Publications

Abstract

Complement activation is essential for select physiologic processes during pregnancy; however, excess activation has been associated with an increased risk for preterm birth (PTB). African American (AA) women experience disproportionately higher rates of inflammation-Associated PTB than other groups of women; thus, the purpose of this study was to explore the relationship between complement activation and perinatal outcomes among AA women. A plasma sample was collected between 8 and 14 weeks' gestation from a cohort of healthy AA women (N = 144) enrolled in a larger PTB cohort study. Medical record review was conducted to collect information on clinical factors (cervical length, health behaviors, gestational age at delivery). Multiple regression analysis was used to explore the relationships between complement marker (C3a/Bb) concentrations and the outcomes of interest after adjusting for baseline characteristics. C3a/Bb concentrations were not significant predictors of the gestational age at delivery, cervical length, or behavioral risk factors for PTB in this sample. Complement markers may not influence pregnancy outcomes among AA women in the same way as in predominantly white populations; however, more studies are needed to define complement dysregulation and the relationship with outcomes among AA women.

Abstract

Rates of maternal morbidity and mortality in the United States represent an urgent crisis. The purpose of this article is to consolidate current postpartum care guidelines to provide a comprehensive approach to care in the postpartum period. We include a critical examination of the reasons for some women's lack of attendance at postpartum visits, the current state of postpartum care, and the unmet needs of women. We review several postpartum care programs and suggest possible solutions for the postpartum period, including clinical implications for continuity of care for women with comorbidities including gestational diabetes, hypertension, and depression.

Abstract

Background and Purpose: There is no reliable and valid version of the Practice Environment Scale of the Nursing Work Index-Revised (PES-NWI-R) in Arabic. The purpose of this study was to describe the systematic instrument translation and validation of the PES-NWI-R. Methods: Using the Content Validity Indexing-based approach, 32 expert nurses from four countries in the Eastern Mediterranean Region (Jordan, Oman, Saudi Arabia, and United Arab Emirates) participated in the validation of this translation. Results: The content validity index score of the overall scale was excellent (0.87 for the relevancy, and 0.95 for the quality of Arabic translation). Conclusion: Our study supported the content validity of the Arabic version of the instrument which provided the first valid Arabic translation of the instrument.

Abstract

This integrative review uses an ecological framework to examine research describing multilevel contributors to health inequities among Latina childbearing women in rural U.S. communities. Rurality exacerbates existing structural issues and makes the accumulation of both social capital and cultural competence in accessing and utilizing the health care system difficult. Four electronic databases were searched—Ovid/Medline, Web of Science, Google Scholar, and CINAHL—over the period of 2006 to 2018. Twenty-nine full-text articles met inclusion criteria. Findings were that a convoluted immigration policy, health care delivery and payment systems, geographic and economic barriers, discrimination, gender roles, and reproductive coercion all contribute to decreased utilization of health care, which in turn contributes to health inequities. More attention is required to situate Latina health inequities in rural communities within the context of other health-relevant aspects of discrimination and reproductive coercion, and to understand the contribution that the health care system itself has on these health inequities. Use of the ecological framework for this integrative review integrates well with inclusive vulnerable population research approaches such as community-based participatory research, because of its multilevel focus.

Abstract

Objective: To explore the correlation between health literacy and healthy behaviors in patients with stroke, and provide corresponding reference for patients' rehabilitation intervention. Methods: A convenient sampling method was used to select 508 stroke patients from the neurology department and physiatry department of fore third-grade hospitals in Guiyang from November 2017 to March 2018. A total of 508 stroke patients were investigated and analyzed using the Chronic Diseases Health Literacy Survey Scale, the Health Promotion Lifestyle Scale II, and the General Survey Form. Results: The overall score of healthy behavior of stroke patients was (31.26±7.74) points, the overall score of healthy behavior of stroke patients was (123.26±23.74) points; Pearson correlation analysis: health literacy level and healthy behavior level were positively correlated (r=0.625,P<0.01); the relationship between the level of healthy behavior and the improvement of health will which is from the health literacy is the strongest (r=0.621,P<0.01); the correlation between the health literacy and the self-actualization level which is from healthy behaviors is the highest (r=0.562,P<0.01). Conclusion: The level of health literacy is positively correlated with the level of health behavior, and there is a positive correlation between each dimension. Medical personnel should start from the correlation between health literacy and health behavior, to improve the rehabilitation treatment of patients.

