Behavioral Medicine最新文献

Stroke survivors experience physical and psychological symptoms. However, long-term symptom prevalence and symptom associations have not been extensively studied. The current study aimed to assess the prevalence of physical and psychological symptoms across four years after stroke and to evaluate the relationship between these symptoms. We conducted a secondary analysis of a prospective, clinical, observational study. Physical (pain, fatigue, and physical impairment) and psychological (loss of interest, depressed mood, anxiety, and worry) symptoms were assessed using the International Consortium for Health Outcomes Measurement Standard Set for Stroke and the Patient Health Questionnaire for Depression and Anxiety three months, one year, two years, three years, and four years after hospital admission. We evaluated the prevalence of these symptoms across time and conducted a network analysis using panel vector autoregressive modeling. Physical impairment and fatigue had the highest prevalence in the sample. Psychological symptoms were also consistently observed, however, at a lower prevalence. There was no reduction in any symptom's prevalence across the course of four years after stroke. Furthermore, psychological and physical symptoms were associated with each other. Physical impairment was most strongly associated with the other symptoms, and anxiety symptoms preceded depressive symptoms. Thus, despite established follow-up care in Germany, symptoms persisted for years after stroke. Further, the observed symptom associations suggest the need to investigate the impact of physical symptoms on psychological distress. Our findings emphasize the need to prevent and treat persisting physical and psychological symptoms after stroke.

Recent research suggests that in addition to structural barriers (e.g., access), psychosocial factors like medical mistrust can influence uptake of COVID-19 tools and treatments. However, less is known about racial differences in how medical mistrust affects SARS-CoV-2 antibody testing. We evaluated whether medical mistrust alters receptivity to SARS-CoV-2 antibody testing, and whether this influence differs across race. African American (N = 298) and White American (N = 205) participants were recruited from a Midwest urban community for an online study about COVID-19 and SARS-CoV-2 antibody testing. Participants completed the Group-Based Medical Mistrust Scale and then viewed educational videos about the SARS-CoV-2 virus, antibodies, and antibody testing. Participants reported their receptivity to antibody testing using Theory of Planned Behavior (TPB) measures (attitudes, normative beliefs, perceived behavioral control, and intentions). Medical mistrust was significantly higher among African Americans than White Americans, although there were no race differences in receptivity to antibody testing. Multiple regression analyses showed that higher medical mistrust was associated with lower receptivity to antibody testing across all TPB measures. A significant race x medical mistrust interaction revealed that medical mistrust was more strongly associated with less favorable antibody testing attitudes among White Americans than African Americans. Results suggest that medical mistrust may be a psychosocial barrier to antibody testing. However, despite being higher among African Americans, mistrust may exert a stronger influence on receptivity toward antibody testing among White Americans, highlighting a need to consider medical mistrust as a barrier to health behavior responses across racial groups.

Factors such as structural racism and disinvestment in community mental health and social services have resulted in harmful interactions between law enforcement and individuals experiencing mental health crises. These harms are even more prevalent among racial and ethnic minorities, sexual and gender minorities, and individuals with a mental illness. Nationwide, municipalities are exploring ways to ameliorate the harms experienced during these interactions, with some implementing alternative crisis response units. In Durham, North Carolina, we conducted interviews with staff of one such program to better understand what aids and prevents successful program implementation. Participants reported that buy-in from program partners such as other first responders as well as from the broader community facilitated program operations. Barriers disclosed included inadequate funding of local social services and changing policies and procedures.

