Browsing by Subject "Coping"

Utilizing data from The National Longitudinal Study of Adolescent Health (Add Health), the current study examined the relationship between cultural values, coping behavior, and HIV risk behaviors among African-American/Black and Hispanic/Latino adolescents (N = 437). The goal of this research was to provide the first step towards testing the construct validity of a theoretical model in which values and cultural context contribute to coping behaviors and coping, in turn, mediates the association between values and HIV risk profile. African-American participants endorsed higher levels of Africentric and religious values than did Hispanic participants and endorsed higher utilization of religious coping. Cultural values including familismo and religiosity were associated with more adaptive coping behavior and lower sexual and substance use risk behaviors across racial/ethnic groups. Results for other cultural values were inconsistent. Coping behavior predicted substance use risk behaviors but was not associated with sexual risk behaviors. Mediation was not supported except in the case of religious coping and religiosity. Implications for HIV prevention and directions for future research are discussed.

Problem and Purpose: Adolescents and young adults (AYAs) with cancer are a population with unique age-specific characteristics and often neglected therapeutic needs. Specifically, Korean AYAs with cancer reported greater level of stress that comes from unique cultural and societal characteristics, but there is a lack of support systems to help their healthy adjustment to the cancer diagnosis. Family communication allows family members to share thoughts and feelings openly and clearly with one another, particularly regarding stressful situations. Studies have shown the importance of family support and communication for maintaining psychological well-being in pediatric patients with cancer, yet despite its pivotal role, little attention has been paid to the parent-adolescent communication in the childhood cancer context. We conducted an integrative literature review on facilitators and barriers to parent-child communication in the childhood cancer context and found that most children, AYAs and their parents were struggling to engage in family communication because of their fear related to expected negative outcomes by sharing sensitive topics, such as emotional harms to each other. In addition, they were rarely aware of the potential benefits from engaging in family communication. However, we also found that there was a lack of research on parent-adolescent communication in the Korean childhood cancer context. This gap in the literature makes us to conduct these dissertation studies with aims of: (1) understanding the Korean parent-adolescent communication experiences in the childhood cancer context, and (2) exploring the potential benefits from engaging in parent-adolescent communication in the Korean childhood cancer context.

Methods: The overall dissertation studies were conducted in Korean. First, a qualitative descriptive design study with a sample of 10 AYAs with cancer and their parents was conducted to explore Korean adolescents’ and their parents’ experiences related to therapeutic and emotional communication in the childhood cancer context. Individual semi-structured interviews were conducted in Korean. The interview transcripts were translated and analyzed using a traditional content analysis, generating themes. Based upon the findings, we designed a cross sectional, descriptive, correlational design study to determine the relationship between engaging in parent-adolescent communication and use of positive coping in Korean AYAs, and the underlying mechanism. Data were collected from 144 AYAs aged 11-26, and their 73 parents, using a packet of self-administered questionnaires that included measures on sociodemographic and health history, parent-adolescent communication, family cohesion, hope, and uncertainty. The study obtained the needed institutional Review Board approvals from both Duke University and the Korean study site.

Results: From the first, qualitative descriptive design study with Korean adolescents with cancer and their parents, we developed the overarching core theme of “I cannot share my feelings” as a synthesis of three main themes that emerged: (1) restricted topics that I can share; (2) being closer but lacking depth; and (3) effects of restricted topics oncoping. Contrary to our expectation that participants would avoid communication related to the cancer diagnosis, they reported no challenges in communicating about treatment or day-to-day management routines; however, consistent with prior findings, they often experienced challenges in communicating about emotions due to a desire to protect one another. Furthermore, this family communication challenge resulted in creating serious risks for ineffective coping. Therefore, we conducted the next proposed study to determine the relationship between engaging in parent-adolescent communication and use of courageous coping. From this correlational, descriptive design study, we found a significant relationship between engaging in effective family communication and use of courageous coping (confrontive, optimistic, and supportant), regardless of AYA’s gender, age, cancer treatment status, and the level of symptom distress in both cases of mother and AYAs (0.26,p=0.0024, R2=0.07, medium effect), and a father and AYAs (0.25,p=0.0042, R2=0.06, medium effect). Next, we also revealed that the family cohesion was a significant mediator of the relationship between family communication and use of courageous coping in case of communicating with both a mother and a father. For example, the effect of communication with mother on use of courageous coping was reduced and no longer statistically significant, after controlling for family cohesion (Model 1, 0.11,p=0.2753, partial r2=0.01, very small effect). Last, this finding suggested that uncertainty directly influenced hope, and hope then fully mediated the impact of family cohesion on use of courageous coping among Korean AYAs with cancer when communicating with a mother. Whereas, hope only partially mediated the impact of family cohesion on the use of courageous coping among Korean AYAs when communicating with a father. Therefore, we revealed that uncertainty in illness and hope mediated the relationship between family cohesion and courageous coping in Korean AYAs with cancer.

