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1.  Spouse Confidence in Self-Efficacy for Arthritis Management Predicts Improved Patient Health 
In addition to patient self-efficacy, spouse confidence in patient efficacy may also independently predict patient health outcomes. However, the potential influence of spouse confidence has received little research attention.
The current study examined the influence of patient and spouse efficacy beliefs for arthritis management on patient health.
Patient health (i.e., arthritis severity, perceived health, depressive symptoms, lower extremity function), patient self-efficacy, and spouse confidence in patients’ efficacy were assessed in a sample of knee osteoarthritis patients (N = 152) and their spouses at three time points across an 18-month period. Data were analyzed using structural equation models.
Consistent with predictions, spouse confidence in patient efficacy for arthritis management predicted improvements in patient depressive symptoms, perceived health, and lower extremity function over 6 months and in arthritis severity over 1 year.
Our findings add to a growing literature that highlights the important role of spouse perceptions in patients’ long-term health.
PMCID: PMC4331068  PMID: 24604529
Arthritis; Chronic illness; Couples; Longitudinal; Self-efficacy
2.  [No title available] 
PMCID: PMC3925767  PMID: 24317955
3.  [No title available] 
PMCID: PMC3941986  PMID: 23868613
4.  [No title available] 
PMCID: PMC3945417  PMID: 24347406
5.  [No title available] 
PMCID: PMC3945440  PMID: 24154988
6.  [No title available] 
PMCID: PMC3945721  PMID: 24096957
7.  [No title available] 
PMCID: PMC3945734  PMID: 24136092
8.  [No title available] 
PMCID: PMC3950935  PMID: 24347405
9.  Benefits of psychotropic medications on depressive symptoms and HIV medication adherence among HIV-positive men and women 
Psychiatric symptoms including depression are common among people living with HIV/AIDS (PLWHA), and antidepressant medications have been shown to reduce depressive symptoms and also enhance antiretroviral (ARV) adherence in this population.
Because these benefits have not been studied among PLWHA using other psychotropic (PSY) medications in addition to antidepressants, we examined the impact of adherence to a diverse range of PSY medications (including antidepressants, mood stabilizers, and anti-psychotic medications) on depressive symptoms and ARV adherence in PLWA.
Participants for this cohort study were recruited through physician outpatient clinics. Depressive symptoms were assessed monthly using a 10-item version of the Center for Epidemiological Studies – Depression (CES-D) scale; PSY and ARV medication adherence were assessed using monthly unannounced telephone pill count assessments across a three-month period.
A general community-based, healthcare setting was utilized for the study.
Of the 353 PLWHA we identified on stable ARV medications, we were able to maintain contact with 324 (92%) across a 3-month period (227 men; 97 women). Mean age of this convenience sample was 45 years and 90% were African-American.
Main Outcome Measure
Mean ARV adherence across a 3-month study period.
The results showed that greater depressive symptoms were associated with lower ARV adherence among our sample of PLWHA. Greater adherence to PSY medications regardless of medication class was positively related to higher ARV adherence. We also found that greater adherence to PSY medications significantly reduced the negative association between depressive symptoms and ARV medication adherence among PLWHA.
The results of this study point to the need for screening and treatment of depressive symptoms and also further study of the impact of multiple PSY medications regimens on health outcomes among PLWHA.
PMCID: PMC4285379  PMID: 22076697
11.  Divergent Associations of Antecedent- and Response-Focused Emotion Regulation Strategies with Midlife Cardiovascular Disease Risk 
It is not known whether various forms of emotion regulation are differentially related to cardiovascular disease risk.
The purpose of this study is to assess whether antecedent and response-focused emotion regulation would have divergent associations with likelihood of developing cardiovascular disease.
Two emotion regulation strategies were examined: reappraisal (antecedent-focused) and suppression (response-focused). Cardiovascular disease risk was assessed with a validated Framingham algorithm that estimates the likelihood of developing CVD in 10 years. Associations were assessed among 373 adults via multiple linear regression. Pathways and gender-specific associations were also considered.
One standard deviation increases in reappraisal and suppression were associated with 5.9 % lower and 10.0 % higher 10-year cardiovascular disease risk, respectively, in adjusted analyses.
Divergent associations of antecedent and response-focused emotion regulation with cardiovascular disease risk were observed. Effective emotion regulation may promote cardiovascular health.
PMCID: PMC4251797  PMID: 24570218
Emotion regulation; Suppression; Reappraisal; CVD
12.  Internalized stigma, social distance, and disclosure of HIV seropositivity in rural Uganda 
HIV is highly stigmatized, compromising both treatment and prevention in resource-limited settings.
To study the relationship between internalized HIV-related stigma and serostatus disclosure and to determine the extent to which this association varies with the degree of social distance.
