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1.  Testing a Brief Self-Directed Behavioral Weight Control Program 
Clinical obesity treatments are of limited reach. Self-directed weight control attempts are common, but little attention has been given to providing guidance for such efforts in the population. The present research tests a brief intervention approach to weight control. Pilot data were collected from 66 University employees (72.7% female, 81.8% white) randomized to an assessment-only control condition or a single intervention session to teach empirically valid self-directed weight control methods. Mean baseline weight was 87.1 kilograms (range 64.0–120.3 kilograms). Though statistically nonsignificant, intervention participants averaged greater weight loss by 6 months than controls [−0.80 kilograms vs. −0.19 kilograms, F(1, 44) = 0.47, p = .50, Cohen’s d = .21]. There was a significant group × time interaction for self-weighing frequency [F(2, 41) = 10.84, p < .001]. With some enhancement and more attention to dissemination, a brief self-directed program has potential as a useful approach to population weight gain prevention.
PMCID: PMC4306570  PMID: 21660772
Weight control behaviors; Adults; Public Health
2.  Intervention for Homeless, Substance Abusing Mothers: Findings from a Non-Randomized Pilot 
Little empirically-based information is available regarding how best to intervene with substance-abusing homeless mothers. This study pilot-tested a comprehensive intervention with 15 homeless women and their 2- to 6-year-old children, recruited from a local family shelter. All participants were offered integrated intervention with three major components. The first component was housing which included 3 months of rental and utility assistance, and these services were not contingent upon women’s abstinence from drugs or alcohol. The second and third components included 6 months of case management services and an evidence-based substance abuse treatment (Community Reinforcement Approach; CRA). Analysis revealed that women showed reductions in substance use (F2,22 = 3.63; p < .05), homelessness (F2,24 = 25.31; p < .001), and mental health problems (F2,20 = 8.5; p < .01). Further, women reported reduced internalizing (F2,22 = 4.08; p < .05) and externalizing problems (F2,24 = 7.7; p = .01) among their children. The findings suggest that the intervention is a promising approach to meet the multiple needs of this vulnerable population. These positive outcomes support the need for future research to replicate the findings with a larger sample using a randomized design.
PMCID: PMC4297200  PMID: 22676629
homeless mothers; substance abuse; intervention
3.  Substance Abuse Treatment in Persons with HIV/AIDS: Challenges in Managing Triple Diagnosis 
This paper provides a review of the current literature addressing substance abuse treatment in persons living with HIV/AIDS. Clinical management of HIV must account for the “triple diagnosis” of HIV, psychiatric diagnosis, and substance use disorders and requires integrated treatment services that focus beyond just mitigation of substance use and psychiatric and medical symptoms but also address other health behaviors. Because clinical management of HIV/AIDS has shifted significantly with the advent of highly active antiretroviral therapies (HAART) in the mid 1990's, a literature review focusing on literature published since 2000, and using relevant key words was conducted using a wide range of literature search databases. This literature review was complemented by studies to expand on specific treatment modalities for which there was a dearth of literature addressing HIV infected cohorts and to provide discussion of issues around substance abuse treatment as an HIV prevention tool. Existing models of substance abuse treatment including cognitive behavioral therapy and motivational interviewing have proven to be useful for enhancing adherence and reducing substance use in outpatient populations, while methadone maintenance and directly observed treatment have been useful with specific subgroups of users. Contextualization of services heightens the likelihood of successful outcomes and relapse prevention.
