Showing papers in "Annals of Behavioral Medicine in 2007"

A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction.

Abstract: Background: Although mindfulness meditation interventions have recently shown benefits for reducing stress in various populations, little is known about their relative efficacy compared with relaxation interventions.Purpose: This randomized controlled trial examines the effects of a 1-month mindfulness meditation versus somatic relaxation training as compared to a control group in 83 students (M age=25; 16 men and 67 women) reporting distress.Method: Psychological distress, positive states of mind, distractive and ruminative thoughts and behaviors, and spiritual experience were measured, while controlling for social desirability.Results: Hierarchical linear modeling reveals that both meditation and relaxation groups experienced significant decreases in distress as well as increases in positive mood states over time, compared with the control group (p<.05 in all cases). There were no significant differences between meditation and relaxation on distress and positive mood states over time. Effect sizes for distress were large for both meditation and relaxation (Cohen’s d=1.36 and .91, respectively), whereas the meditation group showed a larger effect size for positive states of mind than relaxation (Cohen’s d=.71 and .25, respectively). The meditation group also demonstrated significant pre-post decreases in both distractive and ruminative thoughts/behaviors compared with the control group (p<.04 in all cases; Cohen’s d=.57 for rumination and .25 for distraction for the meditation group), with mediation models suggesting that mindfulness meditation’s effects on reducing distress were partially mediated by reducing rumination. No significant effects were found for spiritual experience.Conclusions: The data suggest that compared with a no-treatment control, brief training in mindfulness meditation or somatic relaxation reduces distress and improves positive mood states. However, mindfulness meditation may be specific in its ability to reduce distractive and ruminative thoughts and behaviors, and this ability may provide a unique mechanism by which mindfulness meditation reduces distress.

Narrative communication in cancer prevention and control: A framework to guide research and application

Abstract: Narrative forms of communication—including entertainment education, journalism, literature, testimonials, and storytelling—are emerging as important tools for cancer prevention and control. To stimulate critical thinking about the role of narrative in cancer communication and promote a more focused and systematic program of research to understand its effects, we propose a typology of narrative application in cancer control. We assert that narrative has four distinctive capabilities: overcoming resistance, facilitating information processing, providing surrogate social connections, and addressing emotional and existential issues. We further assert that different capabilities are applicable to different outcomes across the cancer control continuum (e.g., prevention, detection, diagnosis, treatment, survivorship). This article describes the empirical evidence and theoretical rationale supporting propositions in the typology, identifies variables likely to moderate narrative effects, raises ethical issues to be addressed when using narrative communication in cancer prevention and control efforts, and discusses potential limitations of using narrative in this way. Future research needs based on these propositions are outlined and encouraged.

Self-regulation, self-efficacy, outcome expectations, and social support: social cognitive theory and nutrition behavior.

Abstract: Background: Understanding the need for and accessibility to healthier foods have not improved the overall diets of the U.S. population. Social cognitive theory (SCT) may explain how other variables, such as self-regulation and self-efficacy, may be key to integrating healthier nutrition into U.S. lifestyles.Purpose: To determine how SCT accounts for the nutritional content of food purchases and consumption among adults in a health promotion study.Methods: Participants were 712 churchgoers (18% African American, 66% female, 79% overweight or obese) from 14 churches in southwestern Virginia participating in the baseline phase of a larger health promotion study. Data were collected on the nutrition related social support, self-efficacy, outcome expectations, and self-regulation components of SCT, as well as on the fat, fiber, fruit, and vegetable content of food-shopping receipts and food frequency questionnaires. These data were used to test the fit of models ordered as prescribed by SCT and subjected to structural equation analysis.Results: SCT provided a good fit to the data explaining 35%, 52%, and 59% of observed variance in percent calories from fat, fiber g/1000 kcals and fruit and vegetable servings/1000 kcals. Participants’ age, gender, socioeconomic status, social support, self-efficacy, negative outcome expectations, and self-regulation made important contributions to their nutrition behavior—a configuration of influences consistent with SCT.Conclusions: These results suggest a pivotal role for self-regulatory behavior in the healthier food choices of adults. Interventions effective at garnering family support, increasing nutrition related self-efficacy, and overcoming negative outcome expectations should be more successful at helping adults enact the self-regulatory behaviors essential to buying and eating healthier foods.

