Journal of Behavioral Medicine最新文献

Disparities between Black and White women in stroke risk in the United States are present during midlife, a period during which subclinical indicators of stroke risk accelerate in women. Racism and forms of discrimination have long been associated with cardiovascular pathophysiology. However, few studies have examined midlife discrimination among women and subclinical carotid atherosclerosis, a strong predictor of stroke and myocardial infarction. The Everyday Discrimination Scale, which measures discriminatory experiences, was administered to 304 (including 120 White and 76 Black) midlife women (mean age = 54, SD = 3.9) free of clinical cardiovascular disease. At the same visit, using ultrasonography, we measured four markers of subclinical carotid atherosclerosis, including plaque count, grey scale median, and maximum plaque height. The majority (85%) of women experienced at least one form of discrimination in their daily life. Black women reported experiencing greater discrimination than White women with a mean (SD) Everyday Discrimination Score of 7.3 (5.2) versus 5.7 (4.3). These experiences were most attributed to race, age, income, and "other." Black participants had a higher prevalence of carotid plaque compared to White participants (52% versus 46%). Using Poisson regression, higher discrimination was associated with higher plaque count among Black women only, adjusted for age, systolic blood pressure, low-density lipoprotein cholesterol, and education, such that one standard deviation increase in the Everyday Discrimination Scale was associated with a 25% higher plaque count. Further adjusting for financial strain did not reduce the effect size. We did not observe an association between discrimination and other carotid plaque measures in Black or White women. In Black women, higher levels of discrimination was associated with greater carotid atherosclerosis. Clarifying the relationship between discrimination and subclinical indicators of stroke risk could inform social and healthcare interventions to reduce discrimination and potential associated stroke risk.

Later chronotype (a later sleep/wake time pattern) has been associated with greater caloric intake, lower levels of physical activity, and higher body mass index (BMI); however, less is known regarding whether chronotype predicts changes in weight and weight-related behaviors during a weight loss program. These associations were examined in in 321 non-shift-working adults with obesity (M ± SD age = 49.91 ± 10.75 years; BMI = 35.86 ± 4.07 kg/m²; 84.7% women, 75.7% White) enrolled in a 16-week behavioral weight loss program. It was hypothesized that, after adjusting for age and gender, later chronotype at baseline (assessed via Munich Chronotype Questionnaire [MCTQ]) would predict less weight loss and that this association would be mediated by adherence to caloric intake and physical activity goals. Exploratory analyses examined associations between other MCTQ sleep variables (i.e., social jetlag, sleep duration, sleep loss) and weight loss. Participants lost an average (mean ± SD) of 6.33 ± 4.91% of their baseline weight during the intervention. Greater caloric intake and physical activity goal adherence were associated with greater weight loss, ps < 0.001. Later chronotype predicted lower physical activity goal adherence, p = 0.023; however, there were not significant associations between chronotype and caloric intake goal adherence or weight loss, ps > 0.05. Further, adherence to caloric intake and physical activity goals did not significantly mediate the effect of chronotype on weight loss. Finally, weight change was not predicted by any other MCTQ sleep variables, ps > 0.05. Taken together, results suggest that behavioral weight loss interventions may be similarly beneficial for individuals regardless of chronotype.

Irritable bowel syndrome (IBS), a chronic disorder of gut-brain interaction, is associated with significant life impairment. Smoking has been associated with gastrointestinal problems, but research focused on IBS and smoking is highly limited. The current work sought to evaluate gastrointestinal anxiety (hereafter GI-specific anxiety), an individual difference factor linked to IBS symptom severity and smoking, in terms of smoking abstinence expectancies (i.e., beliefs about the consequences of not smoking) among adults with IBS who smoke. The sample consisted of 263 adults who met criteria for IBS and endorsed smoking 5 or more cigarettes per day (52.1% female; M_age = 44.1 years, SD = 12.71). Hierarchical regression results indicated that greater GI-specific anxiety was associated with higher negative mood, somatic symptoms, and harmful and positive consequences abstinence expectancies; effects ranged from small to medium (4% unique variance for positive consequences to 15% for harmful consequences for somatic symptoms) and were evident after accounting for a wide range of covariates (e.g., depressive symptoms). Overall, the current investigation found that GI-specific anxiety was associated with negative and positive abstinence expectancies among adults with IBS who smoke. Such data are the first to identify individual differences in GI-specific anxiety for abstinence expectancies among a sample of individuals with IBS.

