Changes in Health-Promoting Behaviors and Their Association with Weight Loss,Retention, and Engagement on a Digital Program: Prospective Study

Health-promoting lifestyle behaviors (e.g., as measured by the HPLP-II) are associated with reductions in lifestyle disease mortality, as well as improved well-being, mental health, and quality of life. However, it is unclear how a weight-management program relates to a broad range of these behaviors (i.e., health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management), especially a fully digital program on which individuals have to self-manage their own behaviors in their daily lives (with assistance from a virtual human coach). In the context of a digital setting, this study examined the changes in health-promoting behaviors over 12 months, as well as the associations between health-promoting behaviors and weight loss, retention, and engagement, among participants who self-enrolled in a mobile CBT-based nutritionally focused behavior change weight management program (n = 242). Participants lost a statistically significant amount of weight (M = 6.7 kg; SD = 12.7 kg; t(80) = 9.26, p < 0.001) and reported significantly improved overall health-promoting lifestyle behaviors (i.e., HPLP-II summary scores), as well as, specifically, health responsibility, physical activity, nutrition, spiritual growth, stress management, and interpersonal relations behaviors from baseline to 6 months and from 6 months to 12 months (all ps < 0.008). Health-promoting behaviors at 6 months (i.e., learned health-promoting behaviors) compared to baseline were better predictors of retention and program engagement. A fully digital, mobile weight management intervention can improve HPLP-II scores, which, in turn, has implications for improved retention, program engagement, and better understanding the comprehensive effects of weight management programs, particularly in a digital setting.     

Enhancing multiple domains of well-being by decreasing multiple health risk behaviors: a randomized clinical trial

Abstract Tailored behavior change programs have proven effective at decreasing health risk factors, but the impact of such programs on participant well-being has not been tested. This randomized trial evaluated the impact of tailored telephone coaching and Internet interventions on health risk behaviors and individual well-being. Exercise and stress management were the primary health risks of interest; improvements in other health risk behaviors were secondary outcomes. A sample of 3391 individuals who reported health risk in the areas of exercise and stress management were randomly assigned to 3 groups: telephonic coaching that applied Transtheoretical Model (TTM) tailoring for exercise and minimal tailoring (stage of change) for stress management; an Internet program that applied TTM tailoring for stress management and minimal tailoring for exercise; or a control group that received an assessment only. Participants were administered the Well-Being Assessment and, at baseline, had relatively low well-being scores (mean, 60.9 out of 100 across all groups). At 6 months, a significantly higher percentage of both treatment groups progressed to the Action stage for exercise, stress management, healthy diet, and total number of health risks, compared to the control group. Both treatment groups also demonstrated significantly greater improvements on overall well-being and the domains of emotional health, physical health, life evaluation, and healthy behaviors. There were no differences between the groups for 2 well-being domains: basic access to needs and work environment. These results indicate that scalable, tailored behavior change programs can effectively reduce health risk and accrue to improved well-being for participants. (Population Health Management 2012;15:276-286).     

Evaluation of a stress management course in adult education centres in rural Australia

OBJECTIVE: To investigate whether attending a six-week stress management course in a rural adult education centre is effective in reducing participants' levels of stress, anxiety and depression. DESIGN: Repeated measures design using self-report measures of stress, anxiety and depression at commencement and completion of a six-week stress management course, and six months post-completion follow up. SETTING AND PARTICIPANTS: One hundred and thirty-two adults (age range 18-73 years) living in a rural community who self-enrolled in the stress management course at adult education centres. INTERVENTION: The course consisted of six weekly group sessions. Each two-hour session conducted by mental health professionals, included teaching cognitive behavioural strategies targeted at reducing individual symptoms of stress. MAIN OUTCOME MEASURES: Comparative analysis of pre- and post-test and six-month follow up on measures of stress (Stress Symptom Checklist), anxiety and depression (Hospital Anxiety and Depression Scale). Results: Results indicated a significant reduction in stress symptoms (F(7,90) = 34.92, P < 0.001), anxiety and depression (F(3,95) = 87.92, P < 0.001) from course commencement to course completion. These improvements were sustained six months after course completion for stress symptoms (F(11,65) = 22.40, P < 0.001), anxiety and depression (F(5,73) = 41.78, P < 0.001). CONCLUSION: Findings demonstrate the stress management course is an effective community intervention in a rural community. Challenges for future implementation of the program are discussed.     

