Showing papers in "Health Psychology in 1998"

Stage theories of health behavior: conceptual and methodological issues.

Abstract: Despite growing interest in stage theories of health behavior, there is considerable confusion in the literature concerning the essential characteristics of stage theories and the manner in which such theories should be tested. In this article, the 4 key characteristics of a stage theory-a category system, an ordering of categories, similar barriers to change within categories, and different barriers to change between categories--are discussed in detail. Examples of stage models of health behavior also are described. Four major types of research designs that might be used for testing stage theories are examined, including examples from the empirical literature. The most commonly used design, which involves cross-sectional comparisons of people believed to be in different stages, is shown to have only limited value for testing whether behavior change follows a stage process.

Strategies for analyzing ecological momentary assessment data

Abstract: Studies incorporating repeated observations of momentary phenomena are becoming more common in behavioral and medical science. Analysis of such data requires the use of statistical techniques that are unfamiliar to many investigators. Some common ways of analyzing momentary data are reviewed--aggregation strategies, repeated measures analysis of variance, pooled within-person regression, and two-stage estimation procedures for multilevel models--and are found to be usually suboptimal, possibly leading to incorrect inferences. A broad class of statistical models for multilevel data that can address many research questions typically asked of momentary data are then described. Analytic issues that merit careful consideration include the scaling of momentary variables, allowance for serial autocorrelation of residuals, and the treatment of coefficients that vary across individuals as fixed versus random effects.

Autonomous regulation and long-term medication adherence in adult outpatients.

Abstract: Self-determination theory was applied to explore the motivational basis of adherence to long-term medication prescriptions. Adult outpatients with various diagnoses who had been on a medication for at least 1 month and expected to continue (a) completed questionnaires that assessed their autonomous regulation, other motivation variables, and perceptions of their physicians' support of their autonomy by hearing their concerns and offering choice; (b) provided subjective ratings of their adherence and a 2-day retrospective pill count during an interview with a clinical psychologist; and (c) provided a 14-day prospective pill count during a subsequent, brief telephone survey. LISREL analyses supported the self-determination model for adherence by confirming that patients' autonomous motivation for adherence did mediate the relation between patients' perceptions of their physicians' autonomy support and their own medication adherence.

Types of stressors that increase susceptibility to the common cold in healthy adults.

Abstract: Two-hundred seventy-six volunteers completed a life stressor interview and psychological questionnaires and provided blood and urine samples. They were then inoculated with common cold viruses and monitored for the onset of disease. Although severe acute stressful life events (less than 1 month long) were not associated with developing colds, severe chronic stressors (1 month or longer) were associated with a substantial increase in risk of disease. This relation was attributable primarily to under- or unemployment and to enduring interpersonal difficulties with family or friends. The association between chronic stressors and susceptibility to colds could not be fully explained by differences among stressed and nonstressed persons in social network characteristics, personality, health practices, or prechallenge endocrine or immune measures.

Psychological and cognitive outcomes of a randomized trial of exercise among patients with chronic obstructive pulmonary disease.

Abstract: Exercise rehabilitation is recommended increasingly for patients with chronic obstructive pulmonary disease (COPD). This study examined the effect of exercise and education on 79 older adults (M age = 66.6 +/- 6.5 years; 53% female) with COPD, randomly assigned to 10 weeks of (a) exercise, education, and stress management (EXESM; n = 29); (b) education and stress management (ESM; n = 25); or (c) waiting list (WL; n = 25). EXESM included 37 sessions of exercise, 16 educational lectures, and 10 weekly stress management classes. ESM included only the 16 lectures and 10 stress management classes. Before and after the intervention, assessments were conducted of physiological functioning (pulmonary function, exercise endurance), psychological well-being (depression, anxiety, quality of life), and cognitive functioning (attention, motor speed, mental efficiency, verbal processing). Repeated measures multivariate analysis of variance indicated that EXESM participants experienced changes not observed among ESM and WL participants, including improved endurance, reduced anxiety, and improved cognitive performance (verbal fluency).

Predicting Longitudinal Changes in Caregiver Physical and Mental Health: A Stress Process Model

Abstract: Alzheimer's family caregivers (N = 122) reported on physical and mental health, as well as stress process variables, at baseline and at a 1-year follow-up. Hierarchical regression analyses of stress process models revealed that increases in primary stressors (e.g., patient self-care and behavioral problems) did not directly affect changes in the mental and physical health outcome variables. However, analyses of models of direct, mediated, and moderated effects revealed that psychosocial resource variables (appraisals, coping responses, and social support) were related to caregiver outcomes over time through several mechanisms. In particular, benign appraisals of stressors, the use of approach coping, and greater levels of social support were associated with more positive caregiver health outcomes over time.

