Acceptance of sexual minorities, discrimination, social capital and health and well-being: A cross-European study among members of same-sex and opposite-sex couples

Background: Awareness of health disparities based on sexual orientation has increased in the past decades, and many official public health agencies throughout Europe call for programs addressing the specific needs of lesbian, gay and bisexual (LGB) individuals. However, the acceptance of LGB individuals varies significantly in different countries, which potentially influences health and well-being in this population. We explored differences in self-rated health and subjective well-being between individuals living in same-sex and opposite-sex couples. We also examined the effects of discrimination and country-level variations in LGB acceptance on health and well-being and the potential mediating role of social capital in these associations. Methods: Using the 2010 European Social Survey (n = 50,781), 315 individuals living with a same-sex partner were matched and compared with an equal number of individuals living in opposite-sex couples. We performed structural equation modeling analyses to estimate path coefficients, mediations and interactions. Results: LGB acceptance was significantly related to better self-rated health and subjective well-being among all individuals, and these associations were partially mediated by individual social capital. No differences in these associations were found between individuals living in same-sex and opposite-sex couples. Sexuality-based discrimination had an additional significantly negative effect on self-related health and subjective well-being. Conclusions: The findings of this study suggest a negative association between exposure to discrimination based on sexual orientation and both health and well-being of individuals living in same-sex couples. Members of same-sex couples and opposite-sex couples alike may benefit from living in societies with a high level of LGB acceptance to promote better health and well-being

Effects of a mindfulness based childbirth and parenting program on pregnant women's perceived stress and risk of perinatal depression-Results from a randomized controlled trial

The aim of this study was to test the efficacy of a Mindfulness-Based Childbirth and Parenting Program (MBCP) in reducing pregnant women's perceived stress and preventing perinatal depression compared to an active control condition.; First time pregnant women (n = 197) at risk of perinatal depression were randomized to MBCP or an active control treatment, which consisted of a Lamaze childbirth class. At baseline and post-intervention, participants filled out questionnaires on perceived stress, depressive symptoms, positive states of mind, and five facets of mindfulness.; Compared to the active control treatment, MBCP significantly reduced perceived stress (p = 0.038, d = 0.30) and depressive symptoms (p = 0.004, d = 0.42), and increased positive states of mind (p = 0.005, d = 0.41) and self-reported mindfulness (p = 0.039, d = 0.30). Moreover, change in mindfulness possibly mediated the treatment effects of MBCP on stress, depression symptoms, and positive states of mind. The subscales "non-reactivity to inner experience" and "non-judging of experience" seemed to have the strongest mediating effects.; The outcomes were self-report questionnaires, the participants were not blinded to treatment condition and the condition was confounded by number of sessions.; Our results suggest that MBCP is more effective in decreasing perceived stress and risk of perinatal depression compared to a Lamaze childbirth class. The results also contribute to our understanding of the underlying psychological mechanisms through which the reduction of stress and depression symptoms may operate. Thus, this study increases our knowledge about efficient intervention strategies to prevent perinatal depression and promote mental wellbeing among pregnant women

Skin examination behavior: the role of melanoma history, skin type, psychosocial factors, and region of residence in determining clinical and self-conducted skin examination

