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Health Psychology - Vol 35, Iss 11

Health Psychology is a scholarly journal devoted to furthering an understanding of scientific relationships between behavioral principles on the one hand and physical health and illness on the other. The readership has a broad range of backgrounds, intere

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Copyright: Copyright 2016 American Psychological Association

Anticipated regret and organ donor registration: A randomized controlled trial.


Objective: To test whether simply asking people to rate the extent to which they anticipate feeling regret for not registering as an organ donor after death increases subsequent verified organ donor registration. Method: There were 14,509 members of the general public (both registered and nonregistered donors) randomly allocated to 1 of 4 arms, each receiving different questionnaires. The no-questionnaire control (NQC) arm received a survey measuring demographics and whether or not they were registered organ donors. The questionnaire control (QC) arm completed the NQC questions plus questions regarding affective attitudes and intention to register as an organ donor. The theory of planned behavior (TPB) questionnaire arm received the QC questionnaire, plus additional items measuring TPB variables. The anticipated regret (AR) arm received the TPB questionnaire, plus 2 additional items measuring anticipated regret. The main outcome measures were number of nondonor participants who subsequently registered 6 months later, as verified by the United Kingdom national transplant register. Results: Intention-to-treat (ITT) analysis in nonregistered donors (N = 9,139) revealed the NQC arm were more likely to register as an organ donor (6.39%) compared with the AR (4.51%) arm. Conclusions: A brief anticipated regret intervention led to a decrease in registration. A potential reason is discussed in terms of questionnaire item content “priming” negative perceptions of organ donation. This is a methodological concern that needs to be addressed in studies that use similar interventions. Current controlled trials: number: ISRCTN922048897. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

The impact of changing attitudes, norms, and self-efficacy on health-related intentions and behavior: A meta-analysis.


Objective: Several health behavior theories converge on the hypothesis that attitudes, norms, and self-efficacy are important determinants of intentions and behavior. However, inferences regarding the relation between these cognitions and intention or behavior rest largely on correlational data that preclude causal inferences. To determine whether changing attitudes, norms, or self-efficacy leads to changes in intentions and behavior, investigators need to randomly assign participants to a treatment that significantly increases the respective cognition relative to a control condition, and test for differences in subsequent intentions or behavior. The present review analyzed findings from 204 experimental tests that met these criteria. Method: Studies were located using computerized searches and informal sources and meta-analyzed using STATA Version 11. Results: Experimentally induced changes in attitudes, norms, and self-efficacy all led to medium-sized changes in intention (d+ = .48, .49, and .51, respectively), and engendered small to medium-sized changes in behavior (attitudes-d+ = .38, norms-d+ = .36, self-efficacy-d+ = .47). These effect sizes generally were not qualified by the moderator variables examined (e.g., study quality, theoretical basis of the intervention, methodological characteristics, and features of the targeted behavior), although effects were larger for interventions designed to increase (vs. decrease) behavioral performance. Conclusion: The present review lends novel, experimental support for key predictions from health behavior theories, and demonstrates that interventions that modify attitudes, norms, and self-efficacy are effective in promoting health behavior change. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Major flood related strains and pregnancy outcomes.


Objective: To assess the impact of experiencing a major flood during pregnancy on fetal growth and length of gestation, and to consider how flood-related strains might contribute to these effects. Method: The Red River Pregnancy Project was a prospective study carried out for 3 months immediately after the historic 2009 crest of the Red River in Fargo, North Dakota. Pregnant community residents who were at least 18 years old with a singleton, intrauterine pregnancy participated in the study (N = 169). Analyses examined if birth weight and length of gestation were associated with residential distance from flooding and gestational age at time of the flood crest. Results: For pregnancies earlier in gestation during the crest (–1 SD = 12 weeks), birth weight decreased as distance from flooding decreased (−42.29 g/mi, p.10). Biparietal growth trajectories showed a decrease in growth after the crest of the flood but only for women early in pregnancy. However, various measures of flood related and general stress or strain did not explain these effects. Length of gestation was not associated with distance from or the timing of the flood. Conclusions: Pregnant women in the first trimester who experience a major flood near their homes are at risk of having lower birth weight neonates due to a reduction in fetal growth. The mechanisms of this effect deserve further attention in rapidly mounted investigations after disaster. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Posttraumatic stress symptomatology and appearance distress following burn injury: An interpretative phenomenological analysis.


