Showing papers in "Health Psychology in 2011"

Exercise improves executive function and achievement and alters brain activation in overweight children: a randomized, controlled trial.

Abstract: Objective: This experiment tested the hypothesis that exercise would improve executive function. Design: Sedentary, overweight 7- to 11-year-old children (N 171, 56% girls, 61% Black, M SD age 9.3 1.0 years, body mass index [BMI] 26 4.6 kg/m 2 , BMI z-score 2.1 0.4) were randomized to 13 1.6 weeks of an exercise program (20 or 40 min/day), or a control condition. Main Outcome Measures: Blinded, standardized psychological evaluations (Cognitive Assessment System and Woodcock-Johnson Tests of Achievement III) assessed cognition and academic achievement. Functional MRI measured brain activity during executive function tasks. Results: Intent to treat analysis revealed dose-response benefits of exercise on executive function and mathematics achievement. Preliminary evidence of increased bilateral prefrontal cortex activity and reduced bilateral posterior parietal cortex activity attributable to exercise was also observed. Conclusion: Consistent with results obtained in older adults, a specific improvement on executive function and brain activation changes attributable to exercise were observed. The cognitive and achievement results add evidence of dose-response and extend experimental evidence into childhood. This study provides information on an educational outcome. Besides its importance for maintaining weight and reducing health risks during a childhood obesity epidemic, physical activity may prove to be a simple, important method of enhancing aspects of children’s mental functioning that are central to cognitive development. This information may persuade educators to implement vigorous physical activity.

Loneliness, Social Isolation, and Behavioral and Biological Health Indicators in Older Adults

Abstract: Objective: A number of mechanisms have been proposed through which social isolation and loneliness may affect health, including health-related behavioral and biological factors. However, it is unclear to what extent isolation and loneliness are independently associated with these pathways. The objective of the present analysis was to determine the impact of social isolation and loneliness, individually as well as simultaneously, on health-related behavioral and biological factors using data from the English Longitudinal Study of Ageing (ELSA). Method: Data on health behaviors (smoking and physical activity) were analyzed from 8,688 participants and data on blood pressure, cholesterol, and inflammatory markers were analyzed from over 5,000 of these participants who were eligible for a nurse visit and blood sampling. Loneliness was measured using the short form of the Revised UCLA scale and an index of social isolation was computed incorporating marital status; frequency of contact with friends, family, and children; and participation in social activities. Results: Fewer than 2% of participants reported being lonely all the time, while nearly 7% had the highest possible scores on social isolation. Both social isolation and loneliness were associated with a greater risk of being inactive, smoking, as well as reporting multiple health-risk behaviors. Social isolation was also positively associated with blood pressure, C-reactive protein, and fibrinogen levels. Conclusions: Loneliness and social isolation may affect health independently through their effects on health behaviors. In addition, social isolation may also affect health through biological processes associated with the development of cardiovascular disease.

Systematic review of maintenance of behavior change following physical activity and dietary interventions.

Abstract: Objective: In the past decade, there has been no systematic review of the evidence for maintenance of physical activity and/or dietary behavior change following intervention (follow-up) This systematic review addressed three questions: 1) How frequently do trials report on maintenance of behavior change? 2) How frequently do interventions achieve maintenance of behavior change? 3) What sample, methodologic, or intervention characteristics are common to trials achieving maintenance? Design: Systematic review of trials that evaluated a physical activity and/or dietary behavior change intervention among adults, with measurement at preintervention, postintervention, and at least 3 months following intervention completion (follow-up) Main Outcome Measures: Maintenance of behavior change was defined as a significant between-groups difference at postintervention and at follow-up, for one or more physical activity and/or dietary outcome Results: Maintenance outcomes were reported in 35% of the 157 intervention trials initially considered for review Of the 29 trials that met all inclusion criteria, 21 (72%) achieved maintenance Characteristics common to trials achieving maintenance included those related to sample characteristics (targeting women), study methods (higher attrition and pretrial behavioral screening), and intervention characteristics (longer duration [>24 weeks], face-to-face contact, use of more intervention strategies [>6], and use of follow-up prompts) Conclusions: Maintenance of physical activity and dietary behavior change is not often reported: when it is, it is often achieved To advance the evidence, the field needs consensus on reporting of maintenance outcomes, controlled evaluations of intervention strategies to promote maintenance, and more detailed reporting of interventions

Can(not) take my eyes off it: attention bias for food in overweight participants

Abstract: Objective: The aim of the current study was to investigate attention biases for food cues, craving, and overeating in overweight and healthy-weight participants. Specifically, it was tested whether attention allocation processes toward high-fat foods differ between overweight and normal weight individuals and whether selective attention biases for food cues are related to craving and food intake. Method: Eye movements were recorded as a direct index of attention allocation in a sample of 22 overweight/obese and 29 healthy-weight female students during a visual probe task with food pictures. In addition, self-reported craving and actual food intake during a bogus “taste-test” were assessed. Results: Overweight participants showed an approach-avoidance pattern of attention allocation toward high-fat food. Overweight participants directed their first gaze more often toward food pictures than healthy-weight individuals, but subsequently showed reduced maintenance of attention on these pictures. For overweight participants, craving was related to initial orientation toward food. Moreover, overweight participants consumed significantly more snack food than healthy-weight participants. Conclusion: Results emphasize the importance of identifying different attention bias components in overweight individuals with regard to craving and subsequent overeating.

Using aversive images to enhance healthy food choices and implicit attitudes: An experimental test of evaluative conditioning.

Abstract: Objective: To examine the effect of communicating images of energy-dense snack foods paired with aversive images of the potential health consequences of unhealthy eating, on implicit and explicit attitudes and food choice behavior. Design: Participants were randomly allocated to either an evaluative conditioning (EC) procedure that paired images of snack foods with images of potential adverse health consequences or a control condition that featured images of snack foods alone. Main Outcome Measures: Implicit attitudes were assessed pre- and post-intervention. Explicit attitudes and food choice behavior were assessed post-intervention. Results: The conditioning intervention made implicit attitudes toward energy-dense snacks more negative, with this effect greatest in those with relatively more favorable implicit attitudes toward these snacks at baseline. Participants in the conditioning intervention were more likely to choose fruit rather than snacks in a behavioral choice task, a relationship mediated by changes in implicit attitudes. Conclusion: Presenting aversive images of potential health consequences with those of specific foodstuffs can change implicit attitudes, which impacts on subsequent food choice behavior.

