Showing papers in "Health Psychology in 2005"

Affect, risk, and decision making.

Abstract: Risk in the modern world is perceived and acted on in two fundamental ways. Risk as feelings refers to individuals’ fast, instinctive, and intuitive reactions to danger. Risk as analysis brings logic, reason, and scientific deliberation to bear on risk management. In the present article, we examine what recent research in psychology and cognitive neuroscience reveals about risk as feelings and how it may influence judgments and decisions in cancer prevention and control. Background and Theory: The Importance of Affect Although the visceral emotion of fear certainly plays a role in risk as feelings, we focus here on a “faint whisper of emotion” called affect. As used here, affect means the specific quality of goodness or badness (a) experienced as a feeling state (with or without consciousness) and (b) demarcating a positive or negative quality of a stimulus. Affective responses occur rapidly and automatically—note how quickly you sense the feelings associated with the stimulus word treasure or the word hate. We argue that reliance on such feelings can be characterized as “the affect heuristic,” with the experienced feelings being used as information in the decision process. In this article, we trace the development of the affect heuristic across a variety of research paths followed by ourselves and many others. We also discuss some of the important practical implications resulting from the ways that this heuristic impacts how individuals perceive and evaluate risk and, more generally, how it influences all human decision making. Finally, we briefly discuss some important implications for communication and decision making pertaining to cancer prevention and treatment.

Loneliness, Social Network Size, and Immune Response to Influenza Vaccination in College Freshmen.

Abstract: Antibody response to the influenza immunization was investigated in 83 1st-semester healthy university freshmen. Elevated levels of loneliness throughout the semester and small social networks were independently associated with poorer antibody response to 1 component of the vaccine. Those with both high levels of loneliness and a small social network had the lowest antibody response. Loneliness was also associated with greater psychological stress and negative affect, less positive affect, poorer sleep efficiency and quality, and elevations in circulating levels of cortisol. However, only the stress data were consistent with mediation of the loneliness–antibody response relation. None of these variables were associated with social network size, and hence none were potential mediators of the relation between network size and immunization response.

Can the theory of planned behavior predict the maintenance of physical activity

Abstract: This study tested the ability of the theory of planned behavior to predict actual participation in physical activity and explored the development of activity habits in a 12-week longitudinal study. People enrolling in a gymnasium (N = 94) completed standard theory of planned behavior measures at baseline and follow-up; behavior was monitored objectively in the intervening period. The data were analyzed by using both standard and repeatable events survival analysis. Results showed that (a) perceived behavioral control was significantly predictive of intentions and actual behavior, (b) stable exercise habits developed in the first 5 weeks of the study, and (c) successful prior performance enhanced perceptions of behavioral control. The implications for developing theory-based interventions that promote the maintenance of health behavior are discussed.

Hot-cold empathy gaps and medical decision making.

Abstract: Prior research has shown that people mispredict their own behavior and preferences across affective states. When people are in an affectively “cold” state, they fail to fully appreciate how “hot” states will affect their own preferences and behavior. When in hot states, they underestimate the influence of those states and, as a result, overestimate the stability of their current preferences. The same biases apply interpersonally; for example, people who are not affectively aroused underappreciate the impact of hot states on other people’s behavior. After reviewing research documenting such intrapersonal and interpersonal hot–cold empathy gaps, this article examines their consequences for medical, and specifically cancer-related, decision making, showing, for example, that hot–cold empathy gaps can lead healthy persons to expose themselves excessively to health risks and can cause health care providers to undertreat patients for pain.

Sources and types of social support in youth physical activity.

Abstract: This study examines the influence of sources and types of social support on youth physical activity. The sample comprised 372 youth (mean age=12.05 years, SD=1.63). Youth were 76% White and 50.3% female. The annual household income for the sample was 20% under $30,000; 30% $30,000-$49,999; 25% $50,000-$69,999; 13% $70,000-$89,999; and 12% $90,000 and above. Results revealed that friends who support and watch youth engage in activities are significantly and positively related to youth physical activity. Significant correlations existed among the type factors. Future research should examine the sources and nature of support and the mechanisms through which social support influences youth physical activity.