We fit multivariable Poisson regression models, with cluster-correlated robust estimates of variance, to data from 259 persons with HIV enrolled in an ongoing cohort study in rural Uganda.
Persons with more internalized stigma were less likely to disclose their seropositivity. The magnitude of association increased with social distance such that the largest association was observed for public disclosures and the smallest association was observed for disclosures to sexual partners.
Among persons with HIV in rural Uganda, internalized stigma was negatively associated with serostatus disclosure. The inhibiting effect of stigma was greatest for the most socially distant ties.
PMCID: PMC3795853  PMID: 23690283
HIV; social stigma; disclosure; Uganda
13.  Self-rated Health among Pregnant Women: Associations with Objective Health Indicators, Psychological Functioning, and Serum Inflammatory Markers 
Biobehavioral correlates of self-rated health in pregnancy are largely unknown.
The goals of this study were to examine, in pregnant women, associations of self-rated health with 1) demographics, objective health status, health behaviors and psychological factors and 2) serum inflammatory markers.
In the 2nd trimester of pregnancy, 101 women provided a blood sample, completed measures of psychosocial stress, health status, and health behaviors, and received a comprehensive periodontal examination.
The following independently predicted poorer self-rated health: 1) greater psychological stress, 2) greater objective health diagnoses, 3) higher body mass index, and 4) past smoking (versus never smoking). Poorer self-rated health was associated with higher serum interleukin-1β (p = .02) and marginally higher macrophage migration inhibitory factor (p = .06). These relationships were not fully accounted for by behavioral/psychological factors.
This study provides novel data regarding factors influencing subjective ratings of health and the association of self-rated health with serum inflammatory markers in pregnant women.
PMCID: PMC3797861  PMID: 23765366
pregnancy; inflammation; self-rated health; cytokines; subjective health; pregnant women
14.  Association of acute coronary syndrome-induced posttraumatic stress disorder symptoms with self-reported sleep 
Symptoms of posttraumatic stress disorder (PTSD) after acute coronary syndrome (ACS) are associated with recurrent ACS events and mortality. Poor sleep may be a mechanism, but the association between PTSD and sleep after ACS is unknown.
To estimate the association between ACS-induced PTSD symptoms and self-reported sleep.
ACS-induced PTSD symptoms were assessed 1-month post-ACS in 188 adults using the Impact of Events Scale-Revised. Sleep was assessed using the Pittsburgh Sleep Quality Index. Linear and logistic regression models were used to determine whether PTSD symptoms were associated with self reported sleep, independent of sociodemographic and clinical covariates.
In adjusted models, ACS-induced PTSD symptoms were associated with worse overall sleep (β = 0.22, p = 0.003) and greater impairment in six of seven components of sleep (all p’s < 0.05).
ACS-induced PTSD symptoms may be associated with poor sleep, which may explain why PTSD confers increased cardiovascular risk after ACS.
PMCID: PMC3800234  PMID: 23720185
posttraumatic stress disorder; sleep; acute coronary syndrome
15.  Factors Associated with Discontinuation of Bupropion and Counseling among African American Light Smokers in a Randomized Clinical Trial 
African Americans are at risk for inadequate adherence to smoking cessation treatment yet little is known about what leads to treatment discontinuation.
Examine the factors associated with discontinuation of treatment in African American light smokers (≤10 cigarettes per day).
Bupropion plasma levels and counseling attendance were measured among 540 African American light smokers in a placebo-controlled randomized trial of bupropion.
By Week 3, 28.0% of subjects in the bupropion arm had discontinued bupropion and only moderate associations were found between plasma levels and self-reported bupropion use (rs=0.38). By Week 16, 36.9% of all subjects had discontinued counseling. Males had greater odds of discontinuing medication (OR=2.02, 95% CI, 1.10–3.71, p=0.02) and older adults had lower odds of discontinuing counseling (OR=0.96, 95% CI, 0.94–0.97, p<0.0001).
Bupropion and smoking cessation counseling are underutilized even when provided within the context of a randomized trial. Future research is needed to examine strategies for improving treatment utilization among African American smokers.
PMCID: PMC3815499  PMID: 23733379
Smoking cessation; discontinuation of treatment; African Americans
16.  Indoor Tanning Use among Adolescent Males: The Role of Perceived Weight and Bullying 
Appearance motives predict indoor tanning use in adolescents; however, research has primarily focused on females. Salient social factors, such as bullying victimization have yet to be explored in the context of indoor tanning.
To examine the role of perceived weight and bullying victimization in indoor tanning use among adolescent males.
Data on perceived weight, bullying victimization, and frequency of indoor tanning were obtained from the 2009 Youth Risk Behavior Survey—a nationally representative sample of U.S. high school students.
