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issn:0887-0.46
1.  Self-reported health bias: The role of daily affective valence and arousal 
Psychology & health  2013;28(7):784-799.
Objective
The present study addresses gaps in the literature on affect-biased health perceptions by a) investigating health bias while considering both valence and arousal components of affect; b) establishing the presence of, and variability in, affective health bias at the daily level; and c) exploring daily health bias in a non-clinical, community sample of adults.
Design
Participants were 477 adults (aged 33–80 years) who reported daily health events, health satisfaction, and affect for up to 56 days. Health bias was present when the effect of a given day’s health events on that day’s health satisfaction was significantly moderated by that day’s affect. Multilevel modeling was used to investigate fixed and random within-day effects.
Main Outcome Measure
Daily health satisfaction.
Results
Significant interaction effects indicated the presence of health bias on the daily level: positively-valenced affect buffered the negative impact of health events on health satisfaction, whereas negatively-valenced affect exacerbated this association; additionally, valence emerged as the most salient characteristic of positive affect, whereas arousal was a differentiating factor for negative affect.
Conclusion
The results provide evidence that both valence and arousal components of affect are important to consider when investigating day-level health bias, and that these effects can be detected using a general population of adults.
doi:10.1080/08870446.2012.759224
PMCID: PMC3688676  PMID: 23336519
Health Bias; Daily Diary; Positive Affect; Negative Affect; Health Satisfaction
2.  The Perils of Ignoring Design Effects in Experimental Studies: Lessons from a Mammography Screening Trial 
Psychology & health  2013;28(5):593-602.
Objective
Threats to external validity including pretest sensitization and the interaction of selection and an intervention are frequently overlooked by researchers despite their potential to significantly influence study outcomes. The purpose of this investigation was to conduct secondary data analyses to assess the presence of external validity threats in the setting of a randomized trial designed to promote mammography use in a high risk sample of women.
Design
During the trial, recruitment and intervention implementation took place in three cohorts (with different ethnic composition), utilizing two different designs (pretest-posttest control group design; posttest only control group design).
Results
Results reveal that the intervention produced different outcomes across cohorts, dependent upon the research design used and the characteristics of the sample.
Conclusion
These results illustrate the importance of weighing the pros and cons of potential research designs before making a selection and attending more closely to issues of external validity.
doi:10.1080/08870446.2012.756880
PMCID: PMC3630258  PMID: 23289517
external validity; research design; methodology; cancer screening; randomized controlled trial
3.  Step-down approach to behavioural weight loss treatment: a pilot of a randomised clinical trial 
Psychology & health  2013;28(10):10.1080/08870446.2013.789875.
Background
In a stepped-down approach, patients begin with a more intensive treatment and are stepped down to a less intensive treatment based on achieving treatment goals. This study compared a standard behavioural weight loss programme (BWLP) to a stepped-down approach to treatment.
Methods
Fifty-two overweight/obese adults (Age: M = 47 years, SD = 13.5; female = 67%) participated in an 18-week BWLP. Half of them were randomly assigned to be stepped down from weekly group meetings based on completion of weight loss goals (3%) every 6 weeks, while the other half remained in their groups regardless of weight loss.
Results
There was a significant difference favouring the BWLP in the proportion of participants who met or exceeded their 3% weight loss goal during the first six weeks. While not statistically significant by the end of treatment, the BWLP participants lost nearly 3% more body weight than stepped-down participants (SC = 4.9% vs. BWLP = 7.8%; p = .10). Greater self-monitoring was associated with increased likelihood of stepped-care eligibility and higher percent weight loss at the end of treatment (p < .01).
Conclusion
There was little evidence to support the efficacy of the stepped-down approach for behavioural weight loss treatment employed in this investigation.
doi:10.1080/08870446.2013.789875
PMCID: PMC3865978  PMID: 23607537
stepped-care; weight loss; obesity
4.  Effects of current physical activity on affective response to exercise: Physical and social-cognitive mechanisms 
Psychology & health  2012;28(4):418-433.
