Predicting positive attitudes about quitting drug and alcohol use among homeless women.

Two separate path models for alcohol and drugs were tested in which psychosocial, environmental, and sociodemographic variables predicted behavioral and substance abuse related factors as well as the key outcome of positive attitudes about quitting drugs (N = 620) or alcohol (N = 526) in a sample of 709 homeless women. A positive attitude about quitting alcohol was predicted by more Addiction Symptoms, fewer Positive Effects from using alcohol, and not having a partner who uses alcohol. A positive attitude about quitting drugs was predicted by more Drug Problems, greater Drug Use in the Past 6 Months, more Active Coping, more education, less Emotional Distress, not having a partner who uses drugs, and fewer Addiction Symptoms. Implications of the results for drug and alcohol interventions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Homeless men and women: Differential associations among substance abuse, psychosocial factors, and severity of homelessness.

Latent variable multiple-group confirmatory factor analyses assessed gender differences in relationships among drug and alcohol use, measures indicating severity of homelessness, criminal history, prior institutionalization, and mental illness (N?=?531 homeless persons; 386 men and 145 women). Severity was indicated by length of time homeless, housing quality, and victimization. Men reported more substance use, a longer time homeless, poorer housing quality, greater criminal involvement, and less likelihood of living with a child. Constrained multiple-group models surfaced 5 significantly different relationships between latent constructs. Men had stronger relationships between mental illness and prior institutionalization, drug use and mental illness, and drug use and victimization, whereas women had stronger relationships between drug use and alcohol use, and criminal involvement and drug use. Service delivery implications and suggestions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subtypes of alcohol involvement and their relationships to exits from homelessness

This study sought to ascertain the presence of meaningful subtypes of alcohol and other drug involvement among homeless persons. Subtypes were derived using factor analysis to determine dimensions underlying alcohol involvement and cluster analysis to create unique subtypes. The types with the highest level of alcohol or drug use had the longest period of continuous homelessness and were less likely to have exited from homelessness when reinterviewed 6 months later. The dimensions represent a more sophisticated framework for describing alcohol and drug involvement among homeless persons and may be useful for practitioners in conducting assessments, designing programs, and planning interventions.     

Predictors of patient outcomes following interactions with nurses

A research and theory-based model was used to identify outcome predictors of hospitalized patients' perceptions of caring and support by nurses. The model tested the effects of cogent personal characteristics of patients (general level of self-esteem and need for control while hospitalized) on their perceptions of humanistic caring and support from nurses and, in turn, considered the effect of these variables on situational appraisal, coping strategies, psychological distress, and coping effectiveness. The 120 hospitalized adult patients indicated that the moderate amount of humanistic caring they received was beneficial. Several factors influenced caring ratings. Higher positive ratings were received from younger patients; however, people with low self-esteem and those desiring more control over their care or reporting a high degree of pain tended to perceive more threat and psychological distress as a results of their encounters with nurses. Following positive caring experiences with nurses, patients with higher self-esteem levels reported effective coping. Overall, positive caring experiences, along with coping strategies and decreased psychological distress levels, explained 40% of the variance of hospitalized patients' ability to cope effectively following their encounters with nurses.     

Modeling cognitive adaptation: A longitudinal investigation of the impact of individual differences and coping on college adjustment and performance.

Drawing on cognitive adaptation theory, optimism, psychological control, and self-esteem were explored as longitudinal predictors of adjustment to college in a sample of 672 freshmen. Although a direct effect of optimism on adjustment was found, most of the predicted effects were mediated by coping methods. Controlling for initial positive and negative mood, the beneficial effects of optimism, control, and self-esteem on adjustment were mediated by the nonuse of avoidance coping, greater use of active coping, and greater seeking of social support. Alternative models of the causal relations among these variables did not fit the data as well as the a priori mediational model. The results of a 2-yr follow-up indicated that self-esteem and control predicted greater motivation and higher grades, controlling for college entrance exam scores. Implications for cognitive adaptation theory and for interventions with populations under stress are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-esteem, social support, internalized homophobia, and coping strategies of HIV+ gay men.