African American adolescents are at risk of living in obesogenic environments, which may contribute to low-quality dietary intake and associated obesity risk. Family mealtime builds capacity for health behaviors; however, limited studies have assessed facilitators or barriers of family mealtime using an ecological approach among African American families. This study longitudinally (baseline, 8 weeks, 16 weeks) evaluated a range of ecological factors as predictors of family mealtime frequency and quality among 151 overweight African American adolescent-parent dyads (adolescent Mage = 12.9 ± 1.7; MBMI%=96.3 ± 4.4; %female = 60.9% [adolescent], 96.0% [parent]) that participated in the Families Improving Together (FIT) for Weight Loss trial. Multilevel model analyses demonstrated a significant two-way interaction between perceived neighborhood healthy food access and time (B = 0.11, SE = 0.05, p = 0.025), such that greater perception of neighborhood access to healthy foods was associated with increased family mealtime quality over time. Further, a significant two-way interaction between family social support for healthy eating and time (B = 0.13, SE = 0.06, p = 0.018), such that higher levels of reported social support were associated with increased family mealtime quality over time. Finally, a marginal two-way interaction between parental limit-setting on health behaviors and time (B = 0.19, SE = 0.10, p = 0.069), such that greater limit-setting was associated with increased family mealtime frequency over time. These findings indicate the importance of environmental and interpersonal support in supporting family mealtime frequency and quality in African American families. Trial registration ClinicalTrials.gov # NCT01796067. The trial was registered on February 21, 2013, and the first participant was enrolled July 12, 2013.

Objective: Most individuals who complete a behavioral weight loss intervention (BWLI) regain weight. The current study is a preliminary investigation into the efficacy of a telephone coaching intervention to aid recovery from weight regain during weight loss maintenance.

Methods: Participants (n = 77) who had recently completed a BWLI and had lost ≥ 5% of their initial body weight were instructed to engage in daily weighing using a "smart" scale. Participants were randomized to receive four consecutive weeks of brief coaching phone calls or no intervention. Randomization was activated when individuals regained > 1.5% of their baseline weight. Assessments were completed at baseline and 12 months.

Results: Sixty-six participants (M ± SD age = 54.2 ± 9.9 years, 68% female) regained > 1.5% and were included in analyses. Individuals who received coaching completed 3.9 ± 0.5 calls and showed statistically-significant improvements in weight compared to the control group in the short-term (i.e., from randomization activation to 40 days later; M±SE Coaching: -1.05%±0.30 vs. Control: 0.37%±0.31, p < 0.001). However, there were not significant differences in weight regain by group at the 12-month study end (Coaching: 5.18%±0.72 vs. Control: 5.71%±0.76, p = 0.62).

Conclusions: Brief telephone coaching is a promising intervention for reversing short-term weight regain. Future research should focus on improving the coaching intervention to promote long-term weight loss maintenance, including exploration into offering multiple rounds of coaching.

Clinical trial registration: NCT04293055.

Objective: Binge-spectrum eating disorders (BSEDs) are characterized by recurrent binge-eating episodes and have grown vastly in prevalence. Many individuals with BSEDs also report elevated food addiction (FA), which is described as a strong, irresistible urge to consume highly palatable processed food. Many studies have found individuals with BSEDs and/or FA often use food to soothe negative emotions-including loneliness, yet loneliness as a specific emotion associated with disordered eating is understudied. This study investigated trajectories of loneliness across the day and how loneliness trajectories were associated with daily binge-eating and FA symptoms using ecological momentary assessment (EMA).

Methods: Adults with BSEDs and/or FA (N = 49; M_age=34.9 ± 12.1; 77.1% cisgender female) completed an 11-day EMA protocol, which assessed loneliness, binge eating, and FA. Multilevel latent growth mixture models were used to empirically derive daily loneliness trajectories and evaluate associations with binge eating and FA.

Results: Six daily trajectories of loneliness were found, which differed in intercept and slope of loneliness across the day. Compared to "stable low loneliness" days, "elevated early loneliness, decreasing then increasing" and "elevated early loneliness, decreasing" days showed higher daily FA symptoms. There were no significant differences between trajectories on daily binge-eating symptoms.

Conclusions: The results support daily loneliness, particularly days with elevated early loneliness, as a salient factor associated with elevated daily FA symptoms. Thus, interventions targeting morning loneliness should be considered for FA intervention. There were several study limitations, such as inability to make causal conclusions, moderate between-subjects sample size, and lack of clinical interview assessment.