The coronavirus 2019 (COVID-19) pandemic escalated family stress and prompted interruptions of regular healthcare visits. Such pandemic-related disruptions may be particularly deleterious among Black youth with chronic health conditions, such as type 1 diabetes. The present study leveraged longitudinal data from a multi-center randomized clinical trial (Clinicaltrials.gov [NCT03168867]) and a follow-up ancillary study focused on effects of COVID-19 to examine blood glucose trajectories and diabetes family conflict among Black adolescents with type 1 diabetes and their caregivers. Throughout the primary and ancillary studies, both adolescents and caregivers reported on their experience of diabetes family conflict across seven study visits. At each of these visits, the adolescent's hemoglobin A1c (HbA1c) was measured as an indicator of their blood glucose levels; further, HbA1c data during the study window was also extracted from the electronic medical record. Results demonstrated that HbA1c among the sample was linearly improving prior to the pandemic, but improvement halted following the onset of COVID-19. Following COVID-19 onset, average HbA1c remained stable, but higher than the recommended level. Higher mean levels of diabetes family conflict across the study were associated with higher HbA1c on average. However, diabetes family conflict did not predict changes in HbA1c trajectories pre- or post-pandemic onset. These findings highlight the potential stagnation of improving health-related outcomes during the COVID-19 pandemic for Black adolescents with type 1 diabetes and the need for further longitudinal work examining the familial and systemic factors contributing to the negative health consequences of the COVID-19 pandemic.

Studies estimating the associations of physical activity (PA) and sedentary behavior (SB) with cardiometabolic risk factors and related conditions among people living with HIV (PWH) are limited. Data from the National Health and Nutrition Examination Survey (NHANES) (2007-08 through 2017-18 cycles) (N = 23,810) includes 125 PWH (representing 742,174 PWH). Adults were classified based on life epoch: emerging (18-29 yrs), early (30-44 yrs) and middle (45-59 yrs) adulthood. Achieving aerobic PA Guidelines (≥150 min/wk of moderate-vigorous intensity PA [MVPA]) was quantified from self-report data collected across three domains (transportation, occupation/household, and leisure-time). SB was self-reported time sitting (min/day), regardless of domain. Cardiometabolic conditions included blood pressure, body mass index (BMI), weight status, hypertension, and chronic kidney disease. Regression models estimated the differences in PA and SB by HIV status and among PWH we estimated the association of achieving PA Guidelines with cardiometabolic conditions. We also investigated whether age modified these relations and explored differences in domain-specific PA across life epochs. These analyses indicate that not meeting the PA Guidelines resulted in greater odds of obesity and higher diastolic blood pressure, which increases risk for poor health among PWH-an already high-risk group for cardiovascular disease. Future longitudinal studies are needed to establish temporality.

Mistrust of the health care system is associated with underutilization of medical services and poor self-reported health, which itself is an important indicator for future morbidity and mortality. This study examines how several factors influence the association between medical mistrust and self-rated health in a middle-aged socioeconomically diverse cohort over 16 years. Participants (n = 1673) from the Health Aging in Neighborhoods of Diversity over the Life Span Study formed the sample. Information was gathered on race (African American/White), sex, poverty status, health literacy, and two measures of perceived discrimination. Linear mixed model regression was used for several models to examine the independent and combined influence of these factors on how medical mistrust is related to self-rated health over time. Poverty status exhibited the greatest influence on longitudinal self-rated health. Poverty status and health literacy did not influence the association between medical mistrust and self-rated health but perceived discrimination did. Stratified analyses by race found that White participants exhibited greater influence from medical mistrust and perceived discrimination on self-rated health than African American participants. Increasing trust, improving communication, and reducing unfair treatment across vulnerable groups is likely to improve health in middle-aged adults, but reducing overall poverty is likely to have the greatest effect.

Diet and physical activity together affect health as important components of energy intake and energy expenditure, but few studies have considered the temporal interaction effect between them. Therefore, this study aimed to identify real-world 24-h physical activity intensity and energy intake trajectories and explore their associations with all-cause mortality. A total of 6389 participants from the 2003-2006 annual survey of the National Health and Nutrition Examination Survey (NHANES) were involved as baseline data in this study. Physical activity data was obtained from the physical activity monitor ActiGraph AM-7164. Energy intake data was collected by the Mobile Examination Center and telephone 3 to 10 days later. All-cause mortality data were obtained in 2019. The group-based trajectory model (GBTM) was used to identify trajectories of 24-h physical activity intensity and 24-h energy intake. Weighted Cox proportional hazard regressions were used to estimate the association between 24-h trajectory groups and all-cause mortality. The 24-h energy intake-physical activity intensity dual trajectories were divided into four groups, including group1 (46.9%): three meals and low active, group2 (36.2%): three meals and moderately active, group3 (8.8%): night eating and moderately active, and group4 (8.1%): three meals and highly active. The dual trajectories were associated with all-cause mortality. Compared to participants with three meals and low activity levels, participants with three meals and moderate activity had a reduced risk of all-cause mortality. In summary, this study found that participants with three meals and moderately active had a lower risk of all-cause mortality.

