Testing Theoretical Models and Frameworks in Child Health Research

  • Thomas A. Wills
  • Sean D. Cleary
Part of the Issues in Clinical Child Psychology book series (ICCP)


In this chapter we discuss testing theoretical models of processes in child health research. By this we mean the kind of research that is based on deriving predictions from a theoretical portrayal of the process that has engaged the investigator’s interest and designing a study to provide a test of this model. Some may think that theoretical models are always complicated and abstruse, but this is not the case; in fact, some of the best models may be quite simple ones. A child psychologist may pose a question such as, “Why are some children more at risk for a certain condition?” or “How do families adapt successfully to their child’s chronic disease?” or “What makes a particular treatment technique effective?” The psychologist’s thinking about the process underlying the outcome provides the basis for a model of how things occur: How do environmental and familial factors combine to create risk; what coping processes lead to adaptation; what mediating variables are responsible for the effectiveness of a therapeutic program. Such statements are the beginning of a testable model.


Arthritis Depression Covariance Income Nicotine 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Newbuiy Park, CA: Sage Publications.Google Scholar
  2. Arbuckle, J. L. (1995). AMOS for Windows. Analysis of moment structures (Version 3.5). Chicago, IL: Smallwaters.Google Scholar
  3. Bandura, A. (1969). Social learning theory of identificatory processes. In D. Goslin (Ed.), Handbook of socialization theory and research (pp. 213–262). Chicago: Rand McNallGoogle Scholar
  4. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84,191–215.PubMedCrossRefGoogle Scholar
  5. Baranowski, T., & Nader, P. R. (1985). Family involvement in health behavior change programs. In D. Turk & R. Kerns (Eds.), Health, illness, and families (pp. 81–107). New York: Wiley.Google Scholar
  6. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51,1173–1182.PubMedCrossRefGoogle Scholar
  7. Bentler, P. M. (1989). EQS structural equations program manual. Los Angeles, CA: BMDP Statistical Software.Google Scholar
  8. Bentler, P. M. (1990). Comparative fit indices in structural models. Psychological Bulletin, 107,238–246.PubMedCrossRefGoogle Scholar
  9. Biglan, A., Weissman, W., & Severson, H. (1985). Coping with social influences to smoke. In S. Shiftman & T. A. Wills (Eds.), Coping and substance use (pp. 95–116). Orlando, FL: Academic Press.Google Scholar
  10. Bollen, K. A. (1989). Structural equations with latent variables. New York: Wiley.Google Scholar
  11. Carver, C. S., Scheier, M. F., & Pozo, C. (1992). Conceptualizing the process of coping with health problems. In H. S. Friedman (Ed.), Hostility, coping and health (pp. 167–187). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  12. Cohen, J. (1992). A power primer. Psychological Bulletin, 112,155–159.PubMedCrossRefGoogle Scholar
  13. Cohen, J., & Cohen, P. (1983). Applied multiple regression/correlation analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.Google Scholar
  14. Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310–357.PubMedCrossRefGoogle Scholar
  15. Cole, R. E., & Reiss, D. (Eds.) (1993). How do families cope with chronic illness? Hillsdale, NJ: Lawrence Erlbaum.Google Scholar
  16. Compas, B. E. (1987). Coping with stress during childhood and adolescence. Psychological Bulletin, 101, 393–403.PubMedCrossRefGoogle Scholar
  17. Compas, B. E., Malcarne, V. L., & Banez, G. A. (1992). Coping with psychosocial stress: A developmental perspective. In B. N. Carpenter (Ed.), Personal coping: Theory, research, and application (pp. 47–63). Westport, CT: Praeger.Google Scholar
  18. Conger, R. D., Elder, G. H., Jr., Lorenz, F. O., Conger, K.J., Simons, R. L., Whitbeck, L. B., Huck, S., & Melby, J. N. (1990). Linking economic hardship to marital quality and instability. Journal of Marriage and the Family, 52, 643–656.CrossRefGoogle Scholar
