Marilyn Stern

Stress, Coping, and Family Environment The Adolescent's Response to Naturally Occurring Stressors

This study extended previous research by assessing the specific coping responses of adolescents as a function of age, type of stressor, and quality of family environment. The findings demonstrated that adolescents employ a range of coping strategies in response to stressors within and external to the family. These strategies varied as a function of age, type of stressor, and perceptions of the quality of the family environment. Specifically, among those who identified interpersonal conflicts as their primary stressor, younger adolescents were more likely to use emotion-based coping strategies than were older adolescents. Using emotion-based strategies, however, was associated with less adaptive family functioning. Further, these coping strategies were orderable on the dimension ofpreference. Thefindings underscored the importance of examining moderating factors and individual differences when studying coping responses to stressful situations.

Adjustment to Occupational Stress: The Relationship of Perceived Control to Effectiveness of Coping Strategies.

A sample of 187 medical center nurses described 2 stressful occupational episodes varying in perceived controllability and provided information regarding the coping strategies used. Outcome measures assessed effectiveness of coping across 3 dimensions : perceived coping effectiveness, job affect, and psychological adjustment. Negative affectivity was measured to control for its tendency to inflate stress-adjustment relationships. Use of problem-solving strategies was related to perceived coping effectiveness only for high-control episodes. However, differential use of coping across levels of controllability was not related to job affect or psychological adjustment. Avoidant coping was strongly associated with negative affect at work. In contrast, problem-reappraisal and problem-solving strategies were related to positive affect at work. Implications for theory and practice are discussed.

Working with Children Providing a Framework for the Roles of Counseling Psychologists

The general purpose of this article is to provide a review of potential roles that counseling psychologists can assume in meeting the needs of children. Conceptualized within the method of intervention dimension, roles will be examined relative to different childhood stressors whose impact is influenced by a childs developmental stage. Examples are provided to illustrate the function of various roles in different contexts. Special attention is given to the topic of divorce, a prevalent stressor that often has a significant intra- and interpersonal impact on the children it affects.

Adolescents with Cancer: Self-Image and Perceived Social Support as Indexes of Adaptation

This study compared 48 adolescents with cancer and a contrast group of 40 healthy adolescents on two indexes of adjustment, self-image, and perceived social support. Overal4 the findings suggested that adolescents with cancer were relatively well-adjusted, although they exhibited, in comparison to healthy adolescents, a less positive self-image in terms of their social and sexual self Several differences were found when the relationship between stressors appraised as most difficult to deal with and perceived social support was examined. Adolescents with cancer dealing with stressors related to family and interpersonal relationships perceived relatively higher levels of social support than did healthy adolescents. In contrast, healthy adolescents perceived greater levels of social support than did adolescents with cancer when stressors related to external demands were identified as most difficult to manage. These results support the importance of considering the relationship between situations appraised as stressful and the process of adjustment to cancer for adolescents.

Prevalence of the metabolic syndrome among obese adolescents enrolled in a multidisciplinary weight management program: clinical correlates and response to treatment.

OBJECTIVE The aim of this study was to determine the prevalence of the metabolic syndrome at baseline and after 6 months of lifestyle modification among obese adolescents referred to a multidisciplinary weight management program. METHODS A total of 165 obese adolescents were evaluated at baseline, and measurements were repeated in 57 subjects who completed 6 months of the program. Metabolic syndrome was defined as having three or more of the following: a body mass index (BMI) >97(th) percentile, hypertension, low high-density lipoprotein cholesterol (HDL-C), hypertriglyceridemia, and impaired fasting glucose (IFG). RESULTS The prevalence of a BMI >97(th) percentile, hypertension, hypertriglyceridemia, low HDL-C, and IFG was 92.7, 54.5, 29.1, 26.7, and 2.4%, respectively. The prevalence of the metabolic syndrome at baseline was 30.3%. After 6 months of lifestyle modification, BMI z scores, percent body fat, total cholesterol, and low-density lipoprotein cholesterol (LDL-C) decreased significantly from baseline; however, there was no significant change in the number of subjects demonstrating >or=three criteria of the metabolic syndrome. CONCLUSIONS Approximately one third of the study subjects met the criteria of the metabolic syndrome, emphasizing the growing concern for the future development of premature cardiovascular disease in this high-risk population. Our data suggest that new strategies for lifestyle modification may be needed to improve cardiovascular risk factors significantly among adolescents with obesity.

Psychosocial factors and perspectives on weight gain and barriers to weight loss among adolescents enrolled in obesity treatment.

