Behavioral Medicine

Moderation of Mood in the Transfer of Self-Regulation From an Exercise to an Eating Context: Short- and Long-Term Effects on Dietary Change and Obesity in Women Abstract Background Behavioral obesity treatments require an improved understanding of the dynamics of associated psychological changes. This study aimed to clarify previous research on self-regulatory skills' transfer from an exercise to eating context, effects of mood on self-regulatory strength, and related effects on a targeted eating behavior. Methods Women with obesity participated in a yearlong community-based cognitive-behavioral treatment that first focused on self-regulatory skills development for exercise maintenance, then use of similar self-regulatory skills and improved mood to facilitate short- and long-term increases in fruit/vegetable intake and reduction in weight. Groups were based on high (≥ 5% of baseline weight; n = 51) and low (< 5%; n = 49) weight reduction 2 years post-initiation. Results Improvements in eating self-regulation and fruit/vegetable intake were greatest in the high weight-reduction group. Using lagged variable analyses to assess directionality, mood significantly moderated the prediction of eating self-regulation change by exercise self-regulation change. The effect of increased exercise self-regulation on fruit/vegetable intake change over 6 months was significantly mediated by eating self-regulation change. Participants' initial weight moderated the effect of eating self-regulation change on fruit/vegetable intake. Change in eating self-regulation over 6 months predicted self-regulation at 24 months. Short-term change in fruit/vegetable intake predicted weight change over 2 years through its association with long-term fruit/vegetable consumption. Conclusions Findings supported the expected carry-over of self-regulation from an exercise to eating context, mood effects on self-regulatory strength, and associations of exercise with eating and weight changes via effects on psychological variables. Results have implications for sustained effects associated with behavioral treatments.

Pre-surgical Caregiver Burden and Anxiety Are Associated with Post-Surgery Cortisol over the Day in Caregivers of Coronary Artery Bypass Graft Surgery Patients Abstract Background The relationship between pre-surgical distress and diurnal cortisol following surgery has not been investigated prospectively in caregivers of coronary artery bypass graft (CABG) patients before. We aimed to examine the relationship between pre-surgical anxiety and caregiver burden and diurnal cortisol measured 2 months after the surgery in the caregivers of CABG patients. Method We used a sample of 103 caregivers of elective CABG patients that were assessed 28.86 days before and 60.94 days after patients' surgery. Anxiety and caregiver burden were assessed using the anxiety subscale of the Hospital Anxiety and Depression Scale and the Oberst Burden Scale respectively. Saliva samples were collected to measure cortisol area under the curve with respect to ground (AUCg) and diurnal cortisol slope. Anxiety and caregiver burden were entered into linear regression models simultaneously. Results While high levels of pre-surgical anxiety were positively associated with increased follow-up levels of AUCg (β = 0.30, p = 0.001), greater pre-surgery perceived burden score was associated with steeper cortisol slope (β = 0.27, p = 0.017) after controlling for a wide range of covariates. Conclusion These outcomes support the utility of psychological interventions aimed to increase the awareness of caregiving tasks and demands in informal caregivers.

Sleep Quality and Inflammation in Married Heterosexual Couples: an Actor-Partner Analysis Abstract Background Subjective sleep quality is a predictor of important health outcomes, but little work has examined the social context of sleep that might inform theoretical models and intervention approaches. The present study tested actor-partner models of sleep quality and its links to inflammatory markers. Method Participants were 84 middle-age to older adult heterosexual married couples who completed the Pittsburgh Sleep Quality Index and had blood drawn for determination of CRP and IL-6 levels. Results Main results indicated that only actor levels of poor global sleep quality predicted higher CRP levels. No actor × partner or gender × actor/partner interactions were significant. These results were also not moderated by relationship quality. Secondary analyses, focused on the different components of sleep quality, revealed marginally significant evidence for partner's poor sleep (i.e., sleep disturbances, sleep latency) on one's own inflammatory outcomes. Conclusion These results suggest the promise of modeling sleep quality as a dyadic process that can impact inflammation and potentially related health outcomes.

Physical Activity After Breast Cancer Surgery: Does Depression Make Exercise Feel More Effortful than It Actually Is? Abstract Background Prior to treatment, breast cancer patients are less physically fit compared to peers; during cancer treatment, their fitness typically declines. Depressive symptoms are associated with reduced activity up to 5 years post-treatment, but research has not identified mechanisms linking depression and lower activity. The current study assessed relationships among breast cancer patients' depression and perceived exertion during exercise as well as heart rate, an objective indicator of exertion. Methods Participants were 106 breast cancer patients, stages I–IIIA, who completed surgery but had not started adjuvant treatment. Heart rate and self-rated exertion, measured using the Borg Scale of Perceived Exertion, were assessed every 2 min during a graded exercise test. Depression was assessed using the CES-D and a structured clinical interview. Results Compared to women below the CES-D clinical cutoff, women with significant depressive symptoms reported steeper increases in exertion during the exercise test (p = .010) but had similar heart rates (p = .224) compared to women below the cutoff. Major depression history was unrelated to perceived exertion (ps > .224) and heart rate (ps > .200) during exercise. Conclusions Women with currently elevated depressive symptoms experienced exercise as more difficult compared to women below the CES-D cutoff, but these self-perceptions did not reflect actual heart rate differences. Depression may make exercise feel more demanding, which could ultimately decrease patients' likelihood of engaging in regular exercise. Results support the use of depression screening tools following breast cancer surgery to identify and intervene on individuals at risk for decreased physical activity during survivorship.

