and interpersonal connection when they communicate with men with newly diagnosed prostate cancer.

An Exploratory Model of the Relationships Between Cancer-Related Trauma Outcomes on Quality of Life in Non-Hodgkin Lymphoma Survivors

Given that more than one third of some cohorts of cancer survivors exhibit post-traumatic stress disorder (PTSD) symptomatology, this study examines how trauma outcomes might relate to quality of life (QOL). Eight hundred thirty survivors of adult lymphoma were assessed for PTSD, post-traumatic growth (PTG) and QOL. Structural equation modeling revealed that QOL was best explained by the model in which stressors (e.g., co-morbidities) were mediated by PTSD and PTG. Trauma outcomes mediated the relationship between specific stressors and QOL. These findings support using PTSD and PTG as a diagnostic framework in understanding symptomatology in survivors.

The role of helplessness, outcome expectation for exercise and literacy in predicting disability and symptoms in older adults with arthritis

OBJECTIVE To examine the effect of outcome expectation for exercise (OEE), helplessness, and literacy on arthritis outcomes in 2 community-based lifestyle randomized controlled trials (RCTs) conducted in urban and rural communities with older adults with arthritis. METHODS Data from 391 participants in 2 RCTs were combined to examine associations of 2 psychosocial variables: helplessness and OEE, and literacy with arthritis outcomes. Arthritis outcomes namely, the Health Assessment Questionnaire-Disability Index (HAQ-DI) and arthritis symptoms pain, fatigue and stiffness Visual Analogue Scales (VAS), were measured at baseline and at the end of the interventions. Complete baseline and post-intervention data were analyzed using STATA version 9. RESULTS Disability after intervention was not predicted by helplessness, literacy, or OEE in the adjusted model. Arthritis symptoms after the intervention were all significantly predicted by helplessness at various magnitudes in adjusted models, but OEE and literacy were not significant predictors. CONCLUSION When literacy, helplessness, and OEE were examined as predictors of arthritis outcomes in intervention trials, they did not predict disability. However, helplessness predicted symptoms of pain, fatigue, and stiffness, but literacy did not predict symptoms. PRACTICE IMPLICATIONS Future sustainable interventions may include self-management components that address decreasing helplessness to improve arthritis outcomes.

Whose Stress is Making Me Sick? Network-stress and Emotional Distress in African-American Women

Research on stress-related health outcomes in African-American women often neglects “network-stress”: stress related to events that occur to family, friends, or loved ones. Data from the African-American Womens Well-Being Study were analyzed to examine self-stress and network-stress for occurrence, perceived stressfulness, and association with symptoms of psychological distress. Women reported a higher number of network-stress events compared with self-stress events. Occurrences of network-stress were perceived as undesirable and bothersome as self-stress. Both types of stress were significantly associated with psychological distress symptoms. Including network-stress may provide a more complete picture of the stress experiences of African-American women.