Objective
Affective responses during exercise are often important determinants of exercise initiation and maintenance. Current physical activity may be one individual difference that is associated with the degree to which individuals have positive (or negative) affective experiences during exercise. The objective of this investigation was to explore physical and cognitive explanations of the relationship between current activity status (more versus less active) and affective response during a 30-minute bout of moderate-intensity exercise.
Method
Participants reported their current level of physical activity, exercise self-efficacy, and affect during a 30-minute bout of moderate-intensity exercise.
Results
More active individuals experienced higher levels of positive affect and tranquility and lower levels of negative affect and fatigue during exercise. Multivariate models for each affective state indicated separate processes through which physical activity may be associated with changes in affect during exercise.
Conclusions
These models indicate that affect experienced during physical activity is related to current activity level and these relationships can be partially explained by the physical and cognitive factors explored in this study. Recommendations for future research to elucidate whether positive affective response to physical activity improves as a function of becoming more active over time are discussed.
doi:10.1080/08870446.2012.733704
PMCID: PMC3593984  PMID: 23088712
affect; exercise; transdisciplinary; physiological; self-efficacy
5.  Young Mothers’ Decisions to Use Marijuana: A Test of an Expanded Theory of Planned Behavior 
Psychology & health  2010;25(5):569-587.
The current study examines the Theory of Planned Behavior’s (TPB) ability to predict marijuana use among young women who experienced a premarital pregnancy before age 18, using longitudinal data. The validity of the TPB assumption that all other variables work through TPB constructs is also tested. Indicators of four constructs that have been shown in the literature to be predictive of marijuana use -- persistent environmental adversity, emotional distress, adolescent marijuana use, drug use in the social network – were tested as predictors of attitudes, norms, and self-efficacy, in a structural equation modeling framework. All paths from distal predictors were through the mediating TPB constructs, in accordance with the tenets of the model. Implications of these findings for the TPB model and for understanding factors that lead to marijuana use are discussed.
doi:10.1080/08870440902777554
PMCID: PMC3951994  PMID: 20204940
Theory of Planned Behavior; adolescents; marijuana use; decision-making
6.  Who Benefits from a Psychosocial Counseling vs. Educational Intervention to Improve Psychological Quality of Life in Prostate Cancer Survivors? 
Psychology & health  2012;28(3):336-354.
Objective
We examined selected survivor characteristics to determine what factors might moderate the response to two psychosocial interventions.
Design
Seventy-one prostate cancer survivors were randomly assigned to either a telephone-delivered health education (THE) intervention or a telephone-delivered interpersonal counseling (TIP-C) intervention.
Measures
Psychological QOL outcomes included depression, negative and positive affect, and perceived stress.
Results
For three of the psychological outcomes (depression, negative affect and stress), there were distinct advantages from participating in THE. For example, more favorable depression outcomes occurred when men were older, had lower prostate specific functioning, were in active chemotherapy, had lower social support from friends and lower cancer knowledge. Participating in the TIP-C provided a more favorable outcome for positive affect when men had higher education, prostate specific functioning, social support from friends and cancer knowledge.
Conclusion
Unique survivor characteristics must be considered when recommending interventions that might improve psychological QOL in prostate cancer survivors. Future research must examine who benefits most and from what components of psychosocial interventions to enable clinicians to recommend appropriate psychosocial care.
doi:10.1080/08870446.2012.731058
PMCID: PMC3574213  PMID: 23045995
psychosocial interventions; QOL; prostate cancer; psychological distress
7.  Older adults’ beliefs about the timeline of type 2 diabetes and adherence to dietary regimens 
Psychology & health  2012;28(2):139-153.
