Showing papers in "Annals of Behavioral Medicine in 2020"

Predicting Social Distancing Intention and Behavior During the COVID-19 Pandemic: An Integrated Social Cognition Model.

Abstract: BACKGROUND: Social distancing is a key behavior to minimize COVID-19 infections. Identification of potentially modifiable determinants of social distancing behavior may provide essential evidence to inform social distancing behavioral interventions. PURPOSE: The current study applied an integrated social cognition model to identify the determinants of social distancing behavior, and the processes involved, in the context of the COVID-19 pandemic. METHODS: In a prospective correlational survey study, samples of Australian (N = 365) and U.S. (N = 440) residents completed online self-report measures of social cognition constructs (attitude, subjective norm, moral norm, anticipated regret, and perceived behavioral control [PBC]), intention, action planning, habit, and past behavior with respect to social distancing behavior at an initial occasion. Follow-up measures of habit and social distancing behavior were taken 1 week later. RESULTS: Structural equation models indicated that subjective norm, moral norm, and PBC were consistent predictors of intention in both samples. Intention, action planning, and habit at follow-up were consistent predictors of social distancing behavior in both samples. Action planning did not have consistent effects mediating or moderating the intention-behavior relationship. Inclusion of past behavior in the model attenuated effects among constructs, although the effects of the determinants of intention and behavior remained. CONCLUSIONS: Current findings highlight the importance of subjective norm, moral obligation, and PBC as determinants of social distancing intention and intention and habit as behavioral determinants. Future research on long-range predictors of social distancing behavior and reciprocal effects in the integrated model is warranted.

Socioeconomic Status Moderates the Effects of Health Cognitions on Health Behaviors within Participants: Two Multibehavior Studies.

Abstract: Background: Socioeconomic differences in health-related behaviors are a major cause of health inequalities. However, the mechanisms (mediation/moderation) by which socioeconomic status (SES) affects health behavior are a topic of ongoing debate. Purpose: Current research on SES as moderator of the health cognitions–health behavior relation is inconsistent. Previous studies are limited by diverse operationalizations of SES and health behaviors, demographically narrow samples, and between-person designs addressing within-person processes. This paper presents two studies addressing these shortcomings in a within-person multibehavior framework using hierarchical linear models. Methods: Two online studies, one cross-sectional and one 4 week longitudinal, assessed 1,005 (Study 1; Amazon MTurk; USA only) and 1,273 participants (Study 2; Prolific; international). Self-reports of multiple SES indicators (education, income, occupation status; ZIP code in Study 1), health cognitions (from the theory of planned behavior), and measures of six health behaviors were taken. Multilevel models with cross-level interactions tested whether the within-person relationships between health cognitions and behaviors differed by between-person SES. Results: Education significantly moderated intention-behavior and attitude-behavior relationships in both studies, with more educated individuals showing stronger positive relationships. In addition, ZIP-level SES (Study 1) moderated attitude-behavior effects such that these relationships were stronger in participants living in areas with higher SES. Conclusions: Education appears to be an important resource for the translation of intentions and attitudes into behavior. Other SES indicators showed less consistent effects. This has implications for interventions aiming at increasing intentions to change health behaviors, as some interventions might inadvertently increase health inequalities.

Precision Health: The Role of the Social and Behavioral Sciences in Advancing the Vision

Abstract: Author(s): Hekler, Eric; Tiro, Jasmin A; Hunter, Christine M; Nebeker, Camille | Abstract: BackgroundIn 2015, Collins and Varmus articulated a vision for precision medicine emphasizing molecular characterization of illness to identify actionable biomarkers to support individualized treatment. Researchers have argued for a broader conceptualization, precision health. Precision health is an ambitious conceptualization of health, which includes dynamic linkages between research and practice as well as medicine, population health, and public health. The goal is a unified approach to match a full range of promotion, prevention, diagnostic, and treatment interventions to fundamental and actionable determinants of health; to not just address symptoms, but to directly targetgenetic, biological, environmental, and social and behavioral determinants of health.PurposeThe purpose of this paper is to elucidate the role of social and behavioral sciences within precision health.Main bodyRecent technologies, research frameworks, and methods are enabling new approaches to measure, intervene, and conduct social and behavioral science research. These approaches support three opportunities in precision health that the social and behavioral sciences could colead including: (a) developing interventions that continuously “tune” to each person’s evolving needs; (b) enhancing and accelerating links between research and practice; and (c) studying mechanisms of change in real-world contexts. There are three challenges for precision health: (a) methods of knowledge organization and curation; (b) ethical conduct of research; and (c) equitable implementation of precision health.ConclusionsPrecision health requires active coleadership from social and behavioral scientists. Prior work and evidence firmly demonstrate why the social and behavioral sciences should colead with regard to three opportunity and three challenge areas.

Do Combinations of Behavior Change Techniques That Occur Frequently in Interventions Reflect Underlying Theory

Abstract: Background Behavioral interventions typically include multiple behavior change techniques (BCTs). The theory informing the selection of BCTs for an intervention may be stated explicitly or remain unreported, thus impeding the identification of links between theory and behavior change outcomes. Purpose This study aimed to identify groups of BCTs commonly occurring together in behavior change interventions and examine whether behavior change theories underlying these groups could be identified. Methods The study involved three phases: (a) a factor analysis to identify groups of co-occurring BCTs from 277 behavior change intervention reports; (b) examining expert consensus (n = 25) about links between BCT groups and behavioral theories; (c) a comparison of the expert-linked theories with theories explicitly mentioned by authors of the 277 intervention reports. Results Five groups of co-occurring BCTs (range: 3-13 BCTs per group) were identified through factor analysis. Experts agreed on five links (≥80% of experts), comprising three BCT groups and five behavior change theories. Four of the five BCT group-theory links agreed by experts were also stated by study authors in intervention reports using similar groups of BCTs. Conclusions It is possible to identify groups of BCTs frequently used together in interventions. Experts made shared inferences about behavior change theory underlying these BCT groups, suggesting that it may be possible to propose a theoretical basis for interventions where authors do not explicitly put forward a theory. These results advance our understanding of theory use in multicomponent interventions and build the evidence base for further understanding theory-based intervention development and evaluation.

