Behavioral Medicine

Correction to: Caregiver Burden and Work Productivity Among Japanese Working Family Caregivers of People with Dementia The authors have noted that the number of participants in the final sample should be 377, rather than 379. In this correction, the two mistaken cases were removed and analyses were repeated with 377 cases.

Complex Patterns Across the Migration Process and Associated HIV Testing and Risk Behaviors among Latino Immigrants Abstract Background Migrants are at elevated risk for adverse HIV-related outcomes. Yet, there is limited understanding about the complexity of the migration process and the different migration experiences that may influence HIV testing and risk behaviors. This study examined whether patterns in immigrants' migration experience were associated with HIV risk and preventive behaviors. Methods Surveys were conducted with Latino immigrant adults (n = 306) in New York City during the spring of 2017. Informed by formative interviews, variables were developed to assess the migration process and document information about Latino immigrants' experiences during six particular stages of migration (pre-departure, travel, destination, interception, return, and settlement). We conducted a Latent Class Analysis (LCA) to detect patterns in the migration experience among participants and examined the associations between the latent classes and HIV testing and risk behaviors. Results LCA clustered participants into three migration experience classes: positive experience (50.3%), neutral experience (36.3%), and negative experience (13.4%). The migration classes were significantly associated with sociodemographic variables, including sex, age, and income. Different experiences during the migration process did not influence immigrants' past or current HIV testing or risk behaviors. However, the migration classes were associated with immigrants' future intentions to test for HIV with the positive migration experience class reporting greater intentions to test for HIV in the next 12 months than the negative experience class (aOR, 2.95; 95% CI, 1.21–7.17; p < .05). Conclusion Results suggest the applicability of a migration experience framework for understanding future HIV risk and preventive behaviors among immigrants.

Commonalities and Differences in Psychological Adjustment to Chronic Illnesses Among Older Adults: a Comparative Study Based on the Stress and Coping Paradigm Abstract Background This study aimed to validate the role of the stress and coping paradigm in the context of psychological adjustment to chronic illnesses among older adults by using the structural equation modeling technique, as well as investigating the differences in structural weights between older adults with arthritis and older adults with hypertension. Method A cross-sectional study was conducted with 325 older adults with chronic illnesses (149 hypertension, 176 arthritis), aged 60–88 years, who completed questions on perceived social support, psychological resources, threat appraisal, self-efficacy, coping strategy, depressive symptoms, and anxiety. Results The results revealed that older adults with arthritis experienced significantly higher anxiety (t = 2.91, p < 0.01) than those with hypertension, whereas no significant difference in their depressive symptoms was observed (t = 1.61, p > 0.05). Social support, psychological resources, threat appraisal, and self-efficacy had a significant direct relationship with psychological distress (β = − 0.15, β = − 0.38, β = 0.19, β = − 0.23, respectively). Multi-group analyses showed significant differences in structural weights between older adults with hypertension and those with arthritis (Δχ2 = 41.336, Δdf = 18, p < 0.01). Conclusion The stress and coping paradigm appears to be applicable for adjustment to chronic illnesses by allowing direct paths from social support, psychological resources, threat appraisal, and self-efficacy to psychological distress. The differences in structural weights may offer an intervening angle for clinical practitioners to design targeted interventions for older adults with different types of chronic illnesses.

Caregiver Burden and Work Productivity Among Japanese Working Family Caregivers of People with Dementia Abstract Background We examined the association between caregiver burden and work productivity (i.e., absenteeism, presenteeism, and overall work impairment) among working family caregivers of people with dementia and whether job characteristics (i.e., job demands, job control, supervisor and coworker support) moderate this association. Methods A cross-sectional correlational study design using a web-based questionnaire survey was conducted among 379 Japanese working family caregivers of people with dementia (105 female, age range 20–77) in May 2016, which measured caregiver burden, work productivity, care situation, job characteristics, and demographics. Caregiver burden was designated as an independent variable and each aspect of work productivity as a dependent variable in a hierarchical multiple regression analysis, adjusting for demographics. Interaction terms between caregiver burden and each job characteristic were also included in the model. Results Caregiver burden was significantly and positively associated with presenteeism (β = 0.219, p < 0.001) and overall work impairment (β = 0.181, p < 0.001), while the association of caregiver burden with absenteeism was not significant (β = − 0.003, p = 0.953). Interaction effects of caregiver burden × coworker support on presenteeism (β = − 0.189, p = 0.023) and overall work impairment (β = − 0.172, p = 0.034) were significant. According to simple slope analyses, caregiver burden was greater at lower levels of coworker support compared to higher levels of coworker support for both presenteeism and overall work impairment. Conclusions Our study suggests that higher caregiver burden is associated with a decrease in work productivity. Additionally, coworker support appears to buffer the association of caregiver burden with presenteeism and overall work impairment among working family caregivers of people with dementia.

