The effectiveness of reinforcing exercise behavior with material incentives is unclear.
Conduct a systematic review of existing research on material incentives for exercise, organized by incentive strategy.
Ten studies conducted between January 1965 and June 2013 assessed the impact of incentivizing exercise compared to a non-incentivized control.
There was significant heterogeneity between studies regarding reinforcement procedures and outcomes. Incentives tended to improve behavior during the intervention while findings were mixed regarding sustained behavior after incentives were removed.
The most effective incentive procedure is unclear given the limitations of existing research. The effectiveness of various incentive procedures in promoting initial behavior change and habit formation, as well as the use of sustainable incentive procedures should be explored in future research.
Reinforcement; Incentive; Operant Conditioning Theory; Physical Activity
To test experiential and behavioral processes of change as mediators of the prediction of exercise behavior by two self-regulation traits, self-efficacy and self-motivation, while controlling for exercise enjoyment.
Structural equation modeling was applied to questionnaire responses obtained from a diverse sample of participants. Objective measures defined adherence (928 of 1279 participants attended 80% or more of sessions) and compliance (867 of 1145 participants exercised 30 minutes or more each session at their prescribed heart rate).
Prediction of attendance by self-efficacy (inversely) and self-motivation was direct and also indirect, mediated through positive relations with the typical use of behavioral change processes. Enjoyment and self-efficacy (inversely) predicted compliance with the exercise prescription.
The results support the usefulness of self-regulatory behavioral processes of the Transtheoretical Model for predicting exercise adherence, but not compliance, extending the supportive evidence for self-regulation beyond self-reports of physical activity used in prior observational studies.
African American; Hispanic; heart rate monitoring; mediators; processes of change; self-efficacy; self-motivation; structural equation modeling
Few previous studies have examined the influence of instrumental and emotional social support on physical activity (PA) longitudinally in underserved adolescents.
This longitudinal study was a secondary analysis of the Active by Choice Today (ACT) trial examining whether instrumental social support predicts increases in PA in underserved adolescents, above and beyond emotional social support provided by family or peers.
Students in 6th grade (N=1422, 73% African American, 54% female, Mage=11 years) in the ACT trial participated. At baseline and 19 weeks, previously validated measures of social support (family instrumental, family emotional, and peer emotional) were completed and moderate-to-vigorous PA (MVPA) was assessed using 7-day accelerometry estimates.
A mixed ANCOVA demonstrated that baseline (p=.02) and change in family instrumental support (p=.01), but not emotional support from family or peers, predicted increases in MVPA across a 19-week period.
Future interventions in underserved adolescents should enhance opportunities for instrumental support for PA.
Physical activity; instrumental social support; emotional social support; African Americans; adolescence
Information avoidance is a defensive strategy that undermines receipt of potentially beneficial but threatening health information and may especially occur when threat management resources are unavailable.
We examined whether individual differences in information avoidance predicted intentions to receive genetic sequencing results for preventable and unpreventable (i.e., more threatening) disease and, secondarily, whether threat management resources of self-affirmation or optimism mitigated any effects.
Participants (N=493) in an NIH study (ClinSeq®) piloting the use of genome sequencing reported intentions to receive (optional) sequencing results and completed individual difference measures of information avoidance, self-affirmation, and optimism.
Information avoidance tendencies corresponded with lower intentions to learn results, particularly for unpreventable diseases. The association was weaker among individuals higher in self-affirmation or optimism, but only for results regarding preventable diseases.
Information avoidance tendencies may influence decisions to receive threatening health information; threat management resources hold promise for mitigating this association.
Information Avoidance; Genomics; Genetics; Self-affirmation; Threat; Optimism
Pain hypervigilance is an important aspect of the fear-avoidance model of pain that may help explain individual differences in pain sensitivity among persons with knee osteoarthritis (OA).
The purpose of this study was to examine the contribution of pain hypervigilance to clinical pain severity and experimental pain sensitivity in persons with symptomatic knee OA.
We analyzed cross-sectional data from 168 adults with symptomatic knee OA. Quantitative sensory testing was used to measure sensitivity to heat pain, pressure pain, and cold pain, as well as temporal summation of heat pain, a marker of central sensitization.
