Behavioral Medicine最新文献

Young adults attending vocational education and training schools often engage in various health risk factors, including poor dietary habits. School canteens are key settings that can promote students' healthy food choices. This study aims to enhance the skills of vocational school canteen staff in preparing healthy food, student-centered communication, and meal presentation. A mixed-methods approach incorporated participatory action research and grounded theory (GT) analysis. The participants included 17 staff members, aged 21 to 60 years, working at three canteens that serve 557 students. Over eight months, four workshops were conducted, with staff engaging in exploratory actions between sessions to enhance student interaction and create healthy meals accommodating student preferences. Data collected from observations, field notes, and interviews were analyzed using GT, while survey data on student meal preferences were described statistically. A one-week choice architecture intervention was implemented in one canteen, and receipt data were collected to assess the impact of the new meal presentations and assessed using binomial logistic regression. The GT analysis identified the core category: "A dialogical hospitality approach facilitates reassurance." The workshops enhanced the staff's skills in healthy food preparation, incorporating student preferences and boosting their confidence in employing a hospitality-based dialogical approach, reassuring students to make healthy food choices. The choice architecture intervention led to a significant increase in the sales of healthy meals. This study highlights the importance of involving staff in targeted training through participatory methods to promote students' healthier food options in vocational school settings.

Obesity is a major global health issue, increasing morbidity and mortality through its association with noncommunicable diseases. Black African women experience disproportionately high obesity rates, reaching 37% in the UK, reflecting complex genetic, sociocultural, and environmental factors, with migration influencing dietary changes. This study explored factors shaping the dietary choices of Black African immigrant women with overweight and obesity in the UK, focusing on individual, sociocultural, and environmental influences. A qualitative design was employed, using semi-structured online interviews with 15 participants, analyzed thematically through reflexive thematic analysis. Participants were African immigrant women from sub-Saharan Africa, ages ≥18 years, first- or second-generation immigrants, with a BMI >25 kg/m². Recruitment and interviews occurred between March and May 2024. Findings revealed tensions between sociocultural food preferences and children's Westernized tastes. Cultural identity, food-related shame, and ambivalence about traditional diets in public or work settings shaped practices. Work demands and limited time constrained preparation of traditional meals, while economic pressures and high costs of culturally appropriate foods restricted choices. Psychological stress and reliance on convenience foods emerged as coping strategies, often undermining health intentions. These findings highlight the need for culturally tailored, community-based interventions addressing barriers of cost, access, and time as well as potential strategies to support dietary autonomy and cultural retention. Future research should adopt longitudinal approaches to examine how these dynamics evolve, informing sustainable interventions.

Emerging adulthood is a critical developmental period characterized by physiological and psychosocial vulnerabilities that may increase susceptibility to gastrointestinal (GI) symptoms and disorders. Stress during this time can disrupt gut-brain communication, exacerbating GI distress and associated health risks. Gender and race/ethnicity are also associated with GI symptom presentation and pain perception, yet these factors remain understudied. This study examines GI symptoms (Gastrointestinal Symptom Rating Scale), GI-specific anxiety (Visceral Sensitivity Index), and adverse childhood experiences (ACEs) in a diverse, non-medical college sample, exploring discernable differences among gender and racial/ethnic identities for key variables. The study included 1364 participants who were on average approximately 20 years old, recruited from five four-year colleges within a large public university system in New York City, completed an online survey. Multiple correspondence analysis (MCA), a multivariate technique, was used to identify patterns across categorical variables. MCA results showed that all GI symptoms were associated with GI-specific anxiety but were mostly unrelated to ACEs. Males and transgender females had significantly less GI symptoms and GI-specific anxiety compared to females and gender non-conforming participants. Participants who identified as White had significantly more GI symptoms and GI-specific anxiety compared to those who identified as Black. This work underscores the need for better recognition and intervention given the substantial burden of GI discomfort experienced by a sizable portion of this emerging adult sample, the strong link between GI-specific anxiety and symptoms, and differences in burden by gender and race/ethnicity.

Gulf War Illness (GWI) is a highly prevalent chronic, multisymptomatic condition associated with worsening physical health and quality of life among veterans. Specifically, GWI symptoms may disrupt physical functioning that negatively impacts overall health. Complementary and integrative health interventions that promote physical activity, such as Tai Chi, may be critical to addressing physical functioning in veterans with GWI. The present study is a secondary analysis of data from a randomized controlled trial comparing Tai Chi to a Wellness intervention on physical functioning outcomes in a sample of 53 veterans with GWI and pain. Gait speed, fast walking speed, lower body strength, and self-reported physical activity were assessed across four timepoints: baseline, posttreatment, 3-month follow-up, and 9-month follow-up. Treatments were delivered in a 60-minute group format twice a week for 12 weeks (24 sessions total). Results from multilevel regression models revealed that Tai Chi was related to greater increases in time spent on flexibility exercise whereas improvements in gait speed were associated with Wellness, though between-treatment differences were small. These findings are promising because they provide preliminary evidence for the utility of two treatments that may improve specific physical functioning outcomes in veterans with GWI, especially in accommodating physical difficulties associated with the condition that few treatments have addressed.

