Recruitment and retention of diverse couples in relationship education with integrated economic services

Compared to higher income couples, those with low incomes experience a host of challenges and disparities in their intimate relationships, including lower levels of relationship satisfaction, higher rates of breakup of cohabiting relationships, and higher rates of divorce. In recognition of these disparities, a number of interventions targeting couples with low incomes have been developed. These interventions historically focused primarily on improving relationship skills through relationship education, but in recent years a new approach that integrates economic-focused interventions alongside relationship education has emerged. This integrated approach is intended to better address the challenges facing couples with low incomes, but the theory-driven, top-down approach to intervention development leaves open the question of whether couples with low incomes are interested in participating in a program that combines these two disparate components. The current study draws from a large randomized controlled trial of one such program (N = 879 couples) to provide descriptive information about the recruitment and retention of couples with low incomes in a study of relationship education with integrated economic services. Results indicate that it is possible to recruit a large, linguistically, and racially diverse sample of couples living with low income to participate in an integrated intervention, but the uptake of relationship-focused services was higher than the uptake of economic-focused services. Additionally, attrition over a 1-year follow-up data collection period was low but required labor-intensive efforts to reach participants for the survey. We highlight successful strategies for the recruitment and retention of diverse couples and discuss implications for future intervention efforts.

Household income differentiates quantity and quality of shared spousal time

Shared time is a centrally important component of relationship maintenance, and over the past few decades, couples have reported spending increasingly more time together. However, over this same time period divorce rates have risen much higher for lower income couples compared to higher income couples. One theorized explanation for the disparity in divorce rates between lower and higher income couples is a difference across the socioeconomic strata in the quantity and quality of time couples spend together. This theory argues that lower income couples may experience a time deficit because they face a greater number of stressors that take up time, diminishing the quantity of time they have available to spend together. They may also need to use the time they do have available to deal with stressors rather than engaging in more enjoyable activities together, diminishing the quality of time they share. Using a sample of N = 14,788 respondents from the American Time Use Survey, the present study examined whether household income was associated with the quantity and quality of time married couples spend together. Consistent with predictions, lower income couples spent less alone time together but this was moderated by weekday versus weekend and presence of children. Lower income couples also reported higher levels of stress during time spent with their spouse than higher income couples, and this association was moderated by hours worked by the couples. Results support the theory, indicating that quantity and quality of time may be important factors in understanding differences in relationship outcomes between lower and higher income couples. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Enhancing fathers' parenting through strengthening couple functioning: A randomized controlled trial of low-income couples

OBJECTIVE

High levels of father engagement are associated with better outcomes for children across a number of domains. Correlational evidence suggests that the quality of the romantic relationship between parents plays a strong role in the extent to which fathers are meaningfully involved with their children, but existing literature cannot address whether this link is causal. To address this gap, the present study leveraged data from a randomized controlled trial of a couple-focused relationship education program for low-income couples to examine whether intervention-induced improvements in couple functioning led to better fathering outcomes.

METHOD

Data were drawn from the Supporting Healthy Marriages study, in which 6,298 low-income, married couples with children were randomized to an intervention or control condition. Couple relationship functioning was assessed 12-months postrandomization, and fathering behavior across four dimensions (involvement, warmth, responsiveness, and monitoring) was assessed 30-months postrandomization.

RESULTS

Structural equation models revealed that the intervention had a significant direct effect on fathers' and mothers' couple functioning, but did not have a significant direct effect on fathering outcomes. However, the intervention did have a significant indirect effect on fathering outcomes through fathers' ratings of couple functioning, such that the intervention was associated with small positive indirect effects on fathers' involvement, warmth, responsiveness, and monitoring.

