International Journal of Behavioral Medicine最新文献

Background: Bedtime procrastination is a widespread sleep problem among university students, particularly medical students, with detrimental effects on physical and mental health. Self-compassion, a positive psychological quality characterized by kindness toward oneself, may serve as a protective factor against sleep-delaying behaviors.

Method: This cross-sectional study used a convenience sampling method which invited participants to answer a survey through the university's official channels. A total of 743 valid questionnaires were finally included for analysis. The measurement tools used in the study included the Nighttime Media Use Questionnaire, the Self-Compassion Scale, and the Bedtime Procrastination Scale. Descriptive statistical analysis, difference tests, and correlation analysis were conducted using SPSS 26.0. A serial mediation model was tested using PROCESS macro (Model 6) to examine the direct and indirect pathways between these variables while controlling for gender and age.

Results: Self-compassion demonstrated a negative association with bedtime procrastination. Serial mediation analysis indicated that self-compassion influenced bedtime procrastination through a serial mediation pathway involving reduced nighttime media use in the dark, which subsequently decreased media use duration, ultimately leading to lower bedtime procrastination. Both the indirect pathway and the direct effect of self-compassion remained statistically significant.

Conclusion: This study finds a significant association between self-compassion and bedtime procrastination among medical students, partially explained by a serial mediation pathway involving nighttime media use. The model proposes that enhancing self-compassion and fostering healthy media habits are potential strategies to mitigate bedtime procrastination in high-stress student populations.

Background: While daydreaming is a common cognitive process with adaptive potential, it can manifest in maladaptive forms marked by compulsivity and functional impairment. This study compared individuals with maladaptive daydreaming (MD), immersive daydreaming (ID), and healthy controls (HC) regarding impulsivity, coping strategies, and daydreaming's impact.

Methods: Participants were selected from a previous MD study based on their scores. The Structured Clinical Interview for Maladaptive Daydreaming confirmed group classifications: 20 MD, 17 ID, and 28 HC participants. Impulsivity was measured using the Barratt Impulsiveness Scale and UPPS Impulsive Behavior Scale; coping strategies were assessed with the COPE Inventory.

Results: The MD group showed significantly higher Maladaptive Daydreaming Scale-16 scores than the ID group, especially on functional impairment, loss of control, and emotional distress items. Although both groups reported similar daydreaming frequency and content, MD experienced more negative consequences related to daydreaming. Compared to HC, MD used more mental and behavioral disengagement and less active coping. Both MD and ID groups showed reduced active coping overall. Additionally, MD reported higher humor use as a coping mechanism than HC. In terms of impulsivity, the MD group showed elevated scores across multiple dimensions, while the ID group displayed moderate elevations in attentional impulsivity and urgency.

Conclusions: MD is associated with distinct psychological features, including greater impulsivity and reliance on avoidant coping, distinguishing it from ID and HC. The elevated humor use indicates potential adaptive emotional regulation. Findings underscore the clinical significance of daydreaming-related impairments and support targeting executive functions, impulsivity, control loss, and emotion regulation in interventions.

Background: Problematic substance use is associated with poor HIV clinical outcomes, including among adolescents and young adults (AYAs) living with HIV. Higher levels of potentially problematic substance use among those diagnosed with HIV during the COVID-19 pandemic may have been mediated by declining levels of social capital and varied depending on an individual's level of anticipated stigma. We sought to determine whether social capital mediates the relationship between time of HIV diagnosis (pre- versus intra-pandemic) and potentially problematic substance use as a function of anticipated stigma.

Method: This moderated mediation analysis utilized baseline data from two demographically similar cohorts of young South Africans ages 18-24 years who tested positive for HIV either before or during the COVID-19 pandemic. The relationships between time of diagnosis in relation to the COVID-19 pandemic, social capital, potentially problematic substance use, and anticipated stigma were analyzed using a series of logistic regression, mediation, and moderated mediation analyses.

Results: Compared to their peers diagnosed before the pandemic, young people diagnosed during the COVID-19 pandemic were more likely to screen positive for potentially problematic substance use (OR 3.561; CI 1.827, 6.943; p < 0.001). Social capital was an inconsistent mediator of the relationship between time of diagnosis and potentially problematic substance use, such that lower social support observed among those diagnosed during the COVID-19 pandemic partially suppressed the positive association between pandemic time of diagnosis and potentially problematic substance use (indirect effect =  -0.363; CI -0.717, -0.119). There was a significant moderated mediation effect of anticipated stigma (index of moderated mediation = 0.028; CI 0.03, 0.061), indicating that the negative indirect effect of time of diagnosis on potentially problematic substance use weakened at higher levels of anticipated stigma.

Conclusion: Diagnosis during the COVID-19 pandemic was associated with a greater likelihood of screening positive for potentially problematic substance use. Although those diagnosed during the pandemic reported lower social capital, social capital was itself associated with potentially problematic substance use. However, this association weakened at high levels of anticipated stigma. These findings may suggest that diagnosis during the pandemic may have exposed those with higher social capital to social networks and norms conducive to substance use, underscoring the need for longitudinal research and interventions addressing the social contexts shaping substance use in this population.