The aim of the current descriptive study was to explore factors related to psychosocial wellbeing, weight gain and perceived barriers to exercise and nutrition in 135 obese adolescents enrolled in a multidisciplinary weight management program. Participants completed initial intake interviews, which included information about psychosocial well-being, factors associated with weight gain, and barriers to exercise and nutrition. We examined the associations among psychosocial factors and participants’ attendance compliance for the nutrition, exercise, and behavioral support and modification components of the program. Results indicated that familial factors were associated with weight gain, and family, peer, and individual factors were associated with barriers to healthy eating and exercise. Among the psychosocial factors, history of trauma was negatively associated with compliance. Findings emphasize the importance of addressing psychosocial well-being and using a systems approach to weight management for obese adolescents.

Evaluation of a 6-month multi-disciplinary healthy weight management program targeting urban, overweight adolescents: Effects on physical fitness, physical activity, and blood lipid profiles

This study evaluated preliminary physical fitness, physical activity, and blood lipid profile data obtained from overweight adolescents upon enrolling in a healthy weight management program and following 6 months of program participation. One hundred and sixty-eight participants (13.4+/-1.8 years, 37.9+/-8.3 kg/m(2), 59.5% female and 76.2% African-American) enrolled in the program. The intervention addressed factors related to nutrition, physical activity, and other behaviors related to weight management. Sixty-four participants (38.1%) completed 6 months of program participation. While there was no significant reduction in body mass or body mass index (BMI), BMI z-score was reduced by 1.2% (p < 0.05), cardiorespiratory fitness was increased by 10.8% (p = 0.001), body fat percentage was reduced by 2.6% (p = 0.001), total cholesterol was reduced by 7.2% (p < 0.001), and low density lipoprotein (LDL-C) was reduced by 8.4% (p < 0.001) at 6 months. Continued development and evaluation of programs designed to prevent and treat child and adolescent overweight is warranted to address this major public health issue.

Medical students' differential use of coping strategies as a function of stressor type, year of training, and gender

The cognitive-transactional model of stress was used to study the process by which medical students cope with stress. The study examined the coping responses employed by male and female first- and fourth-year medical students as a function of those situations they appraised as most stressful. Multivariate analyses of variance (MANOVAs) revealed that preferred coping strategies varied by stressor type and year of training. In dealing with medical-school-related stressors, first-year students used self-blame and problem-solving styles of coping more than did fourth-year students. When dealing with interpersonal stressors, however, fourth-year students tended to use confrontive coping more than did first-year students. Surprisingly, whether the student was a man or a woman had no impact on coping responses. The findings underscored the importance of the moderating impact of the appraisal process on the coping strategies employed to manage stressful situations. Implications for medical education, as well as for future research on coping with stress, are discussed.

Six-Month Dietary Changes in Ethnically Diverse, Obese Adolescents Participating in a Multidisciplinary Weight Management Program

This study’s objective was to examine dietary and metabolic changes in obese adolescents who completed 6 months of participation in an outpatient multidisciplinary weight management program (N = 67). Participants (75% African American, 66% female, mean age = 13.7 years) completed 24-hour dietary recalls and underwent measurement of anthropometrics and fasting blood lipid parameters at baseline and after 6 months of participation. General linear models suggested that participants significantly reduced total energy, total fat, saturated fat, carbohydrate, sodium, and sugar intakes, and increased fiber and fruit and vegetable intake (P < .05). Gender-stratified models showed differences in fruit/vegetable intake, percentage calories from fat, sodium, and dietary cholesterol intakes by gender. Significant improvements in body mass index percentile and lipid profiles were also found, lending objective support to the dietary changes participants made. Findings suggest that participation in this multidisciplinary treatment helped participants make behaviorally based dietary changes, which were associated with improved dietary intakes and health status.

Caring for the Caregivers: An Investigation of Factors Related to Well-Being Among Parents Caring for a Child with Smith-Magenis Syndrome

Smith-Magenis syndrome (SMS) is a complex disorder characterized by numerous challenges, including intellectual disability, speech delay, decreased pain sensitivity, sleep disturbances, hyperactivity, mood instability, and self-injury. Caregivers must readily adapt to the ever-changing needs of the child. Due to these demands, caregivers may encounter difficulties maintaining their own level of well-being. Thus, a total of 112 primary caregivers (i.e., parents) of individuals diagnosed with SMS responded to online questionnaires to assess demographic and psychosocial factors, such as perceptions of child health vulnerability, benefit finding, sleep behaviors, anxiety and depression symptomatology, and caregiver satisfaction and self-efficacy, which may be related to caregiver well-being. Results show that, among mothers, caregiver well-being was directly related to perceived child health vulnerability, caregiver satisfaction, and benefit finding, and a significant moderating effect was observed for depression/anxiety counseling after beginning the caregiver role on the relationship between anxiety symptomatology and caregiver well-being. Results further suggest that maternal caregivers who report high levels of anxiety but do not seek counseling fair the worst in terms of well-being. Among fathers, lower depression symptoms and greater benefit finding were related to higher levels of caregiver well-being. These data show that many factors play roles in influencing coping and well-being among SMS caregivers. Investigating these variables and relationships may reveal additional resources and interventions to assist primary caregivers.