CONCLUSIONS

Intervention-derived improvements in the couple relationship led to improvements in father engagement, supporting a causal association between these variables. Couple-focused interventions may be a viable option to enhance couple functioning and (indirectly) fathers' parenting among families living with low incomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

How diverse are the samples used to study intimate relationships? A systematic review

The social and behavioral sciences have long suffered from a lack of diversity in the samples used to study a broad array of phenomena. In an attempt to move toward a more contextually-informed approach, multiple subfields have undertaken meta-science studies of the diversity and inclusion of underrepresented groups in their body of literature. The current study is a systematic review of the field of relationship science aimed at examining the state of diversity and inclusion in this field. Relationship-focused papers published in five top relationship science journals from 2014-2018 (N = 559 articles, containing 771 unique studies) were reviewed. Studies were coded for research methods (e.g., sample source, dyadic data, observational data, experimental design) and sample characteristics (e.g., age, education, income, race/ethnicity, sexual orientation). Results indicate that the modal participant in a study of romantic relationships is 30 years old, White, American, middle-class, college educated, and involved in a different-sex, same-race relationship. Additionally, only 74 studies (10%) focused on traditionally underrepresented groups (i.e., non-White, low-income, and/or sexual and gender minorities). Findings underscore the need for greater inclusion of underrepresented groups to ensure the validity and credibility of relationship science. We conclude with general recommendations for the field.

Experiencing a Natural Disaster Temporarily Boosts Relationship Satisfaction in Newlywed Couples

How do natural disasters affect intimate relationships? Some research suggests that couples are brought closer together after a disaster, whereas other research suggests that relationships become more strained in the aftermath. Yet all of this work is limited by a lack of predisaster data that would allow for examination of how relationships actually change. The current study is the first to use longitudinal data collected before and after a natural disaster to examine its effect on relationship outcomes. Using a sample of 231 married couples in Harris County, Texas, who experienced Hurricane Harvey, we found that spouses experienced significant increases in satisfaction from before to after the hurricane, but the increase was temporary; couples decreased in satisfaction after the initial boost. Thus, couples appear to grow closer in the immediate aftermath of a natural disaster but then revert to their prehurricane levels of functioning as the recovery period continues.

The development of communication behavior over the newlywed years

Communication behavior occupies a fundamental role in basic and applied relationship science, yet we know very little about how this important process develops over time, and how the natural developmental process is linked with relationship outcomes. The present study aims to examine the development of naturally occurring trajectories of couple communication behavior across three domains, examined concurrently; positive affect, negative affect, and effective problem solving. A large sample of newlywed couples recruited from low-income neighborhoods (N = 431) completed observational discussion tasks at 4 time points, spanning 2.5 years, and provided data on marital status 4.5 years into marriage. Results from multivariate group-based trajectory modeling indicate that three groups of couples can be distinguished, with the best communicators demonstrating high levels of positivity and effectiveness and low levels of negativity, the worst communicators demonstrating low levels of positivity and effectiveness and high levels of negativity, and the middle group demonstrating low levels of all three dimensions. Trajectory group membership was significantly associated with demographic and relationship characteristics, such that the best communicators had more adaptive relationship characteristics and less demographic risk. Wives' trajectory group membership was significantly associated with divorce rates such that the best communicators had the lowest divorce rate (9%), and the worst communicators had the highest divorce rate (22%). Overall, communication behavior is quite consistent over time, indicating that early interaction dynamics tend to be enduring and predictive of relationship outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Too Stressed to Help? The Effects of Stress on Noticing Partner Needs and Enacting Support

Although couples' support exchanges are especially important during times of stress, coping with stress often taxes individuals' energy and resources and may render it more difficult for partners to provide support to one another. In a daily diary study of 121 married couples, we examined whether spouses' chronic and daily non-marital stressors were associated with their capacity to accurately perceive their partner's support needs and to provide support when needed. Consistent with the notion that stress may be linked to reduced perspective-taking, husbands experiencing greater chronic stress were less accurate in their assessments of their partner's support needs across the diary days. Moreover, even when husbands did notice that their partner desired support, they were less likely to provide support if they were coping with their own stress that day. Thus, the findings highlight the multiple pathways through which stress can undermine support provision within relationships.