Pain hypervigilance was associated with greater clinical pain severity, as well as greater pressure pain. Pain hypervigilance was also a significant predictor of temporal summation of heat pain.
Pain hypervigilance may be an important contributor to pain reports and experimental pain sensitivity among persons with knee OA.
Patients’ medication-related concerns and necessity-beliefs predict adherence. Evaluation of the potentially complex interplay of these two dimensions has been limited because of methods that reduce them to a single dimension (difference scores).
We use polynomial regression to assess the multidimensional effect of stroke-event survivors’ medication-related concerns and necessity-beliefs on their adherence to stroke-prevention medication.
Survivors (n=600) rated their concerns, necessity-beliefs, and adherence to medication. Confirmatory and exploratory polynomial regression determined the best-fitting multidimensional model.
As posited by the Necessity-Concerns Framework (NCF), the greatest and lowest adherence was reported by those with strong necessity-beliefs/weak concerns and strong concerns/weak necessity-beliefs, respectively. However, as could not be assessed using a difference-score model, patients with ambivalent beliefs were less adherent than those exhibiting indifference.
Polynomial regression allows for assessment of the multidimensional nature of the NCF. Clinicians/Researchers should be aware that concerns and necessity dimensions are not polar opposites.
Polynomial Regression; Necessity-Concerns Framework (NCF) and the Beliefs about Medicines Questionnaire (BMQ); Medication Adherence; Stroke Survivors; Bivariate Evaluation Plane
Cross-sectional studies show that human immunodeficiency virus (HIV) stigma is negatively correlated with social support.
The purpose of this study is to examine the bidirectional relationship between social support and HIV stigma.
We collected quarterly data from a cohort of 422 people living with HIV in Uganda, followed for a median of 2.1 years. We used multilevel regression to model the contemporaneous and 3-month-lagged associations between social support and both enacted and internalized stigma.
Lagged enacted stigma was negatively correlated with emotional and instrumental social support, and lagged instrumental social support was negatively correlated with enacted stigma. Internalized stigma and emotional social support had reciprocal lagged associations.
Interventions to reduce enacted stigma may strengthen social support for people living with HIV. Improved social support may in turn have a protective influence against future enacted and internalized stigma.
HIV/AIDS; Stigma; Social support; Uganda
Uptake of colorectal cancer screening is lower than desired. Screening decision making research has traditionally focused on benefits and barriers to screening. This study examines the relation of affective associations with screening (feelings and emotions associated with screening) to colonoscopy screening uptake.
Participants were 103 African American community adults. Participants completed a structured interview assessing perceived benefits of and barriers to colonoscopy screening, affective associations with colonoscopy, colonoscopy screening behavior, and intentions for future screening.
Higher positive and lower negative affective associations with screening were both significant predictors of colonoscopy uptake. Affective associations fully mediated the relation of perceived benefits and barriers to screening uptake. Affective associations were associated with intentions for future screening.
Incorporation of affective associations into models of screening decision making and intervention approaches to address screening compliance has utility for advancing our understanding of screening adherence as well as increasing screening rates.
Affective associations; Health decision making; Colonoscopy
Chronic pain with co-morbid depression is characterized by poor mood regulation and stress-related pain.
Compare depressed and non-depressed pain patients in mood and pain stress reactivity and recovery, and test whether a post-stress positive mood induction moderates pain recovery.
Women with fibromyalgia and/or osteoarthritis (N=110) underwent interpersonal stress and were then randomly assigned by pain condition and depression status, assessed via the Center for Epidemiological Studies-Depression scale, to positive versus neutral mood induction.
Depression did not predict stress-related reactivity in despondency, joviality, or clinical pain. However, depression X mood condition predicted recovery in joviality and clinical pain; depressed women recovered only in the positive mood condition, whereas non-depressed women recovered in both mood conditions.
Depression does not alter pain and mood stress reactivity, but does impair recovery. Boosting post-stress jovial mood ameliorates pain recovery deficits in depressed patients, a finding relevant to chronic pain interventions.