The effects of a health promotion program on physical, mental, and dietetic health status in climacteric women

PURPOSES: The purpose of this study was to evaluate the effects of a six months health promotion program on physical and mental health status assessments in climacteric women. METHODS: Seventy-two women, with a mean (+/- SD) age of 51.3 (+/- 3.1 yr.), body weight of 51.5 (+/- 6.3 kg), and Body Mass Index of 22.4 (+/- 2.4 kg/m2), residing in Tokyo Metropolitan area, participated as subjects in a health promotion program, completing health status assessments. Health promotion was performed once a week, two hours per session, sixteen times. The lecture and exercise program, in the first half, included basic information on diet, exercise and relaxation, and prevention of life-style related disease, and instructions for walking exercise, dancing, and dumbbell exercise. In the latter half, they performed extended walking, stretching, and autogenic training for relaxation. Healthy foods were also supplied. Before and after the program, health status was assessed, with a general medical health check, a questionnaire regarding nutrition, exercise and relaxation activities, and determination of dietary intake based on food records, eating behavior, complaints (CMI, Nichidai stress score) and physical activity levels. RESULTS: After the six months of the program: 1) Total cholesterol levels had decreased significantly, along with both systolic and diastolic blood pressure, body weight and BMI; 2) Major nutrient intake, density of nutrients and eating behavior were improved, with decrease in daily salt intake, and increase significant in daily energy expenditure; 3) Stress scores by the Nichidai stress check were decreased significantly, subjects with higher stress scores at the beginning of programs having marked change, and neurotic tendencies were decreased in CMI categories II-IV. CONCLUSION: These results suggest that, in order to maintain and/or improve the QOL of climacteric women, good dietary habits and physical activities, such as walking, and psychological support are essential. Further long-term investigations of larger populations (middle-aged to elderly) are now necessary.     

Cognitive adaptation: a women's health perspective for reducing stress during childbearing

The purpose of this study is to evaluate psychological changes in women of three minority ethnic groups in a program of psychosocial services that promoted positive cognitive adaptation to childbearing throughout pregnancy and the postpartum period. In this prospective longitudinal study, both cognitive adaptation and generalized stress were measured at each trimester of pregnancy as well as after birth and 3 months postpartum. The mean scores at each time are first compared with first trimester scores for women in the program and then with scores for comparable women in a cross-sectional sample tested before the program. For women in the program, results of the psychological adaptation measures and the stress measures had improved from their first trimester value by the time of birth. Stress levels of women in the program were less than for women in the corresponding comparison sample from the third trimester on. Enhanced perinatal services that include interventions and monitoring strategies aimed at improving the cognitive adaptation of women to childbearing are important in promoting stress reduction in women and infants.     

Bank One's worksite-based asthma disease management program

Non-occupational asthma is a common disease affecting approximately 6% of the US population. Asthma accounts for an estimated 3 million workdays lost each year in the United States and for reduced employee job productivity. Although asthma disease management programs are relatively common in managed care organizations, they generally have not been offered at the workplace. A total of 168 employees with asthma were identified, and 76 participated in a worksite asthma disease management program. Of them, 41 (53.9%) completed an Asthma Therapy Assessment Questionnaire (ATAQ) at baseline, post-program (2 months), 4 months, and 12 months. The total ATAQ Index declined from 3.59 at baseline to 2.76 at 12 months (p < 0.01). After the program, significantly more employees reported using controller medications (the desired behavior) rather than reliever medications. A worksite-based disease management program for asthma should reduce medical care costs and absenteeism and improve worker productivity.     