Abstract

Nurse practitioners need to critically appraise the abundance of research evidence and clinical practice guidelines to make astute decisions about the implementation of the best available evidence to clinical practice. There are numerous ways to appraise research and practice guidelines that are designed to inform clinical practice with the overall goals of improving patient outcomes. This article presents existing tools to appraise the research evidence in addition to a guide for providers on critical appraisal of a research study.

Abstract

Objective: Multiple studies have examined cross-generational patterns of preterm birth (PTB), yet results have been inconsistent and generally focused on primarily white populations. We examine the cross-generational PTB risk across racial/ethnic groups. Study Design Retrospective study of 388,474 grandmother-mother-infant triads with infants drawn from birth registry of singleton live births between 2005 and 2011 in California. Using logistic regression (odds ratios [ORs] and confidence intervals [CIs]), we examined the risk of preterm delivery by gestational age, sociodemographic, socioeconomic, and obstetric clinical characteristics stratified by maternal race/ethnicity. Results The risk of having a preterm infant <32 weeks was greater for women born at <32 weeks (OR: 2.09, 95% CI: 1.62-2.70) and 32 to 36 weeks (OR: 1.51, 95% CI: 1.35-1.70). This increased risk of preterm delivery was present among women in all race/ethnicity groups (white [AOR: 2.00, 95% CI: 1.52-2.63), black [AOR: 1.79, 95% CI: 1.37-2.34], Hispanic [AOR: 2.39, 95% CI: 2.05-2.79], and Asian [AOR: 2.12, 95% CI: 1.20-3.91]), with hypertension as the only consistent risk factor associated with increased risk of preterm delivery. Conclusion Our findings suggest a cross-generational risk of PTB that is consistent across race/ethnicity with hypertension as the only consistent risk factor.

Abstract

Simulation followed by debriefing is increasingly common in clinical nursing education. Yet, limited studies have compared approaches to debriefing—the portion of simulations where participants re-examine and make sense of their experience. In this study, 120 baccalaureate nursing students in Quebec were randomized to receive one of two types of debriefing (self-assessment with Plus-Delta vs. guided reflection using a structured tool with REsPoND) after each of four simulations (a hemorrhage scenario, two sepsis scenarios, and a trauma simulation) during which their situation awareness was measured as a proxy for their clinical judgment. Unexpectedly, situation awareness scores showed little to no consistency across students or simulations and no clear improvements over time were noted, which rendered the comparison of the debriefing approaches across scenarios problematic. However, when comparing the two iterations of the sepsis scenario, students who participated in a reflective debriefing showed greater improvement in their recognition of abnormalities in patient vital signs and level of consciousness than students whose debriefing involved self-assessment.

Abstract

BACKGROUND AND OBJECTIVES: Delirium creates distinct emotional distress in patients and family caregivers, yet there are limited tools to assess the experience. Our objective was to develop separate patient and family caregiver delirium burden instruments and to test their content and construct validity.RESEARCH DESIGN AND METHODS: Two hundred forty-seven patients and 213 family caregivers were selected from an ongoing prospective cohort of medical-surgical admissions aged ≥70 years old. New patient and family caregiver delirium burden instruments were developed and used to measure the subjective experiences of in-hospital delirium. Delirium and delirium severity were measured by the Confusion Assessment Method (CAM) and CAM-Severity (long form).RESULTS: Both Delirium Burden (DEL-B) instruments consist of eight questions and are measured on a 0 - 40 point scale. Final questions had good clarity and relevancy, as rated by the expert panel, and good internal consistency (Cronbach's α = .82-.86). In the cohort validation, Patient DEL-B (DEL-B-P) was 5.1 points higher and Family Caregiver DEL-B (DEL-B-C) was 5.8 points higher, on average, for patients who developed delirium compared to those who did not (p < .001). Test-retest reliability of DEL-B-C at baseline and 1 month was strong (correlation = .73). Delirium severity was mildly-moderately correlated with DEL-B-P (correlation = .34) and DEL-B-C (correlation = .26), suggesting contribution of other factors.DISCUSSION AND IMPLICATIONS: We created instruments to reliably measure and evaluate the burden of delirium for patients and their family caregivers. Although additional validation is indicated, these instruments provide a key first step toward measuring and improving the subjective experience of delirium for patients and their families.