Chronic pain; depression; positive mood induction; stress recovery
Informal caregiving can be deleterious to mental health, but research results are inconsistent and may reflect an interaction between caregiving and vulnerability to stress.
We examined psychological distress among 1,228 female caregiving and non-caregiving twins. By examining monozygotic and dizygotic twin pairs discordant for caregiving, we assessed the extent to which distress is directly related to caregiving or confounded by common genes and environmental exposures.
Caregiving was associated with distress as measured by mental health functioning, anxiety, perceived stress, and depression. The overall association between caregiving and distress was confounded by common genes and environment for mental health functioning, anxiety, and depression. Common environment also confounded the association of caregiving and perceived stress.
Vulnerability to distress is a factor in predicting caregivers' psychosocial functioning. Additional research is needed to explicate the mechanisms by which common genes and environment increase the risk of distress among informal caregivers.
Twins; Caregiving; Psychological distress
Lung cancer patients and their spouses may engage in blame attributions regarding the cancer cause, which may adversely affect their psychological adjustment.
To examine whether dyadic adjustment and network support moderate the association between blame and distress in couples affected by lung cancer.
Patients and their spouses completed questionnaires within 1 month of treatment initiation (baseline) and at 6-month follow-up.
Multilevel modeling of data from 158 couples revealed that, at baseline, dyadic adjustment moderated the association between blame and distress for patients but not spouses (p<.05). Controlling for baseline distress, baseline blame predicted later distress (p<.05) for both patients and spouses regardless of dyadic adjustment. Network support moderated this association at follow-up.
For patients experiencing low dyadic adjustment, blame was associated with increased distress. Not initially but later, network support may protect against low levels but not high levels of blame in patients and spouses.
Lung cancer; attributions of blame; couples; distress; dyadic adjustment; social support
Excessive pain during medical procedures is a widespread problem but is especially problematic during daily wound care of patients with severe burn injuries.
Burn patients report 35–50% reductions in procedural pain while in a distracting immersive virtual reality, and fMRI brain scans show associated reductions in pain-related brain activity during VR. VR distraction appears to be most effective for patients with the highest pain intensity levels. VR is thought to reduce pain by directing patients’ attention into the virtual world, leaving less attention available to process incoming neural signals from pain receptors.
We review evidence from clinical and laboratory research studies exploring Virtual Reality analgesia, concentrating primarily on the work ongoing within our group. We briefly describe how VR pain distraction systems have been tailored to the unique needs of burn patients to date, and speculate about how VR systems could be tailored to the needs of other patient populations in the future.
Virtual reality; Pain distraction; Analgesia
Lung cancer morbidity and mortality may increase the risk for distress in couples facing this malignancy.
We examined the prevalence of psychological and relationship distress in lung cancer patients and their spouses, predictors of psychological distress for both, and whether relationship satisfaction moderated the relation between patient and spouse distress.
Participants (169 patients and 167 spouses) completed questionnaires provided during clinic appointments at baseline (within one month of treatment initiation) and through the mail 3 and 6 months later. Analyses were from the baseline data.
In total, 34.6% of patients and 36.4% of spouses reported psychological distress. Patient and spouse distress were correlated, depending on the symptom examined. Only 10.9% of patients and 14.1% of spouses reported distressed spousal relationships. Distress predictors for patients included less positive social interaction support, more behavioral disengagement and self-distraction coping, and the spouse reporting less use of humor for coping. Predictors for spouses included more behavioral disengagement and substance use coping, more blaming the patient for causing the cancer, and the patient using more behavioral disengagement coping. Relationship satisfaction moderated the association between each partner's distress.
Psychosocial counseling for lung cancer patients should include spouses and target decreasing individual distress and enhancing relationship satisfaction.
Couples and lung cancer; Psychosocial distress; Relationship satisfaction
Few experimental studies have been conducted on social determinants of pain tolerance.
This study tests a brief, computer-delivered social norm message for increasing pain tolerance.
Healthy young adults (N=260; 44 % Caucasian; 27 % Hispanic) were randomly assigned into a 2 (social norm)×2 (challenge) cold pressor study, stratified by gender. They received standard instructions or standard instructions plus a message that contained artifically elevated information about typical performance of others.
