Behavioral Medicine最新文献

Debilitating fatigue is common in people living with kidney disease and often persists after a kidney transplant. Current understanding of fatigue is centered around pathophysiological processes. Little is known about the role of cognitive and behavioral factors. The aim of this study was to evaluate the contribution of these factors to fatigue among kidney transplant recipients (KTRs). A cross-sectional study of 174 adult KTRs who completed online measures of fatigue, distress, illness perceptions, and cognitive and behavioral responses to fatigue. Sociodemographic and illness-related information was also collected. 63.2% of KTRs experienced clinically significant fatigue. Sociodemographic and clinical factors explained 16.1% and 31.2% of the variance in the fatigue severity and fatigue impairment, respectively, increasing by 28% and 26.8% after adding distress. In adjusted models, all the cognitive and behavioral factors except for illness perceptions were positively associated with increased fatigue-related impairment, but not severity. Embarrassment avoidance emerged as a key cognition. In conclusion, fatigue is common following kidney transplantation and associated with distress and cognitive and behavioral responses to symptoms, particularly embarrassment avoidance. Given the commonality and impact of fatigue in KTRs, treatment is a clinical need. Psychological interventions targeting distress and specific beliefs and behaviors related to fatigue may be beneficial.

We investigated health, economic, and social disparities among lesbian, gay, bisexual, and sexually diverse adults, 18 years and older. Analyzing 2011-2019 Washington State Behavioral Risk Factor Surveillance System (N = 109,527), we estimated and compared the prevalence rates of background characteristics, economic and social indicators, health outcomes, chronic conditions, health care access, health behaviors, and preventive care by gender and sexual identity. Sexual minority adults reported heightened risks of poor general health, physical and mental health, disability, subjective cognitive decline, and financial barriers to health care, compared with their straight counterparts. Economic disparities and disability were evident for lesbians and both bisexual adult women and men. We found higher rates of smoking and excessive drinking among lesbians and bisexual women, and higher rates of smoking and living alone among gay men. Sexually diverse adults experience disparities in health care access. This study is one of the first to identify disparities among sexually diverse populations, in addition to lesbian, gay, and bisexual adults. More research is required to understand the mechanisms of disparities within these groups to address their distinct intervention needs.

Studies examining the effects of discrimination on emotional well-being have often overlooked (a) differential effects of both everyday and lifetime discrimination and (b) how both types of discrimination may exacerbate stressor-related affect-even when daily stressors are unrelated to discrimination. The current study examined the effects of daily stressors not attributed to discrimination (i.e., nondiscrimination-related daily stressors) on daily negative and positive affect in the presence of either form of discrimination (everyday and lifetime). Participants who completed the second wave of the Survey of Midlife Development in the US (MIDUS-II) and the National Study of Daily Experiences (NSDE-II) answered questionnaires about everyday and lifetime discrimination. Later, they completed daily phone interviews across 8 consecutive days, asking about the nondiscrimination-related daily stressors and the positive and negative affect they had experienced that day. Multilevel model analyses revealed that everyday discrimination was associated with decreased daily positive affect and lifetime discrimination was associated with increased daily negative affect. Moreover, higher frequency of everyday discrimination exacerbated the within-person effects of nondiscriminatory daily stressors on negative affect. Results underscore the importance of considering both independent and synergistic effects of discrimination on daily emotional well-being.

Youth between the ages of 13 and 24 account for over 20% of new HIV diagnoses in the United States but are the least likely age group to be HIV tested in healthcare settings including the emergency department. This is in part due to the fact that almost 50% of youth decline testing when offered. We elucidated youth patients' perspectives on barriers to and facilitators of routine HIV testing of youth in an urban emergency department setting. Thirty-seven patients aged 13-24 years were recruited from the pediatric and adult emergency departments at a high-volume hospital in New York City from August 2019 to March 2020. Semi-structured in-depth interviews were conducted with all participants. Interviews were audio-recorded and transcribed verbatim, and transcripts were coded using an inductive thematic analysis approach. Youths' main reasons for declining HIV testing when offered included low risk perception, privacy concerns, HIV-related stigma, and low levels of HIV-related knowledge. Participants' responses suggested that HIV educational materials provided when testing is offered may be insufficient. Participants recommended providing additional HIV education and better incorporating HIV testing into the emergency department routine to increase testing among youth. Efforts are needed to help youth recognize their own HIV risk and increase their HIV-related knowledge. This may be accomplished by providing youth with additional educational materials on HIV, possibly via tablet-based interventions or other methods that may enhance privacy, combined with discussions with healthcare providers. Such efforts may help increase HIV testing acceptance among youth seen in the emergency department.

Black and Latinx transgender women in the United States (U.S.) are at disproportionately high risk for HIV. Although HIV pre-exposure prophylaxis (PrEP) reduces the risk of HIV infection, uptake and persistence (i.e., ability to continue taking PrEP over time) can be a challenge for Black and Latinx transgender women due to myriad social and structural forces. In this qualitative study, we present unique data on the facilitators of PrEP persistence from Black and Latinx transgender women who initiated PrEP and exhibited varying levels of persistence during a demonstration project in Southern California. PrEP persistence was assessed by collecting quantitative intracellular tenofovir-diphosphate (TFV-DP) levels on dried blood spot (DBS) samples collected at weeks 12 and 48. Informed by the socioecological framework, we conducted and analyzed interviews using qualitative content analysis to determine themes on the facilitators of PrEP persistence. Individual-level facilitators included the use of reminders, having high individual-level HIV risk perception, feeling empowered to take PrEP, and reporting having improved peace of mind and mental health because of taking PrEP. Interpersonal/Community-level facilitators included feeling motivation to prevent HIV in the community, motivation to prevent HIV in the context of sex work, and having high community-level risk perception. Structural-level facilitators included having positive experiences in affirming healthcare settings and having PrEP visits combined with other gender-related healthcare visits. Interventions aiming to increase PrEP uptake and persistence among Black and Latinx transgender women in the U.S. should harness the multiple levels of support exhibited by those who were able to start and persist on PrEP in the face of the myriad social and structural barriers.