Psychosocial health problems increase risk for HIV among urban young men who have sex with men: Preliminary evidence of a syndemic in need of attention

Abstract: Background: Young men who have sex with men (YMSM) experience disparities in HIV rates and potentially in mental health, substance abuse, and exposure to violence.Purpose: We assessed the extent to which these psychosocial health problems had an additive effect on increasing HIV risk among YMSM.Methods: An urban sample of 310 ethnically diverse YMSM reported on psychosocial health problems, sexual risk behaviors, and HIV status. A count of psychosocial health problems was calculated to test the additive relationship to HIV risk.Results: The prevalence of psychosocial health problems varied from 23% for regular binge drinking to 34% for experiencing partner violence. Rates of sexual risk behaviors were high and 14% of YMSM reported receiving a HIV + test result. Psychosocial health problems cooccurred, as evidenced by significant bivariate odds ratios (ORs) between 12 of the 15 associations tested. Number of psychosocial health problems significantly increased the odds of having multiple anal sex partners (OR=1.24), unprotected anal sex (OR=1.42), and an HIV-positive status (OR 1.42), after controlling for demographic factors.Conclusions: These data suggest the existence of cooccurring epidemics, or “syndemic,-of health problems among YMSM. Disparities exist not only in the prevalence of HIV among YMSM but also in research to combat the epidemic within this vulnerable population. Future research is needed to identify risk and resiliency factors across the range of health disparities and develop interventions that address this syndemic.

Misleading tests of health behavior theories

Abstract: Most tests of cognitively oriented theories of health behavior are based on correlational data. Unfortunately, such tests are often biased, overestimating the accuracy of the theories they seek to evaluate. These biases are especially strong when studies examine health behaviors that need to be performed repeatedly, such as medication adherence, diet, exercise, and condom use. Several misleading data analysis procedures further exaggerate the theories’ predictive accuracy. Because correlational designs are not adequate for deciding whether a particular construct affects behavior or for testing one theory against another, most of the literature aiming to test these theories tells us little about their validity or completeness. Neither does the existing empirical literature support decisions to use these theories to design interventions. In addition to discussing problems with correlational data, this article offers ideas for alternative testing strategies.

Adoption and maintenance of four health behaviors: Theory-guided longitudinal studies on dental flossing, seat belt use, dietary behavior, and physical activity

Abstract: Background: Adoption and maintenance of health behaviors are often poorly predicted by behavioral intentions. To bridge the gap between intentions and behavior, strategic planning and recovery self-efficacy have been suggested as proximal predictors.Purpose: The aim was to examine the usefulness of a prediction model that includes planning and self-efficacy as postintentional mediator variables.Methods: Four longitudinal studies were conducted on dental flossing (Study I, N = 157), seat belt use (Study II, N = 298), dietary behaviors (Study III, N = 700), and physical activity (Study IV, N = 365). Dental flossing and seat belt use were assessed in students by paper-and-pencil questionnaires, whereas dietary behavior and physical activity inventories were presented to the general public in the internet.Results: By structural equation modeling, it was found that one common model fits all four data sets well. Results differed in terms of variance accounted for, but the overall patterns of estimated parameters were similar across samples.Conclusions: Self-efficacy and planning seemed to be functional as proximal predictors of health behaviors, whereas health risk perception appeared to be a negligible factor. When predicting health behaviors, self-regulatory variables should be used in addition to the behavioral intention.

A cohort-sequential latent growth model of physical activity from ages 12 to 17 years.

Abstract: Background: Despite serious public health implications of decreased physical activity during adolescence, few longitudinal studies have been conducted to determine the trajectory and important correlates of physical activity change during this period.Purpose: This study examines change in physical activity from ages 12 to 17 years and the influences of personal, family, peer, and demographic factors on activity patterns.Methods: Data were from 371 youth. The sample was 50.1% female, 76% White, 12% African American, 4% Hispanic, 2% Asian, 2% American Indian, and 4% other or mixed races. Mean age was 12.05 years (SD=1.63) at Time 1. Multivariate latent growth curve modeling (LGM), a cohort-sequential design, and a multiple-group design by sex were employed.Results: Youth physical activity declined significantly from ages 12 to 17. Boys had higher initial levels of physical activity than girls. Efficacy to overcome barriers, physically active friends, and friend social support all played roles in reducing the decline in physical activity. Early maturing boys, although more physically active initially, experienced a greater decline in physical activity compared to later maturing boys.Conclusions: These findings encourage further research on the etiology and development of youth physical activity using procedures such as LGM to better understand the risk and protective factors associated with youth physical activity decline.

Physical activity and mental health outcomes during menopause: a randomized controlled trial.

Abstract: Background: Many women experience detriments in mental health during the menopausal transition. Physical activity may attenuate these adverse outcomes but few studies investigating such effects exist.Purpose: This study examined the effects of a 4-month randomized controlled exercise trial on mental health outcomes in 164 previously low-active middle-aged women (M age=49.9; SD=3.6).Methods and Results: Participants completed body composition and fitness assessment and a battery of psychological measures at the beginning and end of a 4-month randomized controlled exercise trial with three arms: walking, yoga, control. The results indicated that walking and yoga were effective in enhancing positive affect and menopause-related QOL and reducing negative affect. Women who experienced decreases in menopausal symptoms across the trial also experienced improvements in all positive mental health and QOL outcomes and reductions in negative mental health outcomes. Whether menopausal symptoms increased or decreased across the trial appeared to be determined in part by whether there were increases or decreases in cardiorespiratory fitness.Conclusions: Physical activity appears to enhance mood and menopause-related QOL during menopause, however, other aspects of mental health may be affected only as a result of reduction in menopausal symptoms. Increasing cardiorespiratory fitness could be one way to reduce menopausal symptoms.