Those receiving a social norm message displayed significantly higher pain tolerance, F(1, 255)=26.95, p<.001, ηp2=.10 and pain threshold F(1, 244)=9.81, p=.002, ηp2=.04, but comparable pain intensity, p>.05. There were no interactions between condition and gender on any outcome variables, p>.05.
Social norms can significantly increase pain tolerance, even with a brief verbal message delivered by a video.
Social norm; Descriptive norm; Injunctive norm; Pain; Technology; Brief intervention; 2×2 factorial
In chronic illness self-care, social support may influence some health behaviors more than others.
Examine the relationship between social support and seven individual chronic illness self-management behaviors including two healthy “lifestyle” behaviors (physical activity and diet) and five more highly-skilled and diabetes-specific (“medical”) behaviors (checking feet, oral medication adherence, insulin adherence, self-monitoring of blood glucose, and primary care appointment attendance).
Using cross-sectional administrative and survey data from 13,366 patients with type 2 diabetes, we specified Poisson regression models to estimate adjusted relative risks (ARR) of practicing each self-management behavior at higher vs lower levels of social support.
Higher levels of emotional support and social network scores were significantly associated with lifestyle behaviors [healthful eating ARR (95%CI) 1.14 (1.08, 1.21) and 1.10 (1.05, 1.16), and physical activity 1.09 (1.01, 1.17) and 1.20 (1.12, 1.28)]. Both social support measures were also associated with checking feet [ARR 1.21 (1.12, 1.31) and 1.10 (1.02, 1.17)]. Neither measure was significantly associated with other medical behaviors.
Social support was associated with increased adherence to lifestyle self-management behaviors, but was not associated with increased medical self-management behaviors, other than foot self-examination.
Social Support; Diabetes Mellitus; Self-Management
Emerging adulthood is a high-risk period for mental health problems and risk behaviors for youth generally and for physical health problems among those with type 1 diabetes.
To examine whether adolescents’ relationships with parents and friends predict health and risk behaviors during emerging adulthood.
Youth with and without diabetes were enrolled at average age 12 and followed for 7 years. Parent and friend relationship variables, measured during adolescence, were used to predict emerging adulthood outcomes: depression, risk behavior, and, for those with diabetes, diabetes outcomes.
Parent relationship quality predicted decreased depressive symptoms and, for those with diabetes, decreased alcohol use. Parent control predicted increased smoking, reduced college attendance, and, for control participants, increased depressive symptoms. For those with diabetes, parent control predicted decreased depressive symptoms and better self-care. Friend relationship variables predicted few outcomes.
Adolescent parent relationships remain an important influence on emerging adults’ lives.
Emerging adulthood; parent relationships; diabetes; risk and resistance framework
Background and Purpose
We examined three theoretical models (self-enhancement theory, consistency theory, and combined model) for understanding how expectations and test result favorability influence smokers' desire for a retest following hypothetical genetic test results.
College smokers (N = 128) read a brochure describing a biomarker for lung cancer (the GSTM1 gene) then reported whether they thought they had the gene (indicating lower lung cancer risk) or were missing the gene (indicating higher lung cancer risk). Participants then reported whether they would get retested if they received favorable GSTM1 results versus unfavorable GSTM1 results.
Participants were most likely to want a retest, suggesting rejection of the results, if they expected favorable news yet received unfavorable news.
The findings supported the combined model such that smokers expressed greatest interest in a retest when they imagined genetic risk feedback that challenges both enhancement and consistency motives.
lung cancer; genes; expectations; consistency theory; self-enhancement theory
Behavioral diaries for observation of health-related behaviors assume absence of reactivity (i.e., change in behavior resulting from observation), while self-monitoring diaries maximize reactivity for behavior change. Little is known about when and for whom behavioral diary studies become self-monitoring interventions.
This study evaluated the moderating effects of social cognitive variables on reactivity in sexual risk behavior and risk appraisals in a diary study of men who have sex with men (MSM).
143 MSM completed weekly online sexual diaries for three months. Analyses were conducted with Hierarchical Linear Modeling.
