The effectiveness of a motivational interviewing primary-care based intervention on physical activity and predictors of change in a disadvantaged community

Little research exists on the impact of behavior change interventions in disadvantaged communities. We conducted a prospective study to explore the effectiveness of motivational interviewing on physical activity change within a deprived community and the social- psychological and motivational predictors of change in physical activity including stage of change, self-efficacy, social support, and variables from self-determination theory and the theory of planned behavior. Five motivational interviewing counsellors recruited 207 patients and offered motivational interviewing sessions to support physical activity behavior change. At 6-months there were significant improvements in physical activity, stage of change, and social support. A dose–response relationship was evident; those who attended 2 or more consultations increased their total physical activity, stage of change and family social support more than those who attended just one. Hierarchical regression analyses indicated that number of sessions and change in stage of change predicted 28.4 % of the variance in change in total physical activity and, with social support from friends, 21.0 % of the variance in change walking time. Change in perceived behavioral control and attitudes, friend social support, and number of sessions predicted 16.8 % of the variance in change in vigorous physical activity. Motivational interviewing is an effective approach for promoting physical activity amongst lower socio-economic status groups in the short term. The study demonstrates good translational efficacy, and contributes to a limited number of physical activity interventions targeting low income groups in the UK.     

Evidence for a cognitive bias of interpretation toward threat in individuals with a Type D personality

Biological and behavioral mediators link Type D personality with a poor prognosis in heart disease. However, the mediator role of cognitive biases is still unknown. This study tested whether Type D individuals exhibit an interpretative bias for ambiguous social situations. For this aim we examined Type D and non-Type D individuals’ evaluations of written social situations that varied in terms of situations’ clarity (clear, ambiguous) and social judgment (neutral, negative). A convenience sample of 42 young, healthy adults rated each situation in relation to the difficulty of formulating a verbal response, anticipated distress, and perceived threat, and they completed the Type D personality scale (DS14; Denollet, 2005). Results showed an interpretation bias among Type D individuals, as they rated ambiguous or neutral situations as significantly more distressing compared to non-Type D individuals. Only clearly negative situations were rated similarly by Type D and non-Type D individuals. The discussion suggests that this interpretation bias in Type D individuals would increase their vulnerability to perceived stress.     

Impact of family environment and support on adherence,metabolic control,and quality of life in adolescents with diabetes

Background: Diabetes is a common disease in pediatric populations. Family functioning has been related to child adaptation to diabetes. Purpose: To determine the impact of family factors on diabetes, particularly the influence of family support and family environment on adherence to treatment, quality of life, and metabolic control in Portuguese adolescents with type 1 diabetes, taking in consideration age, sex, duration of disease, and social class. Method: This study used a cross-sectional design. A sample of 157 Portuguese diabetic patients filled disease-specific measures on adherence and quality of life and family functioning measures. Hypotheses were that family support and an organized family environment (high cohesion and low conflict) would be positively associated with better adherence, metabolic control, and quality of life. Results: This study’s results confirmed that adherence was predicted by family support for females and lower-class patients while metabolic control was predicted by family conflict for upper-class patients. Quality of life was predicted by lack of family conflict and family social support for both males and females as well as lower-class patients. Conclusion: The results highlight the importance of studying family variables in adolescents’ diabetes care within the wider cultural factors affecting the patient.     

Attributions of adolescents with type 1 diabetes related to performing diabetes care around friends and peers: the moderating role of friend support

OBJECTIVE: To examine the relationships among negative attributions of friend and peer reactions to diabetes management in social situations, anticipated adherence difficulties, friend support, diabetes stress, and metabolic control. METHODS: A sample of 102 adolescents with Type 1 diabetes completed instruments measuring attribution of friend and peer reactions, anticipated adherence, friend support, and diabetes stress. Metabolic control was measured by the percentage of hemoglobin A1c. RESULTS: Structural equation modeling demonstrated an excellent fit of two models depicting the mediating role of anticipated adherence difficulties and diabetes stress on the relationship between negative attributions of friend (first model) and peer (second model) reactions and metabolic control. Friend support was found to moderate the path between diabetes stress and metabolic control in an unexpected manner. That is, as friend support increased, so did the relationship between stress and metabolic control. CONCLUSIONS: Adolescents who make negative attributions about reactions of friends and/or non friend peers are likely to find adherence difficult in social situations and have increased stress, with the latter associated with metabolic control. Results are discussed in terms of a social information processing model of adjustment.     