  19. Doherty, W. J., & Campbell, T. L. (1988). Families and health. Newbury Park, CA: Sage.Google Scholar
  20. Donovan, J. E., & Jessor, R. (1985). Structure of problem behavior in adolescence and young adulthood. Journal of Consulting and Clinical Psychology, 53, 890–904.PubMedCrossRefGoogle Scholar
  21. DuBois, D. L., Feiner, R. D., Meares, H., & Krier, M. (1994). Prospective investigation of the effects of socioeconomic disadvantage, life stress, and social support on early adolescent adjustment. Journal of Abnormal Psychology, 103, 511–522.CrossRefGoogle Scholar
  22. Dubow, E. F., & Tisak, J. (1989). The relation between stressful life events and adjustment in elementary school children: The role of social support and social problem-solving skills. Child Development, 60, 1412–1423.PubMedCrossRefGoogle Scholar
  23. Elder, G. H., Jr., Nguyen, T. V., & Caspi, A. (1985). Linking family hardship to children’s lives. Child Development, 56, 361–375.PubMedCrossRefGoogle Scholar
  24. Fergusson, D. M., & Horwood, L. J. (1995). Early disruptive behavior, IQ, and later school achievement and delinquent behavior. Journal of Abnormal Child Psychology, 23,183–199.PubMedCrossRefGoogle Scholar
  25. Flay, B. R., Hu, F. B., Siddiqui, O., Day, L. E., Hedeker, D., Petraitis, J., Richardson, J., & Sussman, S. (1994). Differential influence of parental smoking and friends’ smoking on adolescent initiation and escalation of smoking. Journal of Health and Social Behavior, 35, 248–265.PubMedCrossRefGoogle Scholar
  26. Folkman, S., & Lazarus, R. S. (1985). “If it changes it must be a process”: Study of emotion and coping during three stages of a college examination. Journal of Personality and Social Psychology, 48, 150–170.PubMedCrossRefGoogle Scholar
  27. Friedman, L. S., Lichtenstein, E., & Biglan, A. (1985). Smoking onset among teens: An empirical analysis of initial situations. Addictive Behaviors, 10,1–13.PubMedCrossRefGoogle Scholar
  28. Friedman, M., & Rosenman, R. H. (1974). Type A behavior and your heart. New York: Knopf.Google Scholar
  29. Garmezy, N., & Masten, A. S. (1991). The protective role of competence indicators in children at risk. In E. M. Cummings, A. L. Greene, & K. H. Karraker (Eds.), Life-span developmental psychology: Perspectives on stress and coping (pp. 151–174). Hillsdale, NJ: Erlbaum.Google Scholar
  30. Gilbert, D. G. (1979). Paradoxical tranquilizing and emotion-reducing effects of nicotine. Psychological Bulletin, 86, 643–661.PubMedCrossRefGoogle Scholar
  31. Graham, J. W., Marks, G., & Hansen, W. B. (1991). Social influence processes affecting adolescent substance use. Journal of Applied Psychology, 76, 291–298.PubMedCrossRefGoogle Scholar
  32. Hansen, W. B., & Graham, J. W. (1991). Preventing alcohol, marijuana, and cigarette use among adolescents: Peer pressure resistance training versus establishing conservative norms. Preventive Medicine, 20, 414–430.PubMedCrossRefGoogle Scholar
  33. Hauser, S. (1991). Adolescents and their families: Paths of ego development. New York: Free Press.Google Scholar
  34. Hauser, S. T., Jacobson, A. M., Lavori, P., Wolsdorf, J. I., Herskowitz, R. D., Milley, J. E., Bliss, R., Wertlieb, D., & Stein, J. (1990). Adherence among children and adolescents with IDDM: Immediate and long-term linkages with the family milieu. Journal of Pediatric Psychology, 15, 527–542.PubMedCrossRefGoogle Scholar
  35. Hayduk, L. A. (1987). Structural equation modeling with LISREL. Baltimore, MD: Johns Hopkins University PressGoogle Scholar
  36. Hinshaw, S. P. (1992). Externalizing behavior problems and academic underachievement in childhood and adolescence: Causal relationships and underlying mechanisms. Psychological Bulletin, 111, 127–155.PubMedCrossRefGoogle Scholar
  37. Hinshaw, S. P. (1994). Attention deficits and hyperactivity in children. Thousand Oaks, CA: Sage.Google Scholar
