Annals of Behavioral Medicine最新文献

Many middle-aged to older adults do not engage in regular exercise at all, despite its importance for healthy aging. Extensive research grounded in behavioral and social science theories has identified numerous determinants of exercise. However, few studies used an exposure-wide approach, a data-driven exploratory method particularly useful for identifying novel determinants.

Methods: We used data from 13 771 participants in the Health and Retirement Study, a diverse, national panel study of adults aged >50 years in the United States, to evaluate 62 candidate determinants of exercise participation. Candidate predictors were drawn from the following domains: health behaviors, physical health, psychological well-being, psychological distress, social factors, and work. We used Poisson regression with robust error variance to individually regress exercise in the outcome wave (t2: 2014/2016) on baseline candidate predictors (at t1: 2010/2012) controlling for all covariates in the previous wave (t0: 2006/2008).

Results: Some physical health conditions (eg, physical functioning limitations and lung disease), psychological factors (eg, health mastery, purpose in life, and positive affect), and social factors (eg, helping others, religious service attendance, and volunteering) were robustly associated with increased subsequent exercise. Among factors related to psychological distress, perceived constraints stood out as a factor in reducing exercise.

Conclusions: We identified potentially novel exercise determinants, such as helping friends/neighbors/relatives, religious attendance, and volunteering, that have not been captured using a theory-driven approach. Future studies validating these findings experimentally in midlife and older adults are needed.

Background: As part of a study to test the feasibility and acceptability of the Finding Respect and Ending Stigma around HIV (FRESH) intervention to reduce stigmas and improve HIV viral suppression, our team collected qualitative data from men who have sex with men (MSM) with HIV, transgender women with HIV, and HIV healthcare providers for their perspectives on different stigmas in Dominican Republic healthcare settings.

Purpose: We aimed to develop an understanding of the causes, consequences, and domains of stigma among sexual and gender minorities with HIV in Dominican Republic HIV clinics.

Methods: Data collection occurred in Santo Domingo and Santiago (2020-2021) and included four focus groups with MSM with HIV (n = 26), in-depth interviews with transgender women with HIV (n = 14), and in-depth interviews with HIV healthcare providers (n = 16). All data collection occurred in person and was audio recorded. Standardized guides were used for focus groups and in-depth interviews. Using a deductive process, 2 research associates thematically coded data in the NVivo software.

Results: On average, focus groups were 81 minutes, provider in-depth interviews were 24 minutes, and transgender women in-depth interviews were 32 minutes. We identified 4 key themes that mapped to 4 domains of stigma affecting MSM and transgender women with HIV: migrant stigma, religious stigma, sexual and gender minorities (SGM) stigma, and HIV stigma. All participant types noted the persistence of stigma and discrimination in healthcare settings in the Dominican Republic. The consequences of these stigmas were reported as being significant, including attempted suicide.

Conclusions: Interventions to reduce stigma experienced by SGM populations with HIV should address structural barriers, including inner and outer contexts of HIV care provision and cultural norms and values that propagate stigma. Findings offer insights about which stigmas could be targeted in future studies and how to potentially address stigma to improve population health in the Dominican Republic.

Background: Depression affects 33% of women with type 2 diabetes (T2D) and leads to increased risks of premature mortality. Fluctuation and variation of depressive presentations can hinder clinical identification.

Purpose: We aimed to identify and examine subgroups characterized by distinct depressive symptom trajectories among women with T2D.

Methods: This retrospective analysis leveraged the Women's Interagency HIV Study data to identify depressive symptom trajectories based on the Center for Epidemiological Studies Depression scores (2014-2019) among women with and without HIV. Descriptive statistics characterized sample demographics (eg, age, race, income), clinical indices (eg, hemoglobin A1C [HbA1c], BMI, HIV status), and psychosocial experiences (eg, discrimination, social support, anxiety, pain). We used growth mixture modeling to identify groups defined by distinct depressive symptom trajectories and parametric and non-parametric tests to examine demographic, clinical, and psychosocial differences across subgroups.

Results: Among the 630 women included, the mean age was 50.4 (SD = 8.3) years, 72.4% identified as Black and non-Hispanic, and 68.2% were living with HIV. Five subgroups were identified and distinguished by severity and symptom type. Participants with lower incomes (P = .01), lower employment (P < .0001), lower social support (P = .0001), and experiences of discrimination (P < .0001) showed greater membership in threshold, moderate, and severe depressive subgroups. Subgroup membership was not associated with metabolic indices (BMI, HbA1c) or HIV status. Anxiety, pain, and loneliness (all P = .0001) were worse in subgroups with higher depressive symptoms.

Conclusions: Among women with T2D, depressive symptom trajectories differ across clinical and social contexts. This study advances precision by delineating subgroups within a broad clinical category.

