Journal of Behavioral Medicine最新文献

High levels of meat consumption pose well-documented risks to both human health and environmental sustainability. Given the substantial resources required for meat production and the pressures of population growth, continued reliance on meat as the dominant protein source is increasingly untenable. The Midwest region of the United States, which exhibits disproportionately high rates of both meat production and consumption, represents a particularly critical context for interventions aimed at shifting dietary behavior. Encouraging adoption of meat analogues in this region could have an outsized impact on both consumption patterns and environmental outcomes. The present study draws on theories of limited-resource social dilemmas and extends prior research on pro-environmental messaging and food labeling to evaluate strategies for increasing acceptance of meat analogues. A 2 (label present vs. absent) × 3 (label type: education, identity, social norm) factorial experiment was conducted to assess expected liking, willingness to try, willingness to purchase, and willingness to substitute meat analogues for conventional meat among Midwestern adults. Findings revealed a significant interaction between social norm and identity labels: when presented in combination, these labels increased expected liking (p = .013), willingness to purchase (p = .007), and willingness to substitute (p = .011). In contrast, education labels produced a significant backfiring effect on willingness to try (p = .013), raising important concerns about the efficacy of commonly used sustainability messaging. Finally, results indicated that the majority of participants were not willing to pay more for environmentally sustainable meat analogues, a pattern that diverges from past findings and highlights the need for pricing strategies.

Indigenous Peoples experience the highest age-adjusted prevalence of type 2 diabetes of any racial group in the U.S. Though the management of type 2 diabetes requires regular healthcare visits, North American Indigenous individuals with diabetes do not always utilize the healthcare available to them, and this lack of utilization may lead to poor health outcomes over time. Drawing on literature showing that North American Indigenous patients experience discrimination in healthcare and that experiencing discrimination in healthcare is associated with healthcare avoidance and/or delay, the current study conceptualized unmet healthcare utilization as healthcare avoidance and used path analysis with longitudinal data (four points of data collection) to examine the relationships between healthcare discrimination, healthcare avoidance, and self-rated health in a sample of 192 Indigenous adults with type 2 diabetes from the northern Midwest U.S. We found that healthcare avoidance was negatively associated with baseline self-rated health, and that healthcare avoidance partially explained the negative effect of lifetime healthcare discrimination on self-rated health at the final follow-up of the study. These results show that healthcare avoidance statistically mediates the relationship between healthcare discrimination and self-rated health and suggest that healthcare avoidance is an important mechanism linking healthcare discrimination to worse self-rated health over time. Ultimately, we argue that creating more inclusive and less microaggressive healthcare spaces is important for individual health outcomes and macro-level health inequities. Continued efforts to understand instances of and to diminish healthcare mistreatment of Indigenous Peoples are recommended.

Research demonstrates that demographic (e.g., age, sex), behavioral (e.g., exercise), and lifestyle (e.g., drinking habits) factors are related to individual differences in cognition and health. Although some work has examined modifiable psychosocial factors (e.g., control beliefs, purpose in life, social contact) in relation to cognition and health, they are typically examined separately. We used data from the Midlife in the United States (MIDUS) study to investigate whether a composite measure of sense of control, purpose in life, and social support assessed at the second wave (M2) would be associated with cognition (episodic memory, executive function) and health (functional health, chronic conditions) ten years later at the third wave (M3). Participants (N = 2,497) ranged from 33 to 83 years old. We created a continuous composite of sense of control, purpose in life, and social support by standardizing and summing the individual factor scores. Using multiple regression, we tested the composite as a predictor of 10 year changes in episodic memory, executive function, functional health, and chronic conditions. We found that those higher on the psychosocial composite demonstrated greater maintenance of cognition and health compared to those lower on the composite, even after controlling for demographic, behavioral, and lifestyle risk and protective factors. Education moderated the effect of the composite on functional health, such that having a higher psychosocial score was more predictive of better functional health among those with lower and moderate levels of education. We discuss the value of using a psychosocial composite measure and implications for public health.