Acculturation Moderates the Effects of Expressive Writing on Post-Traumatic Stress Symptoms Among Chinese American Breast Cancer Survivors Abstract Background Previous research indicated that the benefits of expressive writing on cancer patients' physical and psychological well-being may vary across cultures. However, it remains unknown whether the within-ethnicity cultural orientation would also moderate the efficacy of expressive writing. Immigrants are a special population who differ widely in extent of endorsing the home culture and the host culture. We examined the role of acculturation in moderating the effect of expressive writing among Chinese American breast cancer survivors in reducing different post-traumatic stress disorder (PTSD) symptom clusters: re-experiencing, avoidance, and arousal. Method Ninety-six Chinese American breast cancer survivors were randomly assigned to three groups to write about cancer-related topics: a self-regulation group to write about deepest feelings, stress coping, and finding benefits; an emotional disclosure group to write about deepest feelings; and a cancer-fact group to write about cancer experience objectively. The only examined moderator, acculturation, was assessed at baseline. PTSD symptoms were assessed at baseline and 1-, 3-, and 6-month follow-ups. Results Acculturation moderated the effect of expressive writing at 3- and 6-month follow-ups. Among participants with low acculturation, PTSD symptoms were less severe in the self-regulation and cancer-fact groups compared with the emotional disclosure group; in contrast, no group differences in PTSD were found among highly acculturated participants. Conclusions Our findings highlight the important role of sub-ethnic cultural orientation in the efficacy of psychosocial interventions targeting immigrant populations. Trial Registration ClinicalTrials.gov Identifier: NCT03546673

Associations of Pain Intensity and Frequency With Loneliness, Hostility, and Social Functioning: Cross-Sectional, Longitudinal, and Within-Person Relationships Abstract Background The current studies investigated associations between pain intensity and pain frequency with loneliness, hostility, and social functioning using cross-sectional, longitudinal, and within-person data from community-dwelling adults with varying levels of pain. Method Secondary analysis of preexisting data was conducted. Study 1 investigated cross-sectional (baseline data: n = 741) and longitudinal (follow-up data: n = 549, observed range between baseline and follow-up: 6–53 months) associations. Study 2 tested within-person associations using daily diaries across 30 days from a subset of the participants in Study 1 (n = 69). Results Cross-sectionally, pain intensity and frequency were associated with higher loneliness (βintensity = 0.16, βfrequency = 0.17) and worse social functioning (βintensity = − 0.40, βfrequency = − 0.34). Intensity was also associated with higher hostility (β = 0.11). Longitudinally, pain intensity at baseline predicted hostility (β = 0.19) and social functioning (β = − 0.20) at follow-up, whereas pain frequency only predicted social functioning (β = − 0.21). Within people, participants reported higher hostility (γ = 0.002) and worse social functioning (γ = − 0.013) on days with higher pain, and a significant average pain by daily pain interaction was found for loneliness. Pain intensity did not predict social well-being variables on the following day. Conclusion Pain intensity and frequency were associated with social well-being, although the effects were dependent on the social well-being outcome and the time course being examined.

Coding Client Language in Motivational Interviewing for HIV Medication Adherence Using Self-Determination Theory Abstract Background Both motivational interviewing (MI) and self-determination theory (SDT) emphasise the importance of an individual's autonomy. SDT proposes that motivation is on a continuum with autonomous motivation (AM) at the self-determined end of the spectrum. Whether client speech reflects AM is not coded in MI process studies, however, as it is subsumed under the broader category of change talk (CT). We aimed to code naturalistic speech within MI sessions for HIV medication (antiretroviral) adherence according to whether expressed motivation was autonomous or controlled. We then assessed relationships between adherence and both autonomous/controlled motivational speech (AM/CM) and CT. Methods We developed a new coding tool (the SDT coding system: SDTCS) to measure naturally occurring AM speech and CM speech expressed during an MI session targeting antiretroviral (ART) adherence with 62 adults living with HIV (16 female; mean age 40 years). We coded the same sessions using the motivational interviewing skills code (MISC) 2.5 and then examined relationships with on-time ART adherence. Results The SDTCS was developed using a combined inductive and deductive approach. Adequate reliability estimates were achieved and the measure possessed good content validity. Naturally occurring AM speech had a stronger relationship to ART adherence in the week after the MI session than CM speech. There was also some evidence that the relationship between AM speech and adherence was stronger than between CT and adherence. Conclusion Future refinement and extension of the SDTCS could allow for a more nuanced understanding of client motivational speech that is currently provided by existing coding tools.

