Behavioral Medicine最新文献

Adolescents with congenital heart disease (CHD) have elevated risk for acquired cardiovascular complications, increasing their vulnerability to e-cigarette-related health harms. Impulsivity and risky decision-making have been associated with adolescent substance use, but the relationships between these factors and e-cigarette-related outcomes among cardiovascular at-risk adolescents with CHD are unknown. This cross-sectional study aimed to (a) determine the associations of impulsivity and risky decision-making with e-cigarette-related outcomes (i.e. susceptibility, ever use, perceptions of harm and addictiveness) via variable-oriented analysis (logistic regression), (b) identify groups of adolescents with similar profiles of impulsivity and risky decision-making via exploratory person-oriented analysis (latent profile analysis; LPA), and (c) examine differences on e-cigarette-related outcomes between profile groups. Adolescents aged 12 to 18 years with CHD (N = 98) completed a survey assessing impulsivity facets (Short UPPS-P) and e-cigarette-related outcomes and were administered a risky decision-making task (Iowa Gambling Task, Version 2; IGT2). In variable-oriented analyses, impulsivity facets (negative urgency, positive urgency, lack of premeditation) but not risky decision-making were associated with e-cigarette susceptibility and ever use. The exploratory LPA identified two groups with similar patterns of responding on the Short UPPS-P and IGT2 labeled "Low Impulsivity" and "High Impulsivity," which were primarily characterized by significant differences in negative and positive urgency. Adolescents in the High Impulsivity group had increased odds of e-cigarette susceptibility but not ever use compared to the Low Impulsivity group. This work indicates that strategies to prevent e-cigarette use among adolescents with CHD may be enhanced by addressing impulsivity, particularly negative and positive urgency.

Law enforcement personnel are often first to respond to calls involving behavioral health emergencies. However, encounters with law enforcement are more dangerous and lethal for people with behavioral health conditions. Co-responding models, wherein law enforcement and behavioral health professionals respond to calls together, are among the top programs developed to improve responding to behavioral health crises. The current study describes a qualitative process evaluation of a co-responding pilot program in New Jersey: "Alternative Responses to Reduce Instances of Violence & Escalation" (ARRIVE Together). The evaluation centered on the experience of the co-responding team as to their perceptions of specific deployments and of the program implementation overall. Semi-structured interviews were conducted following 10 consecutive encounters (three interviews per encounter; February-March 2022). Transcripts were transcribed and thematically analyzed by two trained researchers independently. Once thematically analyzed, researchers determined a consensus and developed a SWOT analysis report. Thematic analysis produced six major themes: communication, staffing, training, resources, community outreach, and deployments with minors. Overall, participants were enthusiastic about the program, but they shared numerous observations about ways in which the program could be improved. Sample size, the brief follow-up window, and lack of generalizability to other contexts were among the most limiting factors. Further research should include an effectiveness evaluation and extend to urban and suburban communities and communities of color. Future research should also explore after-response affects including accessibility to follow-up care. The current study gives insight into piloting a co-responding model for approaching behavioral health crisis calls.

In the United States, HPV vaccination is available for unvaccinated 27 to 45 year olds based on a shared clinical decision with a health care provider. Since the implementation of the guideline, little has been known about provider perceptions of this recommendation. The purpose of this study was to elucidate health care provider perspectives on HPV vaccination for 27 to 45 year olds in the United States. Semi-structured interviews were conducted virtually with 18 health care providers regarding current HPV vaccination practices for 27 to 45 year olds, perceptions of the guideline, and shared clinical decision-making needs. Thematic analysis was conducted using interview transcripts, and interrater reliability was achieved for >10% of the transcripts. Overall, most participants reported that they have recommended HPV vaccination to patients aged 27 to 45 year olds; however, they applied various criteria to guide these discussions. Some participants considered the patients' relationship statuses, sexual partnerships, past HPV infection history, and age. Potential needs to facilitate shared clinical decision-making processes included medical record prompts and brief educational materials. While most health care providers in this sample discussed HPV vaccination with their patients ages 27 to 45 years old, there were inconsistencies in the interpretation of the guideline. The lack of specificity in the recommendation will likely result in significant and potentially inequitable implementation difficulties.

