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Preview: Health Psychology - Vol 29, Iss 1

Health Psychology - Vol 35, Iss 12

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

Last Build Date: Fri, 09 Dec 2016 10:00:07 EST

Copyright: Copyright 2016 American Psychological Association

Sleep quality subtypes and obesity.


Objective: Poor sleep quality could be a risk factor for obesity. This article utilized a person-centered approach to investigate whether distinct sleep quality subtypes were associated with obesity directly, and indirectly via physical activity. Method: The sample included 8,932 Australian employees who participated in the Household, Income and Labor Dynamics in Australia Survey. Structured interviews and self-report questionnaires collected information on sleep quality, obesity, and relevant demographic, health, and work-related variables. Latent class analysis identified distinct subtypes of sleep quality. General linear modeling examined the associations of sleep quality subtypes with body mass index (BMI) and waist circumference. Multicategorical mediation models examined indirect paths linking sleep quality classes with obesity via physical activity. Results: Five distinct sleep quality subtypes were identified: Poor Sleepers (20.0%), Frequent Sleep Disturbances (19.2%), Minor Sleep Disturbances (24.5%), Long Sleepers (9.6%), and Good Sleepers (26.7%). BMI, waist circumference, and physical activity differed among the sleep quality subtypes, with similar results observed for males and females. For example, Poor Sleepers had the highest BMIs, followed by Frequent Sleep Disturbances and Minor Sleep Disturbances; Long Sleepers and Good Sleepers had the lowest BMIs. Mediation analyses indicated that low levels of physical activity linked the Poor Sleep, Frequent Sleep Disturbance, and Long Sleep classes with higher BMI. Conclusions: These results provide new insights into the nature of sleep quality in employees. In particular, distinct sleep quality patterns had differing associations with measures of obesity, suggesting the need for tailored workplace interventions. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Is daytime napping associated with inflammation in adolescents?


Objective: Daytime napping has been associated with poor health outcomes in adults. It is not known whether daytime napping is similarly linked to adverse health in adolescents, although many report napping. The present study evaluated associations between daytime napping and 2 markers of increased inflammation, high-sensitivity C-reactive protein and interleukin-6 (IL-6), in healthy high school students. Methods: Two hundred thirty-four Black and White high school students completed a week of actigraph and diary measures of sleep and napping and provided a fasting blood sample. Napping measures were the proportion of days napped and the average minutes napped across 1 week during the school year. Results: Linear regressions adjusted for age, sex, race, average nocturnal sleep duration, time between sleep protocol and blood draw, and body mass index percentile demonstrated that proportion of days napped measured by actigraphy, B(SE) = .41(.19), p < .05, across the full week was positively associated with IL-6. Higher proportions of school days napped between 2 p.m. and 6 p.m., B(SE) = .40(.20), p < .05, and between 6 p.m. and 10 p.m., B(SE) = .57(.28), p < .05, were associated with increased IL-6. No associations emerged between average actigraphy-assessed nap duration and either study outcome. Diary-reported napping was unrelated to either study outcome. Conclusions: Actigraphy-assessed napping and IL-6 are associated but the direction of the relationship remains to be determined. Overall, napping is an important factor to consider to better understand the relationship between short sleep and cardiovascular health in adolescents. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Temporal relationships between sleep and physical activity among breast cancer patients with insomnia.


Objective: The present study prospectively investigated the day-to-day bidirectional relationships between objective measures of sleep parameters and physical activity among breast cancer patients with insomnia symptoms. Method: A subgroup of participants (N = 66) enrolled in a randomized controlled trial for insomnia comorbid with cancer wore an actigraphic recorder for seven 24-hr periods before the intervention. Multilevel models examined whether sleep parameters (sleep onset latency, wake after sleep onset [WASO], total wake time [TWT], sleep efficiency [SE], and total sleep time [TST]) on a given night predicted the levels of physical activity (daily activity counts and minutes of moderate to vigorous physical activity [MVPA]) the following day and vice versa. Results: Adjusted models revealed that a lower WASO (β= −.12, SE = .07, p < .05), TWT (β = −.14, SE = .05, p < .05), and TST (β = −.14, SE = .06, p < .05) were significantly associated with a greater daily activity count fluctuation the next day. Conversely, greater total daily count fluctuations were significantly associated with a higher WASO (β = .18, SE = .08, p < .05), TWT (β = .12, SE = .04, p < .05), and TST (β = .22, SE = .08, p < .05) the following night. Conclusions: These findings support a reciprocal and complex relationship between sleep parameters and physical activity. While they do not confirm a possible beneficial effect of physical activity on objective sleep parameters, they suggest that successful insomnia treatment could increase daily physical activity in patients with cancer. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Obstructive sleep apnea and weight loss treatment outcome among adults with metabolic syndrome.


