Heather L. Smyth

Objective: Prior research reported that some women are skeptical toward messages about mammography screening evidence, particularly information about overdiagnosis and false positives. The proposed cause of skepticism is that the evidence is surprising and different from other screening messages, a finding which suggests that skepticism might decline as the information becomes more familiar. The present research tested the hypothesis that skepticism declines over time with repeated exposure, and sought to replicate prior evidence for the antecedents of observed skepticism. Methods: This longitudinal study recruited women ages 39–49 from two health systems. Women received a decision aid (DA) communicating mammography screening evidence prior to an annual well visit. Skepticism toward the DA information was measured immediately after the DA, after the clinic visit, and 3 months later. Hypothesis‐relevant predictors of skepticism were assessed. Results: Skepticism was greater toward information about overdiagnosis and false positives compared to benefits, and skepticism was greater among participants who felt the evidence conflicted with past screening messages. We also observed that higher breast cancer anxiety was associated skepticism toward screening harms. Moreover, contrary to predictions, two facets of skepticism—reactance and disbelief—increased over time. Exploratory post hoc analyses suggested that increases in skepticism were associated with participants' perceptions that the DA conflicted with their doctors' screening message. Conclusions: Some people express skepticism toward mammography evidence, and these feelings are associated with perceived conflicting messages and cancer anxiety. Skepticism may not decline over time if messages from other sources conflict with the DA information. Trial Registration: ClinicalTrials.gov registration NCT05838417

Background: Birth trauma can negatively impact maternal and family wellbeing in the short‐ and long‐term. We investigated risk and protective factors for birth trauma that are under the direct purview of providers who care for women in the perinatal period, including obstetric complications and positive perceptions of provider care. Methods: We applied hierarchical logistic regression to secondary data collected by the Colorado Department of Public Health and Environment from a racially diverse, population‐based sample of postpartum mothers ( n = 1534) to investigate whether the number of obstetric complications across the perinatal period was associated with higher odds of birth trauma (self‐reported difficulty coping with birth experience) and whether positive perceptions of perinatal care were protective against birth trauma, controlling for sociodemographic and birth characteristics. Results: Mothers who had more obstetric complications throughout the perinatal period had significantly higher odds of birth trauma (adjusted OR = 1.21, 95% CI: 1.05, 1.38), and mothers who had more positive perceptions of perinatal care had significantly lower odds of birth trauma (adjusted OR = 0.91, 95% CI: 0.85, 0.96). The interaction between number of obstetric complications and perceptions of perinatal care was not significant. Discussion: Women's experience across the entire perinatal period, including complications and perceptions of care during pregnancy, labor and delivery, and postpartum, can influence their perception of birth trauma. Monitoring and attending to emotional distress and improving quality of patient–provider interactions throughout the perinatal period may help to prevent and mitigate the negative impacts of traumatic birth.

Background: Mediation analysis has a long history, with numerous examples of mediation being tested in clinical trials and observational studies. Mediation analysis focuses on outcome mechanisms, providing a lens for understanding the why behind clinical outcomes. While mediation is a statistical method, it is as much, if not more, about study design, assumptions, and conceptual underpinnings. Several authors have already provided excellent summaries of the state of the science of mediation in nursing research and statistical tutorials; however, barriers remain to adopting robust mediation methods. Objectives: Provide an accessible introduction to causal mediation, encourage research designs that incorporate principles of causal inference, and provide a straightforward explanation of the assumptions inherent in study design and statistical modeling in causal mediation. Methods: We first review causal mediation assumptions, including practical examples relevant to nursing. Then we walk through an example demonstration of assumptions in the context of one of our own studies. We conclude with a pragmatic discussion of common considerations when incorporating mediation into a study design. Results: Through the illustrative example, we demonstrate how to evaluate core assumptions of causal mediation in practice and how design decisions influence the plausibility of meeting them. The example serves as a practical template for applying causal mediation concepts in nursing research. Discussion: The quality of causal inference in mediation analysis depends on research design as much as it does on statistical sophistication. Mediation analysis is most powerful when researchers treat its causal assumptions as design principles rather than technical add-ons. No amount of post-hoc statistical adjustment can fully compensate for weaknesses in measurement, temporality, or study conceptualization.

