Search

Online interventions that elicit kindness may enhance well-being. We tested the efficacy of three kindness interventions among breast cancer survivors. Participants (N = 137, M age = 62.65 years) were randomized to perform acts of kindness for others, acts of kindness for self, self-kindness meditation, or a daily-activities-writing control and completed three activities each week for 4 weeks. Primary (well-being, depressive symptoms) and secondary outcomes (social support, self-kindness) were assessed pre- and post-intervention. No differences emerged in the primary outcomes. However, relative to controls, participants in the acts of kindness to others condition reported greater increases in social support, and participants in the self-kindness meditation condition reported greater decreases in self-kindness. Among breast cancer survivors, performing prosocial acts may enhance feelings of social support. The two self-kindness conditions yielded either null or detrimental effects, suggesting that further research is needed on best practices for conducting self-focused kindness interventions.

Gratitude activities have been shown to increase well-being and other positive outcomes in numerous experiments to date. The current study tested whether self-directed gratitude interventions that vary by type (i.e., social vs. nonsocial) and format (i.e., long-form letters vs. shorter lists) produce differential benefits. To that end, 958 Australian adults were assigned to one of six activities to complete each day for 1 week, including five gratitude activities that varied by type and format and an active control condition (i.e., keeping track of daily activities). Regressed change analyses revealed that, overall, long-form writing exercises (i.e., essays and letters) resulted in greater subjective well-being and other positive outcomes than lists. Indeed, those who were instructed to write social and nonsocial gratitude lists did not differ from controls on any outcomes. However, participants who wrote unconstrained gratitude lists-that is, those who wrote about any topics they wanted-reported greater feelings of gratitude and positive affect than did controls. Finally, relative to the other gratitude conditions, participants who wrote gratitude letters to particular individuals in their lives not only showed stronger feelings of gratitude, elevation, and other positive emotions but also reported feeling more indebted. This study demonstrates that not only does gratitude "work" to boost well-being relative to an active neutral activity, but that some forms of gratitude may be more effective than others. We hope these findings help scholars and practitioners to develop, tailor, implement, and scale future gratitude-based interventions.Supplementary informationThe online version contains supplementary material available at 10.1007/s42761-022-00160-3.

Numerous investigations to date have established the benefits of expressing gratitude for improved psychological well-being and interpersonal relationships. Nevertheless, the social dynamics of gratitude remain understudied. Do the effects of gratitude differ when it is expressed privately, communicated directly to the benefactor one-to-one, or shared publicly? We tested this question in a preregistered intervention study. An ethnically and economically diverse sample of undergraduate students (N = 916) was randomly assigned to 1 of 4 conditions: (1) write gratitude letters and do not share them (private gratitude), (2) share gratitude one-to-one with benefactors via text (1-to-1 gratitude), (3) share gratitude publicly on social media (public gratitude), or (4) track daily activities (control). Participants were asked to complete their assigned activity four times with different people (as applicable) over the course of about a week. Overall, participants assigned to any digital gratitude intervention experienced improvements in state gratitude, positive emotions, negative emotions, elevation, connectedness, support, and loneliness, relative to controls. Relative to all other conditions, participants assigned to text their benefactors showed the biggest boosts in social connectedness and support. Our findings show that easily scalable digital gratitude interventions can advance the well-being of young college students.Supplementary informationThe online version contains supplementary material available at 10.1007/s42761-022-00150-5.