Objective: To examine the frequency and correlates of skin examination behaviors in an international sample of individuals at varying risk of developing melanoma. Design: A cross-sectional, web-based survey. Setting: Data were collected from the general population over a 20-month period on behalf of the Melanoma Genetics Consortium (GenoMEL). Participants: A total of 8178 adults from Northern (32%), Central (33%), and Southern (14%) Europe, Australia (13%), and the United States (8%). Main outcome measures: Self-reported frequency of skin self-examination (SSE) and clinical skin examination (CSE). Results: After adjustment for age and sex, frequency of skin examination was higher in both Australia (odds ratio [OR]SSE=1.80 [99% CI, 1.49-2.18]; ORCSE=2.68 [99% CI, 2.23-3.23]) and the United States (ORSSE=2.28 [99% CI, 1.76-2.94]; ORCSE=3.39 [99% CI, 2.60-4.18]) than in the 3 European regions combined. Within Europe, participants from Southern Europe reported higher rates of SSE than those in Northern Europe (ORSSE=1.61 [99% CI, 1.31-1.97]), and frequency of CSE was higher in both Central (ORCSE=1.47 [99% CI, 1.22-1.78]) and Southern Europe (ORCSE=3.46 [99% CI, 2.78, 4.31]) than in Northern Europe. Skin examination behavior also varied according to melanoma history: participants with no history of melanoma reported the lowest levels of skin examination, while participants with a previous melanoma diagnosis reported the highest levels. After adjustment for region, and taking into account the role of age, sex, skin type, and mole count, engagement in SSE and CSE was associated with a range of psychosocial factors, including perceived risk of developing melanoma; perceived benefits of, and barriers to, skin examination; perceived confidence in one's ability to engage in screening; and social norms. In addition, among those with no history of melanoma, higher cancer-related worry was associated with greater frequency of SSE. Conclusions: Given the strong association between psychosocial factors and skin examination behaviors, particularly among people with no history of melanoma, we recommend that greater attempts be made to integrate psycho-education into the fabric of public health initiatives and clinical care, with clinicians, researchers, and advocacy groups playing a key role in guiding individuals to appropriate tools and resources

Skin cancer prevention : Behaviours related to sun exposure and early detection

Skin cancer is an emerging public health problem in Sweden. Even though the most important risk factor for the development of skin cancer - sun exposure - is known, the incidence of skin cancer is still increasing. Every year approximately 30,000 people in Sweden are diagnosed with skin cancer and approximately 400 die of this condition. In addition to the deaths and suffering caused by skin cancer, its treatment incurs considerable health costs. The aim of this thesis was to examine factors relevant to sun-related behaviours and early detection of malignant skin lesions. The preventive effects of two information strategies on sun-related behaviours and early detection of malignant melanoma were also studied. Three samples were studied with questionnaires, these were: 52 female nurses attending a postgraduate course in research methodology at the Karolinska Institutet, 2,615 adolescents (13, 15 and 17 year of age) randomly selected from the population in Sweden, and 1,743 adults (18-37 year of age) randomly selected from the population in Stockholm County. The first sample completed the questionnaires in connection to lectures, whereas the other two responded to mailed questionnaires. Further, 90 patients recruited from the Karolinska hospital and 30 randomly selected persons from Stockholm County (18 to 79 year of age) participated in an interview study. The results showed that the questionnaires commonly used to measure sun-related behaviours had sufficient reliability. The studies confirm previous findings that adolescents and adults in Sweden spend a lot of time in the sun, frequently with the intention of becoming tanned, and frequently become sunburnt. The studies also highlighted variables associated with sun-related behaviour. Knowledge about skin cancer was not associated with decreased sunbathing or increased sun protection behaviour among adolescents. In fact, high knowledge was positively related to frequent sunbathing. Positive attitudes towards sunbathing and having a tan were strongly related to exposure to solar radiation. Being around people who frequently sunbathe was related to intentional tanning and vacation to sunny resorts. To perceive sun exposure as risky increased the likelihood of intending to decrease sunbathing and undertake sun protection behaviour. Perceived control over the risks with sun exposure was associated with sun protection behaviour among women. An individual ultraviolet (UV) radiation intensity indicator and information about the UV index (a measure of the intensity of solar radiation) did not affect sun-related behaviour more than general written information about sun protection. Health care providers seem to play an important role in early detection of malignant melanoma, as more than 1/3 of the melanoma patients interviewed said that their melanoma was detected at a visit to a physician for another reason. The ABCD criteria (a description of the characteristics of early melanoma) seem to increase laymen's ability to make adequate judgements of skin lesions and could be used in secondary preventive interventions. The results of the present thesis contribute to the understanding of factors relevant to sunrelated behaviours. Taking these factors into account when planning skin cancer prevention activities may improve the effectiveness of these efforts

How many sexual minorities are hidden? Projecting the size of the global closet with implications for policy and public health.