Predictors of Posttraumatic Growth Following Bone Marrow Transplantation for Cancer

Abstract: There is growing recognition that the experience of cancer can have a positive as well as a negative psychological impact. This longitudinal study sought to identify predictors of posttraumatic growth among cancer patients (N 72) undergoing bone marrow transplantation. Greater posttraumatic growth in the posttransplant period was related to younger age; less education; greater use of positive reinterpretation, problem solving, and seeking alternative rewards as coping strategies in the pretransplant period; more stressful appraisal of aspects of the transplant experience; and more negatively biased recall of pretransplant levels of psychological distress. Findings partially support J. A. Schaefer and R. H. Moos’s (1992) model of life crises and personal growth and also suggest that temporal self-comparisons contribute to the experience of posttraumatic growth.

Optimistic personality and psychosocial well-being during treatment predict psychosocial well-being among long-term survivors of breast cancer.

Abstract: In considering well-being among survivors of life-threatening illnesses such as breast cancer, 2 important questions are whether there is continuity between initial adjustment and longer term adjustment and what role personality plays in long-term adjustment. In this research, a sample of 163 early stage breast cancer patients whose psychosocial adjustment was first assessed during the year after surgery completed the same measures 5-13 years after surgery. Initial reports of well-being were relatively strong predictors of follow-up well-being on the same measures. Initial optimism and marital status also predicted follow-up adjustment, even controlling for earlier adjustment, which exerted a substantial unique effect in multivariate analyses. In contrast, initial medical variables played virtually no predictive role. There is substantial continuity of subjective well-being across many years among survivors of breast cancer, rooted partly in personality and social connection.

Positive Emotion and Health: Going Beyond the Negative.

Abstract: This study examined the relationships between positive emotions and health. Two positive emotions were considered, hope and curiosity, in conjunction with 3 physician-diagnosed disease outcomes: hypertension, diabetes mellitus, and respiratory tract infections. Medical data were abstracted over a 2-year period from 1,041 patient records from a multispecialty medical practice, and emotions were assessed through a mailed questionnaire. Across 3 disease outcomes, higher levels of hope were associated with a decreased likelihood of having or developing a disease. Higher levels of curiosity were also associated with decreased likelihood of hypertension and diabetes mellitus. Results suggest that positive emotion may play a protective role in the development of disease.

Impact of Perceived Consensus on Stereotypes About Obese People: A New Approach for Reducing Bias.

Abstract: In 3 experiments, the authors tested the effect of perceived social consensus on attitudes toward obese people. Participants completed self-report measures of attitudes toward obese people prior to and after manipulated consensus feedback depicting attitudes of others. In Study 1 (N=60), participants decreased negative and increased positive stereotypes after learning that others held more favorable attitudes toward obese people. In Study 2 (N=55), participants improved attitudes when they learned about favorable attitudes of obese people from an in-group versus an out-group source. In Study 3 (N=200), a consensus approach was compared with other stigma reduction methods. Social consensus feedback influenced participants' attitudes and beliefs about causes of obesity. Providing information about the uncontrollable causes of obesity and supposed scientific prevalence of traits also improved attitudes.

Misimagining the unimaginable: the disability paradox and health care decision making.

Abstract: Good decision making often requires accurate predictions about how potential outcomes will make one feel. However, people often mispredict the emotional impact of unfamiliar circumstances. For example, they often overestimate the emotional impact that chronic illnesses and disability will have on their lives. In the present article, the authors look at possible sources of error in both the happiness reports of patients with chronic illness or disability and the happiness predictions of healthy people asked to imagine the same illnesses and disabilities. On balance, the available evidence suggests that, whereas patients misreport their well-being, healthy people also mispredict the emotional impact that chronic illness and disability will have on their lives.

Introduction to the special section on dissemination: dissemination research and research dissemination: how can we close the gap?