The selection of appropriate statistical models is essential for accurately interpreting the analysis of count data, especially in behavioral medicine. Traditionally, Poisson and Negative Binomial models have been commonly employed, but they may not always be the most optimal choices, particularly when dealing with data with an abundance of zeroes, which can be effectively modeled using zero-inflated and zero-altered (hurdle) models. Additionally, U-shaped distributions where the data are clustered around both ends-low and high counts-with fewer occurrences in the middle, cannot be adequately captured by traditional approaches and further complicate the analysis. This paper critically examines the widespread use of zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB) models in the context of adolescent substance use data, identifying their potential limitations. Using a dataset from a smoking study of 1263 adolescents who reported smoking behavior across eight waves, we analyzed the sparse count outcome "Days Smoked in the Past Month," with covariates such as sex, age, and GPA recorded at each wave. Through a comprehensive evaluation of smoking behavior count outcomes-employing model identification via the Kolmogorov-Smirnov (KS) test, validation through confirmation studies, and regression analysis guided by Akaike Information Criterion (AIC). The range of models covered includes: ZIP, Poisson hurdle (PH), ZINB, negative binomial hurdle (NBH), zero-inflated negative binomial with fixed r (ZINB-r), negative binomial hurdle with fixed r (NBH-r), zero-inflated beta-binomial (ZIBB), beta-binomial hurdle (BBH), zero-inflated beta-binomial with fixed n (ZIBB-n), beta-binomial hurdle with fixed n (BBH-n), zero-inflated beta-binomial with fixed alpha and beta (ZIBB-ab), beta-binomial hurdle with fixed alpha and beta (BBH-ab), zero-inflated beta negative binomial (ZIBNB), and beta negative binomial hurdle (BNBH). Our study demonstrates the superior model fitting and regression analysis capabilities of the ZIBB and BBH models. Notably, our findings reveal the effectiveness of the ZIBB model in capturing the U-shaped distribution observed in real-world data. This underscores the importance of exploring a wider range of models beyond ZIP and ZINB for count data analysis. This study advocates for the broader application of these more sophisticated models in behavioral medicine, with the goal to enhance the accuracy and reliability of research outcomes.

Obesity in the United States is highly prevalent and often comorbid with other burdensome and debilitating conditions, such as chronic pain. To better address pain in the context of obesity, it is important to consider vulnerability factors associated with pain experiences. Anxiety sensitivity (i.e., fears of the potentially harmful consequences of anxiety-related symptoms) is an actionable transdiagnostic vulnerability factor robustly linked to pain. However, the unique role of specific sub-facets of anxiety sensitivity on pain-related outcomes such as pain intensity and disability have not been examined among individuals with weight-related concerns (e.g., obesity). The current study sought to explore the unique role of anxiety sensitivity sub-facets (i.e., physical, cognitive, and social concerns) with pain intensity and disability. Participants included 158 adults (61.8% female, M_age = 31.6, SD = 10.68) who completed a baseline assessment for a larger randomized controlled trial for stress and weight-related behaviors (e.g., emotional eating). Results indicated that higher anxiety sensitivity physical concerns was associated with increased pain intensity and disability, whereas higher anxiety sensitivity social concerns was associated with lower pain intensity and disability. The present findings suggest the potential clinical utility of targeting anxiety sensitivity physical concerns in pain management among individuals with weight-related concerns.

Both emotion regulation and physical activity are associated with improved emotional well-being, including high self-esteem. However, most prior work comparing this relationship is limited by either subjective bias or ecological validity. Using objective (i.e., accelerometer-derived) measures of physical activity, this study investigated the relationship between moderate-to-vigorous physical activity (MVPA) and two trait emotion regulation strategies. We predicted that trait reappraisal (i.e., the habitual use of cognitive reappraisal to regulate emotions in daily life), but not trait suppression (i.e., the habitual use of expressive suppression to regulate emotions in daily life), would be associated with higher engagement in MVPA. We also predicted that physical activity would buffer reliance on trait reappraisal, such that individuals who engaged in more MVPA would be less likely to report emotion regulation difficulties or low self-esteem. Participants (N = 251 adults, ages 17-88 years) filled out questionnaires assessing trait emotion regulation, emotion regulation difficulties, and self-esteem, and wore an ActiGraph® on their non-dominant wrist for one week (M(SD) = 7.46(2.32) days). Regression and moderation analyses were conducted on variables of interest. Neither trait reappraisal nor suppression were associated with MVPA. MVPA significantly moderated the negative relationship between trait reappraisal and emotion regulation difficulties, such that the relationship was stronger at lower levels of MVPA. Effects were not found with self-esteem or trait suppression. These results indicate that MVPA may be beneficial in maintaining emotional well-being, particularly in the face of emotion regulation difficulties.

