Journal of Behavioral Medicine最新文献

Habits are mental representations of associations between actions and contextual contingencies. Habit formation can be efficacious in promoting health behavior maintenance, including for highly complex behaviors such as physical activity. Changes in circumstances (e.g., job transitions, moving home) or the advent of disruptive events (e.g., work-related or personal responsibilities) can lead to habit discontinuity by eliminating the contextual contingencies associated with the behavior. Recently, habit theorists have distinguished between preparation or instigation and execution habits, with preparation or instigation habits proposed as central to the development and maintenance of complex habitual behaviors. Discontinuity for complex habitual behaviors may entail disruption of preparation, instigation, or execution habits making such behaviors highly vulnerable to disruption and discontinuity. We propose that the advent of events such as increased work demands or personal responsibilities (e.g., job demands or personal circumstances such as caregiving) and competing highly rewarding activities (e.g., technology-mediated screen activities such as using smartphone apps and games) have high potential to disrupt preparation and instigation habits for complex behaviors. We outline the mechanisms involved and propose several strategies that may be employed to minimize disruption and discontinuity of complex habitual behaviors using physical activity as an illustration. We identify reaffirming original goals, self-monitoring, and planning strategies as potentially efficacious means to minimize the potential for events and competing activities to disrupt physical activity preparation and instigation habits. We call for future research to investigate the efficacy of these strategies in managing disruptive events and promote maintenance of habitual physical activity habit maintenance.

Objective: To examine the impact of coping styles in older adults with asthma on the prospective relationship between depressive symptoms and asthma outcomes, and how their perceptions of social support influenced their coping styles.

Methods: Adults 60 and over with asthma were recruited and interviewed about their experiences of asthma, depression, and other psychosocial factors over three time points (Baseline, 6-month, and 12-month visits). Structural equation models examined the mediating roles of coping styles in the relationship between depressive symptoms (assessed by BDI-II) and asthma outcomes (i.e., asthma control, asthma quality of life, asthma-related distress, asthma-related hospitalizations, and oral corticosteroid use) and the mediating role of perceived social support in the relationship between depressive symptoms and coping style.

Results: 455 participants were included in this study. Overall, 33.9% of the study population self-identified as Black and 32.8% as Hispanic. Depressive symptoms at baseline predicted less spiritual coping at 6 months (β =  - 0.15, p = 0.03), more negative coping at 6 months (β = 0.44, p < .0001), and worse asthma outcomes at 12 months (β = 0.31, p < .0001). None of the coping styles significantly mediated the relationship between depressive symptoms and asthma outcomes. Perceived social support mediated the relationship between depressive symptoms and positive coping, such that more depressive symptoms predicted less perceived social support, which in turn resulted in less positive coping engagement (β =  - 0.06, p = 0.03).

Conclusions: This study demonstrates that in older adults with asthma depressive symptoms impact perceived social support, coping strategy selection (including spiritual coping), and subsequent asthma outcomes.

The dominant public health narrative equates excess weight with poor health, and previous research has demonstrated that people judge adults with higher body weights as being in poor health, even when they engage in healthy lifestyles. The present study investigated whether the same pattern of beliefs holds for perceptions of children's health. Participants (n = 445) viewed the health profile of a female child that varied in terms of weight status (normal weight, obese), health behaviors (good, poor), and age (younger, older), and then rated the child's overall health and indicated their agreement with suggested behavior recommendations. For older children, targets with obesity were perceived as less healthy and were recommended to engage in more healthy and weight control behaviors than were the targets with normal weight. Health behaviors did influence perceptions of health and behavioral recommendations, but much less so for the target with obesity than for the target with normal weight. For younger children, participants placed a greater emphasis on health behaviors than on weight in their perceptions of the target's health and healthy behavior recommendations, but the target's weight did play a greater role in weight-control behavior recommendations. Overall, perceptions of older children reflect the mainstream weight-centric health beliefs that are perpetuated in public health messaging, whereas perceptions of younger children seem to be more aligned with the scientific evidence supporting the importance of health behaviors to overall health. Public health messaging, particularly messaging targeting parents, should be reframed to focus on the importance of engagement with health behaviors without reference to weight.

Pain Coping Skills Training (PCST) is a first-line cognitive-behavioral, non-pharmacological treatment for chronic pain and comorbid symptoms. PCST has been shown to be effective in racially and ethnically diverse cohorts across several chronic medical conditions. However, PCST has not been evaluated in those with end stage kidney disease (ESKD) receiving in-center maintenance hemodialysis. Due to the high rates of morbidity associated with ESKD, and time-intensive treatment, an adaptation of PCST was warranted to address the unique challenges experienced by people living with ESKD. Using current guidelines developed by Card and colleagues for intervention adaptation, PCST was adapted so that it could be implemented among people living with ESKD in a national multisite trial. The objective of this paper was to describe the adaption process outlined by Card and colleagues including how the team selected an effective intervention to adapt, developed a program model, identified mismatches in the original intervention and study population, and then adapted the intervention for those with ESKD treated with in-center maintenance hemodialysis. Finally, we briefly describe future directions for clinical practice and research with the adapted PCST intervention for those with ESKD.Trial registration: ClinicalTrials.gov #NCT04571619.