Abstract: One of the greatest challenges facing health promotion and disease prevention is translating research findings into evidence-based public health and clinical practices that are actively disseminated and widely adopted. Despite the tremendous strides made in developing effective disease prevention and control programs, there has been little study of effective dissemination of evidence-based programs to and adoption by community, public health, and clinical practice settings. This special section provides a venue in which to highlight exemplary dissemination research efforts while also identifying limitations in research to date and framing important future research questions. This issue establishes a resource for investigators interested in dissemination research, with relevance to health psychology. In this sense, it can serve as a benchmark by which to examine subsequent progress. The 6 articles reflect the state of the science in dissemination research for the promotion and adoption of health behavior change interventions.

Results of the healthy body healthy spirit trial.

Abstract: Healthy Body Healthy Spirit was a multicomponent intervention to increase fruit and vegetable (F & V) consumption and physical activity (PA) delivered through Black churches. Sixteen churches were randomly assigned to 3 intervention conditions. At baseline, 1,056 individuals were recruited across the 16 churches, of which 906 (86%) were assessed at 1-year follow-up. Group 1 received standard educational materials, Group 2 received culturally targeted self-help nutrition and PA materials, and Group 3 received the same intervention as did Group 2 as well as 4 telephone counseling calls based on motivational interviewing (MI) delivered over the course of 1 year. At 1-year follow-up, Groups 2 and 3 showed significant changes in both F & V intake and PA. Changes were somewhat larger for F & V. For F & V, but not PA, there was a clear additive effect for the MI intervention.

Using UV photography to reduce use of tanning booths: a test of cognitive mediation.

Abstract: Two laboratory studies were conducted in which a new type of intervention was used to reduce ultraviolet radiation (UV) exposure from tanning booth use among college students (Time 1 Ns = 70 and 134). The intervention uses UV photography to highlight the damage to facial skin caused by previous UV exposure. When the authors controlled for baseline measures of booth use, students in both studies who viewed their UV photographs reported less booth use at a follow-up session 3-4 weeks later than did students not shown a copy of their photograph. Also, in both studies, the decline in use was significantly mediated by a Tanning Cognition Index composed of variables suggested by the prototype-willingness (prototype) model of health risk: tanning attitudes, tanner prototypes, and willingness to engage in risky UV exposure.

Traumatic stress, perceived global stress, and life events: prospectively predicting quality of life in breast cancer patients.

Abstract: The authors investigated the relationship between stress at initial cancer diagnosis and treatment and subsequent quality of life (QoL). Women (n = 112) randomized to the assessment-only arm of a clinical trial were initially assessed after breast cancer diagnosis and surgery and then reassessed at 4 months (during adjuvant treatment) and 12 months (postadjuvant treatment). There were 3 types of stress measured: number of stressful life events (K. A. Matthews et al., 1997), cancer-related traumatic stress symptoms (M. J. Horowitz, N. Wilner, & W. Alvarez, 1979), and perceived global stress (S. Cohen, T. Kamarck, & R. Mermelstein, 1983). Using hierarchical multiple regressions, the authors found that stress predicted both psychological and physical QoL (J. E. Ware, K. K. Snow, & M. Kosinski, 2000) at the follow-ups (all ps < .03). These findings substantiate the relationship between initial stress and later QoL and underscore the need for timely psychological intervention.

Partner unsupportive responses, avoidant coping, and distress among women with early stage breast cancer: patient and partner perspectives.

Abstract: This 18-month longitudinal study examined the associations among partner unsupportive behavior, avoidant coping, and distress experienced by 219 women with early stage breast cancer. The role of patient and partner ratings of unsupportive behavior were evaluated. Results indicated that patient and partner ratings of unsupportive behavior were highly correlated. Growth curve modeling suggested that unsupportive behavior, from both patient and partner perspectives, predicted more avoidant coping and distress. When partner and patient perceptions were placed in the same model, patient perceptions mediated the association between partners' ratings of their unsupportive behavior and patient distress. Avoidance also mediated the association between unsupportive behavior and distress, extending prior cross-sectional findings. Results highlight the long-term detrimental effects of partners' unsupportive behavior on the quality of life of women with early stage breast cancer.

