Outlook | Newsletter of the Society of Behavioral Medicine

Newest Issues of Annals of Behavioral Medicine and Translational Behavioral Medicine

SBM's two journals, Annals of Behavioral Medicine and Translational Behavioral Medicine (TBM), continuously publish articles online, many of which become available before issues are printed. A few of the newest Annals and TBM articles currently accessible online are listed below.

Annals of Behavioral Medicine

Introduction to the Second Special Section on Health Disparities
Authors: Keith E. Whitfield; Laura M. Bogart; Tracey A. Revenson; Christopher R. France
Without Abstract: Here we present the second special section on health disparities in Annals of Behavioral Medicine. Papers in the first section, published in February 2012, examined potential explanations and risk factors for disparities, resilience factors that might narrow health disparities, and interventions to improve health outcomes in populations affected by health disparities. The articles spanned a range of health conditions and risk factors across the lifespan, focusing primarily on disparities among ethnic groups.

Maternal Experiences with Everyday Discrimination and Infant Birth Weight: A Test of Mediators and Moderators Among Young, Urban Women of Color
Authors: Valerie A. Earnshaw PhD; Lisa Rosenthal PhD; Jessica B. Lewis, LMFT; Emily C. Stasko, MPH; Jonathan N. Tobin PhD; Tené T. Lewis PhD; Allecia E. Reid PhD; Jeannette R. Ickovics, PhD
Abstract: Racial/ethnic disparities in birth weight persist within the USA. The purpose of this study is to examine the association between maternal everyday discrimination and infant birth weight among young, urban women of color as well as mediators (depressive symptoms, pregnancy distress, and pregnancy symptoms) and moderators (age, race/ethnicity, and attributions of discrimination) of this association. A total of 420 women participated (14-21 years old; 62 % Latina, 38 % Black), completing measures of everyday discrimination and moderators during their second trimester of pregnancy and mediators during their third trimester. Birth weight was primarily recorded from medical record review. Path analysis demonstrated that everyday discrimination was associated with lower birth weight. Depressive symptoms mediated this relationship, and no tested factors moderated this relationship. Given the association between birth weight and health across the lifespan, it is critical to reduce discrimination directed at young, urban women of color so that all children can begin life with greater promise for health.

Affective Reactivity to Daily Stressors and Long-Term Risk of Reporting a Chronic Physical Health Condition
Authors: Jennifer R. Piazza, PhD; Susan T. Charles, PhD; Martin J. Sliwinski, PhD; Jacqueline Mogle, PhD; David M. Almeida, PhD
Abstract: Daily stressors, such as an argument with a spouse or an impending deadline, are associated with short-term changes in physical health symptoms. Whether these minor hassles have long-term physical health ramifications, however, is largely unknown. The current study examined whether exposure and reactivity to daily stressors is associated with long-term risk of reporting a chronic physical health condition. Participants (N = 435) from the National Study of Daily Experiences completed a series of daily diary interviews between 1995 and 1996 and again 10 years later. Greater affective (i.e., emotional) reactivity to daily stressors at time 1 was associated with an increased risk of reporting a chronic physical health condition at time 2. Results indicate that how people respond to the daily stressors in their lives is predictive of future chronic health conditions.

Physical Activity and Differential Methylation of Breast Cancer Genes Assayed from Saliva: A Preliminary Investigation
Authors: Angela D. Bryan, PhD; Renee E. Magnan, PhD; Ann E. Caldwell Hooper, MA; Nicole Harlaar, PhD; Kent E. Hutchison, PhD
Abstract: Individuals who exercise are at lower risk for breast cancer and have better post-diagnosis outcomes. The biological mechanisms behind this association are unclear, but DNA methylation has been suggested. We developed a composite measure of DNA methylation across 45 CpG sites on genes selected a priori. We examined the association of this measure to self-reported physical activity and objectively measured cardiovascular fitness in a sample of healthy nonsmoking adults (n = 64) in an exercise promotion intervention. Individuals who were more physically fit and who exercised more minutes per week had lower levels of DNA methylation. Those who increased their minutes of physical activity over 12 months experienced decreases in DNA methylation. DNA methylation may be a mechanism linking exercise and cancer incidence and could serve as a biomarker for behavioral intervention trials. Studies with larger samples, objectively measured exercise, and more cancer-related markers are needed.