The association of perceived weight status with indoor tanning use significantly varied by bullying victimization, such that perceiving oneself as being very underweight or very overweight was associated with increased indoor tanning, particularly for those males who were victims of bullying.
Bullying victimization may be a risk factor for indoor tanning use among adolescent males who perceive their weight as extreme.
PMCID: PMC3701737  PMID: 23494291
skin cancer; tanning; weight; bullying; body image
17.  Physical Activity and Health Outcomes among HIV-infected Men who have Sex with Men: A Longitudinal Mediational Analysis 
Low physical activity is associated with depression, which may in turn, negatively impact antiretroviral therapy (ART) adherence among HIV-infected individuals; however, prior studies have not investigated the relationships between physical inactivity and ART non-adherence.
To examine the association of physical inactivity, depression, ART non-adherence, and viral load in HIV-infected men who have sex with men.
The sample (N = 860) was from a large, multicenter cohort of HIV-infected patients engaged in clinical care.
Across time, depression mediated the relationship between physical inactivity and ART non-adherence, γ = .075, and the relationship between physical inactivity and viral load, γ = .05. ART non-adherence mediated the relationship between depression and viral load, γ = .002, and the relationship between physical inactivity and viral load, γ = .009.
Low levels of physical activity predicted increased depression and poor ART adherence over time, which subsequently predicted higher viral load.
PMCID: PMC3714319  PMID: 23483379
HIV/AIDS; physical activity; depression; adherence; viral load
18.  Night/day ratios of ambulatory blood pressure among healthy adolescents: Roles of race, socioeconomic status, and psychosocial factors 
Elevated nighttime blood pressure (BP) predicts hypertension and its complications in adulthood.
To assess the independent effects of race and family income on night/day BP among adolescents and to examine whether negative emotions, low positive resources, and unpleasant interactions during the day are also related.
Healthy African American and Caucasian high school students (N=239) wore an ambulatory BP monitor for 48 hours, recorded quality of ongoing interpersonal interactions, and completed questionnaires.
African Americans and those with lower family income had higher night/day BP ratios. African Americans reporting greater negative emotions, lower positive resources, and more unpleasant interactions had higher night/day BP ratios.
Racial differences in night BP emerge by adolescence, independent of family income. African Americans, especially those high in negative emotions and low in positive resources, may be at higher relative risk for hypertension later in life in part due to elevated night BP.
PMCID: PMC3742588  PMID: 23549997
race; socioeconomic status; ambulatory blood pressure; BP dipping; adolescents; negative emotions; positive resources
19.  Effects of Anger Awareness and Expression Training versus Relaxation Training on Headaches: A Randomized Trial 
Background and purpose
Stress contributes to headaches, and effective interventions for headaches routinely include relaxation training (RT) to directly reduce negative emotions and arousal. Yet, suppressing negative emotions, particularly anger, appears to augment pain, and experimental studies suggest that expressing anger may reduce pain. Therefore, we developed and tested anger awareness and expression training (AAET) on people with headaches.
Young adults with headaches (N = 147) were randomized to AAET, RT, or a wait-list control. We assessed affect during sessions, and process and outcome variables at baseline and 4 weeks after treatment.
On process measures, both interventions increased self-efficacy to manage headaches, but only AAET reduced alexithymia and increased emotional processing and assertiveness. Yet, both interventions were equally effective at improving headache outcomes relative to controls.
Enhancing anger awareness and expression may improve chronic headaches, although not more than RT. Researchers should study which patients are most likely to benefit from emotional expression versus emotional reduction approaches to chronic pain.
PMCID: PMC3778035  PMID: 23620190
headaches; relaxation; emotional exposure; emotional processing; anger
21.  Behavioral Impacts of Sequentially versus Simultaneously Delivered Dietary Plus Physical Activity Interventions: the CALM Trial 
Few studies have evaluated how to combine dietary and physical activity (PA) interventions to enhance adherence.
We tested how sequential vs. simultaneous diet plus PA interventions affected behavior changes.
200 participants over age 44 years not meeting national PA and dietary recommendations (daily fruit and vegetable servings, percent of calories from saturated fat) were randomized to one of four 12-month telephone interventions: sequential (Exercise-First or Diet-First), Simultaneous, or Attention-Control. At 4 months, the other health behavior was added in the sequential arms.
93% of participants were retained through 12 months. At 4 months, only Exercise-First improved PA, and only the Simultaneous and Diet-First interventions improved dietary variables. At 12 months, mean levels of all behaviors in the Simultaneous arm met recommendations, though not in the Exercise-First and Diet-First arms.
We observed a possible behavioral suppression effect of early dietary intervention on PA that merits investigation.
