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)     

Effect of a behavioral self-regulation intervention on patient adherence in hemodialysis.

The present study examined the efficacy of a behavioral intervention designed to increase adherence to fluid-intake restrictions among hemodialysis patients. Twenty intervention-group patients were compared with 20 matched control patients on an indicator of fluid-intake adherence at 3 time points. The Group X Time interaction was significant, indicating that patients in the 2 groups exhibited a differential pattern of change in fluid-intake adherence across the follow-up period. The intervention and control groups did not differ significantly in terms of adherence at the initial postintervention period but did differ at the 8-week follow-up. The observed group differences were, in part, due to a trend toward increasingly better adherence in the intervention group and poorer adherence in the control group across the follow-up period. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resisting tempting foods and smoking behavior: Implications from a self-control theory perspective.

Objective: Individuals may desire to diet or restrain from eating certain foods while attempting to quit smoking out of concern for weight gain. However, previous research and clinical tobacco treatment guidelines suggest that concurrent dieting may undermine attempts to quit smoking. The current study applied the self-control strength model, which posits that self-regulation relies on a limited strength that is consumed with use, to test whether resisting tempting sweets would lead to a greater likelihood of subsequent smoking. Design: Participants were 101 cigarette smokers randomly assigned to resist eating either from a tempting plate of sweets or from a plate of less tempting vegetables. All participants were then given a 10-min recess. Main Outcome Measures: Whether participants smoked during the break, measured with a breath carbon monoxide sample, served as the primary dependent variable. Results: As predicted, participants who resisted sweets were more likely to smoke during the break (53.2%) than those who resisted vegetables (34.0%), χ2(1, N = 101) = 3.65 p     

Mediation of a preventive intervention's 6-year effects on health risk behaviors.

Using data from a 6-year longitudinal follow-up sample of 240 youth who participated in a randomized experimental trial of a preventive intervention for divorced families with children ages 9 to 12, the current study tested mechanisms by which the intervention reduced substance use and risky sexual behavior in mid to late adolescence (15–19 years old). Mechanisms tested included parental monitoring, adaptive coping, and negative errors. Parental monitoring at 6-year follow-up mediated program effects to reduce alcohol and marijuana use, polydrug use, and other drug use for those with high pretest risk for maladjustment. In the condition that included a program for mothers only, increases in youth adaptive coping at 6-year follow-up mediated program effects on risky sexual behavior for those with high pretest risk for maladjustment. Contrary to expectation, program participation increased negative errors and decreased adaptive coping among low-risk youth in some of the analyses. Ways in which this study furthers our understanding of pathways through which evidence-based preventive interventions affect health risk behaviors are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mechanisms of health behavior change in persons with chronic illness or disability: The Health Action Process Approach (HAPA).

Objective: The present article presents an overview of theoretical constructs and mechanisms of health behavior change that have been found useful in research on people with chronic illness and disability. A self-regulation framework (Health Action Process Approach) serves as a backdrop, making a distinction between goal setting and goal pursuit. Risk perception, outcome expectancies, and task self-efficacy are seen as predisposing factors in the goal-setting (motivational) phase, whereas planning, action control, and maintenance/recovery self-efficacy are regarded as being influential in the subsequent goal-pursuit (volitional) phase. The first phase leads to forming an intention, and the second to actual behavior change. Such a mediator model serves to explain social–cognitive processes in health behavior change. By adding a second layer, a moderator model is provided in which three stages are distinguished to segment the audience for tailored interventions. Identifying persons as preintenders, intenders, or actors offers an opportunity to match theory-based treatments to specific target groups. Numerous research and assessment examples, especially within the physical activity domain, serve to illustrate the application of the model to rehabilitation settings and health promotion for people with chronic illness or disability. Conclusions/Implications: The theoretical developments and research evidence for the self-regulation framework explain the cognitive mechanisms of behavior change and adherence to treatment in the rehabilitation setting. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Pilot study of a health-focused day program on improving health behaviors, clinical functioning, and perceived wellness in individuals with severe mental illness.