Mapping a Syndemic of Psychosocial Risks During Pregnancy Using Network Analysis Abstract Background Psychosocial risks during pregnancy impact maternal health in resource-limited settings, and HIV-positive women often bear a heavy burden of these factors. This study sought to use network modeling to characterize co-occurring psychosocial risks to maternal and child health among at-risk pregnant women. Methods Two hundred pregnant HIV-positive women attending antenatal care in South Africa were enrolled. Measured risk factors included younger age, low income, low education, unemployment, unintended pregnancy, distress about pregnancy, antenatal depression, internalized HIV stigma, violence exposure, and lack of social support. Network analysis between risk factors was conducted in R using mixed graphical modeling. Centrality statistics were examined for each risk node in the network. Results In the resulting network, unintended pregnancy was strongly tied to distress about pregnancy. Distress about pregnancy was most central in the network and was connected to antenatal depression and HIV stigma. Unintended pregnancy was also associated with lack of social support, which was itself linked to antenatal depression, HIV stigma, and low income. Finally, antenatal depression was connected to violence exposure. Conclusions Our results characterize a network of psychosocial risks among pregnant HIV-positive women. Distress about pregnancy emerged as central to this network, suggesting that unintended pregnancy is particularly distressing in this population and may contribute to further risks to maternal health, such as depression. Prevention of unintended pregnancies and interventions for coping with unplanned pregnancies may be particularly useful where multiple risks intersect. Efforts addressing single risk factors should consider an integrated, multilevel approach to support women during pregnancy. Trial Registration ClinicalTrials.gov identifier: NCT03069417

What Determines Support for Donor Registration Systems? The Influence of Sociopolitical Viewpoint, Attitudes Toward Organ Donation, and Patients' Need Abstract Background In forming opinions about donor registration systems such as opt-in versus opt-out, the sociopolitical implications of these systems may be confounded with attitudes toward organ donation itself, causing people to talk at cross purposes. The goal of the present research was to examine the interactive effects of sociopolitical viewpoint, attitude toward donation (as evidenced by current registration status in study 1 and registration intention of unregistered individuals in study 2), and patients' need for organs on people's support for a particular system. Method In study 1, we randomly assigned registered donors, registered nondonors, and nonregistered individuals to one of three sociopolitically inspired solutions to reducing the organ shortage, distinguishing between solutions based on autonomy, coercion by the state, and reciprocity, respectively. In study 2, we concentrated specifically on young and unregistered people in order to examine how prior donation intentions or indecision with respect to donor registration affect responses to the three different sociopolitical viewpoints. In both studies, we also manipulated salience of patients' need. Results Registered donors in study 1 and unregistered individuals with donation intention in study 2 (high in sympathy, low in anxiety) were highly and equally supportive of a solution based on autonomy and coercion. In contrast, registered nondonors in study 1 and unregistered and undecided individuals in study 2 (lower in sympathy, higher in anxiety) were less supportive of a solution based on coercion than autonomy. Study 2 also found that, for undecided individuals, a more salient need state was associated with a drop in anxiety and stronger support for coercion. Results for a system based on reciprocity were more difficult to interpret. Conclusion Individuals most concerned with the need of patients waiting for an organ are relatively indifferent with respect to the sociopolitical implications of a registration system, while those strongly objecting to a coercive role for the state express reservations against organ donation itself. In order to help people to form balanced opinions about organ donation systems, we recommend to make the prosocial and sociopolitical aspects equally salient and deserving of debate.

Perceptions of Health Behaviors and Mobile Health Applications in an Academically Elite College Population to Inform a Targeted Health Promotion Program Abstract Background College is a critical developmental time when many emerging adults engage in unhealthy behaviors (i.e., lack of exercise, poor diet, smoking) and consequently experience an increased risk for a decline in cardiovascular health. Understanding the beliefs and opinions of the target population is important to develop effective health promotion interventions. The goal of this study was to understand opinions regarding health and health-related mobile technology of college students at an academically elite Midwestern university in order to inform a mobile health promotion intervention following the integrated behavioral model framework. Method Eighteen college students between the ages of 18 and 22 participated in one of four focus groups, where they discussed perceptions of health behaviors, technology use, and their college environment. Data were analyzed using inductive thematic analysis as well as consensus and conformity analysis. Results Students reported prioritizing academic success over health and believed in a cultural norm within the university that unhealthy behavioral practices lead to increased academic success. Other identified barriers to achieving good health were (a) low self-efficacy for engaging in healthy behaviors when presented with conflicting academic opportunities and (b) low estimation of the importance of engaging in health behaviors. Regarding mobile health applications (apps), students reported preferring apps that were visually attractive, personalized to each user, and that did not involve competing against other users. Conclusion These results have implications for the development of mobile health promotion interventions for college students, as they highlight facilitators and barriers to health behavior change in an academically elite student body.