Neural Activity During Health Messaging Predicts Reductions in Smoking Above and Beyond Self-Report

Abstract: Objective:The current study tested whether neural activity in response to messages designed to help smokers quit could predict smoking reduction, above and beyond self-report.Design:Using neural activity in an a priori region of interest (a subregion of medial prefrontal cortex [MPFC]), in response to ads designed to help smokers quit smoking, we prospectively predicted reductions in smoking in a community sample of smokers (N!28) who were attempting to quit smoking. Smoking was assessed via expired carbon monoxide (CO; a biological measure of recent smoking) at baseline and 1 month following exposure to professionally developed quitting ads.Results:A positive relationship was observed between activity in the MPFC region of interest and successful quitting (increased activity in MPFC was associated with a greater decrease in expired CO). Theaddition of neural activity to a model predicting changes in CO from self-reported intentions, self-efficacy, and ability to relate to the messages significantly improved model fit, doubling the variance explained (R self-report !.15,R self-report "neural activity ! .35,R change !.20).Conclusion:Neural activity is a useful complement to existing self-report measures. In this investigation, we extend prior work predicting behavior change based on neural activity in response to persuasive media to an important health domain and discuss potential psychological interpretations of the brain‐behavior link. Our results support a novel use of neuroimaging technology for understanding the psychology of behavior change and facilitating health promotion.

Children's fear during procedural pain: preliminary investigation of the Children's Fear Scale.

Abstract: UNLABELLED Many children consider getting a needle to be one of their most feared and painful experiences. Differentiating between a child's experience of fear and pain is critical to appropriate intervention. There is no gold standard one-item self-report measure of fear for use with children. OBJECTIVE To conduct an initial investigation of the psychometric properties of the Children's Fear Scale (CFS; based on the adult Faces Anxiety Scale) with young school-age children. METHOD Children and their parents were filmed during venipuncture and completed pain and fear ratings immediately after the procedure (n = 100) and 2 weeks later (n = 48). Behavioral coding of the procedures was conducted. RESULTS Support was found for interrater reliability (Time 1: rs = .51, p < .001) and test-retest reliability (rs = .76, p < .001) of the CFS for measuring children's fear during venipuncture. Assessment of construct validity revealed high concurrent convergent validity with another self-report measure of fear (Time 1: rs = .73, p < .001) and moderate discriminant validity (e.g., Time 1: rs = -.30, p < .005 with child coping behavior; rs = .41, p < .001 with child distress behavior). CONCLUSIONS The CFS holds promise for measuring pain-related fear in children. In addition to further investigation into the psychometric properties of the CFS during acute pain with a wider age range, future research could validate this measure in other contexts. The utility of a one-item measure of fear extends beyond the field of pediatric pain to other contexts including intervention for anxiety disorders and children in hospital.

Understanding Narrative Effects: The Impact of Breast Cancer Survivor Stories on Message Processing, Attitudes, and Beliefs among African American Women

Abstract: OBJECTIVE—Examine the longitudinal effects of personal narratives about mammography and breast cancer compared with a traditional informational approach. METHOD—African American women (n=489) ages 40 and older were recruited from lowincome neighborhoods in St. Louis, MO and randomized to watch a narrative video comprised of stories from African American breast cancer survivors or a content-equivalent informational video. Effects were measured immediately post-exposure (T2) and at 3- (T3) and 6-month (T4) follow-up. T2 measures of initial reaction included positive and negative affect, trust, identification, and engagement. T3 message-processing variables included arguing against the messages (counterarguing) and talking to family members about the information (cognitive rehearsal). T4 behavioral correlates included perceived breast cancer risk, cancer fear, cancer fatalism, perceived barriers to mammography, and recall of core messages. Structural equation modeling examined inter-relations among constructs. RESULTS—Women who watched the narrative video (n=244) compared to the informational video (n=245) experienced more positive and negative affect, identified more with the message source, and were more engaged with the video. Narratives, negative affect, identification, and engagement influenced counterarguing, which in turn influenced perceived barriers and cancer fatalism. More engaged women talked with family members more, which increased message recall. Narratives also increased risk perceptions and fear via increased negative affect. CONCLUSIONS—Narratives produced stronger cognitive and affective responses immediately, which in turn influenced message processing and behavioral correlates. Narratives reduced counterarguing and increased cognitive rehearsal, which may increase acceptance and motivation to act on health information in populations most adversely affected by cancer disparities.

Mind over milkshakes: mindsets, not just nutrients, determine ghrelin response.

Abstract: Objective: To test whether physiological satiation as measured by the gut peptide ghrelin may vary depending on the mindset in which one approaches consumption of food. Methods: On 2 separate occasions, participants (n = 46) consumed a 380-calorie milkshake under the pretense that it was either a 62

Relationship characteristics and sexual risk-taking in young men who have sex with men.