Abstract

Aims: The aim of this systematic review was to examine the characteristics and the efficacy of dementia caregiving interventions among the Chinese population. Background: In recent years, an increasing number of dementia caregiving interventions have been developed for Chinese older adults living in Asia that aim to reduce caregivers’ burden, depression and distress, and enhance quality of life. Little is known, however, on the nature and the efficacy of these interventions. Design: Systematic review with narrative summary. Data sources: We searched four databases for studies published in English between 1 January 1994–30 December 2017. Nineteen studies reported in 23 articles were included in the final analysis. Review methods: We used a set of criteria from the Cochrane Collaboration tool to assess for the risk of bias across studies. Results: We found that interventions varied in length, frequency, approach, and content, making comparisons across studies challenging. Caregivers’ burden, depression, and distress were improved among most included studies. All studies that examined quality of life of caregivers (N = 6) showed improvement. Most of the interventions showed beneficial effects on care recipients’ behavioural symptoms, agitation, and depression; cognitive function, however, failed to improve. Conclusion: Although the review found mixed results on intervention outcomes, the majority of interventions showed a potential to improve the health and well-being of dementia caregivers and care recipients. This review provides suggestions for future dementia caregiving research in the Chinese population, such as inclusion of relevant theoretical frameworks and more rigorous research designs.

Abstract

AimsThe aim of this systematic review was to examine the characteristics and efficacy of dementia caregiving interventions among the Chinese population.BackgroundIn recent years, an increasing number of dementia caregiving interventions have been developed for Chinese older adults living in Asia that aim to reduce caregivers’ burden, depression and distress and enhance quality of life. Little is known, however, on the nature and the efficacy of these interventions.DesignSystematic review with narrative summary.Data SourcesWe searched four databases for studies published in English between 1 January 1994 ‐ 30 December 2017. Nineteen studies reported in twenty‐three articles were included in the final analysis.Review MethodsWe used a set of criteria from the Cochrane Collaboration tool to assess for the risk of bias across studies.ResultsWe found that interventions varied in length, frequency, approach and content, making comparisons across studies challenging. Caregivers’ burden, depression and distress were improved among most included studies. All studies that examined quality of life of caregivers (N=6) showed improvement. Most of the interventions showed beneficial effects on care recipients’ behavioral symptoms, agitation and depression; cognitive function, however, failed to improve.ConclusionAlthough the review found mixed results on intervention outcomes, the majority of interventions showed a potential to improve the health and well‐being of dementia caregivers and care recipients. This review provides suggestions for future dementia caregiving research in the Chinese population, such as inclusion of relevant theoretical frameworks and more rigorous research designs.This article is protected by copyright. All rights reserved.

Abstract

Objectives: Dental care is the most commonly cited unmet health-care service due to cost. Previous research has highlighted the unmet dental needs of people living with HIV (PLWH). Understanding associations among dental insurance availability, dental care utilization, and the presence of unmet dental needs among PLWH is a public health priority. Methods: Oral health surveys were collected cross-sectionally (April–October 2016) among 1,442 women living with HIV (WLWH) in the Women's Interagency HIV Study. Logistic regression models were used to analyze the association between having versus not having dental insurance by type (Ryan White, private, Medicaid/Medicare) and two primary outcomes: a) typical frequency of dental visits (at least annually, less than annually) and b) reporting an unmet dental need in the past 6 months. Results: All dental insurance types were associated with higher odds of receiving annual dental care and, for those with either Medicare/Medicaid or private insurance, lower odds of having an unmet dental need. When WLWH were asked to describe their oral health, poor self-reported condition was associated with both an unmet dental need (odds ratio [OR]: 4.52, 95 percent Confidence Interval [CI] [3.29–6.20]) and lower odds of annual dental care utilization (OR: 0.44, 95 percent CI [0.34–0.57]). Self-reported depressive symptom burden was also linked to having an unmet dental need (OR: 2.10, 95 percent CI [1.46–3.01]). Conclusions: Dental insurance coverage increases dental care utilization and is associated with better oral health among WLWH. In the era of health-care reform, dental insurance coverage may be instrumental for enhancing treatment outcomes.

Abstract

According to the U.S. census Bureau, close to 20% of the U.S. population speaks a language other than English at home. Home health care (HHC) patients who speak English less than very well or have limited English proficiency (LEP) are at an increased risk for medication mismanagement and serious health consequences. The purpose of this study was to examine if there were differences in medication management between English-speaking patients and patients with LEP receiving HHC services. Data for this cross-sectional observation study were collected from 2010 to 2014. Medication management was measured by two items in the Centers for Medicare and Medicaid Services–mandated Outcomes Assessment Information Set (OASIS). All patients in the database who were taking medications and had a valid admission and discharge assessment from HHC were included in the analysis. Inverse probability of treatment weighting (IPTW) with a marginal structural model was used to address potential imbalances in observed patient characteristics when estimating the effect of having LEP or being an English-speaking HHC patient on changes in medication management over the course of a HHC episode. Estimates from marginal structural model with inverse probability weighting indicate that being LEP was associated with less improvement in medication management and increased likelihood of getting worse over the course of a HHC episode. This study is one of the first to demonstrate that patients with LEP experience disparities in medication management when compared to English-speaking patients in HHC.