Background: The close relationship processes and health model and the dyadic health influence model posit that relationship beliefs (eg, relationship satisfaction) and influence strategies (eg, provision and receipt of positive and negative social control) mediate health behavior change. However, evidence for such mediation in parent-child dyads is limited.

Purpose: Two complementary mediation hypotheses were tested: (1) social control forms indirect relationships with sedentary behavior (SB), via relationship satisfaction acting as a mediator; and (2) relationship satisfaction forms indirect relationships with SB, with social control operating as a mediator.

Methods: Data from 247 parent-child dyads (9- to 15-year-old children) were analyzed using manifest mediation models. SB was measured with GT3X-BT accelerometers at Time 1 (T1; baseline) and Time 3 (T3; 8-month follow-up). Relationship satisfaction and social control were assessed at T1 and Time 2 (T2; 2-month follow-up). Path analysis models, controlling for baseline SB, were fit.

Results: Received positive control (children, T1) was associated with higher relationship satisfaction in both children and parents (T2), which in turn were related to lower and higher parental SB at T3, respectively. Provided positive control (parents; T1) was related to higher SB (T3) in children. Relationship satisfaction among children (T1) predicted higher levels of received positive and negative control (children, T2).

Conclusions: Provided and received positive social control may form direct and indirect associations with SB in parent-child dyads. Future research may need to consider further subtypes of positive control, which may explain the divergent effects of this form of control on SB.

Background: Self-efficacy is a modifiable intervention target in behavioral weight loss interventions. However, its role in the context of digital interventions is less clear.

Purpose: To determine change in self-efficacy in a digital weight loss intervention, and whether self-efficacy is associated with engagement in self-monitoring diet or weight loss.

Methods: This is a secondary analysis of the GoalTracker study among 100 adults with overweight or obesity enrolled in a 12-week standalone digital weight loss intervention emphasizing daily self-monitoring. At baseline, 1 month, and 3 months, we assessed self-efficacy for controlling eating (via the Weight Efficacy Lifestyle Questionnaire; WELQ) and self-efficacy for tracking diet. Dietary self-monitoring engagement data were collected from the MyFitnessPal app. Weight was collected in person on a calibrated scale. Analyses included participants with complete data (N range: 72-99).

Results: Positive change from baseline to 1 month in self-efficacy for controlling eating was associated with higher dietary self-monitoring engagement (r = 0.21, P = .008) but not with 3-month weight change (r = -0.20, P = .052). Meanwhile, positive change from baseline to 1 month in self-efficacy for tracking diet was associated in a beneficial direction with both outcomes (r = 0.57, P < .001; r = -0.35, P < .001, respectively). However, on average, self-efficacy for controlling eating did not change over time while self-efficacy for tracking diet decreased (P < .001).

Conclusion: Improvements in self-efficacy-particularly for tracking diet-early on in a digital weight loss intervention served as a mechanism of greater engagement and weight loss, highlighting the need for strengthening intervention strategies that promote early self-efficacy within a digital context.

Background: Patients' negative expectations about medication can exacerbate side effect burden leading to low adherence and persistence. A novel intervention involves targeting mindsets about non-severe symptoms; reframing them as encouraging signs of medication working.

Purpose: This study aimed to assess whether a brief symptom-mindset intervention can improve symptom experience and adherence in patients starting methotrexate to treat an inflammatory rheumatic disease.

Methods: A randomized controlled trial was conducted with patients starting methotrexate. Participants were randomly assigned (1:1) to a mindset intervention or standard information control condition. Symptom mindset was assessed after 4 weeks to check intervention efficacy. The primary outcome was symptom experience after 4 weeks. Secondary outcomes were adherence and motivation to take methotrexate (4 weeks), as well as continuation and C-reactive protein (12 weeks).

Results: Forty-seven participants were randomly assigned to the intervention (n = 24) or control group (n = 23). All participants completed the study. After 4 weeks, compared to the control group, intervention participants endorsed more positive symptom mindsets, experienced less symptom burden (mean difference -2.70 [95% CI, -4.50, -0.90] P = .005), fewer general symptoms (3.53 [-6.99, .79] P = .045) and a similar number of methotrexate-specific symptoms (-0.79 [-2.29, 0.71] P = .295). The intervention group had better motivation and adherence to methotrexate at 4 weeks and better continuation, and C-reactive protein at 12 weeks than the control group. There was no difference in side effect attribution.

Conclusions: In patients starting methotrexate, a mindset intervention reframing the role of non-severe side effects is a promising approach for improving symptom experience and early stage medication persistence.