Abstract: The vast majority of HIV transmissions occur in the context of a sexual dyad (CDC, 2010b), but most research is focused on individuals as the unit of analysis (Karney, et al., 2010; Zea, Reisen, Poppen, & Bianchi, 2009). Recent research has highlighted the value of considering relationship factors as predictors of HIV transmission and as the unit for intervention. Sullivan and colleagues (2009) reported that among men who have sex with men (MSM) 68% of HIV transmissions were in the context of a main sex partnership, which is defined by the National HIV Behavioral Surveillance System as “someone who you feel committed to above all others” (p. 1155). This was contrasted with only 32% of HIV transmissions in the context of casual sex partnerships, which contradicted traditional thinking that casual relationships should be the unit for interventions among MSM. Disparities in HIV prevalence between Black and White MSM have also been poorly explained by individual behavior (Millett, Flores, Peterson, & Bakeman, 2007), and one study of young MSM aged 23-29 found that partner characteristics partially accounted for the race difference (Bingham et al., 2003). In particular, this research indicated that having had an older, Black male partner helped to explain the racial disparity in HIV rates. Taken together, these studies illustrate the value of research on characteristics of relationships and partners that may be related to HIV risk. The current study explored the effects of relationship and partner characteristics on the frequency of unprotected sex among young MSM, who account for nearly 70% of all new HIV/AIDS diagnoses among all adolescents and young adults in the U.S. (CDC, 2010a). The CDC has estimated that HIV diagnosis rates among MSM are 60 times the rate in other men and 54 times the rate in women (Purcell et al., 2010). Furthermore, young MSM (ages 13 to 24) showed the highest increase in new infections between 2001 and 2006 (CDC, 2008), with a 93% increase among young Black MSM. Our approach in the current study builds on prior work showing that HIV risk behaviors differ not only between individuals, but also across relationships and occasions of sex (e.g., Cooper, 2010; Mustanski, 2007; Zea et al., 2009). These studies have demonstrated that the majority of variability in condom use is within individuals, who may have protected sex with one partner but engage in unprotected sex with a different partner or in a different context. Here we focused on the sexual partnership as the unit of analyses; our approach extends the methodology used in past cross-sectional studies of adult MSM by using a longitudinal design that allowed for the inclusion of more partnerships over a longer timeframe (e.g., Zea et al., 2009). Past studies have also generally focused on one relationship factor at a time (Gorbach & Holmes, 2003), and we extended that work by simultaneously considering multiple relationship and partner characteristics, thereby estimating the relative importance of each factor when considered in conjunction with other factors.

A prospective study of positive psychological well-being and coronary heart disease.

Abstract: Objective: Research suggests that positive psychological well-being is associated with cardiovascular health. However, much of this research uses elderly samples and has not determined the pathways by which psychological well-being influences cardiovascular disease or whether effects are similar for men and women. This study investigates the association between two aspects of well-being (emotional vitality and optimism) and coronary heart disease (CHD) in a sample of middle-aged men and women, and considers potential mediating factors. Method: Between 1991 and 1994, well-being and coronary risk factors were assessed among 7,942 individuals without a prior cardiovascular event from the Whitehall II cohort. Incident CHD (fatal CHD, first nonfatal myocardial infarction, or first definite angina) was tracked during 5 person-years of follow-up. Results: Positive psychological well-being was associated with reduced risk of CHD with an apparent threshold effect. Relative to people with the lowest levels of well-being, those with the highest levels had minimally adjusted hazard ratios of 0.74, 95% confidence interval [0.55, 0.98] for emotional vitality and 0.73, 95% confidence interval [0.54, 0.99] for optimism. Moreover, the association was strong for both genders and was only weakly attenuated when accounting for ill-being. Neither health-related behaviors nor biological factors explained these associations. Conclusions: Positive psychological well-being was associated with a modest, but consistent reduced risk of incident CHD. The relationship was comparable for men and women, and was maintained after controlling for cardiovascular risk factors and ill-being. Additional research is needed to identify underlying mechanisms and investigate whether interventions to increase well-being may enhance cardiovascular health.

Interaction between physical environment, social environment, and child characteristics in determining physical activity at child care.

Abstract: Objective: To investigate the association between the child-care environment and physical activity of 2- and 3-year-olds. Based on an ecological view of environmental influences on health behavior, we hypothesized that the social and physical environment, as well as child characteristics (age and gender), would show independent and interactive effects on children's physical activity intensity. Design: Observations of physical activity intensity were performed among children (N = 175) at 9 Dutch child-care centers. Aspects of the child-care environment were assessed using the validated Environment and Policy Assessment and Observation (EPAO) Instrument. Multilevel linear regression analyses examined the association of environment and child characteristics with children's activity intensity. Moderation was tested by including interaction terms in the analyses, with subsequent post hoc analyses for significant interaction terms. Main Outcome Measure: Observed child physical activity intensity, measured with the Observational System for Recording Physical Activity in Children - Preschool Version. Results: A large proportion of the observed activities were classified as sedentary, while far fewer observations were classified as moderate or vigorous. Activity opportunities in the physical environment (assessed using EPAO) and prompts by staff and peers were significantly and positively related to physical activity intensity, while group size was negatively related to activity intensity. The influence of the physical environment was moderated by social environment (peer group size), while the social environment in turn interacted with child characteristics (age and gender) in determining activity intensity. Conclusion: Our findings are in line with the ecological perspective regarding environmental influences on behavior, and stress the importance of incorporating the child-care environment in efforts to prevent childhood overweight and obesity. © 2010 American Psychological Association.

The reciprocal relationship between physical activity and depression in older European adults: a prospective cross-lagged panel design using SHARE data.

Abstract: Objective The aim of this prospective study was to investigate the reciprocal nature of the physical activity-depressive symptoms relationship in 17,593 older adults from 11 European countries older adults (M age = 64.07, SD = 9.58) across two-year follow-up. Also, gender and age were examined as potential moderators of this relation. Method A two-wave cross-lagged panel design and latent change score models with structural equation modeling was used to analyze data. Depressive symptoms were measured at baseline (T1) and follow-up (T2) using the EURO-D scale, capturing the two factors of affective suffering and motivation. Physical activity was measured at T1 and T2 as frequency of moderate physical activity and vigorous physical activity. Results Cross-sectional latent variable analyses revealed that higher levels of physical activity at T1 and T2 were associated with lower levels of affective suffering and motivation at T1 and T2. Physical activity at T1 was significantly associated with affective suffering and motivation at T2. The relations of depressive symptoms at T1 with physical activity at T2 were not significant. However, a cross-lagged model showed best model fit, supporting a reciprocal prospective relationship between physical activity and depressive symptoms in older adults. Latent change in depressive symptoms factors was related to latent change in physical activity indicating complex and dynamic associations across time. Conclusions Regular physical activity may be a valuable tool in the prevention of future depressive symptoms in older adults, and depressive symptoms may also prevent older adults from engaging in regular physical activity.