Conclusion: Above all, in this dissertation study, we explored the Korean parent-adolescent communication experiences from the perspectives of Korean AYAs and their parents. The main finding from this study is that Korean adolescents with cancer and their parents struggle to share their emotional needs because of their fear related to the expected emotional harms and they hardly expect the benefits from engaging in family communication. The urgent needs to inform them of the benefits from engaging in family communication lead us to examine the relationship between engaging in parent-adolescent communication and use of courageous coping in the childhood cancer context. This study finding revealed the positive relationship between engaging in parent-adolescent communication and use of courageous coping among Korean AYAs and other mediating roles of family cohesion, uncertainty, and hope. This study highlighted the important role of family cohesion, decreased uncertainty, and increased hope in communicating with AYAs in the childhood cancer context to help their positive adjustment to cancer diagnosis by fostering their use of positive coping.

Implications: The current study helped us to be able to understand the family communication experiences of Korean AYAs and their parents in the childhood cancer context and provided directions to guide development of future family communication model and interventions. However, several limitations also exist and provide direction for future research. First, the future study need to employ a longitudinal design study to help clearer understanding of Korean family communication experiences and the relationship between engaging in family communication and use of courageous coping among Korean AYAs with cancer. Secondly, future study with bigger sample size are necessary. Finally, although this study was conducted targeting Korean AYAs living in Korea, the study findings will provide good implications to USA health care providers taking care of Korean AYAs, broadly other Asian AYAs from similar cultural backgrounds.

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Adolescent girls in sub-Saharan Africa must transition through puberty in the context of heightened risk for reproductive tract infections and mental illness. At the same time, girls experience menstrual stigma and a lack of resources to manage menstruation. Although menstruation and other puberty-specific stressors may negatively impact girls’ well-being, little is known about the relationships between puberty-specific stressors, coping, mental health, and reproductive health among girls in sub-Saharan Africa. The present dissertation seeks to fill this gap by investigating the types of puberty-specific stressors experienced by adolescent girls and young women in Tanzania, how girls cope with stressors, and the associations between stress and coping and mental health and reproductive health. A qualitative interview study and cross-sectional survey study were conducted to explore stress, coping, and health among adolescent girls in Tanzania. Both studies showed that girls experienced significant and disruptive puberty-specific stressors, with sexual pressure and menstrual pain constituting two of the most common stressors. Stressors were associated with depression, anxiety, and reproductive tract infections. Active coping and avoidant coping showed inconsistent relationships with stressors and mental health. Overall, psychosocial interventions are needed to reduce the negative impact of puberty-specific stressors on mental health and reproductive health among adolescent girls in Tanzania.

Purpose. Suicide is the second leading cause of death globally among young adults 15-29 years old. Addressing adolescent suicidal thoughts and behavior (STB) is especially important in low and middle income countries (LMIC) where 46% of suicides occur before 25 years of age. This burden is highest in Asia, with adolescent rates two times greater than the global average. This study examines the role of gender in influencing the relationship between coping dysfunction, self-validation, and suicidality among adolescents in the context of a school-based mental health promotion program in post-earthquake Nepal.

Methods. In this mixed-methods study, adolescents (N = 102, 50% female) attending secondary school (12 – 18 years old, average age 14.3 years) in a highly earthquake-affected region near Kathmandu, Nepal, completed the Ways of Coping Checklist, Self-Validation/Self-Invalidation Questionnaire, and the Suicide Screener Questionnaire. Participants of semi-structured interviews included 23 students, 2 teachers, and 3 caregivers. Gender-stratified focus group discussions (n = 2) were also conducted among students.

Results. The stressor that students identified most frequently (71.4% of interviewees) in qualitative interviews was academic-related sources. Scores on the Ways of Coping Checklist skills and dysfunction scales did not differ significantly by gender. However, girls scoring high in coping dysfunction (t = -2.511, p = 0.015) and low in self-validation (t = 2.916, p = 0.005) were significantly more likely to endorse suicidal ideations in the past two weeks compared to boys with similar dysfunction (t = -0.237, p = 0.813; and self-validation scores t = 1.087, p = 0.282).

Conclusions. Although gender differences in coping skills and coping dysfunction were not quantitatively observed, qualitative analyses revealed that dysfunctional coping was more frequently reported by girls. Future studies should examine the temporal relationship between coping strategies and suicidality. Suicide risk reduction programs should evaluate enhancing adaptive coping skills usage as a mechanism of action to reduce suicidality among girls. Additional research is needed to identify salient risk factors for boys.

This cross-cultural study investigates the challenges affecting HIV+ women in rural Kenya and Durham, North Carolina. Examining the linkages between social support and coping, the study finds that many experiences with social support and coping are shared across countries, despite differences in education, occupation status, and cultural identities. Age, education, and employment status were not found to be statistically significant determinants of total COPE or treatment-specific social support scores for either population. Religion was a recurring theme in both contexts, both in the quantitative and qualitative sets of data. It was a statistically significant determinant of total treatment-specific social support and also mentioned many times throughout the interviews as a preferred coping method. Most of the women expressed that support from their family and friends as well as health professionals helped them to positively cope with their disease and gave them hope for prolonged life.