RESEARCH INTERESTS

My primary identity is as a health psychologist, and my research for the past two decades has focused on psychosocial adaptation to chronic stress – that is, how recurring life strains affect individuals, families and communities, and how individuals, families and communities cope with these chronic strains.  My training was in community psychology and social ecology.  As a consequence, my research is conducted in naturalistic settings and examines behavior within the broader context of the ecology of human development.  For example, the research moves from asking whether coping affects health and well-being to asking the questions of how, when, why, and for whom coping have their strongest influence. Thus, interactions are the key for me – and I examine the unique and joint influences of contextual factors at multiple levels of analysis.

The lion’s share of my work has centered on the stressor of major physical illness.  I have studied stress and coping processes among children, adolescents and adults, married couples, and families facing recently-diagnosed and long-term chronic illnesses; the use of age and gender stereotypes by physicians; the influence of supportive and non-supportive interpersonal relationship on health; and why mutual-help groups work.  Within the past few years my focus has turned more to women's health issues, including a longitudinal study of long-term psychological adaptation among breast cancer survivors, and the effect of perceived racism on health outcomes such as cardiovascular disease and smoking.   

ONGOING STUDIES

Systematic Review: Measures of Sexual Quality of Life for Female Cancer Survivors.
Sara I. McClelland, M.A., Co-Principal Investigator
Funded by an R03 grant from NCI.
There is a 1 in 3 chance that a woman will develop cancer in her lifetime. As survival rates continue to rise, growing numbers of women are living with cancer. In response, clinical researchers have focused on quality of life issues for cancer survivors, such as sexual quality of life (SQoL). Sexuality and intimacy have been shown to play important roles in long-term survivorship. However, there is growing concern that the construct of SQoL has not been adequately measured for female cancer survivors, including female sexual response, fertility, and menopausal status. The proposed project aims to address key questions regarding the conceptualization and measurement of SQoL for female cancer survivors using systematic review techniques. The specific aims are: (1) To review how the domain of female SQoL varies by cancer site, stage of survivorship, life stage, and the presence of a partner/spouse; (2) To assess the quality of the research on female SQoL; (3) To describe how SQoL has been measured for female cancer survivors by reviewing and identifying item gaps in existing self-report assessment tools; (4) To identify cancer-specific and gender-specific concerns that researchers and physicians need to be informed about concerning women’s sexual quality of life. Using the principles of systematic literature review, we will undertake a thorough search of the published and unpublished literature. SQoL is broadly defined to include sexual function and dysfunction, sexual satisfaction, and sexual health. Each eligible study in the sample will be coded with respect to a number of features, such as the setting of the study, participants, methodology, and study quality. Coding procedures will be rigorously developed to maintain validity and reliability. We will also systematically analyze approximately 75 assessment tools on the item, subscale, and scale levels to document item gaps, i.e., a significant oversight in content. Our analysis will include, but go beyond, traditional psychometric assessments of reliability and validity. Using a systematic coding system that we have developed and piloted, we will code item content in order to evaluate how the domain of SQoL has been addressed. The findings will provide a clear summary of the strengths and weaknesses of available measures and items used to assess SQoL among female cancer survivors.

Expressive Writing & Adjustment to Colorectal Cancer
Steve Lepore, Ph.D., Temple University, Co-PI 
Julie Pranikoff, M.A., Project Director
Funded by an R21 grant from NCI.
Expressive writing is a theory-driven behavioral medicine intervention that is designed to enhance health and well-being through increased cognitive and emotional processing of traumatic events. Many studies have shown the health benefits of expressive writing in relatively healthy, non-clinical populations writing under highly controlled laboratory conditions. A few pilot studies have provided suggestive evidence of benefits of expressive writing on adjustment to cancer, but most of these studies have had less than ideal designs. The proposed study aims to: (1) Determine the feasibility of applying a brief, inexpensive expressive writing intervention to individuals recently treated for CRC; (2) Identify demographic and psychosocial factors that influence feasibility; (3) Determine the potential efficacy of expressive writing for improving a range of healthrelated quality of life outcomes (e.g., depressive symptoms, physical functioning and symptoms, social-emotional growth); and (4) Identify demographic and psychosocial factors that may influence the efficacy of the writing intervention. We will use a three-group, pre-post design, in which 183 women and men recently treated for Stage l-lll colon or rectal cancer will be randomly assigned to one of three conditions: expressive writing, control writing, or no writing. Data will be collected through structured, face-to-face interviews conducted shortly before the writing intervention and again at one and three months after the intervention. Primary outcomes include feasibility indicators (e.g., accrual and retention rates, acceptability of procedures, and adherence to writing instructions) and quality of life variables (general and cancer-specific, psychological depression, and social-emotional growth). Moderator variables include psychosocial variables (e.g., social constraints, intrusive thoughts) as well as socio-demographic and medical factors. Moderator analyses will focus on exploring who benefits from expressive writing and why. For instance, we predict that expressive writing will be most beneficial for people with CRC who: (a) have inadequate social support, or who feel constrained in discussing their cancer with others, and (b) have intrusive thoughts about their cancer, because the safe emotional expression of writing should buffer them from the negative effects of such unbidden thoughts on quality of life outcomes.

FEARS OF RECURRENCE , COPING  AND PSYCHOSOCIAL ADJUSTMENT AMONG LONG-TERM BREAST CANCER SURVIVORS
Ronni Greenwood, Ph.D., University of Dundee, Project Director.
One difficulty that appears to be shared by many women who are living with breast cancer is the fear of recurrence.  These fears, unlike overall psychological distress, do not necessarily lessen over time.  However, for many women, remaining cancer-free for five years after initial treatment is a major milestone: the five-year survival rate for localized breast cancer is 97% (9).  Thus, cognitions and emotions about cancer recurrence, as well as strategies used to cope with these fears may change at this time.  As fears are cognitive representations of future threats to well-being, can cognitive coping strategies minimize these fears and increase psychological adjustment both before and after the 5-year milestone?  A number of studies have examined coping with breast cancer but none have focused on how women cope with fears about recurrence in particular.  The specific aims of the study are threefold: 1) to investigate whether fears posed by the possibility of recurrence of breast cancer persist or diminish over the five years post-treatment, and how fears of recurrence changes as a function of time, age, and medical factors (e.g., type of initial treatment, additional adjuvant treatments); 2) to examine how breast cancer survivors cope with fears of recurrence, and how coping strategies change as a function of time, age, and medical factors; and 3) to examine if cognitive, behavioral and emotional modes of coping can predict long-term adjustment to breast cancer. Data were collected by questionnaire data from 169 women at 1-6 years post-diagnosis and then again 1 year later and 3 years later.

Personality and Physiological Predictors of Mental and Physical Health Symptoms in the Aftermath of 9-11
Stephen Lepore, Ph.D., Co-Investigator
Peter Weston, Ph.D., Co-Investigator
Bill Cross, Ph.D., Co-Investigator
 The major goal of this study is to determine if stable, physiological measures of reactivity and personality dispositions such as anger and ethnic identity predict the degree to which persons experience psychological distress and symptoms of post-traumatic stress disorder in response to the terrorist attacks in New York City.  A prominent, though not widely tested, theory in the fields of behavioral and psychosomatic medicine is that individual differences in reactivity to stress can account for variation in mental and physical health following exposure to stress.  Thus, among persons who were high reactors prior to the disaster—those persons who exhibited exaggerated stress responses in a controlled laboratory setting before 9-11—we expect an exponential degree of emotional and somatic problems, as well as symptoms of PTSD in the months following the terrorist attacks.