Regret in Cancer-Related Decisions

Abstract: Decision-related regret is a negative emotion associated with thinking about a past or future choice. The thinking component generally takes the form of a wish that things were otherwise and involves a comparison of what actually did or will take place with some better alternative--a "counterfactual thought." For predecisional (anticipated) regret, the thinking involves a mental simulation of the outcomes that might result from different choice options. Prior research has focused on regret associated with decision outcomes, addressing especially (a) the comparison outcome selected and (b) whether the outcome resulted from action or inaction. More recent research examines regret associated with the choice itself and with the preceding decision process. Interest here has focused on the justifiability of the choice made or the process used. In this article, the authors review current regret research and propose directions for extending it to cancer-related decisions.

Maternal influences on daughters' restrained eating behavior.

Abstract: This study examined whether mothers' preoccupation with their own weight and eating was linked to daughters' restrained eating behavior. Participants included 173 non-Hispanic, White mother-daughter dyads, measured longitudinally when daughters were ages 5, 7, 9, and 11. Mothers who were preoccupied with their own weight and eating reported higher levels of restricting daughters' intake and encouraging daughters to lose weight over time. Mothers' encouragement of daughters' weight loss was linked to daughters' restrained eating behavior; this relationship was partially mediated by daughters' perception of maternal pressure to lose weight. These findings suggest that mothers' preoccupation with weight and eating, via attempts to influence daughters' weight and eating, may place daughters at risk for developing problematic eating behaviors.

Childhood Sexual and Physical Abuse and the 1-Year Prevalence of Medical Problems in the National Comorbidity Survey.

Abstract: In a population sample (N=5,877; ages 15 to 54), the authors found childhood sexual and physical abuse to be associated with the 1-year prevalence of serious health problems for both men and women. The authors also found that participants' psychiatric disorders partially mediated the effects of physical and sexual abuse on adult health. However, childhood abuse continued to independently influence health status after the authors controlled for psychiatric disorders. Contrary to expectations, individuals who experienced a combination of sexual and physical abuse did not have a higher frequency of health problems than those who experienced either type of abuse alone. Implications for these findings are discussed, including possible mechanisms that may account for the association between childhood abuse and adult health problems. Language: en

A stress and coping model of medication adherence and viral load in HIV-positive men and women on highly active antiretroviral therapy (HAART).

Abstract: The authors tested a structural model that incorporated age, time since diagnosis, social support, coping, and negative mood as predictors of medication adherence and HIV viral load on 188 men and 134 women on highly active antiretroviral therapy (HAART). The authors used psychosocial latent factors formed from baseline measures to predict latent factors of adherence, as assessed by electronic monitoring and self-report, and viral load defined by indicators assessed over a 15-month period. Results from the model indicate that greater negative mood and lower social support are related to greater use of avoidance-oriented coping strategies. Use of these coping strategies by patients on HAART is related to poorer medication adherence and, subsequently, higher viral load. This model advances researchers' understanding of the contribution of psychosocial variables in predicting treatment adherence and disease progression in HIV-positive men and women.

A communication model of shared decision making: accounting for cancer treatment decisions.

Abstract: The authors present a communication model of shared decision making (CMSDM) that explicitly identifies the communication process as the vehicle for decision making in cancer treatment. In this view, decision making is necessarily a sociocommunicative process whereby people enter into a relationship, exchange information, establish preferences, and choose a course of action. The model derives from contemporary notions of behavioral decision making and ethical conceptions of the doctor-patient relationship. This article briefly reviews the theoretical approaches to decision making, notes deficiencies, and embeds a more socially based process into the dynamics of the physician-patient relationship, focusing on cancer treatment decisions. In the CMSDM, decisions depend on (a) antecedent factors that have potential to influence communication, (b) jointly constructed communication climate, and (c) treatment preferences established by the physician and the patient.

Testing a model of pain appraisal and coping in children with chronic abdominal pain.