The relationship was examined between self-esteem, social support, internalized homophobia, and coping strategies used by gay men (N?=?89) who were positive for human immunodeficiency virus (HIV) and between the use of coping strategies and mood state. Multiple regressions were conducted with avoidant (escape avoidance, accepting responsibility) and proactive (seeking social support, planful problem solving) coping serving as criterion variables. Greater homophobia and less self-esteem predicted avoidant coping, whereas less homophobia and less time since diagnosis predicted proactive coping. Greater time since diagnosis, less avoidant coping, less homophobia, and greater self-esteem predicted better mood state and accounted for 50% of the total variance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping strategies, drinking motives, and stressful life events among middle adolescents: Associations with emotional and behavioral problems and with academic functioning.

A sample of 733 middle adolescents was used to study interrelations among coping strategies, drinking motives, stressful life events (major, daily positive, and daily negative), emotional and behavioral problems, and academic functioning. A main-effects (vs. stress-buffering) model was supported. Some predictors (e.g., task-oriented coping, major stressful events) were general in their predictive relations to the outcome variables, whereas others were highly specific (e.g., emotion-focused coping predicting depressed affect). Overall, the predictors accounted for 22-53% of the variance in regression equations. Positive daily events predicted higher levels of alcohol use, alcohol problems, and delinquent activity, as well as higher academic performance and lower levels of depressed affect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Visual coping scenarios to facilitate discussion of coping responses with impoverished women at risk for AIDS

1. Impoverished and homeless women are prone to coping with life stresses through drug and alcohol use. 2. Visual coping scenarios are culturally sensitive strategies to help impoverished minority women discuss effective coping responses. 3. A visual coping scenario redirects attention from a negative emotional event to an effective problem-focused coping strategy.     

Individual differences in memory associations involving the positive and negative outcomes of alcohol use.

In previous studies of memory association and alcohol use, the authors found that positive outcomes of drinking were associated in memory with alcohol concepts among heavier drinkers. The present study examined whether previous alcohol use predicted associative memory responses to negative, as well as positive, outcomes of drinking. It also examined whether the normative frequency of positive and negative outcomes affected responses. In the present sample of 609 students, previous alcohol use, normative frequency of outcome, and the number of outcomes listed strongly predicted alcohol-related associative responses to positive outcomes and, to a lesser extent, negative outcomes. The results suggest that repetitive alcohol use strengthens the association in memory between alcohol concepts and both positive and negative outcomes. However, thoughts about potential positive outcomes may be more readily cued by situational factors and events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Severity of homelessness and adverse birth outcomes.

Predictors and the prevalence of adverse birth outcomes among 237 homeless women interviewed at 78 shelters and meal programs in Los Angeles in 1997 were assessed. It was hypothesized that they would report worse outcomes than national norms, that African Americans would report the worst outcomes because of their greater risk in the general population, and that homelessness severity would independently predict poorer outcomes beyond its association with other adverse conditions. Other predictors included reproductive history, behavioral and health-related variables, psychological trauma and distress, ethnicity, and income. African Americans and Hispanics reported worse outcomes than are found nationally, and African Americans reported the worst outcomes. In a predictive structural equation model, severity of homelessness significantly predicted low birth weight and preterm births beyond its relationship with prenatal care and other risk factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anger reduction in early adolescents.

High-anger 6–8th graders received cognitive-relaxation coping skills (CRCS), social skills training (SST), or no treatment. Compared to the control, CRCS and SST were equally effective in reducing trait, general, and personal–situational anger and outward negative anger expression, as well as increasing controlled anger expression. On other variables, however, CRCS showed some superiority. Although both interventions led to equivalent reductions on one measure of anxiety, CRCS lowered depression, shyness, general deviance, and another measure of anxiety, whereas SST did not and was not significantly different from other groups. CRCS lowered school deviance more than SST. No between-group differences were found on self-esteem, alcohol consumption, or intoxication. Possible explanations of these findings were discussed, along with methodological issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with a breast cancer diagnosis: A prospective study.