The common-sense model posits that behavioural coping with illness is shaped by a complex combination of individuals’ abstract and concrete beliefs about their illness. We investigated this theoretical assumption in a study of 116 older adults diagnosed with type 2 diabetes who completed in-person interviews at baseline and six and twelve months later. Specifically, we examined 1) the interaction of patients’ abstract and concrete beliefs about the timeline of their diabetes as a predictor of change in adherence to a healthy diet and 2) whether these interactive effects differ among male and female patients. Abstract timeline beliefs were conceptualized as those pertaining to disease duration; concrete timeline beliefs were conceptualized as those pertaining to variability of disease symptoms (i.e., symptoms are stable versus fluctuating). As predicted, duration beliefs were positively associated with improvement in adherence among patients who viewed disease symptoms as stable, but not among those who viewed symptoms as variable. When gender was considered, these interactive effects were observed among male (but not female) patients. Findings revealed that the behavioural effects of men’s abstract knowledge about their diabetes were conditioned by their concrete representations of the disease, suggesting a bottom-up process of influence with implications for intervention.
doi:10.1080/08870446.2012.685740
PMCID: PMC3447991  PMID: 22594631
illness beliefs; common-sense model; type 2 diabetes; adherence; gender
8.  Leisure Activities, Caregiving Demands, and Catecholamine Levels in Dementia Caregivers 
Psychology & health  2011;27(10):1134-1149.
This study examined whether satisfaction from leisure activities moderates the relationship between caregiving demands (i.e., hours per day spent caring for a spouse with dementia) and resting levels of the catecholamines norepinephrine (NE) and epinephrine (EPI). Spousal caregivers (N=107; mean age 73.95±8.12 years) were assessed in home for plasma levels of NE and EPI, amount of care provided, and leisure satisfaction. Regression was used to determine whether leisure satisfaction moderated the relationship between hours providing care per day and catecholamine levels. A significant interaction was found between hours caregiving and leisure satisfaction for NE, but not for EPI. Post hoc regressions were conducted for both NE and EPI. At low leisure satisfaction, time spent caring for a spouse was positively associated with plasma NE (β = .41; p = .005) and EPI (β = .44; p = .003). In contrast, at high levels of satisfaction, time caregiving was not significantly associated with plasma NE (β = −.08; p = .57) or EPI (β = .23; p = .12). These findings suggest that leisure satisfaction may protect caregivers from increases in catecholamines, which have been implicated in cardiovascular risk. Further support for these findings may impact psychological treatments for distressed caregivers.
doi:10.1080/08870446.2011.637559
PMCID: PMC3346846  PMID: 22149759
leisure satisfaction; leisure activities; catecholamine; dementia caregiving; cardiovascular disease
9.  Examining predictors of physical activity among inactive middle-aged women: An application of the health action process approach 
Psychology & health  2011;27(7):829-845.
This study tested several relationships predicted by the Health Action Process Approach (HAPA) in a sample of 175 generally healthy, inactive, middle-aged women (40–65 yrs old) over a 12 week period. Participants’ physical activity, risk perceptions, outcome expectancies, action self-efficacy, and intentions were measured at baseline. Planning and maintenance self-efficacy were measured four weeks later. Physical activity behaviour was measured twelve weeks after baseline. The HAPA relationships were examined using a structural equation model. The data fit the model well and revealed several significant relationships. Action self-efficacy was the best predictor of intention. Maintenance self-efficacy was the best predictor of planning and behaviour. Contrary to the tenets of HAPA and to past research, planning did not predict behaviour. Overall, HAPA provides a useful framework for identifying determinants of physical activity intentions and behaviour within a group of inactive, middle-aged women.
doi:10.1080/08870446.2011.609595
PMCID: PMC3288881  PMID: 21867395
10.  Assessing treatment motivation among patients receiving antiretroviral therapy: A multidimensional approach 
Psychology & health  2011;27(6):674-687.
Using multidimensional scaling analysis (MDS), this study examined how patient conceptualisations of treatment motivation compare with theoretically-based assumptions used in current assessment approaches. Patients undergoing antiretroviral therapy for HIV/AIDS (n = 39) rated for similarity all possible pairings of 23 treatment descriptions, including descriptors of intrinsic, extrinsic, approach, and avoidance motivation. MDS analyses revealed that patient perceptions of intrinsic and extrinsic motivation often differ from those based on definitions derived from common interpretations of self-determination theory. Findings also showed that patients reported motivation for avoiding treatment when they associated their medication regimens with side effects and other negatively-valenced outcomes. The study describes new applications of MDS in assessing how patients perceive the relationship between treatment behaviours and specific forms of motivation, such as intrinsic and extrinsic motivation. In addition, the study suggests how MDS may be used to develop behavioural strategies aimed at helping patients follow their regimens consistently by identifying treatment conceptualisations and contexts that facilitate or impede adherence.
doi:10.1080/08870446.2011.618536
PMCID: PMC3306482  PMID: 21942538
HIV/AIDS; antiretroviral; adherence; motivation; psychometrics/statistics & numerical data
11.  Conscientiousness mediates the relation between perceived parental socialisation and self-rated health 
Psychology & health  2012;27(9):1048-1061.