Accurate estimation of perinatal sleep is important for informing future research and multigenerational health interventions. We compared diary- and actigraphy-estimated sleep parameters during pregnancy and postpartum. We informed our interpretation of these analyses with participants' feedback about these sleep estimation methods. This preregistered study ( https://doi.org/10.17605/OSF.IO/UZFRD ) included 92 English-speaking, women-identified birthing parents who completed sleep diaries and wore wrist actigraphs for 7 days during the 3rd trimester of pregnancy, 6 weeks postpartum, and 16 weeks postpartum. Sleep parameters included total sleep time (TST), sleep efficiency (SE), sleep onset latency (SOL), and wake after sleep onset (WASO). Multilevel models tested associations between diary and actigraphic sleep over time. Results indicated that diary and actigraphic sleep parameters were significantly associated over time, although actigraphic TST, SE, and SOL tended to be lower-and WASO longer-than diary estimations. WASO estimations were significantly more discrepant during 6 weeks postpartum than during the 3rd trimester or 16 weeks postpartum. Using conventional content analysis, three primary themes emerged from participants' feedback about sleep diaries and wrist actigraphs that enriched our interpretation of multilevel model results: (1) Wearability, (2) Functionality/Ease of Use, and (3) Measurement Accuracy. This study was the first to implement a multimethod design supplemented by qualitative data to investigate not only the association between diary and actigraphic perinatal sleep, but what it is like for birthing parents to engage with these sleep estimation methods. This study has important implications for behavioral medicine research and practice with perinatal populations.

The Integrated Change Model describes several social and cognitive factors (e.g., health attitudes, social support, self-efficacy) that can affect medication adherence. Guided by this model, we sought to identify profiles of socio-cognitive facilitators of ART (antiretroviral therapy) adherence among diversely minoritized persons living with HIV enrolled in a behavioral intervention trial in Atlanta, Georgia (N = 477). To do this, we performed latent profile analysis on baseline responses to scales assessing 6 indicators of interest: HIV-care self-efficacy, social support, TasP (treatment-as-prevention) beliefs, trust in healthcare providers, perceived need for ART, and trust in ART. We regressed emergent profiles on internalized, enacted, and microaggressive HIV stigma and compared prospective 30-day ART adherence and several cross-sectional HIV outcomes across profiles. Mean age was 29 years; 83% of participants were non-Hispanic Black, 53% were gay/homosexual-identifying, and 12% were gender expansive. Three profiles emerged: "Constrained/Capable" (6%), featuring high self-efficacy but low-moderate provider trust, social support, TasP beliefs, ART trust, and ART need; "Conflicted" (13%), featuring high TasP beliefs, provider trust, and ART need but moderate self-efficacy, ART trust, and social support; and "Motivated" (81%), featuring high levels of all indicators. Greater internalized, enacted, and microaggressive stigma were positively associated with "Conflicted" relative to "Motivated" profile membership. ART-nonadherence, unsuppressed viral load, and viral load unawareness were more likely for the "Conflicted" relative to the "Motivated" profile. Personalized HIV care tailored to such profiles may improve ART adherence and related outcomes for minoritized persons living with HIV.

The purpose of the study was to evaluate the feasibility, acceptability, and preliminary efficacy of mindfulness-based therapy for insomnia (MBT-I) among Black women. The MBT-I group received weekly sessions that included mindfulness meditation and behavioral sleep strategies. The time and attention control group received lifestyle health education (HE) that included healthy eating, physical activity, and sleep hygiene. The primary outcome was post-intervention changes in insomnia severity score by the Insomnia Severity Index (ISI) at week 10. Other measures included: Pittsburgh Sleep Quality Index, Sleep Hygiene Practice, Spielberger State-Trait Anxiety Inventory (STAI), and Patient Health Questionnaire-9 (PHQ-9). Objective sleep was measured by Actiwatch™ at baseline and week 10. Thirty Black women completed the interventions with no attrition. About 97% of all participants attended 6-8 out of 8 sessions. The ISI scores were reduced at week 10 (MBT-I vs. HE: -7.67 vs. -7.22, p < .05). Anxiety and depression symptoms were significantly improved only in the MBT-I group. This is the first MBT-I for Black women with insomnia. Online MBT-I may be feasible and acceptable for Black women. The MBT-I and HE showed a clinically significant improvement in insomnia symptoms (ISI reduction > 7). MBT-I may be more effective in improving anxiety and depression symptoms than HE. Our findings encourage further study efforts with a longer follow-up and larger sample size to address sleep health disparities among Black women.

