Annals of Behavioral Medicine最新文献

Background: Medical illnesses are major stressors not only for the patients but also for their family caregivers, yet existing tools are inadequate to assess mechanistic response patterns to such stressors.

Purpose: We sought to validate a stress induction task that pertains to close relationships and health-related concerns with adult patients with cancer and their family caregivers.

Methods: Patients newly diagnosed with colorectal cancer (n = 123, 56 years old, 34% female, 60% Hispanic, 6.5 months post-diagnosis) and their family caregivers (55 years old, 66% female, 59% Hispanic) underwent an experimental session during which both individuals imagined a scenario where one person is hit by a car (patient) and the partner (caregiver) has no means to provide or seek out help for the victim. The session consisted of 6 phases: baseline, scenario provision, speech preparation, speech by caregiver, speech by patient, and recovery.

Results: Results of general linear modeling with repeated measures revealed that the task induced significant affective, stress, and cardiovascular responses in both patients and caregivers. Stress reactivity and recovery patterns, however, varied by patients versus caregivers, stress induction phases, and the types of assessment.

Conclusions: Findings suggest the newly developed stress task as an acceptable tool for studying stress regulation in medical and family contexts. With further validation, this tool may help identify psychological and physiological pathways to improve the stress coping outcomes of adult patients with cancer and their family caregivers.

Background: By 2045, the global population of people with diabetes (PWD) is projected to reach 783 million. Health education tools are needed to enhance glycemic management among PWD.

Purpose: This study evaluated the effects of a diabetes conversation map (CM) intervention on glycated hemoglobin (HbA1c) and examined the mediating roles of health behavior improvements among PWD in Taiwan.

Methods: A large randomized controlled trial (N = 602) investigated: (1) whether an additional 1-hour, theory-driven CM intervention (N = 300), compared with usual shared-care service only (N = 302), could significantly better improve PWD's HbA1c at 3-month posttest, and (2) whether the CM intervention's effects on HbA1c reduction were mediated through desired changes in diet and exercise health behaviors between pretest and 3-month posttest.

Results: Multivariate linear autoregression analysis demonstrated that controlling for baseline levels, the CM group exhibited significantly lower HbA1c (β = -0.101) at 3-month posttest than the control group. In addition, the CM group showed significantly greater improvements in both diet (β = 0.261) and exercise (β = 0.239) health behaviors between the pretest and 3-month posttest, compared with the control group. Further mediation analysis revealed that the CM intervention's effects on HbA1c reduction were primarily mediated through improvements in diet (β = -0.126, P < .001), rather than improvements in exercise (β = -0.023, P = .465).

Conclusions: Integrating brief, single-session CM interventions, as described in this study, into existing diabetes shared-care frameworks may effectively enhance diet and exercise health behaviors and thereby improve HbA1c management among PWD.

Background: More screen time (ST) is associated with dysregulation of the individual biological systems (cardiovascular, immune, metabolic, and neuroendocrine) involved in the stress response in youth. However, its relationship with allostatic load (AL), a measure of the cumulative physiological stress response, is unclear in youth.

Purpose: To investigate the associations between ST types and AL outcomes in youth and to explore sociodemographic and behavioral moderators of these relationships.

Methods: Cross-sectional data were from 1053 US youth aged 12-17 years (Mage = 14.20; 54% male; 21% Hispanic) in the 2015-2018 National Health and Nutrition Examination Survey (NHANES). ST was assessed as watching TV/videos and computer use/playing computer games. AL was measured using 7 biomarkers across 3 systems: cardiovascular (systolic and diastolic blood pressure, heart rate), immune (C-reactive protein), and metabolic (body mass index, glycohemoglobin, and high-density lipoprotein). Weighted multivariable regression models assessed whether ST predicted AL composite and subsystem (cardiovascular, immune, and metabolic) scores. Moderation by age, sex, income, race/ethnicity, and physical activity was explored.

Results: A 1-hour/day increase in watching TV/videos was associated with a 4% increase in mean AL composite score (incident rate ratio = 1.040; 95% CI = 1.008, 1.073; P = .015), while computer use/gaming showed no significant associations (P's > .05). Age moderated the TV/videos-AL cardiovascular association (P = .009), with older youth having higher AL cardiovascular scores.

Conclusions: More time spent watching TV/videos was associated with higher cumulative physiological stress in youth. Prospective studies are needed to determine causal pathways and potential intervention targets in youth.

Background: Adolescent and young adult survivors of childhood cancer (AYA) are at risk for treatment-related late effects (eg, heart and lung problems) which may be mitigated by physical activity (PA). To design effective, tailored PA interventions for this population, predictors and benefits of PA behavior need to be measured in real-time.