Mother’s stress, mood and emotional involvement with the infant: 3 months before and 3 months after childbirth

Adverse effects of maternal anxiety and depression are well documented, namely on the foetus/child behaviour and development, but not as much attention has been given to the mother’s emotional involvement with the offspring. To study mother’s prenatal and postpartum stress, mood and emotional involvement with the infant, the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale and the Mother-to-Infant Bonding Scale were filled in and cortisol levels were measured, 3 months before and 3 months after childbirth, in a sample of 91 Portuguese women. From pregnancy to the postpartum period, mother’s cortisol levels, anxiety and emotional involvement toward the child decrease. No significant change was observed regarding mother’s depression. Mother’s depression predicted a worse emotional involvement before childbirth, while mother’s anxiety predicted a worse emotional involvement with the infant after childbirth. Additionally, pregnant women with a worse emotional involvement with the offspring are at risk of poorer emotional involvement with the infant and higher anxiety and depression at 3 months postpartum. It should be given more attention to mother’s poor emotional involvement with the offspring during pregnancy, as it interferes with her emotional involvement with the infant and her psychological adjustment 3 months after childbirth.     

Chronic and discrete stress as predictors of children's adjustment.

Diabetes, as a chronic stressor, and negative life events (NLEs), as a discrete stressor, were related to children's behavioral adjustment, along with moderating effects of the family environment. Diabetes and NLEs predicted both higher internalizing (INT) and externalizing (EXT) behavior problems, suggestive of nonspecific distress. Higher family conflict and lower cohesion each predicted more behavior problems (INT-EXT). However, conflict was the sole moderator of the stressors. Higher family conflict and diabetes exacerbated children's EXT behavior problems, with clinically elevated scores. Higher family conflict and higher NLEs resulted in clinically elevated INT-EXT behaviors. Conversely, low family conflict protected children's behavioral functioning from the stressors. Family cohesion was the sole predictor of children's social competencies but did not moderate the stressors.     

The interplay of dyadic and individual planning of pelvic-floor exercise in prostate-cancer patients following radical prostatectomy

This study broadens the current understanding of the role of planning by focusing on the interplay between individual and dyadic planning (i.e. making plans about the target person’s behaviour together with a partner). Self-report data from N = 141 prostatectomy-patients and their partners were assessed at three times within 1 year post-surgery. Direct and indirect effects of dyadic and individual planning on patients’ pelvic-floor exercise (PFE) were tested. Proposed mediators were social support, social control, and action control. Cross-sectionally, the dyadic planning–PFE relationship was mediated by patients’ received support and partners’ provided social control. Longitudinally, mediators of dyadic planning were partners’ provided social control and support. Effects of individual planning on PFE were mediated by action control at baseline only. Also, at lower levels of individual planning, patients’ dyadic planning was more strongly associated with receipt of social control. Results underscore the importance of social factors in the planning process and its mechanisms in health-behaviour change.     

Emotional support and gender in people living with HIV: effects on psychological well-being

Current research indicates that emotional support is strongly associated with physical and psychological adjustment in persons living with HIV/AIDS. While gender-differences in health and health behaviors of HIV positive patients are well studied, less is known about how men and women living with HIV/AIDS may differentially perceive and integrate support into their lives, and how it subsequently affects their psychological well-being. This cross-sectional study examines how emotional support received from partners and family/friends and gender explains psychological well-being (i.e., stress, depression, anxiety) in a sample of 409 partnered European HIV positive individuals. We hypothesized that gender would modify the associations between support and psychological well-being such that men would benefit more from partner support whereas women would benefit more from family/friend support. Results revealed that regardless of the source of support, men’s well-being was more positively influenced by support than was women’s well-being. Women’s difficulties in receiving emotional support may have deleterious effects on their psychological well-being.     

