Behavioral Medicine最新文献

The purpose of the present study was to examine whether individuals with varying reported and/or suspected insomnia and sleep apnea presentations differed with respect to pain.Data included 3,161 adults who participated in an online study investigating sleep and health. Participants reported a lifetime history of prior sleep disorder diagnoses while the presence of suspected sleep disorders was determined using the Insomnia Severity Index and the STOP-Bang. Average pain intensity was assessed using a visual analogue scale and pain interference was determined using two items from the PHQ-15. Participants who reported diagnoses of insomnia and/or sleep apnea reported greater pain intensity and interference compared to those with no sleep disorder; however, no differences in pain were observed between the various reported sleep disorders. Of participants who did not report either insomnia or sleep apnea diagnoses, 24% were suspected of having either insomnia, sleep apnea, or both disorders based on responses to questionnaires. Participants with one or more suspected sleep disorders reported higher pain intensity and interference than those without a suspected disorder. Additionally, having either suspected insomnia or suspected comorbid insomnia and sleep apnea was associated with greater pain intensity compared to only having suspected sleep apnea. Sleep disorders go commonly undiagnosed and are associated with adverse pain experiences. While results do not support a synergistic effect of suspected insomnia and sleep apnea on pain, findings indicate that screening for sleep disorders is warranted and may have important implications for pain treatment.

Skin cancer is highly burdensome, but preventable with regular engagement in sun protective behaviors. Despite modest effectiveness of sun-protective behavior promotional efforts thus far, rates of engagement in sun-protective behaviors remain low. More is needed to understand motivation for using sunscreen, wearing sun-protective clothing, and seeking shade. This study tested whether the links of intention and habit strength with behavior differed between sun-protective behaviors. It was hypothesized that sun protective behaviors would be predicted by both habit and intention and that intention-behavior associations would be weaker for people with stronger habits. Participants residing in Queensland, Australia (N = 203; 75.96% female; M age = 37.16 years, SD = 14.67) self-reported their intentions and habit strength about sun-protective behavior for the next 7 days. Participants were followed-up 7 days later to self-report their sun-protective behavior. Multilevel modeling, accounting for nesting of multiple behaviors within-person, revealed that habit moderated the intention strength - behavior association and this moderation effect did not differ as a function of which behavior was being predicted. People with strong or moderate habit strength tended to act in line with their intentions; however, for people with very weak habits (2 SD < M), there was less alignment between their intention and behavior. These findings suggest that habit plays a facilitative role in the implementation of strong sun protective behavior intentions. Interventions should consider how to encourage intention and habit to enhance sun-protective behaviors and reduce the burden of skin cancer from sun exposure.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.1903380 .

Nationally, opioid overdose remains strikingly persistent among people experiencing homelessness and housing instability. Limited information is available about the characteristics of this phenomenon in economically disadvantaged communities of color. This study sought to evaluate the association between key contextual factors and experiencing a non-fatal opioid overdose among people who use heroin in Washington Heights, New York City. We conducted a cross-sectional survey (N = 101) among participants seeking harm reduction services who reported heroin use in the last three months. Binary logistic regression models examined the association between key social and structural factors and the likelihood of ever experiencing a non-fatal opioid overdose and recently experiencing a non-fatal opioid overdose. The majority of the sample reported housing instability and lived in poverty; almost 42% were homeless. After adjustment, participants who injected heroin were more likely to have ever experienced a non-fatal opioid overdose. Also, younger participants who reported hunger in the last six months were more likely to have experienced a non-fatal opioid overdose in the last three months. Findings suggest the role of structural vulnerability in shaping overdose risk among the participants. Overdose prevention strategies should consider factors of the social and economic environment to mitigate barriers to accessing health and social services within the context of the current opioid crisis.