PMCID: PMC3999248  PMID: 24274175
substance abuse; HIV; psychiatric disorder; triple diagnosis; treatment
4.  Family ecological predictors of physical activity parenting in low income families 
Physical activity (PA) parenting, or strategies parents use to promote PA in children, has been associated with increased PA in children of all ages, including preschool-aged children. However, little is known about the circumstances under which parents adopt such behaviors. This study examined family ecological factors associated with PA parenting. Low-income parents (N = 145) of preschool-aged children (aged 2 to 5 years) were recruited from five Head Start centers in upstate New York. Guided by the Family Ecological Model (FEM), parents completed surveys assessing PA parenting and relevant family and community factors. Hierarchical regression analysis identified independent predictors of PA parenting. Parent depressive symptoms, life pressures that interfere with PA and perceived empowerment to access PA resources were associated with PA parenting. Community factors, including neighborhood play safety and social capital, were not independently associated with PA parenting in the multivariate model. Together, family ecological factors accounted for a large proportion of the variance in PA parenting (R2 = .37). Findings highlight the need to look beyond cognitive predictors of PA parenting in low-income families and to examine the impact of their broader life circumstances including indicators of stress.
PMCID: PMC4000568  PMID: 24236806
parenting; child; physical activity; family ecology
5.  Nocturnal Blood Pressure Non-Dipping, Posttraumatic Stress Disorder, and Sleep Quality in Women 
Women with posttraumatic stress disorder (PTSD) have poor sleep quality and increased risk of cardiovascular disease (CVD). Non-dipping of nocturnal blood pressure may be an explanatory factor for the relationship between sleep and CVD found in previous research.
The current study was designed to determine if non-dipping nocturnal blood pressure was associated with trauma exposure, PTSD diagnosis, PTSD symptoms, and sleep quality in a sample of women.
Participants completed 24 hours of ABPM and self-report questionnaires. Non-dipping was defined as less than 10% reduction in blood pressure during sleep.
The frequency of non-dippers did not differ by diagnostic status (d=.15). However, non-dippers endorsed more traumatic event categories (d=.53), more PTSD hyperarousal symptoms (d=.53), poorer overall sleep quality (d=.59), more frequent use of sleep medication (d=.62), greater sleep-related daytime dysfunction (d=.58), and longer sleep onset latencies (d=.55) than dippers.
Increased attention to nocturnal blood pressure variation may be needed to improve blood pressure control in trauma-exposed women.
PMCID: PMC3964784  PMID: 24236808
circadian blood pressure; PTSD; sleep quality; cardiovascular disease; psychological trauma
6.  Improving Confidence for Self Care in Patients with Depression and Chronic Illnesses 
The aim of this study was to examine whether patients who received a multi-condition collaborative care intervention for chronic illnesses and depression had greater improvement in self-care knowledge and efficacy, and whether greater knowledge and self-efficacy is positively associated with improved target outcomes. A randomized controlled trial with 214 patients with comorbid depression and poorly controlled diabetes and/or coronary heart disease tested a 12-month team-based intervention that combined self-management support and collaborative care management. At 6 and 12 month outcomes the intervention group showed significant improvements over the usual care group in confidence in ability to follow through with medical regimens important to managing their conditions and to maintain lifestyle changes even during times of stress. Improvements in self care-efficacy were significantly related to improvements in depression, and early improvements in confidence to maintain lifestyle changes even during times of stress explained part of the observed subsequent improvements in depression.
PMCID: PMC3628828  PMID: 23398269
self-efficacy; self-management; chronic illness care; collaborative care
7.  Factors associated with HIV testing history among Black men who have sex with men (BMSM) in Los Angeles County 
Black men who have sex with men (BMSM) are disproportionately affected with HIV, and nearly half are unaware of their status. Those unaware of their status are more likely to engage in risky behavior; thus, HIV-testing uptake is crucial. This study explored correlates of past 2-year HIV-testing history. BMSM (n = 102) completed self-administered questionnaires. Fisher exact test indicated that BMSM at clubs/bars and gay pride events had higher rates of being tested within the past two years (86%−65%) than did participants who responded to online advertisements (44%, p < 0.001). Those untested for HIV were more likely to have had receptive anal sex without a condom (50 % vs 25%, p = 0.033), used the Internet seeking sex (65% vs 26%, p < 0.001), low HIV knowledge (52% vs 22%, p = 0.005), and less education. Literacy and tailored online interventions might be worth considering to increase HIV-testing uptake.