Abstract

Although Korean American women have a higher risk of developing cervical cancer, currently there are limited culturally relevant intervention strategies for improving primary prevention of cervical cancer by promoting HPV vaccination in this population. This study reports the development of a cross-cultural, cross-generational storytelling HPV intervention using a peer-paired method, in which two storytellers interactively share their stories, as a particular innovation that might resonate with Korean American young women. The acceptability of the intervention was assessed by self-reported satisfaction and endorsement with the intervention in a pilot randomized control trial (RCT). We compared participants' responses to the intervention by their generation and cultural identity. One hundred and four Korean college women between the ages of 18-26 were recruited from the Northeastern US Participants randomized to the intervention group received a storytelling video (n = 54); the comparison group received written information (n = 50). The acceptability of the intervention was measured immediately post-intervention. The intervention group had significantly greater satisfaction than the comparison group (P < 0.05). Participants reported greater endorsement for videos that reflected their cultural and generational experiences. Future study is needed to examine the impact of such interventions on objective follow-up on HPV vaccination in a large-scale RCT.

Abstract

Implementation of dietary and lifestyle interventions prior to and early in pregnancy in high risk women has been shown to reduce the risk of gestational diabetes mellitus (GDM) development later in pregnancy. Although numerous risk factors for GDM have been identified, the ability to accurately identify women before or early in pregnancy who could benefit most from these interventions remains limited. As nulliparous women are an under-screened population with risk profiles that differ from their multiparous counterparts, development of a prediction model tailored to nulliparous women may facilitate timely preventive intervention and improve maternal and infant outcomes. We aimed to develop and validate a model for preconception and early pregnancy prediction of gestational diabetes mellitus based on clinical risk factors for nulliparous women. A risk prediction model was built within a large California birth cohort including singleton live birth records from 2007–2012. Model accuracy was assessed both internally and externally, within a cohort of women who delivered at University of Iowa Hospitals and Clinics between 2009–2017, using discrimination and calibration. Differences in predictive accuracy of the model were assessed within specific racial/ethnic groups. The prediction model included five risk factors: race/ethnicity, age at delivery, pre-pregnancy body mass index, family history of diabetes, and pre-existing hypertension. The area under the curve (AUC) for the California internal validation cohort was 0.732 (95% confidence interval (CI) 0.728, 0.735), and 0.710 (95% CI 0.672, 0.749) for the Iowa external validation cohort. The model performed particularly well in Hispanic (AUC 0.739) and Black women (AUC 0.719). Our findings suggest that estimation of a woman’s risk for GDM through model-based incorporation of risk factors accurately identifies those at high risk (i.e., predicted risk >6%) who could benefit from preventive intervention encouraging prompt incorporation of this tool into preconception and prenatal care.

Abstract

Background: This pilot study collected preliminary data for the modification of the VioScreen Food Frequency Questionnaire (FFQ), an adult-validated, self-administered, web-based dietary assessment tool for use in older children. Methods: A convenience sample of 55 children, aged 6–14 years, completed the VioScreen FFQ and 3-day diet record (reference standard). Caregivers completed a short sociodemographic questionnaire. Reported dietary intakes from the VioScreen FFQ and 3-day diet record were calculated using standard nutrient databases, and descriptive statistics were used to examine differences in food/beverage items and portion sizes between the two methods. Informal focus groups obtained user feedback and identified components of the VioScreen FFQ that required modifications. Results: The highest de-attenuated Pearson correlation coefficients between the VioScreen FFQ and 3-day diet record were observed for iron (r = 0.69), saturated fat (r = 0.59), and vegetables (r = 0.56), and the lowest were for whole grains (r = 0.11) and vitamin C (r = 0.16). Qualitative feedback was overall positive, and six technological modifications were identified. Conclusion: Findings from this pilot study provided valuable information on the process of evaluating the use of the VioScreen FFQ among older children, and will inform the future development of a modified version for this population.