Patient-Centered Culturally Sensitive Health Care: Model Testing and Refinement

Abstract: Patient-centered culturally sensitive health care has the following specific characteristics: (a) it emphasizes displaying patient-desired, modifiable provider and staff behaviors and attitudes, implementing health care center policies, and displaying physical health care center environment characteristics and policies that culturally diverse patients identify as indicators of respect for their culture and that enable these patients to feel comfortable with, trusting of, and respected by their health care providers and office staff; (b) it conceptualizes the patient-provider relationship as a partnership that emerges from patient centeredness; and (c) it is patient empowerment oriented (Tucker, Mirsu-Paun, van den Berg et al., 2007). This care is unique in that it is based on views of culturally diverse patients rather than the views of health care professionals (e.g., psychologists, physicians, and health care site administrators) as to the health care provider and staff behaviors and attitudes and the health care characteristics and policies that convey cultural sensitivity. Empowering patients to share their views concerning culturally sensitive health care is a manifestation of patient-centeredness. Health care providers and staff can be responsive to such views of patients through engaging in behaviors and attitudes and fostering clinic characteristics and policies identified as important by culturally diverse patients. This patient-provider partnership approach to health care can enable culturally diverse patients to experience patient-centered culturally sensitive health care. Some health researchers have called for such care in response to findings indicating that patient-centered culturally sensitive health is associated with positive health behaviors and outcomes for both minority and majority patients (Davis et al., 2005; Safran, 2004). Other health researchers have asserted that provider cultural sensitivity and cultural competence are negatively associated with race/ethnicity-related health disparities (Betancourt, Green, Carrillo, & Park, 2005). Tucker, Herman, Ferdinand et al. (2007) developed a Patient-Centered Culturally Sensitive Health Care (PC-CSHC) Model to explain the link between patient-centered culturally sensitive health care and patients’ treatment adherence, health promoting behaviors, and health outcomes. They argued that their model could guide the research and clinical activities of psychologists and other health professionals who are interested in promoting culturally sensitive health care with the ultimate goal of promoting health and reducing health disparities among culturally diverse patients. The model was developed from an extensive literature review and from an ongoing program of research that to date has included the following: (a) use of focus groups with culturally diverse adults to identify what constitutes patient-centered culturally sensitive health care from the perspectives of patients (Tucker, Herman, Pederson, Higley et al., 2003), (b) use of the data from the focus groups to develop the inventory for assessing patient-centered culturally sensitive health care that was used in the present study (Tucker, Mirsu-Paun, van den Berg, et al. (2007), and (c) research on various aspects of the model (Jones, Tucker, Herman, 2009; Tucker, Butler, & Loyuk, 2009; Richards, Tucker, Ferdinand, Brozyna & Shapiro, 2008). However, key tenets of the model have not been put to empirical testing. The purpose of the present study is to test the PC-CSHC Model and, if necessary, offer further empirically-based recommendations for refining it.

The "ick" factor, anticipated regret, and willingness to become an organ donor.

Abstract: Objective: This research tested the role of traditional rational-cognitive factors and emotional barriers to posthumous organ donation. An example of an emotional barrier is the “ick” factor, a basic disgust reaction to the idea of organ donation. We also tested the potential role of manipulating anticipated regret to increase intention to donate in people who are not yet registered organ donors. Design: In three experiments involving 621 members of the United Kingdom general public, participants were invited to complete questionnaire measures tapping potential emotional affective attitude barriers such as the “ick” factor, the desire to retain bodily integrity after death, and medical mistrust. Registered posthumous organ donors were compared with nondonors. In Experiments 2 and 3, nondonors were then allocated to a simple anticipated regret manipulation versus a control condition, and the impact on intention to donate was tested. Main Outcome Measures: Self-reported emotional barriers and intention to donate in the future. Results: Traditional rational-cognitive factors such as knowledge, attitude, and subjective norm failed to distinguish donors from nondonors. However, in all three experiments, nondonors scored significantly higher than donors on the emotional “ick” factor and bodily integrity scales. A simple anticipated regret manipulation led to a significant increase in intention to register as an organ donor in future. Conclusions: Negative affective attitudes are thus crucial barriers to people registering as organ donors. A simple anticipated regret manipulation has the potential to significantly increase organ donation rates.

Growth trajectories of exercise self-efficacy in older adults: influence of measures and initial status.