Effects of social support and personal coping resources on depressive symptoms: Different for various chronic diseases?

Abstract: Effects of psychosocial coping resources on depressive symptoms were examined and compared in older persons with no chronic disease or with recently symptomatic diabetes mellitus, lung disease, cardiac disease, arthritis, or cancer. The 719 persons without diseases reported less depressive symptoms than the chronically ill. Direct favorable effects on depressive symptoms were found for having a partner, having many close relationships, greater feelings of mastery, greater self-efficacy expectations, and high self-esteem. Buffer effects were observed for feelings of mastery, having many diffuse relationships, and receiving emotional support. Buffer effects were differential across diseases for emotional support (in cardiac disease and arthritis only) and for diffuse relationships (in lung disease). Receiving instrumental support was associated with more depressive symptoms, especially in diabetes patients.

Experimental evidence for stages of health behavior change: the precaution adoption process model applied to home radon testing.

Abstract: Hypotheses generated by the precaution adoption process model, a stage model of health behavior, were tested in the context of home radon testing. The specific idea tested was that the barriers impeding progress toward protective action change from stage to stage. An intervention describing a high risk of radon problems in study area homes was designed to encourage homeowners in the model's undecided stage to decide to test, and a low-effort, how-to-test intervention was designed to encourage homeowners in the decided-to-act stage to order test kits. Interventions were delivered in a factorial design that created conditions matched or mismatched to the recipient's stage (N = 1,897). Both movement to a stage closer to testing and purchase of radon test kits were assessed. As predicted, the risk treatment was relatively more effective in getting undecided people to decide to test than in getting decided-to-act people to order a test. Also supporting predictions, the low-effort intervention proved relatively more effective in getting decided-to-act people to order tests than in getting undecided people to decide to test.

Role strain in couples with and without a child with a chronic illness : associations with marital satisfaction, intimacy, and daily mood

Abstract: This study examined marital role strain in 33 couples caring for a child with cystic fibrosis (CF) and 33 couples with a healthy child. The relationship between role strain, marital satisfaction, and psychological distress was tested. Couples completed a structured interview, questionnaires, a card sort procedure, and 4 daily diaries assessing activities and mood. Couples in the CF versus comparison group reported greater role strain on measures of role conflict, child-care tasks, and exchanges of affection. They also spent less time in recreational activities, but no reliable group differences were found in marital satisfaction or depression. Regression analyses indicated that role strain was related to marital satisfaction and depression and that recreation time accounted for additional variance. Path analysis suggested that recreation mediated the negative relationship between role strain and distress. The importance of using a contextual, process-oriented approach is discussed.

Ecological momentary assessment (EMA) with treated alcoholics: Methodological problems and potential solutions.

Abstract: Ecological Momentary Assessment, a methodology by which information can be obtained about phenomena as they occur in a person's natural environment, was used to assess the antecedents to relapse in treated alcohol abusers. Alcoholic participants (N = 27) were asked to record their urge to drink alcohol and their mood state, situation, and alcohol use on 5- x 7-in. record cards in response to 8 random prompts per day for 21 consecutive days after discharge from a Veterans Affairs inpatient treatment center. The purpose of the research was to determine the extent to which drinking urges occurred in the patient's home environment after treatment and to identify the mood states and alcohol-related stimuli associated with urges. Field recordings were prompted by a programmable wrist watch. Results suggested that compliance with procedures was excellent and that the occurrence of drinking and of drinking urges was relatively rare. However, significant methodological problems were brought to light that may have compromised the results. These problems are presented and potential solutions are proposed.

Effects of task strain, social conflict, and emotional activation on ambulatory cardiovascular activity: daily life consequences of recurring stress in a multiethnic adult sample.

Abstract: Ambulatory blood pressure (ABP) may be an independent predictor of cardiovascular endpoints, but little is known about its psychosocial determinants. The acute effects of psychosocial processes on cardiovascular activity during daily life were examined by random-effects regression. Healthy adults (N = 120) were monitored over a 6-day period with ABP monitors and computer-assisted self-report assessments. Task strain, social conflict, and emotional activation were rated following each ABP measurement, as were activity, posture, and other covariates. Results show that blood pressure (BP) and heart rate (HR) were elevated during periods of emotional activation (high negative affect or high arousal). Diastolic BP was lower during periods involving high decisional control, and HR was lower during high-control, low-demand activities. There were substantial individual differences in the effects of psychosocial influences on ambulatory cardiovascular activity. Psychological factors are reliable determinants of ABP, which may account in part for the unique predictive value of ABP.