Social Distancing as a Health Behavior: County-Level Movement in the United States During the COVID-19 Pandemic Is Associated with Conventional Health Behaviors.

Abstract: Background Social distancing-when people limit close contact with others outside their household-is a primary intervention available to combat the COVID-19 pandemic. The importance of social distancing is unlikely to change until effective treatments or vaccines become widely available. However, relatively little is known about how best to promote social distancing. Applying knowledge from social and behavioral research on conventional health behaviors (e.g., smoking, physical activity) to support public health efforts and research on social distancing is promising, but empirical evidence supporting this approach is needed. Purpose We examined whether one type of social distancing behavior-reduced movement outside the home-was associated with conventional health behaviors. Method We examined the association between GPS-derived movement behavior in 2,858 counties in USA from March 1 to April 7, 2020 and the prevalence of county-level indicators influenced by residents' conventional health behaviors. Results Changes in movement were associated with conventional health behaviors, and the magnitude of these associations were similar to the associations among the conventional health behaviors. Counties with healthier behaviors-particularly less obesity and greater physical activity-evidenced greater reduction in movement outside the home during the initial phases of the pandemic in the USA. Conclusions Social distancing, in the form of reduced movement outside the home, is associated with conventional health behaviors. Existing scientific literature on health behavior and health behavior change can be more confidently used to promote social distancing behaviors during the COVID-19 pandemic.

Weight Stigma as a Predictor of Distress and Maladaptive Eating Behaviors During COVID-19: Longitudinal Findings From the EAT Study.

Abstract: BACKGROUND: Weight stigma is common for people with obesity and harmful to health. Links between obesity and complications from COVID-19 have been identified, but it is unknown whether weight stigma poses adverse health implications during this pandemic. PURPOSE: We examined longitudinal associations between prepandemic experiences of weight stigma and eating behaviors, psychological distress, and physical activity during the COVID-19 pandemic in a diverse sample of emerging adults. METHODS: Participants (N = 584, 64% female, mean age = 24.6 ± 2.0 years, mean body mass index [BMI] = 28.2) in the COVID-19 Eating and Activity over Time (C-EAT) study were cohort members of the population-based longitudinal study EAT 2010-2018. Weight stigma reported by participants in 2018 was examined as a predictor of binge eating, eating to cope, physical activity, depressive symptoms, and stress during COVID-19. Data were collected via online surveys during the U.S. outbreak of COVID-19 in 2020. RESULTS: Prepandemic experiences of weight stigma predicted higher levels of depressive symptoms (s = 0.15, p < .001), stress (s = 0.15, p = .001), eating as a coping strategy (s = 0.16, p < .001), and an increased likelihood of binge eating (odds ratio = 2.88, p < .001) among young adults during the COVID-19 pandemic but were unrelated to physical activity. Although associations remained after accounting for demographic characteristics and BMI, the magnitude of longitudinal associations was attenuated after adjusting for prior levels of the outcome variables. CONCLUSIONS: Young adults who have experienced weight stigma may have increased vulnerability to distress and maladaptive eating during this pandemic. Public health messaging could be improved to support people of diverse body sizes and reduce the harmful consequences of weight stigma.

Mindfulness-Based Interventions for Adults with Cardiovascular Disease: A Systematic Review and Meta-Analysis.

Abstract: Background Individuals with cardiovascular disease (CVD) report psychological distress and poor physical functioning and may benefit from mindfulness training. Purpose To examine the effects of mindfulness-based interventions (MBIs) on psychological and physiological measures in adults with CVD using meta-analysis. Methods Comprehensive searches identified studies that (a) evaluated MBIs in adults with CVD or who had experienced a cardiac event, (b) included a comparison condition, and (c) assessed psychological (e.g., anxiety and depression) or physiological (e.g., systolic or diastolic blood pressure [BP]) outcomes. Independent raters coded methodological (e.g., design and quality) and intervention features (e.g., intervention content) as potential moderators. Weighted mean effect sizes (d+), using full information maximum likelihood estimation, were calculated. Results Of the 1,507 records reviewed, 16 studies met inclusion criteria (N = 1,476; M age = 56 years; 40% women). Compared to controls, participants who received an MBI reported greater improvements in psychological outcomes (i.e., anxiety, depression, distress, and perceived stress: d+s = 0.49 to 0.64). MBI recipients also reduced their systolic (d+ = 0.89, 95% confidence interval [CI] = 0.26, 1.51; k = 7) but not diastolic (d+ = 0.07, 95% CI = -0.47, 0.60; k = 6) BP relative to controls. Conclusions MBIs demonstrated favorable effects on psychological and physiological outcomes among adults with CVD. Future research should investigate if such benefits lead to improvements in disease outcomes in studies with longer follow-ups.