Young Thai People's Exposure to Alcohol Portrayals in Society and the Media: A Qualitative Study for Policy Implications Abstract Background Although previous quantitative studies have documented the association between exposure to alcohol portrayals and drinking attitudes in Western countries, few qualitative studies have explored this matter in Thailand. A better understanding of the association in young Thais is required for a more efficient alcohol policy development. This study aims to explore the information young Thais have learnt from exposure to alcohol portrayals in society and the media, examine how this exposure shapes their drinking attitudes, and investigate the alignment of policy-makers' views on drinking with those of young people. Methods Two qualitative research methods were employed. Seventy-two university students (38 men, 34 women) aged 20–24 participated in focus groups conducted on campus. Semi-structured interviews were conducted with academia, civil society and representatives from government who were involved in alcohol policy. Recorded data were transcribed verbatim, systematically coded and analysed using content analysis. Results Young Thais were regularly exposed to alcohol portrayals, particularly on social media and in their social environment. Being increasingly exposed to alcohol portrayals, particularly on social media, and the role of the alcohol industry emerged as concerning matters to the academia and civil society sectors. In response to the concerns, the government social media monitoring and alcohol censorship had become more challenging. Conclusions This study reflects the growing concerns from academia and civil society sectors of the impacts of increased alcohol exposure and the role that the industry may have on young people's drinking attitudes. It highlights the need for response to significant policy challenges to reduce these impacts.

Perceptions of Physical Activity Promotion, Transportation Support, Physical Activity, and Body Mass: an Insight into Parent-Child Dyadic Processes Abstract Background Socio-ecological models indicate that family, school, and community environment explains children's physical activity and body weight. This study investigated whether parental perceptions of school/community-based physical activity (PA) promotion programs as well as parental and child perceptions of parental instrumental support for child PA (transportation provision) would predict child body weight. Child moderate-to-vigorous physical activity (MVPA) was hypothesized to mediate these associations. Method Data of 879 parent-child dyads were collected at two measurement points: the baseline (T1) and the 7–8-month follow-up (T2). Parents were 23–68 years old (83.3% women), while children were 5–11 years old (52.4% girls). Parents and children reported their perceptions of environment, support (T1), and MVPA (T1, T2). Parental and child body weight and height were measured objectively (T1, T2). Results Path analyses indicated indirect effects of parental perceptions of school/community-based PA policies (T1) and parental perceptions of transportation provision (T1) on child body weight (T2), with child MVPA (T2) operating as the mediator. There were no direct or indirect effects of child perceptions of parental transportation provision (T1) on child MVPA or body weight (T2). Similar patterns of associations were found for the total sample and the subsample of children with overweight/obesity. Conclusion Parental perceptions of school/community-based PA policies and transportation provision may explain changes in child MVPA and body weight. Interventions aimed at prevention of child overweight/obesity may benefit from a focus on parental transportation provision to PA facilities and parental awareness of PA promotion at local environment.

Psychosocial Syndemics and Sexual Risk Practices Among U.S. Adolescents: Findings from the 2017 U.S. Youth Behavioral Survey Abstract Background The present study aims to (1) identify classes of psychosocial syndemics among adolescents in the U.S. based on psychological factors, such as depression and suicidal ideation, and social factors, such as binge drinking, alcohol use, and drug use; (2) identify correlates of psychosocial syndemics; and (3) examine the independent associations between psychosocial syndemic factors and sexual risk practices. Method We used latent class analysis and a sample of 14,762 U.S. high school students who participated in the 2017 Youth Risk Behavior Surveillance System to examine youth population profiles based on shared characteristics of syndemics. Adjusting for sociodemographic factors, we conducted logistic regression to explore the connections between psychosocial syndemic factors and three sexual risk practices, namely, early initiation of sexual intercourse, condom use, and sex with multiple partners. Results The study results indicate that three classes of risk exist among the sample: substance misuse (class 1, n = 3872, 26.2%), normative (class 2, n = 8791, 59.6%), and mental health problems (class 3, n = 2099, 14.2%). Class membership of psychosocial syndemics was significantly different by gender, age group, and race. The odds of initiating sexual intercourse before age 13 were positively associated with participants belonging in the substance misuse class and the mental health problem class. The odds of using condoms during the last sexual intercourse for currently sexually active adolescents were lower for participants classified in the substance misuse class. The likelihood of reporting having sex with four or more partners in a lifetime was higher among participants belonging to the substance misuse class. Conclusion The study advances our understanding of the heterogeneity of class membership associated with psychosocial syndemic risk factors among adolescents and extends our understanding of syndemics in the area of adolescent health. Thus, practitioners and policymakers can design multicomponent and multilevel school-based HIV/STI prevention programs that meet the needs of adolescents.