The pathways between parenting behaviours, personality and physical health have all been separately studied. Prior research has paid little attention to the indirect effects of personality in the path between parenting behaviours and better health. The purpose of this study was to explore the mediational effects of conscientiousness on the relationships between parental socialisation of responsibility and self-rated health, and to examine potential age differences in this mediational pathway. In total, 736 female and 749 male members across Japan participated in this study. They were divided into three groups by age category: younger-, middle-aged and older-aged. Conscientiousness and health were concurrently rated, while parental socialisation of responsibility was retrospectively assessed. Our analyses revealed that parental socialisation of responsibility is positively associated with conscientiousness and self-rated health, that conscientiousness is positively associated with self-rated health, and that conscientiousness fully mediated the effect of parental socialisation of responsibility on self-rated health. The mediational links were consistent across younger, middle-aged and older-aged cohorts. Our findings suggest that greater parental socialisation of responsibility relates to higher conscientiousness, and consequently healthier adults. These findings imply that parental behaviours could be a plausible target for intervention to foster the development of conscientiousness and better health.
doi:10.1080/08870446.2011.652110
PMCID: PMC3625927  PMID: 22292501
conscientiousness; parental socialisation of responsibility; self-rated health; moderated mediation
12.  Endogenous Testosterone Levels Are Associated With Assessments of Unfavourable Health Information 
Psychology & health  2012;27(4):507-514.
The purpose of this study was to investigate whether participants’ assessments of unfavourable health information are associated with individual differences in basal testosterone. Testosterone has previously been related to assessments of threat in social and other domains. Fifty-two undergraduate males were tested for a minor, fictitious medical condition (‘TAA deficiency’) in a paradigm that was developed to examine the thoughts and behaviours of individuals who have just received unfavourable medical news. In a variation on the classic paradigm, all participants were told that they had ‘TAA deficiency,’ after which they rated the seriousness and prevalence of that condition as well as 19 other actual conditions. Higher testosterone levels were significantly correlated with lower estimates of both the seriousness and prevalence of TAA deficiency as well as lower median seriousness and prevalence estimates of the 19 actual conditions. Findings are discussed in light of current research in the field of behavioural endocrinology. This study provides preliminary evidence that individual differences in assessments of threatening health information may be associated with neurobiological characteristics.
doi:10.1080/08870446.2012.657639
PMCID: PMC3308627  PMID: 22348295
Health threat; testosterone; TAA deficiency paradigm
13.  Risk perceptions and worry about common diseases: A between- and within-subjects examination 
Psychology & health  2012;28(4):434-449.
Objective
To test the relationships between worry and perceptions of likelihood and severity (two indicators of risk perception) across eight common diseases, and to examine contributions of individual and disease variability in worry and risk perceptions.
Methods
Participants were 294 people recruited through the Multiplex Initiative, in which a genetic susceptibility test for 8 common diseases was offered to healthy adults. Participants completed a baseline telephone survey and Web-based surveys measuring the variables for this ancillary study, without a commitment to be tested.
Results
Between- and within-subjects analyses yielded the following findings: 1) worry is more related to likelihood perceptions than to severity perceptions; 2) severity perceptions add significantly to explained worry variances above and beyond likelihood perceptions; 3) the likelihood × severity perception does not add to explained variance in worry above its components; 4) risk perceptions and worries form two identifiable clusters: cancer diseases and cardiovascular-metabolic diseases; 5) there are significant differences in risk perceptions and worry among diseases; 6) there are significant gender differences in risk perceptions and worry about common diseases; 7) variance in risk perception and worry is explained by a combination of between- and within-subjects variances, with the latter being more powerful.
