Using data from a randomized, experimental trial of a brief family-based preventive intervention for parentally-bereaved families, this study evaluated whether participation in the Family Bereavement Program (FBP) when the offspring were in childhood/adolescence (ages 8 to 16) improved competencies when the offspring were emerging/young adults (ages 23 to 32). Participants were 244 emerging/young adults; data used were from assessments at pretest, posttest, 6 years post-intervention, and 15 years post-intervention. In addition to testing the direct effects of the program, developmental cascade effects models were used to test the relations between program-induced improvements in positive parenting and decreased negative life events at posttest and subsequent effects on domains of competence and behavior problems in adolescence/emerging adulthood (ages 14 to 22) and four developmental competencies of emerging/young adulthood: academic, peer, romantic, and work competence. Results supported a cascading effects model of program effects on competence outcomes. In the full sample, there were significant mediation effects of the intervention to decreased negative life events at posttest to increased grade-point average (GPA) at the 6-year follow-up to higher academic and work competence at the 15-year follow-up. For females only, two additional significant mediational pathways of the FBP occurred. The FBP led to an increase in peer competence 6 years post-intervention, which was associated with an increase in work competence 15 years post-intervention. Also, the FBP led to a decrease in externalizing problems in adolescence/emerging adulthood, but externalizing problems were positively associated with work competence. For males, additional mediation effects of the FBP on work competence occurred. The FBP decreased negative life events. However, higher negative life events were associated with lower externalizing problems in adolescence/emerging adulthood, and externalizing problems were positively associated with work competence. For males only, a significant three-pathway mediation effect of the intervention occurred on increased positive parenting at posttest to increased romantic attachment at the 6-year follow-up to higher romantic competence at the 15-year follow-up. Peer competence showed continuity over development. Mediational analyses highlighted the role of program-induced improvements in parenting, reductions in exposure to negative life events, and earlier developmental competencies on competence outcomes in emerging/young adulthood. Implications for promoting resilience in parentally-bereaved, at-risk youth are discussed.

Students at High Achieving Schools (HASs) have recently been identified as an at-risk population, and excessive pressure to excel is considered the cause of this maladjustment. However, the specific aspects of pressure that lead to these outcomes have yet to be comprehensively explored. In two schools, one public and one independent, this study examined multiple constructs potentially implicated: feelings of pressure to succeed from different sources (parents, teachers, coaches, the self, and friends) and total felt pressure. Also considered are dimensions of being overextended across commitments, including hours of sleep, homework, and levels of associated strain and enjoyment. These indices were all examined in relation to adolescents’ internalizing and externalizing symptoms, as well as feelings of disengagement with school, after controlling for attachment to both parents. Results showed that total felt pressure, and pressure felt from the self, were most notably related to internalizing symptoms and disengagement with school. Additionally, strain from commitments showed unique links with depression, anxiety, and negative feelings about school. Finally, enjoyment from different commitments showed robust links with feelings about school. Overall, the different pressure predictors showed sporadic links with externalizing behaviors and substance use. Findings are discussed in terms of directions for interventions as well as future research with HAS populations.

Interpersonal strain is linked with depressive symptoms in middle-aged adults. Self-compassion is an emerging resilience construct that may be advantageous in navigating relationship strain by helping individuals respond to emotions in a kind and nonjudgmental way. Although theory and empirical evidence suggests that self-compassion is protective against the impact of stress on mental health outcomes, many studies have not investigated how self-compassion operates in the context of relationship strain. In addition, few studies have examined psychological or physiological mechanisms by which self-compassion protects against mental health outcomes, depression in particular. Thus, this study examined 1) the extent to which trait self-compassion buffers the relation between family strain and depressive symptoms, and 2) whether these buffering effects are mediated by hope and inflammatory processes (IL-6) in a sample of 762 middle-aged, community-dwelling adults. Results from structural equation models indicated that family strain was unrelated to depressive symptoms and the relation was not moderated by self-compassion. Hope, but not IL-6, mediated the relation between family strain and depressive symptoms and the indirect effect was not conditional on levels of self-compassion. Taken together, the findings suggest that family strain may lead individuals to experience less hope and subsequent increases in depressive symptoms, and further, that a self-compassionate attitude does not affect this relation. Implications for future self-compassion interventions are discussed.