Psychosocial Correlates of Atrial Natriuretic Peptide: A Marker of Vascular Health
Authors: Patrick Smith, PhD; Martti T. Tuomisto, PhD; James Blumenthal, PhD; Andrew Sherwood, PhD; Lauri Parkkinen, MS; Mika Kähönen, MD; Ilkka Pörsti, MD; Silja Majahalme, MD; Väinö Turjanmaa, MD
Abstract: Psychosocial factors have been associated with cardiovascular outcomes, but few studies have examined the association between psychosocial function and natriuretic peptides. The purpose of this study is to determine the predictive value of hostility, anger, and social support in relation to atrial natriuretic peptide (ANP), a marker of vascular health, among middle-aged men. One hundred twenty-one men (mean age = 39.8 years, SD = 4.1) underwent assessments of ANP and completed the Cook-Medley Hostility Scale, the Spielberger State-Trait Anger Scale, and the Interview Schedule for Social Interaction. Higher levels of hostility (Β = 0.22 [95 % CI 0.04, 0.40], P =0.032) and trait anger (Β = 0.18 [95 % CI 0.01, 0.37], P = 0.044) were associated with greater ANP levels. In contrast, higher perceived social support was also associated with lower ANP levels, (Β = −0.19 [95 % CI −0.05, −0.41], P = 0.010). Psychosocial factors, including hostility, anger, and social support, are associated with varying ANP levels among middle-aged men, independent of cardiovascular and behavioral risk factors.

Translational Behavioral Medicine: Practice, Policy, Research

Treatment-enhanced paired action contributes substantially to change across multiple health behaviors: secondary analyses of five randomized trials
Authors: Hui-Qing Yin; James O. Prochaska; Joseph S. Rossi; Colleen A. Redding; Andrea L. Paiva; Bryan Blissmer; Wayne F. Velicer; Sara S. Johnson; Hisanori Kobayashi
Abstract: The dominant paradigm of changing multiple health behaviors (MHBs) is based on treating, assessing, and studying each behavior separately. This study focused on individuals with co-occurring baseline health-risk behavior pairs and described whether they changed over time on both or only one of the behaviors within each pair. Data from five randomized trials of computer-tailored interventions (CTIs) that simultaneously treated MHBs were analyzed. The differences between treatment and control proportions that achieved paired action and singular action at 24 months follow-up, and the proportional contribution of paired action to overall change on each behavior, were assessed across 12 behavior pairs (including energy balance, addictive, and appearance-related behaviors). CTIs consistently produced more paired action across behavior pairs. Paired action contributed substantially more to the treatment-related outcomes than singular action. Studying concurrent changes on MHBs as demonstrated allows the effect of simultaneously treating MHBs to be assessed.

Multiple health behavior change: a synopsis and comment on "A review of multiple health behavior change interventions for primary prevention"
Authors: Winter Johnston, BA; Joanna Buscemi, PhD; Michael J. Coons, PhD
Abstract: The ninth column on Evidence-Based Behavioral Medicine is a synthesis of a recent systematic meta-review of multiple health behavior change (MHBC) interventions published by Prochaska and Prochaska in the American Journal of Lifestyle Medicine (Am J Life Med 5:208-221, 2011). Health risk behaviors are highly prevalent and increase the risk of developing and exacerbating chronic disease. The purpose of the meta-review was to examine the efficacy of MHBC interventions in a variety of populations and settings. The available literature was synthesized into three health behavior domains including energy-balance behaviors (physical activity and nutrition), addictive behaviors, and disease-related prevention. Twelve systematic reviews were identified that summarized more than 150 randomized clinical trials. Findings suggest that: (1) Physical activity and nutrition interventions are effective in producing weight loss among adults and female youth, (2) treating two addictive behaviors produces a higher long-term abstinence rate than treating a single behavior, and (3) although preventive interventions for cardiovascular disease and cancer significantly reduce health risk behaviors, reductions in disease incidence are yet to be demonstrated.