Adjustment to chronic pain: the role of pain acceptance, coping strategies, and pain-related cognitions.

Abstract: Background: Previous research has found that acceptance of pain is more successful than coping variables in predicting adjustment to pain.Purpose: To compare the influence of acceptance, pain-related cognitions and coping in adjustment to chronic pain.Methods: One hundred seventeen chronic pain patients attending the Clinical Pain Unit were administered a battery of questionnaires assessing pain acceptance, active and passive coping, pain-related cognitions, and adjustment.Results: The influence of acceptance, coping, and cognition on all the adjustment variables was considered simultaneously via Structural Equation Modeling using LISREL 8.30 software. A multigroup analysis showed that the male and female samples did not significantly differ regarding path coefficients. The final model showed that acceptance of pain determined functional status and functional impairment. However, coping measures had a significant influence on measures of emotional distress. Catastrophizing self-statements significantly influenced reported pain intensity and anxiety; resourcefulness beliefs had a negative and significant influence on depression.Conclusions: These findings suggest that acceptance may play a critical role in the maintenance of functioning and, with this aim, acceptance-based treatments are promising to avoid the development of disability. They also lend support to the role of control beliefs and of active coping to maintain a positive mood. Acceptance and coping are presented as complementary approaches.

Are psychological characteristics related to risk of the metabolic syndrome? A review of the literature.

Abstract: Backround: We evaluate the evidence that depression, anger, hostility, and anxiety are related to risk for the metabolic syndrome, focusing as well on its components of central adiposity and insulin resistance. In addition, we identify possible moderators of these associations and summarize plausible underlying biobehavioral pathways.Methods: Medline, PsycINFO, PubMed, and Web of Science searches were conducted using the keywords metabolic syndrome, syndrome x, central adiposity/obesity, visceral adiposity/obesity, body fat distribution, waist circumference, waist hip ratio, insulin resistance/sensitivity, glucose tolerance, psychological, depression, hostility, anger, cynicism, and anxiety.Results: The current literature provides cross-sectional evidence for an association between psychological characteristics and the metabolic syndrome. Prospective data, though limited, suggest that depression, hostility, and anger predict increased risk for the metabolic syndrome. Data on modifiers are too limited to permit definitive conclusions. Negative health behaviors and hypothalamic and sympathetic dysregulation are identified as plausible underlying pathways.Conclusions: More prospective studies, conducted with diverse samples, are needed to delineate the direction of this relationship and the proposed biobehavioral mechanisms; experimental investigations are needed to test for causality. Nevertheless, findings suggest that psychological characteristics, especially depression, hostility, and anger, may increase risk for the metabolic syndrome, providing a novel direction for prevention and treatment interventions.

The contribution of changes in diet, exercise, and stress management to changes in coronary risk in women and men in the multisite cardiac lifestyle intervention program.

Abstract: Background: The relative contribution of health behaviors to coronary risk factors in multicomponent secondary coronary heart disease (CHD) prevention programs is largely unknown.Purpose: Our purpose is to evaluate the additive and interactive effects of 3-month changes in health behaviors (dietary fat intake, exercise, and stress management) on 3-month changes in coronary risk and psychosocial factors among 869 nonsmoking CHD patients (34% female) enrolled in the health insurance-based Multisite Cardiac Lifestyle Intervention Program.Methods: Analyses of variance for repeated measures were used to analyze health behaviors, coronary risk factors, and psychosocial factors at baseline and 3 months. Multiple regression analyses evaluated changes in dietary fat intake and hours per week of exercise and stress management as predictors of changes in coronary risk and psychosocial factors.Results: Significant overall improvement in coronary risk was observed. Reductions in dietary fat intake predicted reductions in weight, total cholesterol, low-density lipoprotein cholesterol, and interacted with increased exercise to predict reductions in perceived stress. Increases in exercise predicted improvements in total cholesterol and exercise capacity (for women). Increased stress management was related to reductions in weight, total cholesterol/high-density lipoprotein cholesterol (for men), triglycerides, hemoglobin A1c (in patients with diabetes), and hostility.Conclusions: Improvements in dietary fat intake, exercise, and stress management were individually, additively and interactively related to coronary risk and psychosocial factors, suggesting that multicomponent programs focusing on diet, exercise, and stress management may benefit patients with CHD.

Guide to health: nutrition and physical activity outcomes of a group-randomized trial of an Internet-based intervention in churches.