A Comparison of Low-Income Versus Higher-Income Individuals Seeking an Online Relationship Intervention

Compared to higher-income couples, low-income couples experience higher rates of relationship disruption, including divorce and breakup of cohabiting relationships. In recognition of this disparity in relationship outcomes, relationship interventions have increasingly been targeted at this population. However, these interventions have had limited impacts on the relationships of low-income couples. Developing interventions that are effective and responsive to the needs of low-income couples requires descriptive data on the challenges those couples perceive in their own relationships and an assessment of how their needs compare to the more affluent couples typically served by relationship interventions. The current study sampled over 5,000 individuals at the time they were seeking an online relationship intervention and compared the relationship functioning and life circumstances reported by low-income individuals to that of higher-income individuals. Results indicate that low-income individuals seeking a relationship intervention had higher levels of relationship distress (lower relationship satisfaction, more intense primary relationship problems, and less relationship stability), and had greater levels of contextual stress (more children living at home, less likely to be employed full-time, and lower levels of perceived health). Results suggest that future interventions designed to target low-income couples, as well as practitioners working with low-income couples, should be prepared to handle higher levels of relationship distress and contextual stressors than they may typically see in more affluent couples.

Early Effects of the COVID-19 Pandemic on Relationship Satisfaction and Attributions

How has the COVID-19 pandemic affected intimate relationships? The existing literature is mixed on the effect of major external stressors on couple relationships, and little is known about the early experience of crises. The current study used 654 individuals involved in a relationship who provided data immediately before the onset of the pandemic (December, 2019) and twice during the early stages of the pandemic (March and April, 2020). Results indicate that relationship satisfaction and causal attributions did not change over time, but responsibility attributions decreased on average. Changes in relationship outcomes were not moderated by demographic characteristics or negative repercussions of the pandemic. There were small moderation effects of relationship coping and conflict during the pandemic, revealing that satisfaction increased and maladaptive attributions decreased in couples with more positive functioning, and satisfaction decreased and maladaptive attributions increased in couples with lower functioning.

Trajectories of Marital Satisfaction in Diverse Newlywed Couples

Couples' marital satisfaction is thought to decline over the newlywed years, but recent research indicates that the majority of spouses have high, stable trajectories during this period and significant declines occur only among initially dissatisfied spouses. These findings are drawn from predominantly White, middle-class samples, however, which may over-estimate marital stability compared to samples with higher levels of sociodemographic risk. Accordingly, the current study tested the generalizability of newlyweds' marital stability by examining satisfaction trajectories among 431 ethnically diverse newlywed couples living in low-income neighborhoods. Consistent with previous work, most spouses had high levels of satisfaction, substantial declines were limited to spouses with lower initial levels of satisfaction, and divorce significantly differed between groups. Wives with higher levels of sociodemographic risk started marriage less satisfied and declined more in satisfaction. Overall, these findings reveal risky and resilient relationships among disadvantaged couples, with considerable stability during the newlywed years.

Premarital parenthood and newlyweds' marital trajectories

An increasing number of couples in the United States are entering their first marriage having already had a child together, raising important questions about whether and how these couples' marriages differ from newlywed couples who enter marriage without children. The current study used 5 waves of data collected over the first 4.5 years of marriage from a sample of ethnically diverse, first-married newlywed couples living with low incomes to examine the effects of premarital parenthood on couples' self-reported satisfaction, observed communication, and marital dissolution over time. Among couples who entered marriage with a shared biological child (premarital parents), satisfaction levels were lower and communication was less effective, less positive, and more negative than couples entering marriage without children. Rates of change in marital functioning did not differ between groups, but the rate of marital dissolution was twice as high among premarital parents (19.1%) relative to couples who were not parents at the start of marriage (9.5%). These between-groups differences remained robust after controlling for several demographic differences (race, age, education, household income, work status, relationship length, premarital cohabitation), and initial differences in communication did not account for between-groups differences in marital satisfaction or dissolution. Together, these findings indicate that newlywed marriage unfolds in similar ways for low-income couples with and without children at the start of marriage, but couples raising children at the time of marriage have greater vulnerability to marital distress and dissolution. Further research is needed to characterize this risk and how interventions can offset it. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Barriers and facilitators of relationship help-seeking among low-income couples