Objectives: Although many traumatic incidents result in changes to appearance, little research has examined the experience of individuals distressed by such changes in connection with psychological processes involved in posttraumatic stress disorder (PTSD). This study aimed to examine how PTSD and appearance concern associated with burn injury are experienced when both difficulties co-occur. Method: The qualitative method of interpretative phenomenological analysis (IPA) was used to provide a framework for building nuanced accounts of individual experience. In-depth analysis was conducted with interview data obtained from 8 women, who were purposively selected on the basis of being distressed in relation to burn scarring, and having symptoms of PTSD. Results: Participants described how changes in appearance were experienced as maintaining a sense of threat through social stigma, and acting as a trigger for re-experiencing the traumatic incident that had caused the burn injury. As such, appearance concern and PTSD symptomatology appeared intertwined within the participants’ accounts of their postburn injury recovery. Conclusions: This is the first study to consider some of the processes through which PTSD and appearance concern might be mutually maintained. The results suggest that psychosocial interventions need to be tailored to simultaneously address processes related to concerns about change in appearance and also with traumatic re-experiencing. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Socioeconomic status, psychological resources, and inflammatory markers: Results from the MIDUS study.


Objective: Our objective was to investigate interactions of psychological resources and socioeconomic status (SES)—as well as potential gender differences and the explanatory role of childhood and adult stress exposures, health behaviors, and negative and positive affect—in predicting markers of systemic inflammation. Method: We utilized a sample of adults from the Midlife Development in the U.S. (MIDUS) study who provided biomarker data (N = 1,152). SES was operationalized as a composite of education, income, and occupational prestige, and the psychological resources construct was operationalized as a latent factor measured with optimism, perceived control, and self-esteem. Linear regression models examined these 2 factors and their interaction in predicting interleukin-6 (IL-6) and C-reactive protein (CRP) measured on average 2 years later, as well as 3-way interactions involving gender and the impact of covariate adjustment. Results: Psychological resources interacted with SES in men (for IL-6: p < .001; for CRP: p = .04) but not in women. In men, greater psychological resources was associated with lower concentrations of IL-6 at lower levels of SES but higher concentrations of both markers at higher levels of SES. The inverse association between resources and IL-6 at low SES was moderately attenuated upon adjustment for negative affect. Conclusion: Socioeconomic status might modulate the linkage between psychological resources and systemic inflammation in men. At lower levels of SES, resources may be related to lower inflammation in part through lower negative affect. Associations with higher inflammation at higher SES add to growing evidence suggesting that adaptive psychological characteristics may be associated with markers of poorer physiological function under certain conditions. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

A model of tailoring effects: A randomized controlled trial examining the mechanisms of tailoring in a web-based STD screening intervention.


Objective: This study explores the mechanisms of tailoring within the context of RU@Risk a brief Web-based intervention designed to promote sexually transmitted disease (STD) testing among young adults. This is one of a few studies to empirically examine theorized message processing mechanisms of tailoring and persuasion outcomes in a single model. Method: Sexually active college students (N = 1065) completed a pretest, were randomly assigned to explore a tailored or nontailored website, completed a posttest, and were offered the opportunity to order a free at-home STD test kit. As intervention effects were hypothesized to work via increases in perceived risk, change in perceived risk from pretest to posttest by condition was examined. Hypothesized mechanisms of tailoring (perceived personal relevance, attention, and elaboration) were examined using structural equation modeling (SEM). All analyses controlled for demographic variables and sexual history. Results: As predicted, perceived risk of STDs increased from pretest to posttest, but only in the tailored condition. Results revealed that exposure to the tailored (vs. nontailored) website increased perceived personal relevance, attention to, and elaboration of the message. These effects in turn were associated with greater perceived risk of STDs and intentions to get tested. Additionally, participants in the tailored condition were more likely to order a test kit. Conclusions: Findings provide insight into the mechanisms of tailoring with important implications for optimizing message design. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Viral challenge reveals further evidence of skin-deep resilience in African Americans from disadvantaged backgrounds.


