International Journal of Behavioral Medicine最新文献

Background: Asthma and obesity are two of the most common pediatric conditions in the USA that are comorbid and exacerbate one another. This study examined whether asthma management self-efficacy-perceived ability to control asthma-mediates the relationship between obesity and asthma outcomes, including pulmonary function, perception of respiratory compromise, and emergency department visits.

Methods: In total, 303 children ages 10-17 were recruited from clinics in the Bronx. Participants were on average 13.20 years old (SD = 2.22), 53.8% male, 62.7% Latino, and 47.2% Black. The study consisted of a baseline visit with spirometry testing to assess pulmonary function and questionnaires to evaluate demographics, healthcare utilization, and self-efficacy. Participants were also assigned peak flow monitors to measure perception of respiratory compromise, which were utilized at home twice daily for 4 weeks.

Results: Obesity was associated with worse pulmonary function (β =  - 3.83, p = 0.03). Asthma management self-efficacy was associated with more accurate perception (β = 5.14, p = 0.03). Obesity was not associated with self-efficacy, accurate perception, or emergency department visits. Asthma management self-efficacy did not mediate the relationship between obesity and asthma outcomes, nor was it associated with pulmonary function or emergency visits.

Conclusions: This study confirms the association between obesity and worse pulmonary function in Black and Latino children. The link between higher asthma management self-efficacy and more accurate perception of respiratory compromise independent of obesity status suggests a modifiable target for intervention irrespective of body habitus.

Background: The co-occurrence of physical inactivity and poor mental health in the college student population can lead to chronic health issues that have negative short-term effects (e.g., academic success). Poor mental health is associated with long-term conditions (e.g., obesity, serious mental illness) that are linked to premature mortality. The purpose of this study was to examine the information-motivation-behavioral (IMB) skills model and evaluate its ability to explain the variance in the use of exercise prescription in mental health treatment.

Method: Mental health professionals (MHPs) (n = 255) were recruited from college counseling centers in the USA. Structural equation modeling was used to examine the relationship between the predictor variables of information (exercise knowledge and benefits of exercise), motivation (personal beliefs, perceived barriers, and organizational support), and behavioral skills (self-efficacy), and the outcome variable of exercise prescription (i.e., brief counseling and referral for exercise).

Results: The predictors accounted for 23% of the variance in exercise prescription (p = .001). Organizational support had a significant direct effect on exercise prescription (β = 0.27, p = .05). Personal beliefs (β = 0.96, p = .05) and organizational support (β = 0.31, p = .04) had significant direct effects on self-efficacy for prescribing exercise. MHP personal exercise behavior was associated with exercise prescription.

Conclusion: MHPs may be willing to support physical activity promotion and exercise prescription, but organizational structures are critical to enhance and sustain the delivery of this adjunctive therapy. The personal exercise history of MHPs may be an important consideration for behavior change interventions. The development and validation of scales are important considerations for future intervention study design.

Background: This scoping review aims to map the quantitative literature investigating vaccine-related individual and contextual determinants of COVID-19 vaccination uptake, identify and define constructs assessed, and describe the characteristics of self-report measures.

Methods: A systematic search of electronic databases was conducted to capture peer-reviewed journal articles published between December 31, 2019, and December 25, 2021. Studies conducted in English and collecting data from general population samples using self-report measures of vaccine-related determinants of COVID-19 vaccination behavior were eligible. Data were analyzed using a descriptive statistics and content analysis, and constructs were mapped onto the COM-B model. The review pre-registration is available on the Open Science Framework ( https://osf.io/82fsz ).

Results: This review identified 157 studies (6153 abstracts and 997 full texts screened) and 425 vaccine-related constructs were retrieved from included studies. Of these, 4% were mapped to capability factors, 85% to motivation, and 11% to opportunity. The most frequently assessed constructs were positive attitudes (19% of constructs), negative attitudes (16%), intention (10%), and beliefs (8%). Only 11% of studies used or adapted pre-existing measures in their surveys. Psychometric properties of self-report measures used were not reported in the majority of studies (60%).

Conclusions: Findings suggest a predominant focus on perceived individual-level predictors of COVID-19 vaccination with inconsistent measurement, potentially compromising research validity. This research highlights opportunities to explore social/environmental factors, establish unified definitions, and employ validated self-report measures for robust survey-based studies on COVID-19 vaccination determinants.

Background: Efficacious programs to sustain smoking cessation are limited for postpartum women, particularly for those who are low-income. Social support may help enhance cessation efforts. However, the specific types of support potentially associated with cessation success are not well evaluated. The purpose of this study was to assess the relationship between different types of social support and smoking relapse among low-income women in the postpartum phase.