Despite being at elevated risk for relationship distress and dissolution, couples living with low incomes are less likely than their middle-class counterparts to participate in couple therapy. To increase treatment use among economically disadvantaged couples, information is needed on how they perceive barriers to treatment and on factors that might facilitate their help-seeking. The first aim of the present study was to identify the prevalence of attitudinal, structural, and relational barriers to seeking therapy for the relationship among individuals who perceived a need for help with their relationship. The second aim was to test whether having direct experience with a relationship intervention (through receipt of premarital education) or indirect experience (by having a social network member who has received couple therapy) is associated with reduced barriers and greater use of therapy for the relationship. Using self-report data from 231 ethnically diverse newlywed couples living in low-income neighborhoods, we find that men and women identify cost and uncertainty about where to go for help as their top two barriers to seeking therapy for the relationship, followed by the partner not wanting therapy (for women) and the belief that individual counseling would be more helpful than couple therapy (for men). Direct and indirect experiences with relationship interventions was associated with increased likelihood that couples sought therapy for the relationship. These results suggest specific directions that can be taken to improve the accessibility of interventions, thereby providing low income couples with resources that might enhance their relationship. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Premarital education and later relationship help-seeking

Despite evidence that empirically supported couple therapies improve marital relationships, relatively few couples seek help when they need it. Low-income couples are particularly unlikely to engage in relationship interventions despite being at greater risk for distress and dissolution than their higher-income counterparts. The present study aimed to clarify how premarital education influences couples' progression through different stages of later help-seeking, as identified in prior research. Using 5 waves of self-report data from a sample of 431 ethnically diverse newlywed couples living in low-income neighborhoods, analyses revealed that wives who received premarital education later considered seeking therapy at a higher level of relationship satisfaction and lower level of problem severity than those who did not receive premarital education, though this was not true for husbands. Wives who received premarital education were also more likely as newlyweds to say that they would seek therapy if their relationship was in trouble, though husbands were not. Spouses who considered seeking therapy were more likely to follow through with participation if they had received premarital education, whereas if they had not received premarital education they were more likely to consider seeking therapy without following through. Similarly, among couples who received therapy, those who also received premarital education sought therapy earlier than those who did not receive premarital education, though not at a higher level of relationship satisfaction. Taken together, these results suggest that participation in premarital education is linked with later help-seeking by empowering couples to take steps throughout their marriage to maintain their relationship. (PsycINFO Database Record

Bidirectional Associations Between Newlyweds' Marital Satisfaction and Marital Problems over Time

Prevailing views of marital functioning generally adopt the view that marital problems predict decreases in marital satisfaction, but alternative theoretical perspectives raise the possibility that lowered satisfaction can also predict increases in problems. The current study sought to integrate and compare these perspectives by examining the bidirectional cross-lagged associations between newlyweds' reports of their marital satisfaction and marital problems over the first 4 years of marriage. Using annual assessments from 483 heterosexual newlywed couples, we find evidence for problem-to-satisfaction linkages as well as satisfaction-to-problem linkages. Satisfaction was a stronger predictor of marital problems early in marriage but not as time passed; by Year 4 only problem-to-satisfaction linkages remained significant. These findings are consistent with the idea that couples with more problems go on to report lower levels of satisfaction and couples with lower levels of satisfaction go on to report more marital problems. This dynamic interplay between global judgments about relationship satisfaction and ongoing specific relationship difficulties highlights the value of examining bidirectional effects to better understand marital functioning over time.

