Jeanne M. Tschann

Psychobiologic reactivity to stress and childhood respiratory illnesses: results of two prospective studies.

Psychological stress is thought to undermine host resistance to infection through neuroendocrine-mediated changes in immune competence. Associations between stress and infection have been modest in magnitude, however, suggesting individual variability in stress response. We therefore studied environmental stressors, psychobiologic reactivity to stress, and respiratory illness incidence in two studies of 236 preschool children. In Study 1, 137 3- to 5-year-old children from four childcare centers underwent a laboratory-based assessment of cardiovascular reactivity (changes in heart rate and mean arterial pressure) during a series of developmentally challenging tasks. Environmental stress was evaluated with two measures of stressors in the childcare setting. The incidence of respiratory illnesses was ascertained over 6 months using weekly respiratory tract examinations by a nurse. In Study 2, 99 5-year-old children were assessed for immune reactivity (changes in CD4+, CD8+, and CD19+ cell numbers, lymphocyte mitogenesis, and antibody response to pneumococcal vaccine) during the normative stressor of entering school. Blood for immune measures was sampled 1 week before and after kindergarten entry. Environmental stress was indexed with parent reports of family stressors, and a 12-week respiratory illness incidence was measured with biweekly, parent-completed symptom checklists. The two studies produced remarkably similar findings. Although environmental stress was not independently associated with respiratory illnesses in either study, the incidence of illness was related to an interaction between childcare stress and mean arterial pressure reactivity (beta =.35, p <.05) in Study 1 and to an interaction between stressful life events and CD19+ reactivity (beta =.51, p <.05) in Study 2. In both studies, reactive children sustained higher illness rates under high-stress conditions, but lower rates in low-stress conditions, compared with less reactive peers. Stress was associated with increased rates of illnesses, but only among psychobiologically reactive children. Less reactive children experienced no escalation in illness incidence under stressful conditions, suggesting that only a subset of individuals may be susceptible to the health-altering effects of stressors and adversity.

Children in foster care: factors influencing outpatient mental health service use.

OBJECTIVE To determine factors influencing outpatient mental health service use by children in foster care. METHOD Detailed survey and administrative data were collected on 480 children who entered long-term foster care in San Diego County from May 1990 through October 1991. These data were linked with claims data from Medicaid and San Diego County Mental Health Services information systems. A Poisson regression model was used to determine whether the following factors influenced outpatient mental health service use: age, race/ethnicity, gender, maltreatment history, placement pattern, and behavioral problems as measured by the Achenbach Child Behavior Checklist (CBCL). RESULTS Except for maltreatment history, all independent variables included in the multivariate regression model were statistically significant. The total number of outpatient mental health visits increased with age, male gender, and non-relative foster placements. Relative to Caucasians, visits were lower for Latinos, and Asian/Others, but comparable for African-Americans. Concerning maltreatment history, differences were only found in one category; children experiencing caretaker absence received fewer visits compared to children who did not experience caretaker absence. Children with CBCL Total Problem Scale T-scores of 60 or greater had significantly more visits than those with a score less than 60. CONCLUSIONS Both clinical and non-clinical factors influence outpatient mental health service use by foster children. Limitations imposed by gender, race/ethnicity, and placement setting need to be addressed by child welfare policies. These finding suggest that guidelines are needed to systematically link children in foster care with behavioral problems to appropriate services.

Initiation of substance use in early adolescence: the roles of pubertal timing and emotional distress.

Two hypotheses regarding the effects of pubertal timing on substance use were tested in a prospective study of 221 young adolescents. A maturational-deviance hypothesis predicted that early-maturing girls and late-maturing boys would experience heightened emotional distress, which in turn would influence initiation and use of substances. Alternatively, an early-maturation hypothesis predicted that early-maturing girls would engage in more substance use than all other groups, independent of emotional distress. Early-maturing adolescents reported more substance use within 1 year. Adolescents experiencing elevated levels of negative affect also reported greater substance use within the next year. However, pubertal timing was not related to emotional distress. Results support the early-maturation hypothesis for girls and suggest its extension to boys.

“The Ball Was Always In His Court”: An Exploratory Analysis Of Relationship Scripts, Sexual Scripts, And Condom Use Among African American Women

This qualitative study explored the association between African American womens interpersonal relationship and sexual scripts and condom use with primary partners. Participants were 14 lower to middle-income women between the ages of 22 and 39 involved in emotionally and sexually intimate heterosexual relationships. Relationship types included those that were: stable, emotionally committed; casual, primarily sexual; and unstable, emotionally imbalanced and/or conflict-ridden. Respondents completed a semi-structured interview and a questionnaire about their relationships, sexual, and condom use behaviors. Data analyses identified 3 interpersonal relationship scripts (i.e., men control relationships, women sustain relationships, infidelity is normative) and 2 interpersonal sexual scripts (i.e., men control sexual activity; women want to use condoms, but men control condom use) that may indirectly or directly decrease African American womens condom use with primary partners, and in turn increase their HIV risk. We discuss these interpersonal scripts within the context of sociocultural factors relevant to African American women, heterosexual relationships, and communities.