Background: Stress plays a pivotal role in physical health. Although many studies have linked stress reactivity (daily within-person associations between stress exposure and negative affect) to physical health outcomes, we know surprisingly little about how changes in stress reactivity are related to changes in physical health.

Purpose: The current study examines how change in stress reactivity over 18 years is related to changes in functional health and chronic health conditions.

Methods: Three measurement bursts from the National Study of Daily Experiences (N = 2880; 55% female) each included daily measures of stressor exposure and negative affect across 8 consecutive days, yielding 33 944 days of data across 18 years of adulthood. At each wave, participants reported their functional health limitations (ie, basic activities of daily living [ADL] and instrumental activities of daily living [IADL]) and chronic health conditions. Multilevel structural equation models simultaneously modeled stress reactivity at Level 1, longitudinal changes in stress reactivity at Level 2, and the association between changes in stress reactivity and changes in functional limitations and chronic conditions at Level 3.

Results: Higher levels of stress reactivity at baseline were associated with more functional health limitations 18 years later (ADLs: Est. = 0.90, P = .001; IADLs: Est. = 1.78, P < .001). Furthermore, individuals who increased more in their stress reactivity across the 18-year period also showed greater increases in their functional health limitations (ADLs: Est. = 4.02, P = .017; IADLs: Est. = 5.74, P < .001) and chronic conditions (Est. = 11.17, P = .008).

Conclusions: These findings highlight the strong connection between health and stress in daily life, and how they travel together across adulthood.

Objective: To compare the effectiveness of a static, text-based diabetes education and support intervention (Dulce Digital, DD) versus a dynamic approach with personalized feedback and goal setting (Dulce Digital-Me, DD-Me) in improving diabetes outcomes.

Design and methods: Comparative effectiveness trial in 310 Latine adults with poorly managed type 2 diabetes in a Federally Qualified Health Center in Southern California, randomized to DD, DD-Me-Auto (algorithm-driven text-based personalized feedback), or DD-Me-Tel (coach delivered personalized feedback). Changes in HbA1c (primary outcome), low-density lipoprotein-cholesterol, systolic blood pressure, and patient-reported outcomes were examined across 6 and 12 months, with the primary comparison being DD versus DD-Me (combined automated and telephonic).

Results: Participants were 52.1 (±10.2) years old, 69.7% female, with HbA1c 9.3% (±1.6) at baseline. Across groups, there was a statistically significant improvement in HbA1c at 6 months (mean∆ per month = -0.17, 95% CI -0.20, -0.14; P < .001) and 12 months (mean∆ per month = -0.07, 95% CI -0.09, -0.05; P < .001). However, there were no time-by-group interaction effects indicating group differences in clinical outcomes across 6 or 12 months. The DD-Me groups showed greater improvements across time than the DD group for diabetes self-management behaviors.

Conclusions: Static and adaptive digital interventions for Latine adults with type 2 diabetes had similar and clinically significant effects on HbA1c across 12 months. Simple digital approaches can be integrated within primary care-based chronic care models to reduce diabetes disparities.

Clinicaltrials.gov registration: NCT03130699, Initial Release 04/24/2017, https://clinicaltrials.gov/ct2/show/NCT03130699?term=NCT03130699&draw=2&rank=1.

Background: Firearms-related health sciences research has documented disparities in fatal and nonfatal firearm injury impacting populations in the United States defined by race and ethnicity, age, gender, and geography. Recent reports from research and advocacy organizations have highlighted a need for this research to include sexual and gender minority (ie, lesbian, gay, bisexual, transgender, and queer [LGBTQ+]) populations to guide public health efforts to prevent homicide, suicide, and injury.

Purpose: The current review examines and summarizes existing research related to firearms and LGBTQ+ populations in the United States.

Methods: A search of PubMed, Embase, CINAHL, PsycInfo, LGBT Life, and Scopus was conducted in May 2024 using search strings related to LGBTQ+ populations, firearms, and suicide. Articles were included in this review if they were peer-reviewed, empirical studies assessing any construct related to firearms among LGBTQ+ people in the United States.

Results: Ultimately, 35 studies were included. Constructs examined in included studies were suicide (n = 6), homicide (n = 4), responses to the Pulse nightclub shooting (n = 9), nonfatal interpersonal violence (n = 4), and firearm access and ownership (n = 12).

Conclusions: Findings identified substantial gaps in the literature, underscoring an urgent need for LGBTQ+ health researchers and firearm injury prevention researchers to collaboratively extend and improve the evidence base on firearms among LGBTQ+ populations. Key recommendations include improving Sexual Orientation and Gender Identity data collection in firearms research, collecting original data to address LGBTQ+-specific and LGBTQ+-inclusive research questions regarding firearms, broadening the scope of firearms constructs assessed among LGTBQ+ populations, and using intersectionality to guide future research.