The Mediating Roles of Perceived Stress and Health Behaviors in the Relation Between Objective,Subjective, and Neighborhood Socioeconomic Status and Perceived Health

Background

Objective, subjective, and neighborhood socioeconomic status (SES) are associated with perceived health, morbidity, and mortality.

Purpose

We investigated whether perceived stress and health behaviors mediated the relation between the three types of SES and perceived health.

Methods

Participants (N?=?508) attending a public clinic completed a computerized survey assessing objective SES (income, education, employment); health behaviors; perceived stress; and perceived health. They also indicated their social standing relative to others (subjective SES) and provided their current address to determine neighborhood SES.

Results

In a structural equation model including all three SES types, lower objective and subjective SES were related to poorer perceived health. When mediators were included in the model, there were significant indirect effects of (a) SES on health through stress and (b) SES on health through stress and health-compromising behaviors.

Conclusions

Interventions to reduce the impact of stressors could improve the health of socioeconomically disadvantaged individuals.     

Combining Self-Affirmation and Implementation Intentions: Evidence of Detrimental Effects on Behavioral Outcomes

Background

There is limited evidence that self-affirmation manipulations can promote health behavior change.

Purpose

The purpose of this study was to explore whether the efficacy of a self-affirmation manipulation at promoting exercise could be enhanced by an implementation intention intervention.

Methods

Participants (Study 1?N?=?120, Study 2?N?=?116) were allocated to one of four conditions resulting from the two (self-affirmation manipulation: no affirmation, affirmation) by two (implementation intention manipulation: no implementation intention, implementation intention) experimental design. Exercise behavior was assessed 1 week post-intervention.

Results

Contrary to prediction, those participants receiving both manipulations were significantly less likely to increase the amount they exercised compared to those receiving only the self-affirmation manipulation.

Conclusion

Incorporating an implementation intention manipulation alongside a self-affirmation manipulation had a detrimental effect on exercise behavior; participants receiving both manipulations exercised significantly less in the week following the intervention.     

Reflective and Automatic Processes in Health Care Professional Behaviour: a Dual Process Model Tested Across Multiple Behaviours

Background

Clinicians’ behaviours require deliberate decision-making in complex contexts and may involve both impulsive (automatic) and reflective (motivational and volitional) processes.

Purpose

The purpose of this study was to test a dual process model applied to clinician behaviours in their management of type 2 diabetes.

Methods

The design used six nested prospective correlational studies. Questionnaires were sent to general practitioners and nurses in 99 UK primary care practices, measuring reflective (intention, action planning and coping planning) and impulsive (automaticity) predictors for six guideline-recommended behaviours: blood pressure prescribing (N?=?335), prescribing for glycemic control (N?=?288), providing diabetes-related education (N?=?346), providing weight advice (N?=?417), providing self-management advice (N?=?332) and examining the feet (N?=?218).

Results

Respondent retention was high. A dual process model was supported for prescribing behaviours, weight advice, and examining the feet. A sequential reflective process was supported for blood pressure prescribing, self-management and weight advice, and diabetes-related education.

Conclusions

Reflective and impulsive processes predict behaviour. Quality improvement interventions should consider both reflective and impulsive approaches to behaviour change.     

Using Mental Imagery to Deliver Self-Regulation Techniques to Improve Sleep Behaviors

Background

Poor sleep habits and insufficient sleep represent significant workplace health issues.

Purpose

Applying self-regulation theory, we conducted a randomized, controlled trial testing the efficacy of mental imagery techniques promoting arousal reduction and implementation intentions to improve sleep behavior.

Method

We randomly assigned 104 business employees to four imagery-based interventions: arousal reduction, implementation intentions, combined arousal reduction and implementation intentions, or control imagery. Participants practiced their techniques daily for 21 days. They completed online measures of sleep quality, behaviors, and self-efficacy at baseline and Day 21; and daily measures of sleep behaviors.

Results

Participants using implementation intention imagery exhibited greater improvements in self-efficacy, sleep behaviors, sleep quality, and time to sleep relative to participants using arousal reduction and control imagery.

Conclusions

Implementation intention imagery can improve sleep behavior for daytime employees. Use of arousal reduction imagery was unsupported. Self-regulation imagery techniques show promise for improving sleep behaviors.     