Conclusions
Risk perception research should pay attention to severity perceptions, within-subjects variability and inter-disease differences should not be ignored, gender perspectives on illness perceptions should be acknowledged, and health psychologists must prepare for considering groups of illnesses in addition to single diseases.
doi:10.1080/08870446.2012.737464
PMCID: PMC3566271  PMID: 23121110
risk perception; worry; severity; likelihood; within-subjects
14.  Distress and emotional well-being in breast cancer patients prior to radiotherapy: An expectancy-based model 
Psychology & health  2011;27(3):347-361.
Understanding precursors to distress and emotional well-being (EWB) experienced in anticipation of radiotherapy would facilitate the ability to intervene with this emotional upset (i.e., higher distress, lower EWB). Thus the present study tested an expectancy-based model for explaining emotional upset in breast cancer patients prior to radiotherapy. Women affected by breast cancer (N=106) were recruited and participants completed questionnaires prior to commencing radiotherapy. Structural equation modeling was used test a cross-sectional model, which assessed the ability of dispositional optimism (Life Orientation Test-Revised - two factors), response expectancies (VAS items), medical (type of surgery, cancer stage, chemotherapy history) and demographic (age, race/ethnicity, education, marital status) variables to predict both EWB (Functional Assessment of Chronic Illness Therapy - Emotional Well-being Subscale) and distress (Profile of Mood States - Short Version). The model represented a good fit to the data accounting for 65% of the variance in EWB and 69% in Distress. Significant predictors of emotional upset were pessimism, response expectancies, Latina ethnicity, cancer stage, and having had a mastectomy. These variables explained a large portion of emotional upset experienced prior to radiotherapy for breast cancer and are important to consider when aiming to reduce distress and improve EWB in this context.
doi:10.1080/08870446.2011.569714
PMCID: PMC3299868  PMID: 21678183
distress; quality of life; breast neoplasm; radiotherapy; optimism; response expectancies
15.  Perceived stress in prodromal Huntington disease 
Psychology & health  2011;27(2):196-209.
This study examines perceived stress and its relationship to depressive symptoms, life changes and functional capacity in a large sample of individuals who are positive for the Huntington disease (HD) gene expansion but not yet diagnosed. Participants were classified by estimated proximity to HD diagnosis (far, mid, near) and compared with a non gene-expanded comparison group. Persons in the mid group had the highest stress scores. A significant interaction between age and time since HD genetic testing was also found. Secondary analyses using data from a different data collection point and including a diagnosed group showed the highest stress scores in the diagnosed group. Possible explanations and implications are discussed.
doi:10.1080/08870446.2010.529141
PMCID: PMC3165107  PMID: 21623544
Huntington disease; perceived stress; depression
16.  Developing a spouse version of the Illness Perception Questionnaire-Revised (IPQ-R) for husbands of women with rheumatoid arthritis 
Psychology & health  2009;24(4):473-487.
A husband’s beliefs about his wife’s rheumatoid arthritis (RA) may be important to his provision of support and well-being. We adapted seven subscales of the Illness Perception Questionnaire-Revised to assess husbands’ beliefs about their wives’ RA. We recruited 190 couples (average years married = 22; average years with RA = 14) from community settings to complete surveys assessing illness perceptions, psychosocial and illness variables at baseline and four-month followup. We conducted exploratory factor analyses, calculated Cronbach’s alphas for each factor, and examined construct validity. This process yielded six parallel wife and husband subscales assessing beliefs about the (a) timeline, (b) consequences and (c) cyclical nature of RA, and women’s RA (d) emotional responses, (e) control and (f) illness coherence. All items loaded above 0.50 on their respective factors and Cronbach’s alphas ranged from 0.72 to 0.86. Subscales were inter-related in a manner consistent with previous research and husbands’ beliefs were related to a variety of illness and adjustment variables. The factor structure was replicated in the same sample at follow-up (n = 165). This study introduces an instrument to assess spouse beliefs about RA that may help to elucidate the role of spousal relationships in illness adaptation.
doi:10.1080/08870440701867788
PMCID: PMC3549265  PMID: 20205006
illness perceptions; rheumatoid arthritis; spouses; initial validation
17.  Randomized Trial of Expressive Writing for Distressed Metastatic Breast Cancer Patients 
Psychology & health  2011;27(1):88-100.
