International Journal of Behavioral Medicine最新文献

Background: Physical inactivity is a major modifiable risk factor for illness and chronic disease. Despite strong evidence supporting the benefits of regular physical activity (PA), participation declines markedly after adolescence, particularly among college students.

Objectives: To examine multilevel determinants of physical activity among college students and identify key individual- and institution-level indicators associated with meeting recommended PA guidelines.

Methods: A cross-sectional multilevel analysis was conducted using a large national randomized sample of college students (n = 23,183) from multiple universities. Two hierarchical levels were defined: student level and college level. Hierarchical Linear Modeling (HLM) was applied to account for data clustering and to assess interactions between levels of influence on PA. The primary outcome was meeting the American College of Sports Medicine (ACSM) PA guidelines (≥30 minutes of moderate PA on ≥5 days per week).

Results: Overall, 29% of students reported meeting ACSM PA recommendations, while 24% reported no days of physical activity. Intention to lose weight was the strongest predictor, increasing the odds of meeting PA guidelines by 41%. Male students were 40% more likely to meet PA recommendations compared with female students. Institutional exposure to PA information was also significant; students who reported receiving PA-related information from their institutions had a 32% higher likelihood of meeting PA guidelines than those who did not.

Conclusions: Physical activity among college students is influenced by a complex interplay of individual and institutional factors. Interventions should address both levels by enhancing health education, promoting supportive campus environments, and implementing inclusive wellness programs. Future research should integrate multiple theoretical perspectives to better explain unexplained variations in PA behavior and inform more effective strategies to promote physical activity in university settings.

Background: The purpose of this study was to examine the feasibility and fidelity of an 8-week teacher-guided active play intervention in an early childcare education setting. The secondary aim of this study was to examine the effects of the intervention on physical activity (PA) levels, time-on-task (TOT), and explore how teacher habit formation (automaticity) influenced implementation fidelity.

Method: Two preschool centers were randomly assigned to the intervention (n = 27 children, 3.91 ± 0.53 years) or the control group (n = 25 children, 3.69 ± 0.81 years). Teachers in the intervention group delivered 15-min indoor and outdoor active play opportunities for 8 weeks. Retention measures occurred 14 weeks later. Weekly checklists and informal interviews were conducted to assess intervention fidelity. Likert-style surveys were completed by teachers each week to assess automaticity. Wrist-worn accelerometers assessed PA during the school day. A modified time sampling technique was implemented for TOT observations.

Results: Teacher reports indicated the intervention was relatively easy to implement. The intervention group participated in significantly greater amounts of indoor PA from baseline to post-intervention (F (1,40) = 13.59, p < 0.001, η_p² = 0.254) and from baseline to retention (F (1,33) = 16.84, p < 0.001, η_p² = 0.994) when compared to the control group. Active play opportunities did not significantly impact TOT.

Conclusion: This study indicates that this type of intervention is feasible, particularly for indoor active play opportunities, and automaticity impacts implementation fidelity. Results of this study highlight the need to help decrease teacher barriers and increase active play during the preschool day.

Background: To compare healthcare consumption and work absenteeism of individuals with and without persistent complaints after COVID-19 and determine to what extent cognitive-behavioural factors, neuropsychological functioning and depressive symptoms influence this relationship.

Method: Individuals with (n = 129) and without (n = 96) persistent fatigue (Checklist Individual Strength (CIS) fatigue ≥ 35) and difficulty concentrating (CIS concentration ≥ 18) at least 3 months (IQR 16-28 months) after SARS-CoV-2 infection were included. Using the Treatment Inventory of Costs in Patients, healthcare consumption (number of visits) and work absenteeism (≥ 3 weeks absent from paid work) in the past 3 months were assessed. Mediation analyses were performed to investigate whether the putative factors indeed influence the relationship between persistent complaints and work absenteeism or healthcare consumption.

Results: Individuals with persistent complaints more often visited a healthcare professional in the past 3 months (3; IQR = 0-11) than participants without persistent complaints (0; IQR = 0-2, p < 0.001). None of the putative factors was associated with healthcare consumption. Work absenteeism (n = 21/85 with paid work) and work disability (n = 27/225) were only reported by participants with persistent complaints, so no mediation analysis could be performed. Within the group with persistent symptoms, worse neuropsychological functioning (attention and executive functioning) and two illness perception subscales were associated with an increased likelihood of work absenteeism.

Conclusion: The relationship between reporting persisting symptoms and increased healthcare consumption could not be explained by cognitive-behavioural factors, depressive symptoms or neuropsychological functioning. In participants with persistent complaints, illness perceptions and neuropsychological functioning were associated with work absenteeism.