BackgroundExtremely preterm (EPT) birth has been related to dysregulation of stress responses and behavioral/learning problems at school age. Early adverse experiences can blunt HPA axis reactivity. We hypothesized that an attenuated cortisol awakening response would be associated with developmental and behavioral problems at school age in EPT children.MethodsThis secondary analysis of a sub-cohort of the SUPPORT study included children born between 24 and 27 weeks, evaluated at 6-7 years with a neurodevelopmental battery and cortisol measures. Differences were tested between EPT and a term-born group. Relationships of cortisol awakening response to test scores were analyzed.ResultsCortisol was measured in 110 EPT and 29 term-born 6-7 year olds. Unadjusted WISC-IV and NEPSY-II scores were significantly worse among EPT children only. Conners Parent Rating Scale behavior scores were significantly worse among EPT children. After adjusting for covariates, blunted cortisol awakening responses were found to be associated with poorer scores on memory tests and greater problems with inattention for the EPT group (p

Many people believe that “living happily ever after” involves finding a romantic partner. Regardless, it seems obvious that at least some single people are happier than some coupled people. But how likely is it, and what factors predict whether singles will be as happy as their coupled peers? The present paper addressed these questions via a secondary analysis of an existing cross-sectional dataset (N = 2,000) of coupled (n = 1,438) and single (n = 562) adults. We identified 10 candidate predictors of life satisfaction, seven of which were significant in multiple regression models. Using the seven significant predictors as indicators in latent profile analysis (LPA), we identified four distinct profiles (or groups) of coupled adults and six distinct profiles of single adults. We then further conceptualized these profiles in terms of interpersonal indicators (friend satisfaction, closest friend intimacy, family satisfaction, and romantic satisfaction) and intrapersonal indicators (self-esteem, perceived stress, and physical health). Some profiles had very favorable levels of interpersonal and intrapersonal indicators and some had very unfavorable levels, while several profiles fell in between the two extremes with a range of nuances. Overall, people with favorable levels were happier than those with unfavorable levels—regardless of their relationship status, but disadvantages in one area (e.g., self-esteem) could be offset by advantages in another area (e.g., friendship satisfaction). Most importantly, in comparing single and coupled profiles directly, we found that the vast majority of single adults follow a range of life satisfaction patterns (from happy to unhappy) that is nearly identical to that of their coupled peers.

Cross-sectional, longitudinal, and experimental research demonstrates that subjective well-being (e.g., positive emotions, life satisfaction) relates to, precedes, and leads to employee success on numerous work-related outcomes. We extend these findings by considering how organizations might improve worker well-being. Accordingly, we propose the Worker Well-Being Continuous Improvement Framework with three phases: (1) an initial phase with a pretest assessment of worker well-being; (2) a test phase, where a specific positive change to improve worker well-being is implemented; and (3) a concluding phase that administers a posttest assessment to examine the effectiveness of the change. We also discuss three important considerations to address when implementing the framework: (1) measuring employee well-being, (2) building thriving work cultures, and (3) deploying positive activity interventions. Consequently, organizations can rapidly test evidence-based practices to select the most relevant and effective positive changes for their employees.

In homage to the life and work of Ed Diener (1946–2021), the present study assessed the dimensions of the tripartite model (positive affect, negative affect, and life satisfaction) and two additional dimensions (domain satisfaction and happiness) to investigate the structure of subjective well-being using exploratory factor analysis and the bifactor model. Specifically, we tested whether these five dimensions belong to an essentially unidimensional subjective well-being construct. Towards this goal, we used a large, previously collected dataset closely matched to the U.S. census (N = 2,000, ages 18–65+ ; 52.4% female; 66.3% White; 14.9% Hispanic; 12% Black) and selected 24 items representing the five dimensions. Our results showed that all 24 items were internally consistent and highly correlated. Exploratory factor analyses revealed there were five underlying factors best characterizing the data. When fit to the bifactor model, a strong underlying general subjective well-being factor emerged. Additionally, general factor scores were highly reliable according to conventional reliability standards. A confirmatory factor analysis also supported the bifactor structure of subjective well-being. Overall, our findings suggest all 24 items from the five dimensions reflect one essentially unidimensional construct, which can be combined into a single subjective well-being score. Domain satisfaction and subjective happiness both belong to subjective well-being in the same way that the original three dimensions of life satisfaction, negative affect, and positive affect do.

