Annals of Behavioral Medicine最新文献

Background: Side effects following vaccination intensify vaccine hesitancy, which remains a significant challenge to public health. Research suggests that a proportion of side effects are not caused by the vaccine but are instead associated with psychological factors that influence nocebo responding.

Purpose: This study investigates the psychological and demographic factors associated with symptom reporting postvaccination, the attribution of these symptoms as side effects, and their influence on future intentions to vaccinate.

Methods: A prospective, longitudinal design was employed with 225 influenza vaccination recipients. Demographic and psychological measures (including anxiety, vaccination attitudes, and side effect expectations) were completed at baseline. Side effects were measured immediately and 1-week following the vaccination. Future intentions to vaccinate were measured 1-week postvaccination.

Results: Anxiety (P < .001) and perceived sensitivity to vaccines (P = .044) predicted the number of symptoms reported immediately following vaccination. Anxiety (P < .001) and perceived sensitivity (P = .035) along with baseline symptoms (P < .001) predicted symptoms 1 week following the vaccination. Female gender (P = .003), younger age (P = .018), anxiety (P < .001), and baseline symptoms (P = .009) predicted whether participants attributed symptoms as vaccination side effects. Anti-vaccination attitudes were associated with less intention to vaccinate in the future (P = .033).

Conclusions: Nocebo-associated psychological factors contributed to symptoms experienced after an influenza vaccination. Findings demonstrate that the way symptoms are noticed, and then interpreted as side effects, appear to be separate mechanisms promoted by different factors. This study improves identification of side effect reporters prior to vaccination.

Background: Low levels of physical activity (PA), more prevalent among those with low education, require effective interventions. Fewer trials have tested interventions to decrease sedentary behavior (SB). No school-based interventions have shown lasting effects on PA or SB in vocational schools.

Purpose: To examine whether the Let's Move It intervention has effects on behavioral and clinical outcomes among vocational students after 2 and 14 months.

Methods: A cluster randomized trial in 6 school units in vocational education in Finland (N = 1112) (mean age 18.5 years, range 15-46). The multi-component intervention targeted in-class activity opportunities (eg, teacher-led activity breaks, equipment in classrooms), and students' motivation and self-regulation (eg, 6 group sessions, à 45-60 min, during the intensive intervention period of 2 months). Valid (≥ 4 days, ≥ 10 h/day) accelerometer data were obtained from 741 students at baseline, 521 (70.3%) at 2 months, and 406 (54.8%) at 14 months.

Results: No evidence of a significant intervention effect on the co-primary outcomes (moderate-to-vigorous PA, SB, breaks in SB) was found. Participants in the intervention arm reduced their total daily SB time by 32 min (95% CI, -43.2 to -20.8) on weekdays, compared with the control arm's reduction of 8.6 (95% CI, -19.5 to 2.3) and engaged in more accelerometer-measured light PA during school time. Few differences were found in secondary outcomes. The fidelity of intervention delivery was relatively good.

Conclusions: This school-based intervention did not affect leisure-time activity. Despite a positive outcome on school-time light PA, more comprehensive or intensive environmental changes may be needed to meaningfully improve vocational students' total activity.

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.

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: The daily dynamics among affect, physical activity, and sleep are often explored by taking a unidirectional approach. Yet, obtaining a comprehensive understanding of the reciprocal dynamics among affect and health behaviors is crucial for promoting daily well-being.

Purpose: This study examined the reciprocal associations among affect, physical activity, and sleep in daily life in a U.S. national sample of mid- and later-life adults.

Methods: The study sample included 1,171 participants (mean age = 62.61 years, SD = 10.26 years, 57% female, 82% White) with 9,033 daily interview days from the daily diary project of the third wave of the Midlife in the United States study (MIDUS III). Participants reported their daily experiences across eight consecutive days. Using a dynamic structural equation modeling, we examined day-to-day autoregressive and cross-lagged associations among positive and negative affect, physical activity, and sleep.