Which Components of a Smartphone Walking App Help Users to Reach Personalized Step Goals? Results From an Optimization Trial

Abstract: Background The Assistant to Lift your Level of activitY (Ally) app is a smartphone application that combines financial incentives with chatbot-guided interventions to encourage users to reach personalized daily step goals. Purpose To evaluate the effects of incentives, weekly planning, and daily self-monitoring prompts that were used as intervention components as part of the Ally app. Methods We conducted an 8 week optimization trial with n = 274 insurees of a health insurance company in Switzerland. At baseline, participants were random-ized to different incentive conditions (cash incentives vs. charity incentives vs. no incentives). Over the course of the study, participants were randomized weekly to different planning conditions (action planning vs. coping planning vs. no planning) and daily to receiving or not receiving a self-monitoring prompt. Primary outcome was the achievement of personalized daily step goals. Results Study participants were more active and healthier than the general Swiss population. Daily cash incentives increased step-goal achievement by 8.1%, 95% confidence interval (CI): [2.1, 14.1] and, only in the no-incentive control group, action planning increased step-goal achievement by 5.8%, 95% CI: [1.2, 10.4]. Charity incentives, self-monitoring prompts, and coping planning did not affect physical activity. Engagement with planning interventions and self-monitoring prompts was low and 30% of participants stopped using the app over the course of the study. Conclusions Daily cash incentives increased physical activity in the short term. Planning interventions and self-monitoring prompts require revision before they can be included in future versions of the app. Selection effects and engagement can be important challenges for physical-activity apps. Clinical Trial Information This study was registered on ClinicalTrials.gov, NCT03384550.

Weight Stigma and Weight-Related Health: Associations of Self-Report Measures Among Adults in Weight Management.

Abstract: BACKGROUND Weight stigma impairs health. Few studies have disentangled the associations of experienced versus internalized stigma with weight-related outcomes. PURPOSE To examine weight and health variables associated with weight stigma experiences and internalization in the largest-to-date sample of adults in weight management. METHODS WW (formerly Weight Watchers) members (N = 18,769, 94.6% female, 91.1% white) completed an online survey from 2017 to 2018. Participants reported whether they had experienced weight stigma and, if so, the onset, past-year frequency and distress, and interpersonal sources of stigma. Participants completed the Modified Weight Bias Internalization Scale (WBIS-M) and self-reported: past-year weight and lifetime weight cycles; current self-monitoring behaviors; eating self-efficacy; physical activity; perceived stress; eating to cope; body image; and mental and physical health-related quality-of-life (HRQOL). Participants reported their demographic characteristics, including height and weight to compute body mass index. RESULTS In logistic and linear regression analyses (controlling for participant characteristics), WBIS-M scores were negatively associated with weight loss, self-monitoring, eating self-efficacy, body image, and mental HRQOL and positively associated with weight gain, weight cycling, perceived stress, and eating to cope (p < .001). Experiencing weight stigma was associated with greater weight loss and less weight gain, although associations with other variables had small effect sizes (absolute β values < 0.10). WBIS-M scores remained significantly associated with all variables when including stigma onset, frequency/distress, and sources. CONCLUSIONS Internalized, but not experienced, weight stigma was consistently associated with adverse weight and health factors. Developing and testing interventions targeting internalized stigma in the context of weight management should be a research priority.

The Unique and Interactive Effects of Patient Race, Patient Socioeconomic Status, and Provider Attitudes on Chronic Pain Care Decisions.

Abstract: Background Compared to White and high socioeconomic status (SES) patients, Black and low SES patients receive less adequate pain care. Providers may contribute to these disparities by making biased decisions that are driven, in part, by their attitudes about race and SES. Purpose We examined the effects of patient race and SES on providers' chronic pain decisions and the extent to which providers' implicit and explicit attitudes about race and SES were related to these decisions. Methods Physician residents/fellows (n = 436) made pain care decisions for 12 computer-simulated patients with chronic back pain that varied by race (Black/White) and SES (low/high). Physicians also completed measures assessing implicit and explicit attitudes about race and SES. Results There were three significant race-by-SES interactions: (a) For high SES patients, Black (vs. White) patients were rated as having more pain interference; the opposite race difference emerged for low SES patients. (b) For high SES patients, Black (vs. White) patients were rated as being in greater distress; no race difference emerged for low SES patients. (c) For low SES patients, White (vs. Black) patients were more likely to be recommended workplace accommodations; no race difference emerged for high SES patients. Additionally, providers were more likely to recommend opioids to Black (vs. White) and low (vs. high) SES patients, and were more likely to use opioid contracts with low (vs. high) SES patients. Providers' implicit and explicit attitudes predicted some, but not all, of their pain-related ratings. Conclusion These results highlight the need to further examine the effects of patient race and SES simultaneously in the context of pain care.

Science Communication in the Age of Misinformation.

Abstract: Behavioral medicine scientists, practitioners, and educators can engage in evidence-based science communication strategies to amplify the science and combat misinformation. Such efforts are critical to protect public health during crises such as the COVID-19 pandemic and to promote overall well-being.

Lung Cancer Stigma: Does Smoking History Matter?

Abstract: BACKGROUND Lung cancer patients commonly report stigma, often attributing it to the well-established association of smoking as the leading preventable cause. Theory and research suggest that patients' smoking history may differentiate patients' experience of lung cancer stigma. However, there is inconsistent evidence whether lung cancer stigma varies by patients' smoking history, owing to limitations in the literature. PURPOSE This study examined differences in lung cancer patients' reported experience of lung cancer stigma by smoking history. METHOD Participants (N = 266, 63.9% female) were men and women with lung cancer who completed a validated, multidimensional questionnaire measuring lung cancer stigma. Multivariable regression models characterized relationships between smoking history (currently, formerly, and never smoked) and lung cancer stigma, controlling for psychological and sociodemographic covariates. RESULTS Participants who currently smoked reported significantly higher total, internalized, and perceived lung cancer stigma compared to those who formerly or never smoked (all p < .05). Participants who formerly smoked reported significantly higher total and internalized stigma compared to those who never smoked (p < .001). Participants reported similar levels of constrained disclosure, regardless of smoking history (p = .630). CONCLUSIONS Total, internalized, and perceived stigma vary meaningfully by lung cancer patients' smoking history. Patients who smoke at diagnosis are at risk for experiencing high levels of stigma and could benefit from psychosocial support. Regardless of smoking history, patients reported similar levels of discomfort in sharing information about their lung cancer diagnosis with others. Future studies should test relationships between health-related stigma and associated health behaviors in other stigmatized groups.