PMCID: PMC3795616  PMID: 23930896
HIV/AIDS; MSM; HIV Testing; Risk factors
8.  Predictors of Adherence in the Women’s Health Initiative Calcium and Vitamin D Trial 
The authors analyzed data from the Women’s Health Initiative (WHI) Calcium and Vitamin D Supplementation Trial (CaD) to learn more about factors affecting adherence to clinical trial study pills (both active and placebo). Most participants (36,282 postmenopausal women aged 50–79 years) enrolled in CaD 1 year after joining either a hormone trial or the dietary modification trial of WHI. The WHI researchers measured adherence to study pills by weighing the amount of remaining pills at an annual study visit; adherence was primarily defined as taking ≥ 80% of the pills. The authors in this study examined a number of behavioral, demographic, procedural, and treatment variables for association with study pill adherence. They found that relatively simple procedures (ie, phone contact early in the study [4 weeks post randomization] and direct social contact) later in the trial may improve adherence. Also, at baseline, past pill-use experiences, personal supplement use, and relevant symptoms may be predictive of adherence in a supplement trial.
PMCID: PMC3770154  PMID: 19064373
adherence; calcium supplementation; clinical trial; women
9.  Mediators of Change in Psychosocial Interventions for Cancer Patients: A Systematic Review 
Careful reviews and meta-analyses have made valuable contributions to understanding the efficacy of psychosocial interventions for cancer patients. An important next step is to determine the mediators that explain the influence of efficacious interventions on outcomes. This systematic review summarizes tests of mediating variables from twenty-two projects conducted from 1989–2010. Although all authors provided some type of rationale for considering particular mediating relationships, the investigations varied widely with respect to the extent to which formal theoretical constructs were tested, the type and goals of the interventions studied, and the broad types of outcomes and potential mediators examined. Although there was some evidence supporting selected mediating relationships, with positive findings often found when mediating variables represented behaviors targeted by an intervention, the findings were mixed. Expanding the focus of research to include mechanisms in psychosocial oncology intervention research is necessary for providing a unified picture of how mediating relationships may be operating in this field.
PMCID: PMC3426916  PMID: 22873734
cancer; psychosocial; intervention; treatment; quality of life
10.  [No title available] 
PMCID: PMC3648584  PMID: 23121208
11.  Approach to Antihypertensive Adherence: A Feasibility Study on the Use of Student Health Coaches for Uninsured Hypertensive Adults 
Behavioral Medicine  2012;38(1):19-27.
Despite pharmacologic advances, medication non-adherence continues to challenge primary care providers in blood pressure (BP) management.
Medical, nursing and pharmacy students (n = 11) were recruited and trained as health coaches for uninsured, hypertensive patients (n = 25) of a free clinic in an uncontrolled open trial. Pre-post analysis was conducted on BP, medication adherence, frequency of home BP monitoring, and healthy behavior (e.g., diet, exercise). Patient satisfaction and feasibility of a student coach model was qualitatively evaluated.
In the 12 patients who completed the intervention, an increase in medication adherence as measured by the Brief Medication Questionnaire was observed (P < 0.01), with a 11 mmHg reduction in systolic BP (P = 0.03). Qualitative data showed patient satisfaction with the intervention and other healthy behavior change.
This feasibility study shows use of student health coaches to combat medication non-adherence in uninsured, hypertensive adults is promising.
PMCID: PMC3311508  PMID: 22356599
health coach; hypertension; medication adherence
12.  Psychosocial Stress and Cardiovascular Disease: Pathophysiological Links 
The remarkable decline in cardiovascular disease (CVD) experienced in developed countries over the last 40 years appears to have abated. Currently, many CVD patients continue to show cardiac events despite optimal treatment of traditional risk factors. This evidence suggests that additional interventions, particularly those aimed at nontraditional factors, might be useful for continuing the decline. Psychosocial stress is a newly recognized (nontraditional) risk factor that appears to contribute to all recognized mechanisms underlying cardiac events, specifically, (a) clustering of traditional cardiovascular risk factors, (b) endothelial dysfunction, (c) myocardial ischemia, (d) plaque rupture, (e) thrombosis, and (f) malignant arrhythmias. A better understanding of the behavioral and physiologic associations between psychosocial stress and CVD will assist researchers in identifying effective approaches for reducing or reversing the damaging effects of stress and may lead to further reductions of CVD morbidity and mortality.