Abstract: Self-efficacy expectations reflect one’s beliefs in his or her ability to successfully carry out a course of action (Bandura, 1997). Such perceptions influence the activities in which individuals choose to engage, the amount of effort they will invest in those activities, and the extent to which they will persist when they encounter barriers and/or failures. As the central active agent in Bandura’s social cognitive theory, self-efficacy has been consistently identified as a determinant of an array of health behaviors including physical activity (Bandura, 1997; McAuley & Blissmer, 2000). There is evidence that the salience of self-efficacy perceptions may differ depending upon which stage of the exercise process the individual is currently in. Bandura (1997) posits that cognitive variables such as self-efficacy have the greatest impact on behavior when the task is physiologically and/or psychologically demanding. The physical activity literature provides evidence to support this position whereby the influence of self-efficacy is considered to be strongest during the initial stages of an exercise program, when the behavior is novel, and barriers such as fatigue and time constraints are likely to augment the perceived difficulty of maintaining an exercise routine (McAuley, Courneya, Rudolph, & Lox, 1994; Oman & King, 1998). Once the behavior becomes more habitual, the role of efficacy cognitions diminishes. However, in exercise trials, it is likely that self-efficacy shifts again as the organized intervention terminates and the individual is faced with the challenge of continuing to exercise regularly without the structured routine to which he or she has become accustomed (McAuley, 1993). There are multiple sources from which one may derive efficacy, including mastery experiences, social persuasion, social modeling, and the interpretation of physiological and affective responses (Bandura, 1997). In the context of an exercise trial, one might expect self-efficacy to increase as a function of engagement in and exposure to activity, interactions with their exercise leader and peers, and through their affective states. From a social cognitive perspective, self-efficacy might be expected to increase with repeated exposures to physical activity. However, several studies detailing findings from randomized controlled physical activity trials report either no change in efficacy across varying lengths of intervention time or reductions in efficacy from baseline to the end of the interventions and beyond. For example, Moore et al. (2006) employed an eight-week lifestyle modification intervention to improve exercise maintenance in individuals enrolled in a cardiac rehabilitation program. They reported a small decrease in barriers self-efficacy (d = −.09) and a moderate decrease in exercise self-efficacy (d = −.67) at intervention end. At 12-month follow-up, barriers efficacy remained stable whereas exercise efficacy declined further. McAuley, Jerome, Marquez, Elavsky, and Blissmer (2003) examined the effects of a six-month exercise program on barriers and exercise efficacy in older adults and found a significant decline in both measures across the trial. However, there was a greater reduction in exercise efficacy (d = −.92) than in barriers efficacy (d = −.18). Finally, Hughes and her colleagues (2004) conducted an eight-week, multi-component, center-based physical activity intervention followed by home-based activity in older adults with lower extremity osteoarthritis. Once again, there were declines in barriers efficacy from baseline at two (d = −.56) and six months (d = −.59) and smaller declines in exercise efficacy at two (d = −.16) and six months (d = −.36). Why would self-efficacy decline with continued participation in an exercise intervention? We believe that there may be three issues to consider here. First, as McAuley and Mihalko (1998) have suggested, in the context of relatively inactive older adults, participants may simply not have the appropriate previous experiences upon which to form accurate efficacy expectations and, therefore, over-estimate their capabilities at baseline. In essence, as they become exposed to the intervention they recalibrate their personal efficacy. Second, in the event that recalibration takes place and the true baseline self-efficacy is lower than measured, one might expect to see increases throughout the program (i.e., at mid-point), and then a reduction at program end as individuals consider the challenges associated with exercising independently. A third possible explanation is that not all exercise self-efficacy measures might be expected to have similar trajectories. For example, barriers efficacy measures and measures which assess efficacy for adherence to exercise prescriptions over time may not fare as well as those measures which assess gradations of task (e.g., walking further or longer). This may be particularly true when participants have performance-based tests on a frequent basis. This supposition was evidenced in a study by Rejeski et al. (2008) whereby efficacy for a 400 meter walk (i.e., a task-related measure) increased at six months but reverted to baseline at 12 months. Further, it is often assumed that individuals in health-related interventions are drawn from a single population and have similar trajectories across these interventions. This assumption is the basis of linear growth curve modeling (Bollen & Curran, 2006). However, a more realistic assumption may be that different sub-groups (e.g., combinations of demographic factors, health status, or adherence to an intervention) exist within intervention studies. It is wholly possible that such groups display different trajectories of growth across time. The notion of the existence of “latent classes” or subgroups who exhibit heterogeneity in their behavior is an assumption of growth mixture modeling (McLachlan & Peel, 2000) and such an approach has been gaining popularity, particularly in the study of health behavior (e.g., Barnett, Guavin, Craig, Katzmarzyk, 2008; Jackson & Sher, 2005). Identifying sub-groups within clinical trials that evidence different trajectories of growth across time could have significant implications for treatment outcomes, identification of determinants of these trajectories, and for the implementation of different intervention strategies for different sub-groups. Here, our focus was on sub-groups dually-defined by baseline efficacy scores and efficacy trajectories. We report data examining the differential effects of a 12-month randomized controlled exercise trial on three measures of self-efficacy in a sample of older men and women. In doing so, we attempt to answer several questions. First, do individuals recalibrate their efficacy expectations in a downward trajectory after being exposed to the exercise intervention? We hypothesized that barriers and exercise self-efficacy would be overestimated at baseline, be reduced with exposure to the intervention (i.e., a true baseline), increase at six months and then decline at program termination. Statistically speaking, for each of these measures we compared a linear growth curve (i.e., single growth process) with a piecewise growth model (i.e., three growth processes accounting for hypothesized transition points). Second, we were interested in whether task-related efficacy measures behave differently than barriers/adherence type measures in terms of growth. We hypothesized that the task-related measure (i.e. self-efficacy for walking) would increase across the trial, as a function of personal assessments of progress and physical testing (i.e., treadmill testing and 1-mile walk test). Finally, an exploratory question focused upon whether there were different sub-groups within our sample (i.e., classes) relative to self-efficacy and whether the trajectory of growth for these classes was different.

Reliability and validity of self-reported smoking in an anonymous online survey with young adults.

Abstract: Objective The Internet offers many potential benefits to conducting smoking and other health behavior research with young adults. Questions, however, remain regarding the psychometric properties of online self-reported smoking behaviors. The purpose of this study was to examine the reliability and validity of self-reported smoking and smoking-related cognitions obtained from an online survey.

The role of adherence in the relationship between conscientiousness and perceived health.

Abstract: OBJECTIVE Conscientious individuals experience better physical health, in part because of their greater propensity to behave in ways that maintain wellness. In the current study we examined whether and how adherence mediates the relation between conscientiousness and physical health. Moreover, we examined whether these effects differed for adhering to doctor's orders (doctor adherence) versus adhering to medication regimens (medication adherence), as the latter is likely more relevant for older adults' health. METHOD A nationwide sample of adults (N = 2,136, Mage = 51 years) completed personality and adherence measures, in addition to a self-report measure of perceived general health, in an online survey. Correlational analyses were performed to examine the basic relations between the constructs of interest. A bootstrapping approach was employed for examining whether the indirect effect through adherence was conditional on age. RESULTS Doctor adherence partially mediated the relation between conscientiousness and perceived health across adulthood. However, the indirect effect of medication adherence was conditional on age, insofar that medication adherence mediated the link between conscientiousness and perceived health only for older adults in the sample (i.e., those around age 51 and over). CONCLUSION These results suggest that although conscientious individuals report higher levels of both doctor and medication adherence, the role of adherence in explaining the link between conscientiousness and health may differ across adulthood.