ObjectiveProsocial behavior has been linked to improved physical health, but the biological mechanisms involved remain unclear. This study tested whether a 4-week kindness intervention could reduce expression of a stress-related immune response gene signature known as the Conserved Transcriptional Response to Adversity (CTRA).MethodsIn a diverse sample of community adults (N = 182), study participants were randomly assigned to perform 3 kind acts for other people, to perform 3 kind acts for themselves, or to list daily activities (control), on one day per week over 4 weeks. CTRA gene expression was measured by RNA sequencing of dried blood spots (DBS) collected at baseline and 5 weeks later (1 week after completing study assignments). Participants' descriptions of their kind acts were coded for protocol adherence and act content.ResultsParticipants who were randomized to perform kind acts for others showed significant reductions in CTRA gene expression relative to controls. Participants who were randomized to perform kind acts for themselves also showed significant reductions in CTRA gene expression relative to controls, but this pattern emerged only for those who failed to perform the requested self-kind acts (protocol non-adherent). Those who fully adhered to the self-kindness protocol showed no change in CTRA gene expression and did not differ from controls. Act content analyses implicated self-stress-reducing behavior in the paradoxical effects of self-kindness and the physical presence of others in the effects of prosocial behavior.ConclusionsProsocial engagement-doing something kind for others rather than oneself-reduces CTRA gene expression. The nature of kind acts and their intended recipient plays a key role in shaping the genomic impact of kindness.

The quality of individuals’ social relationships consistently predicts greater well-being. But little is known about the relative importance of different relationship types for life satisfaction, including the relative importance of friendships compared to other types of relationships. Some have theorized that one intimate relationship is all you need. However, romantic partners, family, and friends may contribute uniquely or interactively to well-being. The current study assessed life satisfaction and relationship satisfaction in survey data collected from a large, diverse sample of respondents. Satisfaction with each type of relationship was significantly and independently associated with life satisfaction, over and above other variables in the model. Friendship (not family) interacted with intimate relationships: when respondents were highly satisfied with their intimate relationships, they were happy with their lives regardless of friendship quality. But when they were unhappy with their intimate relationships, they were only happy with their lives if they had good friends.

Could 10 min of gratitude per week have the potential to change the trajectories of young students' lives? With over 1,000 ninth- and tenth-grade students, we tested whether a simple 4-week classroom-based gratitude intervention would prompt increases in well-being and motivate students to become better people and attain better grades. Over the course of 1 month, students were assigned to spend 10 min each week writing gratitude letters to their parents, teachers, coaches, or friends and completing additional gratitude-related reflection activities or to try to become more organized each week by listing their daily activities and reflecting on the obstacles and benefits (control). Importantly, relative to controls, students in the gratitude conditions reported greater LS and motivation to improve themselves and maintained these levels throughout the semester. This sustained self-improvement motivation and LS were partially mediated by increases in feelings of connectedness, elevation, and indebtedness. Interestingly, negative affect partially mediated the effect of gratitude on LS, but not on improvement motivation. No group differences emerged in academic performance over time. This study provides evidence that expressing gratitude and reflecting on their benefactors' actions may help keep high school students motivated and satisfied with their lives over the course of a semester. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Gratitude science often conflates the processes of actors recalling and sharing gratitude, as well as neglecting to study targets (benefactors receiving gratitude) and witnesses (those witnessing gratitude). We explored the roles (actors, targets, and witnesses) and processes (recalling, sharing, receiving, and witnessing) involved in gratitude exchanges. In Study 1, undergraduate students (actors; N = 369) wrote letters about either gratitude or daily activities to their parents (targets; N = 247), with half instructed to share their letters with their parents, and half not to share. In Study 2, adolescents (witnesses; N = 267) read either gratitude, positive, or neutral letters written by hypothetical peers addressed to benefactors. Actors recalling gratitude showed improvements in state gratitude, mood, and satisfaction (partial rs = .11 to.15; Study 1); actors sharing gratitude experienced boosts in state gratitude and relationship closeness (rs = .13 to.19; Study 1); targets receiving gratitude demonstrated increases in state gratitude, indebtedness, and elevation (rs = .14 to.16; Study 1); and witnesses observing gratitude reported increased positive affect and elevation (rs =.24), but decreased state gratitude (r = −.12; Study 2). These studies provide initial evidence that different gratitude roles and processes have divergent effects.