  38. Holmbeck, G. N. (1997). Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: Examples from the child-clinical and pediatric psychology literatures. Journal of Consulting and Clinical Psychology, 65, 599–610.PubMedCrossRefGoogle Scholar
  39. Hoyle, R. L., & Smith, G. T. (1994). Formulating clinical research hypotheses as structural equation models: A conceptual overview. Journal of Consulting and Clinical Psychology, 62, 492–440.Google Scholar
  40. Hoyle, R. H. (Ed.). (1995). Structural equation modeling: Concepts, issues, and applications. Thousand Oaks, CA: Sage.Google Scholar
  41. Hu, L-T., & Bentler, P. M. (1995). Evaluating model fit. In R. H. Hoyle (Ed.), Structural equation modeling: Concepts, issues, and applications (pp. 76–99). Thousand Oaks, CA: Sage.Google Scholar
  42. Jaccard, J., & Wan, C. K. (1996). LISREL approaches to interaction effects in multiple regression. Thousand Oaks, CA: Sage.Google Scholar
  43. Jessor, R., & Jessor, S. (1977). Problem behavior and psychosocial development. New York: Academic Press.Google Scholar
  44. Jöreskog, K. G., & Sörbom, D. (1988). LISREL 7: A guide to the program and applications. Chicago: SPSSGoogle Scholar
  45. Kazdin, A. E. (1995). Conduct disorders in childhood and adolescence (2nd ed.). Thousand Oaks, CA: Sage.Google Scholar
  46. Khantzian, E. J. (1990). Self-regulation and self-medication factors in alcoholism and the addictions: Similarities and differences. In M. Galanter (Ed.), Recent developments in alcoholism (Vol. 8, pp. 255–271). New York: Plenum Press.Google Scholar
  47. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer.Google Scholar
  48. Loehlin, J. C. (1987). Latent variable models: An introduction to factor, path, and structural analysis. Hillsdale, NJ: Erlbaum.Google Scholar
  49. Lustig, J. L., Ireys, H. T., Sills, E. M., & Walsh, B. B. (1996). Mental health of mothers of children with juvenile rheumatoid arthritis: Appraisal as a mediator. Journal of Pediatric Psychology, 21, 719–733.PubMedCrossRefGoogle Scholar
  50. MacCallum, R. (1986). Specification searches in covariance structure modeling. Psychological Bulletin, 100,107–120.CrossRefGoogle Scholar
  51. MacCallum, R. C., Roznowski, M., & Necowitz, L. B. (1992). Model modifications in covariance structure models. Psychological Bulletin, 111, 490–504.PubMedCrossRefGoogle Scholar
  52. MacKinnon, D. P. (1994). Analysis of mediating variables in prevention and intervention studies. In L. Beatty & A. Cazares (Eds.), Scientific methods in prevention research (pp. 127–153). Washington, DC: U.S. Government Printing Office. (DHHS Publication No. 94-3631).Google Scholar
  53. MacKinnon, D. P., Johnson, C. A., Pentz, M. A., Dwyer, J. H., Hansen, W. B., Flay, B. R., & Wang, E. Y.-I. (1991). Mediating mechanisms in a school-based drug prevention program. Health Psychology, 10, 164–172.PubMedCrossRefGoogle Scholar
  54. Mann, B. J., & McKenzie, E. P. (1996). Pathways among marital functioning, parental behaviors, and child behavior problems in school-age boys. Journal of Clinical Child Psychology, 25, 183–191.CrossRefGoogle Scholar
  55. Martin, C. S., Earleywine, M., Blackson, T. C., Vanyukov, M. M., Moss, H. M., & Tarter, R. E. (1994). Aggressivity, inattention, hyperactivity, and impulsivity in boys at high and low risk for substance abuse, journal of Abnormal Child Psychology, 22, 177–203.PubMedCrossRefGoogle Scholar
  56. Masten, A. S., Morison, P., Pellegrini, D., & Tellegen, A. (1990). Competence under stress: Risk and protective factors. In J. Rolf, A. S. Masten, D. Cicchetti, K. H. Nuechterlein, & S. Weintraub (Eds.), Risk and protective factors in the development of psychopathology (pp. 236–256). New York: Cambridge University Press.CrossRefGoogle Scholar
  57. McClelland, G. H., & Judd, C. M. (1993). Statistical difficulties of detecting interactions and moderator effects. Psychological Bulletin, 114, 376–390.PubMedCrossRefGoogle Scholar
  58. Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press.Google Scholar