Eating and exercise habits established in adolescence are associated with immediate and long-term health outcomes. These habits may be influenced by adolescents' socioeconomic status (SES), such that low SES households often experience inequitable access to nutritious foods and opportunities for exercise. Emerging evidence suggests that social factors, such as social skills and social support may support adolescents' health behavior engagement. Thus, this study tested if social factors might be a viable target for interventions to reduce SES disparities in health behavior among adolescents. Using data from the Future of Families and Child Wellbeing Study, we examined (1) if household SES is associated with adolescents' self-reported frequency of healthy eating and exercise, and (2) if social factors (e.g., social skills, connectedness, social support) mitigate the negative association between SES and each health behavior. Regression analyses revealed that adolescents in lower SES households reported fewer days of healthy eating and exercise. Social skills and support were positively associated with exercise for all adolescents, but did not reduce the SES disparity. Social skills and support were only associated with healthy eating for adolescents with higher SES, but connectedness was associated with healthy eating for all adolescents. Even so, connectedness did not reduce the SES difference in healthy eating. These findings suggest that high quality social relationships and social skills may have a significant but small positive effect on health behavior for adolescents in low SES households, and that systemic change is needed to achieve health equity and improve health outcomes for all adolescents.

Individuals with cerebral palsy (CP) often exhibit mental health problems, including depressive symptoms. This study investigated self-reported depressive symptoms in children and adolescents with and without CP and associated factors. Herein, 52 and 38 children and adolescents with and without CP were enrolled in the CP and typically developing (TD) groups. Depressive symptoms were assessed using the Birleson Depression Self-Rating Scale for Children. Parents of the participants completed the Strengths and Difficulties Questionnaire. Self-reported depressive symptoms were more severe in the CP group than in the TD group, which was primarily attributed to declining activities and enjoyment in daily life. Depressive symptoms in the CP group were not correlated with age, the severity of CP, or parent-reported behavioral features. However, in the overall cohort, the cluster with high levels of depressive symptoms had significantly higher proportions of individuals with CP and participants with conduct, emotional, and peer problems. Multivariate analyses revealed that only peer problems were associated with increased depressive symptoms. Furthermore, peer problems fully mediated the relationship between the presence of CP and depressive symptoms. Our study suggests that providing opportunities for activities involving social interactions with peers and offering support to enable the enjoyment of such activities from an early age are imperative to prevent an increase in depressive symptoms in children with CP.

Childhood obesity has been associated with high levels of systemic inflammation, increasing the risk of metabolic and cardiovascular diseases throughout life. Genetic and environmental factors, such as parental body mass index (BMI), can influence this relationship, impacting the inflammatory health of offspring from childhood. This study investigates the influence of parental BMI on the relationship between BMI and high-sensitivity C-reactive protein (hs-CRP) levels in offspring. A cross-sectional study was conducted with 423 children and adolescents from a municipality in southern Brazil. Offspring BMI was calculated using measured weight and height, while parental BMI was determined from self-reported measurements and classified based on World Health Organization cutoff points. hs-CRP levels were assessed using a high-sensitivity assay. The moderating effect of parental BMI on the relationship between offspring BMI and hs-CRP levels was analyzed through multiple linear regression models using the PROCESS macro extension for SPSS. Results indicated a direct association between offspring BMI and hs-CRP levels across all models, showing that hs-CRP levels increased linearly with BMI in offspring. A direct relationship between paternal obesity and offspring hs-CRP levels was observed, along with a significant inverse interaction between paternal BMI and offspring BMI with hs-CRP levels. Among schoolchildren with lower BMI, those with parents with obesity exhibited higher hs-CRP levels compared to peers with parents classified as eutrophic or overweight. These findings suggest that children of parents with obesity tend to have elevated levels of inflammation, regardless of their own BMI.