Results: Results revealed that higher positive affect predicted a greater likelihood of engaging in moderate-to-vigorous physical activity (MVPA) and better sleep quality the following day. Higher sleep quality predicted increased positive affect, reduced negative affect, and a greater likelihood of MVPA engagement the next day. Longer sleep duration predicted lower negative affect the following day. However, MVPA engagement predicted subsequent higher negative affect.

Conclusions: Findings underscore the importance of simultaneously considering affect, physical activity, and sleep in studying their day-to-day dynamics, and the protective role of positive affect and sleep quality in daily life. Maintaining high positive affect and managing sleep quality may be important intervention targets for enhancing daily well-being.

Background: Observationally, family and social support are important for optimal diabetes self-management; however, interventions targeting family/social support have not consistently been effective. A novel, diabetes-specific family functioning typology offers the opportunity to classify types of baseline family functioning to determine for whom family interventions may be effective.

Purpose: We examined the effects of an intervention by baseline type of family functioning post hoc, to inform differential benefit from interventions.

Methods: Participants were randomized to enhanced treatment as usual or a 9-month, mobile phone-delivered, family-focused, self-care support intervention. Adults with type 2 diabetes (N = 318) who participated in the randomized clinical trial (RCT) and provided baseline data were included. We determined participants' diabetes-specific family functioning types at baseline using a validated, survey-administered, typology assessment tool. We investigated the associations between type and engagement (eg, attending coaching sessions and responding to text messages) and psychosocial (eg, well-being and diabetes distress) and glycemic outcomes at mid- and post-treatment.

Results: Despite overall high engagement, there was variability across types in engagement and effects. WantMoreInvolvement benefited the most; Satisfied withLowInvolvement showed early improvements that waned; Collaborative &Helpful were highly engaged but derived minimal benefits from the intervention; and CriticallyInvolved benefitted the least and may have experienced some harm.

Conclusions: We demonstrated the utility of a novel diabetes-specific family functioning typology to explain variability in response to a family-focused intervention. Findings from this work answer the calls for systems-level consideration in precision behavioral medicine and drive hypothesis generation for future, tailored interventions.

Registration: The larger RCT is registered with ClinicalTrials.gov (NCT04347291).

Background: This is the first study to examine longitudinal associations between self-selected timing of moderate-to-vigorous physical activity (MVPA) and health outcomes in young adults over 18 months.

Methods: Young adults (N = 434, Mage = 23.9, SDage = 4.6 years) enrolled in a weight management trial recorded 4-7 days of ActiGraph wear time at ≥1 time point (baseline, months 6, 12, and 18). Time-of-day categories were based on quartiles of the temporal distribution of MVPA min/h at baseline: morning (06:00-11:59), afternoon (12:00-15:59), evening (16:00-18:59), and night (19:00-00:59). The proportion of weekly MVPA accumulated during each time category was the predictor in longitudinal linear mixed-effects models predicting body mass index (BMI) and total weekly MVPA. Longitudinal quasibinomial generalized estimating equations models predicted cardiometabolic risk. Interactions were tested, and marginal trend estimates were generated for sex and age subgroups.

Results: The analytic sample was 79% female and 49% non-Hispanic White, with a mean (±SD) weekly MVPA of 311 ± 167 min at baseline. In adjusted models, there were no associations with BMI. Morning MVPA was inversely associated with cardiometabolic risk (OR [95% CI]: 0.99 [0.98-0.99]) for both sex and age groups. Evening MVPA was inversely associated with cardiometabolic risk for 26-35 year olds (0.98 [0.97-0.99]). Morning MVPA was associated with greater total MVPA across subgroups, and afternoon MVPA was associated with less total MVPA in women.

Conclusions: Over 18 months, incremental health benefits may accrue with optimal activity timing in young adults. Activity-based interventions designed to improve cardiometabolic and behavioral health outcomes in young adults may be optimized by tailoring timing recommendations to demographic factors.

