Relationships Between Perceived Stress and Health Behaviors in a Sample of Working Adults.

The study examined associations between perceived stress and fat intake, exercise, alcohol consumption, and smoking behaviors. Data were from surveys of 12,110 individuals in 26 worksites participating in the SUCCESS project (D. J. Hennrikus, R. W. Jeffery, & H. A. Lando, 1995), a study of smoking cessation interventions. Linear regression analyses examined cross-sectional associations between stress level and health behaviors. Analyses were stratified by gender and controlled for demographics. High stress for both men and women was associated with a higher fat diet, less frequent exercise, cigarette smoking, recent increases in smoking, less self-efficacy to quit smoking, and less self-efficacy to not smoke when stressed. Stress was not associated with alcohol intake. Findings suggest that the association between stress and disease may be moderated in part by unhealthy behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-help interventions for smoking cessation.

Self-help interventions for smoking cessation are an important bridge between the clinical and public health approaches to smoking cessation. The current literature on self-help interventions is encouraging but incomplete. Although their quit rates are lower than those of more intensive programs, self-help interventions could have a large public health impact because of their potential for widespread distribution. Studies comparing self-help to more intensive treatment suggest that long-term cessation rates for self-help programs are potentially as high as rates for face-to-face interventions, with lower quit rates for self-help programs that are likely due to differences in program adherence. Tailored materials and personalized adjuncts (e.g., written feedback or telephone counseling) that promote program adherence may increase cessation rates. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Computer-based smoking cessation interventions in adolescents: description, feasibility, and six-month follow-up findings

The impact of adolescent smoking cessation clinics has been disappointing due to low participation rates, high attrition, and low quit rates. This paper describes two computerized self-help adolescent smoking cessation intervention programs: 1) a program utilizing the expert system which is based on the transtheoretical model of change and 2) a popular action-oriented smoking cessation clinic program for teens which was modified for computer presentation. High participation rates in the program among 132 smokers demonstrate the high feasibility and acceptability of the programs. Quit rates of up to 20% were observed during the intervention, and an additional 30% made unsuccessful quit attempt(s). The 6-month follow-up findings indicated that adolescents were poorly prepared to maintain abstinence.     

Helping hospitalized smokers quit: New directions for treatment and research.

To date, relatively little work has been done to develop or evaluate effective inpatient quit-smoking treatment programs. However, there is growing interest in programs that motivate and assist the hospitalized smoker to quit smoking and remain abstinent. This article represents the rationale for hospital-based smoking treatment programs and introduces a practical minimal-contact treatment model based on extensive studies of primary-care-based and self-help interventions, on a limited number of inpatient studies, and on several prominent theories of health behavior change. Recent controlled and exploratory studies of inpatient interventions are reviewed, including programs for the general medical population and programs for special patient groups such as patients hospitalized for cardiovascular disease, pulmonary disease, cancer, and drug or alcohol dependency. Major findings are summarized, and recommendations are given for future treatment and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of daily mood, work hours, and iso-strain variables on self-reported health behaviors.

Four hundred and twenty-two employees completed daily diaries measuring positive affect, negative affect, work hours, and health behaviors (snacking, smoking, exercise, alcohol, caffeine consumption) on work days over a 4-week period. In addition, measures of job demands, job control, and social support (iso-strain variables) were completed on 1 occasion. Multilevel random coefficient modeling was used to examine relationships between the job characteristics, daily work variables, and self-reported health behaviors. Results indicated a more important role for within-person daily fluctuations than for between-persons variations in predicting health behaviors. Whereas negative affect was negatively related to health behavior for both men and women, work hours had negative impacts for women only. Iso-strain variables showed few main effects and a modest number of interactions with daily variables (mainly for men). Findings point to the limited impact of stable features of work design compared to the effects of daily work stressors on health behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior modification for obesity: The evaluation of exercise, contingency management, and program adherence.

Investigated crucial aspects of behavioral programs for obesity including (a) the assumption that Ss actually engage in requested behaviors and that these behaviors mediate weight loss, (b) the effect of exercise on weight loss, and (c) the problem of long-term maintenance and generalization to the clinically obese. Exercise and self-managed contingency components were compared in a 2?×?2 factorial design on 44 obese Ss and were evaluated after 10 wks of treatment and 3-mo and 1-yr follow-ups. Significant weight loss was observed for all groups at program termination and the 3-mo follow-up, with only those exposed to exercise and/or contingency management maintaining weight loss after 1 yr. There were no main effects or interactions at program termination or at the 3-mo follow-up. However, the influence of exercise at the 1-yr follow-up was noticeable. Assessment of program adherence indicated that Ss engaged in program behaviors, yet only 1 of 10 such behaviors was related to weight loss. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Benefits of collecting local data on breast cancer and mammography practices in northwestern Pennsylvania

