International Journal of Behavioral Medicine最新文献

Purpose: Depression is the second most prevalent mental disease among adolescents, yet only a small percentage seek or receive treatment for the disease. Physical activity (PA) interventions hold promise as an alternative or adjunct to clinical treatment for depression. However, previous studies have been inconsistent regarding the relationship between PA and depressive symptoms in children and adolescents. The purpose of this study was to assess the effect of PA intervention on depressive symptoms in children and adolescents through a meta-analysis.

Methods: Literature from 10 electronic databases and 4 registries was systematically searched. Combined estimates (standardized mean difference, SMD) and 95% CIs were calculated using a random-effects model to assess the effect of PA on depressive symptoms in adolescents. Relevant subgroup analyses and sensitivity analyses were also performed.

Results: Results showed that PA improved depressive symptoms in children and adolescents (SMD = -0.707, 95% CI: -0.901 to -0.514). Subgroup analyses showed that PA improved adolescent depressive symptoms in different regions, different types of PA, moderate- to vigorous-intensity PA, different single-session time PA, different frequency PA, and different duration PA.

Conclusions: PA interventions could be used to reduce depressive symptoms in children and adolescents. A mixed program and vigorous-intensity PA intervention was the most effective in improving depressive symptoms in children and adolescents. The selection of a 4 to 8-week, no less than 4 times per week, single-session PA program of no more than 30 min may yield desirable results.

Background: Tobacco use among adolescents remains an important public health issue. This study investigated the association between parental migration and adolescents' tobacco use among adolescents in western China, including its mediating and moderating mechanism.

Method: This study was conducted in Qinghai Province, China, from April 1 to May 31, 2023. The participants were recruited via stratified random sampling. A total of 2811 adolescents were involved. Univariate logistic regressions were conducted to examine the associated factors of adolescents' tobacco use, including cigarette and electronic cigarette (e-cigarette) use. Pathway analysis was used to examine the moderation effect of tobacco sales exposure and mediation effect of loneliness in the relationship between parental migration and tobacco use.

Results: The study found that the proportion of adolescents who had ever used cigarette and e-cigarette in the sample were 19.5% and 12.2%, respectively. Among adolescents who were exposed to tobacco sales, parental migration was directly associated with cigarette use (standardized b = 0.18, 95%CI 0.04, 0.32) and e-cigarette use (standardized b = 0.24, 95%CI 0.09, 0.38). Meanwhile, loneliness served as a mediator in the association between parental migration and both the use of cigarette (standardized b = 0.014, 95%CI 0.01, 0.02) and e-cigarette (standardized b = 0.02, 95%CI 0.01, 0.03) among adolescents who were not exposed to tobacco sales.

Conclusion: The tobacco control strategies and surveillance should be strengthened in school neighborhood. Health education and interventions are warranted for adolescents, especially those with parental migration in underdeveloped areas in China.

Background: Clinical decision-making in oncology is influenced not only by clinical guidelines but also by psychological, emotional, and social factors, especially in end-of-life care. One such influence is Concorde syndrome, known as the sunk cost fallacy, where past investments lead physicians to continue treatment even when it is no longer medically justified. Although discussed in behavioral science, this phenomenon has not been systematically measured in oncology practice. Therefore, this study aimed to develop and validate a psychometric instrument to assess the psychosocial factors contributing to potentially irrational continuation of treatment among medical oncologists managing patients with no remaining therapeutic options.

Method: This cross-sectional psychometric study comprised both scale development and validation phases. Item generation was informed by literature review and expert consultation, followed by a two-round Delphi panel for content validation and pilot testing. The final 20-item CONCORD Scale underwent exploratory and confirmatory factor analyses, as well as assessments of internal consistency, test-retest reliability, and construct validity.

