Annals of Behavioral Medicine最新文献

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: Emerging evidence suggests that the Superwoman Schema (SWS)-the sociocultural representation of Black women as naturally strong, independent, and nurturing-may play an important role in Black women's cardiovascular health; but findings have been relatively mixed. One interesting possibility is that environmental mastery, a sense of control over one's environment, may mitigate negative aspects of SWS.

Purpose: We investigated whether mastery moderated the association between SWS and pulse wave velocity (PWV), the gold standard measure of arterial stiffness linked to cardiovascular morbidity and mortality.

Methods: Participants were N = 368 early middle-aged (30-45 years old) Black women from the southeastern USA who completed the 35-item Giscombé Superwoman Schema Questionnaire and Ryff's 14-item environmental mastery scale. Carotid-femoral PWV was assessed using the SphygmoCor device. Linear regression models examined the main and interactive associations of SWS and mastery on PWV, adjusting for age, education, income, body mass index, smoking status, blood pressure, and antihypertensive medication use.

Results: Analyses revealed a significant overall SWS endorsement by mastery interaction [β = -.11, P = .02], such that SWS was positively associated with higher PWV only when mastery was low. Three SWS dimensions drove this association: SWS strength, SWS suppress emotions, and SWS resistance to vulnerability (all P-values < .05) showing similar patterns to the overall SWS interaction with mastery.

Conclusions: In Black women, high endorsement of SWS is associated with greater arterial stiffness when environmental mastery is low. Thus, SWS may be more physiologically taxing when one senses less control over their environment.

Background: African American adults exhibit disproportionately high rates of tobacco-related diseases and associated death. Experiences with racial discrimination contribute to health disparities among African Americans, but more research is needed to understand associations between perceived discrimination and tobacco use as well as potential protective factors.

Purpose: This study examined associations between perceived racial discrimination and cigarette smoking, as well as religion and spirituality as moderators of any associations.

Methods: Cross-sectional data were drawn from the Jackson Heart Study, a study of cardiovascular disease risk factors among African American adults in Jackson, MS. Measures included perceived everyday discrimination and major life events discrimination that was attributed to race. Participants also reported religious attendance, prayer, spirituality, and whether they prayed in response to discriminatory experiences. Logistic regression models tested associations between perceived racial discrimination and cigarette smoking status, and interactions between religiosity/spirituality and discrimination in predicting smoking status.

Results: A total of 2,972 participants were included in the analysis (62.7% female, mean age 55.1 years). Thirteen percent reported currently smoking cigarettes. Everyday racial discrimination was associated with a higher likelihood of current smoking (p = .01). The association between lifetime racial discrimination and current smoking status was weaker for those who reported prayer as a reaction compared to those who did not report prayer as a reaction (adjusted odds ratio = 0.32, 95% confidence interval: 0.11 to 0.91) while adjusting for demographics and covariates.

Conclusions: Stressful experiences with racial discrimination may create risks for health behaviors like smoking. However, prayer may act as a coping strategy to help buffer the effects of racial discrimination on smoking behavior.

The United States is experiencing unprecedented disruptions to its health infrastructure due to recent federal policy changes threatening public health programs, research funding, and healthcare equity. Policy reversals have rescinded critical initiatives, including diversity, equity, and inclusion efforts; Medicaid support; and international health collaborations. Data removal and censorship further hinder public health decision-making, while personnel and budget cuts to the National Institutes of Health and the Centers for Disease Control and Prevention jeopardize research and local health initiatives. These shifts threaten the career development of early career researchers, limit access to crucial datasets, and undermine the stability of public health training programs. The recommended response for researchers, professionals, and concerned citizens is to take immediate action. Advocacy efforts should focus on engaging policymakers, issuing public statements, and lobbying for alternative funding. Public awareness campaigns are needed to counteract misinformation, leverage media influence, and educate communities on the implications of policy rollbacks. Strengthening grassroots networks by supporting local health initiatives, digital outreach, and mobilizing professionals is critical. Protecting scientific integrity requires advocating for data restoration, opposing censorship, and promoting independent research funding. Legal and institutional resistance can help challenge harmful policies through court actions and amicus briefs. International collaboration should be prioritized to sustain global health partnerships despite US government withdrawals. Proactive leadership in safeguarding public health research and practice has never been greater. Through strategic advocacy, legal action, and community engagement, we should defend public health research, ensure essential services access, and uphold health equity for all.

Background: Although sleep disparities contribute to racial health disparities, little is known about factors affecting sleep among African Americans. One such factor may be positive affect, which could impact sleep directly (direct effect hypothesis) or indirectly by buffering the effects of stress (stress buffering hypothesis).