Use of information and communication technology to improve health, known as eHealth, is an emerging concept in healthcare that may present opportunities to promote physical activity in adults with obesity. The purpose of this research was to systematically review eHealth intervention studies to promote physical activity in adults with obesity. Five electronic databases were used. Two authors screened articles, assessed risk of bias, and extracted data independently. A qualitative data synthesis for summarizing the findings was performed using harvest plots. In the search, 2276 articles were identified, and 18 studies met all inclusion criteria. Study quality ranged from poor to good. The included studies varied in intervention technology (e.g., web-based), physical activity assessment (e.g., device-based), and control group (e.g., wait-list). Behavioral change techniques used in the included studies were consistent with some techniques (e.g., self-monitoring) known as effective in face-to-face interventions, but more efficiently employed in eHealth using information and communication technology. Overall, this systematic review showed that a web-based or physical activity monitor-based eHealth intervention had the potential to effectively promote physical activity in adults with obesity. Some recommendations for future eHealth interventions to promote physical activity in adults with obesity were provided (e.g., use of theory, accelerometers).

The present study aims to investigate the relationship between a diagnosis of diabetes and health behavior changes among middle-aged and older adults, and whether self-efficacy and social support moderate the relationship. The study sample was selected from the 2006 to 2016 waves of the Health and Retirement Study (N = 13,143). A diagnosis of diabetes was ascertained by self-reported physician-diagnosed condition. Self-efficacy was measured using a 5-item scale. Social support from family and friends was measured separately by a same 3-item scale. Three health behaviors were assessed, including drinking, smoking, and physical activity. Mixed-effects regression models were conducted to test the study aims. Findings showed that participants reduced drinking after a diagnosis of diabetes. A significant interaction between social support from family and a diabetes diagnosis was found in predicting drinking reduction and smoking cessation. These findings suggest that a diagnosis of diabetes may trigger individuals' motivation to initiate health-promoting behaviors. Mobilizing social support from family may help individuals adopt health-promoting behaviors and manage diabetes after a diagnosis.

COVID-19 has become a global pandemic. Throughout most of the pandemic, mitigating its spread has relied on human behavior, namely on adherence to protective behaviors (e.g., wearing a face mask). This research proposes that Protection Motivation Theory (PMT) can contribute to understanding differences in individual adherence to COVID-19 behavioral guidelines. PMT identifies four fundamental cognitive components that drive responses to fear appeals: perceptions of susceptibility (to the disease), severity (of the disease), self-efficacy (to protect oneself), and response efficacy (i.e., recommended behaviors' effectiveness). Two online self-report studies assessed PMT components' capacity to predict adherence to protective behaviors concurrently and across culturally different countries (Israel, Germany, India; Study 1), and again at six-week follow-up (Israeli participants; Study 2). Study 1's findings indicate excellent fit of the PMT model, with about half of the variance in adherence explained. No significant differences were found between participants from Israel (n = 917), Germany (n = 222) and India (n = 160). Study 2 (n = 711) confirmed that PMT components continue to predict adherence after six weeks. In both studies, response efficacy was the PMT component most strongly associated with adherence levels. This study demonstrates that PMT can serve as a theoretical framework to better understand differences in adherence to COVID-19 protective behaviors. The findings may further inform the design of adherence-promoting communications, suggesting that it may be beneficial to highlight response efficacy in such messages.

The COVID-19 vaccines are highly effective in preventing COVID-19 illness; however, pregnant people were not included in the original COVID-19 vaccine trials, with resultant conflicting recommendations from health organizations regarding vaccinations for this high-risk population. Pregnant and lactating healthcare workers (HCWs), along with people planning a pregnancy, identified as "obstetric HCWs" in our study, were among the first to make decisions regarding vaccinating themselves against COVID-19. Given that HCWs are key sources of information and access to vaccinations, this study was conducted to understand the perceptions and knowledge of obstetric HCWs regarding the COVID-19 vaccine. An electronic survey to HCWs at a tertiary care institution in Pittsburgh, PA identified 83 obstetric HCWs, of which 65 (78.3%) received at least one dose of the either the Pfizer or Moderna COVID-19 vaccine, and 18 (21.7%) had not received any doses of vaccine. Pregnancy status influenced more people not to receive than to receive the vaccine. We found that both vaccinated and non-vaccinated obstetric HCWs had accurate knowledge regarding the COVID-19 vaccine. However, compared to non-vaccinated obstetric HCWs, vaccinated obstetric HCWs tended to endorse beliefs regarding herd immunity, believed they had a higher chance of acquiring COVID-19, and felt that the COVID-19 vaccine was safe for fetuses and people who were pregnant, lactating, breastfeeding, or planning a pregnancy. This study offers insight into obstetric individuals' perceptions and knowledge of the COVID-19 vaccine, and highlights areas where additional education and outreach may help obstetric individuals make informed decisions on receiving the COVID-19 vaccine.