Evaluation of the "Time to Quit" self-help smoking cessation program.

Public health and hospital nurses have widespread contact with smokers; an effective smoking cessation program administered by nurses has tremendous potential. This study evaluated: 1) the effectiveness of the self-help cessation program, "Time to Quit"/"Moi aussi, j'écrase" (TTQ), provided on a one-to-one basis; and 2) a smoking cessation training program for baccalaureate nursing students. Nursing students recruited 307 smokers who were randomly assigned to receive one of two interventions. Control smokers received a list of community smoking cessation resources and experimental subjects received this list plus TTQ. Smoking self-reports and cotinine levels were obtained at baseline, six weeks and nine months. More smokers receiving TTQ had reduced at six weeks post-intervention, while there were no differences in quit or reduction rates at the nine-month follow-up. Students were positive about learning the techniques and their knowledge scores were significantly higher than those of non-participating students.     

Stressmanagement als Burn-out-Prophylaxe

Burnout is a possible consequence of excessive demands, high levels of stress, or a consequence of lack of resources for coping with difficult tasks. Systematic stress management might be effective in reducing the risk for development of a burnout syndrome. Based on a literature search on available research papers and meta-analyses in Medline and Pubmed, current findings on the content and effectiveness of stress management programs are reported for different target groups. Stress management programs can be divided into programs focusing on primary, secondary, and tertiary prevention. In contrast to primary prevention programs, secondary and tertiary preventive programs focus on the specific needs of different target groups. Cognitive-behavioral programs have been shown to be the most effective interventions. A combination of psycho-educational treatment with follow-up or booster sessions increases the long-term outcome in the prevention of burn-out syndromes. Beside the duration of the program, focus on problems and sustainability of supply is important for the long-term effectiveness in secondary and tertiary prevention.     

Worksite health promotion: feasibility testing of repeated weight control and smoking cessation classes

Abstract This paper describes a study examining the feasibility of a worksite health promotion program that was repealed twice in one year. Weight control and smoking cessation classes, which included a supporting incentive component, were made available at a worksite of 485 white-collar employees continuously throughout one year. Identical education programs were offered twice at six-month intervals. Results suggest that this model of program implementation is attractive to employees. Total participation over 12 months included an estimated 53% of overweight employees in the weight program and 23% of smokers in the smoking cessation program. The two series of classes, run back to back, generated similar participation. Thirty-nine percent of weight control participants and six percent of smoking cessation participants who enrolled in the first program also enrolled in the second. Weight losses and smoking cessation rates were comparable for the two cycles, with a mean weight loss of about seven pounds and a smoking cessation rate at six months of about 33%. Surveys of a random sample of employees at baseline and again at 12 months showed a 28% reduction in the prevalence of cigarette smoking, but no change in average weight or the prevalence of overweight. This study suggests that health promotion programs at worksites which offer repeated opportunities for employee participation are promising and deserve further study.     

Long-term maintenance of exercise and healthy eating behaviors in overweight adults

BACKGROUND: Most people experience weight regain following the termination of a weight management program. The failure to maintain changes in diet and exercise patterns is a major factor. This study presents 24-month outcomes of a healthy-lifestyle weight management program designed to promote long-term changes in diet and exercise behaviors. METHODS: Overweight and obese adults (n = 144; BMI = 32.5 +/- 3.8) completed a 6-month clinic-based weight management program and were followed for an additional 18 months. Assessments completed at baseline, 6, 12, and 24 months included weight, body composition, dietary recalls, self-reported physical activity, and mediator variables based on Transtheoretical Model of Health Behavior Change. RESULTS: At 24 months, subjects maintained decreases in weight, % body fat, caloric intake, % kcal saturated fat, and increases in weekly exercise minutes (P < 0.05). Individuals who maintained regular exercise at 24 months had higher confidence scores and higher use of experiential and behavioral processes. Individuals who maintained a healthy diet at 24 months had lower temptation scores and higher use of experiential and behavioral processes. CONCLUSIONS: A healthy-lifestyle weight management program is successful at promoting long-term changes in exercise and dietary behaviors. Individuals who actively engage in the maintenance process are more likely to succeed.     