Objective: The purpose of this study was to examine whether adults with obesity and metabolic syndrome who screen as high risk for obstructive sleep apnea (OSA) lose less weight as part of a weight loss intervention than those who screen as low risk. Method: We conducted a secondary analysis of a randomized trial comparing 2 weight loss interventions consisting of dietary counseling for adults with obesity and metabolic syndrome. Participants were screened for sleep apnea using a validated screening questionnaire. Percent weight loss was calculated from weight measured at baseline and intervention end (12 months). Weight loss of 5% or greater was considered clinically significant. Multivariate linear and logistic regression models estimated the association between OSA screening status (high vs. low risk) and percent weight loss and clinically significant weight loss, adjusting for relevant covariates including body mass index and sleep duration. Results: Nearly half of participants (45.8%) screened as high risk for OSA. Participants who screened as high risk for OSA lost less weight (1.2% ± 4.2% vs. 4.2% ± 5.3%) and were less likely to lose 5% or greater (24.4% vs. 75.6%) than participants without OSA. Conclusion: Among adults with obesity and metabolic syndrome, those at high risk for OSA lost less weight in response to a dietary counseling intervention than adults with low risk of OSA. Routine OSA screening should be considered as part of weight loss treatment programs. Additional research is needed to determine how to tailor weight loss treatment for those with high risk for OSA. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Effects of a randomized gratitude intervention on death-related fear of recurrence in breast cancer survivors.


Objective: Among the most prevalent and distressing concerns endorsed by breast cancer survivors is fear of cancer recurrence (FOR), and one of the most salient facets is the worry that a recurrence of cancer could cause one’s death. The primary goal of the present study was to test the effects of a brief, low-cost gratitude intervention on overall FOR and death-related FOR, positing pursuit of meaningful goals as a theoretically driven putative mediator. To replicate published tests of similar gratitude-eliciting interventions, positive affect (PA) was also considered as an outcome. Method: Sixty-seven women with early stage breast cancer were randomly assigned to either a 6-week online gratitude intervention or a 6-week online control condition. Outcomes were assessed at pre- and posttreatment, as well as 1 month and 3 months after the end of treatment. The mediator, meaningful goal pursuit, was measured via assessments over the 6-week intervention period. Results: Results revealed that patients in the gratitude intervention experienced a significant decrease in death-related FOR compared to the control condition. Moreover, this effect was significantly mediated by meaningful goal pursuit (and not by PA). The gratitude intervention was also found to prevent declines in PA observed in the control condition. Conclusions: Overall, findings support the notion that a brief gratitude intervention can promote well-being and psychological adaptation to cancer by stimulating the pursuit of meaningful goals and subsequently reducing death-related FOR. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Fear of recurrence in long-term cancer survivors—Do cancer type, sex, time since diagnosis, and social support matter?


Objective: Fear of recurrence (FoR) is among the most important concerns for cancer survivors. Studies on potentially influencing variables, like time since diagnosis, cancer type, and sex, have yielded heterogeneous results. Also social support has rarely been examined as an influencing factor. This study aims to increase knowledge on these factors. Method: Analyses are based on cross-sectional data of long-term survivors of breast, colorectal, and prostate cancer (5–16 years postdiagnosis), recruited by 6 German population-based cancer registries. Six thousand fifty-seven women and men were included in the analyses. FoR was assessed using the short form of the Fear of Progression Questionnaire (FoP-Q-SF). The associations of cancer type, age, sex, time since diagnosis, and social support with moderate/high FoR were identified via multiple logistic regression analyses. Results: The majority of long-term cancer survivors reported experiencing FoR, mostly in low intensity. Female survivors, survivors ≤54 or 55–59 years of age, 5 to 7 years postdiagnosis, with a lower education, with recurrence/metastases, or being socially isolated were at greater risk to experience moderate/high FoR. Cancer type and stage at diagnosis did not reach statistical significance. Conclusion: Our results indicate a potential vulnerability for women to experience FoR in moderate/high severity. Also younger and socially isolated survivors were at greater risk to suffer from moderate/high levels of FoR and should thus be monitored for high levels of FoR and be offered the support needed to manage their fears. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

A systematic review of factors that contribute to nocebo effects.