Pathways to Health: an Examination of HIV-Related Stigma, Life Stressors, Depression, and Substance Use Abstract Background Despite antiretroviral treatment (ART) being an efficacious treatment for HIV, essentially making it a chronic non-terminal illness, two related and frequent concerns for many people living with HIV/AIDS (PLWHA) continue to be HIV-related stigma and life stress. These two variables are frequently associated with depression, substance use, and poorer functional health. Studies to date have not fully examined the degree to which these constructs may be associated within one model, which could reveal a more nuanced understanding of how HIV-related stigma and life stress affect functional health in PLWHA. Methods The current study employed hybrid structural equation modeling to examine the interconnectedness and potential indirect relationships of HIV-related stigma and life stress to worse health through substance use and depression, controlling for ART adherence and age. Participants were 240 HIV-infected individuals who completed a biopsychosocial assessment battery upon screening for an RCT on treating depression in those infected with HIV. Results Both HIV-related stigma and stressful life events were directly related to depression, and depression was directly related to health. There were significant indirect effects from stigma and stress to health via depression. There were no significant effects involving substance use. Conclusion It is important to continue to develop ways to address stigma, stressful life events, and their effects on distress in those living with HIV. Expanding our knowledge of disease progression risk factors beyond ART adherence is important to be able to design adjuvant interventions, particularly because treatment means that people living with HIV have markedly improved life expectancy and that successful treatment means that HIV is not transmittable to others.

Association Between Deviation of Fairness Perceptions from Group Average and Serious Psychological Distress in Japanese Worksites: a Cross-Sectional Study Abstract Background Workers with deviating fairness perceptions are likely to be excluded and become isolated at worksites, leading to psychological distress. The study aimed to examine the cross-sectional association between deviation of fairness perception from the group average and serious psychological distress in Japanese worksites. Methods Secondary data analysis of an existing Japanese occupational cohort data using a multilevel logistic regression model was conducted for 8701 workers from 12 companies in Japan who participated in the baseline survey (from April 2010 to March 2012). Individual perception of interactional and procedural fairness was measured with the Japanese version of the Organizational Justice Scale. Group averages were calculated within workers' reference groups, categorized by company affiliation, age group, gender, and occupational class. Psychological distress was measured using the K6 scale, and serious psychological distress was defined as a total K6 score of 13 or more. Results Both low deviation and high deviation of interactional fairness perception were significantly and positively associated with serious psychological distress (odds ratio (OR) = 1.24, 95% confidence intervals (CI); 1.03–1.49 and OR = 1.57, 95% CI; 1.12–2.19), independently of individual-level fairness perception, group-level mean fairness perception, demographic characteristics, and health-related behaviors. Only high deviation of procedural fairness perception was significantly and positively related to serious psychological distress (OR = 1.51, 95% CI; 1.11–2.06). Conclusions The results indicated that divergent perceptions of fairness at worksites may deserve further exploration for equal achievement of workers' psychological well-being.

Relations of Subjective Social Status and Brooding with Blood Pressure Abstract Background Brooding, a type of rumination, and subjective social status (SSS) may be two interacting factors for cardiovascular disease (CVD). Our goal was to examine the relations of brooding and SSS with systolic blood pressure (SBP) and diastolic blood pressure (DBP), two measures of CVD. We predicted that [1] brooding and SSS are each related to SBP and DBP and [2] the interaction of brooding and SSS is linked to SBP and DBP. Method In this cross-sectional study, college student participants (n = 240; 58.6% female, age: M = 23.95 years, SD = 8.62) completed demographics questionnaires, the Ruminative Response Scale, and MacArthur Subjective Social Status scale, and gave blood pressure samples. Results Linear models suggested that, for participants low in SSS, high brooding and DBP were positively related. For participants high in SSS, high brooding and low DBP were negatively related. There were no relations between SSS, brooding, and SBP. Conclusions As predicted, for individuals with low SSS, more brooding was associated with higher DBP. Yet, in individuals with high SSS, more brooding was associated with lower DBP. There was no relation between SSS, brooding, and SBP. Our results suggest that brooding may serve as diathesis for some symptoms of CVD (i.e., high DBP but not high SBP) in individuals with low SSS. We discuss how other factors, like burnout or defensive pessimism, may contribute to the relation between high SSS, high brooding, and low DBP.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com