Purpose: To examine the feasibility and acceptability of ecological momentary assessment (EMA) combined with accelerometry and explore the dynamic associations between PA and real-time physical and psychosocial factors among AYA.

Methods: AYA (N = 20, mean age = 18.9 years) recently off cancer treatment participated in a 2-week intensive monitoring protocol in which they completed up to 4 EMA surveys/day assessing current mood, pain, fatigue, arousal, PA intentions and motivation, and social-environmental context, while PA levels were passively monitored using a wrist-worn ActiGraph GT9X accelerometer. Acceptability was measured via self-report.

Results: EMA and accelerometry were feasible and acceptable (≥70% compliance and study endorsement) for AYA. Multilevel models showed that AYA engaged in more PA when they were away from home, with others, in a better mood, less fatigued, more energetic, and more motivated than their own average levels. Further, when AYA engaged in more PA than their usual levels in the hour before completing an EMA survey, they subsequently reported less fatigue, less pain, more energy, and a more positive mood.

Conclusions: EMA and accelerometry are acceptable and feasible among AYA survivors of childhood cancer. This methodology can be utilized for understanding the real-time barriers, facilitators, and benefits of PA behaviors in this at-risk population to design effective, dynamic PA interventions.

Background: Success in community-based interventions addressing colorectal cancer (CRC) disparities among men relies on their active engagement in screening activities, yet traditional masculinity norms may deter men from participating in preventive health behaviors.

Purpose: This cross-sectional study examined the association between masculinity barriers to medical care (MBMC) and CRC-screening intent and behaviors among men aged 18-75, attending state fairs in 2 midwestern states.

Methods: CRC-screening intent was assessed for all participants. Screening participation and current screening status were also examined among men aged 45-75 years (screening-age eligible). Composite scores were calculated overall and for each MBMC subscale, with higher scores indicating a stronger endorsement of traditional masculine ideologies. Multivariable logistic regression was employed, adjusting for confounders.

Results: Our findings highlight a high prevalence of self-reported CRC-screening behaviors among men in our study sample (n = 937), with 78% expressing intentions to obtain screening. Among screening-age eligible men (n = 377), 79% reported having participated in CRC screening, with 72% being up-to-date (UTD) with screening. A strong inverse relationship was observed between CRC-screening intention and behaviors, and the Health Problem Minimization subscale as well as Fear of Being Perceived as Gay subscale. Conversely, higher scores on the Provider Role subscale were associated with higher odds of having ever participated in CRC screening, and of being UTD with screening.

Conclusions: Addressing masculinity-related barriers, particularly Health Problem Minimization, could help increase CRC screening uptake among men. Future intervention strategies should consider reframing CRC screening as an act of self-care and strength, emphasizing health empowerment rather than aligning solely with traditional masculine or provider-role ideologies, which may themselves present limitations. By promoting a broader and more inclusive view of masculinity, interventions can better engage men in preventive health behaviors and ultimately improve CRC-screening adherence and outcomes.

Background: The mechanisms through which the blended mindfulness-based stress reduction (MBSR) program improves diabetes self-management among individuals with Type 2 diabetes mellitus (T2DM) remain unclear.

Purpose: This study aims to evaluate the effectiveness of blended MBSR on perceived stress, anxiety, and depressive symptoms, while also exploring the potential mechanisms underlying its effects on improving diabetes self-management.

Methods: One hundred individuals with T2DM were recruited and randomly assigned to two groups (50 participants each) from March 2020 to July 2020. A randomized clinical trial, combined with generalized estimating equations for repeated measures, was employed to assess the intervention effects of the blended MBSR on perceived stress, anxiety, and depressive symptoms compared to standard care. Mediation analyses using Model 4 in SPSS PROCESS were conducted to evaluate the contributions of the blended MBSR to diabetes self-management.

Results: Participants in the blended MBSR group showed a significant reduction in perceived stress, anxiety, and depressive symptoms compared to the control group over 12 weeks. Bootstrap mediation analyses indicated that changes in perceived stress and anxiety fully mediated the effect of the blended MBSR on diabetes self-efficacy. In contrast, depressive symptoms were not associated with diabetes self-efficacy and therefore did not qualify as mediators. Additionally, diabetes distress was found to be an insignificant mediator. Furthermore, changes in diabetes self-efficacy served as a partial mediator of the positive effects of the blended MBSR on diabetes self-management.

Conclusions: The blended MBSR program effectively reduced perceived stress, anxiety, and depressive symptoms in individuals with T2DM. The intervention's impact on perceived stress and anxiety contributed to an increase in diabetes self-efficacy, subsequently enhancing diabetes self-management. Interventions that aim to reduce perceived stress and anxiety, while also increasing diabetes self-efficacy, are recommended to develop diabetes self-management strategies with clearly defined mechanistic pathways.