Randomized Controlled Trial of a Behavior Change Intervention to Increase Physical Activity and Quality of Life in Prostate Cancer Survivors

Background

Physical activity improves health in prostate cancer survivors; however, participation rates are low.

Purpose

This study aims to determine the effects of an implementation intention intervention on physical activity and quality of life in prostate cancer survivors.

Methods

Prostate cancer survivors (N?=?423) were randomly assigned to a standard physical activity recommendation, a self-administered implementation intention, or a telephone-assisted implementation intention. Physical activity and quality of life were assessed at baseline, 1, and 3 months.

Results

Analyses of covariance using multiple imputation showed that physical activity at 1 month increased by 86 min/week in the standard physical activity recommendation group compared with 168 min/week in the self-administered implementation intention group (P?=?0.023) and 105 min/week in the telephone-assisted implementation intention group (P?=?0.35).

Conclusions

A self-administered implementation intention intervention resulted in a meaningful short-term increase in physical activity. Supplementation with additional intervention strategies and more frequent intervention may improve longer-term exercise. (ClinicalTrials.gov number NCT01410656).     

Socioeconomic Status, Nocturnal Blood Pressure Dipping, and Psychosocial Factors: A Cross-Sectional Investigation in Mexican-American Women

Background

Despite established links between reduced nocturnal blood pressure (BP) dipping and cardiovascular disease, BP dipping research in Hispanics is limited.

Purpose

This study investigated socioeconomic status (SES) as a predictor of BP dipping and the contributions of psychosocial factors to this relationship. Analyses were conducted for the overall sample and separately for higher and lower acculturated women.

Methods

Mexican-American women (N?=?291; 40?C65?years) reported demographics and completed psychosocial assessments and 36-h ambulatory BP monitoring.

Results

Lower SES related to reduced BP dipping in the overall sample and in more US-acculturated women (r??s?=?.17?C.30, p??s?<?.05), but not in less-acculturated women (r??s?=?.07, p??s?>?.10). An indirect effect model from SES to BP dipping via psychosocial resources/risk fits well across samples.

Conclusions

In Mexican-American women, the nature of SES gradients in BP dipping and the roles of psychosocial resources/risk differ by acculturation level.     

Associations Between Socioeconomic Status and Catecholamine Levels Vary by Acculturation Status in Mexican-American Women

Background

Lower socioeconomic status (SES) is associated with poorer health, possibly through activation of the sympathetic nervous system.

Purpose

This study aimed to examine the association between SES and catecholamine levels, and variations by acculturation.

Methods

Three hundred one Mexican-American women underwent examination with a 12-h urine collection. Analyses tested associations of SES, acculturation (language and nativity), and their interaction with norepinephrine (NOREPI) and epinephrine (EPI).

Results

No main effects for SES or the acculturation indicators emerged. Fully adjusted models revealed a significant SES by language interaction for NOREPI (p?<?.01) and EPI (p?<?.05), and a SES by nativity interaction approached significance for NOREPI (p?=?.05). Simple slope analyses revealed that higher SES related to lower catecholamine levels in Spanish-speaking women, and higher NOREPI in English-speaking women. Although nonsignificant, similar patterns were observed for nativity.

Conclusions

Associations between SES and catecholamines may vary by acculturation, and cultural factors should be considered when examining SES health effects in Hispanics.     

Spouse Confidence in Self-Efficacy for Arthritis Management Predicts Improved Patient Health

Background

In addition to patient self-efficacy, spouse confidence in patient efficacy may also independently predict patient health outcomes. However, the potential influence of spouse confidence has received little research attention.

Purpose

The current study examined the influence of patient and spouse efficacy beliefs for arthritis management on patient health.

Methods

Patient health (i.e., arthritis severity, perceived health, depressive symptoms, lower extremity function), patient self-efficacy, and spouse confidence in patients’ efficacy were assessed in a sample of knee osteoarthritis patients (N?=?152) and their spouses at three time points across an 18-month period. Data were analyzed using structural equation models.