Experiencing poor, unrefreshing sleep is a common occurrence for individuals with chronic pain. Sleep disturbance predicts not only greater pain and disability, but also heightened negative affect and reduced positive affect in individuals with chronic pain. Such fluctuations in affect have been linked with more negative and fewer positive social events. For those with chronic pain, negative social relations can exacerbate pain, whereas positive social interactions can help decrease disability. Thus, exploring the sleep‒social functioning process in chronic pain may be one way to improve daily functioning and quality of life. The current study examined positive and negative affect as two parallel mediators of the within-day relations between sleep quality and positive and negative social events in individuals with chronic pain. For 21 days, electronic daily diary reports were collected from 220 individuals with fibromyalgia, a condition characterized by widespread chronic pain. Within-person relations among reports of last night’s sleep quality, afternoon affects and pain, and evening social events were estimated via multilevel structural equation modeling. Findings showed that positive affect mediated both the sleep quality‒positive social events and sleep quality‒negative social events relations. That is, greater than usual sleep disturbance last night predicted afternoon reports of lower than usual positive affect. Low positive affect, in turn, predicted evening reports of fewer than usual positive social events and more than usual negative social events that day, controlling for the effects of afternoon pain. In addition, negative affect mediated the sleep quality‒negative social events link. That is, greater than usual sleep disturbance last night predicted afternoon reports of higher than usual negative affect, which, in turn, predicted evening reports of more than usual negative social events that day, controlling for the effects of afternoon pain. Of the three significant mediated paths, the sleep quality‒positive affect‒positive social events path was the strongest in magnitude. Thus, a night of poor sleep can have an impact on social events the next day in those with chronic pain by dysregulating affect. Further, findings highlight the key role of positive affect in the sleep‒social functioning process and potential socio-affective benefits of sleep interventions in chronic pain.

The transition out of high school is a major milestone for adolescents as they earn greater autonomy and responsibilities. An estimated 69.2% of adolescents enroll in higher education immediately following high school completion, including increasing numbers of Latino adolescents (National Center for Education Statistics, 2016). Integrative model (García Coll et al., 1996) suggests a need for research on promotive and protective contextual factors for ethnic minority children and adolescents. Guided by the model, the proposed research will explore a salient Latino cultural value, familism, and family communication as predictors of changes in depressive symptoms from high school to university among Latino adolescents (N = 209; 35.6% male; Mage=17.59, SD=.53). Furthermore, sleep, a key bioregulatory mechanism, was explored as a potential moderator of these processes (Dahl & El-Sheikh, 2007). On average, familism values were not associated with college depressive symptoms, but family communication was significantly negatively associated with college depressive symptoms. Neither sleep duration nor sleep problems significantly moderated the association between familism values and college depressive symptom. Patterns were similar for family communication. The interaction between sleep problems and familism-support values were significantly associated with college depressive symptoms. However, when simple slopes were probed, none were significant.

Research on self-regulatory variables like mindfulness and effortful control proposes strong links with physical and mental health outcomes across the lifespan, from childhood and adolescence to adulthood and old age. One pathway by which self-regulation may confer health benefits is through individual differences in reports of and emotional responses to daily negative and positive events. Mindfulness is broadly defined as non-reactivity to inner experiences, while effortful control is broadly defined as attentional and behavioral regulation. Mindfulness and effortful control have both been conceptualized to exert their beneficial effects on development through their influence on exposure/engagement and emotional reactivity/responsiveness to both negative and positive events, yet few empirical studies have tested this claim using daily-diary designs, a research methodology that permits for examining this process. With a sample of community-dwelling adults (n=191), this thesis examined whether dispositional mindfulness (i.e., non-reactivity of inner experience) and effortful control (i.e., attention and behavioral regulation) modulate reports of and affective reactivity/responsiveness to daily negative and positive events across 30 days. Results showed that mindfulness and effortful control were each associated with reduced exposure to daily stressors but not positive events. They also showed that mindfulness and effortful control, respectively, predicted smaller decreases in negative affect and smaller increases in positive affect on days that positive events occurred. Overall, these findings offer insight into how these self-regulatory factors operate in the context of middle-aged adults’ everyday life.