Background: It is standard practice for healthcare providers to give weight loss advice or counseling to higher-weight patients (ie, those with a BMI ≥ 30 kg/m2), but the immediate psychological consequences of this practice have rarely been examined.

Purpose: We hypothesized that receiving weight loss advice from a healthcare provider might lead people to feel both motivated to engage in healthy behaviors and stigmatized for their weight.

Methods: Participants with higher weight (N = 294) were randomly assigned to read one of two doctor-patient interaction scenarios, and they were asked to imagine that they were the patient receiving advice. The scenario either involved the doctor giving behavioral weight loss advice (ie, standard diet and exercise recommendations) or control advice, which did not address weight or weight loss. Immediately after reading, participants reported their levels of behavioral motivation and weight-based identity threat.

Results: Participants who received weight loss (versus control) advice reported significantly greater motivation for healthy eating and greater weight-based identity threat (Ps < .001, ds from 0.42 to 0.64). There were no significant group differences in perceptions of provider empathy or willingness to engage with the healthcare system in the future (Ps > .1, ds from 0.13 to 0.2).

Conclusions: As hypothesized, receiving weight loss advice made participants feel motivated to engage in healthy eating behavior, but it also made them feel stigmatized. These findings suggest that the standard practice of delivering weight loss advice should be reexamined, as it may harm higher-weight people and perpetuate inequity.

Background: Adolescent and young adult survivors of childhood cancer (AYA) are at risk for treatment-related late effects (eg, heart and lung problems) which may be mitigated by physical activity (PA). To design effective, tailored PA interventions for this population, predictors and benefits of PA behavior need to be measured in real-time.

Purpose: To examine the feasibility and acceptability of ecological momentary assessment (EMA) combined with accelerometry and explore the dynamic associations between PA and real-time physical and psychosocial factors among AYA.

Methods: AYA (N = 20, mean age = 18.9 years) recently off cancer treatment participated in a 2-week intensive monitoring protocol in which they completed up to 4 EMA surveys/day assessing current mood, pain, fatigue, arousal, PA intentions and motivation, and social-environmental context, while PA levels were passively monitored using a wrist-worn ActiGraph GT9X accelerometer. Acceptability was measured via self-report.

Results: EMA and accelerometry were feasible and acceptable (≥70% compliance and study endorsement) for AYA. Multilevel models showed that AYA engaged in more PA when they were away from home, with others, in a better mood, less fatigued, more energetic, and more motivated than their own average levels. Further, when AYA engaged in more PA than their usual levels in the hour before completing an EMA survey, they subsequently reported less fatigue, less pain, more energy, and a more positive mood.

Conclusions: EMA and accelerometry are acceptable and feasible among AYA survivors of childhood cancer. This methodology can be utilized for understanding the real-time barriers, facilitators, and benefits of PA behaviors in this at-risk population to design effective, dynamic PA interventions.

Objective: Emerging research suggests the use of certain strategies to cope with stressors relate to disease and mortality risk, and lifestyle habits may be underlying mechanisms. Studies show psychological symptoms (eg, anxiety) and states (eg, happiness) predict the likelihood of adopting an integrated lifestyle that encompasses key health-related behaviors, like smoking. Yet, whether psychological processes, including stress-related coping, influence the adoption of a healthy lifestyle is unknown. We investigated whether coping strategies typically deemed adaptive (eg, seeking emotional support) and maladaptive (eg, denial) relate to sustaining a healthy lifestyle over a 16-year follow-up. We also explored whether variability in the use of these strategies, reflecting attempts to find the best strategy for a given stressor, subsequently relates to lifestyle.

Methods: Women (N = 46 067) from the Nurses' Health Study II cohort reported their use of 8 coping strategies in 2001, from which we also derived coping variability levels (lower, moderate, greater). Health behaviors (eg, physical activity, smoking, sleep), self-reported every 4 years from baseline until 2017, were combined into a lifestyle score. Generalized estimating equations, controlling for baseline demographics and health-related factors, were performed.

Results: Most adaptive strategies and greater variability levels were associated with a higher likelihood of sustaining a healthy lifestyle (eg, active coping, relative risk [RR] = 1.09, 95% confidence interval [CI], 1.08-1.11), with the reverse evident with maladaptive strategies (eg, behavioral disengagement, RR = 0.94, CI, 0.93-0.95), but some unexpected results also emerged.

Conclusions: Findings highlight the importance of going beyond the usual (mal)adaptive categorization of coping strategies when investigating their predictive value with behavioral outcomes.