Longitudinal Analysis Supports a Fear-Avoidance Model That Incorporates Pain Resilience Alongside Pain Catastrophizing.

Abstract: Background The fear-avoidance model of chronic pain holds that individuals who catastrophize in response to injury are at risk for pain-related fear and avoidance behavior, and ultimately prolonged pain and disability. Purpose Based on the hypothesis that the predictive power of the fear-avoidance model would be enhanced by consideration of positive psychological constructs, the present study examined inclusion of pain resilience and self-efficacy in the model. Methods Men and women (N = 343) who experienced a recent episode of back pain were recruited in a longitudinal online survey study. Over a 3-month interval, participants repeated the Pain Resilience Scale, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia, Pain Self-Efficacy Questionnaire, the McGill Pain Questionnaire, and NIH-recommended measures of pain, depressive symptoms, and physical dysfunction. Structural equation modeling assessed the combined contribution of pain resilience and pain catastrophizing to 3-month outcomes through the simultaneous combination of kinesiophobia and self-efficacy. Results An expanded fear-avoidance model that incorporated pain resilience and self-efficacy provided a good fit to the data, Χ2 (df = 14, N = 343) = 42.09, p = .0001, RMSEA = 0.076 (90% CI: 0.05, 0.10), CFI = 0.97, SRMR = 0.03, with higher levels of pain resilience associated with improved 3-month outcomes on measures of pain intensity, physical dysfunction, and depression symptoms. Conclusions This study supports the notion that the predictive power of the fear-avoidance model of pain is enhanced when individual differences in both pain-related vulnerability (e.g., catastrophizing) and pain-related protective resources (e.g., resilience) are considered.

Moving in Sync: Hourly Physical Activity and Sedentary Behavior are Synchronized in Couples.

Abstract: BACKGROUND Overall time spent in moderate-to-vigorous intensity physical activity (MVPA) and sedentary behavior are both correlated in couples. Knowledge about the nature and psychosocial correlates of such dyadic covariation could inform important avenues for physical activity promotion. PURPOSE The present study investigates hour-by-hour covariation between partners (i.e., synchrony) in MVPA and sedentary behavior as partners engage in their daily lives and links it with person-level MVPA/sedentary behavior, temporal characteristics, and relationship variables. METHODS We used 7-day accelerometer data from two couple studies (Study 1, n = 306 couples, aged 18-80 years; Study 2, n = 108 couples, aged 60-87 years) to estimate dyadic covariation in hourly MVPA and sedentary behavior between partners. Data were analyzed using coordinated multilevel modeling. RESULTS In both studies, hourly MVPA and sedentary behavior exhibited similarly sized dyadic covariation between partners in the low-to-medium range of effects. Higher MVPA synchrony between partners was linked with higher individual weekly MVPA and higher individual weekly sedentary levels, whereas higher sedentary synchrony between partners was associated with higher individual weekly MVPA but lower individual weekly sedentary levels. MVPA and sedentary synchrony were higher in the morning and evening, more pronounced on weekends, and associated with more time spent together, longer relationship duration, and time-varying perceptions of higher partner closeness. CONCLUSIONS This study demonstrates that MVPA and sedentary behaviors do not occur in a social vacuum. Instead, they are linked with close others such as partners. Thus, capitalizing on social partners may increase the effectiveness of individual-level physical activity interventions.

Emotional Responses to Stressors in Everyday Life Predict Long-Term Trajectories of Depressive Symptoms.

Abstract: Background Individuals' emotional responses to stressors in everyday life are associated with long-term physical and mental health. Among many possible risk factors, the stressor-related emotional responses may play an important role in future development of depressive symptoms. Purpose The current study examined how individuals' positive and negative emotional responses to everyday stressors predicted their subsequent changes in depressive symptoms over 18 months. Methods Using an ecological momentary assessment approach, participants (n = 176) reported stressor exposure, positive affect (PA), and negative affect (NA) five times a day for 1 week (n = 5,483 observations) and provided longitudinal reports of depressive symptoms over the subsequent 18 months. A multivariate multilevel latent growth curve model was used to directly link the fluctuations in emotions in response to momentary stressors in everyday life with the long-term trajectory of depressive symptoms. Results Adults who demonstrated a greater difference in stressor-related PA (i.e., relatively lower PA on stressor vs. nonstressor moments) reported larger increases in depressive symptoms over 18 months. Those with greater NA responses to everyday stressors (i.e., relatively higher NA on stressor vs. nonstressor moments), however, did not exhibit differential long-term changes in depressive symptoms. Conclusions Adults showed a pattern consistent with both PA and NA responses to stressors in everyday life, but only the stressor-related changes in PA (but not in NA) predicted the growth of depressive symptoms over time. These findings highlight the important-but often overlooked-role of positive emotional responses to everyday stressors in long-term mental health.

Health Warnings and Beverage Purchase Behavior: Mediators of Impact.