Women with metastatic breast cancer and significant psychological distress (N = 87) were assigned randomly to engage in four home-based sessions of expressive writing or neutral writing. Women in the expressive writing group wrote about their deepest thoughts and feelings regarding their cancer, whereas women in the neutral writing group wrote about their daily activities in a factual manner. No statistically significant group differences in existential and psychological well-being, fatigue, and sleep quality were found at 8-weeks post-writing. However, the expressive writing group reported significantly greater use of mental health services during the study than the neutral writing group (55% vs. 26%, respectively; p < .05). Findings suggest that expressive writing may improve uptake of mental health services among distressed cancer patients, but is not broadly effective as a psychotherapeutic intervention.
doi:10.1080/08870446.2010.551212
PMCID: PMC3175346  PMID: 21678181
metastatic breast cancer; expressive writing; psychological distress; sleep; fatigue
18.  Integration of Five Health Behaviour Models: Common Strengths and Unique Contributions to Understanding Condom Use 
Psychology & health  2011;26(11):1499-1520.
The purpose of this research was to select from the health belief model (HBM), theories of reasoned action (TRA) and planned behaviour (TPB), information-motivation-behavioural skills model (IMB), and social cognitive theory (SCT) the strongest longitudinal predictors of women’s condom use and to combine these constructs into a single integrated model of condom use. The integrated model was evaluated for prediction of condom use among young women who had steady versus casual partners. At Time 1, all constructs of the five models and condom use were assessed in an initial and a replication sample (n= 193, n= 161). Condom use reassessed 8 weeks later (Time 2) served as the main outcome. Information from IMB, perceived susceptibility, benefits, and barriers from HBM, self-efficacy and self-evaluative expectancies from SCT, and partner norm and attitudes from TPB served as indirect or direct predictors of condom use. All paths replicated across samples. Direct predictors of behaviour varied with relationship status: self-efficacy significantly predicted condom use for women with casual partners, while attitude and partner norm predicted for those with steady partners. Integrated psychosocial models, rich in constructs and relationships drawn from multiple theories of behaviour, may provide a more complete characterization of health protective behaviour.
doi:10.1080/08870446.2011.572259
PMCID: PMC3175333  PMID: 21678166
health behaviour model integration; young women’s condom use; theories of reasoned action and planned behaviour; health belief model; information-motivation-behavioural skills model; social cognitive theory
19.  Dyadic concordance among prostate cancer patients and their partners and health-related quality of life: Does it matter? 
Psychology & health  2011;26(6):651-666.
Serious and chronic illnesses occur within a family context, affecting not only the patient but the spouse/partner, children, and extended family network. Spouses/partners are likely to experience the greatest personal impact, and may influence patient adjustment. Also, the intimate relationship may be affected by the illness experience. This study examined whether dyadic concordance on characteristics of prostate cancer (PC) was related to health-related quality of life (HRQOL), psychological distress, and marital adjustment in PC patients and their female partners. Couples (N = 164) completed questionnaires on appraisals of PC, and individual and dyadic adjustment. Patient and partner PC appraisal ratings were positively correlated. There was a general pattern of patients and partners in concordant dyads, versus those in dyads in which spouses maximized or minimized PC characteristics, reporting significantly better individual HRQOL outcomes, although there were several exceptions. Patient-partner appraisal (dis)agreement generally did not significantly predict dyadic adjustment. Overall, results suggest that dyadic disagreement is associated with worse HRQOL in couples facing PC.
doi:10.1080/08870441003721251
PMCID: PMC3216478  PMID: 20680885
chronic illness; prostate cancer; appraisals; coping; spouses; survivorship
20.  Strategies Adopted by Late Middle-Age and Older Adults with HIV/AIDS to Explain their Physical Symptoms 
Psychology & health  2011;26(0 1):41-62.