The current study examined the unique influence of emotional childhood abuse on positive and negative aspects of different types of social relationships (e.g., family, spouse/partner, and friends) in midlife and whether genetic variations of the oxytocin receptor gene (OXTR) moderated these associations. Genetic variations in OXTR are measured by single-nucleotide polymorphisms (SNPs), which have been the most substantially studied prospects for explaining individual differences in socio-behavioral phenotypes. Specifically, an SNP, rs53576, involving a guanine (G) to adenine (A) substitution located in the third intron of the OXTR has been associated with fundamental aspects of social processes and behaviors. Compared to A carriers, individuals homozygous for the G allele have enhanced social competencies and tend to elicit more positive responses from social partners, consequently increasing the overall quality of social relationships across the lifespan. However, the G allele of the OXTR has also been associated with greater social sensitivity. In the current study, conducted among a sample of 614 adults in midlife, it was shown that emotional childhood abuse was significantly associated with having less supportive and more strained relationships in midlife. Regarding supportive family relationships, the effect of emotional childhood abuse was moderated by the OXTR rs53576 polymorphism. Specifically, under conditions of more emotional abuse in childhood, individuals homozygous for the G allele had more supportive family relationships in midlife compared to A carriers. Overall, the findings suggest that genetic variations of OXTR rs53576 may be an important candidate in understanding the development of social relationship functioning within the context of negative early life experiences.

Cognitive reappraisal, or redefining the meaning of a stressful circumstance, is useful in regulating emotional responses to acute stressors and may be mobilized to up- or down- regulate the stressors’ emotional salience. A conceptually-related but more targeted emotion regulation strategy to that offered by cognitive reappraisal, termed positive cognitive shift, was examined in the current study. Positive cognitive shift (“PCS”) is defined as a point of cognitive transformation during a chronic, stressful situation that alters the meaning and emotional salience of the situation for the individual. Key aspects of the PCS that differentiate it from the broader reappraisal construct are that it 1) is relevant to responses to chronic (versus acute) aversive events, 2) is deployed when there is a mismatch between coping and stressors, and 3) involves insight together with redefinition in meaning of the situation generating stress. The current study used qualitative and quantitative analyses to 1) examine whether PCS is an observable, reliable, and valid experience in response to a stressful event that occurred in the past year, and 2) test whether PCS moderates the relations between the number of past-year stressful life circumstances and subsequent emotional well-being and functional health. A community sample of 175 middle-aged individuals were interviewed regarded a past chronic stressor and completed questionnaires regarding number of past year stressors and health outcomes. Theory-based coding of interviews was conducted to derive reliable scores for PCS, and findings indicated that PCS was evident in 37.7 % of participant responses. Furthermore, PCS scores were related positively to openness, personal growth from one’s most difficult lifetime event, and affect intensity-calm, in line with predictions. Also in line with prediction, PCS moderated the relations between number of past-year life events and health outcomes, such that the deleterious relations between past year stressful events and cognitive functioning, wellbeing, positive affect, and negative affect were weaker among individuals higher versus lower in PCS. Of note, PCS moderation effects diminished as the number of stressful events increased.