Background: Physical activity is essential for health and wellbeing. However, many individuals fail to reach the recommended levels and obesity rates are increasing. Health-related social control refers to strategies employed by 1 person (agent) to influence another person's (target) health behavior. These strategies can be classified into persuasion (eg, encouraging or motivating) or pressure (eg, nagging or coercing). However, much of the existing research is cross-sectional and mostly focuses on the experiences of the targets.

Purpose: This study investigates how persuasion and pressure within overweight romantic couples relate to outcomes in both agents and targets. Specifically, it examines same-day associations with positive and negative affect, as well as physical activity.

Methods: This study is a secondary analysis of the 14-day follow-up period from a randomized controlled trial. Accelerometers and daily diaries tracked 99 overweight romantic couples. For each outcome and each partner, separate multilevel models were fitted.

Results: Daily persuasion used by agents was associated with increased physical activity in targets and a more favorable affect in agents. Daily pressure was not associated with the physical activity of either partner but was linked to a more unfavorable affect in the agent. Both persuasion and pressure were unrelated to the targets' affect.

Conclusions: Health-related social control in romantic relationships relates to same-day outcomes of both agents and targets. Our findings suggest that health behavior change interventions and weight loss programs could benefit from encouraging persuasion and limiting pressure.

Introduction: Economic, social, and traumatic stressors have been shown to impact mental and physical health. Few studies have considered whether different domains of stressors have a differential effect on health outcomes or have considered stressors across the lifecourse. We characterize stress cumulatively (life stress) and across different domains and examine their relation to adult mental and physical health using prospectively collected data from the DISPAR study.

Methods: At 4 timepoints (birth, age 9, 15, and 50), economic, relational, and traumatic stressors were assessed, and interviews were conducted between 1959 and 2012. Experiences of major discrimination were assessed at age 50. Life stress scores and domain-specific stress scores, (occurring in either childhood or adulthood), were created. The Kessler distress scale, self-reported health, and objective measured allostatic load (AL) were assessed at age 50.

Results: Adjusting for race and sex, life stress was associated with all 3 outcomes. Domain-specific analysis showed that only SES stressors impacted all outcomes (poorer self-rated health, higher distress, and higher AL). Relational stress was associated with distress only; experiences of discrimination were associated with poor self-rated health and distress.

Conclusion: Stressors across the lifecourse have been proposed to affect wear and tear on multiple bodily systems and to affect multiple health outcomes. Our empirical test supported this hypothesis in a 50-year old cohort and in particular the impact of economic stress across physical and mental health outcomes.

Background: Daily hassles, as minor stressful events, are common in life. However, they have received less attention in previous studies on relationships between stressful events and nicotine product use. Meanwhile, daily uplifts have also been investigated less in research on nicotine use.

Purpose: The current study was conducted to explore the relationships between daily measures of hassles, uplifts, and the use of nicotine products (ie, cigarettes, e-cigarettes).

Methods: This was a daily diary study. Participants completed 1 diary each day for up to 7 days. One hundred and eighty-one adults who currently use cigarettes or e-cigarettes solely or co-use both completed a total of 886 daily diary entries. Multilevel modeling was used to predict the daily use of the above nicotine products from daily hassles, daily uplifts, and their interactions.

Results: Daily hassles were positively associated with any daily nicotine use. There were no significant associations between daily hassles and daily cigarette use or between daily hassles and daily e-cigarette use. Daily uplifts were not directly associated with any behaviors, but daily hassles and daily uplifts showed a significant interaction in affecting any daily nicotine use, daily cigarette use, and daily e-cigarette use. In each use pattern, increasing levels of uplifts were associated with an attenuation of the relationship between hassles and the use of nicotine products.

Conclusions: It may be worthwhile to explore further the effects of daily hassles and daily uplifts on nicotine product use through ecological momentary assessments.