Because sexual orientation concealment can exact deep mental and physical health costs and dampen the public visibility necessary for advancing equal rights, estimating the proportion of the global sexual minority population that conceals its sexual orientation represents a matter of public health and policy concern. Yet a historic lack of cross-national datasets of sexual minorities has precluded accurate estimates of the size of the global closet. We extrapolated the size of the global closet (i.e., the proportion of the global sexual minority population who conceals its sexual orientation) using a large sample of sexual minorities collected across 28 countries and an objective index of structural stigma (i.e., discriminatory national laws and policies affecting sexual minorities) across 197 countries. We estimate that the majority (83.0%) of sexual minorities around the world conceal their sexual orientation from all or most people and that country-level structural stigma can serve as a useful predictor of the size of each country's closeted sexual minority population. Our analysis also predicts that eliminating structural stigma would drastically reduce the size of the global closet. Given its costs to individual health and social equality, the closet represents a considerable burden on the global sexual minority population. The present projection suggests that the surest route to improving the wellbeing of sexual minorities worldwide is through reducing structural forms of inequality. Yet, another route to alleviating the personal and societal toll of the closet is to develop public health interventions that sensitively reach the closeted sexual minority population in high-stigma contexts worldwide. An important goal of this projection, which relies on data from Europe, is to spur future research from non-Western countries capable of refining the estimate of the association between structural stigma and sexual orientation concealment using local experiences of both

Coping with Breast Cancer: A Meta-Analysis

<div><p>Objective</p><p>The primary aim of this study was to examine the associations between different types of coping and psychological well-being and physical health among women with breast cancer. A second aim was to explore the potential moderating influences of situational and measurement factors on the associations between coping and psychological well-being and physical health.</p><p>Methods</p><p>On 14 February 2011, a literature search was made for articles published in the PubMed and PsycINFO databases before January 2010. On 5 September 2013, a repeated literature search was made for articles published before May 2013. In the final analyses, 78 studies with 11 948 participants were included.</p><p>Results</p><p>Efforts to facilitate adaptation to stress, such as Acceptance and Positive Reappraisal, were related to higher well-being and health. Disengagement and avoidance types of coping were associated with lower well-being and health. The analyses indicated that, in several circumstances, coping effectiveness was dependent on cancer stage, treatment, disease duration, and type of coping measure.</p><p>Conclusions</p><p>Use of coping targeting adjustment and avoiding use of disengagement forms of coping were related to better psychological well-being and physical health. Adaptive strategies and avoiding disengagement forms of coping seemed particularly beneficial for women undergoing treatment.</p></div

Description of studies included in the meta-analysis.

<p>^aThe way they were classified in the coding process</p><p><i>Note.</i><b>Coping measures</b>: MAC  =  Mental Adjustment to Cancer (Greer & Watson, 1987); Mini-MAC  =  Mini-mental Adjustment to cancer (Watson, Law, dos Santos, Greer, Baruch, & Bliss, 1994); CISS =  Coping Inventory for Stressful Situations (Endler & Parker, 1990); CSI  =  Coping Strategies Inventory (Tobin, Holroyd, Reynolds, & Wigal, 1989); CHIP  =  Coping with Health Injuries and Problems scale (Endler, Parker, & Summerfeldt, 1998); WOC  =  Ways of Coping Questionnaire (Folkman & Lazarus, 1980); FQC  =  Freiburg Questionnaire of Coping with Illness (Muthny, 1988); RSQ-CV  =  Responses to Stress questionnaire - cancer version (Compas, et al., 2006); RCOPE  =  Religious coping scale (Pargament, Koenig, & Perez, 2000); UCL  =  Utrecht Coping List (Schreurs & van de Willige, 1988). <b>Types of coping</b>: Acc  =  Acceptance; ADD  =  Alcohol/Drug Disengagement; App =  Approach; BD  =  Behavioral Disengagement; DA  =  Direct Action; DC  =  Disengagement Coping; EA/Di  =  Escape/Avoidance/Distancing; EF  =  Emotion Focused; FS  =  Fighting Spirit; Ho  =  Hopelessness; PCC  =  Primary Control Coping; PF  =  Problem Focused; Pl  =  Planning; PR  =  Positive Reappraisal; Ru  =  Rumination; SB  =  Self-Blame; SC  =  Self-Controlling; SCC  =  Secondary Control Coping; SI  =  Social Isolation; Sp  =  Spirituality; SSS  =  Seeking Social Support; V =  Venting. <b>Outcomes</b>: NA  =  negative affect; PA  =  positive affect; PH  =  physical health.</p><p>Description of studies included in the meta-analysis.</p