Abstract

This article describes the development of the diverse standardized patient simulation (DSPS) cultural competence education strategy, which is designed to improve students' knowledge, skills, and attitudes with regard to providing culturally competent care. Development of the DSPS was guided by the Jeffreys' Cultural Competence and Confidence model. As a carefully orchestrated educational intervention utilizing standardized patient pedagogy, the DSPS had content validity review and followed international guidelines and standards for design, implementation, evaluation, and standardized patient training. This strategy was integrated into a nine-credit, 15-week medical-surgical nursing course. A step-by-step description for the development of the DSPS is provided.

Abstract

BACKGROUND: The prevalence of adults with Type 1 diabetes (T1D) is increasing, and their risk of cardiovascular disease is high. Comorbid diabetes distress and depressive symptoms may affect their cardiovascular health. OBJECTIVES: The purpose of this study was to describe the relationship between diabetes distress and depressive symptoms with cardiovascular health factors. METHODS: This was a cross-sectional survey of a sample of adults with T1D. Valid and reliable instruments were used to collect the data on sociodemographics, diabetes-related complications, psychological factors, and cardiovascular health factors. Independent-sample t tests, analysis of variance, chi-square analyses, and linear regression were used to compare the cardiovascular health factors among the three levels of diabetes distress scores and the two levels of depressive symptom scores. RESULTS: Our sample included 83 adults with a mean age of 45.2 years and a mean duration of T1D of 20 years. The majority scored low in the Diabetes Distress Scale, whereas 18% scored moderate and 18% scored high. Twenty-two percent had increased levels of depressive symptoms. There were significant correlations between diabetes distress and fear of hypoglycemia, depressive symptom scores, hemoglobin A1c, and total cholesterol. Depressive symptom scores were significantly correlated with hemoglobin A1c. Hemoglobin A1c and total cholesterol were significantly higher in those with higher levels of diabetes distress. There were no significant differences in cardiovascular health between those who scored below or above the cut point for depressive symptoms, but there was a finding toward higher mean body mass index, hemoglobin A1c, and a lower weekly step count in those who had elevated depressive symptoms. In the linear regression, only diabetes distress was significantly associated with hemoglobin A1c. DISCUSSION: This is a sample with elevated diabetes distress and depressive symptoms, both of which may affect their risk of cardiovascular disease.

Abstract

Introduction: Standardized patient simulation can be an effective strategy to foster cultural competence education. Methodology: Guided by the Cultural Competence and Confidence Model, this grant-funded, longitudinal, one-group, pretest and posttest study used the Transcultural Self-Efficacy Tool (TSET) to examine the effect of the Diverse Standardized Patient Simulation (DSPS) cultural competence education strategy on students’ (n = 53) transcultural self-efficacy. Developed by following recommended guidelines and standards, the DSPS had content validity review. It aimed to improve students’ knowledge, skills, and attitudes with regard to providing culturally competent nursing care. The statistical methods included t-tests, McNemar’s test, correlation analyses, and Mann–Whitney U-test. Results: The DSPS influenced statistically significant changes (increase) in students’ transcultural self-efficacy perceptions (p <.05). All students regardless of background benefited from formalized cultural competence education. Discussion: Evidence-based strategies such as the DSPS can offer a valuable guide for educators to foster cultural competence education.

Abstract

Introduction: Smoking prevalence is high in Vietnam, yet tobacco dependence treatment (TDT) is not widely available. Methods: We conducted a quasiexperimental study that compared the effectiveness of health care provider advice and assistance (ARM 1) versus ARM 1 plus village health worker (VHW) counseling (ARM 2) on abstinence at 6-month follow-up. This study was embedded in a larger two-arm cluster randomized controlled trial conducted in 26 community health centers (CHCs) in Vietnam. Subjects (N = 1318) were adult patients who visited any participating CHC during the parent randomized controlled trial intervention period and were self-identified as current tobacco users (cigarettes and/or water pipe). Results: At 6-month follow-up, abstinences rates in ARM 2 were significantly higher than those in ARM 1 (25.7% vs. 10.5%; p <. 001). In multivariate analyses, smokers in ARM 2 were almost three times more likely to quit compared with those in ARM 1 (adjusted odds ratio [AOR] = 2.96, 95% confidence interval [CI] = 1.78% to 4.92%). Compared to cigarette-only smokers, water pipe-only smokers (AOR = 0.4, 95% CI = 0.26% to 0.62%) and dual users (AOR = 0.62, 95% CI = 0.45% to 0.86%) were less likely to achieve abstinence; however, the addition of VHW counseling (ARM 2) was associated with higher quit rates compared with ARM 1 alone for all smoker types. Conclusion: A team approach in TDT programs that offer a referral system for health care providers to refer smokers to VHW-led cessation counseling is a promising and potentially scalable model for increasing access to evidence-based TDT and increasing quit rates in low middle-income countries (LMICs). TDT programs may need to adapt interventions to improve outcomes for water pipe users. Implications: The study fills literature gaps on effective models for TDT in LMICs. The addition of VHW-led cessation counseling, available through a referral from primary care providers in CHCs in Vietnam, to health care provider's brief cessation advice, increased 6-month biochemically validated abstinence rates compared to provider advice alone. The study also demonstrated the potential effectiveness of VHW counseling on reducing water pipe use. For LMICs, TDT programs in primary care settings with a referral system to VHW-led cessation counseling might be a promising and potentially scalable model for increasing access to evidence-based treatment.