Background: Secondary prevention programs, for modifiable risk factors such as physical inactivity and poor diet, can reduce recurrent stroke risk, but access remains inequitable. To deliver secondary prevention information to more stroke survivors, alternative approaches are needed. The purpose of this study is to evaluate the feasibility and usability of a co-designed website aimed at improving physical activity and diet quality in stroke survivors.

Method: A pre-post intervention study with, adult stroke survivors, who accessed the i-REBOUND after stroke website for 4 weeks, was conducted. Quantitative and qualitative data were collected. Feasibility, focused on domains of acceptability, demand, and limited efficacy, was assessed using Bowen's Feasibility Framework. Pre-post changes in limited efficacy (self-efficacy) were assessed using paired t-tests, mean differences (MD), and 95% confidence intervals (CI). Usability was measured by the System Usability Scale. Open-ended responses were mapped deductively.

Results: Most participants (survey n = 42, interviews n = 7) found the i-REBOUND after stroke website feasible to use. The website was described as easy to navigate with motivating content. Some participants reported improvements in diet and physical activity, but these did not translate into self-efficacy improvements for diet (MD 0.1, 95% CI [-0.1 to 0.3]) or physical activity (MD -0.1, 95% CI [-0.3 to 0.1]). It remains unclear whether having access to a website like i-REBOUND after stroke can support behavior change.

Conclusion: It is feasible for most stroke survivors to use a website aimed at reducing secondary stroke risk. Further studies are needed to assess the efficacy and effectiveness of such websites in promoting long-term improvements in physical activity and diet quality.

Background: Fatigue is a pervasive, debilitating symptom of chronic obstructive pulmonary disease (COPD) that significantly impacts patients' overall health and quality of life. However, its underlying mechanisms and associations with physical, psychological, behavioral, and other health factors remain unclear. This study investigated longitudinal associations between fatigue and these factors in COPD.

Method: A total of 247 COPD patients (mean age, 67.3 ± 8.1 years; 60% male; mean forced expiratory volume in 1 s (FEV1) 57 ± 21% predicted) from primary and secondary care were enrolled in a longitudinal observational study. Two-wave autoregressive cross-lagged panel models (ARCLM) examined relationships between fatigue and associated factors at baseline and 1 year later.

Results: Severe fatigue was prevalent in 53% of participants at baseline, with no significant change at follow-up. ARCLM findings indicated that baseline physical activity was the only predictor of reduced fatigue after 1 year. Moreover, higher baseline fatigue predicted poorer health-related quality of life, more severe dyspnea, and greater dyspnea-related emotional distress at follow-up. Although the initial focus was on fatigue, the analysis revealed a complex network of longitudinal relationships between multiple studied variables extending beyond fatigue.

Conclusion: Physical activity was the only direct predictor of fatigue, while fatigue directly influenced dyspnea, dyspnea-related emotions, and health-related quality of life. This study highlights the important role of fatigue within a complex network of physical, psychological, health status, and behavioral factors. The complexity of the interrelatedness of these factors suggests that single-target interventions are unlikely to be effective. Rather, integrated interventions, such as pulmonary rehabilitation, are needed.

Background: Several factors may influence adherence to the recommended twice-weekly strength activity guideline. Currently, there is a paucity of literature examining the associations of socioeconomic status (SES) on meeting the strength activity guideline among adults with disabilities. The purpose of this analysis is to examine the associations of SES on meeting the strength activity guideline among people with disabilities.

Methods: Using data from the 2017-2019 Behavioral Risk Factor Surveillance System, 14,425 adults with disabilities were classified as meeting or not meeting the strength activity guideline. Several SES variables, education, employment status, income level, household size, number of children, federal poverty level, partnered status, and homeownership were included in the analysis and served as independent variables. Separate unadjusted and adjusted logistic regression models were conducted to relate the effect of SES on meeting the strength activity guideline among people with disabilities.

Results: Among participants, 73.73% (95% CI [72.28, 75.15]) did not meet the guideline. Participants who were college or technical school graduates (aOR = 1.97, 95% CI [1.50, 2.57]) were more likely to meet the strength activity guideline, while other SES variables were found to be not statistically significantly associated with meeting the strength activity guideline (p > .05).

Conclusions: Many SES factors were not associated with meeting the strength activity guideline among people with disabilities. Future targeted strategies may need to consider factors besides SES factors of people with disabilities to promote adherence to the strength activity guideline.