Communication moderates effects of residential mobility on relationship quality among ethnically diverse couples

Although interpersonal communication is a defining feature of committed relationships, the quality of couple communication has not proven to be a straightforward cause of relationship quality. At the same time, emerging models argue that external circumstances likely combine with communication to generate changes in relationship quality. We integrate these 2 ideas by proposing that communication does exert effects on changes in relationship quality, but primarily when couples encounter challenging situations that require an adaptive response. In the present study we examine residential moves to different neighborhoods as one such adaptive challenge. We conducted a longitudinal study of 414 newlywed couples to examine whether observed communication moderates the effect of moving to higher- or lower-income neighborhoods on changes in relationship quality. Results indicate that communication exerts no main effects on relationship quality. Consistent with the proposed model, however, wives who displayed less positive, less effective, and more negative behaviors experienced greater decreases in relationship quality, but only when couples moved to substantially higher-income neighborhoods. Because communication may not affect relationship quality until couples encounter qualitatively new demands, strengthening relationships may pivot less on improving communication skills and more on ensuring that couples' circumstances do not overwhelm the skills that they already possess. (PsycINFO Database Record

Are Problems that Contribute to Divorce Present at the Start of Marriage, or Do They Emerge Over Time?

Divorced individuals offer explanations for why their relationship ended, yet little is known about the development of these problems during the relationship. Problems that lead to divorce may exist at the beginning of the marriage (enduring dynamics model) or may develop over time (emergent distress model). We asked 40 divorced individuals about the reasons for their divorce and compared the development of problems that did and did not contribute to their divorce over the first few years of their marriage. Results support an emergent distress model for wives; they saw problems that lead to divorce increasing over time, whereas results for husbands indicated that they were less attuned to problems overall, suggesting that wives are the bellwether for relationship problems.

Education and job-based interventions for unmarried couples living with low incomes: Benefit or burden?

OBJECTIVE

Government initiatives undertaken to improve the earning potential of disadvantaged unmarried parents assume that job training and additional schooling will strengthen these families, yet alternative models predict that these same interventions could overwhelm couples' limited resources, undermining family stability.

METHOD

We use 3 waves of dyadic data and propensity score analysis to test these competing perspectives by examining the effects of job-related and school-related interventions on 3-year marriage rates. The sample consists of unmarried new parents averaging $20,475 in household income, 52% of whom are African American and 20% of whom are Hispanic/Latino.

RESULTS

Marriage rates decreased, from 17% to 10%, for couples in which men participated in school-related interventions. Mediation analyses indicate that school-related interventions reduce the amount of time men spend with their child and the amount of money they contribute to their household, reducing marriage rates in turn. Marriage rates were unaffected by women's participation in school-related interventions, and by men's and women's participation in job-related interventions.

CONCLUSION

Implementing economic interventions that increase income while minimizing demands on the limited resources of economically distressed couples may prove necessary for strengthening society's most vulnerable families. (PsycINFO Database Record

Abstract TMP27: How Generalizable are Rehabilitation Trials? The Results of a Large International Rehabilitation Trial (AVERT)

Introduction: Generalizability of the results of randomized controlled trials (RCTs) could be compromised when recruitment is poor. We aimed to examine potential threats to generalizability of a multicenter RCT using data from A Very Early Rehabilitation Trial (AVERT).

Methods: AVERT is a prospective, parallel group, assessor-blinded, randomized, clinical trial. The trial setting is acute stroke units at 44 hospitals in 8 countries. Among the first 20,000 patients screened for AVERT, 1158 were recruited and randomized. We use the Proximal Similarity Model, which considers the person, place, and setting and practice, as a framework for considering generalizability. As well as comparing the recruited patients to the target population, we performed an exploratory analysis of the demographic, clinical, site and process factors associated with recruitment.

Results: The demographics and stroke characteristics of the included patients in the trial were broadly similar to population based norms, with the exception that men featured more often in those recruited (63%) than not recruited (53%, p<0.001). The most common reason for non-recruitment was late arrival to hospital (i.e. >24 hours). Overall, being older and female reduced the odds of recruitment to the trial. More women than men were excluded for most of the reasons, including refusal. The odds of exclusion due to early deterioration were particularly high for those with severe stroke (OR=10.4, p<0.001, 95%CI: 9.27–11.65).

Conclusions: A model which explores person, place and setting and practice factors can provide important information about the external validity of a trial, and could be applied to other clinical trials.