Results

Consistent with predictions, spouse confidence in patient efficacy for arthritis management predicted improvements in patient depressive symptoms, perceived health, and lower extremity function over 6 months and in arthritis severity over 1 year.

Conclusions

Our findings add to a growing literature that highlights the important role of spouse perceptions in patients’ long-term health.     

Psychosocial Mediators of Two Community-Based Physical Activity Programs

Background

Previous findings are inconclusive regarding the mediators of physical activity behavior change.

Purpose

To test self-efficacy and social support as mediators of Active Choices, a telephone-delivered physical activity intervention, and Active Living Every Day, a group-based physical activity intervention, implemented with midlife and older adults in community settings.

Methods

MacKinnon's product of coefficients was used to examine social support and self-efficacy as mediators of change in physical activity. The proportion of the total effect mediated was calculated. Each model controlled for age, gender, race (white vs. non-white), body mass index (BMI), and education (high school graduate or less vs. at least some college).

Results

Increases in self-efficacy mediated increases in physical activity among Active Choices (n?=?709) and Active Living Every Day (n?=?849) participants. For Active Living Every Day, increases in social support also mediated increases in physical activity in single mediator models.

Conclusions

Increasing self-efficacy and social support may help increase physical activity levels in older adults.     

Socioeconomic status and children’s mental health: results from the Bergen Child Study

Purpose

It is generally accepted that mental health problems are unequally distributed across population strata defined by socioeconomic status (SES), with more problems for those with lower SES. However, studies of this association in children and adolescents are often restricted by the use of global measures of mental health problems and aggregation of SES-indicators. We aim to further elucidate the relationship between childhood mental health problems and SES by including more detailed information about mental health and individual SES-indicators.

Methods

The participants (N?=?5,781, age 11–13) were part of the Bergen Child Study (BCS). Mental health was assessed using the teacher, parent and self-report versions of the Strengths and Difficulties Questionnaire (SDQ), including an impact section, used to measure symptom dimensions and probability of psychiatric disorders. Parent reports of family economy and parental education were used as SES measures.

Results

For each SES indicator we confirmed an inverse relationship across all the symptom dimensions. Poor family economy consistently predicted mental health problems, while parental education level predicted externalizing disorders stronger than internalizing disorders.

Conclusion

In this Norwegian sample of children, family economy was a significant predictor of mental health problems as measured across a wide range of symptom dimensions and poor economy predicted a high probability of a psychiatric disorder. Longitudinal studies of the impact of low family income as well as other SES factors on externalizing and internalizing symptom dimensions and disorders are called for.     

A Prospective Examination of Exercise and Barrier Self-efficacy to Engage in Leisure-Time Physical Activity During Pregnancy

Background

Pregnant women without medical contraindications should accumulate 30 min of moderate exercise on most days of the week, yet many pregnant women do not exercise at recommended levels.

Purpose

The purpose the study was to examine barriers to leisure-time physical activity (LTPA) and investigate barrier and exercise self-efficacy as predictors of self-reported LTPA during pregnancy.

Methods

Pregnant women (n?=?160) completed questionnaires eliciting barriers to LTPA, measures of exercise and barrier self-efficacy, and 6-week LTPA recall at gestational weeks 18, 24, 30, and 36.

Results

A total of 1,168 barriers were content-analyzed, yielding nine major themes including fatigue, time constraints, and physical limitations. Exercise self-efficacy predicted LTPA from gestational weeks 18 to 24 (β?=?0.32, R ²?=?0.26) and weeks 30 to 36 (β?=?0.41, R ²?=?0.37), while barrier self-efficacy predicted LTPA from weeks 24 to 30 (β?=?0.40, R ²?=?0.32).

Conclusions

Pregnant women face numerous barriers to LTPA during pregnancy, the nature of which may change substantially over the course of pregnancy. Higher levels of self-efficacy to exercise and to overcome exercise barriers are associated with greater LTPA during pregnancy. Research and interventions to understand and promote LTPA during pregnancy should explore the dynamic nature of exercise barriers and foster women's confidence to overcome physical activity barriers.     

Self-Regulatory Fatigue,Quality of Life,Health Behaviors,and Coping in Patients with Hematologic Malignancies

Background

Self-regulatory fatigue may play an important role in a complex medical illness.