Mother's Stress: Implications for Attachment Relationships

This study included thirty-three mothers of children who were attending a preschool program for high-risk families. The children's age ranged from 36-54 months. The Attachment Q-Set and the Parenting Stress Index were used to measure the relationships between parental stress and the security of attachment relationships. Results showed a significant negative relationship between the Child Domain section of the PSI and Attachment Q-Set scores. Within this sample the mean security scores were significantly higher for the group of mothers with the lowest stress scores.

Implications for the field include the importance of a comprehensive, multi-agency-coordinated, early intervention service delivery model which could operate on a variety of levels at once. Service providers need to be cognizant of the impact of the stress cycle on families and its developmental outcomes for young children. A paradigm shift may be necessary in order to move early intervention services from a crisis to a preventive-based model.     

Repeated Depression Screening During the First Postpartum Year

PURPOSE

Postpartum depression (PPD) screening at 4 to 12 weeks’ postpartum can improve outcomes for women when linked to in-practice management programs. The benefit of repeated PPD screening during the first year postpartum remains unclear.

METHODS

We report a substudy of a large pragmatic trial of early PPD screening and practice management, the Translating Research into Practice for Postpartum Depression (TRIPPD) study. Outcome analyses were based on demographic information and Patient Health Questionnaire (PHQ-9) screening scores from questionnaires mailed to all enrolled women at baseline (4 to 12 weeks’ postpartum) and again at 6 and at 12 months’ postpartum. The main outcomes of this substudy were the 6- and 12-month rates of PHQ-9 scores that were 10 or greater for women whose baseline PHQ-9 scores were less than 10. Women whose scores were 10 or greater would be considered at high risk of PPD and appropriate for further evaluation.

RESULTS

At 6 months, 134 (10.9%) of the 1,235 women who did not have PHQ-9 scores greater than 10 at baseline had elevated scores appropriate for further evaluation. At 12 months, 59 (6.1%) of the 969 women who did not have PHQ-9 scores greater than 10 at baseline or at 6 months had elevated scores. Together the 6- and 12-month repeated screenings identified 193 women at high risk of depression. This finding represents 13.5% of the 1,432 women whose screening results were negative for PPD at baseline.

CONCLUSIONS

Repeated PPD screening at 6 and 12 months’ postpartum increases the percentage of women identified as being at high risk of PPD. Further work will be required to understand the impact of this repeated screening on patient outcomes.     

Effects of an education program for stress reduction on supervisor knowledge, attitudes, and behavior in the workplace: a randomized controlled trial

Supervisors at work play a large role in stress management at the workplace. Providing supervisors with necessary information and useful skills might be one effective approach that will lead to stress reduction. However, very few studies have investigated the effect of supervisor education by using a rigorous study design. In a randomized controlled trial, we tried to clarify how an education program for stress reduction influences supervisor knowledge, attitudes, and behavior concerning stress management. The subjects were 46 supervisors of an old, established sake brewery manufacturer of 301 employees. The supervisors were assigned to either the intervention group (24 supervisors) or the control group (22 supervisors). We conducted a single-session education program that included the guidelines for worker mental health promotion to the intervention group. The education program was composed of a basic education lecture and active listening training. The effects of this program on supervisor knowledge, attitudes, and behavior were measured using an original, self-administered questionnaire. The intervention effect was tested by examining an interaction effect between groups and time (before education, three and six months after education). The education favorably affected supervisor knowledge (F=7.92; p=.001). As for behavior, the intervention effect was marginally statistically significant (F=2.51; p=.088). For the attitude score, however, there were no beneficial effects. In conclusion, the provision of necessary information and useful skills to supervisors seems to improve supervisor knowledge and behavior regarding stress management at the workplace for at least six months.     