Purpose: We tested the direct effect and stress buffering effects of positive affect on sleep at three levels (day, week, trait) in a sample of 210 older African American adults, ranging in age from 50 to 89 years old.

Method: Daily positive affect, perceived stress, sleep quality, and sleep duration were collected for five consecutive days. Multilevel modeling was used to test the direct and stress buffering hypotheses both within-person (day level) and between-persons (week level). Trait positive affect, past five-year stress severity, and global sleep quality were assessed cross-sectionally. Regression was used to test the direct and stress buffering hypotheses at the trait level.

Results: In line with the direct effect hypothesis, higher week-level positive affect predicted better sleep quality and sleep duration. Day-level positive affect was not significantly associated with daily sleep quality or daily sleep duration. Higher trait positive affect predicted better global sleep quality. However, neither day-level perceived stress nor past five-year stress severity significantly interacted with positive affect measures for any sleep outcome; no interaction effect was observed on week-level sleep duration. Positive affect and perceived stress interacted at the week level to predict sleep quality, but not in the hypothesized direction.

Conclusions: We found support for the direct effect hypothesis at the week- and trait-levels, but not at the day level. In contrast, we found no support for the stress buffering hypothesis.

Background: Polygenic risk scores (PRS) hold promise for early lung cancer detection and personalized treatment, yet factors influencing patient interest in PRS-based genetic testing are not well understood.

Purpose: Grounded in the health belief model, this mixed-methods study explored knowledge, attitudes, perceived benefits and barriers to lung cancer PRS, and preferences for receiving PRS results.

Results: The study included 141 individuals (41% African American, 63% female) recruited from two hospital affiliates of a comprehensive cancer center in the Southwestern United States. Although participants recognized the severity of lung cancer, knowledge of PRS was limited. Concerns about privacy, psychological impacts, and uncertainty about result usefulness diminished interest in genetic testing for polygenic risk. Significant differences (P < .05) in attitudes were observed: women expressed heightened concerns about psychological effects, and African Americans reported greater perceptions of stigma and concerns about potential familial consequences. Qualitative findings emphasized the psychological burden of learning one's genetic risk, particularly among those with family cancer histories or smoking exposure. Participants emphasized the need for clear, actionable results and assurances of data privacy.

Conclusions: Perceived benefits and barriers to PRS-based testing varied by sociodemographic and personal risk factors, with concerns about stigma, psychological burden, and privacy shaping attitudes. Given participants' emphasis on clear, actionable results, strategies to enhance uptake should improve risk communication, ensure data privacy, and provide guidance on risk-reducing actions. Tailored approaches addressing subgroup-specific concerns may improve diverse patient engagement and equitable access to PRS.

Background: Tai Chi and Qigong (TCQ) can be a non-pharmacological intervention for individuals with mental illness, improving physical function and mental health.

Purpose: This meta-analysis investigated the effects of TCQ on physical function and psychiatric symptoms in adults with schizophrenia or mood disorders.

Methods: Randomized clinical trials on the effect of TCQ on physical function or psychiatric symptoms in individuals with mental illness, published in English, Korean, or Chinese, were included. A systematic search of 17 electronic databases up to September 2024 was conducted. The risk of bias was assessed using Cochrane RoB 2.0. Data were analyzed through meta-analysis, subgroup analysis, and meta-regression.

Results: Nineteen randomized studies (n = 1243, mean age 53 years) reported outcomes on physical function (k = 11) and psychiatric symptoms (k = 18). The risk of bias assessment showed that 21.1% of studies had a low risk, 73.7% had some concerns, and 5.3% had a high risk. TCQ significantly improved physical function (Hedges' g = 0.53, 95% CI, 0.26-0.81) and psychiatric symptoms (Hedges' g = 0.63, 95% CI, 0.41-0.85) in individuals with serious mental illness (SMI), regardless of intervention duration and comparison type. TCQ showed no significant effect on physical function in individuals with schizophrenia but demonstrated a significant moderate effect in those with mood disorders (Hedges' g = 0.56, 95% CI, 0.32-0.80). TCQ significantly improved psychiatric symptoms in both groups (schizophrenia: Hedges' g = 0.64, 95% CI, 0.26-1.02; mood disorders: Hedges' g = 0.64, 95% CI, 0.33-0.96). Meta-regression indicated that the effects of TCQ on physical function covaries with those on psychiatric symptoms among individuals with SMI (Q = 21.43, df = 9, P = .011).