Immune checkpoint inhibitor-associated colitis (ICIC) affects approximately 15% of cancer patients treated with immunotherapy. Although histological evaluation is potentially valuable for both the diagnosis of ICIC and evaluation of disease activity, use in clinical practice is heterogeneous. We aimed to develop expert recommendations to standardize histological assessment of disease activity in patients with ICIC. Using the modified Research and Development/University of California Los Angeles (RAND/UCLA) appropriateness methodology, an international panel of 11 pathologists rated the appropriateness of 99 statements on a 9-point Likert scale during two rounds of anonymous voting. Results were discussed between rounds using moderated videoconferences. There are currently no disease-specific instruments for assessing histological features of ICIC. The panel considered that colonoscopy with at least three biopsies per segment from a total of at least five segments, including both endoscopically normal and inflamed areas, was appropriate for tissue acquisition. They agreed that biopsies should be oriented such that the long axis of the colonic crypts is visualized and should be stained with hematoxylin and eosin. Histological items that the panel voted were appropriate to evaluate in ICIC included the degree of structural/architectural change, chronic inflammatory infiltrate, lamina propria and intraepithelial neutrophils, crypt abscesses and destruction, erosions/ulcerations, apoptosis, surface intraepithelial lymphocytosis, and subepithelial collagen thickness. The appropriateness of routine immunohistochemistry was uncertain. These expert recommendations will help standardize assessment of histological activity in patients with ICIC. The panel also identified the development and validation of an ICIC-specific histological index as a research priority.

Singles are an understudied yet growing segment of the adult population. The current study aims to expand the lens of relationship science by examining the well-being of unpartnered, single adults using latent profile analysis. We recruited singles (N = 4,835) closely matched to the United States census (ages 18-65; 57.5% female; 71.1% White; 14.5% Black; 13.8% Hispanic) for an exploratory cross-sectional survey using five variables that strongly predict well-being (friendship satisfaction, family satisfaction, self-esteem, neuroticism, and extraversion). All five variables significantly predicted life satisfaction for the full sample. Latent profile analyses detected 10 groups (or profiles) of singles. Half of the profiles were happy (above the full sample mean of life satisfaction) and half of the profiles were unhappy (below the mean). Each profile had its own unique patterns relating to personal relationships, self-esteem, and personality traits. The happiest profile had the best relationships, self-esteem, and personality, while the unhappiest profile had the worst relationships, self-esteem, and personality. The profiles in between these two extremes had more nuanced patterns. For example, one relatively happy profile in the middle had high friendship satisfaction but low family satisfaction, while an adjacent profile showed the opposite pattern. Overall, singles who had positive relationships-both with themselves and others-were happiest.

Although gratitude is typically conceptualized as a positive emotion, it may also induce socially oriented negative feelings, such as indebtedness and guilt. Given its mixed emotional experience, we argue that gratitude motivates people to improve themselves in important life domains. Two single-timepoint studies tested the immediate emotional and motivational effects of expressing gratitude. We recruited employees (n = 224) from French companies in Study 1 and students (n = 1026) from U.S. high schools in Study 2. Participants in both studies were randomly assigned to either write gratitude letters to benefactors or outline their weekly activities (control condition). Expressing gratitude led to mixed emotional experiences (e.g., greater elevation and indebtedness) for employees and students as compared with the control group. Students also felt more motivated and capable of improving themselves, as well as conveyed stronger intentions to muster effort towards self-improvement endeavors.