There was no evidence of reactivity for the sample as a whole. Social cognitive variables (e.g., risk reduction motivation, condom use intentions, and social norms) moderated reactivity in study outcomes. For example, more highly motivated MSM experienced declines in serodiscordant unprotected anal intercourse over time.
Effectiveness of behavioral self-monitoring strategies may vary depending on social cognitive domains.
behavioral diaries; self-monitoring; health behavior; sexual risk; HIV/AIDS; men who have sex with men
Parents may pursue common disease risk information about themselves via multiplex genetic susceptibility testing (MGST) for their children.
To prospectively assess whether parents who received MGST disclosed their test results to their child, intended to change the child’s health habits or have the child tested.
Eighty parents who opted for free MGST completed an online survey about a child in their household before undergoing MGST and a follow-up telephone survey three months after receiving results.
Few parents (21%) disclosed results to the child. Undergoing MGST was unrelated to intentions to change the child’s health habits but did increase parental willingness to test the child. Greater willingness to test a child was associated with positive attitudes toward pediatric genetic testing and intentions to change the child’s health habits.
The experience of receiving MGST had little impact on parents’ perceptions or behaviors related to their minor child.
genetic predisposition to disease; genetic testing/psychology; health knowledge; attitudes; practice; parents; psychology
Depression is a risk factor for nonadherence to HIV/AIDS treatment.
A meta-analysis was conducted to examine whether treatment of depression and psychological distress improves antiretroviral therapy adherence.
PubMed and PsycINFO databases were systematically searched for relevant articles. Studies that reported an association between depression treatment (or an intervention with a component addressing mental health) and antiretroviral adherence were included.
Across 29 studies of 12,243 persons living with HIV/AIDS, treatment of depression and psychological distress improved antiretroviral adherence (p < .001). The odds of a person adhering were 83% better if he/she was treated for depression. Greater improvements in adherence were found for samples with lower CD4 counts or more severe depression, for interventions specifically targeting depression (versus addressing mental health as a secondary objective), longer treatments, and observational studies.
These findings support the need for detection and treatment of depression among persons living with HIV/AIDS.
depression; HIV/AIDS; adherence; compliance; antiretroviral therapy; meta-analysis
Impaired sleep enhances pain, perhaps by disrupting pain modulation.
Given that emotion modulates pain, the present study examined whether emotional modulation of pain and nociception is impaired in persons with severe insomnia symptoms relative to controls.
Insomnia group (n=12) met ICD-10 symptoms for primary insomnia and controls (n=13) reported no sleep impairment. Participants were shown emotionally-evocative pictures (mutilation, neutral, erotica) during which suprathreshold pain stimuli were delivered to evoke pain and the nociceptive flexion reflex (NFR; physiological correlate of spinal nociception).
Emotional responses to pictures were similar in both groups, except that subjective valence/pleasure ratings were blunted in insomnia. Emotional modulation of pain and NFR was observed in controls, but only emotional modulation of NFR was observed in insomnia.
Consistent with previous findings, pain modulation is disrupted in insomnia which might promote pain. This may stem from disrupted supraspinal circuits not disrupted brain-to-spinal cord circuits.
insomnia; pain modulation; sleep; psychophysiology; descending modulation; affect
The course of depressive symptoms during and after breast cancer treatment is not well understood.
We sought to identify patient subgroups based on distinct trajectories of depressive symptoms using growth mixture modeling and determine whether subgroups could be distinguished by demographic and clinical characteristics and coping strategies.
Women with early stage breast cancer completed the Center for Epidemiologic Studies–Depression Scale on three occasions designed to reflect clinically meaningful events and on three occasions during the post-treatment period. The Illness Management Questionnaire was completed prior to treatment.
A three-class mixture model provided the best fit to the data. In univariate analyses, subgroup membership was significantly (ps < .05) associated with marital status, history of depression and focusing on symptoms. In multivariate analysis, marital status and focusing on symptoms remained significant (ps < .05) predictors of subgroup membership.
Distinct trajectories of depression can be identified during and after adjuvant therapy for breast cancer. Predictors of these trajectories have implications for addressing depressive symptoms in this clinical population and for future research.
Breast cancer; depression; trajectory