Purpose

Examine associations between self-regulatory fatigue, quality of life, and health behaviors in patients pre- (N?=?213) and 1-year post-hematopoietic stem cell transplantation (HSCT; N?=?140). Associations between self-regulatory fatigue and coping strategies pre-HSCT were also examined.

Method

Pre- and 1-year post-HSCT data collection. Hierarchical linear regression modeling.

Results

Higher self-regulatory fatigue pre-HSCT associated with lower overall, physical, social, emotional, and functional quality of life pre- (p’s?p’s?p?p?p?p’s?Conclusion This is the first study to show self-regulatory fatigue pre-HSCT relating to decreased quality of life and health behaviors, and predicting changes in these variables 1-year post-HSCT.     

Physical Activity and Health Outcomes Among HIV-Infected Men Who Have Sex with Men: A Longitudinal Mediational Analysis

Background

Low physical activity is associated with depression, which may, in turn, negatively impact antiretroviral therapy (ART) adherence among HIV-infected individuals; however, prior studies have not investigated the relationships between physical inactivity and ART non-adherence.

Purpose

The purpose of this study was to examine the association of physical inactivity, depression, ART non-adherence, and viral load in HIV-infected men who have sex with men.

Methods

The sample (N?=?860) was from a large, multicenter cohort of HIV-infected patients engaged in clinical care.

Results

Across time, depression mediated the relationship between physical inactivity and ART non-adherence (γ?=?0.075) and the relationship between physical inactivity and viral load (γ?=?0.05). ART non-adherence mediated the relationship between depression and viral load (γ?=?0.002) and the relationship between physical inactivity and viral load (γ?=?0.009).

Conclusions

Low levels of physical activity predicted increased depression and poor ART adherence over time, which subsequently predicted higher viral load.     

Predicting Human Papillomavirus Vaccine Uptake in Young Adult Women: Comparing the Health Belief Model and Theory of Planned Behavior

Background

Although theories of health behavior have guided thousands of studies, relatively few studies have compared these theories against one another.

Purpose

The purpose of the current study was to compare two classic theories of health behavior??the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB)??in their prediction of human papillomavirus (HPV) vaccination.

Methods

After watching a gain-framed, loss-framed, or control video, women (N?=?739) ages 18?C26 completed a survey assessing HBM and TPB constructs. HPV vaccine uptake was assessed 10?months later.

Results

Although the message framing intervention had no effect on vaccine uptake, support was observed for both the TPB and HBM. Nevertheless, the TPB consistently outperformed the HBM. Key predictors of uptake included subjective norms, self-efficacy, and vaccine cost.

Conclusions

Despite the observed advantage of the TPB, findings revealed considerable overlap between the two theories and highlighted the importance of proximal versus distal predictors of health behavior.     

Competitive Testing of Health Behavior Theories: How Do Benefits,Barriers, Subjective Norm,and Intention Influence Mammography Behavior?

Background

Competitive hypothesis testing may explain differences in predictive power across multiple health behavior theories.

Purpose

We tested competing hypotheses of the Health Belief Model (HBM) and Theory of Reasoned Action (TRA) to quantify pathways linking subjective norm, benefits, barriers, intention, and mammography behavior.

Methods

We analyzed longitudinal surveys of women veterans randomized to the control group of a mammography intervention trial (n?=?704). We compared direct, partial mediation, and full mediation models with Satorra–Bentler χ ² difference testing.

Results

Barriers had a direct and indirect negative effect on mammography behavior; intention only partially mediated barriers. Benefits had little to no effect on behavior and intention; however, it was negatively correlated with barriers. Subjective norm directly affected behavior and indirectly affected intention through barriers.

Conclusions

Our results provide empiric support for different assertions of HBM and TRA. Future interventions should test whether building subjective norm and reducing negative attitudes increases regular mammography.     

Does Affective Valence During and Immediately Following a 10-Min Walk Predict Concurrent and Future Physical Activity?

Background

Affect may be important for understanding physical activity behavior.

Purpose

To examine whether affective valence (i.e., good/bad feelings) during and immediately following a brief walk predicts concurrent and future physical activity.