Health mindsets refer to beliefs about the malleability (growth mindset) versus stability (fixed mindset) of physical health and have gained traction as a predictor of health beliefs and behaviors. Across two studies, we tested whether health mindsets were associated with avoiding personalized health risk information. In Study 2, we also tested whether conceptually-related constructs of internal and chance health locus of control, health self-efficacy, fatalism, and genetic determinism were associated with information avoidance. Health mindsets were manipulated in Study 1 (college students, n = 284; 79.58% female; M_age = 19.74) and measured in Study 2 (participants recruited through MTurk, n = 735; 42.04% female; M_age = 35.78). In both studies, participants viewed a prediabetes infographic and were informed they could learn their prediabetes risk by completing an online risk calculator. Behavioral obligation was also manipulated in both studies to test whether an additional behavioral requirement associated with learning one's risk would exacerbate any negative impact of health mindsets on avoidance rates. All participants then indicated their interest in learning their prediabetes risk (avoidance intentions) and decided whether to complete the online risk calculator (avoidance behavior). In Study 1, there was no impact of health mindsets, behavioral obligation, or their interaction on avoidance intentions or behavior. Study 2 similarly did not provide consistent evidence for an association of health mindsets, behavioral obligation, or their interaction with avoidance intentions or behavior. However, in Study 2, internal health locus of control was consistently associated with both intentions and behavior. Health information avoidance may be a barrier to prevention and early detection of disease. To encourage individuals to learn potentially important health information, public health interventions might seek to increase people's beliefs that their own actions play a role in their health outcomes. Interventions may also seek to increase people's knowledge about and skills regarding improving their health outcomes, which may influence health locus of control beliefs.

Objective: Examine the feasibility and acceptability of a social identity-informed, online delivered, running and walking group program to support low-active post-secondary students' exercise behavior and well-being during the COVID-19 pandemic.

Methods: A two-arm, non-blinded, parallel pilot randomized controlled trial was conducted whereby low-active post-secondary students at a Canadian university were equally randomized to an online delivered running/walking group program or an attention control condition. Primary feasibility and acceptability outcomes included program interest, study enrolment and retention, questionnaire completion, program attendance, program satisfaction, and affective exercise attitudes. Post-program interviews were conducted to ascertain participants' experiences with the program. Secondary outcomes included well-being, exercise behavior, social identity, social support, and exercise identity.

Results: Ninety-two individuals were screened for eligibility, and 72 were equally randomized to the online group program or attention control condition. Recruitment exceeded the target sample size (60), study adherence and questionnaire completion were above 90%, program attendance was moderate (M = 5.03/8), self-report program satisfaction was moderate-to-high (M = 4.13/5), and there was no condition effect for affective attitudes. During interviews, participants expressed satisfaction with the program. They also discussed challenges with developing a shared sense of identity and social connection with group members via online platforms. There were small condition effects for exercise-related well-being and exercise identity and no condition effects for the remaining secondary outcomes. Social identity scores were moderate (M = 4.63/7).

Conclusions: The STRIDE program was feasible and acceptable but should be delivered and piloted in-person before a full-scale efficacy trial is conducted.

Trial registration: ClinicalTrials.gov NCT04857918; 2021-04-20.

Multiple intervention strategies have been found effective for increasing physical activity among breast cancer survivors, yet most breast cancer survivors fail to meet physical activity recommendations. Optimization of interventions can facilitate real word implementation to ensure effective and efficient intervention delivery. Using a full-factorial design based on the Multiphase Optimization Strategy, 337 breast cancer survivors were randomized to receive a combination of four intervention components: (1) supervised exercise sessions, (2) facility membership, (3) Active Living Every Day (ALED), and (4) Fitbit. Moderate-to vigorous (MVPA) and light-intensity physical activity (LPA) were measured at baseline, 3 months, and 6 months with a hip-worn Actigraph GT3X+. Normal linear mixed models with separate intercepts for each subject were fit in the SAS 9.4 Mixed procedure. Participants who received supervised exercise sessions engaged in more MVPA, 153.58 min/week vs. 133.0 min/week (F = 3.97, p = 0.048) and LPA, 170.26 min/day versus 160.98 light PA minutes/day (F = 4.67, p = 0.032), compared to participants who did not receive supervised exercise. The effects of the three other intervention components on MVPA were not significant; however, those that received ALED engaged in less LPA (F = 6.6, p = 0.011). Supervised exercise sessions resulted in significant increases in MVPA and LPA in a sample of breast cancer survivors. Of note, these sessions were provided only during the first 6 weeks of the intervention and effects remained significant at 6 months. Results of this trial could inform future implementation efforts to ensure effective and efficient delivery of physical activity programs for breast cancer survivors.