Abstract: Background: Theory-based interventions accessible to large groups of people are needed to induce favorable shifts in health behaviors and body weight.Purpose: The aim was to assess nutrition; physical activity; and, secondarily, body weight in the tailored, social cognitive Guide to Health (GTH) Internet intervention delivered in churches.Methods: Participants (N=1,071; 33% male, 23% African American, 57% with body mass index ≥25, 60% sedentary, Mdn age=53 years) within 14 Baptist or United Methodist churches were randomized to the GTH intervention only (GTH-Only; 5 churches), with church-based supports (GTH-Plus; 5 churches), or to a waitlist (control; 4 churches). Verified pedometer step counts, measured body weight, fat, fiber, and fruit and vegetable (FV p=.005) and at follow-up (∼1.20 vs. ∼0.50 servings; p=.038) and increased fiber at post (∼3.00 g) compared to control (∼1.5 g; p=.006) and follow-up (∼3.00 g vs. ∼2.00 g; p=.040). GTH-Plus participants compared to control increased steps at post (∼1,500 steps/day vs. ∼400 steps/day; p=.050) and follow-up (∼1,000 steps/day vs. ∼−50 steps/day; p=.010), increased FV p=.007) and follow-up (∼1.3 servings; p=.014), increased fiber at post (∼3.00 g; p=.013), and follow-up (∼3.00; p=.050) and decreased weight at post (∼−0.30 kg vs. ∼+0.60 kg; p=.030).Conclusions: Compared to control, both GTH treatments improved nutrition at posttest, but church supports improved physical activity and nutrition at posttest and follow-up, suggesting environmental supports may improve Internet-based interventions.

Applying the RE-AIM framework to assess the public health impact of policy change

Abstract: Background and Purpose: Planning and evaluation models have been developed to assess the public health impact of health promotion interventions. However, few have been applied to health policies. There is an important need for models to help design and evaluate health policies.Methods: This article applies the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) planning and evaluation framework to health policies. We provide definitions and application examples for different policies.Results: As demonstrated by a case study, the RE-AIM dimensions and definitions can also apply to policies. Considerations regarding compliance and enforcement are presented to clarify the complex implementation dimension.Conclusions: The RE-AIM framework can be useful in estimating public health impact, comparing different health policies, planning policies designed for increased likelihood of success, and identifying areas for integration of policies with other health promotion strategies.

Physical symptoms, beliefs about medications, negative mood, and long-term HIV medication adherence

Abstract: Background: Near-perfect levels of HIV medication adherence are necessary for treatment to be successful. However, many patients continue to report nonadherence to HIV treatment.Purpose: This study examines the relationship between symptoms of HIV and medication adherence and evaluates beliefs about HIV medications and negative mood states as potential mediators of this relationship.Methods: These relationships were tested with structural equation modeling using a 15-month longitudinal design. The ethnically diverse convenience sample included 325 HIV-infected men who have sex with men and women prescribed Highly Active Antiretroviral Therapy (HAART).Results: Results showed that a greater number of symptoms were associated with poorer medication adherence, and this relationship was partially mediated by increases in concerns about HAART. Contrary to expectations, negative mood states were not directly related to medication adherence. In the final model, concerns about HAART and general distrust of medications each predicted poorer HAART adherence. Necessity beliefs about HAART and level of educational attainment each predicted better adherence. The final model accounted for approximately 24% of the variance in HAART adherence.Conclusions: The results of this study suggest that Horne’s (1) necessity-concerns framework can be successfully applied to identify beliefs about medication that are important predictors of adherence to HAART over time. These findings have relevance for developing interventions to improve medication adherence among HIV-infected patients.

The neighborhood and home environments: disparate relationships with physical activity and sedentary behaviors in youth.

Abstract: Background: To increase participation in physical activity, it is important to understand the factors associated with a child’s choice to be physically active or sedentary. The neighborhood and home environments may be related to this choice.Purpose: To determine whether the neighborhood environment or number of televisions in the home environment are independently associated with child physical activity and television time.Methods: The associations of the neighborhood and home environments on active and sedentary behaviors were studied in 44 boys and 44 girls who wore accelerometers and recorded their television watching behaviors. Neighborhood environment variables were measured using extensive geographic information systems analysis.Results: Hierarchical regression analyses were used to predict physical activity after controlling for individual differences in age, socioeconomic status, percentage overweight, and time the accelerometer was worn in Step 1. Sex of the child was added in Step 2. A neighborhood design variable, street connectivity, accounted for an additional 6% (p≤·01) of the variability in physical activity in Step 3. A block of variables including a measure of neighborhood land use diversity, percentage park area, and the interaction of Percentage Park Area × Sex then accounted for a further 9% (p≤·01) of the variability in physical activity in Step 4. Increased access to parks was related to increased physical activity in boys but not in girls. The number of televisions in the home accounted for 6% (p≤·05) of the variability in television watching behavior. Neighborhood environment variables did not predict television watching that occurs in the home.Conclusion: The neighborhood environment is more strongly associated with physical activity of boys than girls. Sedentary behaviors are associated with access to television in the home environment. To promote physical activity in children, planners need to design environments that support active living and parents should limit access to television viewing in the home.