Evidence that self-affirmation reduces alcohol consumption: randomized exploratory trial with a new, brief means of self-affirming.

Abstract: Objective: To test the ability of a new, brief means of affirming the self (the “self-affirming implementation intention”) to decrease alcohol consumption against a standard means of self-affirmation (the self-affirming “kindness” questionnaire) and an active control condition; to test whether self-affirmation effects can be sustained beyond the experimental session; and to examine potential moderators of the effects. Method: Two hundred seventy-eight participants were randomly allocated to one of three conditions: control questionnaire, self-affirming questionnaire, and self-affirming implementation intention. All participants were exposed to a threatening health message, designed to inform them about the health risks associated with consuming alcohol. Main Outcome Measures: The main outcome measure was subsequent alcohol intake. Results: There were significant public health gains and statistically significant decreases (>1 unit/day) in alcohol consumption in the two experimental conditions but not in the control condition. At the end of the study, participants in the control condition were consuming 2.31 units of alcohol per day; people in the self-affirming questionnaire condition were consuming 1.52 units of alcohol per day; and people in the self-affirming implementation intention condition were consuming 1.53 units of alcohol per day. There were no significant differences between the self-affirming questionnaire and self-affirming implementation intention, and adherence did not moderate the effects. Self-affirmation also improved message processing, increased perceived threat, and led to lower message derogation. Conclusions: The findings support the efficacy of a new, brief self-affirmation manipulation to enhance the effectiveness of health risk information over time. Further research is needed to identify mediators of the effects of self-affirmation on health behavior change

Identification of distinct depressive symptom trajectories in women following surgery for breast cancer.

Abstract: Objective Depressive symptoms, common in breast cancer patients, may increase, decrease, or remain stable over the course of treatment. Most longitudinal studies have reported mean symptom scores that tend to obscure interindividual heterogeneity in the symptom experience. The identification of different trajectories of depressive symptoms may help identify patients who require an intervention. This study aimed to identify distinct subgroups of breast cancer patients with different trajectories of depressive symptoms in the first six months after surgery. Method Among 398 patients with breast cancer, growth mixture modeling was used to identify latent classes of patients with distinct depressive symptom profiles. These profiles were identified based on Center for Epidemiological Studies-Depression (CES-D) scale scores completed just prior to surgery, and 1, 2, 3, 4, 5, and 6 months after surgery. Results Four latent classes of breast cancer patients with distinct depressive symptom trajectories were identified: Low Decelerating (38.9%), Intermediate (45.2%), Late Accelerating (11.3%), and Parabolic (4.5%) classes. Patients in the Intermediate class were younger, on average, than those in the Low Decelerating class. The Intermediate, Late Accelerating, and Parabolic classes had higher mean baseline anxiety scores compared to the Low Decelerating class. Conclusions Breast cancer patients experience different trajectories of depressive symptoms after surgery. Of note, over 60% of these women were classified into one of three distinct subgroups with clinically significant levels of depressive symptoms. Identification of phenotypic and genotypic predictors of these depressive symptom trajectories after cancer treatment warrants additional investigation.

Subjective Well-Being and Mortality revisited: Differential Effects of Cognitive and Emotional Facets of Well-Being on Mortality

Abstract: Objective: Subjective well-being (SWB) is an important predictor of mortality. To date, surprisingly little is known about whether cognitive and emotional facets of SWB independently predict mortality, and whether such effects vary by age. Method: This study examined differential effects of life satisfaction (LS), positive affect (PA), and negative affect (NA) on mortality in a conjoint analysis using data of German adults between the ages of 40 to 85 years (N
3,124). Effects of SWB facets were analyzed using Cox Proportional Hazards Models. Results: LS and PA predicted mortality over and above sociodemographic factors and physical health (HRLS
.89, 95% CI
.79 –1.00, p  .05, HRPA
.81, 95% CI
.70-.93, p  .05). However, this effect diminished when including self-rated health and physical activity. NA was not associated with mortality. Age group comparative analyses revealed that PA predicted mortality in older adults (65) even after controlling for self-rated health and physical activity (HRPA
.82, 95% CI
.70-.97, p  .05). In middle-aged participants, no SWB indicator predicted mortality when controlling for covariates. Conclusions: These findings suggest a differential impact of cognitive and emotional well-being on mortality and suggest that in middle-aged adults the effects of SWB on mortality are attenuated by self-rated health and physical activity. The study underscores the importance of SWB for health and longevity, particularly for older adults.

Using the Health Action Process Approach and implementation intentions to increase flu vaccine uptake in high risk Thai individuals: a controlled before-after trial.

Abstract: Objective: Influenza vaccination rates remain suboptimal in many countries, including Thailand. This study compared the effect of a theory-based educational leaflet, based on the Health Action Process Approach (HAPA), and action planning intervention with a standard government information leaflet designed to increase influenza vaccination uptake among high-risk Thai adults. Design: A controlled before and after trial was conducted. Participants in the intervention (n = 99) received a leaflet based on the HAPA and asking them to form an action plan identifying where, when, and how they would seek vaccination. Those in the comparison condition (n = 102) received a standard government information leaflet. Main Outcomes Measures: There are 2 sets of outcome measures: (a) process measures of HAPA related variables taken at T1 and T2, and (b) vaccination rates during the subsequent 2 months. Results: The HAPA intervention resulted in greater changes on measures of risk perception, outcome expectancies, self-efficacy, and intention than the comparison condition. Stronger intentions to obtain vaccination were explained by changes in outcome expectancies, perceived self-efficacy for arranging time and transportation, and planning. No significant difference in vaccination rates was observed between two groups. Influenza vaccination was directly predicted by self-efficacy and intention. Conclusion: Results demonstrate that a HAPA-based leaflet may be a useful tool to enhance individual's vaccination intention, but larger trials are required to confirm these findings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)

Socioeconomic inequalities in colorectal cancer screening uptake: does time perspective play a role?