Influence of HIV Status and Age on Cognitive Representations of Others

Abstract: In 2 studies the postulate that the perception of time left in life influences the ways that people conceptualize social relationships was explored. It was hypothesized that when time is limited, emotional aspects of relationships are highly salient. In Study 1, a card-sort paradigm involving similarity judgments demonstrated, for a sample of persons 18 to 88 years old, that the prominence of affect in the mental representations of prospective social partners is positively associated with age. In Study 2, the same experimental approach was applied to a sample of young gay men similar to one another in age, but notably different in their health status (that is, HIV negative; HIV positive, asymptomatic; and HIV positive, symptomatic). It was found that, with age held constant, increasing closeness to the end of life is also associated with an increasing prominence of affect in the mental representations of social partners. The results suggest that the perception of limited time, rather than chronological age, is the critical variable influencing mental representations of social partners.

Depression and self-medication with nicotine: the modifying influence of the dopamine D4 receptor gene.

Abstract: This study evaluated whether there are genetic subgroups of depressed individuals who are more or less predisposed to engage in self-medication smoking practices. Smokers (N = 231) completed self-report questionnaires of depression and smoking practices and were genotyped for the dopamine D4 receptor (DRD4) gene. A significant interaction (DRD4 Genotype x Depression) was found for stimulation smoking and negative-affect reduction smoking. Specifically, these smoking practices were significantly heightened in depressed smokers homozygous for the short alleles of DRD4 but not in those heterozygous or homozygous for the long alleles of DRD4. These preliminary results suggest that the rewarding effects of smoking and the beneficial effects of nicotine replacement therapy for depressed smokers may depend, in part, on genetic factors involved in dopamine transmission.

Expression of stressful experiences through writing: effects of a self-regulation manipulation for pessimists and optimists.

Abstract: This study assessed the effectiveness of a writing task designed to foster self-regulatory coping with stressful experiences to reduce medical clinic visits and to promote adjustment. Students entering college (N = 122) who were classified as optimists or pessimists by using a dispositional optimism measure participated in a self-regulation task (expressing thoughts and feelings about entering college and then formulating coping plans), a disclosure task (expressing thoughts and feelings only), or a control task (writing about trivial topics) for 3 weekly writing sessions. Among optimists, both the self-regulation task and the disclosure task reduced illness-related clinic visits during the following month; among pessimists, only the self-regulation task reduced clinic visits. In general, the self-regulation task beneficially affected mood state and college adjustment whereas the disclosure task increased grade point averages.

Fibromyalgia and women's pursuit of personal goals: a daily process analysis.

Abstract: For 30 days, 50 women with primary fibromyalgia syndrome reported daily progress and effort toward a health-fitness and a social-interpersonal goal and the extent to which their pain and fatigue hindered their accomplishment. They also carried palmtop computers to assess their sleep and their pain, fatigue, and positive and negative mood throughout the day. Analyses of the person-day data set showed that on days during which pain or fatigue increased from morning to evening, participants perceived their goal progress to be more attenuated by pain and fatigue. Unrestorative sleep the night before predicted the following day's effort and progress toward accomplishing health-fitness goals, but not social-interpersonal goals. Finally, participants who reported more progress toward social-interpersonal goals on a given day were more likely to evidence improvements in positive mood across the day, regardless of any changes in pain or fatigue that day.

Activity restriction and prior relationship history as contributors to mental health outcomes among middle-aged and older spousal caregivers.

Abstract: In a sample of cancer patients (n = 75) and spousal caregivers (24 men and 51 women), restriction in caregiver routine activities mediated associations between caregiving stress (patient symptom severity) and caregiver depressed affect and resentment. Moreover, the antecedents and affective consequences of caregiver activity restriction were consistent with the theory of communal relationships (e.g., M. S. Clark & J. Mills, 1979, 1993). If a relationship had been communal in the past (i.e., characterized by mutual concern for and responsiveness to one another's needs), activity restriction was predicted by intimacy and affectional loss (rather than by the severity of patient symptoms) and in turn predicted caregiver depressed affect. Among caregivers in less communal relationships, activity restriction was predicted by severity of patient symptoms (rather than by intimacy and affectional loss) and in turn predicted resentment of care recipients and the caregiving role.

Caregiving from the recipient's perspective: Negative reactions to being helped.