PMCID: PMC3755035  PMID: 23609341
Physical Activity; Dietary Change; Multiple Health Behaviors; Sequential; Simultaneous; Stress
22.  Phone-Delivered Mindfulness Training for Patients with Implantable Cardioverter Defibrillators: Results of a Pilot Randomized Controlled Trial 
The reduction in adrenergic activity and anxiety associated with meditation may be beneficial for patients with implantable cardioverter defibrillators.
To determine the feasibility of a phone-delivered mindfulness intervention in patients with defibrillators and to obtain preliminary indications of efficacy on mindfulness and anxiety.
Clinically stable outpatients were randomized to a mindfulness intervention (8 weekly individual phone sessions) or to a scripted follow-up phone call. We used the Hospital Anxiety and Depression Scale and the Five Facets of Mindfulness to measure anxiety and mindfulness; and multivariate linear regression to estimate the intervention effect on pre-post intervention changes in these variables.
We enrolled 45 patients (23 mindfulness, 22 control; age 43–83; 30 % women). Retention was 93 %; attendance was 94 %. Mindfulness (beta = 3.31; p = .04) and anxiety (beta = − 1.15; p = .059) improved in the mindfulness group.
Mindfulness training can be effectively phone-delivered and may improve mindfulness and anxiety in cardiac defibrillator outpatients.
PMCID: PMC3758416  PMID: 23605175
mindfulness; anxiety; implantable cardioverter defibrillators; phone-delivery
23.  Medication Adherence Is Associated with Having a Caregiver Among Cardiac Patients 
Medication non-adherence is a significant contributor to suboptimal control of blood pressure and lipids.
This study determined if having a paid and/or family caregiver was associated with medication adherence in patients hospitalized for cardiovascular disease.
Consecutive patients admitted to the cardiovascular service at a university medical center who completed a standardized questionnaire about medication adherence and caregiving (paid/professional or family member/friend) were included in this analysis (N=1,432; 63 % white; 63%male).
Among cardiac patients, 39 % reported being prescribed ≥7 different medications, and one in four reported being non-adherent to their medication(s). Participants who reported having/planning to have a paid caregiver were 40 % less likely to be non-adherent to their medications compared to their counterparts. The association remained significant after adjustment for demographic confounders and comorbid conditions (OR=0.49; 95 %CI=0.29–0.82).
Cardiac patients with a paid caregiver were half as likely to be non-adherent to medications as those without caregivers.
PMCID: PMC3787847  PMID: 23536121
Cardiovascular disease; Medication; Caregiving; Outcomes; Prevention; Adherence
24.  Changes in Condom Use During the First Year of HIV Treatment in Uganda and the Relationship to Depression 
We examined the effect of antiretroviral therapy (ART), and the predictive role of depression, on condom use with primary partners.
Data from three studies in Uganda were combined into a sample of 750 patients with a primary sex partner, with 502 starting ART and 248 entering HIV care, and followed for 12 months. Random-effects logistic regression models were used to examine the impact of ART, and the influence of baseline level and change in depression, on condom use with primary partners.
At Month 12, 61% ART and 67% non-ART patients were consistent condom users, compared to 44% and 41% at baseline, respectively. Multivariate analysis revealed that consistent condom use increased similarly for ART and non-ART patients, and that Minor Depression at baseline and increased depression over time predicted inconsistent condom use.
Improved depression diagnosis and treatment could benefit HIV prevention.
PMCID: PMC4125566  PMID: 24504978
depression; HIV; antiretroviral therapy; condom use; primary partner; Uganda
25.  Anger Suppression and Subsequent Pain Behaviors among Chronic Low Back Pain Patients: Moderating Effects of Anger Regulation Style 
Suppression of anger is linked to subsequent pain intensity among chronic low back patients, but it is not clear whether anger regulation style (trait anger-out, anger-in) moderates these effects or if aroused anger accounts for links between anger regulation style and pain.
Chronic low back pain patients (N=58) were assigned to Suppression or No Suppression conditions for a task with harassing confederate and then underwent structured pain behavior procedures. Spielberger Anger Expression Inventory tapped trait anger-out (AOS) and anger-in (AIS).
Regressions tested Emotion Regulation condition × AOS and AIS effects on outcomes. AOS was related to grimacing and sighing for Suppression condition patients. AIS was related negatively to guarding and bracing for Suppression condition patients. Anger report partly mediated effects for AOS and AIS.
Anger regulation style moderated effects of state anger suppression on subsequent pain behaviors, effects that were partly explained by aroused anger.
PMCID: PMC4170680  PMID: 21544702
Anger suppression; Anger regulation style; Chronic pain; Pain behaviors

Results 1-25 (244)