Applying the polyvagal theory to children's emotion regulation: Social context,socialization, and adjustment

Effective emotion regulation is essential for children's positive development. Polyvagal theory provides a framework for understanding how parasympathetic regulation of cardiac activity contributes to children's adaptive versus maladaptive functioning. Maintenance of cardiac respiratory sinus arrhythmia (RSA) under social challenge should support emotion regulation and behavioral adjustment. Children's effective parasympathetic regulation and behavioral adjustment should be supported by appropriate parental socialization. These proposals were evaluated in a short-term longitudinal study of 94 preschool-aged children. Parenting and basal RSA were measured at home, then 6–10 months later behavioral adjustment and RSA in lab baseline and socially challenging contexts were measured. Children with relatively higher RSA in social challenge than at baseline (ΔRSA) had fewer internalizing problems (IP) and externalizing problems (EP), and better behavioral self-regulation (SR). Mothers who used more negative control had children with lower ΔRSA, more IP and EP, and less SR. Structural equation modeling showed that vagal regulation mediated associations between maternal negative control and children's adjustment; maternal negative control did not predict EP or SR after accounting for ΔRSA. Associations were consistent across boys and girls, with one exception: Higher ΔRSA was significantly associated with fewer EP in boys only. These findings suggest that the practical significance of physiological regulation might be best revealed in ecologically valid procedures, and that children's physiological mechanisms of emotion regulation are shaped by their experiences of parental socialization.     

Cultural context moderates the relationship between emotion control values and cardiovascular challenge versus threat responses

Cultural context affects people's values regarding emotions, as well as their experiential and behavioral but not autonomic physiological responses to emotional situations. Little research, however, has examined how cultural context influences the relationships among values and emotional responding. Specifically, depending on their cultural context, individuals’ values about emotion control (ECV; the extent to which they value emotion control) may have differing meanings, and as such, be associated with differing responses in emotional situations. We examined this possibility by testing the effect of two cultural contexts (28 female Asian-American (AA) versus 28 female European-American (EA) undergraduate students) on the associations between individuals’ ECV and emotional responding (experiential, behavioral, and cardiovascular) to a relatively neutral film clip and a laboratory anger provocation. In the AA group, greater ECV were associated with reduced anger experience and behavior, and a challenge pattern of cardiovascular responding. In the EA group, greater ECV were associated with reduced anger behavior but not anger experience, and a threat pattern of cardiovascular responding. These results are consistent with the notion that individuals’ values about emotion are associated with different meanings in different cultural contexts, and in turn, with different emotional and cardiovascular responses.     

A Path Analysis of Factors Predicting Children's Divorce Adjustment

Eighty-two mother-child pairs from divorced homes completed measures assessing life change events, marital hostility, parenting skills, parent adjustment, child behavior adjustment, and children's self-concept. A path model was constructed to describe direct and indirect effects of causally ordered prior variables on positive and negative child outcomes. Path coefficients suggested the operation of both direct and mediated effects of background factors, postdivorce adjustment of the custodial parent, and current child-rearing environments on adaptive and maladaptive child outcome variables. The impact of age on children's postdivorce adjustment was found to be mediated by the number of major life events they reported. One "causal path" was found to be significant for several child outcomes: Mothers with more children reported better postdivorce adjustment in themselves, which in turn predicted better self-reported parental functioning. More effective parenting was positively associated with better social skills, more involvement in prosocial activities, and less internalized psychopathology in children.     

Interaction of Hippocampal and Neocortical Neurons in Emotionally Negative Situations in Active and Passive Rabbits

Cross-correlation histograms were used to compare the interaction of close-lying cells in the hippocampus (field CA1) and the parietal-temporal areas of the neocortex in active and passive rabbits during exposure to emotionally significant stimuli. Interaction of hippocampal neurons depended on the type of the behavioral response to the stimulus. The greatest changes from baseline were seen in active rabbits in orientational-investigative and active defensive reactions, while the greatest changes in passive animals were in freezing. In all states, cases of common inputs to hippocampal neurons were found more frequently in passive rabbits and excitatory links between neurons with short delays (up to 40 msec) were more frequent in active rabbits. Interaction of neocortical neurons, in contrast with hippocampal neurons, was less dependent on the type of behavioral response to the stimulus and the animal’s behavioral strategy. These results provide evidence of individual-typological features in information processing in hippocampal field CA1 in active and passive animals in emotionally negative situations.     