Health risk changes with a low-cost individualized health promotion program: effects at up to 30 months

BACKGROUND AND PURPOSE. Health promotion programs are increasingly important components of health care in an era of predominantly chronic illness preceded by identified health risk behaviors. We report a large and relatively long experience with a low-cost intervention delivered through the mail and using sequential time-oriented risk appraisal and personalized recommendations, each six months, together with self-management materials. METHODS. We performed a prospective, longitudinal, observational study of 103,937 consecutive program participants observed for at least six months and up to 30 months. The primary study endpoint is overall health risk score, with secondary analysis of individual risk behaviors. A concurrent comparison group utilizes the initial scores of new participants by calendar time over the study period. RESULTS. Strong overall positive effects were observed, with improvement in computed health risk scores over 18 months of 14.7% (p less than .0001) in those 65 and over and 18.4% (p<.0001) in those under 65. At 30 months, improvement was 18.8% (p less than .0001) and 25.7% (p less than .0001), respectively. There was improvement in self-report scores for all targeted health risk behaviors, except for pounds over ideal weight, including smoking; dietary fat, salt, and fiber; alcohol; exercise; cholesterol; and reported stress. There was progressive improvement approximating 5% each six-month period. Results were consistent across age groups 16-35, 36-50, 51-65, and over 65 and over different educational level. Results could not be accounted for by sequential changes in initial health habits of participants over time. DISCUSSION.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of a Wellness-Based Mindfulness Stress Reduction intervention: a controlled trial

PURPOSE: To determine if participation in a Wellness-Based Mindfulness Stress Reduction intervention decreases the effect of daily hassles, psychological distress, and medical symptoms. DESIGN: A randomized controlled trial of a stress reduction intervention with a 3-month follow-up. SETTING: A university setting in West Virginia. SUBJECTS: A total of 103 adults, with 59 in the intervention group and 44 in the control group. Eight-five percent of subjects completed the intervention. Fifty-nine percent and 61% of the intervention and control subjects completed the study, respectively. INTERVENTION: The intervention consisted of an 8-week group stress reduction program in which subjects learned, practiced, and applied "mindfulness meditation" to daily life situations. The control group received educational materials and were encouraged to use community resources for stress management. MEASURES: The Daily Stress Inventory assessed the effect of daily hassles, the Revised Hopkins Symptom Checklist measured psychological distress, the Medical Symptom Checklist measured number of medical symptoms, and a Follow-up Questionnaire measured program adherence. RESULTS: Intervention subjects reported significant decreases from baseline in effect of daily hassles (24%), psychological distress, (44%), and medical symptoms (46%) that were maintained at the 3-month follow-up compared to control subjects (repeated measures analysis of variance [ANOVA]; p < .05). CONCLUSIONS: Self-selected community residents can improve their mental and physical health by participating in a stress reduction intervention offered by a university wellness program.     

妊娠压力对子代早期神经行为发育的影响-基于潜在类别分析的前瞻性队列研究

目的 了解妊娠期心理压力的分类以及主要的压力源,并探讨妊娠压力对子代早期神经行为发育的影响。方法 以深圳出生队列为平台,共纳入913对母子作为研究对象,在孕期通过问卷调查的形式获得一般社会人口学特征以及在孕晚期通过妊娠压力量表评估压力情况,并采用年龄与发育进程问卷(ASQ-3/ASQ-SE)来评估子代在6月龄时的神经行为及社交情况的发育情况。通过潜在类别分析,将妊娠压力进行分类后,应用线性回归,分析校正混杂因素前后妊娠压力与子代神经行为发育之间的关联。结果 妊娠压力可分为“低压力组”、“中度压力组”和“高压力组”。分别占比56.6%、33.6%和9.8%。在校正了年龄、职业等混杂因素以后,妊娠中度压力组的子代在粗大动作能区(β=1.67, 95%CI: -3.29~0.04)的得分较低,妊娠高压力组得子代在解决问题能区(β=-2.51, 95%CI: -4.73~0.29)得分较低,提示神经行为发育较低压力组差。妊娠压力与ASQ-SE的分析显示,妊娠高压力组的子代,ASQ-SE得分较低压力组高(β=4.65, 95%CI: 1.07~8.24),提示社交-情绪发育相对较差。结论 研究发现妊娠中、高压力对子代早期神经行为发育存在不同程度的不良影响。尽早识别和干预这部分孕妇,对母婴健康意义重大。本研究为儿童智能发育的干预时机、措施提出了新的思路。     