Persons with severe mental illness (SMI) have poor physical health and high rates of premature death. There is limited research on health interventions for this population. This pilot study compares the health behaviors and perceived improvement of 2 day programs and comments on conducting research in health intervention in community-based persons with SMI. Nineteen individuals with SMI from a health-focused day program (HFP) and treatment-as-usual day program (TAU) were assessed for clinical functioning, health behaviors, and perceived improvement by using a semistructured interview and the Brief Psychiatric Rating Scale. The special features of the HFP included special dietary planning, a well-equipped gym, staff instruction, supervision of exercise programs, and limited time for smoking. HFP participants reported higher fruit and vegetable intake and greater perceived improvement in confidence than those at the TAU. There were no differences in the amount of exercise and rates of smoking between the programs. Methodological implications for further research in this area are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-affirmation promotes health behavior change.

Objective: Evidence shows that self-affirmation has a positive effect on message acceptance and other variables that motivate health behavior change; however, this has not been translated into actual behavioral change. We propose that particular features of the previous studies may account for this failure; the current study addresses this. It is designed to test whether a self-affirmation manipulation can increase a health-promoting behavior (fruit and vegetable consumption). It also explores the extent to which efficacy variables mediate the self-affirmation and behavior relationship. Design: Women (N = 93) were randomly allocated to a self-affirmation or control task prior to reading a message regarding the health-promoting effects of fruit and vegetables. Main Outcome-Measures: Response-efficacy, self-efficacy, and intention measures were taken immediately after exposure to the message, followed by a 7-day diary record of fruit and vegetable consumption. Results: Self-affirmed participants ate significantly more portions of fruit and vegetables, an increase of approximately 5.5 portions across the week, in comparison to the control group. This effect was mediated by response-efficacy. Conclusion: Self-affirmation interventions can successfully influence health-promoting behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Protective and risk factors in health-enhancing behavior among adolescents in china and the United States: Does social context matter?

An explanatory model of adolescent health-enhancing behavior based on protective and risk factors at the individual level and in 4 social contexts was used in a study of school-based samples from the People's Republic of China (n = 1,739) and the United States (n = 1,596). A substantial account of variation in health-enhancing behavior--and of its developmental change over time--was provided by the model for boys and girls, and for the 3 grade cohorts, in both samples. In both samples, social context protective and risk factors accounted for more unique variance than did individual-level protective and risk factors, and context protection moderated both contextual and individual-level risk. Models protection and controls protection were of particular importance in the explanatory account. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Animal behavior models in health psychology research.

This editorial introduces four articles in this issue of Health Psychology. The four articles are based on symposium presentations from the eighth annual meeting of the Society of Behavioral Medicine. These articles, which describe the use of animal behavior models to study atherogenesis and hypertension, have clear implications for our understanding of relationships between behavior and health. They complement reports of animal research previously published in this journal dealing with such topics as DNA repair and immunosuppression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Staying on and getting back on the wagon: Age-related improvement in self-regulation during a low-calorie diet.

In the present study, we investigated whether self-regulation improves across adulthood, especially regarding the mastery of setbacks and failure in an important health-related behavior, namely, staying on a low-calorie diet when overweight. Overweight women (N = 126; 19–77 years of age, M = 47.2) filled out weekly questionnaires on the outcomes of behavioral, emotional, and cognitive self-regulation during a dieting program; outcomes included deviations from the diet, weight loss, affect, and rumination. Confirming hypotheses, multilevel analyses revealed that—even after controlling for prior dieting attempts—age was associated with better self-reported self-regulation (i.e., fewer deviations from the diet, lower disinhibition and rumination after failure, and higher affective well-being) but not with more weight loss. Results suggest that self-regulation improves with age and shows positive effects on subjective indicators of successfully coping with setbacks but does not directly influence the target-outcome weight loss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rewards and adolescent health behavior: Promise or promise missed.