Comparing strategies to assess multiple behavior change in behavioral intervention studies
Authors: Bettina F. Drake, PhD; Lisa M. Quintiliani, PhD; Amy L. Sapp, ScD; Yi Li, PhD; Amy E. Harley, PhD; Karen M. Emmons, PhD; Glorian Sorensen, PhD
Abstract: Alternatives to individual behavior change methods have been proposed; however, little has been done to investigate how these methods compare. To explore the four methods that quantify change in multiple risk behaviors targeting four common behaviors, we utilized data from two cluster-randomized, multiple behavior change trials conducted in two settings: small businesses and health centers. Methods used were (1) summative, (2) z-score, (3) optimal linear combination, and (4) impact score. In the small business study, methods 2 and 3 revealed similar outcomes. However, physical activity did not contribute to method 3. In the health centers study, similar results were found with each of the methods. Multivitamin intake contributed significantly more to each of the summary measures than other behaviors. Selection of methods to assess multiple behavior change in intervention trials must consider study design and the targeted population when determining the appropriate method/s to use.

Preventing substance abuse and increasing energy balance in middle school students: What works?
Author: Amy A. Eyler
Policy Brief Without Abstract: Unhealthy behavior patterns such as smoking, alcohol use, physical inactivity, and poor diet often being in adolescence and worsen over time. A peak time for interventions to prevent these patterns is when students are in middle school; prior to increased reluctance to change that occurs in high school. While tobacco and alcohol abuse prevention programs in schools have had mixed success, evidence of effective interventions is growing. Similarly, diet and physical activity interventions are promising within the school-age population. Computer or technology-based interventions are being used as a means to implement prevention programs, particularly with this tech-savvy generation of students. The current study combines the Transtheoretical Model of Behavior Change (TTM) with a computer-based intervention for multiple risk behaviors in middle school students.

News from the CDC: collaborations to build capacity at the community level in cancer prevention and control
Authors: Linda Ekwenugo, MPH; Vicki B. Benard, PhD; Cynthia Vinson MPA
Abstract: The Cancer Prevention and Control Research Network (CPCRN) is a national network of ten academic centers funded by the Centers for Disease Control and Prevention and the National Cancer Institute, whose mission is to accelerate the adoption of evidence-based cancer prevention and control practices in communities through increased understanding of program dissemination and implementation. CPCRN researchers collaborate to raise awareness, provide education, guidance, and technical assistance to reduce cancer incidence and mortality rates in their communities. The CPCRN capacity building at the community level involves implementing evidence-based programs, policies, and strategies recommended by the Community Preventive Services Task Force to decrease obesity, increase physical activity, promote healthier behaviors, decrease tobacco use, and improve the appropriate use of cancer screening tests. These accomplishments demonstrate how the collaboration of federal, academic, and community-based organizations can be mutually beneficial by developing partnerships, research infrastructure, and community capacity that can catalyze behavior change.


