Sexual Victimization History and Well-Being: Examining Daily Coping as a Mechanism

Early life sexual victimization (SV) is consistently linked to negative psychological and physical health outcomes, but much remains to be learned about the potential cognitive mechanisms that drive these relationships. Few studies have examined strategies for coping with future daily stressors as predictors of differences in well-being following SV, with even fewer testing these effects within a multilevel framework. To better understand when and how individuals with a history of SV demonstrate significant differences in well-being, the present study examined problem-, meaning-, and avoidance-focused coping strategies as mediators of SV’s impact on daily mood and somatic symptoms and tested whether effects were moderated by the type of stressor with which individuals were coping. 106 undergraduate students completed initial online assessments of trauma history, followed by 11 nightly diary surveys assessing daily stressors, cognitive appraisals, coping, affect, and somatic symptoms. SV participants (n=25) reported greater average somatic symptoms than NSV peers (n=81), mediated by greater use of avoidance coping (ab= 0.66, p pp=.06) and somatic symptoms (ab= .19, p=.04) on these days, mediated by less use of avoidant coping strategies. On days when coping with interpersonal stressors, SV participants had marginal increases in somatic symptoms, mediated by relative increases in avoidant coping (ab= -.10, p= .08). Results suggest that negative sequelae of SV history may be more pronounced on days when individuals are coping with interpersonal stressors, with survivors demonstrating relative resilience in coping with academic stressors. Thus, clinicians may wish to consider the unique characteristics of daily stressors in individuals’ environments, in combination with their dispositional coping style and trauma histories, when implementing interventions to promote adaptive coping

Sexual Victimization History and Well-Being: Examining Daily Coping as a Mechanism

Early life sexual victimization (SV) is consistently linked to negative psychological and physical health outcomes, but much remains to be learned about the potential cognitive mechanisms that drive these relationships. Few studies have examined strategies for coping with future daily stressors as predictors of differences in well-being following SV, with even fewer testing these effects within a multilevel framework. To better understand when and how individuals with a history of SV demonstrate significant differences in well-being, the present study examined problem-, meaning-, and avoidance-focused coping strategies as mediators of SV’s impact on daily mood and somatic symptoms and tested whether effects were moderated by the type of stressor with which individuals were coping. 106 undergraduate students completed initial online assessments of trauma history, followed by 11 nightly diary surveys assessing daily stressors, cognitive appraisals, coping, affect, and somatic symptoms. SV participants (n=25) reported greater average somatic symptoms than NSV peers (n=81), mediated by greater use of avoidance coping (ab= 0.66, p pp=.06) and somatic symptoms (ab= .19, p=.04) on these days, mediated by less use of avoidant coping strategies. On days when coping with interpersonal stressors, SV participants had marginal increases in somatic symptoms, mediated by relative increases in avoidant coping (ab= -.10, p= .08). Results suggest that negative sequelae of SV history may be more pronounced on days when individuals are coping with interpersonal stressors, with survivors demonstrating relative resilience in coping with academic stressors. Thus, clinicians may wish to consider the unique characteristics of daily stressors in individuals’ environments, in combination with their dispositional coping style and trauma histories, when implementing interventions to promote adaptive coping

Qualitative study of Oncology Clinicians’ Perceptions of Barriers to Offering Clinical Trials to Underserved Populations

Introduction Cancer clinical trials represent the “gold standard” for advancing novel cancer therapies. Optimizing trial participation is critical to ensuring the generalizability of findings across patients, yet trial enrollment rates, particularly among minority and socioeconomically disadvantaged populations, remain suboptimal. Methods We conducted in-depth interviews with oncologists at a large academic medical center to explore their (1) attitudes and perceived barriers to offering clinical trials to minority and socioeconomically disadvantaged patients, and (2) recommendations for improving the enrollment of minority and socioeconomically disadvantaged patients in cancer clinical trials. Results Of 23 medical oncologists approached, 17 enrolled (74% response rate; mean age = 47; female = 42%; White = 67%). Content analysis revealed several barriers to enrollment: (1) ethical dilemmas; (2) ambivalence about trial risks and benefits; and (3) concern about patient well-being. Concerns about the legitimacy of informed consent, perceived lack of equipoise, and fear of personal bias influenced clinicians’ decisions to recommend trials during treatment discussions. Concerns about creating an imbalance between trial risks and benefits among patients with high-level needs, including patients with literacy, psychiatric, and other socioeconomic vulnerabilities, impacted clinicians’ enthusiasm to engage in trial discussions. Clinicians identified patient, provider, and system-level solutions to address challenges, including increasing patient and clinician support as well as involving external personnel to support trial enrollment. Conclusion Findings reveal multi-level barriers to offering cancer clinical trials to underrepresented patients. Targeted solutions, including system level changes to support clinicians, patient financial support, and implementation of clinical trial navigation programs were recommended to help reduce access barriers and increase enrollment of underrepresented patients into cancer clinical trials

Study protocol for a hybrid type 1 effectiveness-implementation trial testing virtual tobacco treatment in oncology practices [Smokefree Support Study 2.0]

Abstract Background Persistent smoking among patients diagnosed with cancer is associated with adverse clinical outcomes, yet an evidence-based tobacco use intervention has not been well-integrated into cancer care in community oncology settings. This paper describes the protocol of a nation-wide clinical trial conducted by the ECOG-ACRIN National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base to assess the effectiveness of a virtual tobacco treatment intervention and the process of implementing tobacco treatment in NCORP community oncology settings. Methods/design This two-arm, multisite (n: 49 NCORP sites) hybrid type 1 effectiveness-implementation randomized controlled trial compares the effectiveness of a Virtual Intervention Treatment (VIT) versus an Enhanced Usual Control (EUC) among English and Spanish speaking patients recently diagnosed with cancer, reporting current smoking and receiving care at a participating NCORP Community or Minority/Underserved Site. The VIT includes up to 11 virtual counseling sessions with a tobacco treatment specialist and up to 12 weeks of nicotine replacement therapy (NRT). The EUC arm receives a referral to the NCI Quitline. The primary study outcome is biochemically confirmed 7-day point prevalence smoking abstinence. Moderators of treatment effect will be assessed. The study evaluates implementation processes from participating NCORP site staff via survey, administrative, and focus group data, including reach, acceptability, appropriateness, fidelity, feasibility, adoption, cost and sustainability outcomes. Discussion This trial will generate findings about the effectiveness of an evidence-based virtual tobacco treatment intervention targeting patients diagnosed with cancer and illuminate barriers and facilitators that influence implementing tobacco treatment into community oncology settings nationally. In the era of COVID-19, virtual care solutions are vital for maximizing access and utilization of tobacco treatment delivery. Trial registration ClinicalTrials.gov (NCT03808818) on January 18th, 2019; Last update posted: May 21st, 2020.http://deepblue.lib.umich.edu/bitstream/2027.42/173518/1/12889_2022_Article_13631.pd