Employing the stress and coping theory of R. S. Lazarus and S. Folkman (1984), this study followed 117 women age 40+ regarding personality, cognitive appraisal, coping, and mood variables before breast biopsy, after diagnosis, and, for those who had cancer, after surgery. Upon biopsy, 36 received a cancer diagnosis, and 81 received a benign diagnosis. The 2 groups did not differ on appraisals, coping, or affect before diagnosis. With prebiopsy affect controlled, cancer patients reported more negative affect postbiopsy than did benign patients. Postsurgery, cancer patients expressed less vigor and more fatigue than benign patients, but the groups did not differ on other negative emotions. Prebiopsy, psychosocial predictors accounted for 54% and 29% of the variance in negative and positive emotion, respectively. Prebiopsy variables also predicted postbiopsy and postsurgery mood; cognitive coping was a particularly important predictor of high distress and low vigor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk, resistance, and psychological distress: A longitudinal analysis with adults and children.

The link between risk and resistance factors and psychological and physical distress was examined cross-sectionally and longitudinally over a 1-year period. Risk factors are negative life events and avoidance coping strategies and, for children, parental emotional and physical distress. Resistance factors include self-confidence, an easygoing disposition, and family support. We studied a community sample of over 400 adults and their children. Each of the predictor variables was significantly associated with concurrent and future psychological and physical distress among adults. Moreover, the sets of risk and resistance variables predicted both current and subsequent distress among adults even when the stable component in distress was controlled. Parental risk and resistance—especially family support and maternal dysfunction—also predicted concurrent psychological and, less strongly, physical distress among the children. The associations involving family support and maternal distress and avoidance coping held in cross-sectional analyses even when the stable component in children's distress was controlled. Although family support was associated with children's future psychological and physical distress in zero-order correlations, the relation did not hold when children's initial distress was controlled. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol dependence in homeless men. Incidence, development and determinants]

Against the background of the complex relationship of alcoholism and homelessness, we investigated the question of whether homeless alcoholics and those with homes differed regarding biographical and clinical variables. Therefore, 49 of 72 (68.1%) homeless male visitors to a city kitchen in the center of Berlin, who had fulfilled the ICD-10 criteria for the alcohol-dependence syndrome, were compared with 141 outpatients of the addiction research unit of the Department of Psychiatry of the Free University of Berlin. It was found that homeless alcoholics had more psychosocial disadvantages than other alcoholics. They had been raised more frequently in families with an alcoholic father or mother and a higher number of children. The level of education and job qualification was lower in the homeless alcoholics. Early homelessness was predicted by a lack of sexual behavior (no partnership experienced) and a family history of alcoholism. In the interview, homeless alcoholics reported fewer symptoms of alcohol-dependence syndrome than other alcoholics; however, the first symptoms had been experienced earlier. Alcohol-related somatic and psychological consequences were reported more frequently in alcoholics with homes, whereas social problems were more common in the homeless subjects. The results are discussed in the light of methodological limitations and other reports on the topic.     

Completion and subject loss within an intensive hepatitis vaccination intervention among homeless adults: The role of risk factors, demographics, and psychosocial variables.

Objective: Unprotected sexual behavior, needle sharing, and a prison history are major correlates of hepatitis B Virus (HBV). These risk factors are common among homeless people who also have elevated rates of HBV. We examine whether these behaviors were associated with completion or loss to follow-up of the most intensive and successful condition of a 3-arm HBV vaccination intervention. Significant results would imply that those most in need are the least compliant. Contributions of baseline demographics, physical health, psychosocial variables, and health beliefs were also assessed. Design: Three-hundred thirty- one adults from Los Angeles' Skid Row were assigned to nurse-case-managed sessions with hepatitis education, incentives, and tracking. Successive predictive structural equation models assessed the amount of variance accounted for by the risk variables, demographics, and the health-related variables. Main Outcome Measures: (1) Completion of 3 injections by 6 months; and (2) loss to a 6-month follow-up questionnaire. Results: The 3 risk factors explained 2% of the variance in completion and 1% of the variance in loss. Adding the other variables increased the variance explained to 14% for completion and 13% for loss. African American ethnicity, positive coping, social support, poorer health, no prison history, and greater efficacy significantly predicted completion. White ethnicity, less social support, better health, and less intention to complete predicted participant loss. Conclusion: The program was not strongly rejected differentially as a function of preexisting hepatitis B risk behaviors. Programs designed for homeless people should include malleable psychosocial and health belief model variables. These aspects of the lives of homeless people provide leverage points for future interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Homeless youths and young adults in Los Angeles: prevalence of mental health problems and the relationship between mental health and substance abuse disorders

Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults in increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorders included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults.     