Abstract

Background: China has the world's largest aging population and the number of empty-nest older adults is on the rise. In comparison to the aging population in general, empty-nest older adults have a lower level of subjective well-being and poorer mental health status due to a lack of emotional support from their children. The aim of this study is to conduct an empirical study to evaluate the efficacy of the 'Path-oriented Psychological Self-help Intervention' (P-oPSI) led by nurses on the mental health of empty-nest older adults in the community, to provide a scientific foundation for improving their quality of life. Methods: A Quasi-Experimental controlled intervention study was conducted from 2015 to 2017. A total of 76 empty-nest older adults from 2 districts were recruited using a convenience sampling and assigned to 2 groups based on their residential communities in the city of Chifeng in the Inner Mongolia Autonomous Region, China. The wait list control group participated in a mental health lecture to gain knowledge and learn techniques of mental health promotion. The intervention group additionally received 1 month of training in a nurse-led 'P-oPSI' for a month. Both groups were followed-up for 3 months. Mental health status, coping styles, and psychological self-help ability of the participating empty nest older adults were assessed at the baseline, 1 month, and 3-months follow up, respectively. Two-way analysis of variance and a simple effect test were used to analyse the differences of the two groups. Results: The P-oPSI yielded a greater benefit for the mental health status, coping styles, and psychological self-help ability of the participants in the intervention group. Combined with a simple effect test, the scores of the mental health status, positive coping style, and psychological self-help ability of those in the intervention group significantly increased at 1 month after the baseline (F mental health status = 7.59, F positive coping style = 7.24, F psychological self-help ability = 7.07); and the sustainable effect of this program lasted for 3 months after the intervention (F mental health status = 13.24, F positive coping style = 10.42, F psychological self-help ability = 10.45), which reached statistical significance (P < 0.01). Conclusions: The P-oPSI program significantly improved the level of mental health of empty-nest older adults in China. This intervention provides a new approach of self-management to improve mental health of older adults in community settings. Trial registration: chictr.org.cn: ChiCTR1900025552. Retrospectively registered 1 September 2019.

Abstract

Purpose: Women with breast cancer report varying frequencies of cognitive problems during adjuvant systemic therapy. This variability suggests latent subgroups. Therefore, we identified latent subgroups of self-reported cognitive problems among postmenopausal women with and without breast cancer. We explored associations between membership in these subgroups and (a) demographic, clinical, and symptom characteristics and (b) variations in candidate gene polymorphisms. Methods: We evaluated frequency of cognitive problems using the Patient Assessment of Own Functioning Inventory. Growth mixture modeling identified latent subgroups over 18 months of adjuvant systemic therapy and at matched time points for women without cancer (N = 331). We evaluated for differences among subgroups in demographic, clinical, and symptom characteristics and in 41 single nucleotide polymorphisms in 10 candidate genes involved in DNA repair and oxidative stress pathways (n = 199). We modeled associations between genotypes and subgroup membership using multinomial logistic regression. Results: We identified three latent subgroups: more frequent, persistent, and almost never. Receipt of chemotherapy plus anastrozole, depressive symptoms, and baseline neuropathic symptoms increased the odds of belonging to the more frequent subgroup. Anxiety and depressive symptoms increased the odds of belonging to the persistent subgroup. With covariates controlled for, carrying the ERCC5 rs873601 G minor allele increased the odds of reporting more frequent cognitive problems. Conclusions: Chemotherapy plus anastrozole, depressive symptoms, and presence of neuropathic symptoms may predict more frequent cognitive problems during systemic therapy that later resolve. Mood dysregulation before therapy may predict persistent cognitive problems during therapy. ERCC5 genotype may influence frequency of cognitive problems after controlling for these risk factors.