Objective: Studies have revealed a phenomenon called skin-deep resilience, which develops in upwardly mobile African American youth. They perform well in school, maintain good mental health, and avoid legal problems. Despite outward indications of success, they also show evidence of worse health in biomarker studies. Here we extend this research, asking whether it manifests in differential susceptibility to upper respiratory infection, and if it emerges in European Americans as well. Methods: The sample included 514 adults in good health, as judged by physician examination and laboratory testing. Participants completed questionnaires about lifecourse socioeconomic conditions, conscientiousness, psychosocial adjustment, and lifestyle factors. They were subsequently inoculated with a rhinovirus that causes upper respiratory infection, and monitored in quarantine for 5 days the development of illness. Results: Consistent with past work, African Americans from disadvantaged backgrounds displayed indications of skin-deep resilience. To the extent these participants were high in conscientiousness, they fared better across multiple domains of psychosocial functioning, as reflected in educational attainment, symptoms of depression, and close relationship quality (p values = .01–.04). But analyses of these participants’ susceptibility to infection revealed the opposite pattern; higher conscientiousness was associated with a greater likelihood of becoming ill following inoculation (p value = .03). In European Americans, there was no evidence of skin-deep resilience; conscientiousness was associated with better psychosocial outcomes, but not infection risk. Conclusions: These observations suggest that resilience may be a double-edged sword for African Americans from disadvantaged backgrounds. The same characteristics associated with academic success and psychological adjustment forecast increased vulnerability to health problems. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Longitudinal associations between self-regulation and health across childhood and adolescence.


Objective: There is some evidence to suggest that one’s ability to delay gratification is associated with a lower body mass index (BMI) and slower overall weight gain. Less is known about the role that a broader set of self-regulatory skills, including attention focusing, inhibitory control, and impulsivity, might play in fostering not only a healthy weight but also better overall health and health-related behaviors such as sleep. Method: Participants in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were followed from birth through age 15 beginning in 1991. Self-regulation was assessed when children were 4.5 years old, whereas health-related outcomes were assessed regularly between toddlerhood and adolescence. Structural equation modeling was used to test direct associations between self-regulation and either physical health or sleep in childhood and adolescence. Results: Findings suggest that there are long-term benefits of self-regulation, indexed by multiple dimensions, for children’s health-related outcomes. Children with better self-regulatory skills demonstrated smaller increases in standardized BMI scores and maintained greater mother-reported health across childhood and adolescence. Furthermore, better self-regulation predicted fewer sleep problems and longer sleep duration when children were 8 and 11 but not when they were 15. Conclusions: Early self-regulation, marked by numerous skills, appears to have long-term benefits for children’s health-related outcomes. These findings provide some evidence that targeting childhood self-regulatory skills for improvement may help reduce poor health-related outcomes later in life and offer important insight into potential avenues for intervention. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Changing perceptions and efficacy of generic medicines: An intervention study.


Objective: Generic medicines provide a safe and economical medical treatment and are used routinely throughout the world. However, a significant proportion of individuals view generic medicines as less safe, less effective and of lower quality compared with their equivalent branded medicines. This study aimed to investigate the effect of an educational intervention on improving perceptions and perceived efficacy of generic medicines. Method: Seventy participants who experienced frequent tension headaches were randomized to receive an educational video about generic medicines or a control video. Participants then alternatively took branded and generic ibuprofen to treat their next two consecutive headaches. Changes in perceptions of generic medicines, pain relief and side effects were measured. Results: The intervention was effective in modifying and improving perceptions of generic medicines in the areas of understanding (p < .05), preference for a generic medicine to treat a serious illness (p < .05), and overall preference for generic medicines (p < .01). However, contrary to predictions, participants in the intervention group reported significantly less pain relief (p = .03) and more symptoms (p = .04) after taking generic ibuprofen compared with branded ibuprofen. Conclusion: This study identified that an educational intervention is effective in modifying and improving perceptions of generic medicines but produced paradoxical effects on drug efficacy and side effects. These findings suggest that complex mechanisms are involved in the relationship between perceptions and drug efficacy and contradict the assumption that improving attitudes toward generic medicines will have a flow-on effect to improving health outcomes. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Childhood self-control predicts smoking throughout life: Evidence from 21,000 cohort study participants.