The paper, "Rewards and Adolescent Health Behavior," appearing on the following pages, is the second of two similar, large-scale field studies appearing in this journal on improving dental hygiene practices in junior high school students (see Lund & Kegeles, 1982). Both studies report well-designed and carefully evaluated experiments in the everyday setting of the school and raise two important issues for the reader: (1) Neither offers a great deal of encouragement in respect to the adequacy of our theoretical knowledge or technical competency in achieving substantial change in the health-promoting behaviors of school age children; and (2) Neither study encourages optimism in regard to the cost-effectiveness of health-promotion programs for adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

From adolescence to adulthood: Age-related changes in beliefs about cigarette smoking in a Midwestern community sample.

The current study used a cohort-sequential design to examine age-related changes in health-relevant beliefs from the middle school years through age 37 in a large, midwestern, community sample (N?=?8,556). Results suggest systematic age-related changes such that beliefs in the personalized risks of smoking declined in middle school and then increased, beliefs in generalized health risks increased beginning in the middle school years, and values placed on health as an outcome decreased in the high school years and then increased. These findings suggest that intervention programs must counter declining personalized risk perceptions among middle school students and declining values placed on health among high school age students, (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expectancy influences the operation of personality on behavior.

The authors investigated the moderating effect of expectancies on personality for 2 different addictive behavior processes: (a) drinking and (b) binge eating and purging characteristic of bulimia nervosa. Study 1 found that positive expectancies for social facilitation from drinking moderated the effect of extraversion on drinking behavior among undergraduate men and women. Study 2 found that the expectancy that eating will help manage negative affect moderated the effect of trait urgency on bulimic symptoms among undergraduate women. Thus, the relationships of the trait risk factors to these 2 addictive behaviors are stronger if one also holds certain expectancies for reinforcement from those behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in health-promoting behavior following diagnosis with HIV: Prevalence and correlates in a national probability sample.

Diet, exercise, smoking, and substance use patterns affect the course of illness and quality of life for people with HIV. In interviews with a national probability sample of 2,864 persons receiving HIV care, it was found that most had made health-promoting changes in one or more of these behaviors since diagnosis. Many reported increased physical activity (43%) and improved diet (59%). Forty-nine percent of cigarette smokers quit or cut down; 80% of substance users did so. Desire for involvement in one's HIV care and information seeking-positive coping were the most consistent correlates of change. Other correlates varied by health practice but included health status, emotional well-being, demographics, and attitudes toward other aspects of HIV care. Most people with HIV improve their health behavior following diagnosis, but more might be helped to do so by targeting these behaviors in future interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality influences on change in smoking behavior.

Objective: To investigate associations between personality traits in early adulthood (and changes in them) and change in smoking status. Design: Prospective, longitudinal study of a general-population birth cohort. Main Outcome Measures: We measured smoking at ages 18, 26, and 32, and personality at ages 18 and 26 using the Multidimensional Personality Questionnaire (Tellegen & Waller, in press). We assessed personality’s ability to predict future smoking, and assessed how changes in personality traits relate to change in smoking status. Results: Higher aggression and alienation at age 18 predicted smoking at 26; higher self-control and traditionalism at age 18 predicted nonsmoking at 26; and higher alienation at age 26 predicted persistence of smoking to age 32. Personality change between 18 and 26 was associated with change in smoking behavior; those who stopped smoking decreased more than others in negative emotionality and increased more in constraint. Conclusion: These findings suggest that interventions fostering personality change may be effective in reducing smoking and indicate appropriate targets for such antismoking interventions in young people. In particular, high alienation predicted smoking persistence, perhaps due to resistance to existing antismoking messages; we discuss approaches that may overcome this. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of participation and attrition in a health promotion study involving psychiatric outpatients.

Participant selection biases can reduce the generalizability of research findings and lead to misestimates of intervention effectiveness. The authors examined factors associated with study participation and attrition among psychiatric outpatients recruited for the initial phase of a health promotion trial. Medical records were reviewed to obtain HIV-risk and substance abuse data, as well as psychiatric and demographic characteristics of potential participants. Of 895 eligible outpatients, 67% (n=601) consented to participate, among whom 69% (n=415) completed all baseline appointments. Compared with nonconsenters, consenters were more likely to be at risk for drug problems and to receive care from clinics serving more impaired patients. Study completion was associated with older age, a psychiatric diagnosis other than adjustment disorder and a recent sexually transmitted disease diagnosis. These findings suggest that patients who could most benefit from risk reduction interventions are more likely to participate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychoneuroimmunology: Psychological influences on immune function and health.