Abstract: BACKGROUND To reduce diet-related chronic disease, policymakers have proposed requiring health warnings on sugar-sweetened beverages (SSBs). Health warnings reduced purchases of these products by 22% in our recent randomized controlled trial, but the mechanisms remain unclear. PURPOSE We sought to identify the psychological mechanisms that explain why SSB health warnings affect purchase behavior. METHODS In 2018, we recruited 400 adult SSB consumers to complete a shopping task in a naturalistic convenience store laboratory in North Carolina, USA. We randomly assigned participants to either a health warning arm (all SSBs in the store displayed a text health warning) or to a control arm (SSBs displayed a control label). Participants selected items to purchase with cash. RESULTS Compared to control labels, health warnings elicited more attention, negative affect, anticipated social interactions, and thinking about harms (range of ds = 0.63-1.34; all p < .001). Health warnings also led to higher injunctive norms about limiting SSB consumption (d = 0.27, p = .008). Except for attention, all of these constructs mediated the effect of health warnings on SSB purchases (all p < .05). In contrast, health warnings did not influence other attitudes or beliefs about SSBs or SSB consumption (e.g., healthfulness, outcome expectations, and response efficacy). CONCLUSIONS Health warnings on sugar-sweetened beverages affected purchase behavior by eliciting negative emotions, increasing anticipated social interactions, keeping SSBs' harms at top of mind, and shifting norms about beverage consumption. Results are consistent with recent studies of why tobacco warnings influence quitting behavior, pointing toward a general framework for understanding how health warnings affect behavior. CLINICAL TRIALS REGISTRATION NCT #03511937.

Latinx Health Disparities Research During COVID-19: Challenges and Innovations.

Abstract: Background The Center for Latino Health Research Opportunities (CLaRO) supports and facilitates research addressing substance abuse, violence/trauma, and HIV/AIDS among diverse and underserved Latinx populations. CLaRO runs a pilot awards program for early-stage investigators conducting Latinx health disparities research. This pilot awards program was impacted by the COVID-19 pandemic, necessitating innovative responses for research continuity. Purpose The purpose of this commentary is to describe the challenges and innovative research methods developed in response to COVID-19 to continue Latinx health disparities research in the context of COVID-19. Methods/results This commentary provides a brief description of each CLaRO pilot project, the challenges introduced by COVID-19, and innovative research methods to continue Latinx health disparities research during and beyond COVID-19. Conclusions Despite the challenges COVID-19 presents to the continuity of health disparities research, it also presents unprecedented opportunities to innovate. Such innovation is essential for solving persistent scientific, public health, and clinical challenges underlying current and emerging health disparities.

Risk From Within: Intraminority Gay Community Stress and Sexual Risk-Taking Among Sexual Minority Men

Abstract: Background Sexual minority men remain highly impacted by the human immunodeficiency virus (HIV) with social stress being a clear predictor of their risk for infection. The past several decades of stress research regarding sexual minority men's HIV-risk behaviors has almost exclusively focused on the influence of stress emanating from outside the gay community (e.g., stigma-related stress, or minority stress, such as heterosexist discrimination). However, recent evidence suggests that sexual minority men also face stress from within their own communities. Purpose We sought to examine whether stress from within the gay community, or intraminority gay community stress, might influence sexual minority men's risk behaviors, including HIV-risk behaviors, over-and-above more commonly examined stressors affecting this risk. Methods We tested whether intraminority gay community stress was associated with sexual minority men's HIV-risk behaviors in a large national survey of sexual minority men (Study 1), and experimentally tested intraminority gay community stress's impact on behavioral risk-taking and attitudes toward condom use (Study 2). Results Self-reported exposure to intraminority gay community stress was positively associated with HIV-risk behaviors when accounting for the effects of several commonly examined minority stressors and general life stress (Study 1). Participants who were rejected from an online group of other sexual minority men evidenced greater risk-taking in a subsequent task and reported fewer benefits of condom use than participants who were accepted by the online group, when accounting for state affect (Study 2). Conclusions Sexual minority men's experiences of stress and rejection stemming from their own community may be an important and overlooked predictor of HIV infection and transmission.

Direct and Indirect Relationships Between the Built Environment and Individual-Level Perceptions of Physical Activity: A Systematic Review.

Abstract: Background Socioecological models highlight the potential direct and indirect effects of multiple levels of influence in explaining physical activity (PA). Social cognitive theories, however, position individual cognitions as the mediator of external factors such as the built environment when explaining PA. Purpose To appraise the evidence for direct and indirect associations between the built environment and social cognition to predict PA. Methods Literature searches were concluded in February 2019 using five common databases. Eligible studies were in the English language that included any direct and indirect tests of individual perceptions and the built environment with PA. Results The initial search yielded 18,521 hits, which was reduced to 46 independent studies of primarily medium quality after screening for eligibility criteria. Findings were grouped by type of PA then grouped by the type of individual and built environment constructs within the model, and subdivided by adult and youth samples. There was evidence that self-efficacy/perceived control accounted for the covariance between environmental accessibility/convenience and total PA, while habit accounted for the covariance in this relationship for transport PA, particularly in adult samples. There was no evidence that the built environment had a direct association with PA after controlling for individual-level factors. Conclusions The results provide initial support for the mediation tenet in social cognition models for the relationship between individual, built environment, and PA. In practice, these findings highlight the need for coordinated interventions of individual and environmental change.

Efficacy of an m-Health Physical Activity and Sleep Intervention to improve sleep quality in middle-aged adults: the Refresh Study Randomized Controlled Trial