Purpose: The purpose of this study was to determine the prevalence of self-reported hearing loss and associated risk factors in a representative population-based study of Wisconsin residents. Method: Survey of the Health of Wisconsin participants with data on self-reported hearing loss were included. We reported prevalence of self-reported hearing loss with corresponding 95% confidence intervals (CIs), overall, and stratified by age and sex. Age- and sex-adjusted and multivariable logistic regression models were used to evaluate determinants of self-reported hearing loss, and results are presented as odds ratios with corresponding 95% CIs. Results: There were 2,767 participants (50.7% men) with a mean age of 46 years (range: 21--74) in this study. Prevalence of self-reported hearing loss was 26.8% (24.4, 28.4) and was higher in men (30.3% [27.1, 33.4]) than in women (22.5% [19.9, 25.0]). Prevalence increased with age. After multivariable adjustment, age (per +1 year increase; 1.05 [1.04, 1.06]), male sex (1.57 [1.18, 2.08]), having two chronic diseases (vs. 0; 1.93 [1.16, 3.23]), occupational (2.47 [1.91, 3.19]) and recreational (1.58 [1.22, 2.04]) noise exposure, and poor diet (1.88 [1.28, 2.78]) were associated with higher odds of self-reported hearing loss. Conclusions: Hearing loss is a highly prevalent public health concern and may be at least partially modifiable via interventions to reduce noise exposure and promote health. Statewide prevalence and risk factor data can be used to inform public health practice and promote hearing loss prevention.

ObjectiveThe aim of this study was to determine which initial surgical treatment results in the lowest rate of death or neurodevelopmental impairment (NDI) in premature infants with necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP).Summary background dataThe impact of initial laparotomy versus peritoneal drainage for NEC or IP on the rate of death or NDI in extremely low birth weight infants is unknown.MethodsWe conducted the largest feasible randomized trial in 20 US centers, comparing initial laparotomy versus peritoneal drainage. The primary outcome was a composite of death or NDI at 18 to 22 months corrected age, analyzed using prespecified frequentist and Bayesian approaches.ResultsOf 992 eligible infants, 310 were randomized and 96% had primary outcome assessed. Death or NDI occurred in 69% of infants in the laparotomy group versus 70% with drainage [adjusted relative risk (aRR) 1.0; 95% confidence interval (CI): 0.87-1.14]. A preplanned analysis identified an interaction between preoperative diagnosis and treatment group (P = 0.03). With a preoperative diagnosis of NEC, death or NDI occurred in 69% after laparotomy versus 85% with drainage (aRR 0.81; 95% CI: 0.64-1.04). The Bayesian posterior probability that laparotomy was beneficial (risk difference

ObjectiveTo compare in-hospital outcomes after umbilical cord milking vs delayed cord clamping among infants

ObjectiveTo determine the association of persistent pulmonary hypertension of the newborn (PPHN) with death or disability among infants with moderate or severe hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia.MethodsWe compared infants with and without PPHN enrolled in the hypothermia arm from three randomized controlled trials (RCTs): Induced Hypothermia trial, "usual care" arm of Optimizing Cooling trial, and Late Hypothermia trial. Primary outcome was death or disability at 18-22 months adjusted for severity of HIE, center, and RCT.ResultsAmong 280 infants, 67 (24%) were diagnosed with PPHN. Among infants with and without PPHN, death or disability was 47% vs. 29% (adjusted OR: 1.65, 0.86-3.14) and death was 26% vs. 12% (adjusted OR: 2.04, 0.92-4.53), respectively.ConclusionsPPHN in infants with moderate or severe HIE was not associated with a statistically significant increase in primary outcome. These results should be interpreted with caution given the limited sample size.