The salience and severity of relationship problems among low-income couples

Developing programs to support low-income married couples requires an accurate understanding of the challenges they face. To address this question, we assessed the salience and severity of relationship problems by asking 862 Black, White, and Latino newlywed spouses (N = 431 couples) living in low-income neighborhoods to (a) free list their 3 biggest sources of disagreement in the marriage, and (b) rate the severity of the problems appearing on a standard relationship problem inventory. Comparing the 2 sources of information revealed that, although relational problems (e.g., communication and moods) were rated as severe on the inventory, challenges external to the relationship (e.g., children) were more salient in the free listing task. The pattern of results is robust across couples of varying race/ethnicity, parental status, and income levels. We conclude that efforts to strengthen marriages among low-income couples may be more effective if they address not only relational problems, but also couples' external stresses by providing assistance with child care, finances, or job training.

Exploring threats to generalisability in a large international rehabilitation trial (AVERT)

OBJECTIVE

The purpose of this paper is to examine potential threats to generalisability of the results of a multicentre randomised controlled trial using data from A Very Early Rehabilitation Trial (AVERT).

DESIGN

AVERT is a prospective, parallel group, assessor-blinded randomised clinical trial. This paper presents data assessing the generalisability of AVERT.

SETTING

Acute stroke units at 44 hospitals in 8 countries.

PARTICIPANTS

The first 20,000 patients screened for AVERT, of whom 1158 were recruited and randomised.

MODEL

We use the Proximal Similarity Model, which considers the person, place, and setting and practice, as a framework for considering generalisability. As well as comparing the recruited patients with the target population, we also performed an exploratory analysis of the demographic, clinical, site and process factors associated with recruitment.

RESULTS

The demographics and stroke characteristics of the included patients in the trial were broadly similar to population-based norms, with the exception that AVERT had a greater proportion of men. The most common reason for non-recruitment was late arrival to hospital (ie, >24 h). Overall, being older and female reduced the odds of recruitment to the trial. More women than men were excluded for most of the reasons, including refusal. The odds of exclusion due to early deterioration were particularly high for those with severe stroke (OR=10.4, p<0.001, 95% CI 9.27 to 11.65).

CONCLUSIONS

A model which explores person, place, and setting and practice factors can provide important information about the external validity of a trial, and could be applied to other clinical trials.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN12606000185561) and Clinicaltrials.gov (NCT01846247).

Functional outcomes in ICU – what should we be using? – an observational study

Introduction

With growing awareness of the importance of rehabilitation, new measures are being developed specifically for use in the intensive care unit (ICU). There are currently 26 measures reported to assess function in ICU survivors. The Physical Function in Intensive care Test scored (PFIT-s) has established clinimetric properties. It is unknown how other functional measures perform in comparison to the PFIT-s or which functional measure may be the most clinically applicable for use within the ICU. The aims of this study were to determine (1) the criterion validity of the Functional Status Score for the ICU (FSS-ICU), ICU Mobility Scale (IMS) and Short Physical Performance Battery (SPPB) against the PFIT-s; (2) the construct validity of these tests against muscle strength; (3) predictive utility of these tests to predict discharge to home; and (4) the clinical applicability. This was a nested study within an ongoing controlled study and an observational study.

Methods

Sixty-six individuals were assessed at awakening and ICU discharge. Measures included: PFIT-s, FSS-ICU, IMS and SPPB. Bivariate relationships (Spearman’s rank correlation coefficient) and predictive validity (logistic regression) were determined. Responsiveness (effect sizes); floor and ceiling effects; and minimal important differences were calculated.

Results

Mean ± SD PFIT-s at awakening was 4.7 ± 2.3 out of 10. On awakening a large positive relationship existed between PFIT-s and the other functional measures: FSS-ICU (rho = 0.87, p < 0.005), IMS (rho = 0.81, p < 0.005) and SPPB (rho = 0.70, p < 0.005). The PFIT-s had excellent construct validity (rho = 0.8, p < 0.005) and FSS-ICU (rho = 0.69, p < 0.005) and IMS (rho = 0.57, p < 0.005) had moderate construct validity with muscle strength. The PFIT-s and FSS-ICU had small floor/ceiling effects <11% at awakening and ICU discharge. The SPPB had a large floor effect at awakening (78%) and ICU discharge (56%). All tests demonstrated responsiveness; however highest effect size was seen in the PFIT-s (Cohen’s d = 0.71).