Method: A secondary data analysis was completed using data from a single-arm pilot study assessing a smoking cessation intervention for low-income postpartum women. Women were recruited from Philadelphia Women, Infants, and Children clinics (N = 106) and completed a baseline and 1-month follow-up survey. Multivariable logistic regression analyses assessed the relationship between types of social support and smoking relapse, specifically cessation-specific support (Ways of Quitting social support subscale) as well as general (non-smoking focused) social support and its subdomains (i.e., emotional/informational, tangible, affectionate, social positive support (Medical Outcomes Study Social Support Survey)).

Results: Participants were predominantly non-Hispanic Black (64%), 33% lived with their significant other, and 71% had a household income below $15,000. Most participants had relapsed by the 1-month postpartum assessment (77%). In the final regression models, cessation-specific support was significantly associated with staying smoke free at 1 month postpartum. However, neither general social support nor its subdomains were associated with staying smoke free.

Conclusion: Cessation-specific support may bolster women's cessation attempts during the stressful postpartum period. Smoking cessation interventions should consider integrating cessation-specific support to decrease relapse rates among low-income postpartum women.

Background: Randomized behavioral clinical trials are the gold standard for evaluating efficacy of a behavioral treatment. However, because participants are generally unblinded to treatment, preference for a specific treatment option can lead to biased results and/or reduced treatment efficacy. The purpose was to describe the relative frequency and correlates of existence of a preference and patient preference for either an in-person group-based or a remote self-directed, lifestyle treatment prior to randomization to one of these treatments.

Methods: The Enhanced Lifestyles for Metabolic Syndrome (ELM) trial is a multi-site behavioral clinical trial that compares efficacy of a group-based vs. a self-directed approach to lifestyle change on 2-year remission of the metabolic syndrome. Prior to randomization, participants were asked whether they had a preference for a particular treatment and, if so, which approach they preferred. Baseline data were used for a series of logistic regression models to determine behavioral correlates of treatment preference, independent of socioeconomic factors.

Results: Of the 331 participants, 131 (39.6%) had no preference for either treatment. Among the 200 with a preference, 56 (28.0%) preferred the self-directed program. Strength of a pre-existing habit of eating vegetables on most days was an independent correlate of no preference (adjusted OR, 1.27; 95% CI, 1.01-1.61; p = 0.03) and preference for a self-directed program (adjusted OR, 1.55; 95% CI, 1.09-2.22; p = 0.01).

Conclusion: A pre-existing habit of eating vegetables was associated with no preference and preference for a less intensive lifestyle treatment. Post-treatment follow-up of the trial results will determine if concordance between preference and treatment assignment influences outcomes.

Background: Vaccination against HPV is an effective strategy for the prevention of HPV infection and cervical cancer. Nevertheless, the HPV vaccine uptake rate is low among ethnic minorities in Hong Kong. This study sought to assess the feasibility and acceptability of motivational interviewing among South Asian mother-daughter dyads and to preliminarily examine its effects on knowledge of HPV infection and vaccination, health beliefs, intention to have the daughters vaccinated, and initiation and completion of HPV vaccine series.

Methods: This was a pilot randomised controlled trial. Forty South Asian mothers with at least one daughter aged 9 to 17 years were recruited. The intervention group received a motivational interviewing intervention whereas the control group received usual care. Structured questionnaires were used to collect data on the participants' characteristics and selected outcome variables. Bias-corrected Hedges' g and rate difference together with their 95% confidence intervals were calculated to estimate the effect sizes of the intervention on the outcomes The acceptability was assessed via semi-structured interviews.

Results: A larger proportion of the daughters of the intervention group participants had received the first dose of HPV vaccine (95% [19 out of 20]) vs 0% [0 out of 20]). The intervention group showed greater improvement in knowledge at 3 months after the intervention (Hedges' g = 0.77 (95%CI:0.13-1.41)). Most interviewees were satisfied with the intervention.

Conclusion: The intervention was feasible and acceptable. The intervention can help to increase South Asian mothers' knowledge and to increase the initiation of HPV vaccine series by their daughters.

Trial registration: This study was registered at the Chinese Clinical Trial Registry (ChiCTR2100052751) on 5 November 2021.

Background: We investigate factors affecting HIV knowledge, stigma, and violence among female sex workers (FSW) in Agadir, Rabat, Fes, and Tangier, Morocco, over three rounds of HIV surveillance surveys (2012, 2016, and 2019) conducted using respondent-driven sampling (RDS). Multivariable analyses from RDS studies examining the relationships between variables are under-utilized, particularly analyses that combine multiple locations and years of data together in a principled manner.

Method: We fit three weighted logistic regression models for HIV transmission knowledge, having been denied service (experienced stigma), and having been hit (experienced violence) in the last 12 months, and perform model selection using 41 possible explanatory variables.