Recent theory suggests that members of interdependent (collectivist) cultures prioritize in-group happiness, whereas members of independent (individualist) cultures prioritize personal happiness (Uchida et al. Journal of Happiness Studies, 5(3), 223-239 Uchida et al., 2004). Thus, the well-being of friends and family may contribute more to the emotional experience of individuals with collectivist rather than individualist identities. We tested this hypothesis by asking participants to recall a kind act they had done to benefit either close others (e.g., family members) or distant others (e.g., strangers). Study 1 primed collectivist and individualist cultural identities by asking bicultural undergraduates (N = 357) from Hong Kong to recall kindnesses towards close versus distant others in both English and Chinese, while Study 2 compared university students in the USA (n = 106) and Hong Kong (n = 93). In Study 1, after being primed with the Chinese language (but not after being primed with English), participants reported significantly improved affect valence after recalling kind acts towards friends and family than after recalling kind acts towards strangers. Extending this result, in Study 2, respondents from Hong Kong (but not the USA) who recalled kind acts towards friends and family showed higher positive affect than those who recalled kind acts towards strangers. These findings suggest that people with collectivist cultural identities may have relatively more positive and less negative emotional experiences when they focus on prosocial interactions with close rather than weak ties.Supplementary informationThe online version contains supplementary material available at 10.1007/s42761-020-00029-3.

BackgroundMalhi et al. in this issue critique the clinical high risk (CHR) syndrome for psychosis.MethodResponse to points of critique.ResultsWe agree that inconsistency in CHR nomenclature should be minimized. We respectfully disagree on other points. In our view: a) individuals with CHR and their families need help, using existing interventions, even though we do not yet fully understand disease mechanisms; b) substantial progress has been made in identification of biomarkers; c) symptoms used to identify CHR are specific to psychotic illnesses; d) CHR diagnosis is not "extremely difficult"; e) the pattern of progression, although heterogenous, is discernible; f) "psychosis-like symptoms" are common but are not used to identify CHR; and g) on the point described as 'the real risk,' CHR diagnosis does not frequently cause harmful stigma.DiscussionMalhi et al.'s arguments do not fairly characterize progress in the CHR field nor efforts to minimize stigma. That said, much work remains in areas of consistent nomenclature, mechanisms of disease, dissecting heterogeneity, and biomarkers. With regard to what the authors term the "real risk" of stigma associated with a CHR "label," however, our view is that avoiding words like "risk" and "psychosis" reinforces the stigma that both they and we mean to oppose. Moreover, patients and their families benefit from being given a term that describes what is happening to them.

ObjectiveTo compare short-term outcomes after placental transfusion (delayed cord clamping (DCC) or umbilical cord milking (UCM)) versus immediate cord clamping among extremely preterm infants.DesignRetrospective study.SettingThe Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network registry.PatientsInfants born

Digital education is intertwined with matters of global economics, geopolitics, as well as ongoing changes in what counts as knowledge, skills and learning. We have witnessed throughout the COVID-19 pandemic how technology has been embraced within education from online classes to innovative mobile learning approaches and evaluating humanoid robots in education is the next step. Driven by a need to keep pace with the evolving techno- and socio-economic requirements, schools and society are increasingly adopting artificial intelligence (AI) and robots in their daily activity. This paper presents a feasibility case study in digital health education where a humanoid robot was chosen to teach based on its form and function. With an imperative to establish a strong and sustainable learning space, the aim of this paper is to present results and learn about the future of digital health education from humanoid robots being deployed in digital health learning spaces. The paper concludes by highlighting key design challenges in unbundling educational approaches in the context of humanoid robots. It is intended that the outcomes of this paper will extend beyond the COVID-19 pandemic by contributing to the humanoid robot technology discussion that will push towards more futuristic artificial intelligence in and for education.

Objective: Prosocial behavior can improve psychological well-being and physical health. However, the underlying biological mechanisms that mediate the relationship between prosociality and health remain unclear. In this pre-registered experiment, we tested whether a 4-week kindness intervention could slow leukocyte telomere shortening and increase well-being. Methods: Community adults (N = 230) were randomly assigned to complete 1 of 3 activities, each week for 4 weeks: to perform 3 kind acts for other people, to perform 3 kind acts for themselves, or to list daily activities. At baseline and post-intervention, participants came to the lab to provide a small dried blood spot (DBS) sample via finger prick for analysis of telomere length. Participants completed psychological measures (e.g., loneliness, life satisfaction) at baseline, post-intervention, and at the 2-week follow up.Results: Participants who performed kind acts for others did not demonstrate hypothesized changes in telomere length, nor in well-being, relative to controls. Exploratory analyses revealed that, relative to controls, participants who did kind acts for others showed reductions in loneliness through the 2-week follow up. Conclusions: The salubrious effects of prosocial behavior in the short term are not likely due to the inhibition of cellular aging (at least as indexed by telomere length). However, extending kindness to others holds promise as a plausible intervention to alleviate the public health crisis of loneliness.