On the importance of relationship quality: the impact of ambivalence in friendships on cardiovascular functioning.

Abstract: Background: Social relationships are reliably related to rates of morbidity and mortality. One pathway by which social relationships may influence health is via the impact of relationship quality on cardiovascular reactivity during social interactions.Purpose and Method: This study examined the effects of the quality of a friendship on cardiovascular reactivity when speaking about positive or negative life events with an ambivalent or supportive friend. To examine this, 107 healthy male and female adults (and their same-sex friend) were recruited.Results: Results revealed that participants exhibited the greatest levels of systolic blood pressure reactivity when discussing a negative event with an ambivalent friend compared to a supportive friend. We also found higher resting levels of heart rate and lower respiratory sinus arrhythmia among those who brought in ambivalent friends than those who brought in supportive friends.Conclusion: Individuals may not be able to fully relax in the presence of ambivalent friends and may not benefit from support during stress. This research may help clarify the health-related consequences of differing types of social relationships.

Pain acceptance moderates the relation between pain and negative affect in female osteoarthritis and fibromyalgia patients

Abstract: Background: Chronic pain is often intractable despite advanced medical and psychotherapeutic treatments. Pain acceptance is emerging as a promising complement to control-based pain management strategies and a likely approach to maintaining quality of life for chronic pain patients.Purpose: This theoretically based analysis of an existing database examined the extent to which pain acceptance predicted weekly reports of positive affect (PA) and negative affect (NA), and the relations of pain severity to both PA and NA.Methods: Participants were women, 36 with osteoarthritis and 86 with fibromylagia, who completed an initial assessment for demographics, pain catastrophizing, and pain acceptance, and 2 to 12 weekly assessments of pain severity, PA, and NA.Results: Multilevel modeling analyses indicated that pain acceptance was related to higher levels of PA but was unrelated to NA. Furthermore, pain acceptance moderated the relation of NA and pain severity, such that expected increases in NA during pain exacerbations were buffered by higher levels of pain acceptance.Conclusions: These findings suggest that pain patients with greater capacity to accept pain may be emotionally resilient in managing their condition.

Tobacco retailer density surrounding schools and cigarette access behaviors among underage smoking students

Abstract: Background: Current tobacco access restrictions are ineffective because youth can find noncompliant retailers or social sources from which to get cigarettes.Purpose: The purpose of this study is to examine characteristics related to the cigarettes access behaviors of underage smoking youth.Methods: Data were collected from 20,297 students (Grades 9–12) attending 29 secondary schools in Ontario, Canada in 2001. Multilevel logistic regression analyses were used to examine how tobacco retailers surronding schools, school smoking rates, and student characteristics were related to smokers buying their own cigarettes, getting someone else to buy their cigarettes, or getting their cigarettes from friends.Results: Among underage smokers, 34.3% usually buy their own cigarettes, and 42.1% report that they are never asked for their age when trying to buy cigarettes. The more tobacco retailers there were surrounding a school, the more likely smokers were to buy their own cigarettes and the less likely they were to get someone else to buy their cigarettes. Students’ smoking habits were also related to their cigarette access behaviors.Conclusions: Tobacco retailer density surrounding schools is related to student cigarette access behaviors. Selective enforcement of youth access laws in retail outlets in close proximity to schools might help to prevent underage youth from smoking. *** DIRECT SUPPORT *** A01QO001 00011

Relationships between psychosocial factors and health behavior change in cancer survivors: an integrative review.

Abstract: Background: Adaptive health behavior changes following cancer diagnosis and treatment are associated with better psychological and physical well-being. However, little is known about the roles that psychosocial factors play in facilitating or inhibiting these changes. A better understanding of health behavior change will allow the development of more effective interventions.Purpose: Our goal was to conduct a systematic and exhaustive review of research examining relationships among psychosocial factors and health behavior change in cancer survivors.Method: We searched electronic databases and reference sections of relevant article and chapters to locate all studies that met our criteria (i.e., examined at least one psychosocial variable and one health behavior change in a sample of cancer survivors).Results: We located 30 studies that met criteria. Social support, locus of control, and distress were the focus of most of this literature. Although findings are inconsistent, social support appears to be helpful in making adaptive changes, particularly in exercise; internal locus of control facilitates positive health behavior changes but may depend on survivors’ perceptions of links between behaviors and cancer or recurrence, and cancer-related distress may facilitate adaptive changes although more general distress may impede them. Studies based on theoretical models of health behavior change have demonstrated that stage of readiness to change, intentions, and self-efficacy may be powerful determinants of improvements in health behaviors.Conclusions: Much remains to be learned about the influence of psychosocial factors in survivors’ health behavior change. We describe the limitations of the current state of the research and conclude with suggestions for future research and intervention.