Conclusions

There is high criterion validity for other functional measures against the PFIT-s. The PFIT-s and FSS-ICU are promising functional measures and are recommended to measure function within the ICU.

Trial registration

Clinicaltrials.gov NCT02214823. Registered 7 August 2014).

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-015-0829-5) contains supplementary material, which is available to authorized users.

The effects of oscillating positive expiratory pressure therapy in adults with stable non-cystic fibrosis bronchiectasis: A systematic review

Airway clearance techniques (ACTs) are recommended for patients with stable non-cystic fibrosis (non-CF) bronchiectasis, but the efficacy of oscillating positive expiratory pressure (PEP) therapy compared to other techniques has not been reviewed. A systematic review of studies was conducted in stable patients comparing the effect of oscillating PEP therapy to other ACTs or a control condition. Data were extracted related to sputum expectoration, lung function, gas exchange, quality of life (QOL), symptoms, and exacerbation rate. Seven studies were included with a total of 146 patients, with a mean (SD) PEDro score of 7(1). Oscillating PEP therapy enhanced sputum expectoration compared to no treatment, but has equivalent benefits as the active cycle of breathing technique with gravity-assisted drainage (mean difference [95% CI] -2.8 g [-8.8 to 3.2 g]). Oscillating PEP has a similar effect as other ACTs on dynamic lung volumes, gas exchange and breathlessness. Use of oscillating PEP improved disease-specific QOL (p < 0.001) and cough-related QOL (p < 0.002) compared to no treatment but did not reduce exacerbation rate. In conclusion, in stable non-CF bronchiectasis, oscillating PEP therapy is associated with improvement in sputum expectoration and QOL compared to no treatment. Compared to other ACTs, the effect upon sputum expectoration, lung function, gas exchange, and symptoms are equivalent.

Does premarital education decrease or increase couples' later help-seeking?

Interventions intended to prevent relationship distress are expected to enhance relationship satisfaction and, in turn, reduce the need for later couples counseling. We test this prediction against an alternative possibility: participation in preventive interventions may operate as a gateway for later help-seeking, paradoxically increasing receipt of later couples counseling. A cross-sectional study of 2,126 married individuals examined whether participation in premarital education covaried inversely or directly with couples counseling. Consistent with the gateway hypothesis, receiving premarital education covaried with an increased likelihood of receiving couples counseling. The association between receipt of premarital education and pursuit of couples counseling was moderated by demographic indicators, with the association being stronger for African Americans and for individuals with lower incomes and less formal education. Encouraging the use of premarital interventions may increase the use of therapeutic interventions later in the relationship, especially among high-risk populations.

Does premarital education decrease or increase couples' later help-seeking?

Interventions intended to prevent relationship distress are expected to enhance relationship satisfaction and, in turn, reduce the need for later couples counseling. We test this prediction against an alternative possibility: participation in preventive interventions may operate as a gateway for later help-seeking, paradoxically increasing receipt of later couples counseling. A cross-sectional study of 2,126 married individuals examined whether participation in premarital education covaried inversely or directly with couples counseling. Consistent with the gateway hypothesis, receiving premarital education covaried with an increased likelihood of receiving couples counseling. The association between receipt of premarital education and pursuit of couples counseling was moderated by demographic indicators, with the association being stronger for African Americans and for individuals with lower incomes and less formal education. Encouraging the use of premarital interventions may increase the use of therapeutic interventions later in the relationship, especially among high-risk populations.

Discussion topic and observed behavior in couples' problem-solving conversations: do problem severity and topic choice matter?