Abstract: This prospective study of children with recurrent abdominal pain (N=133; ages 8--15 years) used path analysis to examine relations among dispositional pain beliefs and coping styles, cognitions and behavior related to a specific pain episode, and short- and long-term outcomes. Children believing they could not reduce or accept pain appraised their episode-specific coping ability as low and reported passive coping behavior. Dispositional passive coping had direct effects on both episode-specific passive coping and long-term symptoms and disability. Accommodative coping (acceptance and self-encouragement) was associated with reduced episode-specific distress, which itself predicted reduced depressive symptoms 3 months later. Results suggest that coping-skill interventions for children with chronic pain should target reductions in passive coping and consider the potential benefits of accommodative coping strategies.

Optimism and pessimism as predictors of change in health after death or onset of severe illness in family.

Abstract: The authors prospectively examined changes in health after a major life event (death or onset of severe illness in family) among 5,007 employees (mean age = 44.8 years) whose optimism and pessimism levels were assessed in 1997 and major life events in 2000. Health was indicated by sickness absence days during a period covering 36 months prior to the event and 18 months after the event. Increase in sick days after the event was smaller and returned to the preevent level more quickly among highly optimistic individuals than among their counterparts with low optimism. Parallel changes were not observed in relation to pessimism. These findings suggest that optimism may reduce the risk of health problems and may be related to a faster recovery after a major life event.

Benefit Finding in multiple sclerosis and associations with positive and negative outcomes

Abstract: This study examined the direct and stress-buffering effects of benefit finding on positive and negative outcomes. A total of 502 people with multiple sclerosis completed a questionnaire at Time 1 and, 3 months later, at Time 2 (n = 404). Measures of illness were collected at Time 1, and number of problems, stress appraisal, benefit finding, subjective health, and negative (global distress, negative affect) and positive (life satisfaction, positive affect, dyadic adjustment) outcomes were measured at Time 2. Factor analyses showed the Benefit Finding scale to have 2 dimensions: Personal Growth and Family Relations Growth. Hierarchical regressions showed that after controlling for the effects of demographics, illness, problems, and appraisal, benefit finding showed strong direct effects on the positive outcomes. Benefit finding did not have a direct effect on distress or subjective health but had a weak association with negative affect. Family Relations Growth had a stress-buffering effect on distress.

Interpersonal and print nutrition communication for a Spanish-dominant Latino population: Secretos de la Buena Vida.

Abstract: Participants (N=357) were randomly assigned to 1 of 3 conditions: lay health advisor (promotora) plus tailored print materials, tailored print materials only (tailored), or off-the-shelf print materials (control). The primary outcomes were calories from fat and daily grams of fiber. Secondary outcomes included total energy intake, total and saturated fat intake, and total carbohydrates. Adjusted for baseline values, calories from fat were 29%, 30%, and 30% for the promotora, tailored, and control conditions, respectively, and grams of fiber consumed were 16 g, 17 g, and 16 g. Significant Condition X Time interactions were not observed between baseline and 12-weeks postintervention. The LHA condition achieved significantly lower levels of energy intake, total fat and saturated fat, and total carbohydrates. The relative superiority of the promotora condition may derive from the personal touch achieved in the face-to-face interactions or from the women's use of print materials under the promotora's guidance.

Long-Term Effects of Lifestyle Behavior Change in Coronary Artery Disease: Effects on Recurrent Coronary Events After Percutaneous Coronary Intervention.

Abstract: This study evaluated the effects of a behaviorally oriented cardiac rehabilitation and secondary prevention program on lifestyle changes and on coronary recurrence rates. Patients recently treated with percutaneous coronary intervention (PCI) were randomized to an intervention with an aggressive focus on lifestyle changes (smoking, diet, exercise, and stress; n=46) or to a standard-care control group (n=42). Results showed that the intervention group had significantly larger overall lifestyle changes than the control group after 12, 24, 36, and 60 months. The intervention group had significantly lower rates of all coronary events (acute myocardial infarction, coronary artery bypass graft, PCI, cardiac death; 30.4% vs. 53.7%), and of cardiovascular mortality (2.2% vs. 14.6%). The need for future large-scale and long-term evaluations of lifestyle-oriented secondary prevention interventions of this kind is emphasized.

