Joan M. Patterson

Family stress, coping, and social support

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Associations of smoking prevalence with individual and area level social cohesion

Study objective: To discover if area level social cohesion, neighbourhood safety, and home safety are associated with current cigarette smoking among adults after adjustment for concentrations of poverty and low education. Design: Cross sectional survey of a random sample of adults, stratified by 19 geographical areas. Setting: SHAPE, Survey of the Health of Adults, the Population, and the Environment—conducted in 1998 by the Hennepin County Community Health Department and the Minneapolis Department of Health and Family Support in Minnesota. Participants: 5256 men and 4806 women, 18 years and older, randomly selected from 19 geographical areas in an urban county. Main results: Overall, 21.2% of survey respondents reported current cigarette smoking. Both higher area level social cohesion (OR = 0.85, 95% CI = 0.74 to 0.98) and higher individual social cohesion (OR = 0.96, 95% CI = 0.92 to 0.99) were associated with lower likelihoods of smoking. Similar models were obtained for neighbourhood safety and home safety. Conclusions: These findings contribute to the growing literature on the important role of social cohesion and other area level characteristics on smoking behaviour among adults.

The impact of family functioning on health changes in children with cystic fibrosis

Family stress, family and personal resources, and parental coping were operationalized from self-report questionnaires completed by mothers and fathers in 72 two-parent families who had a child with cystic fibrosis (CF). Three-month and 15-month changes in clinically recorded measures of the CF childs height and weight data and pulmonary functioning were correlated with the family functioning variables. Each of the four criterion indices of CF child health changes were regressed separately on the significant family functioning variables. Twenty-two percent of the variance in 15-month height and weight changes were explained by family stress, family resources, and parental coping. Family functioning variables also explained 17% of the variance in 3-month pulmonary functioning changes and 15% of the variance in 3-month height and weight changes. These findings suggest that the way in which the family functions has indirect effects on critical indices of a CF childs health. These data lend support to an increased focus by physicians and other medical professionals on the health of the total family system as a way to enhance outcomes for children with CF.

Parental Involvement and Family-Centered Care in the Diagnostic and Treatment Phases of Childhood Cancer: Results from a Qualitative Study:

Few research studies have addressed the ways parents participate in their childs medical care, particularly in relation to the cancer experience. The purpose of this study was to explore parents descriptions of their participation in medical care for their children with cancer. For this study, seven focus groups were conducted with 45 parents of 26 children who had completed cancer treatment at least one year prior, and who were still alive. Data were coded using thematic analysis procedures. It was found that parents emphasized their role as advocates during the diagnosis and treatment phases, by informing themselves about their childrens medical conditions, making medical care decisions, limiting the actions of medical professionals, and affirming and supporting medical professionals. These results emphasize the need to employ a family-centered approach in cancer care medical settings, by fostering and supporting the active inclusion of parents in their child’s treatment and management.

Home care for medically fragile children: impact on family health and well-being.

The health status of 48 families providing home care for their medically fragile children was studied. Mothers, as the primary caregivers, experienced a greater decline in their physical health than did fathers or siblings. When the financial burden of providing care was greater and when the relationship with care providers was more strained, families had more physical illness symptoms. Who provided home care services for the medically fragile child influenced the psychosocial impact on the family. Care provided by home health aides was associated with greater negative impact, whereas care from professional nurses reduced the negative impact. The trend toward home care for medically fragile children has been accelerating; this study points to the importance of studying the impact on the family of this kind of care. Policy implications regarding the amount and quality of services and payment for them are discussed.

The Impact of Family Life Events and Changes on the Health of a Chronically Ill Child.

This investigation examined the relationship between a pile-up of family life events (family stress) and changes in the health status of a child member with cystic fibrosis. The data collected from 100 parents and from clinic records of their childrens height, weight, and pulmonary functioning revealed that a decline in pulmonary functioning was associated with a pile-up of family life changes, especially in the areas of (a) family development and relationships, (b) family management and decisions, and (c) family finances. These findings are discussed in terms of the Double ABCX family stress framework. This investigation involved an integration of individual psychological stress research and family stress theory by advancing the Family Inventory of Life Events and Changes (FILE) as a tool to systematically assess cumulative family life changes.

Critical Factors Affecting Family Compliance with Home Treatment for Children with Cystic Fibrosis

The author of this investigation focused on 72 two-parent families who had one or more children with cystic fibrosis living at home to determine what critical family factors are associated with the familys ability to comply with prescribed home treatment. Using the FAAR Model to conceptualize and operationalize the critical variables of demands, resources, family definition, and coping, it was possible to explain 51% of the observed variability in family compliance. These findings indicate the value of focusing on psychosocial family factors in the delivery of health care services and point to the need for further empirical studies for validation of the important role the family has in the health of its members.

Uncertainty in Childhood Chronic Conditions and Family Distress in Families of Young Children

The objective of this study was to identify the relationship between the degree of uncertainty in the child’s chronic condition and family distress. Data were collected from parents (173 mothers, 150 fathers) of young children (12 to 30 months old) who had been diagnosed with a chronic physical health impairment within the past 12 months. Children were divided into separate groups, first based on the predictability of their symptoms and next based on the degree of certainty in their life expectancy. Using analysis of covariance, sex-stratified comparisons were made between the predictability groups and then between the life expectancy groups and five subscales of the Impact-on-Family Scale. Parents of young children with chronic conditions with intermittently unpredictable symptoms reported significantly more family distress than parents of children with more predictable symptoms. No significant differences were found for mothers or fathers between the degree of uncertainty in the child’s life expectancy and family distress.

Promoting Resilience in Families Experiencing Stress

All families experience many different life events, strains, and hassles over their life spans. Stress emerges in the family when demands exceed capabilities. When this imbalance persists and becomes larger, children and other family members often show signs and symptoms of distress, including health-related problems. Pediatricians are increasingly called on to evaluate this situation and to be helpful to stressed families and their children. A family assessment model is presented to aid pediatricians in helping families to identify the sources and degree of stress they are experiencing, and even more importantly, to facilitate their ability to discover and use their own strengths and resources. The goal for the pediatrician is to promote balance and resilience in families, which, in turn, will contribute to better health and functioning in children.

Gender Roles and Coping.

This investigation examined the relationship of gender-role orientation as a psychological resource and specific behavioral coping responses as mitigators of distress for wives experiencing a long-term separation from their military spouses. Although an androgynous gender-role orientation was not directly associated with nondistress, it appeared to mitigate distress indirectly by influencing the coping patterns (family integrity, social support, managing tension and acceptance of lifestyle) wives used to manage the hardships of separation. Those wives experiencing the least distress coped by (a) accepting the lifestyle and being optimistic and (b) by developing self-reliance and esteem. Most importantly, nondistressed wives used a balanced coping strategy which reflected above-average use of all the coping patterns identified, in an effort to attend simultaneously to the family system needs of integration and stability and the personal growth and emotional needs of individual members. The findings from this investigation were discussed in terms of family stress theory, particularly the Double ABCX stress framework (McCubbin and Patterson, 1983a, 1983b) which has been advanced to describe postcrisis adaptation.