Results: Variables significantly associated with higher risk included reasons for sex work, how FSW solicit clients, if female family members are also involved in sex work, ever being forced to have sex, and ever being arrested or jailed. There were also significant differences between cities and in trends over time, with HIV transmission knowledge increasing and having been denied health services and having been hit decreasing.

Conclusion: We found associations indicating that some particularly vulnerable FSW may be subject to multiple intersecting risks related to HIV knowledge, stigma, and violence which may decrease their agency to receive proper HIV testing, care, and treatment. Although Morocco has made excellent progress in providing HIV services to vulnerable populations, this additional analysis will be useful as Morocco makes programmatic decisions related to ending HIV by 2030.

Background: Individuals with obesity who use glucagon-like peptide 1 receptor agonists (GLP-1s) for weight loss are often judged for taking a "shortcut" rather than using "optimal" methods (i.e., diet/exercise). This is linked with beliefs that weight is highly controllable, which predict both anti-fat attitudes and maladaptive weight-related behaviors. This study tested how exposure to a woman whose weight was framed as highly controllable or largely uncontrollable and who was described as losing weight with a GLP-1 vs. diet/exercise affected weight stigma attitudes and maladaptive weight-related cognitions through social comparison processes.

Method: Women with overweight and obesity (N = 163) were exposed to a woman with obesity who varied by described weight controllability and weight loss method. Participants reported the extent to which they engaged in global downward social comparison and weight and body size comparisons to the woman, as well as weight stigma attitudes and maladaptive weight-related cognitions (likelihood of engaging in binge eating, restrictive eating, and exercising hard to control weight).

Results: When the woman lost weight with a GLP-1 (vs. diet/exercise) she was judged more negatively due, in part, to higher global downward social comparison. Reading about weight loss with diet/exercise (vs. GLP-1) led to more maladaptive weight-related cognitions through higher weight and body size comparisons. Emphasizing that weight is less controllable did not reduce stigmatizing attitudes towards a GLP-1 user and had a limited effect on weight-related cognitions.

Conclusion: Further research is necessary to identify interventions to reduce weight stigma towards GLP-1 users and maladaptive weight-related cognitions.

Background: Daily airway clearance therapy (ACT) is a critical aspect of treatment in cystic fibrosis (CF), but poor adherence is a prominent concern. Identifying factors that might enhance or diminish adherence is a priority for treatment centers. Gratitude, a generalized tendency to notice and appreciate positive facets of experience, is a psychosocial resource that has commanded growing research interest. This longitudinal study examined whether gratitude at baseline was associated with ongoing or persistent ACT adherence over the course of a year.

Methods: Trait gratitude was evaluated at baseline using a validated measure, among adults receiving care at a regional CF treatment center. Self-reported adherence to ACT was assessed at baseline, 6 months, and 12 months using the Cystic Fibrosis Treatment Questionnaire. Average age of participants was 27.2 years, 45.5% were women, and 19.7% had severe disease.

Results: In multivariable logistic regression models that accounted for disease severity (Forced Expiratory Volume₁% predicted) and other clinical and demographic variables, individuals with higher baseline gratitude were significantly more likely to demonstrate persistent adherence over the course of the year. Gratitude remained predictive after additionally adjusting for other well-known psychosocial resource variables (social support and emotional well-being).

Conclusion: This is among the first demonstrations that gratitude is associated with persistent self-reported adherence to treatment over time. Findings suggest that gratitude may be important psychosocial resource for adults with CF, as they contend with complex, highly burdensome treatment regimens. Further research is warranted to examine these relationships and their impact on downstream health outcomes.

Background: This study aimed to determine if motivations to use alcohol (coping and social motivations) mediate the relationship between trait mindfulness and a variety of alcohol-related consequences and to determine if the relationship between motivations to use alcohol and alcohol-related consequences is moderated by alcohol use. We determined the factor structure of positive and negative consequences of alcohol use and used this structure as outcomes across eight moderated mediation models.

Methods: Data were obtained from 296 undergraduate students to confirm the alcohol-related consequences factor structure and to test eight moderated-mediation models.

Results: Four alcohol-related consequences scales (romantic/sexual, positive, mild negative, and severe negative consequences) were confirmed. The motive of drinking to cope significantly mediated the relationship between trait mindfulness and all four of the alcohol-related consequences scales. Drinking to socialize did not significantly mediate the relationship between trait mindfulness and all of the alcohol-related consequences scales.

Conclusions: The identified four-factor structure suggests that alcohol-related consequences should be assessed in a more specific manner. Additionally, different motivations for alcohol use relate differentially to trait mindfulness and different alcohol-related consequences; drinking to cope is particularly problematic for this population. Future research on the usefulness of promoting mindfulness to reduce problematic drinking appears warranted.