Abstract: BACKGROUND: Poor sleep health is highly prevalent. Physical activity is known to improve sleep quality but not specifically targeted in sleep interventions. PURPOSE: To compare the efficacy of a combined physical activity and sleep intervention with a sleep-only intervention and a wait-list control, for improving sleep quality in middle-aged adults without a diagnosed sleep disorder. METHODS: Three-arm randomized controlled trial (Physical Activity and Sleep Health (PAS), Sleep Health Only (SO), Wait-list Control (CON) groups; 3-month primary time-point, 6-month follow-up) of 275 (PAS = 110, SO = 110, CON = 55) inactive adults (40-65 years) reporting poor sleep quality. The main intervention component was a smartphone/tablet "app" to aid goal setting and self-monitoring physical activity and/or sleep hygiene behaviors (including stress management), and a pedometer for PAS group. Primary outcome was Pittsburgh Sleep Quality Index (PSQI) global score. Secondary outcomes included several self-reported physical activity measures and PSQI subcomponents. Group differences were examined stepwise, first between pooled intervention (PI = PAS + SO) and CON groups, then between PAS and SO groups. RESULTS: Compared with CON, PI groups significantly improved PSQI global and subcomponents scores at 3 and 6 months. There were no differences in sleep quality between PAS and SO groups. The PAS group reported significantly less daily sitting time at 3 months and was significantly more likely to report ≥2 days/week resistance training and meeting physical activity guidelines at 6 months than the SO group. CONCLUSIONS: PIs had statistically significantly improved sleep quality among middle-aged adults with poor sleep quality without a diagnosed sleep disorder. The adjunctive physical activity intervention did not additionally improve sleep quality. CLINICAL TRIAL INFORMATION: Australian New Zealand Clinical Trial Registry: ACTRN12617000680369; Universal Trial number: U1111-1194-2680; Human Research Ethics Committee, Blinded by request of journal: H-2016-0267.

Adverse Childhood Experiences and Immune System Inflammation in Adults Residing on the Blackfeet Reservation: The Moderating Role of Sense of Belonging to the Community.

Abstract: BACKGROUND Previous research documents an association between adverse childhood experiences (ACEs) and immune system inflammation. High chronic inflammation is believed to be one biological pathway through which childhood adversity may affect health into adulthood. The Blackfeet tribal community has high rates of childhood trauma and community members are disproportionately affected by inflammatory diseases. PURPOSE To investigate whether belonging to the tribal community may moderate the relationship between childhood trauma and immune system inflammation in the Blackfeet tribal community. METHODS In a sample of 90 adults residing on the Blackfeet reservation, we measured ACEs belonging to the tribal community and two markers of immune system inflammation, interleukin-6 (IL-6) and C-reactive protein (CRP). RESULTS We found that independent of age, gender, annual income, body mass index, and depressive symptoms, belonging to the tribal community and ACEs interacted to predict levels of both IL-6 and CRP (B= -.37, t[81] = -3.82, p < .001, R2 change = .07 and B = -.29, t[81] = -2.75, p = .01, R2 change = .08, respectively). The association between ACEs and markers of immune system inflammation was statistically significant for community members who reported low levels of belonging to the community. CONCLUSIONS The findings of this study have important implications for intervention research seeking to reduce risk for inflammatory diseases for at-risk populations. Fostering stronger connections to the larger tribal community may positively affect risk for inflammatory diseases. Future work should examine the behavioral and psychosocial pathways through which stronger connections to community may confer health benefits.

Clean and Contain: Initial Development of a Measure of Infection Prevention Behaviors During the COVID-19 Pandemic.

Abstract: Background The Centers for Disease Control and Prevention (CDC) offer behavioral guidance to prevent the spread of infectious diseases like COVID-19. Cleaning (e.g., cleaning surfaces, washing and sanitizing hands) and containing (e.g., covering coughs, keeping distance from others, especially sick people) behaviors are recommended. Purpose To develop the Clean and Contain Measure, a brief measure of compliance with CDC recommendations for prevention of infectious disease, and validate the measure in individuals experiencing the COVID-19 pandemic. Methods Participants were recruited from Amazon Mechanical Turk and social media. Results In Study 1 (N = 97), exploratory factor analysis revealed two scales: (a) five items assessing cleaning behaviors and (b) four items assessing containing behaviors. Simple structure was obtained and alpha coefficients for both scales were >.83. In Studies 2 (N = 204) and 3 (N = 527), confirmatory factor analysis verified the identical factor structure found in Study 1. All loadings were statistically significant at p .84 for Studies 2 and 3. Conclusions Our measure is a reliable and valid indicator of compliance with cleaning and containing health behaviors that help to prevent the spread of diseases like COVID-19. Future research should replicate construct validity in more diverse samples and continue to refine items, examine construct validity, including predictive and discriminant validity, and improve the measure for future use. With continued use and refinement, this measure could allow health officials and researchers to accurately assess compliance with important infection prevention behavior guidelines.

Mindfulness and Meditative Movement Interventions for Men Living With Cancer: A Meta-analysis.

Abstract: Background Mindfulness-based interventions, Tai Chi/Qigong, and Yoga (defined here as meditative cancer interventions [MCIs]) have demonstrated small to medium effects on psychosocial outcomes in female breast cancer patients. However, no summary exists of how effective these interventions are for men with cancer. Purpose A meta-analysis was performed to determine the effectiveness of MCIs on psychosocial outcomes (e.g., quality of life, depression, and posttraumatic growth) for men with cancer. Methods A literature search yielded 17 randomized controlled trials (N = 666) meeting study inclusion criteria. The authors were contacted to request data for male participants in the study when not reported. Results With the removal of one outlier, there was a small effect found in favor of MCIs across all psychosocial outcomes immediately postintervention (g = .23, 95% confidence interval [CI] 0.02 to 0.44). Studies using a usual care control arm demonstrated a small effect in favor of MCIs (g = .26, 95% CI 0.10 to 0.42). However, there was insufficient evidence of a superior effect for MCIs when compared to an active control group, including attention control. Few studies examined both short-term and long-term outcomes. Conclusions There is evidence for MCIs improving psychosocial outcomes in male cancer survivors. However, this effect is not demonstrated when limited to studies that used active controls. The effect size found in this meta-analysis is smaller than those reported in MCI studies of mixed gender and female cancer patient populations. More rigorously designed randomized trials are needed that include active control groups, which control for attention, and long-term follow-up. There may be unique challenges for addressing the psychosocial needs of male cancer patients that future interventions should consider.

Membership in Sport or Exercise Groups Predicts Sustained Physical Activity and Longevity in Older Adults Compared to Physically Active Matched Controls.