Choice of interactive dance and bicycle games in overweight and nonoverweight youth.

Abstract: Background: Interactive video games are a popular alternative to physical activity in youth. One advancement in computer games are interactive games that use physical activity as a game playing controller, combining exercise and entertainment, or exertainment.Purpose: This study tested the reinforcing value and activity levels of interactive dance and bicycle race games in 18 overweight and 17 non-overweight 8- to 12-year-old youth.Methods: Reinforcing value was studied using a behavioral choice paradigm that provided children the opportunity to respond on progressive ratio schedules of reinforcement for a choice of either playing the video dance or bicycle game using a handheld video game controller or one of three options: dancing or bicycling alone, dancing or bicycling while watching a video, or playing the interactive dance or bicycle game. Reinforcing value was defined in relationship to the amount of responding children engaged in for either choice.Results: Results showed the interactive dance game was more reinforcing than dancing alone or dancing while watching the video (p=.003), but there was no difference across bicycling conditions. Nonoverweight youth were more active when given the opportunity to play the interactive dance game than overweight children (p=.05).Conclusions: These results suggest that children may be motivated to be active when given the opportunity to play an interactive dance game.

Older adults' preferences for exercising alone versus in groups: considering contextual congruence.

Abstract: Background: A growing body of research suggests that older exercisers prefer to exercise alone rather than in group-based settings. One limitation of these studies, however, has been that researchers have failed to take into account the age-related characteristics of groups when asking adults about their preferences for exercise settings.Purpose: The overall purpose of this study was to examine the exercise preferences of 947 adults for involvement in standard exercise classes populated by participants from various categories across the age spectrum.Results: The results revealed that when faced with the prospect of exercising with considerably older or younger exercisers, participants found such an exercise context to be largely unappealing. However, in accordance with the basic tenets of self-categorization theory, the results revealed that older and younger adults alike express a positive preference for exercising in standard exercise classes comprised of similarly aged participants.Conclusions: The findings of this study challenge a growing call for exercise interventions for older adults to be primarily directed at the individual-level, and suggest that group-related intervention strategies may indeed be attractive to older exercisers.

Minimal in-person support as an adjunct to internet obesity treatment

Abstract: Background: Internet-based weight-loss programs appear promising in the short-term but, to data, have not been able to produce the level of weight loss seen in traditional in-person treatment; thus, novel approaches are necessary. Using a combination of interactive technology and in-person support has been beneficial in other areas of medicine.Purpose: The aim of this study is to compare 12-month weight-loss outcomes of an Internet-only behavioral weight-loss treatment with the same program supplemented with monthly in-person meetings.Methods: One hundred and twenty-three participants were randomized to an Internet-only (n=62) or an Internet + in-person treatment (I+IPS; n=61). All participants then participated in a 12-month behavioral weight-loss program conducted over the Internet. The groups met online weekly for the first 6 months and biweekly for the second half of the intervention. The I+IPS group had access to the same Web site as the Internet-only group but, once a month, attended an in-person meeting in place of an online chat. Assessments included body weight, program adherence, and social support measures.Results: An intent-to-treat analysis (n=123) revealed there were no significant Group x Time differences (p=.15) in weight loss at either 6 (−6.8±7.8 vs. −5.1±4.8, p=.15) or 12 months (−5.1±7.1 kg vs. −3.5±5.1 kg, p=.17, for Internet-only and I+IPS, respectively). Differences between groups for those completing all measures (n=77) also revealed no significant differences at 6 months (−9.2±7.0 kg vs. −6.9±4.2 kg, p=.08) or 12 months (−8.0±7.5 kg vs. −5.6±5.5 kg, p=.10 for the Internet-only and I+IPS conditions, respectively).Conclusions: Supplementation of an Internet weight-loss treatment with monthly in-person meetings did not result in greater weight losses over 12 months. Dynamic, socially supportive, and interactive elements of the Web site may have obviated the need for further interpersonal behavioral counseling.

Risk compensation and vaccination: Can getting vaccinated cause people to engage in risky behaviors?

Abstract: Background: Some believe that vaccinating young women against human papillomavirus (HPV) will increase their risky behavior. In more formal terms, vaccination lowers risk perception, and people compensate for their lower perceived risk by reducing other preventive behaviors.Purpose: We test several predictions from the risk compensation hypothesis in the context of vaccination behavior.Methods: We obtained a random sample of adults (N=705), interviewing them by phone just as the Lyme disease vaccine first became available to the public and again 18 months later. Analyses controlled for age, sex, education, and race.Results: Vaccinated respondents were less likely to continue engaging in two of five protective behaviors after vaccination. The frequency of these protective behaviors did not dip below that among the unvaccinated respondents.Conclusions: We found some evidence of regression (protective behaviors dropping, after vaccination, to levels reported by the unvaccinated cohort). However, we did not finddisinhibition (exceeding the risk taking of the unvaccinated cohort), the greater threat to public health. Although we will not know for several years what effect HPV vaccination has on other behaviors, if any, data on other vaccinations can offer critically important information in the interim.