The present study examined the association between adverse childhood experiences (ACEs) and body mass index (BMI) status among children and youth with special health care needs (CYSHCN), and the role of health characteristics and lifestyle factors in predicting BMI. Data from the 2016-2020 National Survey of Children's Health were utilized. Key variables included: ACEs, BMI status, level of functional impairment, depression, weekly level of physical activity, and daily screen time. Multivariable ordinal logistic regression analyses were used to examine associations between selected variables and BMI status. The sample consisted of 19,743 CYSHCN. Respectively, CYSHCN with exposure to 1-2 ACEs (vs. none) and 3+ ACEs (vs. none), had a 22% and 32% increase in odds of a one-level increase in BMI status, controlling for sociodemographic characteristics, level of functional impairment, and depression. When lifestyle factors (i.e., physical activity and screen time) were included in analyses, CYSHCN with exposure to 3+ ACEs (vs. none) had a 27% increase in odds of a one-level increase in BMI status. Thus, we found that ACEs were significantly associated with BMI status. However, the strength of this relation changed when considering CYSHCN health characteristics and CYSHCN lifestyle factors. A higher weekly level of physical activity, in particular, seemed to play a significant role in reducing risk of higher BMI status among CYSHCN with exposure to 3+ ACEs (vs. none). Findings support the development of physical activity promotion programs and education regarding strategic utilization of screen time (e.g., educational apps and games) for CYSHCN and their families.

Cisgender women living with HIV experience elevated cardiovascular disease (CVD) risk that increases with age, a concern given extended life expectancies for people living with HIV. The CVD risk disparity among cisgender women aging with HIV is understudied and remains unclear. Taking a psychoneuroimmunology approach, given this group's intersecting marginalized identities, one potential driver of the disparity is intersectional stigma. Yet not all women living with HIV have coronary artery disease (CAD). Resilience to stigma may serve as a protective factor to CAD, as observed in other health issues. This study aimed to explore the relationship between intersectional stigma, resilience, "traditional" CVD risk factors, and objective indicators of CAD among women aging with HIV. A diverse sample of cisgender women aging with HIV (aged ≥ 35, N = 48) completed a cross-sectional survey, clinical health interview, blood sample, blood pressure, anthropometric measurements, and computed tomography angiography (CTA). CART-based machine learning models assessed the statistical importance of traditional CVD risk factors, intersectional stigma, and resilience for classifying individuals with coronary artery stenosis, calcification, and inflammatory markers associated with CAD. Of the n = 31 who completed CTA, 74% had detectable calcification and 39% stenosis. Intersectional stigma was identified as an important variable for explaining calcification, but not stenosis, and for explaining sCD163, an inflammatory biomarker associated with CAD. Results show a potential psychoneuroimmunology pathway to the CAD disparity among this group. Future longitudinal research should investigate the mechanisms of this pathway and consider stigma as target for intervention to improve cardiovascular health among women aging with HIV.

Tailored language and communication strategies underpin men's engagement with public health initiatives. The aim of this study was to explore men's preferences for language and communication in mental health promotion and provide recommendations for current and future programs. A sequential mixed-methods design was used including five focus groups and 21 individual interviews with 64 men. Interpretive description was used to inductively derive three themes: (1) Using coded language to confer mental health, which highlighted the tacit meaning and implications of language as well as men's covert strategies to communicate their challenges and emotions; (2) Summoning masculine capital with association and metaphors, wherein men's strategies for conveying mental health in acceptable and relatable ways are chronicled; and (3) Dynamism language to signal action and growth, illustrating participants' preference for strength-based approaches and gain-framed messaging that positions men as drivers of self-management and personal development. Important implications for men's mental health promotion are discussed.