Objectives: Medication side effects are common, often leading to reduced quality of life, nonadherence, and financial costs for health services. Many side effects are the result of a psychologically mediated “nocebo effect.” This review identifies the risk factors involved in the development of nocebo effects. Method: Web of Science, Scopus, MEDLINE, PsycINFO, Journals@Ovid full text, and Global Health were searched using the terms “nocebo” and “placebo effect.” To be included, studies must have exposed people to an inert substance and have assessed 1 or more baseline or experimental factor(s) on its ability to predict symptom development in response to the inert exposure. Results: Eighty-nine studies were included; 70 used an experimental design and 19 used a prospective design, identifying 14 different categories of risk factor. The strongest predictors of nocebo effects were a higher perceived dose of exposure, explicit suggestions that the exposure triggers arousal or symptoms, observing people experiencing symptoms from the exposure, and higher expectations of symptoms. Conclusions: To reduce nocebo induced symptoms associated with medication or other interventions clinicians could reduce expectations of symptoms, limit suggestions of symptoms, correct unrealistic dose perceptions, and reduce exposure to people experiencing side effects. There is some evidence that we should do this especially for persons with at-risk personality types, though exactly which personality types these are requires further research. These suggestions have a downside in terms of consent and paternalism, but there is scope to develop innovative ways to reduce nocebo effects without withholding information. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Religious participation predicts diurnal cortisol profiles 10 years later via lower levels of religious struggle.


Objective: Multiple aspects of religion have been linked with a variety of physical health outcomes; however, rarely have investigators attempted to empirically test the mechanisms through which religiosity impacts health. The links between religious participation, religious coping, and diurnal cortisol patterns over a 10-year period in a national sample of adults in the United States were investigated. Method: Participants included 1,470 respondents from the Midlife in the United States (MIDUS) study who provided reports on religious participation, religious coping, and diurnal cortisol. Results: Religious participation predicted steeper (“healthier”) cortisol slopes at the 10-year follow-up, controlling for potential confounds. Further, religious struggle (religious coping marked by tension and strain about religious and spiritual issues) mediated the prospective association between religious participation and cortisol slope, such that greater religious attendance predicted lower levels of religious struggle 10 years later, which in turn was linked with a steeper cortisol slope; this effect remained strong when controlling for general emotional coping and social support. Positive religious coping was unrelated to diurnal cortisol patterns. Conclusion: These findings identify religious struggle as a mechanism through which religious participation impacts diurnal cortisol levels and suggest that diurnal cortisol is a plausible pathway through which aspects of religion influence long-term physical health. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Environmental and psychosocial correlates of objectively measured physical activity among older adults.


Objective: Neighborhood environments can support or hinder physical activity especially as health declines with age. This study puts psychological theories of health behavior change in context with built environment research to better understand the interplay of environmental and psychosocial characteristics impacting older adults’ sedentary behavior and physical activity. Method: The Active Streets, Active People study recruited 193 older adults living in a highly walkable neighborhood in Vancouver, British Columbia, Canada. Participants completed questionnaires on attitudes toward walking, behavioral control for walking, and perceived built environment variables. To assess behavior, participants wore an ActiGraph GT3X + accelerometer for 7 consecutive days. Regression-based path analysis was conducted to examine whether the link between the perceived environment and behavior is mediated by psychosocial variables. Results: In total, 174 participants had valid accelerometry data (Mage = 70.3, SD = 7.2) and demonstrated a daily average of 525.7 min of sedentary behavior (SD = 65.1) as well as high levels of total physical activity (M = 254.3, SD = 65.1 min/day). Mediation analysis revealed that perceived street connectivity and diversity of land use were negatively related to sedentary behavior, but only indirectly through behavioral control. Similarly, effects of street connectivity and diversity of land use on physical activity were mediated by behavioral control. Conclusions: Results highlighted that the perceived built environment is important for physical activity and sedentary behavior, largely because these environmental perceptions are positively linked to older adults’ confidence in walking. By integrating environmental and psychosocial correlates of preventive health behaviors within a theoretical structure, the psychosocial mechanisms through which the environment affects activity can be better understood. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

A model of parental distress and factors that mediate its link with parental monitoring of youth diabetes care, adherence, and glycemic control.