Adverse childhood experiences (ACEs) significantly contribute to health disparities among minoritized populations. However, the characterization and impact of ACEs and the resilience of men who have sex with men (MSM) living with HIV remains under-examined. This study aimed to examine how the clustering profiles of ACEs and social support networks may affect psychosocial outcomes to elucidate ACEs resilience in relation to social support network among MSM living with HIV. Data (2019-2023) were obtained from a prospective cohort of MSM living with HIV from Hawaii and Philadelphia, USA (N = 261). Latent profile analysis and propensity score-weighted generalized estimating equations were used to estimate group-level differences in psychosocial trajectories over the one-year study period. An ACEs-resilient profile with intensified, poly-types of ACEs and a robust social support network was significantly associated with higher perceived social support from family, resilient coping, lower depressive symptoms, and perceived stress, compared to those with similarly heightened ACEs exposure and a less optimal social support network. Bolstering social support networks could potentially improve the holistic range of ACEs-psychosocial outcome resilience among MSM living with HIV with heightened histories of ACEs. Future studies should examine the more nuanced socio-ecological and intrapersonal pathways of ACEs resilience.

Nonadherence to antihypertensive medications is highly prevalent, driving cardiovascular risk. Chemical adherence testing (CAT) can detect the presence of medications or their metabolites in bodily fluid, though it is unclear if its use to date has been equitable. This review aimed to identify the demographics with hypertension in which CAT has been used previously, and to estimate the resulting prevalence of nonadherence. Multiple databases were searched from 2013 to February 2024. We included any published paper that reported CAT data in people with hypertension. Extracted data included: study design and setting, hypertension definition and type, participant sociodemographic factors, and prevalence of nonadherence. Data were synthesized using a random effects meta-analysis with meta-regression, or narrative synthesis. Seventy eligible papers were identified. Many papers did not present key participant sociodemographic data, including ethnicity or socioeconomic, educational or disability status. Most studies were completed in tertiary care settings, and in primarily White patients with apparent treatment-resistant hypertension. The estimated pooled prevalence of complete medication nonadherence was 15.0%, increasing to 33.0% when estimating any kind of nonadherence; heterogeneity was high in both analyses (I² of 94.6% and 95.6%, respectively). Nonadherent patients had higher blood pressure and were prescribed more antihypertensive medications, whilst participant age showed an inverse relationship with prevalence of nonadherence. Key relevant sociodemographic factors were often not reported, limiting the understanding of CAT use in diverse populations. In order to support behavior change interventions to address medication nonadherence in underserved groups, future research should recruit diverse populations to inform equitable implementation.

Review protocol registration: International Prospective Register of Systematic Reviews CRD42024505602.

Perceiving ambiguity-a specific type of uncertainty-can lead to ambiguity aversion. In the context of vaccination, ambiguity aversion can manifest as vaccine hesitancy. We tested various correlates of ambiguity aversion in the context of COVID-19 vaccination to better understand how and why ambiguity about COVID-19 vaccines is associated with COVID-19 vaccine hesitancy. Two studies regarding beliefs about COVID-19 were conducted among 330 college students in the US and 204 college students in Israel during March to June 2023. Participants completed a survey assessing perceived ambiguity about COVID-19 vaccines, COVID-19 risk perceptions (i.e., likelihood, severity, and worry), emotions about COVID-19 vaccines, vaccination intentions, and information seeking about vaccination. Overall, key findings include higher levels of anger among individuals who report higher perceived ambiguity about COVID-19 vaccination, as well as possible engagement in motivated reasoning processes when considering COVID-19 vaccination. More specifically, consistent with motivated reasoning, Americans who perceived higher ambiguity about COVID-19 vaccines reported lower worry about and lower perceived severity of COVID-19, which were each associated with lower vaccination intentions and lower information seeking about COVID-19 vaccines. In line with the Appraisal-Tendency Framework, Americans who perceived higher ambiguity about COVID-19 vaccines reported higher anger about COVID-19 vaccines, which was associated with lower perceived severity of COVID-19. Consistent with conceptualizing ambiguity as an aversive experience, Americans who perceived higher ambiguity about COVID-19 vaccines reported lower happiness about COVID-19 vaccines, which was associated with both lower worry about and lower perceived severity of COVID-19. These relationships were not present in the Israeli sample. Further, both Americans and Israelis who perceived higher ambiguity about COVID-19 vaccines reported lower feelings of relaxation from the COVID-19 vaccine, which was associated with lower perceived severity of COVID-19. These results can improve our understanding of processes involved in ambiguity aversion. Findings also provide greater insight into vaccine hesitancy and have practical implications for creating culturally appropriate vaccine health communications and interventions that consider the phenomenon of ambiguity aversion. Indeed, if motivated reasoning does play a role in responses to ambiguity, incorporating strategies to reduce motivated reasoning may contribute to vaccine uptake.