PMCID: PMC2979339  PMID: 12165968
cardiovascular disease; psychosocial interventions; psychosocial stress; review
13.  Psychosocial Stress and Cardiovascular Disease Part 2: Effectiveness of the Transcendental Meditation Program in Treatment and Prevention 
Psychosocial stress is a nontraditional risk factor for cardiovascular morbidity and mortality that may respond to behavioral or psychosocial interventions. To date, studies applying such interventions have reported a wide range of success rates in treatment or prevention of cardiovascular disease (CVD). The authors focus on a natural medicine approach that research indicates reduces both psychosocial and traditional risk factors for cardiovascular disease—the Transcendental Meditation (TM) program. Randomized controlled trials, meta-analyses, and other controlled studies indicate this meditation technique reduces risk factors and can slow or reverse the progression of pathophysiological changes underlying cardiovascular disease. Studies with this technique have revealed reductions in blood pressure, carotid artery intima-media thickness, myocardial ischemia, left ventricular hypertrophy, mortality, and other relevant outcomes. The magnitudes of these effects compare favorably with those of conventional interventions for secondary prevention.
PMCID: PMC2789000  PMID: 16463759
cardiovascular disease; psychosocial stress; review; Transcendental Meditation
14.  Influence of Coping, Social Support, and Depression on Subjective Health Status Among HIV-Positive Adults With Different Sexual Identities 
The authors examined associations between psychosocial variables (coping self-efficacy, social support, and cognitive depression) and subjective health status among a large national sample (N = 3,670) of human immunodeficiency virus (HIV)-positive persons with different sexual identities. After controlling for ethnicity, heterosexual men reported fewer symptoms than did either bisexual or gay men and heterosexual women reported fewer symptoms than did bisexual women. Heterosexual and bisexual women reported greater symptom intrusiveness than did heterosexual or gay men. Coping self-efficacy and cognitive depression independently explained symptom reports and symptom intrusiveness for heterosexual, gay, and bisexual men. Coping self-efficacy and cognitive depression explained symptom intrusiveness among heterosexual women. Cognitive depression significantly contributed to the number of symptom reports for heterosexual and bisexual women and to symptom intrusiveness for lesbian and bisexual women. Individuals likely experience HIV differently on the basis of sociocultural realities associated with sexual identity. Further, symptom intrusiveness may be a more sensitive measure of subjective health status for these groups.
PMCID: PMC2653049  PMID: 19064372
coping; depression; HIV; sexual identity; symptoms; social support
15.  Memory for Fatigue in Chronic Fatigue Syndrome: Relationships to Fatigue Variability, Catastrophizing, and Negative Affect 
Fatigue in chronic fatigue syndrome (CFS) is usually assessed with retrospective measures rather than real-time momentary symptom assessments. In this study, the authors hypothesized that in participants with CFS, discrepancies between recalled and momentary fatigue would be related to catastrophizing, anxiety, and depression and to variability of momentary fatigue. They also expected that catastrophizing, anxiety, and depression would be associated with momentary fatigue. The authors asked 53 adults with CFS to carry electronic diaries for 3 weeks and record their experiences of momentary fatigue. The authors assessed participants' fatigue recall with weekly ratings and administered questionnaires for catastrophizing, depression, and anxiety. Recall discrepancy was significantly related to the variability of momentary fatigue. In addition, catastrophizing, depression, and momentary fatigue were all significantly related to recall discrepancy. Catastrophizing, depression, anxiety, and momentary negative affect were all significantly associated with momentary fatigue. The findings suggest that momentary fatigue in patients with CFS is related to modifiable psychological factors.