Objective: Low self-control has been linked with smoking, yet it remains unclear whether childhood self-control underlies the emergence of lifetime smoking patterns. We examined the contribution of childhood self-control to early smoking initiation and smoking across adulthood. Methods: 21,132 participants were drawn from 2 nationally representative cohort studies; the 1970 British Cohort Study (BCS) and the 1958 National Child Development Study (NCDS). Child self-control was teacher-rated at age 10 in the BCS and at ages 7 and 11 in the NCDS. Participants reported their smoking status and number of cigarettes smoked per day at 5 time-points in the BCS (ages 26–42) and 6 time-points in the NCDS (ages 23–55). Both studies controlled for socioeconomic background, cognitive ability, psychological distress, gender, and parental smoking; the NCDS also controlled for an extended set of background characteristics. Results: Early self-control made a substantial graded contribution to (not) smoking throughout life. In adjusted regression models, a 1-SD increase in self-control predicted a 6.9 percentage point lower probability of smoking in the BCS, and this was replicated in the NCDS (5.2 point reduced risk). Adolescent smoking explained over half of the association between self-control and adult smoking. Childhood self-control was positively related to smoking cessation and negatively related to smoking initiation, relapse to smoking, and the number of cigarettes smoked in adulthood. Conclusions: This study provides strong evidence that low childhood self-control predicts an increased risk of smoking throughout adulthood and points to adolescent smoking as a key pathway through which this may occur. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Anticipated regret and health behavior: A meta-analysis.


Objective: Risk beliefs are central to most theories of health behavior, yet many unanswered questions remain about an increasingly studied risk construct, anticipated regret. The authors sought to better understand anticipated regret’s role in motivating health behaviors. Method: The authors systematically searched electronic databases for studies of anticipated regret and behavioral intentions or health behavior. They used random effects meta-analysis to synthesize effect sizes from 81 studies (n = 45,618). Results: Anticipated regret was associated with both intentions (r+ = .50, p < .001) and health behavior (r+ = .29, p < .001). Greater anticipated regret from engaging in a behavior (i.e., action regret) predicted weaker intentions and behavior, whereas greater anticipated regret from not engaging in a behavior (i.e., inaction regret) predicted stronger intentions and behavior. Anticipated action regret had smaller associations with behavioral intentions related to less severe and more distal hazards, but these moderation findings were not present for inaction regret. Anticipated regret generally was a stronger predictor of intentions and behavior than other anticipated negative emotions and risk appraisals. Conclusions: Anticipated inaction regret has a stronger and more stable association with health behavior than previously thought. The field should give greater attention to understanding how anticipated regret differs from similar constructs, its role in health behavior theory, and its potential use in health behavior interventions. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Development of the Medical Maximizer-Minimizer Scale.


Objective: Medical over- and underutilization are central problems that stand in the way of delivering optimal health care. As a result, one important question is how people decide to take action, versus not, when it comes to their health. The present article proposes and validates a new measure that captures the extent to which individuals are “medical maximizers” who are predisposed to seek health care even for minor problems, versus “medical minimizers” who prefer to avoid medical intervention unless it is necessary. Method: Studies 1–3 recruited participants using Amazon’s Mechanical Turk. Study 1 conducted exploratory factor analysis (EFA) to identify items relevant to the proposed construct. In Study 2 confirmatory factor analysis (CFA) was conducted on the identified items, as well as tests of internal, discriminant, and convergent validity. Study 3 examined test–retest reliability of the scale. Study 4 validated the scale in a non-Internet sample. Results: EFA identified 10 items consistent with the proposed construct, and subsequent CFA showed that the 10 items were best understood with a bifactor model that assessed a single underlying construct consistent with medical maximizing–minimizing, with 3 of the 10 items cross-loading on another independent factor. The scale was distinct from hypochondriasis, distrust in medicine, health care access, and health status, and predicted self-reported health care utilization and a variety of treatment preferences. Conclusions: Individuals have general preferences to maximize versus minimize their use of health care, and these preferences are predictive of health care utilization and treatment preferences across a range of health care contexts. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)