Communication behavior is an integral part of relationship functioning and, therefore, a common target of relationship interventions. Between-couple variability in observed behaviors is commonly interpreted as reflecting their underlying skill in communication, but other factors, including perceived difficulty of the problem and the topic being discussed, may also covary with communication behavior. The current study examined this possibility by testing whether these two aspects of discussion topics were associated with communication behavior. Ethnically diverse newlywed couples (N = 402 couples) were observed in their homes as they engaged in conflict resolution tasks. Resulting behavioral codes were examined in relation to perceived difficulty of the problem and the topic of the discussion. Higher levels of husband-reported problem difficulty were associated with higher levels of husband and wife negativity, independent of relationship satisfaction. After controlling for problem difficulty and relationship satisfaction, the topic of the discussion was associated with husband and wife positivity, husband and wife negativity, and wife effectiveness, indicating that some topics elicited better or worse communication than others. The substantive focus of couples' conflicts may play an important role in how they communicate, suggesting that the topic of discussion merits close attention in studies of couples and in relationship interventions.

Financial strain and stressful events predict newlyweds' negative communication independent of relationship satisfaction

Social-learning perspectives explicitly recognize the role of partners' personal histories and contexts as possible causes of couple communication behavior, but these assumptions are rarely tested directly, and operationalizations of context in behavioral research on couples rarely extend beyond the interacting dyad. To broaden our understanding of why couples differ in communication, the current study examined whether observed behaviors in marital interactions covary with individual experiences and contextual factors. Behaviors coded from in-home conversations of 414 ethnically diverse newlywed couples were examined simultaneously in relation to childhood and family-of-origin experiences, financial strain and stressful life events, depressive symptoms, and relationship satisfaction. A latent factor representing financial strain and stressful life events was the strongest correlate of negative communication, with higher levels of stress predicting more negativity. Relationship satisfaction was the strongest correlate of observed positivity, with higher levels of satisfaction predicting more positivity. Childhood and family experiences were unrelated to behaviors, whereas results for depressive symptoms were complex and counterintuitive. Because the negative behaviors highlighted in social-learning models of relationship functioning, and often targeted in educational interventions, covary reliably with the stresses and financial strains that couples experience, contextual factors merit greater emphasis in models designed to explain and prevent marital deterioration.

Communication behavior and relationship satisfaction among American and Chinese newlywed couples

Most research on couple communication patterns comes from North America and Europe and suggests cross-cultural universality in effects, but emerging studies suggest that couple communication takes different forms depending on the cultural context in which it occurs. The current study addressed this discrepancy by comparing the observed social support behaviors of 50 newlywed American couples and 41 newlywed Mainland Chinese couples, first on mean levels of positivity and negativity and second on behavior-satisfaction associations. Consistent with predictions derived from observational work by Tsai and Levenson (1997), Chinese couples were observed displaying significantly more negative behavior than American couples, even after controlling for relationship satisfaction; the 2 groups did not differ in observed positive behaviors. Tests of the moderating role of culture on behavior-satisfaction associations showed that positivity was significantly related to relationship satisfaction only for American husbands, whereas negativity was significantly associated with relationship satisfaction only for Chinese husbands. We speculate that cultural contexts may influence the display and evaluation of behavior in intimate relationships, suggesting the need for caution when generalizing models and associated interventions to non-Western couples.

Factor analysis of the Iowa family interaction rating scales

Observational coding systems are uniquely suited for investigating interactional processes in couples and families, but their validity in diverse populations is unknown. We addressed this issue by applying factor analysis to interactional data collected from couples in low-income neighborhoods and coded with the widely used Iowa Family Interaction Rating Scales (IFIRS). Our sample of 414 low-income, ethnically diverse newlywed couples each provided 24-min samples of problem-solving and social support behavior. Interrater reliabilities were strong, and the resultant factors--reflecting positive, negative, and effective communication--were very similar to those obtained with White middle-class samples. Additionally, couples were more negative, less positive, and less effective in problem-solving conversations than in socially supportive conversations, further supporting the validity of the IFIRS in this population. We conclude by discussing the strengths and shortcomings of the IFIRS when used in a low-income, ethnically diverse population.