Although the attributions individuals make about what causes their physical symptoms are known to influence their care seeking and self-care behaviors, much less is known about the strategies they use to arrive at these attributions. The strategies employed to understand the causes of their symptoms were investigated using in-depth interviews with 100 late-middle-age and older adults with HIV/AIDS in New York City. The data revealed that most actively sought to explain their symptoms. The explanatory strategies identified included: relying upon illness or medication representations, lay beliefs about the body and aging, invoking pre-existing vulnerabilities, engaging in lay experimentation, social comparison processes, considering temporal ordering, and consulting authoritative sources. While most offered a single cause for their symptoms, some offered more complex multi-causal explanations. These findings provide understanding into the reasons why some older adults with HIV/AIDS misattribute symptoms resulting in delay in care or care over-utilization, suggesting the need for patient education.
doi:10.1080/08870441003681299
PMCID: PMC3111002  PMID: 21337262
HIV/AIDS; Older people; Causal attribution; Symptom management; Illness representations
21.  Response to an Abnormal Ovarian Cancer Screening Test Result: Test of the Social Cognitive Processing and Cognitive Social Health Information Processing Models 
Psychology & health  2010;26(4):383-397.
All cancer screening tests produce a proportion of abnormal results requiring follow-up. Consequently, the cancer screening setting is a natural laboratory for examining psychological and behavioral response to a threatening health-related event. This study tested hypotheses derived from the Social Cognitive Processing and Cognitive-Social Health Information Processing models in trying to understand response to an abnormal ovarian cancer (OC) screening test result. Women (n=278) receiving an abnormal screening test result a mean of 7 weeks earlier were assessed prior to a repeat screening test intended to clarify their previous abnormal result. Measures of disposition (optimism, informational coping style), social environment (social support and constraint), emotional processing, distress, and benefit finding were obtained. Regression analyses indicated greater distress was associated with greater social constraint and emotional processing and a monitoring coping style in women with a family history of OC. Distress was unrelated to social support. Greater benefit finding was associated with both greater social constraint and support and greater distress. The primacy of social constraint in accounting for both benefit-finding and distress was noteworthy and warrants further research on the role of social constraint in adaptation to stressful events.
doi:10.1080/08870440903437034
PMCID: PMC2911487  PMID: 20419561
Distress; cancer screening; adjustment; psychosocial; coping; health behavior theory
22.  A Randomised Controlled Trial of Written Self-Disclosure for Functional Recurrent Abdominal Pain in Youth 
Psychology & health  2010;26(4):433-447.
Written self-disclosure (WSD) has rarely been evaluated as an intervention for paediatric diseases. To test the efficacy of WSD for youth ages 11–18 with a diagnosis of functional recurrent abdominal pain (RAP), 63 were randomly assigned to receive standard medical care (SMC) alone or WSD in addition to SMC. WSD was administered in three 20-minute sessions, one in the clinic and two by phone in the home. Measures of self-reported pain frequency, somatisation severity, and quality of life were completed at baseline and three-month and six-month follow-up points. Blind review of electronic medical records provided data on clinic visit and phone consultation utilization for the six months prior to and following baseline. Practice of WSD in addition to SMC was associated with significantly fewer activity-limiting GI pain experiences (d = .61) and reduced health care utilization (d = .59) six-months later compared to SMC alone. There were no significant effects for somatisation severity or quality of life at six months. WSD may be a useful treatment adjunct for reducing pain frequency and resulting health care utilization in a portion of youth with functional RAP.
doi:10.1080/08870440903477212
PMCID: PMC2911499  PMID: 20419562
recurrent abdominal pain; adolescents; randomized controlled trial; written self-disclosure; symptom reporting; health care utilization
23.  Modeling Decisions to Undergo Genetic Testing for Susceptibility to Common Health Conditions: An Ancillary Study of the Multiplex Initiative 
Psychology & health  2011;27(4):430-444.