  59. Moffitt, T. E. (1993). The neuropsychology of conduct disorder. Development and Psychopathology, 5,135–151.CrossRefGoogle Scholar
  60. Moffitt, T. E., & Lynam, D. (1994). The neuropsychology of conduct disorder and delinquency: Implications for understanding antisocial behavior. In D. C. Fowles, P. Sutker, & S. H. Goodman (Eds.), Experimental personality and psychopathology research, 1994: Focus on psychopathy and antisocial personality (pp. 233–262). New York: Springer.Google Scholar
  61. Monroe, S. M., & Simons, A. D. (1991). Diathesis-stress theories in the context of life stress research: Implications for the depressive disorders. Psychological Bulletin, 110, 406–425.PubMedCrossRefGoogle Scholar
  62. Newcomb, M. D., & Bentler, P. M. (1988). Impact of adolescent drug use and social support on problems of young adults: A longitudinal study. Journal of Abnormal Psychology, 97, 64–75.PubMedCrossRefGoogle Scholar
  63. Newcomb, M. D., & Felix-Ortiz, M. (1992). Multiple protective and risk factors for drug use and abuse: Cross-sectional and prospective findings. Journal of Personality and Social Psychology, 63, 280–296.PubMedCrossRefGoogle Scholar
  64. Patterson, G. R., DeBaryshe, B. D., & Ramsey, E. (1989). A developmental perspective on antisocial behavior. American Psychologist, 44, 329–335.PubMedCrossRefGoogle Scholar
  65. Perkins, K. A. (1995). Individual variability in responses to nicotine. Behavior Genetics, 25,119–132.PubMedCrossRefGoogle Scholar
  66. Petraitis, J., Flay, B. R., & Miller, T. Q. (1995). Reviewing theories of adolescent substance use: Organizing pieces in the puzzle. Psychological Bulletin, 117, 67–86.PubMedCrossRefGoogle Scholar
  67. Ramsey, G. (Ed.). (1989). The science of family medicine. New York: Guilford.Google Scholar
  68. Rosenbaum, M. (Ed.). (1990). Learned resourcefulness: On coping skills, self-control, and adaptive behavior. New York: Springer.Google Scholar
  69. Rutter, M. (1990). Psychosocial resilience and protective mechanisms. In J. Rolf, A. S. Masten, D. Cicchetti, K. H. Nuechterlein, & S. Weintraub (Eds.), Risk and protective factors in development of psychopathology (pp. 181–214). New York: Cambridge University Press.CrossRefGoogle Scholar
  70. SAS Institute. (1990). SAS Technical Report P-200 SAS/STAT Software: CALIS AND LOGISTIC Procedures (Release 6.04 edition). Cary, NC: Author.Google Scholar
  71. Schumacker, R. E., & Lomax, R. G. (1996). A beginner’s guide to structural equation modeling. Mahwah, NJ: Erlbaum.Google Scholar
  72. Sher, K. J. (1991). Children of alcoholics: A critical appraisal of theory and research. Chicago: University of Chicago Press.Google Scholar
  73. Stark, K. D., Schmidt, K. L., & Joiner, T. E. (1996). Cognitive triad: Relationship to depressive symptoms, parents’ cognitive triad, and perceived parental messages. Journal of Abnormal Child Psychology, 24, 615–631.PubMedCrossRefGoogle Scholar
  74. Stevens, J. (1996). Applied multivariate statistics for the social sciences (3rd ed). Mahwah, NJ: Erlbaum.Google Scholar
  75. Takeuchi, D. T., Williams, D. R., & Adair, R. K. (1991). Economic stress in the family and children’s emotional and behavioral problems. Journal of Marriage and the Family, 53,1031–1041.CrossRefGoogle Scholar
  76. Tarter, R. E. (1988). Are there inherited behavioral traits that predispose to substance abuse? Journal of Consulting and Clinical Psychology, 56,189–196.PubMedCrossRefGoogle Scholar
  77. Thoits, P. A. (1986). Social support as coping assistance. Journal of Consulting and Clinical Psychology, 54, 416–423.PubMedCrossRefGoogle Scholar
  78. Thompson, R. J., Gil, K. M., Gustafson, K. E., George, L. K., Keith, B. R., Spock, A., & Kinney, T. R. (1994). Stability and change in the psychological adjustment of mothers of children and adolescents with cystic fibrosis and sickle cell disease. Journal of Pediatric Psychology, 19,171–188.PubMedCrossRefGoogle Scholar