Introduction: Family caregivers frequently experience sleep challenges that impact their own health and ability to provide care for a care recipient (i.e., the person a caregiver supports). Cognitive-behavioral therapy for insomnia (CBT-I) effectively treats insomnia, but there is limited evidence regarding caregivers' perceived impacts of this intervention. The current study evaluated caregivers' experiences using Sleep Healthy Using The Internet (SHUTi), an Internet-delivered CBT-I intervention.

Method: The sample comprised caregivers with insomnia who supported care recipients requiring medium- or high-intensity care for any condition, including Alzheimer's disease/dementia (21%), cancer (11%), or a mobility problem (11%). Participating caregivers who used SHUTi (n = 82; age M = 53.20, 85% female, 59% lived with the care recipient) provided open-ended feedback about their experience. Responses were analyzed using a rapid content analysis approach.

Results: Responses revealed that caregivers perceived benefits of SHUTi to their functioning and their understanding of sleep. Caregivers described how the intervention improved their overall daytime abilities, mood, and caregiving capacity. They also shared how the intervention helped them prioritize sleep and self-care, gave them insight into their sleep, and increased their knowledge of healthy sleep.

Discussion: Caregivers reported wide-ranging benefits from CBT-I beyond improved sleep. Despite the untailored nature of this intervention, several caregivers described positive impacts on their caregiving capabilities and outlook, resulting from the program helping them to improve their sleep and self-care more broadly. These results suggest that framing caregiver-focused health interventions as important to both caregivers and care recipients may increase caregivers' uptake of such resources.

Background: Weight discrimination is associated with negative psychological and physical health. However, in those with diabetes, a high risk-group for weight discrimination, this association is not well-understood. This study examined the extent to which weight discrimination is longitudinally associated with cardiometabolic risk factors in adults with diabetes.

Methods: Participants were 833 people (aged ≥ 50 years) with diabetes at wave 5 (2010/2011) of the English Longitudinal Study of Ageing (ELSA). Perceived weight discrimination was measured at wave 5. Participants provided outcome data at waves 6 (2012/2013) and 8/9 (2016/17, 2018/2019) including psychological (depressive symptoms), anthropometric (body mass index [BMI]), and cardiometabolic biomarkers (glycated haemoglobin [HbA1c], triglycerides, total cholesterol/high density lipoprotein [HDL] ratio, fibrinogen). Linear regressions controlled for baseline age, sex, wealth, BMI, and baseline measures of the outcome of interest.

Results: Perceived weight discrimination was associated with greater depressive symptoms (B = 1.40, p < 0.001), higher triglycerides (B = 0.50, p = 0.014), poorer total cholesterol/HDL ratio (B = 0.59, p = 0.005), and greater fibrinogen (B = 0.25, p = 0.025) at wave 6. Effects were attenuated in fully adjusted models and at wave 8/9. Findings were not replicated using a general discrimination measure suggesting results are specific to weight discrimination.

Conclusion: Findings suggest that weight discrimination has deleterious effects on a range of cardiometabolic risk factors in those living with diabetes, at least in the short-term. Interventions targeted to help individuals with diabetes cope with weight stigma are warranted to help reduce the risk of future diabetes-related complications.

Background: The relationship between sleep duration and depression represents a critical public health concern. This study examined how weekday and weekend sleep durations are associated with depression prevalence among US adults. The primary research question was: What is the nature of this association across weekdays and weekends?

Method: Data were drawn from the most recent pre-pandemic cycle of the National Health and Nutrition Examination Survey (NHANES; 2017-March 2020), including 4089 adults aged 20 years and older. Correlational and non-linear regression analyses were conducted to explore the associations between sleep duration and depression indicators. Analyses were also stratified by gender to investigate potential gender differences.

Results: Spearman correlation and restricted cubic spline analysis indicated that weekend sleep duration was correlated with depression prevalence, but not with the total depression score or the annoyance of depression. Restricted cubic spline further analysis revealed a U-shaped association of sleep duration with the prevalence, total score, and annoyance of depression. The inflection points for depression prevalence were approximately 7.7 h for weekdays and 8.3 h for weekends. Better sleep durations were identified as 7.5-7.8 h on weekdays and 8.0-8.7 h on weekends, based on the expected odds ratios (ORs) with median sleep durations as the reference. Meanwhile, some gender differences were also observed.

Conclusion: This study supports and extends previous findings, confirming that both insufficient and excessive sleep are associated with higher depression prevalence. Sleep duration in the identified beneficial ranges (using median sleep duration as a reference) may help reduce the risk of depression, with slight variations by gender. Our findings further underscore the complex relationship between sleep and mental health and suggest the need to attend to intra-week variations in sleep behavior. These insights may inform the development of more refined and personalized mental health promotion strategies in the future.