Behavioral Medicine最新文献

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.

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.