Physical activity (PA) levels among breast cancer survivors following surgery are often low, with unclear roles played by pain-related factors. This study investigates the changes in PA and its contributing factors, including pain-related factors, in 184 breast cancer survivors throughout the acute post-operative stage of 1 week (T1), the sub-acute stage of 4 months (T4), and the long-term stage of 12 months (T12). A linear mixed model was utilized to evaluate PA changes in the first year post-surgery. Multivariate regression analyses explored associations between moderate-to-vigorous physical activity (MVPA) and patient characteristics, pain-related factors, emotional and physical functioning, and quality of life (QoL) at each timepoint separately and also explored factors in the acute and sub-acute stage contributing to MVPA at T12. Weekly minutes of MVPA and steps had a significant increase between T4 and T12. All models, adjusted for age and BMI, were significant (p < 0.01) but explained only small proportions of variance of MVPA at T1 (AdjR² :15%), at T4 (AdjR² :25%) and at T12 (AdjR² :26%). Pain-related factors, together with emotional and physical symptom burden, negatively impacted PA at various points in time. Despite these challenges, higher QoL and existential well-being were positive influences. Breast cancer survivors demonstrate increasing PA over the first year post-surgery. Contributing factors differ for each timepoint, highlighting the complex interplay of emotional and physical factors in promoting active lifestyles. Rehabilitation interventions need to hold the time-dependency of contributing factors into account and aim to address both immediate and long-term needs.

Being diagnosed with a chronic illness is a life-altering experience that can be shaped, for better or worse, by psychological factors. How patients think about their illness-their core beliefs about what it means and what it might bring such as whether it is catastrophic, manageable, or even an opportunity-can influence how they respond and adapt. This research introduces the concept of illness mindsets and presents the initial validation of the Illness Mindset Inventory (IMI), a new tool designed to assess these beliefs and their implications for health and well-being. Study 1 examines the factor structure, internal reliability, and discriminant validity of the 9-item IMI in N = 201 healthy participants and N = 200 participants with cancer, diabetes, cardiovascular disease, and/or chronic pain. Study 2 investigates cancer patients (N = 463) with different degrees of illness severity and tests the pre-registered hypothesis that the IMI will account for variability in functioning over and above measures of illness severity. In Study 1, illness mindsets were associated with between 5.7 and 12.1% additional variance in physical, social, and emotional functioning, above and beyond disease status. In Study 2, illness mindsets accounted for between 6.9 and 12.0% additional variance in physical functioning, social functioning, and emotional distress in people diagnosed with cancer above and beyond cancer stage, cancer status, trait optimism, and self-efficacy. Illness mindsets may help account for variance in individual functioning beyond disease status and disease severity. Future research can probe the IMI's utility in supporting patient care; in predicting functioning before, during, and after a diagnosis; and as a potential target for intervention.

Chronic pain is a significant public health problem linked to notable functional impairment and economic burden. Despite considerable research attention, chronic pain treatments only yield small to medium sized effects for pain complaints. Better understanding the pain experience may help improve treatment outcomes for pain. Specifically, intraindividual variation in pain intensity represents a potentially important avenue that captures the dynamic nature of pain and may improve overall understanding of pain. Limited work has examined metrics of intraindividual pain variation across chronic pain populations, but no work has examined how these metrics are associated with pain functional outcomes (pain-related disability, negative affect, and activity avoidance). Therefore, the current study utilized ecological momentary assessment to assess pain intensity, pain-related disability, negative affect, and activity avoidance, 5 times a day for 7 days, among 48 adults with chronic pain. Results suggested that pain instability metrics (e.g., intraindividual standard deviation) were associated with pain-related activity avoidance, while dynamic metrics of variability (e.g. % of time in high pain) were directly associated with pain-related disability and negative affect. Results from the current study have important clinical implications that can be applied to the assessment of pain to guide further treatment planning. Contextualizing pain as a dynamic experience that can be captured via intensive self-report assessment may improve overall intervention outcomes.