Conclusions: TCQ effectively enhances physical function and psychiatric symptoms in individuals with schizophrenia or mood disorders. These findings support TCQ as an effective non-pharmacological intervention for individuals with SMI. Further studies should explore the underlying mechanisms by which TCQ improves psychiatric symptoms through physical function, leading to the development of targeted intervention strategies in this population.*PROSPERO international prospective register of systematic reviews, registration ID CRD42024581253.

Background: Adherence to adjuvant endocrine therapy (AET) in women with breast cancer is poor. Multicomponent intervention packages are needed to address adherence barriers. Optimizing these packages prior to definitive evaluation can increase their effectiveness, affordability, scalability, and efficiency.

Purpose: To pilot procedures for an optimization-randomized controlled trial (O-RCT) of the 'Refining and Optimizing Strategies to support Endocrine Therapy Adherence' (ROSETA) intervention.

Methods: This was a multisite individually randomized external pilot trial using a 24-1 fractional factorial design (ISRCTN10487576). Breast cancer survivors prescribed AET were recruited from 5 hospitals and randomized to one of 8 conditions, each comprising a combination of 4 intervention components set to "on" or "off" (SMS messages, information leaflet, guided self-help, and self-management website). We set criteria to inform the decision to progress to an O-RCT for consent rate, component adherence, and availability of outcome measures, with predefined cutoffs for "green" (proceed), "amber" (minor changes), and "red" (major changes).

Results: Among 141 eligible patients, 54 (38.3%) consented (green range). At least 50.0% of participants adhered to the minimum threshold set for each intervention component (green range). Data for one of the 3 medication adherence measures were available (amber range). Most (86.8%) participants were satisfied with their trial experience. Exploratory analysis indicated some evidence of a negative main effect of the information leaflet on medication adherence (adjusted mean difference = 0.088, 95% CI, 0.018, 0.158).

Conclusions: Progression to a fully powered O-RCT of the ROSETA intervention package is feasible, but review of medication adherence measures is required.

Background: Social cognitive theory proposes outcome expectations as an important factor in behavior change and maintenance. However, it is unknown whether and how outcome expectations interact with prosocial traits in predicting repeated blood donation (RBD) behavior.

Purpose: The current study aimed to test the prospective association between outcome expectations and RBD behavior and the roles of altruism and re-donation intention in this association.

Methods: A total of 850 blood donors recruited from blood donation sites in Hangzhou, China, completed an online baseline survey. Their RBD behavior was captured by checking their blood donation records in the database of Blood Center of Zhejiang Province 6 months later.

Results: Anticipated physical benefits positively predicted RBD behavior, while anticipated physical harms negatively predicted it. Moderated mediation analyses showed that overall outcome expectations and anticipated physical benefits predicted more RBD behavior through increased re-donation intention, and this effect was moderated by altruism. Specifically, the positive effect of overall outcome expectations and anticipated physical benefits on re-donation intention was stronger among donors with lower levels of altruism. Overall outcome expectations and anticipated physical benefits were found to have a significant impact on RBD behavior only in donors with lower levels of altruism.

Conclusions: The findings suggest that interventions aimed at promoting RBD behavior should seek to enhance re-donation intention, overall outcome expectations, and altruism. In particular, it is important to increase the overall outcome expectations-especially anticipated physical benefits-of donors with lower levels of altruism.

Background: While brief behavioral therapy for insomnia (BBTI) has shown promising results in improving sleep outcomes, its effects on health-related quality of life (HRQOL) and mental health among cancer survivors have been understudied.

Purpose: To evaluate the effect of BBTI on HRQOL and mental health outcomes among cancer survivors, relative to an attention control group receiving a healthy eating program (HEP), over periods from baseline to 12 months and from 3 to 12 months.

Methods: A sample of 132 cancer survivors with insomnia symptoms (Mage: 63.7 ± 10 years; 55.3% female) was assessed at baseline, with the final analytical sample of 121 (BBTI = 62, HEP = 59). Self-reported HRQOL, mood disturbance, depression, and anxiety at baseline, 3 months, and 12 months were examined. A multivariate linear model using least squares means evaluated within- and between-group differences.

Results: No significant differences in outcome variables were found between the randomized groups at any time point. Both groups showed significant improvements in total HRQOL, mood disturbance, and anxiety symptoms from baseline to 12 months. Only the BBTI group demonstrated a significant reduction in depressive symptoms within the group, an effect not observed in the HEP group. The most noticeable changes occurred within the first 3 months, with no statistically significant differences from 3 to 12 months within or between groups.

Conclusion: While both randomized groups showed improvements in total HRQOL, mood, and anxiety symptoms, only BBTI produced significant within-group improvements in depressive symptoms over 12 months.

Clinical trial registration: https://ClinicalTrials.gov, NCT03810365.