Background and Objectives: In skilled nursing facilities (SNFs), Section GG replaced Section G as the instrument for measuring function in 2023. To inform how previously validated scales and scores derived from Section G items might be re-produced from Section GG items, we examined key measurement assumptions in both instruments. Research Design and Methods: We identified 1,131,694 Minimum Data Set 3.0 assessments of unique persons with complete Sections GG and G between October 2018 and September 2023 across 2,200 SNFs in the Long-Term Care Data Cooperative. We examined: (i) assessment instructions, (ii) item-level Spearman’s correlations, (iii) measures of fit and factor structure in confirmatory and exploratory factor analyses, and (iv) graded response item response theory parameters. Results: Several Section GG items were conceptually similar and highly correlated (ρ ≥ 0.7). After removing redundant items, a combined scale of both instruments was not unidimensional in confirmatory factor analyses (Comparative Fit Index = 0.753, Tucker-Lewis Index = 0.724, root-mean-square error of approximation = 0.153) and items from each instrument generally loaded onto separate but correlated factors (inter-factor correlation 0.735) in exploratory factor analyses. In item response theory analyses, Section GG items better captured independence while Section G items better captured dependence. Discussion and Implications: Sections GG and G measure related yet distinct constructs, emphasizing the need for caution when interpreting a sum of Section GG items as a reflection of underlying health in SNF patients. Scales and scores derived from Section G items cannot be presumed to be equivalent when derived from Section GG items, and further work is needed examining interchangeability.

Conflicting health messages negatively impact trust. Breast cancer screening (BCS) is one area of healthcare where conflicting messages are common. We examined whether women’s healthcare system trust was impacted after exposure to information about harms and benefits of BCS. We enrolled 497 women into this study. Participants were administered a decision aid (DA) containing information about the harms and benefits of BCS and reported their healthcare system trust pre- and post-DA exposure. We observed a significant decrease in healthcare system trust from pre- to post-DA. This decrease in trust was associated with participants’ perception that the message conflicted with their previously held beliefs and not the reactions it elicited. When people receive information about BCS that conflicts with past health messages, they may lose trust in the healthcare system. This underscores the importance of adopting consistent messages about BCS.

The U.S. Preventive Services Task Force (USPSTF) recently changed its recommendation for mammography screening from informed decision making to biennial screening for women aged 40 to 49 years. Although many women welcome this change, some may prefer not to be screened at age 40 years. To conduct a national probability-based U.S. survey to investigate breast cancer screening preferences among women aged 39 to 49 years. Pre-post survey with a breast cancer screening decision aid (DA) intervention. (ClinicalTrials.gov: NCT05376241). Online national U.S. survey. 495 women aged 39 to 49 years without a history of breast cancer or a known BRCA1/2 gene mutation. A mammography screening DA providing information about screening benefits and harms and a personalized breast cancer risk estimate. Screening preferences (assessed before and after the DA), 10-year Gail model risk estimate, and whether the information was surprising and different from past messages. Before viewing the DA, 27.0% of participants preferred to delay screening (vs. having mammography at their current age), compared with 38.5% after the DA. There was no increase in the number never wanting mammography (5.4% before the DA vs. 4.3% after the DA). Participants who preferred to delay screening had lower breast cancer risk than those who preferred not to delay. The information about overdiagnosis was surprising for 37.4% of participants versus 27.2% and 22.9% for information about false-positive results and screening benefits, respectively. Respondent preferences may have been influenced by the then-current USPSTF guideline. There are women in their 40s who would prefer to have mammography at an older age, especially after being informed of the benefits and harms of screening. Women who wanted to delay screening were at lower breast cancer risk than women who wanted screening at their current age. Many found information about the benefits and harms of mammography surprising. National Cancer Institute.

The Self-Medication Hypothesis (SMH) theorizes that alcohol is used to alleviate negative states. We assessed whether an acute social stressor (Trier Social Stress Test, TSST), a priming dose of alcohol, and participant sex impacted 90-min ad libitum drinking. We expected exposure to stress to be associated with increased consumption, and this effect to be stronger following an alcohol priming dose; we also explored whether participant sex moderated these effects. Using a 2×2 experimental design, we randomized groups of two to three drinkers to stress (TSST vs. no TSST) and priming beverage (alcohol vs. placebo) conditions. All participants subsequently completed the 90-min ad libitum drinking period and were instructed not to exceed more than one alcoholic beverage per hour for optimal performance to model behavioral impaired control. We examined (a) number of drinks ordered, (b) violations of the drink limit, (c) change in breath alcohol concentration (BAC), and (d) peak BAC. Analyses showed that exposure to stress was associated with heavier ad libitum drinking. This effect was qualified by a three-way interaction; women who received a stressor and no prime dose (placebo) reached higher BACs, whereas men who received a stressor and a prime reached higher BACs. The hypothesized interaction between an alcohol priming dose and social stress was only evident among men, whereas women drank more under social stress in the absence of a priming dose. Findings suggest the importance of exploring sex differences in future studies of the SMH. (PsycInfo Database Record (c) 2022 APA, all rights reserved).