Adolescent expectancies, parent-adolescent communication and intentions to have sexual intercourse among inner-city, middle school youth.

Abstract: Background: The incidence and prevalence of pregnancy and sexually transmitted infections among American adolescents remain unacceptably high.Purpose: This research examines adolescent intentions to have sexual intercourse, their expectancies about having sexual intercourse, and maternal communication about the expectancies of engaging in sexual intercourse.Methods: Six hundred sixty-eight randomly selected inner-city middle school students and their mothers completed self-administered questionnaires. Adolescents reported their intentions to have sexual intercourse and the perceived positive and negative expectancies of doing so. Both mothers and adolescents reported on the frequency of communication about these expectancies.Results: Boys reported higher intentions, more positive expectancies, and lower levels of maternal communication than did girls. Expectancies statistically significantly associated with intentions focused on the positive physical, social, and emotional advantages of having sex rather than on concerns about pregnancy and HIV/AIDS. With some exceptions, maternal communication was associated with adolescents-expectancies about engaging in sexual intercourse. However, only modest correlations between maternal and adolescent reports of communication were observed.Conclusions: Results indicate that intervention programs should address the positive expectancies youth have about having sex, not just the threat of pregnancy and HIV/AIDS, and should address potential gender differences in expectancies between boys and girls.

"Does one size fit all?" moderators in psychosocial interventions for breast cancer patients: a meta-analysis.

Abstract: Background: A variety of psychosocial interventions have been developed to promote better adjustment to breast cancer (BC) and their efficacy has been demonstrated repeatedly. However, the effect sizes (ES) vary considerably across studies.Purpose: This article intends to shed light on potential moderators of intervention efficacy for BC patients, such as the intervention type (e.g., education, supportive), the composition of the sample (only BC patients or BC mixed with other cancer types), and the practitioner of the intervention (psychologist, nonpsychologist).Methods: Fifty-six randomized-controlled studies investigating the effectiveness of psychosocial interventions with adult BC patients were meta-analytically reviewed.Results: The overall ES of d=0.26 was similar to previous meta-analyses and moderated by several variables. The ES varied notably based on the composition of the sample, the profession offering the intervention, and the type of intervention. Studies with samples consisting of only BC patients and studies with nonpsychologist-led interventions showed lower ES. Psychoeducation yielded the strongest ES. These moderators maintained their significance even when controlling for the nature of the control group, the format of the intervention, the timing of the intervention, or the stage of disease.Conclusions: These results suggest that among current interventions, psychoeducation is a treatment of choice for BC patients, preferably prior to surgery and led by individuals with a medical expertise. Other psychosocial interventions appear most effective when administered individually and led by a psychologist. In addition, there is a need for improved psychosocial interventions to enhance the present ES for women with BC.

Mapping the social and physical contexts of physical activity across adolescence using ecological momentary assessment

Abstract: Background: Research has sought to understand how environmental factors influence adolescent physical activity, yet little is known about where and with whom adolescents are physically active.Purpose: This study used electronic ecological momentary assessment (e.EMA) to map the social and physical contexts of exercise and walking across adolescence. Differences in physical activity contexts by gender, grade in school, day of the week, and season were examined.Methods: Twice a year between 9th and 12th grade, 502 adolescents (51% female) of mixed ethnicity (55% White) participated in 4-day e.EMA intervals (Thursday-Sunday) where their primary activity (e.g., exercise, TV, homework), social company (e.g., friends, family, class), and physical location (e.g., home, school, outdoors) were assessed every 30 (±10) min during waking hours.Results: Overall, greater proportions of exercise and walking were reported with friends, outdoors, and at school. However, boys were more likely to report exercising and walking in outdoor locations than girls. Exercising with classmates, family, and at school decreased across high school. Walking with family, friends, and outdoors also decreased. On weekdays compared to weekends, students reported a greater proportion of their exercise and walking at school. Students were more likely to report exercising and walking outdoors in the fall and the spring than in the winter.Conclusion: e.EMA showed that the social and physical contexts of adolescent exercise and walking vary as a function of gender, grade in school, day of the week, and season. Understanding the contexts of physical activity during the high school years can be helpful in designing interventions during adolescence.

Does genetic testing result in behavioral health change? Changes in smoking behavior following testing for alpha-1 antitrypsin deficiency.