Chronic low back pain is the second leading cause of disability in the United States, and it is often associated with severe fatigue. However, little is known about individual differences that may be related to poorer mental health and pain among individuals with severe fatigue and chronic low back pain. The aim of the current investigation was to explore the role of fatigue severity and fatigue sensitivity in terms of anxiety and depressive symptoms, pain catastrophizing, pain interference, and pain severity among 783 adults with severe fatigue and chronic low back pain. Results suggest that fatigue severity and fatigue sensitivity were statistically significant predictors for anxiety, depression, pain interference, and pain catastrophizing. However, only fatigue sensitivity significantly predicted pain severity. Overall, the current study provides initial support for the role of fatigue severity and fatigue sensitivity in the presence of mental and physical health complaints among individuals with severe fatigue and chronic low back pain.

Opt-out strategies have been shown to improve participation in cancer screening; however, there are ethical concerns regarding the presumed consent. In this study, we tested an alternative opt-in strategy, called: "enhanced active choice," in which the response options summarize the consequences of the decision. The study was conducted as part of the Maltese colorectal cancer screening program, which offers men and women, aged 60-64, a "one-off" fecal immunochemical test (FIT). A total of 8349 individuals were randomly assigned to receive either an invitation letter that featured a standard opt-in strategy (control condition), or an alternative letter with a modified opt-in strategy (enhanced active choice condition). Our primary outcome was participation three months after the invitation was delivered. Additionally, we also compared the proportion who said they wanted to take part in screening. We used multivariable logistic regression for the analysis. Overall, 48.4% (N = 4042) accepted the invitation and 42.4% (N = 3542) did the screening test. While there were no statistically significant differences between the two conditions in terms of acceptance and participation, enhanced active choice did increase acceptance among men by 4.6 percentage points, which translated to a significant increase in participation of 3.4 percentage points. We conclude that enhanced active choice can improve male screening participation. Given the higher risk of CRC in men, as well as their lower participation screening, we believe this to be an important finding.

Coaction refers to positive change in one behavior increasing the probability of positive change in a second behavior. Because mechanisms of coaction have not been well studied, and its improved comprehension might optimize architectures of multi-component behavioral obesity interventions, this research aimed to incorporate theory to assess whether treatment-associated changes in self-regulation and self-efficacy sequentially mediate an association between increased exercise and improved eating. Women with obesity (Mean age = 47.9 years) were randomized into community-based obesity treatments with either a self-regulatory skills emphasis (n = 47), or a more equal focus on education and self-management (n = 52). Each treatment aimed to foster weight loss and reductions in health risks. Over 6 months, there were significant improvements in exercise outputs, fruit/vegetable consumption, sweets intake, exercise- and eating-related self-regulation, and exercise- and eating-related self-efficacy that were significantly greater in the high self-regulation group. Using aggregated data, bivariate relationships between changes in exercise, and fruit/vegetable and sweets intake, were significant. Serial mediation analyses indicated that increased exercise outputs were associated with improved eating through the sequential relationships of eating-related self-regulation and self-efficacy, while improved eating was associated with increased exercise more directly through exercise-related self-regulation. Moderation analyses demonstrated stronger associations in the high self-regulation group for relationships between changes in exercise and eating-related self-regulation and self-efficacy only. Results initiated analyses into mechanisms of coaction among exercise and eating behaviors, and reinforced the value of self-regulatory skills enhancement directly and through its effects on domain-specific self-efficacy in behavioral obesity treatments.

This study explores the types and extent of potentially traumatic events that youth who have experienced commercial sexual exploitation and trafficking (CSE/T) report, and how these experiences influence mental health. CSE/T youth (N = 110, 11-19 years old) referred to Trauma-Focused Cognitive Behavioral therapists affiliated with Project Intersect provided self-report data between August 2013 and March 2020 at the start (baseline), mid-point, and completion of therapeutic services. This study focuses on the baseline data collected. Bivariate relationships were analyzed, and where bivariate associations were statistically significant, associations were assessed in adjusted regression models. Two logistic regressions were performed: one for the adjusted associations between types of potentially traumatic events reported by CSE/T youth and the outcome PTSD, and a second for the outcome emotional distress. Results indicated that polytrauma was significantly associated with PTSD diagnosis among CSE/T youth. Direct violence victimization and polytrauma were significantly associated with CSE/T youth emotional distress. Results inform behavioral medicine practitioner considerations for how to appropriately assess the potentially traumatic experiences of CSE/T youth, and how these experiences may differentially impact the mental health presentations of youth in clinical treatment. Effective treatment may include precision-based customization of evidence-based practices to ensure that the diverse traumatic experiences and related symptomatology of CSE/T youth are effectively addressed.