  79. Tucker, L. R., & Lewis, C. (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika, 38,1–10.CrossRefGoogle Scholar
  80. Turk, D. C., & Kerns, R. D. (1985). The family in health and illness. In D. Turk & R. Kerns (Eds.), Health, illness, and families (pp. 1–22). New York: Wiley.Google Scholar
  81. Varni, J. W., & Setoguchi, Y. (1996). Perceived physical appearance and adjustment of adolescents with congenital/acquired limb deficiencies: A path-analytic model. Journal of Clinical Child Psychology, 25, 201–208.CrossRefGoogle Scholar
  82. Wallander, J. L., Varni, J. W., Babani, L., Banis, H. T., & Wilcox, K. T. (1989). Family resources as resistance factors for psychological maladjustment in chronically ill and handicapped children. Journal of Pediatric Psychology, 14,157–173.PubMedCrossRefGoogle Scholar
  83. Werner, E. E. (1986). Resilient offspring of alcoholics: A longitudinal study from birth to age 18. Journal of Studies on Alcohol, 47, 34–40.PubMedGoogle Scholar
  84. Wills, T. A. (1986). Stress and coping in early adolescence: Relationships to substance use in urban school samples. Health Psychology, 5, 503–529.PubMedCrossRefGoogle Scholar
  85. Wills, T. A., Blechman, E. A., & McNamara, G. (1996). Family support, coping and competence. In E. M. Hetherington & E. A. Blechman (Eds.), Stress, coping, and resiliency in children and families (pp.107–133). Mahwah, NJ: Erlbaum.Google Scholar
  86. Wills, T. A., & Cleary, S. D. (1996). How are social support effects mediated: A test for parental support and adolescent substance use. Journal of Personality and Social Psychology, 71, 937–952.PubMedCrossRefGoogle Scholar
  87. Wills, T. A., & Filer, M. (1996). Stress-coping model of adolescent substance use. In T. H. Ollendick & R. J. Prinz (Eds.), Advances in clinical child psychology (Vol. 18, pp. 91–132). New York: Plenum Press.CrossRefGoogle Scholar
  88. Wills, T. A., & Filer, M. (1999). Social networks and social support. In A. Baum & T. Revenson (Eds.), Handbook of health psychology. Mahwah, NJ: Erlbaum.Google Scholar
  89. Wills, T. A., McNamara, G., & Vaccaro, D. (1995). Parental education related to adolescent stress-coping and substance use: Development of a mediational model. Health Psychology, 14, 464–478.PubMedCrossRefGoogle Scholar
  90. Wills, T. A., Pierce, J. P., & Evans, R. I. (1996). Large-scale environmental risk factors for substance use. American Behavioral Scientist, 39, 808–822.CrossRefGoogle Scholar
  91. Wills, T. A., Schreibman, D., Benson, G., & Vaccaro, D. (1994). Impact of parental substance use on adolescents: A test of a mediational model. Journal of Pediatric Psychology, 19, 537–555.PubMedCrossRefGoogle Scholar
  92. Wills, T. A., & Shiftman, S. (1985). Coping and substance use: A conceptual framework. In S. Shiftman & T. A. Wills (Eds.), Coping and substance use (pp. 3–24). Orlando, FL: Academic Press.Google Scholar
  93. Wills, T. A., Vaccaro, D., & McNamara, G. (1992). The role of life events, family support, and competence in adolescent substance use: A test of vulnerability and protective factors. American Journal of Community Psychology, 20, 349–374.PubMedCrossRefGoogle Scholar
  94. Windle, M., & Searles, J. S. (1990). Summary, integration, and future directions: Toward a life-span perspective. In M. Windle & J. S. Searles (Eds.), Children of alcoholics: Critical perspectives (pp.217–238). New York, NY: Guilford Press.Google Scholar
  95. Zucker, R. A. (1994). Pathways to alcohol problems: A developmental account of the evidence for contextual contributions to risk. In R. A. Zucker, G. M. Boyd, & J. Howard (Eds.), The development of alcohol problems (pp. 255–289). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism.Google Scholar

Copyright information

© Springer Science+Business Media New York 2000

Authors and Affiliations

  • Thomas A. Wills
    • 1
  • Sean D. Cleary
    • 1
  1. 1.Department of Epidemiology and Social MedicineAlbert Einstein College of MedicineBronxUSA

Personalised recommendations