Objective: Parental monitoring of adolescents’ diabetes self-care is associated with better adherence and glycemic control (A1c). A number of parent-level factors are associated with higher levels of parental monitoring, including lower levels of parental distress (depressive symptoms, stress, anxiety), as well as higher levels of parental self-efficacy for diabetes management and authoritative parenting. Often studied in isolation, these factors may be best considered simultaneously as they are interrelated and are associated with parental monitoring and youth adherence. Method: Structural equation modeling with a cross-sectional sample of 257 parent/youth (aged 11–14) dyads: (a) examined a broad model of parental factors (i.e., parental distress, parental diabetes self-efficacy, authoritative parenting), and (b) assessed their relation to parental monitoring, youth adherence, and A1c. Post hoc analyses of variance (ANOVAs) evaluated clinical implications of daily parental monitoring. Results: Parental distress was not related directly to parental monitoring. Instead less distress related indirectly to more monitoring via higher parental self-efficacy and more authoritative parenting which, in turn, related to better adherence and A1c. Higher parental self-efficacy also related directly to better youth adherence and then to better A1c. Clinically, more parental monitoring related to more daily blood glucose checks and to better A1c (8.48% vs. 9.17%). Conclusions: A broad model of parent-level factors revealed more parental distress was linked only indirectly to less monitoring via lower parental self-efficacy and less authoritative parenting. Behaviorally, more parental monitoring related to better adherence and to clinically better A1c in adolescents. Further study of parent-level factors that relate to parental distress and monitoring of adherence appears warranted. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Brief psychological intervention in patients with cervical cancer: A randomized controlled trial.


Objectives: The diagnosis and treatment of cancer is considered a major life stress that has potential effects on one’s psychological well-being. This study investigated the possible benefits of a brief psychological intervention based on gratitude and mindfulness for positive and negative affect in patients with cervical cancer and explored the potentially mediating role of rumination and reappraisal. Methods: A randomized controlled trial was conducted in 3 public hospitals in China between April 2014 and December 2014. One-hundred twenty postoperative cervical cancer patients were randomly assigned into an intervention group or a wait-list control group. Participants completed self-report measures of positive and negative affect, rumination, and reappraisal before and after the 4-week intervention or waiting period. The outcome effects of the intervention were analyzed by generalized estimating equations (GEE). Mediation analyses were performed using a nonparametric bootstrapping procedure. Results: GEE results indicated significant Time × Group interaction effects on positive affect (B = 1.60, χ2 = 25.90, p < .001), negative affect (B = −2.13, χ2 = 28.02, p < .001), rumination (B = −2.48, χ2 = 6.48, p = .011), and reappraisal (B = 3.28, χ2 = 41.17, p < .001) for the intervention. The effect of the intervention on positive and negative affect was mediated by changes in rumination and reappraisal respectively. Conclusions: The brief psychological intervention improved positive affect and reappraisal and reduced negative affect and rumination in women with cervical cancer. Findings support the beneficial effects for implementing this brief psychological intervention in oncology. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Social support and physical activity change in Latinas: Results from the Seamos Saludables trial.


Objective: Family responsibilities and poor social support are barriers to physical activity among Latinas. This study evaluated the effects of a home- and print-based intervention on social support, moderating effects of familial ties on support and moderate-to-vigorous physical activity (MVPA), and mediating effects of support on MVPA. Method: Participants were randomized to receive through the mail either individually tailored physical activity intervention or general wellness print materials. Familial ties and social support were assessed by marital and child status and the social support for physical activity measure, respectively. MVPA was measured using the 7-day Physical Activity Recall Interview and accelerometer. Assessments were conducted at baseline, 6 months posttreatment, and 12 months follow-up. Results: Participants (n = 266; 40.6 ± 9.9 years old) were mostly immigrant and Spanish-speaking Latinas. The intervention group achieved greater increases in family and friend support compared to the wellness control group from baseline to posttreatment and follow-up (p < .05). Intervention changes in support did not depend on marital or child status. The intervention also increased minutes per week of MVPA more than the wellness control (p < .05) and the effect did not depend on marital or child status. There were significant indirect effects of treatment, indicating the intervention achieved greater increases in MVPA by increasing family (ab = 5.21, SE = 2.94, 95% confidence interval [CI] = 0.91–14.11) and friend (ab = 6.83, SE = 5.15, 95% CI = 0.16–20.56) support. Conclusions: The intervention improved and sustained support from family and friends and MVPA irrespective of familial ties. Social support mediated increases in MVPA. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)