OBJECTIVES: A randomized trial was conducted to evaluate the effectiveness of a work-site health promotion program in reducing obesity and the prevalence of cigarette smoking. METHODS: Thirty-two work sites were randomized to treatment or no treatment for 2 years. Treatment consisted of health education classes combined with a payroll-based incentive system. Evaluation was based on cohort and cross-sectional surveys. RESULTS: Of 10,000 total employees in treatment work sites, 2041 and 270 participated in weight control and smoking cessation programs, respectively. Weight losses averaged 4.8 lbs, and 43% of smoking participants quit. Net 2-year reductions in smoking prevalence in treatment vs control work sites were 4.0% and 2.1% in cross-sectional and cohort surveys, respectively. No treatment effect was found for weight. Treatment effects for smoking prevalence and weight were both positively correlated with participation rates in the intervention programs (r = .45 for smoking and r = .55 for weight). CONCLUSIONS: This work-site health promotion program was effective in reducing smoking prevalence at a cost that is believed to make the investment worthwhile.     

Psychologists' roles and opportunities in rehabilitation and recovery for serious mental illness: A survey of Council of University Directors of Clinical Psychology (CUDCP) clinical psychology training and doctoral education.

The emergence of psychiatric rehabilitation and the recovery movement generate new and expanded roles for psychologists in services for people with serious mental illness (SMI). However, the proportion of psychologists working in SMI services today is substantially less than previous decades. This article reviews the roles of psychologists in various mental health systems and outlines the contributions that psychologists can make in implementing evidence based approaches for people with SMI. A survey of American Psychology Association (APA)-accredited Council of University Directors of Clinical Psychology (CUDCP) Clinical Psychology doctoral programs was conducted. The results of the survey indicate an increase, since the early 1990s, in clinical faculty with SMI interests, and suggest that many graduate programs provide opportunities for SMI-relevant research and practicum training. However, the survey also indicates a lack of coursework on topics relevant to SMI and a lack of coursework relevant to assuming administrative and leadership roles in the mental health system. Despite training opportunities in graduate school, production of new PhDs who choose the SMI field is unlikely to meet the demand. According to the present study, the limiting factor is not availability of training, but student career choice. The opportunities and challenges that psychologists face in SMI recovery-oriented service delivery are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Panel III: Behavioral risk factors related to chronic diseases in ethnic minorities.

This article reviews the evidence on 5 risk behaviors: cigarette smoking, dietary intake, being overweight, limited exercise, and alcohol consumption among African Americans, Asian/Pacific Islanders, Latinos, and Native Americans. Although there is little basis for believing that these high-risk behaviors are any less significant as contributors to chronic disease risk in any ethnic group, the limited information available, especially for Asian/Pacific Islanders and Native Americans, indicates that there may be significant within- and between-group differences in the prevalence of these behaviors. Therefore. some of the ethnic group differences in morbidity and mortality for chronic diseases are partly attributable to differences in behavioral risk profiles. Limited basic health behavior information on most ethnic minority groups delay the development of effective health promotion interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analytic review of obesity prevention programs for children and adolescents: The skinny on interventions that work.

This meta-analytic review summarizes obesity prevention programs and their effects and investigates participant, intervention, delivery, and design features associated with larger effects. A literature search identified 64 prevention programs seeking to produce weight gain prevention effects, of which 21% produced significant prevention effects that were typically pre- to post effects. Larger effects emerged for programs that targeted children and adolescents (vs. preadolescents) and females, programs that were relatively brief, programs that solely targeted weight control versus other health behaviors (e.g., smoking), programs evaluated in pilot trials, and programs wherein participants must have self-selected into the intervention. Other factors, including mandated improvements in diet and exercise, sedentary behavior reduction, delivery by trained interventionists, and parental involvement, were not associated with significantly larger effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials.

A meta-analysis was conducted on controlled clinical trials investigating adaptations of motivational interviewing (AMIs), a promising approach to treating problem behaviors. AMIs were equivalent to other active treatments and yielded moderate effects (from .25 to .57) compared with no treatment and/or placebo for problems involving alcohol, drugs, and diet and exercise. Results did not support the efficacy of AMIs for smoking or HIV-risk behaviors. AMIs showed clinical impact, with 51% improvement rates, a 56% reduction in client drinking, and moderate effect sizes on social impact measures (d=0.47). Potential moderators (comparative dose, AMI format, and problem area) were identified using both homogeneity analyses and exploratory multiple regression. Results are compared with other review results and suggestions for future research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic illness, pain and health behaviors of community behavioral health clients.

Persons with comorbid medical disorders, along with substance use disorders and mental illness, present complex treatment needs that are seldom addressed. Chronic physical illness negatively affects treatment participation and retention, decreasing effectiveness. Studies documenting higher medical morbidity and mortality in such persons have long been available. Less is known about their health behaviors. Respondents (n = 418) at a community behavioral health center were surveyed for prevalence of illness, pain, health behaviors, and interest in lifestyle change. A total of 73% reported at least one chronic health problem, and nearly half rated their health between fair and very poor. Most reported at least one negative health indicator or behavior (e.g., smoking). Encouragingly, nearly 50% desired lifestyle changes including smoking cessation, exercise, and stress management. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parent motivation to enroll in parenting skills programs: A model of family context and health belief predictors.