Results: Exploratory factor analysis (EFA) was conducted with a sample of 116 medical oncologists, and confirmatory factor analysis with 337 participants in Turkey. EFA revealed a four-factor structure: (1) Emotionally Driven Decision-Making, (2) Impact of Prior Clinical Experience, (3) Professional Pressure and Anxiety, and (4) Patient-Centered Decision Conflict. These factors accounted for 74.2% of the total variance, with item loadings ranging from 0.594 to 0.754. Confirmatory factor analysis confirmed good model fit (CFI = 0.937, RMSEA = 0.052, GFI = 0.834). Cronbach's alpha coefficients ranged from 0.834 to 0.948 across subscales and reached 0.969 for the overall scale. Significant inter-subscale and total score correlations further supported structural validity.

Conclusion: The CONCORD (Continuation Over Necessity: Cognitive and Overriding Reasons in Decision-making) Scale is the first validated instrument to quantify emotional, experiential, professional, and interpersonal factors that may lead oncologists to continue treatment beyond clinical necessity in end-of-life care. It offers a novel tool for both research and educational use in ethically sensitive clinical contexts.

Background: Diagnostic shifts commonly occur in young adulthood and are often associated with medication changes. Such changes can have a profound influence on how an individual experiences and perceives mental health services. Prior research on how young adults experience and make meaning of diagnostic shifts and medication changes is limited. This exploratory study seeks to describe how young adults with serious mental health conditions (SMHC) in the United States experience diagnostic adjustments of their SMHC and associated medication changes.

Method: Qualitative interviews were conducted among young adults (ages 25-30) with SMHCs in community-based settings in the Northeast region of the United States. Participatory research methods and qualitative descriptive analysis techniques were used to explore themes around SMHC diagnoses, symptoms, and treatment.

Results: Most young adults identified as women, non-Hispanic, White, self-identified as having major depression or anxiety disorders, and had received multiple diagnoses from providers. Many young adults described being given alternate or "corrected" diagnoses to replace original diagnoses. Pharmacological treatment was common, and many reported periods of "medication trial and error." Shifting diagnoses and changing medications were associated with confusion, ambivalence, and doubt. Medication changes were disruptive to young adults' ability to function in their daily lives.

Conclusion: Diagnostic and medication changes can create "secondary doubt and disruptions" in the perceptions and lives of young adults. More research is needed to understand how secondary doubts and disruptions influence young adults' long-term mental health trajectories. Findings indicate the importance of clear communication and shared decision-making between provider and patient.

Background: Front-of-Pack Nutrition Labeling (FOPNL) is a promising public health measure to promote healthier food choices in the population. The present study tested the impact of the Nutri-Score and warning labels on purchasing intentions and product perceptions in Indonesia and Türkiye, where no FOPNL system is currently in place, and Mexico, where warning labels are mandatory since October 2020.

Method: Adult participants (N = 639; n_Indonesia = 212, n_Mexico = 203, n_Türkiye = 224) were randomly assigned to viewing eight product pairs (chips, instant noodles, meats, condiments, sweet spreads, cookies, yoghurt, fruit drinks) with either no label, a Nutri-Score, or warning labels, and indicated which product (or neither) they would rather buy, and which product was healthier, contained more calories, sugar, saturated fat, and sodium.

Results: Nutri-Score influenced purchasing intentions for four categories; warning labels only for one. Overall, Nutri-Score was somewhat more effective in guiding consumers to identify healthier choices and products higher in nutrients that should be consumed in moderation compared to the warning labels, although effects varied substantially between product categories and nutrients.

Conclusion: Both Nutri-Score and warning labels potentially promote healthier food choices, with Nutri-Score producing somewhat larger and more consistent effects. More research is needed on potential negative consequences of labels and the conditions under which they might appear to maximize public health benefit.

Background: Episodic migraine carries a significant social burden beyond medical symptoms that disrupt interpersonal relationships with family, friends, and coworkers. This study aimed to explore its influence on interpersonal relationships from the perspective of patients.

Method: A sample of N = 20 participants, including 10 males and 10 females, with an age range of 27 to 32 years, was engaged in semi-structured interviews. A reflexive thematic approach within a post-positivist framework was used to explore themes derived from qualitative data.