PMCID: PMC2567050  PMID: 18400687
affect; chronic fatigue syndrome; fatigue; measurement; pain
16.  Parent–Adolescent Relationship Education (PARE): Program Delivery to Reduce Risks for Adolescent Pregnancy and STDs 
The first author recruited parent–adolescent dyads (N = 192) into after-school prevention education groups at middle schools in southeast Texas. This author placed participants in either (1) an Interactive Program (IP) in which they role-played, practiced resistance skills, and held parent–child discussions or (2) an Attention Control Program (ACP) that used the same curriculum but was delivered in a traditional, didactic format. Questionnaires administered at the beginning and end of the 4-session program and again after booster sessions in 3 subsequent semesters provided measures of social controls (eg, communication with parents) and self controls (eg, protection against risk) on the youths' sexual health behaviors. Linear mixed models adjusted for gender, age, and ethnicity showed that the IP, in comparison with the ACP, achieved significant gains in social control by increasing parental rules about having sex and other risky behaviors and also enhanced students' self-control by increasing their knowledge about prevention and enhancing resistance responses when pressured to have sex.
PMCID: PMC2566304  PMID: 18316271
adolescent pregnancy prevention; HIV/STD prevention; parent involvement
17.  Direct and Indirect Links Between Childhood Maltreatment, Posttraumatic Stress Disorder, and Women’s Health 
The authors evaluated the relationships among childhood maltreatment, sexual trauma in adulthood, posttraumatic stress disorder (PTSD), and health functioning in women. Female Veterans’ Affairs (VA) primary care patients (N = 200) completed self-report measures of childhood maltreatment, adult sexual trauma, PTSD symptoms, and current health functioning. The authors used structural equation modeling to test models of the relationship among these variables. Childhood nonsexual maltreatment and adult sexual assault were positively associated with PTSD. Childhood nonsexual maltreatment (β = −.20) and PTSD (β = −.75) were significantly associated with poorer physical and mental health functioning. Adult sexual assault negatively affected health functioning through its association with PTSD. Thus, poor health outcomes associated with childhood maltreatment in women may be conveyed through PTSD. These findings should strengthen efforts directed at identifying and treating PTSD in female victims of childhood maltreatment with the aim of preventing or attenuating poor health outcomes.
PMCID: PMC2547477  PMID: 18316270
childhood maltreatment; health outcomes; posttraumatic stress disorder; sexual trauma
19.  Methods of Testing for Sleeplessness 
Normal nonrandom fluctuations in daily human perfomance have been documented for years. Published research reports have shown patterns of workers' errors in reading gas meters, operators' delays in answering calls, drivers' drowsiness, sleepy locomotive engineers' automatic breaking, vehicle crashes, deaths resulting from disease, brief periods of sleep, and sleep latency in structured naps. The authors summarized these data sets and fitted them with a two-peak-per-day cosine curve derived from the population growth function used in chaos theory. Median parameters extracted from the curve fits predicted a sharp peak of sleepiness at 2:30 AM and a secondary peak at 2:30 PM. The shape of the curve was modified by a nonlinear sleep-deprivation factor. The model appeared to be biological rather than behavioral or social because it applied well to disease-related deaths. The authors also review measurement of sleepiness through electroencephalographic monitoring, self-reports, pupillography, and the Multiple Sleep Latency and the Maintenance of Wakefulness Tests.
PMCID: PMC2474656  PMID: 8731494
circadian rhythm; electroencephalographic (EEG) monitoring; fatigue; public safety; sleep deprivation; sleepiness; testing
20.  Improvements in Chronic Diseases With a Comprehensive Natural Medicine Approach: A Review and Case Series 
Approximately 40% of the US population report using complementary and alternative medicine, including Maharishi Vedic Medicine (MVM), a traditional, comprehensive system of natural medicine, for relief from chronic and other disorders. Although many reports suggest health benefits from individual MVM techniques, reports on integrated holistic approaches are rare. This case series, designed to investigate the effectiveness of an integrated, multi-modality MVM program in an ideal clinical setting, describes the outcomes in four patients: one with sarcoidosis; one with Parkinson’s disease; a third with renal hypertension; and a fourth with diabetes/essential hypertension/anxiety disorder. Standard symptom reports and objective markers of disease were evaluated before, during, and after the treatment period. Results suggested substantial improvements as indicated by reductions in major signs, symptoms, and use of conventional medications in the four patients during the 3-week in-residence treatment phase and continuing through the home follow-up program.