Abstract: Objective: This study examined the role of time perspective in explaining inequalities in colorectal cancer screening attendance. We tested a path model predicting that (a) socioeconomic status (SES) would be associated with consideration of future consequences (CFC), (b) CFC would be associated with perceived benefits/barriers, and (c) barriers and benefits would be associated longitudinally with screening attendance. Method: Data for these analyses came from the control arm (n = 809) of an intervention to increase screening uptake. Participants between 55 and 64 years were offered screening as part of the U.K. Flexible Sigmoidoscopy (FS) Trial. They completed a questionnaire that included demographic and psychological variables. Subsequent screening attendance was recorded. Results: There was clear evidence of SES differences in attendance, with 56% in the most deprived tertile attending their FS appointment, compared with 68% in the middle tertile and 71% in the least deprived tertile (p < .01). Lower SES was associated with lower CFC, higher perceived barriers, and lower perceived benefits (p < .05 for all). Higher CFC, higher perceived benefits, and lower perceived barriers were associated with attendance (p < .01 for all). CFC mediated the association between SES and perceived benefits/barriers, while perceived benefits/barriers mediated the association between CFC and attendance. Conclusion: SES differences in CFC contribute to SES differences in the perceived barriers and benefits of screening, which, in turn, contribute to differences in attendance. Interventions that take CFC into account, for example, by emphasizing short-term benefits, could promote equality in screening participation.

The long-term efficacy of two computer-tailored physical activity interventions for older adults: Main effects and mediators.

Abstract: Objective: Low-cost (e.g., computer-tailored) interventions with sustained effects are needed to increase and maintain physical activity in older adults. This study examined the long-term efficacy of 2 computer-tailored physical activity interventions for older adults and its psychosocial and environmental mediators. Methods: A clustered randomized controlled trial (N = 1,971) was conducted that included 3 research arms: (a) basic computer-tailored print intervention, targeting psychosocial mediators; (b) environmentally computer-tailored print intervention, targeting psychosocial and environmental mediators; and (c) no-intervention control group. Interventions were developed using the intervention mapping approach and consisted of 3 computer-tailored letters delivered over 4 months. Questionnaires assessed the study outcomes (i.e., total weekly days and total weekly minutes of physical activity) at baseline and 12 months. Potential mediators (i.e., awareness, attitude, self-efficacy, intention, social influence, intrinsic motivation, self-regulation, and perceived environment) were assessed at baseline and at 3 or 6 months. Results: Multilevel regression analyses revealed that both interventions significantly changed total weekly days of physical activity compared with the control group, but only the environmentally computer-tailored print intervention significantly changed weekly minutes of physical activity. Multiple mediation models showed that the effects of both interventions on weekly days of physical activity were mediated by changes in awareness and intention. Conclusions: Computer-tailored interventions were effective in inducing long-term behavioral changes in physical activity behavior of older adults. Awareness and intention were found to be important mediators of changing daily physical activity and should be included in future computer-tailored intervention studies.

Socioeconomic Disparities in Pain: The Role of Economic Hardship and Daily Financial Worry

Abstract: Objective—Socioeconomic disparities in pain may be attributable both greater frequency in stressful financial events, as well as greater vulnerability to economic hardship, for those at the lower end of the socioeconomic spectrum. This study investigated the effects of economic hardship and daily financial worry on daily pain among women with a chronic musculoskeletal condition. Design—The sample consisted of 250 women with osteoarthritis (N=105), Fibromyalgia (N=46), or both (N=99). During an initial assessment, participants’ chronic pain diagnosis, level of economic hardship, and demographic information were ascertained. Over 30 days, daily diary assessments recorded daily financial worries and daily pain severity. Hypotheses were tested using multilevel modeling for repeated measures in SAS PROC MIXED. Main Outcome Measure—Daily pain severity. Results—Results indicated that both conditions of economic hardship and daily ratings of financial worry had significant detrimental effects on daily pain. Participants with greater levels of financial stress had greater pain in response to daily financial worries than their counterparts with little or no financial stress. Further, participants in the sample who were not employed and who reported higher levels of financial stress exhibited the most pain reactivity in response to daily financial worries. Conclusion—Financial stress was associated not only with greater exposure to daily financial worries, but also with greater vulnerability to pain on days when daily financial worries were experienced.

Bias for the (un)attractive self: on the role of attention in causing body (dis)satisfaction.

Abstract: Objective: Body dissatisfaction plays a key role in the maintenance of eating disorders, and selective attention might be crucial for the origin of body dissatisfaction. A. Jansen, C. Nederkoorn, and S. Mulkens (2005) showed that eating disorder patients attend relatively more to their own unattractive body parts, whereas healthy controls attend relatively more to their own attractive body parts. In 2 studies, we investigated whether this bias in selective attention is causal to body dissatisfaction and whether an experimentally induced bias for attractive body parts might lead to increased body satisfaction in women who are highly dissatisfied with their bodies. Design: We used a between-subjects design in which participants were trained to attend to either their self-defined unattractive body parts or their self-defined attractive body parts by use of an eye tracker. Main Outcome Measures: State body and weight satisfaction. Results: Inducing a temporary attentional bias for self-defined unattractive body parts led to a significant decrease in body satisfaction and teaching body-dissatisfied women to attend to their own attractive body parts led to a significant increase in body satisfaction. Conclusion: Selective attention for unattractive body parts can play a role in the development of body dissatisfaction, and changing the way one looks may be a new way for improving body dissatisfaction in women. (PsycINFO Database Record (c) 2011 APA, all rights reserved) (journal abstract)

Perceived susceptibility to breast cancer moderates the effect of gain- and loss-framed messages on use of screening mammography.

Abstract: Objective This study examined the role of three distinct beliefs about risk (risks associated with screening, construal of the function of screening as health-affirming or illness-detecting, and perceived susceptibility to breast cancer) in moderating women's responses to framed messages that promote mammography.

The invisible benefits of exercise.