Results: The analysis revealed a predominance of adverse impacts across the data, including work and productivity challenges (sub-themes: social and activity restrictions, impaired functioning at work, workplace stigma, and pressure) and interpersonal conflict and strain (sub-themes: reactions from friends and family, family life, and communication barriers). However, the results indicated positive impacts under the theme of growth (sub-themes: strengthened relationships and growth and adaptation). Network visualization was employed to represent these themes, with numeric codes (0 and 1) used to indicate the absence or presence of specific sub-themes in individual responses. The size of each node in the network was based on its dominance and significance in the analysis.

Conclusion: This study highlighted that episodic migraine significantly disrupts interpersonal relationships. However, it can also strengthen interpersonal bonds and foster growth in some individuals. Future research should examine how interpersonal relationships function both as a source of strain and a potential source of strength. Understanding the factors contributing to growth and adaptation may offer valuable insights for individualized migraine management strategies.

Background: Since the 1990s, Chinese residents have experienced rapid dietary shifts, with potential disparities emerging between rural and urban populations. This study examined dietary patterns and changes across these areas, particularly among older adults.

Methods: Data from four waves (2008-2018) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were used, covering 20,945 older adults aged 65 and above. Latent class analysis identified dietary patterns based on five core food items (fresh vegetable, fruit, meat, egg, dairy products). Multinomial logistic regression assessed correlates of class membership for rural and urban participants.

Results: The study sample included 11,357 rural and 9,588 urban residents. Dietary trends showed greater fluctuations among urban residents than rural residents. Four distinct dietary classes were identified: vegetable-dominant (27.39% rural vs. 37.66% urban), low-frequency (63.42% rural vs. 24.10% urban), balanced (5.10% rural vs. 15.84% urban), and egg-dominant (4.09% rural vs. 22.39% urban). Among rural participants, the odds of following a balanced or egg-dominant diet were significantly higher compared to the low-frequency group (reference group; odds ratio [OR] > 1). Among urban participants, those with formal education, regular exercise, or better self-rated health were more likely to follow vegetable-dominant, balanced, or egg-dominant diets compared to the low-frequency group (OR > 1).

Conclusions: Targeted interventions addressing dietary disparities and promoting balanced diets may reduce nutritional inequality and improve health outcomes, particularly for rural residents.

Background: Globally, human papillomavirus (HPV) vaccine uptake rates have declined within a wider context of vaccine hesitancy. Gender-neutral vaccine programmes are increasing and recommended for the prevention of cervical, anogenital, and oropharyngeal cancers affecting both women and men. To address the problem of suboptimal HPV uptake rates for boys and men, we aimed to understand young men's communication needs for HPV messages in a cross-cultural analysis.

Methods: Qualitative methods consisting of 14 focus group discussions were conducted with young men (18-26 years) about the HPV vaccine in three countries with varying HPV vaccine implementation policies at the time. A total of 55 participants were included from Scotland (n=14), Spain (n=25), single-gendered programmes, and the USA (n=16), gender-neutral programme. Analysis was informed by reflexive thematic analysis.

Findings: Four themes were identified: (1) the 'Girl vaccine': primarily seen as a vaccine for girls, despite varying vaccine knowledge and awareness across contexts; (2) vaccine ambivalence: perceptions of men's HPV risks were low and some vaccine worries were evident from US contexts; (3) altruism: a pervasive theme related to young men's roles and responsibilities for HPV transmission within relationships; (4) trusted sources: messages from health care providers/authorities were persistently valued but direct opportunities were often absent.

Conclusion: Public health messaging to increase HPV vaccination for young men should focus on direct appeal to young men's health through specific and targeted HPV messages for cancer and sexual health benefits to increase the personal relevance of the vaccine. It should also focus on indirect appeal through incorporating messages about safe sex in relationships and for herd immunity. Healthcare providers and authorities are trusted sources of information and can influence men's confidence for the HPV vaccine; opportunities for interactions should be optimised.

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.