Could 10 min of gratitude per week have the potential to change the trajectories of young students' lives? With over 1,000 ninth- and tenth-grade students, we tested whether a simple 4-week classroom-based gratitude intervention would prompt increases in well-being and motivate students to become better people and attain better grades. Over the course of 1 month, students were assigned to spend 10 min each week writing gratitude letters to their parents, teachers, coaches, or friends and completing additional gratitude-related reflection activities or to try to become more organized each week by listing their daily activities and reflecting on the obstacles and benefits (control). Importantly, relative to controls, students in the gratitude conditions reported greater LS and motivation to improve themselves and maintained these levels throughout the semester. This sustained self-improvement motivation and LS were partially mediated by increases in feelings of connectedness, elevation, and indebtedness. Interestingly, negative affect partially mediated the effect of gratitude on LS, but not on improvement motivation. No group differences emerged in academic performance over time. This study provides evidence that expressing gratitude and reflecting on their benefactors' actions may help keep high school students motivated and satisfied with their lives over the course of a semester. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background: Health educators and advocacy groups often use side-by-side visual images to communicate about equity and to distinguish it from equality. Despite the near-ubiquity of these images, little is known about how they are understood by different audiences. Aims: To assess the effectiveness of an image commonly used to communicate about health equity. Method: In 167 interviews with health stakeholders in Greater Cleveland, Ohio, in 2018 to 2019, a commonly used health equity image was shown to participants, who were asked to interpret its meaning. Interviewees included 21 health professionals, 21 clinicians, 22 metro-wide decision makers, 24 community leaders, and 79 community members. Results: About two thirds of our socioeconomically, racial/ethnically, educationally, and professionally diverse sample said the equity image helped clarify the distinction between "equality" and "equity." Yet less than one third offered an interpretation consistent with the image's goals of foregrounding not only injustice but also a need for systemic change. Patterns of misinterpretation were especially common among two groups: ideological conservatives and those of lower socioeconomic status. Conservatives were most likely to object to the image's message. Conclusions: Equity images are widely used by public health educators and advocates, yet they do not consistently communicate the message that achieving equity requires systemic change. In this moment of both public health crisis and urgent concern about systemic racism, new visual tools for communicating this crucial message are needed.

ObjectivesThe objectives describe the frequency that inadequate oral feeding (IOF) is the reason why moderately preterm (MPT) infants remain hospitalized and its association with neonatal morbidities.Study designProspective study using the NICHD Neonatal Research Network MPT Registry. Multivariable logistic regression was used to describe associations between IOF and continued hospitalization at 36 weeks postmenstrual age (PMA).ResultA total of 6017 MPT infants from 18 centers were included. Three-thousand three-seventy-six (56%) remained hospitalized at 36 weeks PMA, of whom 1262 (37%) remained hospitalized due to IOF. IOF was associated with RDS (OR 2.02, 1.66-2.46), PDA (OR 1.86, 1.37-2.52), sepsis (OR 2.36, 95% 1.48-3.78), NEC (OR 16.14, 7.27-35.90), and BPD (OR 3.65, 2.56-5.21) compared to infants discharged and was associated with medical NEC (OR 2.06, 1.19-3.56) and BPD (OR 0.46, 0.34-0.61) compared to infants remaining hospitalized for an alternative reason.ConclusionIOF is the most common barrier to discharge in MPT infants, especially among those with neonatal morbidities.