Abstract: Background: As genetic testing for health risk becomes increasingly available, it becomes important to study the prospective impact of testing on modifiable health behavior.Purpose: This study examines the impact of genetic testing for alpha-1 antitrypsin (AAT) deficiency, a condition that usually results in emphysema in individuals exposed to cigarette smoke. We evaluated whether AAT testing, performed in the home and with minimal contact (reading materials including advice on cessation), results in quit attempts and abstinence.Methods: Identified smokers (N=199) from a larger study of genetic testing were surveyed 3 months following receipt of their AAT genotype. The primary endpoint was the incidence of quit attempts.Results: Smokers who tested severely AAT deficient were significantly more likely to report a 24-hr quit attempt (59%) than were those who tested normal (26%). Carriers had a 34% quit attempt rate. Severely AAT deficient smokers were more likely than both carriers and normals to seek information on treatment, use pharmacotherapy for smoking cessation, and report greater reductions in their smoking. There were no group differences in 3-month abstinence rates.Conclusions: Knowledge of severe AAT deficiency, but not carrier status, may motivate smokers toward cessation. The AAT testing experience may have consequences for outcomes of other genetic conditions with modifiable health behaviors.

Symptoms of depression and anxiety as unique predictors of pain-related outcomes following burn injury.

Abstract: Background: The adverse consequences of burn injuries include pain and psychological distress, which show bidirectional associations. However, much of the existing research has relied on global measures of distress that do not separate distinct symptoms of anxiety and depression.Purpose: The purpose is to assess the prospective effects of anxiety and depression on pain and functional outcomes following burn injury.Methods: This article describes a 2-year cohort study in patients hospitalized for serious burn injuries (assessments at discharge and 6-month, 1-year, and 2-year follow-up). Linear mixed effects analyses were conducted to model anxiety and depression’s unique longitudinal effects; at each time point, depressive and anxiety symptoms were studied as predictors of subsequent changes in pain, fatigue, and physical function.Results: When studied in separate prediction models, both depression and anxiety were strong prospective predictors of greater pain, more fatigue, and physical dysfunction at the subsequent time point (ps<.01). However, when both were included in a single model to study their unique effects, depressive symptoms (but not anxiety) emerged as a signfiicant predictor of subsequent increases in pain and reductions in physical functioning, whereas anxiety (but not depression) predicted subsequent elevations in fatigue.Conclusions: These findings suggest potentially distinct effects of depression and anxiety and imply that assessment and early treatment of both depressive and anxiety symptoms may help improve a broad range of long-term pain-related outcomes following burn inury.

The effect of spirituality and gender on the quality of life of spousal caregivers of cancer survivors

Abstract: Background: Research has indicated spirituality buffers the adverse effect of stress, but few studies have examined the role of spirituality in the context of providing cancer care.Purpose: This study examines the moderating effects of spirituality on the relation between caregiving stress and spousal caregivers’ mental and physical health. In addition, gender differences in the target moderating effects are explored.Methods: A caregiver survey was mailed to familial caregivers nominated by their respective cancer survivors including measures of spirituality (Functional Assessment of Chronic Illness Therapy-Spirituality), caregiving stress (Pearlin Stress Scale), and mental and physical health (MOS Short Form-36). Four hundred and three spousal caregivers provided valid information on these measures.Results: Hierarchical regression analyses supported the hypothesized moderating effects of spirituality but in different patterns. Caregiving stress was associated with poorer mental functioning, which was less prominent among caregivers with a high level of spirituality (stress-buffering effect). Caregiving stress was also associated with poorer physical functioning but was only significant among caregivers with a high level of spirituality (stress-aggravating effect). The same stress-buffering or aggravating effects were found for both sexes.Conclusions: The findings suggest maintaining faith and finding meaning in cancer caregiving buffer the adverse effect of caregiving stress on mental health. Highly spiritual caregivers should also be encouraged to pay more attention to their physical health while providing cancer care.

Positive and negative life changes experienced by survivors of non-Hodgkin’s lymphoma

Abstract: Background: The impact of cancer on adult survivors of aggressive non-Hodgkin’s Lymphoma (NHL) is understudied.Purpose: We examined positive and negative life changes (health behaviors, relationships, financial situation) experienced by survivors of NHL and their association with physical and mental function.Methods: Using the Los Angeles County Cancer Surveillance Program, 744 questionnaires were mailed to adult survivors of NHL: 308 provided complete data for analyses (M age=59.8, SD=14.9).Results: Perceptions of positive and negative life changes were common in our sample, with 77.9% of NHL survivors reporting at least one positive change and 78.6% reporting at least one negative change. Cancer had the greatest positive change on relationships and the most negative change on survivors’ financial situation. There was an equal distribution of survivors classified as having experienced positive change and negative change on health behaviors. Regardless of whether positive and negative life change were entered into separate regression models or the same model, an increase in negative life change in each of the domains was significantly associated with a decrease in physical and mental functioning. Positive change was significantly associated only with physical functioning when examining overall change (p=.018) and health behaviors (p=.013), and the inclusion of negative change attenuated these associations.Conclusions: In designing interventions to improve the mental and physical function of NHL survivors, the greatest benefit may likely be achieved by reducing the negative effects of cancer. Perhaps positive life change are related in more specific ways to other indexes of adjustment, but our findings failed to show a positive relationship with mental and physical function.