Abstract: Background: Physical activity tends to decline in older age, despite being key to health and longevity. Previous investigations have focused on demographic and individual factors that predict sustained physical activity. Purpose: To examine whether engaging in physical activity in the context of sport or exercise group membership can protect against age-related physical activity decline. Methods: Drawn from the English Longitudinal Study of Ageing, participants were members of sport or exercise groups aged 50 and over (N = 2015) as well as nonmember controls, who were matched at baseline for age, sex, and physical activity levels (N = 1881). Longitudinal mixed effects models were used to assess the effect of sport or exercise group membership on physical activity and longevity across a 14-year follow-up. Results: Members of sport or exercise groups experienced an attenuated decline in both moderate and vigorous physical activity over a 14-year follow-up compared to physically active matched controls. Sport or exercise group members were also less likely to have died at follow-up, an effect that was mediated through sustained physical activity. Conclusions: Promoting membership in sport and exercise groups may be a beneficial strategy for supporting sustained physical activity and health among older people.

PMTCT Adherence in Pregnant South African Women: The Role of Depression, Social Support, Stigma, and Structural Barriers to Care.

Abstract: BACKGROUND Depression is a robust predictor of nonadherence to antiretroviral (ARV) therapy, which is essential to prevention of mother-to-child transmission (PMTCT). Women in resource-limited settings face additional barriers to PMTCT adherence. Although structural barriers may be minimized by social support, depression and stigma may impede access to this support. PURPOSE To better understand modifiable factors that contribute to PMTCT adherence and inform intervention development. METHODS We tested an ARV adherence model using data from 200 pregnant women enrolled in PMTCT (median age 28), who completed a third-trimester interview. Adherence scores were created using principal components analysis based on four questions assessing 30-day adherence. We used path analysis to assess (i) depression and stigma as predictors of social support and then (ii) the combined associations of depression, stigma, social support, and structural barriers with adherence. RESULTS Elevated depressive symptoms were directly associated with significantly lower adherence (est = -8.60, 95% confidence interval [-15.02, -2.18], p < .01). Individuals with increased stigma and depression were significantly less likely to utilize social support (p < .01, for both), and higher social support was associated with increased adherence (est = 7.42, 95% confidence interval [2.29, 12.58], p < .01). Structural barriers, defined by income (p = .55) and time spent traveling to clinic (p = .31), did not predict adherence. CONCLUSIONS Depression and social support may play an important role in adherence to PMTCT care. Pregnant women living with HIV with elevated depressive symptoms and high levels of stigma may suffer from low social support. In PMTCT programs, maximizing adherence may require effective identification and treatment of depression and stigma, as well as enhancing social support.

Late and Instable Sleep Phasing is Associated With Irregular Eating Patterns in Eating Disorders.

Abstract: Background Sleep problems are common in eating disorders (EDs). Purpose We evaluated whether sleep-phasing regularity associates with the regularity of daily eating events. Methods ED patients (n = 29) completed hourly charts of mood and eating occasions for 2 weeks. Locomotor activity was recorded continuously by wrist actigraphy for a minimum of 10 days, and sleep was calculated based on periods of inactivity. We computed the center of daily inactivity (CenDI) as a measure of sleep phasing and consolidation of the daily inactivity (ConDI) as a measure of daily sleep rhythm strength. We assessed interday irregularities in the temporal structure of food intake using the standard deviation (SD) of frequency (IFRQ), timing (ITIM), and interval (IINT) of food intake. A self-evaluation of other characteristics included mood, anxiety, and early trauma. Results A later phasing of sleep associated with a lower frequency of eating (eating frequency with the CenDI rho = -0.49, p = .007). The phasing and rhythmic strength of sleep correlated with the degree of eating irregularity (CenDI with ITIM rho = 0.48, p = .008 and with IINT rho = 0.56, p = .002; SD of CenDI with ITIM rho = 0.47, p = .010, and SD of ConDI with IINT rho = 0.37, p = .048). Childhood Trauma Questionnaire showed associations with variation of sleep onset (rho = -0.51, p = .005) and with IFRQ (rho = 0.43, p = .023). Conclusions Late and variable phasing of sleep associated robustly with irregular pattern of eating. Larger data sets are warranted to enable the analysis of diagnostic subgroups, current medication, and current symptomatology and to confirm the likely bidirectional association between eating pattern stability and the timing of sleep.

Bidirectional Associations of Momentary Affect with Physical Activity and Sedentary Behaviors in Working Adults.

Abstract: BACKGROUND Affective experiences and movement-based behaviors form a system that has been shown to influence exercise adherence and mental health outcomes. Little is known about the naturalistic dynamics of the reciprocal associations in this system. PURPOSE We examined the time intervals at which momentary affect precedes and follows movement-based behaviors in everyday life. METHODS A community sample of working adults (n = 111) completed ecological momentary assessments (EMA) asking about current affect states (sad, happy, tired, and interested) six times a day for three consecutive days. Ratings were used to generate scores for momentary affective arousal and valence. Participants also wore an activity monitor. Total activity counts and sedentary duration in the shorter to longer time intervals (5-120 min) before or after EMA were used as indicators of movement-based behaviors. RESULTS Multilevel modeling showed that current affective arousal predicted higher subsequent activity counts in the longer time intervals (120 min) and less subsequent sedentary behavior in the shorter to longer time intervals (5, 60, and 120 min). For the reversed sequence, neither movement-based behavior predicted subsequent momentary arousal or valence. Affective valence was unrelated to movement-based behaviors in either temporal direction. CONCLUSIONS Some naturally occurring affective experiences (i.e., arousal) might precede, rather than follow, movement-based behaviors. Understanding affective arousal may contribute to improved management of subsequent movement-based behaviors in everyday life.