PMCID: PMC2408890  PMID: 10971882
complementary and alternative medicine; chronic disease; Maharishi Vedic Medicine; natural medicine
21.  Personality as a predictor of dietary quality in spouses during midlife 
To examine the NEO personality inventory-revised (NEO-PI-R) as a predictor of dietary quality in married couples, with focus on associations among: 1) each participant’s personality as a predictor of their own dietary assessment, and 2) each participant’s personality as a predictor of their spouses’ dietary assessment.
Participants were 850 couples from the University of North Carolina Alumni Heart Study (UNCAHS). NEO personality data was gathered during the baseline enrollment period from 1988–92. The dietary assessment was based on a modified version of the USDA Healthy Eating Index (MHEI) developed specifically for use in the UNCAHS; and data for calculating this measure were gathered from 1994–96. Analyses focused on examination of: 1) each participant’s NEO assessments with their own MHEI, and 2) each participant’s NEO assessments with their spouse’s MHEI.
Openness was associated with self ratings of dietary quality for both wives’ (r = .28) and husband’s (r =.27). Wives’ Openness levels were also related to their spouses’ ratings of dietary quality (r =.22). The primary facets of Openness accounting for the domain level findings were O2:Aesthetics and O4:Actions. The remaining personality domains (Neuroticism, Extraversion, Agreeableness, and Conscientiousness) were not associated with self or spousal ratings of dietary quality (r’s −.10 – .01).
Openness is associated with healthy eating habits—findings that may bear on disease prevention during midlife.
PMCID: PMC2391304  PMID: 18400684
Personality; NEO-PI-R-Diet; Spouses
22.  Perceived Risk and Worry About Prostate Cancer: A Proposed Conceptual Model 
Prostate cancer is one of the most common forms of cancer among American men, and worry about the disease has psychological, behavioral, and biological consequences. To better understand prostate cancer–specific worry, the authors tested a model of the interrelationships among family history of prostate cancer, perceived risk of and worry about prostate cancer, and perceived risk of and worry about other diseases. Men who attended prostate cancer-screening appointments at a general urology practice (n = 209) were given a brief anonymous self-report measure. Structural equation modeling (LISREL) results indicated: (1) perceived risk of prostate cancer mediated the relationship between family history of prostate cancer and prostate cancer worry; (2) perceived risk of other diseases increased perceived risk of prostate cancer; and (3) prostate cancer worry and increased other disease worry.
PMCID: PMC2258456  PMID: 17120384
anxiety; prostatic neoplasms; risk; risk factors
23.  A Mixed-Methods Pilot Study of the Acceptability and Effectiveness of a Brief Meditation and Mindfulness Intervention for People with Diabetes and Coronary Heart Disease 
Behavioral Medicine  2014;40(2):53-64.
Mindfulness-based interventions can successfully target negative perseverative cognitions such as worry and thought suppression, but their acceptability and effectiveness in people with long-term conditions is uncertain. We therefore pilot tested a six-week meditation and mindfulness intervention in people (n = 40) with diabetes mellitus and coronary heart disease. We used a sequential mixed-methods approach that measured change in worry and thought suppression and qualitatively explored acceptability, feasibility, and user experience with a focus group (n = 11) and in-depth interviews (n = 16). The intervention was highly acceptable, with 90% completing ≥5 sessions. Meditation and mindfulness skills led to improved sleep, greater relaxation, and more-accepting approaches to illness and illness experience. At the end of the six-week meditation course, worry, and thought suppression were significantly reduced. Positive impacts of mindfulness-based interventions on psychological health may relate to acquisition and development of meta-cognitive skills but this needs experimental confirmation.
PMCID: PMC4017270  PMID: 24754440
long-term conditions; meditation; mindfulness; thought suppression; worry

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