Methods

At months?6 and 12 of a 12-month physical activity promotion trial, healthy low-active adults (N?=?146) reported affective valence during and immediately following a 10-min treadmill walk. Dependent variables were self-reported minutes/week of lifestyle physical activity at months?6 and 12.

Results

Affect reported during the treadmill walk was cross-sectionally (month?6: ???=?28.6, p?=?0.008; month 12: ???=?26.6, p?=?0.021) and longitudinally (???=?14.8, p?=?0.030) associated with minutes/week of physical activity. Affect reported during a 2-min cool down was cross-sectionally (month 6: ???=?21.1, p?=?0.034; month 12: ???=?30.3, p?<?0.001), but not longitudinally associated with minutes/week of physical activity. Affect reported during a postcool-down seated rest was not associated with physical activity.

Conclusions

During-behavior affect is predictive of concurrent and future physical activity behavior.     

Effects of a Multiple Health Behavior Change Intervention for Colorectal Cancer Survivors on Psychosocial Outcomes and Quality of Life: a Randomized Controlled Trial

Background

Multiple health behavior change can ameliorate adverse effects of cancer.

Purpose

The purpose of this study was to determine the effects of a multiple health behavior change intervention (CanChange) for colorectal cancer survivors on psychosocial outcomes and quality of life.

Methods

A total of 410 colorectal cancer survivors were randomized to a 6-month telephone-based health coaching intervention (11 sessions using acceptance and commitment therapy strategies focusing on physical activity, weight management, diet, alcohol, and smoking) or usual care. Posttraumatic growth, spirituality, acceptance, mindfulness, distress, and quality of life were assessed at baseline, 6 and 12 months.

Results

Significant intervention effects were observed for posttraumatic growth at 6 (7.5, p?p?=?0.033), spirituality at 6 months (1.8, p?=?0.011), acceptance at 6 months (0.2, p?=?0.005), and quality of life at 6 (0.8, p?=?0.049) and 12 months (0.9, p?=?0.037).

Conclusions

The intervention improved psychosocial outcomes and quality of life (physical well-being) at 6 months with most effects still present at 12 months. (Trial Registration Number: ACTRN12608000399392).     

A Longitudinal Study of the Effects of Instrumental and Emotional Social Support on Physical Activity in Underserved Adolescents in the ACT Trial

Background

Few previous studies have examined the influence of instrumental and emotional social support on physical activity (PA) longitudinally in underserved adolescents.

Purpose

This longitudinal study was a secondary analysis of the Active by Choice Today (ACT) trial examining whether instrumental social support predicts increases in PA in underserved adolescents, above and beyond emotional social support provided by family or peers.

Methods

Students in the sixth grade (N?=?1,422, 73 % African American, 54 % female, M _age?=?11 years) in the ACT trial participated. At baseline and 19 weeks, previously validated measures of social support (family instrumental, family emotional, and peer emotional) were completed and moderate-to-vigorous PA (MVPA) was assessed using 7-day accelerometry estimates.

Results

A mixed ANCOVA demonstrated that baseline (p?=?0.02) and change in family instrumental support (p?=?0.01), but not emotional support from family or peers, predicted increases in MVPA across a 19-week period.

Conclusions

Future interventions in underserved adolescents should enhance opportunities for instrumental support for PA.     

An Ecological Momentary Assessment of Lapse Occurrences in Dieters

Purpose

The aim of this study is to investigate the factors related to dietary lapse occurrence in a community sample of dieters.

Methods

An ecological momentary assessment (EMA) methodology, via mobile phone-based diaries, was employed to record dietary lapse occurrences in a group of dieters (N?=?80; M _age ?=?41.21?±?15.60 years; M _BMI?=?30.78?±?7.26) over 7 days.

Results

Analyses indicated that lapses were positively associated with the strength of dietary temptation, presence of others, coping responses, and the environment (exposure to food cues) in which the dieters were in; lapses were more likely to occur in the evening and were negatively associated with the use of coping mechanisms. Additionally, lapse occurrence was found to mediate the relationships among the above predictors of lapse and the self-efficacy to resist future dietary temptations.

Conclusions

Results provide an insight into the occurrence of lapses in dieters and have implications for interventions focusing on weight loss maintenance and relapse prevention.