New genetic tests reveal risks for multiple conditions simultaneously, although little is understood about the psychological factors that affect testing uptake. We assessed a conceptual model called the Multiplex Genetic Testing Model (MGTM) using structural equation modeling (SEM). The MGTM delineates worry, perceived severity, perceived risk, response efficacy and attitudes toward testing as predictors of intentions and behavior. Participants were 270 healthy insured adults age 25–40 from the Multiplex Initiative conducted within a health care system in Detroit MI, USA. Participants were offered a genetic test that assessed risk for eight common health conditions. Confirmatory factor analysis revealed that worry, perceived risk and severity clustered into two disease domains: cancer or metabolic conditions. Only perceived severity of metabolic conditions was correlated with general response efficacy (β=0.13, p<0.05), which predicted general attitudes toward testing (β=0.24, p<0.01). Consistent with our hypothesized model, attitudes towards testing were the strongest predictors of intentions to undergo testing (β=0.49, p<0.01), which in turn predicted testing uptake (OR 17.7, β=0.97, p<0.01). The MGTM explained a striking 48% of the variance in intentions and 94% of the variation in uptake. These findings support use of the MGTM to explain psychological predictors of testing for multiple health conditions.
doi:10.1080/08870446.2011.586699
PMCID: PMC3175306  PMID: 21660870
Genetic testing; Multiplex Initiative; health behavior; common disease; structural equation modeling; personalized medicine; U.S.A.
24.  Effects of group prenatal care on psychosocial risk in pregnancy: Results from a randomised controlled trial 
Psychology & health  2011;26(2):235-250.
Few interventions have succeeded in reducing psychosocial risk among pregnant women. The objective of this study was to determine whether an integrated group prenatal care intervention already shown to improve perinatal and sexual risk outcomes can also improve psychosocial outcomes compared to standard individual care. This randomised controlled trial included pregnant women ages 14–25 from two public hospitals (N = 1047) who were randomly assigned to standard individual care, group prenatal care or integrated group prenatal care intervention (CenteringPregnancy Plus, CP+). Timing and content of visits followed obstetrical guidelines, from 18-week gestation through birth. Each 2-h group prenatal care session included physical assessment, education/skills building and support via facilitated discussion. Using intention-to-treat models, there were no significant differences in psychosocial function; yet, women in the top tertile of psychosocial stress at study entry did benefit from integrated group care. High-stress women randomly assigned to CP+ reported significantly increased self-esteem, decreased stress and social conflict in the third trimester of pregnancy; social conflict and depression were significantly lower 1-year postpartum (all p-values <0.02). CP+ improved psychosocial outcomes for high-stress women. This ‘bundled’ intervention has promise for improving psychosocial outcomes, especially for young pregnant women who are traditionally more vulnerable and underserved.
doi:10.1080/08870446.2011.531577
PMCID: PMC3311036  PMID: 21318932
pregnancy; randomised controlled trial; intervention; psychosocial; adolescents; group
25.  Longitudinal associations between people’s cessation-related experiences and their satisfaction with cessation 
Psychology & health  2009;24(2):187-201.
We sought to determine whether different social, psychological, emotional, and physiological experiences associated with quitting smoking related to people’s satisfaction with cessation systematically, and whether the strength of the relations changes at different points during the cessation process and for different people (e.g., optimists). Using data from smokers enrolled in a cessation program, we used mixed models to assess the average longitudinal relation between people’s experiences and satisfaction measured at seven time points and whether the relations were moderated by key variables. Eight of nine experiences were related to people’s satisfaction (ps < 0.05) and the models accounted for 39–44% of the within-person variance in satisfaction. Current smoking behavior was more strongly related to people’s satisfaction during their early efforts to quit, whereas some experiences (e.g., feedback from others) had a stronger relation with satisfaction during people’s later efforts to quit or maintain abstinence (ps < 0.05). Individual differences in optimism and prior cessation experience moderated some of the relations (ps < 0.05). The findings mark the first evidence of factors that might influence how people determine their satisfaction with smoking cessation. The implications for tailoring interventions and potentially increasing the likelihood that people maintain abstinence are discussed.
doi:10.1080/08870440701639377
PMCID: PMC3267380  PMID: 20186651
satisfaction; smoking cessation; cessation experiences; behavior change maintenance

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