Although sleep problems are common among patients with coronary heart disease (CHD), there is a lack of prospective research examining its influence on health consequences over time. This study investigated whether poor sleep quality predicted patients' decline in physical health functioning over 6 months and whether social support buffered its detrimental effect. Participants were 185 patients with CHD, who completed measures of sleep, psychosocial characteristics, and physical health functioning at baseline and 6 months. Hierarchical regression analyses were conducted to examine whether global sleep index and its subscales, including sleep efficiency, perceived sleep quality, and daily disturbances (sleep disturbances and daytime dysfunction), predicted the decline of physical health functioning at 6 months. Social support was examined for its moderating effect in buffering the negative influence of poor sleep quality on physical health functioning over 6 months. Findings showed that poorer global sleep index, especially subscales of daily disturbances and lower sleep efficiency, significantly predicted greater decline of physical health functioning at 6 months, even after adjusting for covariates, including baseline functioning and depression. Moreover, social support was found to buffer the detrimental impact of poor sleep quality, especially low sleep efficiency, on 6-month physical health functioning. Findings suggest that improving sleep quality for patients with CHD may be promising to facilitate their long-term health maintenance.

The outbreak of COVID-19 has resulted in increasing needs for mental health treatments and yet simultaneously posed great challenges to the delivery of in-person psychological services. The standard clinical practice suddenly shifted to the use of telepsychology. This study aimed to identify how therapists have been responding to the public health crisis and the rapid transition to telepsychology. We distributed a survey to 502 mental health providers to investigate the challenges and concerns of the delivery of clinical work during the pandemic. Our study found that most therapists (75.9%) transitioned to telepsychology without suspension of services. Therapists reported varied concerns regarding telepsychology, clinical practice, and their personal lives. The most common concerns identified were the use of therapeutic techniques in telepsychology, provision of remote services, and the practitioner's own health. Our findings also indicated that therapists who are students, female, sexual minorities, unpartnered, and working in public settings experienced relatively greater concerns. It may imperative to allocate more resources to those subgroups of therapists to facilitate their clinical work in telepsychology. This study contributed to our understanding of how the pandemic has impacted clinical work and may inform practitioners in coping with the current and any future public crises.

Two rounds of Global Adult Tobacco Survey (GATS) were conducted in 2009-10 and 2016-17 in India. These two surveys provide national comparable data on tobacco usage and its related aspects in India. This study used the data from GATS 2016-17 to examine the salience and impact of cigarette pack pictorial health warnings (PHWs) on quit intention among current cigarette smokers in India. The nationally representative survey interviewed 74, 037 respondents aged ≥15 years with an overall response rate of 92.9% using a multi-stage sampling method. Results of multivariate analysis showed that the strongest predictor for quit intention because of health warnings was "ever made a quit attempt in the past 12 months" and buying cigarette packs instead of loose cigarettes. Compared to GATS 2009-10, GATS 2016-17 observed an increase in salience of cigarette health warnings by 16% and increase in the impact of PHWs on quit intention by 50%. PHWs have a significant impact on intention to quit among cigarette smokers in India with a rising trend. The efforts of Government of India in terms of periodic introduction of new PHWs and increase in the size of warning labels to 85% of the cigarette packs is laudable. The study results support ban on loose cigarettes and warrants stricter implementation of the act prohibiting sale of loose cigarettes.