Currently, many patients suffer from post-circumcision complications caused by poor patient selection and/or poor technique of the practicing physician. In addition, the majority of medical practitioners are incapable of/unwilling to conduct specific circumcision procedures on their patients. In the end, this either results in unsatisfied patient families, who unwillingly have their children circumcised using methods contrary to their belief, or results in individuals who are not certified practitioners of medicine conducting the procedures, greatly increasing the risk of the patients experiencing preventable complications. In order to locally address the aforementioned problems, this thesis committee, consisting of Dr. Frank Infurna, Dr. Justin Ryan, and Dr. Zachary Zuniga, and I, developed a training module that standardized the instruction that interns, residents, attendings, fellows, hospitalists, and other interested physicians will receive regarding neonatal circumcision at Phoenix Children's Hospital. To begin, the pre-operative, intra-operative, and post-operative procedures related to the Gomco clamp neonatal circumcision procedure were heavily researched using literature sourced from library databases and consultation of specialists, such as Dr. Zuniga. Given that the training was developed to instruct individuals within the medical field, the material was then truncated to promote succinctness and specificity towards the targeted population. In order to convey the specific techniques that are clinically preferred to be used in the procedure, one of Dr. Zuniga's Gomco clamp neonatal circumcision procedures was recorded and converted into GIFs, with each GIF depicting a specific technique of the procedure. The aforementioned materials were then arranged into a slide deck in order to mitigate the need for future training facilitators to tamper with the material in the process of creating visuals to be used during the training. Given the sensitivity of the material included in the slide deck, it will only be available for use on Phoenix Children's Hospital premises. To incorporate instruction regarding both the traditional (Gomco clamp) and religiously-preferred circumcision techniques into the training module, appointments, consisting of discussions regarding the procedural, cultural, and social facets that must be taken into consideration when conducting a circumcision procedure on a patient from a Muslim family, were set-up with pediatric physicians, currently practicing in Abu Dhabi, United Arab Emirates, who have specialized knowledge of conducting circumcisions in the Middle East. Since Brit Milah, the Jewish circumcision ceremony, is, unlike in Islam, required to be conducted by a Mohel in either a synagogue or house, it was not covered as holistically as "Khtan", Islamic circumcision, which is less heavily regulated. Thus far, the training module has been piloted twice, once with a group of medical students and physicians and once with medical education program directors and instructors. The critique from both sessions has been used to prepare the material for use in neonatal circumcision training sessions that will be introduced in clerkship and residency curriculum. In the future, the results of this implementation can be used to prepare the module for submission to the American Academy of Pediatrics to be made a prerequisite for physicians to undergo before conducting neonatal circumcisions.

In previous research, Luthar and Barkin (2012) found that across three different samples collected from three high-achieving schools, adolescents reported elevated rates of maladjustment behaviors, which include substance use, and internalizing and externalizing symptoms. Additionally, past research has also indicated that these maladjustment behaviors are related to parent relationships. A group of high-achieving adolescents that research has not yet focused on are those attending boarding schools, who may have higher-quality relationships with parents due to less daily strife. This study aimed to examine high-achieving adolescents across five samples from five high schools, two of which were boarding schools. This study hypothesized that the high-achieving adolescents attending both boarding schools would report lower rates of substance use, internalizing and externalizing symptoms, and lower rates of perceived parent criticism and expectations in comparison to those attending the day schools. Substance use, internalizing and externalizing symptoms, and parent relationships were measured using self-report measures that were completed by students attending these schools. Results showed that both boarding schools reported elevated rates of substance use in comparison to the three day schools and these rates measured above national norms. At the same time, both boarding schools reported lower rates of internalizing and externalizing symptoms when compared to rates reported by the day school students. This study also found that there were differences among parent relationship measures, such as criticism and expectations, among all school samples. Results of this study also showed that aspects of parent relationship, such as parent knowledge, were associated with rates of substance use among all school samples. In summary, boarding school students showed elevated substance use, similar parental relationship quality, and lower mental health symptoms compared to day school students. For all students, some aspects of the parental relationship were related to levels of substance use.