A manual-based group program to improve mental health: what kind of teachers are interested and who stands to benefit from this program?

Purpose

In order to evaluate a manual-based group program for teachers aiming at strengthening mental health, we examined (1) whether the teachers interested in participating differ from their colleagues without interest and (2) whether there is evidence of subgroups benefiting more than others among those who participated.

Methods

Out of a basic sample of 949 schoolteachers, 337 teachers declared interest in a group program. All teachers were surveyed with the “General Health Questionnaire”, the “Maslach Burnout Inventory” and the “Effort Reward Imbalance Questionnaire”. In addition, participating teachers were screened with the “Symptom Checklist 27” T and χ²-tests were calculated to detect differences between those interested in the program and the remaining 612 teachers. Six factors were established and used for a regression analysis that identified specific parameters more or less correlating with health benefits of those who participated in the program.

Results

Findings showed that those declaring interest in the intervention displayed a higher degree of occupational stress according to all health parameters examined. Teachers interested in the program were significantly younger, more frequently female and single. The regression analysis showed that the baseline scores of the six health parameters were the strongest predictors for improvement. Worse scores before the beginning of the intervention correlated with a more positive effect.

Conclusions

Intervention programs aiming at alleviating the mental stress of teachers find the interest of those who need it most. More importantly, the latter are the ones who—at least if our program is applied—benefit best.     

Goal setting, social support, and financial incentives in stress management programs: a pilot study of their impact on adherence

Abstract A stress management program was implemented at two worksites to answer the following questions: 1) Is it feasible to design a stress management program that is of sufficient duration to change old habits, is tailored to the specific needs of the individual, and yet is administratively manageable? 2) To what degree does the use of powerful, reliable, independent variables make it possible for program participants to adhere to a stress management goal of their choosing? A program of six months duration that included personal stress management projects attracted a total of 21 participants at the two worksites. They met their weekly personal project commitments more than 80 percent of the time, and significant changes occurred on a measure of social anxiety.     

The Impact of Cognitive-Behavioral Stress Management Training Program on Job Stress in Hospital Nurses: Applying PRECEDE Model

Background: Nursing is one of the most stressful jobs. The present study aimed to determine the effect of a cognitive-behavioral stress management training program based on PRECEDE model on stress reduction among nurses. Methods: In this quasi-experimental study, which was conducted in 2010, 58 female nurses in Hamadan, northwest Iran were enrolled in the study and were divided into two equal groups included 29 nurses from one Hospital and 29 nurses from the other as intervention and control groups respectively. The data collection tool was a self-administered questionnaire including demographic characteristics and nursing stress scale (NSS). In addition, a questionnaire based on PRECEDE model was used in order to assess predisposing, reinforcing and enabling factors. The intervention was a training program including five sessions during three weeks in which relaxation and problem-solving training was thought. A pre-test and a post-test were performed 1.5 months apart. The t-test, Mann Whitney and Willxocon statistical tests were used for data analysis at 95% significant level using SPSS 13. Results: The baseline score average of job stress was 113.0 and 109.8 for intervention and control groups respectively (P=0.250). After intervention, score average of job stress decreased to 94.0 in experimental group while that of control group remained relatively unchanged (109.2), (P<0.001). A significant difference was found in PRECEDE model constructs and stress management behaviors in intervention group compared to control group after training interventions (P<0.001). Conclusion: Training programs based on PRECEDE model might be effective on decreasing job stress in nurses.