Previous studies have shown associations between individual health behaviors and mental health outcomes. However, the impact of the accumulation of such behaviors on mental health remains unclear. This study aimed to examine the association between an index of accumulated health behaviors and mental health in adolescents, using data from the Brazilian National School Health Survey (PeNSE), which included 4,361 schools and a sample of 124,898 students. Health behaviors were assessed across five domains: healthy diet, alcohol consumption, smoking, physical activity, and sedentary behavior, with scores ranging from 0 to 5. Mental health outcomes (anxiety, sadness, social isolation, stress, and depression) and self-rated health were evaluated based on students' responses about their feelings over the previous 30 days. Regression models were applied, adjusting for key sociodemographic variables. The majority of participants were female, aged 13-15 years, and from the Southeast region. The results showed that a higher accumulation of healthy behaviors was associated with better mental health and more favorable self-rated health. These associations remained consistent after controlling for potential confounders. The findings underscore the importance of promoting multiple healthy behaviors to support mental well-being and self-perceived health among Brazilian adolescents.

Women in midlife (ages 40-60) are at elevated risk of developing cardiovascular disease (CVD), and daily experiences such as stress, physical pain, and poor sleep quality exacerbate this risk. Understanding the severity and temporal sequencing of these experiences as they occur in daily life will inform health promotion efforts for this vulnerable group. To achieve these goals, we used ecological momentary assessment to clarify the occurrence, severity, and temporal associations between momentary stress and pain, and tested for moderating effects of subjective sleep quality on these associations. Participants were 75 women in midlife with >1 risk factors for CVD (mean age = 52 years, mean BMI = 34.0 kg/m²) who completed 10 days of assessment. Multilevel models showed considerable within-person variability in sleep quality and stress. Pain was reported at 32% of moments and showed within-person variability. Within-person, stress and pain were worse on days with poorer sleep; pain intensity was worse after times when stress was worse (vs. better), on days when sleep was poorer. Findings show that women experience considerable variability in their daily experiences of sleep quality, stress, and pain. Greater-than-usual stress may be a real-time marker of later pain, on days when sleep is worse than usual. This clarification of temporal sequencing in women's daily lives may inform just-in-time interventions to mitigate pain.

Pain is highly prevalent among emerging adults (18-25 years old), and rates of cannabis use are increasing among this population. Research indicates pain is a unique risk factor and motivator for substance use. However, evidence for pain-cannabis use relations among emerging adults is largely cross-sectional, and the only prospective evidence focuses on the frequency, quantity, and consequences of cannabis use, not initiation. Accordingly, this is the first study to examine pain as a prospective predictor of cannabis initiation among emerging adults. Data were drawn from five annual waves of the Population Assessment of Tobacco and Health Study. Emerging adults who denied cannabis use at baseline (n = 4,185) were included in the analysis. At baseline, a tenth of emerging adults reported moderate/severe pain (≥4/10). Adjusted Cox regression analysis revealed that emerging adults with moderate/severe baseline pain were more likely to initiate cannabis use, and did so earlier over the subsequent 4 years, than those with no/low baseline pain. These findings provide initial evidence for pain as a risk factor for cannabis initiation during emerging adulthood. Future research is needed to identify mechanisms by which pain motivates cannabis initiation and to examine the utility of pain-targeted content in cannabis use prevention and intervention efforts among emerging adults.