Applying the polyvagal theory to children's emotion regulation: Social context, socialization, and adjustment

Effective emotion regulation is essential for children's positive development. Polyvagal theory provides a framework for understanding how parasympathetic regulation of cardiac activity contributes to children's adaptive versus maladaptive functioning. Maintenance of cardiac respiratory sinus arrhythmia (RSA) under social challenge should support emotion regulation and behavioral adjustment. Children's effective parasympathetic regulation and behavioral adjustment should be supported by appropriate parental socialization. These proposals were evaluated in a short-term longitudinal study of 94 preschool-aged children. Parenting and basal RSA were measured at home, then 6-10 months later behavioral adjustment and RSA in lab baseline and socially challenging contexts were measured. Children with relatively higher RSA in social challenge than at baseline (DeltaRSA) had fewer internalizing problems (IP) and externalizing problems (EP), and better behavioral self-regulation (SR). Mothers who used more negative control had children with lower DeltaRSA, more IP and EP, and less SR. Structural equation modeling showed that vagal regulation mediated associations between maternal negative control and children's adjustment; maternal negative control did not predict EP or SR after accounting for DeltaRSA. Associations were consistent across boys and girls, with one exception: Higher DeltaRSA was significantly associated with fewer EP in boys only. These findings suggest that the practical significance of physiological regulation might be best revealed in ecologically valid procedures, and that children's physiological mechanisms of emotion regulation are shaped by their experiences of parental socialization.     

A Growth QTL on Chicken Chromosome 1 Affects Emotionality and Sociality

Domestication of animals, regardless of species, is often accompanied by simultaneous changes in several physiological and behavioral traits (e.g. growth rate and fearfulness). In this study we compared the social behavior and emotional reactivity, as measured in a battery of behavioral tests, of two groups of chickens selected from a common genetic background, an advanced intercross line between the ancestral red junglefowl (“RJF”) and the domesticated White Leghorn layer (“WL”). The birds were selected for homozygosity for alternative alleles at one locus (a microsatellite marker), centrally positioned in a previously identified pleiotropic growth QTL on chromosome 1, closely linked to one major candidate gene (AVPR1a) for certain aspects of social behavior. Birds homozygous for the WL allele (“WL genotype”) had a modified pattern of social and emotional reactions than birds homozygous for the RJF allele (“RJF genotype”), shown by different scores in a principal components analysis. These results suggest that the growth QTL affects a number of domestication related behavioral traits, and may have been a primary target of selection during domestication. The QTL contains a multitude of genes, several of which have been linked to social behavior (for example the vasotocin receptor AVPR1a targeted in this experiment). Future studies aimed at making a higher resolution genotypic characterization of the QTL should give more information about which of these genes may be considered the strongest candidates for bringing about the behavioral changes associated with animal domestication.     

Gender differences in the psychological adjustment to type 1 diabetes mellitus: an explorative study

This study examined gender differences in (1) the psychological adjustment to diabetes and (2) the relation between psychological adjustment and metabolic control in patients with type 1 diabetes. The 280 adult patients attending the outpatient diabetes clinic completed psychological self-rating questionnaires evaluating coping, depression, marital satisfaction, cognitive and emotional adjustment to diabetes. Glycaemic control was measured with HbA(1c)-values. This study revealed that men used significantly more active coping, less avoiding, less social support seeking and less depressive coping. Despite these differences, glycaemic control was not significantly better in men than in women. Women reported more depressive symptomatology than men did and more women were depressed. Significant gender differences were also found in psychological adjustment to diabetes. The psychological factors negatively related with the psychological adjustment to diabetes in men and women are depressive coping and depressive symptomatology.     

Social Control in Older Adults’ Diabetes Self Management and Well-Being

The “dual effects” hypothesis argues that social control can be effective in promoting positive health-related behavior change, but it can also jeopardize the targeted individual's well-being. This hypothesis is tested using hemoglobin A1C as an objective indicator of behavioral compliance with diabetes self-management behavior and depressive symptoms. Differences in the effects of social control on A1C and depressive symptoms by sex and ethnicity are tested.

Cross-sectional data were obtained from a multi-ethnic sample of older adults with diabetes (N = 593). Greater social control was associated with poorer rather than better odds of achieving glucose control, and with greater depressive symptoms. There was no evidence that social control has differential effects on either glucose control or depressive symptoms by sex or ethnicity. Active use of social control attempts by family members and friends, especially if they are coercive or punitive in nature, are likely counterproductive for maintaining the physical and mental health of older adults with diabetes.     