Lifestyle habits seem interconnected and extant studies suggest that a lifestyle-related modification can impact other related behaviors. For instance, interventions targeting physical activity (PA) could potentially impact dietary patterns and quality. Therefore, we hypothesized that a web-based intervention to increase PA would lead to changes in diet quality without explicit dietary guidance. Our aim was to evaluate changes in diet quality, measured by the Healthy Eating Index 2020 (HEI-2020), following a 12-week web-based PA intervention in adults with obesity. The study consisted of secondary analysis of a 12-week pilot randomized controlled trial, wherein participants (N = 82) were randomized to the Physical Activity for The Heart (PATH) intervention group, which included workout videos and virtual coaching, or a wait-list control group. Diet quality was assessed at baseline and post-intervention using the HEI-2020 based on recalls collected through the Automated Self-Administered 24-h recall (ASA-24) system. Baseline characteristics were similar across groups. Both groups showed small improvements in HEI-2020 total scores after 12 wk (PATH: 65.11 vs. Control: 62.24). Stratification by moderate to vigorous physical activities increase (<60 min. vs. ≥60 min.) revealed greater improvements in specific HEI-2020 components in the ≥60 min group, though overall changes remained modest. The PA intervention led to small improvements in certain diet quality components, suggesting potential interconnectedness between PA and dietary habits. However, overall changes in HEI-2020 scores were modest. Future research with larger samples should explore the effects of PA intervention alone vs. combined with dietary guidance on diet quality in adults with obesity.

Family-based lifestyle interventions for children/adolescents with severe levels of obesity are numerous, but evidence indicates programs fail to elicit short- or longer-term weight loss outcomes. Families with lived experience can provide valuable insight as we strive to improve outcomes from programs. Our aim was to explore elements that families desired in a program designed to treat severe levels of obesity in young people. We recruited a cross-sectional sample of 13 families (parents and young people) who had been referred but had not engaged with the state-wide Perth Children's Hospital, Healthy Weight Service (Perth, Australia), between 2016 and 2018. Utilizing semi-structured interviews and reflexive qualitative thematic analysis, we identified two broad themes, (1) bridging the gap between what to do and how to do it, and (2) peers doing it with you. The first theme reflected parents' and young people's feelings that programs ought to teach specialist-designed practical strategies utilizing non-generic information tailored to address the needs of the family, in a collaboratively supportive way, and encourage young people to learn for themselves. The second theme reflected the importance of social connection facilitated by peer support, and intervention programs should be offered in a group format to foster inclusion. Families indicated a willingness to engage in tertiary intervention programs but desired support from specialized health professionals/programs to be tailored to their needs, sensitive to their experiences and challenges and provide useful practical strategies that support the knowledge-to-action process.

Community-engaged research is increasingly recognized for its potential to advance health equity. The ability to conduct such research in the United States is predicated on the completion of human subjects protection courses; however, prior studies suggest that many of these required courses may not adequately accommodate the varied skillsets and backgrounds of community members involved with carrying out research. The present study explores community researchers' (CRs') experiences with a human subjects protection course frequently required by U.S. academic institutions. Six CRs involved in conducting a community-based participatory research (CBPR) project on Black women's pregnancy-related experiences were interviewed about their completion of the required course. Across multiple interviews, CRs noted challenges with the training length, competing external demands, module readability, content relevancy, end-of-module quizzes, and technology requirements. Despite such obstacles, CRs still valued the opportunity to learn and felt more knowledgeable and capable post-course completion. Recommendations for course improvement were explored. University requirements for human subjects protection trainings may place an undue burden on community members preparing to conduct research, impede academic-community partnerships, and discourage the initiation and continuation of community-engaged studies. Course alternatives that are tailored to CRs as well as community-academic partnerships could enhance the feasibility, relevance, and effectiveness of such trainings.

Use of religious coping in response to life stress is associated with improved mental and physical health outcomes. The aim of this study was to examine the influence of religious coping on conscious self-reported and non-conscious physiological stress responses to an acute, real-world stressor to better understand how this benefit may be conferred. This study examined the trajectory of subjective distress and cortisol patterns leading up to and following a stressful college exam using daily diary and ambulatory saliva samples, respectively (N students = 246). Religious coping was not significantly associated with subjective reports of distress. However, prior to the exam, greater use of religious coping was associated with an ostensibly more adaptive accelerated return to a cortisol baseline. This protective effect was no longer significant when the exam was over, suggesting that religious coping acts as a protective buffer against physiological stress responses rather than aiding in subjective recovery from stress.