In this study, the authors tested a heuristic model of health belief and family context factors associated with parent inclination to enroll in parenting skills programs. They collected data from 1,192 rural midwestern parents of 5th graders. Results support a basic model including health belief constructs derived from the health belief model (I. M. Rosenstock, 1966; perceived teen problem susceptibility, problem severity, program benefits, and program barriers) and an expanded model incorporating the indirect effects of several family context variables, household income, parent education, number of children, child problem behaviors, and past parenting resource use. Perceived program benefits, program barriers, and past parenting resource use showed the strongest influence on the parents' inclination to enroll. Implications for practitioners are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness.

A cognitive-behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers. CBT was compared with treatment as usual (TAU) in a randomized controlled trial with 108 clients with PTSD and either major mood disorder (85%) or schizophrenia or schizoaffective disorder (15%), of whom 25% also had borderline personality disorder. Eighty-one percent of clients assigned to CBT participated in the program. Intent-to-treat analyses showed that CBT clients improved significantly more than did clients in TAU at blinded posttreatment and 3- and 6-month follow-up assessments in PTSD symptoms, other symptoms, perceived health, negative trauma-related beliefs, knowledge about PTSD, and case manager working alliance. The effects of CBT on PTSD were strongest in clients with severe PTSD. Homework completion in CBT predicted greater reductions in symptoms. Changes in trauma-related beliefs in CBT mediated improvements in PTSD. The findings suggest that clients with severe mental illness and PTSD can benefit from CBT, despite severe symptoms, suicidal thinking, psychosis, and vulnerability to hospitalizations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of adherence to a structured exercise program for older women.

This study examined whether psychological, physiological, and health and lifestyle measures were associated with adherence to a structured exercise program for older women. Women aged 60 to 85 years (N?=?102), randomly recruited from the community, were assessed on these measures before and after a 12-month exercise trial. Sixty-nine women completed the trial, and 54 continued participation after the trial for at least 6 months. Adherence was examined at various stages during the trial. Multiple regression analysis revealed that reduced muscle strength, slow reaction time, and psychoactive drug use explained most of the variance in adherence during the trial. In contrast, muscle strength, reasoning ability, depression, and self-reported improvement in strength best predicted continued participation after the trial. The findings have implications for community-based exercise programs and research trials. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Occupational health promotion programs to reduce cardiovascular risk.

This article surveys the literature on worksite health-promotion programs that target cardiovascular risk factors. We review findings in the areas of health-risk appraisal, hypertension control, smoking cessation, weight reduction, and exercise. Programs that address multiple risk factors are also discussed. In each area we discuss what is currently known, highlight exemplary studies, and identify both problems and priorities for future research. Increased attention needs to be paid to motivational and organizational issues that may influence participation in and outcomes of health promotion programs. The initial results in several areas (e.g., smoking cessation, hypertension control) are promising, but additional controlled research is needed to substantiate the optimistic claims that have been made about occupational health promotion. In particular, studies that evaluate impact on all employees in an organization are recommended. Clinicians and researchers also need to appreciate the unique political, logistical, and methodological issues posed by worksite programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prayer, meditation, exercise, and special diets: behaviors of the hardy person with HIV/AIDS

Literature on long-term survivors with AIDS is replete with anecdotal evidence linking survival to such things as (a) holding a positive attitude toward the illness; (b) participating in health-promoting behaviors; (c) engaging in spiritual activities; and (d) taking part in AIDS-related activities. To determine whether there is quantitative research to support this anecdotal evidence, 100 subjects, who were either HIV-positive or diagnosed with ARC or AIDS, completed Kobasa's Personal Views Survey (hardiness measure) and responded to questions regarding perceptions of their physical, emotional, and spiritual health; participation in spiritual activities, selected health-promoting behaviors, and AIDS-related activities. The results demonstrated positive relationships between hardiness and: perception of physical, emotional, and spiritual health; participation in prayer and meditation; and participation in exercise and the use of special diets.     

Home-based reinforcement programs designed to modify classroom behavior: A review and methodological evaluation.

Reviews and evaluates current research on the use of home-based reinforcement programs to modify both disruptive and academic behaviors in the classroom. This treatment program has been used with a variety of students, settings, and behaviors, and the results have been positive. However, the conclusions concerning the effectiveness of home-based reinforcement programs are limited because of the methodologies used in the studies. Appropriate designs were used in less than two-thirds of the studies, monitoring of home and school programs rarely has occurred, and multiple-outcome measures have been ignored. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Size characteristics of larger academic human environmental health programs in the United States

We have performed a benchmark exercise evaluating larger academic programs in human environmental health sciences. These programs are located at schools of public health and at other institutions that have NIEHS Centers of Excellence. The largest programs were those in which there was both an NIEHS center and a public health graduate education program. This suggests that there is synergy between environmental health sciences research and involvement in public and community health.