A worrisome period of uncertainty frequently precedes important life events, and many of the coping strategies people employ during such waiting periods are ineffective. Distraction can be efficacious, but individuals awaiting uncertain news often fail to lose themselves in a sufficiently diverting activity. Across three studies-two observational and one experimental-we test whether flow-inducing activities provide a better distraction and improve the waiting experience. In Study 1, law graduates (N = 125) who experienced more flow while awaiting their bar exam results reported less worry, fewer negative emotions, and more positive emotions. However, they were often unable to accurately identify personally relevant flow-inducing activities. Study 2 replicated these findings in a longitudinal study of doctoral-level students in the academic job market (N = 141). Study 3 experimentally tested the effects of engaging in a flow activity (via an adaptive Tetris game) on undergraduate participants (N = 309) waiting for peers to rate their physical attractiveness. Study 3 successfully replicated the findings of Studies 1 and 2 with a measure of subjective flow experiences, but the manipulation was only effective for bolstering positive emotion and mitigating negative emotions; it did not reduce worry. Our findings point to challenges in moving people toward flow but suggest that engaging in flow may boost well-being during a period of uncertainty and make waiting a little easier. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

ObjectiveTo describe discordance in antenatal corticosteroid use and resuscitation following extremely preterm birth and its relationship with infant survival and neurodevelopment.Study designA multicenter cohort study of 4858 infants 22-26 weeks of gestation born 2006-2011 at 24 US hospitals participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, with follow-up through 2013. Survival and neurodevelopmental outcomes were available at 18-22 months of corrected age for 4576 (94.2%) infants. We described antenatal interventions, resuscitation, and infant outcomes. We modeled the effect on infant outcomes of each hospital increasing antenatal corticosteroid exposure for resuscitated infants born at 22-24 weeks of gestation to rates observed at 25-26 weeks of gestation.ResultsDiscordant antenatal corticosteroid use and resuscitation, where one and not the other occurred, were more frequent for births at 22 and 23 but not 24 weeks (rate ratio [95% CI] at 22 weeks: 1.7 [1.3-2.2]; 23 weeks: 2.6 [2.2-3.2]; 24 weeks: 1.0 [0.8-1.2]) when compared with 25-26 weeks. Among infants resuscitated at 23 weeks, adjusting each hospital's rate of antenatal corticosteroid use to the average at 25-26 weeks (89.2%) was projected to increase infant survival by 7.1% (95% CI 5.4-8.8%) and survival without severe impairment by 6.4% (95% CI 4.7-8.1%). No significant change in outcomes was projected for infants resuscitated at 22 weeks, where few (n = 22) resuscitated infants received antenatal corticosteroids.ConclusionsInfants born at 23 weeks were more frequently resuscitated without antenatal corticosteroids than other extremely preterm infants. When resuscitation is intended, consistent provision of antenatal corticosteroids may increase infant survival and survival without impairment.Trial registrationClinicalTrials.govNCT00063063 (Generic Database) and NCT00009633 (Follow-Up Study).

Gratitude has been associated with better physical health. Yet, surprisingly little research has experimentally investigated the capacity of gratitude to motivate individuals to eat more healthfully. In Study 1, among undergraduate students (N = 327) attempting to achieve a healthy eating goal, state gratitude following a writing activity significantly predicted healthier eating behavior 1 week later. In Study 2, across a 4-week intervention, 9th and 10th grade students (N = 1017) from four high schools were randomly assigned to either write weekly gratitude letters or to list their daily activities each week (control). Teens who expressed gratitude reported healthier eating behavior over time, relative to controls, and this effect was partially mediated by reductions in average negative affect across the intervention period. Thus, our findings suggest that gratitude-based interventions may facilitate improvements in healthy eating behavior in adolescents and young adults.

ObjectiveTo assess whether length of hospital stay is decreased among moderately preterm infants weaned from incubator to crib at a lower vs higher weight.Study designThis trial was conducted in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants with gestational ages 29-33 weeks, birthweight