Abstract: This study investigated predictors of negative reactions to assistance provided to a physically disabled spouse (n = 276, M age: 76.6 years) and the consequences that negative reactions may have for the mental health of the care recipient. Nearly 40% of recipients reported some emotional distress in response to help they received. Fatalistic attitudes, perceived control, and lower self-esteem predicted greater helping distress, whereas lower self-esteem, fatalistic beliefs, and marital conflict were especially likely to lead to helping distress for those who received higher levels of assistance. Helping distress was also found to predict depression as much as 1 year later, suggesting that there may be long-term consequences of negative reactions to assistance. These findings have important implications for the study of caregiving and the relationship between physical impairment and depression.

Partner smoking status and pregnant smoker's perceptions of support for and likelihood of smoking cessation.

Abstract: Perceptions of support for cessation of smoking during pregnancy, likelihood of quitting, and partner smoking status were explored in a sample of 688 pregnant smokers (372 baseline smokers and 316 baseline quitters). Women with nonsmoking partners were significantly more likely to be baseline quitters than women with partners who smoked. Baseline quitters reported significantly more positive support from their partners than did continuing smokers (p = .02). Neither partner smoking status nor partner support at baseline was associated with cessation or relapse later in pregnancy. Women reported greater support, both positive and negative, from nonsmoking partners than from partners who smoked (p = .001). Among partner smokers, those who were trying to quit were perceived to be particularly supportive. Cessation interventions for expectant fathers may increase pregnant women's success at quitting.

AIDS treatment advances and behavioral prevention setbacks: Preliminary assessment of reduced perceived threat of HIV–AIDS.

Abstract: Recent advances in AIDS treatment have brought renewed optimism for prolonging the lives of those infected with HIV. This article examined beliefs about how new treatments may reduce HIV transmission risk among 298 HIV-negative gay and bisexual men attending a gay pride festival. Results from an anonymous survey showed that men who practiced unprotected anal intercourse as the receptive partner (UAR intercourse) were younger, less well educated, and more likely to believe that it is safe to have UAR intercourse with an HIV-positive man who has an undetectable viral load and that new treatments for HIV relieve their worries about unsafe sex. As HIV treatments continue to advance, new challenges for HIV prevention will likely emerge.

Examining the impact of illness representations on psychological adjustment to chronic illnesses

Abstract: Illness representations were assessed in 63 adults with rheumatoid arthritis (RA) and 66 with multiple sclerosis (MS) The relationship of illness representations to concurrent and later mood was explored MS patients' beliefs in symptom variability were associated with higher depressed mood 4 months later, over and above initial levels of depression RA patients who saw RA as curable or who saw themselves as responsible for the illness reported significant increases in depression over time Belief in the serious consequences of RA interacted with later illness severity to predict change in depression When belief in the serious consequences of RA was high, less severe illness status was associated with less depression and more severe illness status was associated with more depression When RA was initially viewed as only moderately serious, less severe illness was associated with somewhat higher levels of depression

Preventive counseling of HIV-positive men and self-disclosure of serostatus to sex partners: new opportunities for prevention.

Abstract: This study examined whether preventive counseling of HIV-positive men (N = 255) was associated with self-disclosure of serostatus to sex partners Men who reported being counseled at posttest and at their current HIV clinic to disclose their serostatus to partners were more likely to have done so than men counseled only at posttest, only at the HIV clinic, or not counseled at either site Disclosure increased with the number of times counseled at the HIV clinic These patterns held for HIV-negative partners, but not for HIV-positive or HIV-unknown partners Disclosure to HIV-negative partners was associated with safer sexual practices The findings suggest that counseling interventions for HIV-positive men, when delivered by multiple sources, may provide an effective means of increasing disclosure to sexual partners

Why are sicker patients less satisfied with their medical care ? tests of two explanatory models

Abstract: Two explanations were tested for why patients who are less healthy tend to be less satisfied with their medical care than healthier patients. The explanations were (a) that poor health produces dissatisfaction directly and (b) that poor health produces dissatisfaction through the mediating effect of physicians' behavior. Two studies are presented that measured patients' health status, patients' satisfaction with care, and their physicians' communication as recorded on audiotape. In Study 1, 114 patients had first visits with rheumatologists; in Study 2, 649 patients had continuing-care visits with physicians in internal and family medicine. Causal modeling revealed that the first study supported the direct explanation. The second study also supported the direct explanation, as well as the mediation explanation with respect to the physician's use of social conversation.