Abstract: Objective To examine whether--and why--people underestimate how much they enjoy exercise Design Across four studies, 279 adults predicted how much they would enjoy exercising, or reported their actual feelings after exercising Main outcome measures Main outcome measures were predicted and actual enjoyment ratings of exercise routines, as well as intention to exercise Results Participants significantly underestimated how much they would enjoy exercising; this affective forecasting bias emerged consistently for group and individual exercise, and moderate and challenging workouts spanning a wide range of forms, from yoga and Pilates to aerobic exercise and weight training (Studies 1 and 2) We argue that this bias stems largely from forecasting myopia, whereby people place disproportionate weight on the beginning of a workout, which is typically unpleasant We demonstrate that forecasting myopia can be harnessed (Study 3) or overcome (Study 4), thereby increasing expected enjoyment of exercise Finally, Study 4 provides evidence for a mediational model, in which improving people's expected enjoyment of exercise leads to increased intention to exercise Conclusion People underestimate how much they enjoy exercise because of a myopic focus on the unpleasant beginning of exercise, but this tendency can be harnessed or overcome, potentially increasing intention to exercise

Results of the “Active by Choice Today” (ACT) Randomized Trial for Increasing Physical Activity in Low-Income and Minority Adolescents

Abstract: National studies indicate that the increasing rate of childhood obesity is a major public health problem and that prevalence rates of obesity among youth have more than tripled in the last three decades (Levi, Vinter, Laurent, & Segal, 2008; Ogden, Carroll, Curtin, Lamb, & Flegal, 2010). Reports indicate that 34.2% of adolescents and 39.5% of African American adolescents are overweight or obese (Ogden et al., 2010). In addition, recent estimates indicate that 50–92% of youth do not meet the national guidelines for engaging in regular physical activity (PA) and PA declines by 50% between the elementary and middle school years (Nader et al., 2008; Troiano et al., 2008; U.S. Department of Health and Human Services, 2008). High levels of obesity have been found to be especially problematic among minority and low-income youth who have less access to safe PA opportunities, and who have lessfamily support for participating in PA (Molnar, Gortmaker, Bull, & Buka, 2004; Pettit, Laird, Bates, & Dodge, 1997). Few studies have examined the effects of school-based interventions on increasing PA in underserved adolescent populations such as low income, ethnic minorities (Bayne-Smith, Fardy, Magel, Schmitz, & Agin, 2004; Coleman, Tiller, Sanchez, et al., 2005; McKenzie et al., 2004; Robinson et al., 2003; Story et al., 2003). In general school-based interventions have had little or only modest effects on increasing PA and have resulted in little to no change in PA outside of school settings (Baranowski, Anderson, & Carmark, 1998; Gortmaker et al., 1999; Kelder, Perry, & Klepp, 1989; Killen et al., 1988; Saunders et al., 2006; van Sluijs, McMinn, & Griffin, 2007). Where comprehensive school-based interventions have typically included common behavior modification components including self-monitoring of PA, goal setting, and behavioral skills training, little attention has been given to involving youth in developing program ideas and PA choices that may enhance more intrinsic motivation, and thus, increase the likelihood of continued engagement in PA. Previous studies have provided evidence for the importance of choice and self-initiated behavior change on increasing intrinsic motivation for engaging in PA (Ferrer-Caja & Weiss, 2000; Thompson & Wankel, 1980; Wilson et al., 2005), but large scale randomized trials have not tested motivational and behavioral skills interventions specifically in low-income, ethnic minority adolescents (Wilson, 2009; Wilson et al., 2002; Wilson et al., 2005). The ACT intervention integrated principles from Self-Determination Theory (Deci, Koestner, & Ryan, 1999; Ryan & Deci, 2000) and Social Cognitive Theory (Bandura, 1989, 2004). Self-Determination Theory (SDT) proposes that behavior changes that are motivated by intrinsic factors such as novel, enjoyable, self-driven, and satisfying experiences will be sustained over time. In the ACT intervention elements from SDT targeted the social environmental during the after-school program for enhancing autonomy (choice), fun, belongingness (engagement), and competence (challenges emphasizing non- competitive play) for PA (Wilson et al., 2006; Wilson et al., 2009). SCT theory assumes that individual-cognitive factors, environmental events, and behavior are interacting and reciprocal determinants of each other. Thus, both cognitive and social factors were integrated into the development of a behavioral skills component of the ACT intervention for increasing PA. The ACT intervention specifically targeted development of behavioral skills (communication, reciprocity of social support, group goal setting, and behavioral competence) for increasing PA outside of program days. In addition, the ACT after-school program social environment (autonomy, choice, participation, belongingness, fun, enjoyment, support) was designed to have a positive impact on cognitive mediators (self-confidence, perceived competence) and motivational orientation (intrinsic motivation, commitment, positive self-concept) to promote longterm PA behavior (Wilson et al., 2009, 2006, 2008). The primary aim of this study was to determine the efficacy of the motivational and behavioral skills ACT intervention (vs. a control program– general health education) on increasing PA at 2-weeks postintervention (primary outcome) and at midintervention (intermediate outcome) in underserved adolescents.

Goal disengagement, functional disability, and depressive symptoms in old age

Abstract: It has been well-established that the experience of functional disability can contribute to depressive symptomatology in older adults (Bruce, 2001; Williamson & Schulz, 1995). This effect is partly due to the adverse consequences that functional disability can have on individuals’ activity or goal constraints, which can lead to failure experiences and loss of control (Lenze et al., 2001). Theory and research also suggest that individuals may be able cope with functional disability. In particular, there are cross-sectional data to suggest that depressive symptoms can be ameliorated if older adults can disengage from goals that have become unattainable in such circumstances (Boerner, 2004; Brandtstadter, Wentura, & Greve, 1993; Schmitz, Saile, & Nilges, 1996). However, longitudinal studies that test this hypothesis explicitly have yet to be performed. To address this gap in the literature, we analyzed four waves of data from a six-year longitudinal study of older adults. We expected that heightened functional disability would forecast increases in depressive symptoms, but only among older adults who had difficulty disengaging from unattainable goals. We did not expect this connection to become established in participants who were capable of disengaging from unattainable goals, because goal disengagement could protect them from repeated failure experiences that typically give rise to depressive symptomatology in old age.