This review focuses on human psychoneuroimmunology studies published in the past decade. Issues discussed include the routes through which psychological factors influence immune function, how a stressor's duration may influence the changes observed, individual difference variables, the ability of interventions to modulate immune function, and the health consequences of psychosocially mediated immune dysregulation. The importance of negative affect and supportive personal relationships are highlighted. Recent data suggest that immune dysregulation may be one core mechanism for a spectrum of conditions associated with aging, including cardiovascular disease, osteoporosis, arthritis, Type 2 diabetes, certain cancers, and frailty and functional decline; production of proinflammatory cytokines that influence these and other conditions can be stimulated directly by negative emotions and indirectly by prolonged infection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risky sexual behavior among married alcoholic men.

The current study explored whether the wives of men entering alcoholism treatment are at risk for sexually transmitted infections (STIs) exposure as a result of their husbands' sexual risk behaviors. The extramarital relationships of married alcoholic men entering outpatient treatment (n = 125) were compared with those of a demographically matched community sample of nonalcoholic married men (n = 125). The proportion of alcoholic men who reported 1 or more extramarital affairs in the previous year (14%) was significantly higher than that of the community sample (4%). Additionally, only 2 alcoholic husbands and 1 nonalcoholic husband reported that his wife was aware of the extramarital relationship. For both groups, none of the men who engaged in extramarital relationships reported consistent use of condoms when having sexual intercourse with their wives or with their extramarital partners. These results suggest that wives of alcoholic men are unknowingly placed at risk for indirect exposure to STIs as a result of their husbands' sexual risk behaviors. Thus, infidelity in treatment-seeking alcohol-abusing men represents a significant public health issue. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The construction and analysis of a leadership behavior rating form.

First, an attempt was made to generalize the leadership dimensions of consideration and initiating structure to midwestern middle-management behaviors. Rating and item analysis procedures were used to obtain a rating form. Split-half reliability coefficients for the 2 dimensions were greater than .80. Secondly, scores from the rating form were analyzed in relation to the formal organizational structure of a large firm. "Significant behavioral variations were observed along the horizontal axis of the company, but not up the vertical axis. Some evidence is presented which supports the leadership climate concept." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric disorders and sexual risk among adolescents in mental health treatment.

Objective: To examine the relationship between psychiatric disorders and sexual behaviors among adolescents receiving mental health treatment. Adolescents in mental health treatment have been found to have higher rates of HIV risk behavior than their peers, but data concerning the relationship between psychopathology and risk are inconsistent and limited. Method: Eight hundred and forty adolescents (56% female, 58% African American, mean age = 14.9 years) and their parents completed computerized assessments of psychiatric symptoms via the Computerized Diagnostic Interview Schedule for Children (Shaffer, 2000a, 2000b). Adolescents also reported on sexual risk behaviors (vaginal/anal sex, condom use at last sex) and completed urine screens for a sexually transmitted infection (STI). Results: Adolescents meeting criteria for mania, externalizing disorders (oppositional defiant, conduct, and attention-deficit/hyperactivity disorders), or comorbid for externalizing and internalizing disorders (major depressive, generalized anxiety, and posttraumatic stress disorders) were significantly more likely to report a lifetime history of vaginal or anal sex than those who did not meet criteria for any psychiatric disorder (odds ratio [OR] = 2.0, 2.3, and 1.9, respectively). Adolescents meeting criteria for mania were significantly more likely to have 2 or more partners in the past 90 days (OR = 3.2) and to test positive for a STI (OR = 4.3) relative to adolescents who did not meet criteria for a psychiatric disorder. Conclusions: The presence of internalizing and externalizing disorders, especially mania, suggests the need for careful screening and targeting of adolescent sexual behavior during psychiatric treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)