Trial registration: Some data from this study emanate from a pilot randomized controlled trial, which was prospectively registered at ClinicalTrials.gov (Identifier: NCT04568460) prior to pa

Background: Pain and substance use frequently co-occur. Research indicates pain motivates alcohol, cannabis, and tobacco use. Pain is also highly co-morbid with Ehlers-Danlos Syndromes (EDS) and Generalized Hypermobility Spectrum Disorder (G-HSD), however, research on pain and substance use in these populations remains limited.

Methods: Descriptive, cross-sectional, retrospective chart review was conducted of 533 patients (89% female) seen at the GoodHope EDS Clinic at Toronto General Hospital and diagnosed with EDS or G-HSD. Patients provided self-report data on pain and substance use. Analyses included descriptive statistics and bivariate correlations.

Results: Half of the sample reported clinically significant pain severity (55%) and interference (57%). Alcohol use was reported by half of the sample (59%) and 18% reported prescription opioid use. Cannabis use was reported by 48%, with 69% using ≥ 4 times per week. Patients who used cigarettes (14%) smoked a median of 8.0 cigarettes per day (IQR = 4.0-12.0). Pain severity and interference were positively associated with cannabis use frequency, quantity, opioid use, and cigarette use (ρ = .13 - .28, ps < .05), and negatively associated with alcohol use (ρ = -.20 and -.20, ps < .05).

Conclusions: Greater pain severity and interference were associated with greater cannabis and cigarette use, but lower alcohol use. Longitudinal studies are needed to determine if pain is a motivator for cannabis/cigarette use and/or if persistent use exacerbates pain in this population. Research should also examine if negative associations between pain and alcohol use reflect alcohol analgesia (i.e., lower pain at greater drinking) or avoidance due to the exacerbation of co-occurring conditions with EDS/G-HSD.

Background: Pain is the leading reason patients seek orthopedic care, but many experience significant delays before seeing a provider. This single-site, parallel-group randomized controlled trial evaluated whether an audio-recorded, brief mindfulness-based intervention (BMBI) delivered in an orthopedic clinic waiting room could reduce pain among patients awaiting an x-ray.

Methods: Participants (n = 159) had a mean age of 52 years (SD = 16.3), were predominantly female (64%) and white (78%). Average pain intensity at baseline was 5.65 (SD = 2.18). Participants were randomized in a 1:1 ratio to receive either a 4-min audio-recorded BMBI or a 4-min injury management control recording. Pain unpleasantness and pain intensity were measured pre- and post-intervention using numeric rating scales.

Results: BMBI Participants reported significantly lower post-intervention pain unpleasantness (4.26 vs. 4.95, p = .021, d = .39) and pain intensity (4.23 vs. 5.21, p < .001, d = .59) compared to the control group. Although pain decreased in both groups, reductions were significantly greater in the BMBI group (p < .05). Notably, 52% of BMBI participants experienced a clinically meaningful pain reduction (i.e., ≥ 10%), compared to 33% in the control group (p = .041). Additionally, more BMBI participants expressed interest in further pain management resources (54% vs. 38%, p = .032).

Conclusions: An audio-recorded BMBI can produce statistically significant and clinically meaningful reductions in acute pain among orthopedic patients in the waiting room and may enhance their desire to seek additional pain management resources. As such, audio-delivered BMBIs represent a complementary pain management approach that can be delivered without clinician involvement. Findings highlight the need to further enhance patient engagement with MBIs in the waiting room and assess their effectiveness across a variety of healthcare environments.

Trial registration: This trial was prospectively registered. Registry: ClinicalTrials.gov, TRN: NCT06171009, Registration date: September 19th 2024.

Background: Endometriosis is a gynecological condition which often causes chronic or recurrent pelvic pain (CPP). The disease can thereby impose a significant burden on affected individuals and their romantic relationships. Existing research highlights the substantial influence of stress, social support, and hormonal factors on pain experience, but data from daily life is scarce.

Methods: This ecological momentary assessment (EMA) study aimed to explore the association of stress, partners' social support styles, cortisol, and oxytocin in daily life with pain experiences among women with CPP (N = 66) across 7 days, resulting in a dataset with up to 2100 data points per variable across multiple measures.

Results: Stress was positively correlated with pain ratings both within and between individuals, while no significant associations were observed between salivary cortisol or oxytocin levels and pain ratings. Distracting as well as solicitous social support was positively related to higher pain ratings on a between-person level but showed no or slightly negative associations with pain on a within-person level.

Conclusion: These findings suggest that both stress and social support can adversely impact pain experience in endometriosis. This knowledge is essential for developing comprehensive interventions: While stress management can be beneficial, the role of social support is more intricate, requiring tailored guidance for close others and their support behavior.

Background: While sleep disturbances are prevalent among individuals with psoriasis, the influence of overall sleep behaviors on psoriasis risk remains unclear. This study aims to investigate the association between overall sleep behaviors and the risk of psoriasis and its subtypes.