Links of communal coping to relationship and psychological health in type 2 diabetes: actor–partner interdependence models involving role, sex, and race

Abstract: Background Communal coping is one person's appraisal of a stressor as shared and collaboration with a partner to manage the problem. There is a burgeoning literature demonstrating the link of communal coping to good relationships and health among persons with chronic disease. Purpose We examined links of communal coping to relationship and psychological functioning among couples in which one person was recently diagnosed with type 2 diabetes. We distinguished effects of own communal coping from partner communal coping on both patient and spouse relationship and psychological functioning, as well as whether communal coping effects were moderated by role (patient, spouse), sex (male, female), and race (White, Black). Methods Participants were 200 couples in which one person had been diagnosed with type 2 diabetes (46% Black, 45% female) within the last 5 years. Couples completed an in-person interview, participated in a discussion to address diabetes-related problems, and completed a postdiscussion questionnaire. Results Own communal coping and partner communal coping were related to good relationship and psychological functioning. Interactions with role, sex, and race suggested: (i) partner communal coping is more beneficial for patients than spouses; (ii) own communal coping is more beneficial for men, whereas partner communal coping is more beneficial for women; and (iii) White patients and Black spouses benefit more from own communal coping than Black patients and White spouses. Conclusion These findings demonstrate the benefits of communal coping across an array of self-report and observed indices, but suggest there are differential benefits across role, sex, and race.

Associations between Health Behaviors and Factors on Markers of Healthy Psychological and Physiological Functioning: a Daily Diary Study.

Abstract: Background Cross-sectional and experimental knowledge highlight the contribution of various health-promoting behaviors, such as physical activity, regular sleep, and healthy nutrition to mental and physical health. Beyond these well-studied lifestyle behaviors, music listening and perceived respect in social interactions are just recently proposed everyday life experiences, which may act as health-promoting factors. Purpose This study tested the simultaneous contribution of several health-promoting behaviors and factors and examined listening to music and positive social interaction by means of perceived respect as new potentially preventive and health-promoting behaviors and factors using an ambulatory assessment design. Methods Seventy-seven young healthy adults (38 women, 23.9 ± 4.5 years) completed surveys on their psychological state (i.e., mood, stress, and fatigue) five times a day for four consecutive days. A saliva sample was collected with each data entry to explore the physiological stress markers salivary cortisol, alpha-amylase, and flow rate as further outcome variables. As predictors, perceived respect, self-reported physical activity, the sleep's restfulness, daily coffee, alcohol, vegetable/fruit consumption, and music listening behavior were recorded. Results Overall, restful sleep, mean daily perceived respect, and listening to music were most clearly associated with more positive psychological states, that is, better mood and lower fatigue and perceived stress. Associations with daily alcohol, coffee, and vegetable/fruit consumption appeared rather minor. While perceived respect scores were associated with lower daily cortisol output, coffee consumption was positively related to daily cortisol and alpha-amylase. Self-reported physical activity was unrelated to either outcome measure. Conclusions These findings provide important insights regarding potential resources of health (i.e., music and respect), their covariation, and which psycho-physiological mechanisms may underlie the links between health factors and well-being. Findings also have implications for the development of interventions aiming to increase resilience and foster health. Here, strategies for improving sleep quality, the use of music, and approaches that emphasize mutual respect and appreciation appear useful additions.

An Avatar-Led Intervention Promotes Smoking Cessation in Young Adults: A Pilot Randomized Clinical Trial

Abstract: Background Smoking remains a global concern, especially for young adults. There is a dearth of smoking cessation programs for this population, who seldom seek help or are motivated to quit. Purpose This pilot study assessed the effectiveness of a digital avatar-led Acceptance and Commitment Therapy (ACT) smoking cessation program (Flexiquit) for young adult smokers at all levels of motivation to quit. Methods Smokers with no particular interest in quitting smoking (65.45% reported being in pre-contemplation or contemplation stages of change) were recruited from three universities (105 smoking ≥ 1 cigarette per day during the past 30 days, 68 females). Those who completed questionnaires online (N = 84; M = 22.44 years, SD = 2.61, range 18-28 years old) were randomized to either a six-session avatar-led intervention (Flexiquit; N = 49) or a wait-list control (N = 35). Primary outcomes included cessation status (7-day point prevalence) and number of cigarettes smoked per day; secondary outcomes were nicotine dependence, intention-to-quit smoking and self-efficacy, assessed at pre- and post-intervention, and only for Flexiquit at 6-month follow-up. Results In intention-to-treat analysis more participants (OR = 3.10, 95% CI = 0.92-10.41) in the treatment group (28.57%) versus the control group (11.43%) reported quitting smoking; however, the difference was not statistically significant (p = .067). There were statistically significant decreases in average number of cigarettes, nicotine dependence and increases in self-efficacy, and intention-to-quit smoking compared to controls. Treatment gains in the Flexiquit group were maintained through the 6-month follow-up. Conclusions An avatar-led digitized smoking cessation intervention based on ACT could increase the odds of quitting smoking. Findings suggest that a digitized program designed to engage young adults in smoking cessation may result in quitting smoking and has a high applicability potential especially among the hard-to-reach population of young adults. Question Can an avatar-led digitized Acceptance and Commitment Therapy (ACT) smoking cessation intervention result in quitting smoking and increasing intention to quit among young smokers at various levels of motivation to quit, compared to a wait-list control group? Findings In this pilot randomized clinical trial that included 84 smokers, 28.57% in the treatment condition versus 11.43% in the wait-list control group were abstinent at post (intention-to-treat [ITT] analysis). An avatar-led digitized ACT smoking cessation intervention results in high quitting smoking rates and has a high applicability potential especially among the hard-to-reach population of young adult smokers.