The role of behavioral experience in judging risks.

This study used conditional risk assessments to examine the role of behavioral experiences in risk judgments. Adolescents and young adults (ages 10-30; N = 577) were surveyed on their risk judgments for natural hazards and behavior-linked risks, including their personal experiences with these events. Results indicated that participants who had experienced a natural disaster or engaged in a particular risk behavior estimated their chance of experiencing a negative outcome resulting from that event or behavior as less likely than individuals without such experience. These findings challenge the notion that risk judgments motivate behavior and instead suggest that risk judgments may be reflective of behavioral experiences. The results have implications for health education and risk communication.

Food Insecurity and Glycemic Control Among Low-Income Patients With Type 2 Diabetes

OBJECTIVE To determine whether food insecurity—the inability to reliably afford safe and nutritious food—is associated with poor glycemic control and whether this association is mediated by difficulty following a healthy diet, diabetes self-efficacy, or emotional distress related to diabetes. RESEARCH DESIGN AND METHODS We used multivariable regression models to examine the association between food insecurity and poor glycemic control using a cross-sectional survey and chart review of 711 patients with diabetes in safety net health clinics. We then examined whether difficulty following a diabetic diet, self-efficacy, or emotional distress related to diabetes mediated the relationship between food insecurity and glycemic control. RESULTS The food insecurity prevalence in our sample was 46%. Food-insecure participants were significantly more likely than food-secure participants to have poor glycemic control, as defined by hemoglobin A1c ≥8.5% (42 vs. 33%; adjusted odds ratio 1.48 [95% CI 1.07–2.04]). Food-insecure participants were more likely to report difficulty affording a diabetic diet (64 vs. 49%, P < 0.001). They also reported lower diabetes-specific self-efficacy (P < 0.001) and higher emotional distress related to diabetes (P < 0.001). Difficulty following a healthy diet and emotional distress partially mediated the association between food insecurity and glycemic control. CONCLUSIONS Food insecurity is an independent risk factor for poor glycemic control in the safety net setting. This risk may be partially attributable to increased difficulty following a diabetes-appropriate diet and increased emotional distress regarding capacity for successful diabetes self-management. Screening patients with diabetes for food insecurity may be appropriate, particularly in the safety net setting.

Condom use in unmarried Latino men: A test of cultural constructs.

The effects of cultural factors on condom use were assessed in a random digit-dialing household survey of 1,600 unmarried Latino adults in 10 states with large Latino populations. Measures of traditional gender-role beliefs, sexual coercion, sexual comfort, and self-efficacy in using condoms were developed specifically for this population. A multisample structural equation model analysis included 594 men who reported one or more heterosexual partners in the 12 months before interview. As predicted, men with more traditional gender-role beliefs reported more sexual coercion and less sexual comfort. Men reporting more sexual coercion and less sexual comfort had lower condom self-efficacy. Men with more condom self-efficacy and stronger condom social norms reported more condom use.

Perceived Discrimination, Perceived Stress, and Mental and Physical Health Among Mexican-Origin Adults

This study provided a test of the minority status stress model by examining whether perceived discrimination would directly affect health outcomes even when perceived stress was taken into account among 215 Mexican-origin adults. Perceived discrimination predicted depression and poorer general health, and marginally predicted health symptoms, when perceived stress was taken into account. Perceived stress predicted depression and poorer general health while controlling for the effects of perceived discrimination. The influence of perceived discrimination on general health was greater for men than women, and the effect of perceived stress on depression was greater for women than men. Results provide evidence that discrimination is a source of chronic stress above and beyond perceived stress, and the accumulation of these two sources of stress is detrimental to mental and physical health. Findings suggest that mental health and health practitioners need to assess for the effects of discrimination as a stressor along with perceived stress.

Attitudes of Beginning Medical Students Toward Older Persons: A Five-Campus Study

OBJECTIVE: To examine the attitudes of beginning medical students toward older persons and their medical care.

Autonomy, relatedness, and the initiation of health risk behaviors in early adolescence.

This study examined the relationships among sociodemographic characteristics, family processes, and the initiation of health risk behaviors in early adolescence. Subjects were 189 6th and 7th graders from a public middle school. A path-analytic model was used to analyze data. Results showed that students who received autonomy support from parents were less likely to initiate sexual intercourse. Students who were emotionally detached from their parents were more likely to fight and use substances. Those who were emotionally detached tended to come from families with low levels of cohesion and acceptance. Sociodemographic variables, such as family structure, gender, and ethnicity, had both direct and indirect effects on health risk behaviors, but the indirect effects were quite small.