Method: This analysis included 405,258 participants. Five sleep behaviors were assessed via questionnaire and used to construct a sleep score (0-5) based on low-risk factors: sleep duration (7-8 h/day), early chronotype, never or rarely insomnia, no snoring, and infrequent daytime sleepiness, with higher scores indicating healthier sleep patterns. Cox proportional hazards models assessed the associations between sleep patterns, individual behaviors, and the risk of psoriasis and its subtypes. Dose-response relationships were further explored using restricted cubic spline models.

Results: During a median follow-up of 13.6 years, 2715 cases of psoriasis were identified, including 523 psoriatic arthritis (PsA) and 2192 non-PsA cases. Healthy sleep scores were associated with a dose-response reduction in the risks of psoriasis and its subtypes. Compared to participants scoring 0-1, those scoring 5 had hazard ratios (95% CL) of 0.69 (0.56-0.87) for incident psoriasis, 0.61 (0.38-0.98) for incident PsA, and 0.69 (0.54-0.88) for incident non-PsA. Participants without frequent daytime sleepiness had a 19% lower risk of psoriasis, while the other four low-risk behaviors were associated with an 8% reduction in risk. Additionally, the inverse association was stronger in individuals under 60 compared to older participants (P-interaction = 0.003).

Conclusion: Maintaining healthy sleep patterns is associated with a significantly lower risk of developing psoriasis, especially in younger individuals.

Background: People with HIV (PWH) are more likely to smoke, have comorbidities, and be less likely to quit than the general population. This study aimed to describe the prescription of smoking cessation medications and quit smoking attempts, and to assess the effect of prevalent and incident comorbidity diagnoses on these two outcomes.

Methods: We analyzed the 2007-2022 HIV Outpatient Study (HOPS) medical records and self-reported risk behavior survey data. We included adult PWH with evidence of current cigarette use at enrollment (baseline) or incident cigarette use. Comorbidities were identified based on laboratory results, clinical diagnoses, and treatments. We assessed associations of time-updated (baseline and incident) comorbidity diagnosis with prescription of smoking cessation medications and first attempt to quit using Cox proportional hazards analyses.

Results: Among 1068 eligible participants followed over a median time of 3.1 years (interquartile range 1.2-6.8 years), 304 (29%) were prescribed smoking cessation medications. Multivariable factors positively associated with prescribed smoking cessation medications included year of first HOPS visit (adjusted hazard ratio (aHR) 1.09), having diagnoses of depression (aHR 1.39), or chronic obstructive pulmonary disease/emphysema (aHR 1.89). Among 464 people who smoked at baseline and had at least one ACASI survey, during a median follow-up time of 2.3 years (interquartile range 0.8-5.2 years), 163 (35%) attempted to quit smoking. Multivariable factors positively associated with first attempt to quit included year of first HOPS visit (aHR 1.24), having a diagnosis of depression (aHR 1.30) or bipolar disorder (aHR 1.62), and being prescribed smoking cessation medications (range aHR 2.62-aHR 5.97, depending on the medication), whereas having a diagnosis of psychosis (aHR 0.29), hypertension (aHR 0.41), or obesity (aHR 0.49) was inversely associated.

Conclusion: In the HOPS, about one-third of smokers were prescribed smoking cessation medications, and of those who completed the risk behavior survey, one-third attempted to quit. Among incident comorbidities examined, time-updated depression was both positively associated with being prescribed smoking cessation medications and attempting to quit smoking. Our results highlight the need for better integration of smoking cessation and prevention programs into PWH care.

Background: The integrated screening action model (I-SAM) posits sources of automatic motivation (e.g., affect-based feeling states like worry, distress) are important predictors of cancer screening engagement. Yet no prior studies demonstrate how these feeling states change across survivorship and relate to screening behavior. This study tested the feasibility and acceptability of collecting longitudinal data on affect-based feeling states among rural breast cancer survivors using a smartphone-based ecological momentary assessment (EMA) platform.

Methods: The study recruited survivors of stage 0-3 breast cancer who recently completed breast cancer treatment at a large, rural academic cancer center. Participants received each of three, 30-day EMA assessment schedules of varied intensity in a randomly assigned order via smartphone app. Participants received 12-18 notification-contingent EMAs each month and were asked to complete an event-contingent EMA each day they attended a medical appointment. Feasibility measures included study recruitment, enrollment, and retention rates. We assessed EMA completion rates and acceptability scores for each schedule and concordance of event-contingent EMAs with verified medical encounters.

Results: Mean age of the 65 enrolled participants was 59 years (range: 36-77). Participants were majority white, non-Hispanic, and 65% lived in a rural area. Fifty-two participants were retained at 3-months. Mean EMA completion rates were 73.7%, 71.7%, 71.7% for the low, medium, and high intensity EMA schedules, respectively. Event-contingent EMA concordance was 53.2%. All schedules achieved a priori benchmarks for acceptability.

Conclusions: It was feasible to recruit and retain rural breast cancer survivors for this research and acceptability ratings were strong for the three EMA sampling intensities evaluated.