Predictors of posttraumatic stress disorder following cancer.

Abstract: This study investigated the predictors of posttraumatic stress disorder (PTSD) following a diagnosis of cancer. Individuals who were recently diagnosed with 1st onset head and neck or lung malignancy (N = 82) were assessed within 1 month of diagnosis for acute stress disorder (ASD) and other psychological responses including depression; individuals were reassessed (N = 63) for PTSD 6 months following their cancer diagnosis. At the initial assessment ASD was diagnosed in 28% of participants, and 22% met criteria for PTSD at 6-months follow-up. Peritraumatic dissociative symptoms at the time of receiving one's cancer diagnosis was the sole predictor of PTSD severity at 6-months follow-up. Elevated dissociative symptoms and greater distress at the initial assessment were the best predictors of PTSD caseness at 6-months follow-up. This study provides evidence for identifying recently diagnosed cancer patients who may benefit from psychological assistance in order to prevent chronic psychopathology.

Matching health messages to monitor-blunter coping styles to motivate screening mammography.

Abstract: This study examined whether providing messages matched to women's monitor-blunter coping styles is effective in encouraging mammography utilization. Female callers to a cancer information hotline were assessed at the end of their regular telephone call and classified as monitors or blunters. A randomly assigned message promoting mammography utilization, tailored for monitors or blunters, was delivered on the telephone, and a similarly tailored brochure and refrigerator magnet were mailed to participants immediately after their call. Women were telephoned 6 and 12 months later to determine whether they had obtained a mammogram. Messages matched to a woman's monitor-blunter coping style encouraged mammography after 6 months more effectively than mismatched messages and were significantly more effective for blunters but not for monitors.

Effects of a weight maintenance diet on bulimic symptoms in adolescent girls: an experimental test of the dietary restraint theory.

Abstract: It is widely accepted that dieting increases the risk for bulimic nervosa, but there have been few experimental tests of this theory. We conducted a randomized experiment with adolescent girls (N=188) to examine the effects of a weight maintenance diet on bulimic symptoms. A manipulation check verified that the diet intervention resulted in weight maintenance and significantly reduced the risk for obesity onset and weight gain observed in assessment-only controls. As hypothesized, the diet intervention resulted in significantly greater decreases in bulimic symptoms and negative affect than observed in controls. These experimental findings, which converge with those from a weight loss diet experiment, appear antithetical to dietary restraint theory and suggest instead that dietary restriction curbs bulimic symptoms.

Neighborhood social disorder as a determinant of drug injection behaviors: a structural equation modeling approach.

Abstract: Neighborhood environments are increasingly recognized as a contextual determinant of health, behaviors, and disease; however, the pathways through which neighborhood characteristics impact health behaviors are poorly understood. This article examines pathways to elucidate how neighborhood social disorder may lead to HIV transmission. Data are from a baseline survey of 701 injection drug users from the Self-Help in Eliminating Lethal Diseases Study, an HIV prevention intervention in Baltimore. Structural equation modeling was used to examine the pathways among social disorder, psychological distress, and drug injection behaviors. The relationship between disorder and injection behaviors in the models tested suggests that psychological distress is higher in more socially disordered neighborhoods, that distress leads to greater injection frequency and equipment sharing, and that injection frequency predicts equipment sharing.

The theory of "truth": how counterindustry campaigns affect smoking behavior among teens.

Abstract: This study used structural equation modeling to test a theory-based model of the pathways by which exposure to the "truth" counterindustry media campaign influenced beliefs, attitudes, and smoking behavior in national random-digit-dial telephone surveys of 16,000 12- to 17-year-olds before, 8 months after, and 15 months after campaign launch. Consistent with concepts from the theory of reasoned action, youth in markets with higher levels of campaign exposure had more negative beliefs about tobacco industry practices and more negative attitudes toward the tobacco industry. Models also provided support for a social inoculation effect, because negative industry attitudes were associated with lower receptivity to protobacco advertising and with less progression along a continuum of smoking intentions and behavior.