Understanding exercise behavior among korean adults: a test of the transtheoretical model

The purpose of this study was to examine the theorized association of Transtheoretical Model (TTM) of behavior change constructs by stage of change for exercise behavior among Korean adults. A total of 1,335 Korean adults were recruited and surveyed from the Nowon district, geographically located in northern Seoul. Four Korean-version questionnaires were used to identify the stage of exercise behavior and psychological attributes of adolescents. Data were analyzed by frequency analysis, MANOVA, correlation analysis, and discriminant analysis. Multivariate F tests indicated that behavioral and cognitive processes of change, exercise efficacy, and pros differentiated participants across the stages of exercise behavior. Furthermore, the findings revealed that adults’ exercise behavior was significantly correlated with the TTM constructs and that overall classification accuracy across the stages of change was 50.6%. This study supports the internal and external validity of the TTM for explaining exercise behavior.     

Predictors of psychological adjustment in school-age children infected with HIV

OBJECTIVE: To assess for significant differences in psychological functioning between HIV-infected children and a demographically matched healthy control group and to examine the utility of applying a stress and coping model to children with HIV disease. METHODS: Participants included HIV-infected children (ages 6-16) and their caregivers (n = 36) and a control group of healthy children and their caregivers (n = 32). During routine clinic visits, children completed measures of psychological adjustment, health locus of control, and coping style, and caregivers completed measures of their own and their child's psychological adjustment. RESULTS: Caregiver-reported and child self-reported psychological adjustment scores did not significantly differ between the HIV and control groups, with the exception of significantly more internalizing behavior problems reported in the control group. Hierarchical multiple regression analyses revealed that the stress and coping model accounted for 36% of the variance in HIV-infected children's self-reported psychological adjustment. In addition, child age and coping style were significant predictors of child self-reported psychological adjustment, but not of caregiver-reported child adjustment. CONCLUSIONS: Approximately 25% of children with HIV disease exhibited clinically significant emotional or behavioral problems; however, even higher rates of psychological adjustment problems were found in healthy children. Children with HIV disease who have not been told their diagnosis and children who endorse more emotion-focused coping strategies tend to exhibit more psychological adjustment problems.     

Behavior of 3-year-old children in a prospective randomized trial of reduced saturated fat and cholesterol diet since infancy: The strip baby project

Interventions aimed at decreased exposure of children to known atherosclerosis risk factors may have untoward behavioral side effects. We examined how children’s behavior or parent’s perception of the behavior of the children at 3 years of age was influenced by the intervention in a prospective randomized trial that began in infancy and effectively decreased scrum cholesterol concentration. This Special Turku coronary Risk factor Intervention Project for babies (STRIP) began when the infant was 7 months old. Half of 1.062 children received individualized dietary counseling at 1-to 3-month intervals during the first 2 years of age and then half-yearly; the other half had an unrestricted diet. At 3 years of age a standardized questionnaire of the child’s behavior was sent to 791 families (76% returned the questionnaire). At the onset of the trial the sociodemographic data of the families and scrum lipid values of the intervention and control children were similar. Later, mean serum cholesterol values of the intervention children remained constantly at a level 6% to 10% below the values of the control children. At 3 years of age the parental perceptions of the child’s behavior suggested minimal differences between the intervention and control children. The intervention children were slightly less jealous and more active and creative, but showed slightly more negative signs of behavior (bed-wetting, problems in falling asleep, fears) than the controls. We conclude that long-term, individualized dietary and lifestyle intervention that begins in infancy slightly influences children’s behavior or parent’s recognition of the behavior of the children at the age of 3 years. This work was supported in part by grants from the Varsinais-Suomi Regional Fund of the Finnish Cultural Foundation, the Mannerheim League for Child Welfare, the Academy of Finland, and the Alli Paasikivi Foundation.     

Attitudes and reactions of Jordanian medical students to the dissecting room

Emotional and psychological reactions of Jordanian medical students to the dissecting room (DR) were assessed. A questionnaire was distributed to 200 students in preclinical years in the academic year 2002–2003 in the faculty of medicine at Jordan University of Science and Technology; 145 students have responded. Varying degree of fear on first entering the DR was reported by 28.4%. The most frequent reactions were recurring visual images of cadavers 28.9% and palpitation 19.3%. Students’ reactions were most commonly elicited by smell of the DR 58.5% and by fear of infection 50.3%. The most frequent method of coping with such fears was by rationalization 89.8%. Significant gender differences (P<0.05) were found in the most aspects of DR experiences. Female students showed higher level of fear, reported recurring visual images of cadavers more often than males, were more disturbed by certain stimuli in the DR and used religious books and praying as coping methods more frequently than their male peers. The need for appropriate psychological preparation of students before DR practical on human cadavers is discussed.