Situational coping and coping dispositions in a stressful transaction.

After reporting dispositional coping styles, 125 undergraduates reported situational coping and 4 classes of affect (from threat, challenge, harm, and benefit appraisals) 2 days before an exam, after the exam but before grades were posted, and after posting of grades. Coping did not predict lower levels of future distress; indeed, some coping seemed to induce feelings of threat. Feelings of harm before the exam induced several kinds of coping after the exam, mostly dysfunctional. Confidence about one's grade was a better predictor of emotions throughout than was coping. Dispositional coping predicted comparable situational coping at low-moderate levels in most cases. Coping dispositions did not reliably predict emotions, however, with these exceptions: Dispositional denial was related to threat, as was dispositional use of social support; dispositional use of alcohol was related to both threat and harm. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personal resilience, cognitive appraisals, and coping: an integrative model of adjustment to abortion

We hypothesized that the effects of personality (self-esteem, control, and optimism) on postabortion adaptation (distress, well-being, and decision satisfaction) would be fully mediated by preabortion cognitive appraisals (stress appraisals and self-efficacy appraisals) and postabortion coping. We further proposed that the effects of preabortion appraisals on adaptation would be fully mediated by postabortion coping. Results of a longitudinal study of 527 women who had first-trimester abortions supported our hypotheses. Women with more resilient personalities appraised their abortion as less stressful and had higher self-efficacy for coping with the abortion. More positive appraisals predicted greater acceptance/reframing coping and lesser avoidance/denial, venting, support seeking, and religious coping. Acceptance-reframing predicted better adjustment on all measures, whereas avoidance-denial and venting related to poorer adjustment on all measures. Greater support seeking was associated with reduced distress, and greater religious coping was associated with less decision satisfaction.     

Direct placement versus multistage models of supported housing in a population of veterans who are homeless.

This study presents information about two models of supported housing when combined with ready access to rent subsidies: a direct placement approach (where individuals are placed directly into independent housing from homelessness), and a multistage continuum approach (where individuals are placed first into a residential setting prior to independent housing). Using observational data from the national Housing and Urban Development–Veterans Affairs Supported Housing (HUD-VASH) program, which provided case management and housing subsidies to homeless veterans with psychiatric or substance abuse disorders, participants were categorized as receiving direct placement housing or multistage housing based on where they spent the majority of days prior to entry into HUD-VASH. Results indicate that multistage housing participants had significantly worse scores on baseline measures of alcohol and drug use, quality of life, and social support, and subsequently experienced significantly greater improvements over time so that, with the exception of employment outcomes, between-groups differences were not significant at later time periods. Multistage participants had health care costs that averaged more than three times those of direct placement participants during the initial period of residential care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivational pathways to alcohol use and abuse among Black and White adolescents.

Using data from a biracial community sample of adolescents, the present study examined trajectories of alcohol use and abuse over a 15-year period, from adolescence into young adulthood, as well as the extent to which these trajectories were differentially predicted by coping and enhancement motives for alcohol use among the 2 groups. Coping and enhancement motivations (M. L. Cooper, 1994) refer to the strategic use of alcohol to regulate negative and positive emotions, respectively. Results showed that Black and White youth follow distinct alcohol trajectories from adolescence into young adulthood and that these trajectories are differentially rooted in the regulation of negative and positive emotions. Among Black drinkers, coping motives assessed in adolescence more strongly forecast differences in alcohol involvement into their early 30s, whereas enhancement motives more strongly forecast differences among White drinkers. Results of the present study suggest that different models may be needed to account for drinking behavior among Blacks and Whites and that different approaches may prove maximally effective in reducing heavy or problem drinking among the 2 groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)