The aim of this study was to identify psychosocial factors associated with, and predictive of, diabetes self-efficacy (DSE) in young adults with youth-onset type 2 diabetes (T2D), a vulnerable, understudied group. In this observational, longitudinal study (T1 = baseline, T2 = 1 year later), 348 participants in the TODAY2 multi-center study of youth-onset T2D, completed valid measures of: diabetes self-efficacy, beliefs about medicines, depression and anxiety symptoms, diabetes distress, attitudes, self-management support, and need insecurities. Multivariable logistic regression models evaluated independent associations of each psychosocial factor with the likelihood of being in the high/low DSE tertile groups. Multivariable linear regression models assessed associations with DSE as a continuous variable. Participants' mean age was 26 years, 67.9% were women, mean diabetes duration was 12.4 years, with mean of 2.5 diabetes-related complications. Greater self-care support increased the odds of high DSE at T2. Beliefs that medicines are overused, moderate-to-severe depressive or anxiety symptoms, and unmet material needs, decreased the odds of high DSE at T2. More support, fewer depressive and anxiety symptoms, and fewer unmet material needs at T1 predicted T2 DSE scores. Cognitions (beliefs that medicines are overused), emotions (depressive/anxiety symptoms), and social factors (self-management support, unmet material needs), were significant longitudinal predictors of DSE in young adults with youth-onset T2D. These potentially modifiable factors should be considered when screening for, and designing, interventions to enhance DSE, to improve health behaviors and forestall the development of complications in this at-risk group.

Military Veterans with Gulf War Illness (GWI), a "medically unexplained" persistent physical syndrome (PPS), have difficult experiences of care, in part, due to non-concordant relationships with their healthcare providers. A critical factor in improving care for this population may be the working alliance, which is the extent to which patients and providers agree on the goals and tasks of treatment and have a shared bond. The present study examined if, for Veterans with GWI, perceptions of the working alliance over time predicted better experiences of care (i.e., patient satisfaction and treatment adherence) and improved health outcomes (i.e., reduced disability, depression symptoms, and physical symptoms). Positive Veteran perceptions of the working alliance at 4 weeks were related to better patient satisfaction and treatment adherence at 12 weeks. Veteran perceptions of the working alliance were not consistently related to reductions in disability, depression symptoms, or physical symptoms. The results of this study suggest that the working alliance is important for improving patient experiences of care but may not be sufficient to consistently impact health outcomes.

Sleep is vital for health and well-being, and familial relationships may impact sleep health. This study investigated the associations between sleep health and familial social support, familial intragroup marginalization, familial conflict, and living environment (i.e., living with parent(s) or legal guardian(s)) among Hispanic adults. Hispanic adult college students (n = 455) completed a survey assessing demographics, sleep quality, and familial social support, intragroup marginalization, and conflict. One hierarchical multiple linear regression model assessed the associations between these familial factors, living environment, and sleep quality. Results indicated that poorer sleep quality was associated with greater familial conflict in the full hierarchical regression model (i.e., Step 6). In Step 2 though, poorer sleep quality was inversely associated with familial social support, yet this association disappeared once familial intragroup marginalization was entered. Post-hoc mediation analysis revealed that familial social support was inversely indirectly associated with sleep quality through familial intragroup marginalization and conflict serially. Living environment did not moderate any relationships between familial factors and sleep quality. That familial social support was initially associated with enhanced sleep quality until familial intragroup marginalization was considered suggests that familial negativity may have a greater impact on sleep health than familial social support. Further, familial social support may influence sleep quality through familial negativity. Familial conflict may be particularly detrimental for sleep health. Clinical implications are discussed. Longitudinal studies are warranted to assess temporality.

Generic medications are developed to match brand-name medications in terms of active ingredients, quality, safety, and strength. Because generic medications cost less than their brand-name counterparts, they present an opportunity to reduce financial burden for patients and social institutions. Studies show, however, that patients often possess negative beliefs and evaluations of generic medications, thereby undermining use and effectiveness. In two pre-registered online experiments with community adults (Total N = 750), we tested the effect of attribute framing on attitudes, attitude certainty, and effectiveness beliefs regarding generic and brand-name medications. In both experiments, framing (positive vs. negative) and brand status (generic vs. brand name) of an allergy medication were manipulated in a 2 × 2 between-participant design. The results of both experiments produced strong effects of the framing and brand status manipulations. Specifically, allergy medicines were rated more favorably with a positive frame as compared to a negative frame. Also, branded allergy medicines were rated more positively than generic allergy medicines. In contrast with the pre-registered hypotheses, the two manipulated variables did not reliably interact to predict outcomes. These results held constant across multiple sets of stimuli and dependent measures. The findings support the position that positive framing can be employed to improve positive evaluations and effectiveness beliefs for both over-the-counter generic and branded medications.