Implications of hiv treatment advances for behavioral research on aids : protease inhibitors and new challenges in hiv secondary prevention

Abstract: Protease inhibitor combination therapies can reduce HIV viral load, improve immune system functioning, and decrease mortality from AIDS. These medical developments raise a host of critical new issues for behavioral research on HIV/AIDS. This article reviews developments in HIV combination therapy regimens and behavioral factors involved in these regimens and focuses on four key behavioral research areas: (a) the development of interventions to promote treatment adherence, (b) psychological coping with HIV/AIDS in the context of new treatments for the disease, (c) the possible influence of treatment on continued risk behavior, and (d) behavioral research in HIV prevention and care policy areas. Advances in HIV medical care have created important new opportunities for health psychologists to contribute to the well-being of persons with HIV/AIDS.

Tailoring information to enhance quitting in smokers with low motivation to quit : three basic efficacy questions

Abstract: Tailoring information to a target individual's features is a promising line of development in self-help interventions. In this article, 752 smokers with explicit low intention to quit were randomly assigned to 1 of 5 conditions: (a) multiple tailored letters with self-help guide, (b) multiple tailored letters only, (c) a single tailored letter with a self-help guide, (d) a single tailored letter only, or (e) a nontailored intervention. Follow-up assessment took place 4 months after the intervention. Results indicated that the single tailored intervention only had no surplus value compared with a nontailored look-alike intervention. The addition of a self-help guide to a tailored intervention was only useful in highly dependent smokers, and multiple tailoring was more effective than single tailoring. It remains important to elucidate why and for whom certain tailored interventions are more effective.

Agency, communion, and cardiovascular reactivity during marital interaction.

Abstract: The concepts of agency and communion have been used to describe sex differences in vulnerability to specific stressor domains. This study examined blood pressure and heart rate responses of 60 married couples to experimental manipulations of disagreement (i.e., communion stressor) and achievement challenge (i.e., agency stressor). Consistent with predictions, disagreement elicited heightened cardiovascular reactivity among wives, but not husbands. In contrast, the achievement challenge elicited heightened cardiovascular reactivity among husbands, but not wives. Participants' responses to a circumplex measure of interpersonal appraisal were consistent with the interpretation of differential responses to agency and communion stressors. Results are congruent with a situational approach to sex differences in cardiovascular reactivity and illustrate the utility of interpersonal methods in the explication of psychosocial risk for cardiovascular disease.

Weight Control During the Holidays: Highly Consistent Self-Monitoring as a Potentially Useful Coping Mechanism

Abstract: The study examined the extent to which trait self-monitoring (the systematic observation and recording of target behaviors) was related to weight control during the high-risk holiday season. The participants (32 women, 6 men) averaged 223.1 Ibs (101.41 kg), 57.2% overweight, 50.2 weeks of participation, and 21.3 Ibs (9.68 kg) lost at the beginning of the study. Consistency of self-monitoring and weight changes were assessed for 3 holiday versus 7 nonholiday weeks. Analyses of variance (Consistency of Self-Monitoring Groups x Holiday/ Nonholiday Weeks) revealed that participants gained 500% more weight per week during holiday compared with nonholiday weeks. Only participants in the most consistent selfmonitoring quarule averaged any weight loss over the 10 weeks of the study and during the holiday weeks.

Trait anxiety, symptom perceptions, and illness-related responses among women with breast cancer in remission during a tamoxifen clinical trial

Abstract: Postmenopausal women with breast cancer in remission (N = 140) who were participating in a randomized clinical trial of tamoxifen chemoprevention therapy completed measures of trait anxiety, symptoms, cancer worry, and breast self-examinations (BSEs) during the first 6 months of the trial. Trait anxiety was associated with heightened sensitivity to tamoxifen-induced symptoms (but not with tendencies to report increases in symptoms unrelated to tamoxifen use), greater tendencies to attribute symptoms to tamoxifen use, and greater cancer worry. Tamoxifen use increased BSE rates among high-anxiety participants. For low-anxiety participants, tamoxifen use increased cancer worry but not BSE rates. Trait anxiety appears to be associated with vigilant activation of illness-related representations that trigger attentiveness to sensations, worry, and protective coping in response to somatic cues.

Interpersonal concerns and psychological difficulties of psoriasis patients: Effects of disease severity and fear of negative evaluation.

Abstract: Psoriasis creates interpersonal difficulties for many sufferers, but little research has examined factors that contribute to the degree of social and psychological disability that a particular person experiences. In all, 318 psoriasis patients completed measures of psychological and social well-being, the severity of their psoriasis, and their dispositional level of fear of negative evaluation (FNE). Analyses showed that disease severity and FNE significantly predicted perceptions of being stigmatized, interpersonal discomfort, stress over others' reactions, distress regarding the observable symptoms of the disease, the degree to which psoriasis interfered with the patients' lives, and patients' quality of life. Furthermore, FNE exerted a particularly strong influence for patients who had severe cases of psoriasis.