Winter 2013	Return to Outlook Main page »
Newest Issues of Annals of Behavioral Medicine and Translational Behavioral Medicine SBM's two journals, Annals of Behavioral Medicine and Translational Behavioral Medicine (TBM), continuously publish articles online, many of which become available before issues are printed. A few of the newest Annals and TBM articles currently accessible online are listed below. Annals of Behavioral Medicine Introduction to the Second Special Section on Health Disparities Authors: Keith E. Whitfield; Laura M. Bogart; Tracey A. Revenson; Christopher R. France Without Abstract: Here we present the second special section on health disparities in Annals of Behavioral Medicine. Papers in the first section, published in February 2012, examined potential explanations and risk factors for disparities, resilience factors that might narrow health disparities, and interventions to improve health outcomes in populations affected by health disparities. The articles spanned a range of health conditions and risk factors across the lifespan, focusing primarily on disparities among ethnic groups. Maternal Experiences with Everyday Discrimination and Infant Birth Weight: A Test of Mediators and Moderators Among Young, Urban Women of Color Authors: Valerie A. Earnshaw PhD; Lisa Rosenthal PhD; Jessica B. Lewis, LMFT; Emily C. Stasko, MPH; Jonathan N. Tobin PhD; Tené T. Lewis PhD; Allecia E. Reid PhD; Jeannette R. Ickovics, PhD Abstract: Racial/ethnic disparities in birth weight persist within the USA. The purpose of this study is to examine the association between maternal everyday discrimination and infant birth weight among young, urban women of color as well as mediators (depressive symptoms, pregnancy distress, and pregnancy symptoms) and moderators (age, race/ethnicity, and attributions of discrimination) of this association. A total of 420 women participated (14-21 years old; 62 % Latina, 38 % Black), completing measures of everyday discrimination and moderators during their second trimester of pregnancy and mediators during their third trimester. Birth weight was primarily recorded from medical record review. Path analysis demonstrated that everyday discrimination was associated with lower birth weight. Depressive symptoms mediated this relationship, and no tested factors moderated this relationship. Given the association between birth weight and health across the lifespan, it is critical to reduce discrimination directed at young, urban women of color so that all children can begin life with greater promise for health. Affective Reactivity to Daily Stressors and Long-Term Risk of Reporting a Chronic Physical Health Condition Authors: Jennifer R. Piazza, PhD; Susan T. Charles, PhD; Martin J. Sliwinski, PhD; Jacqueline Mogle, PhD; David M. Almeida, PhD Abstract: Daily stressors, such as an argument with a spouse or an impending deadline, are associated with short-term changes in physical health symptoms. Whether these minor hassles have long-term physical health ramifications, however, is largely unknown. The current study examined whether exposure and reactivity to daily stressors is associated with long-term risk of reporting a chronic physical health condition. Participants (N = 435) from the National Study of Daily Experiences completed a series of daily diary interviews between 1995 and 1996 and again 10 years later. Greater affective (i.e., emotional) reactivity to daily stressors at time 1 was associated with an increased risk of reporting a chronic physical health condition at time 2. Results indicate that how people respond to the daily stressors in their lives is predictive of future chronic health conditions. Physical Activity and Differential Methylation of Breast Cancer Genes Assayed from Saliva: A Preliminary Investigation Authors: Angela D. Bryan, PhD; Renee E. Magnan, PhD; Ann E. Caldwell Hooper, MA; Nicole Harlaar, PhD; Kent E. Hutchison, PhD Abstract: Individuals who exercise are at lower risk for breast cancer and have better post-diagnosis outcomes. The biological mechanisms behind this association are unclear, but DNA methylation has been suggested. We developed a composite measure of DNA methylation across 45 CpG sites on genes selected a priori. We examined the association of this measure to self-reported physical activity and objectively measured cardiovascular fitness in a sample of healthy nonsmoking adults (n = 64) in an exercise promotion intervention. Individuals who were more physically fit and who exercised more minutes per week had lower levels of DNA methylation. Those who increased their minutes of physical activity over 12 months experienced decreases in DNA methylation. DNA methylation may be a mechanism linking exercise and cancer incidence and could serve as a biomarker for behavioral intervention trials. Studies with larger samples, objectively measured exercise, and more cancer-related markers are needed. Psychosocial Correlates of Atrial Natriuretic Peptide: A Marker of Vascular Health Authors: Patrick Smith, PhD; Martti T. Tuomisto, PhD; James Blumenthal, PhD; Andrew Sherwood, PhD; Lauri Parkkinen, MS; Mika Kähönen, MD; Ilkka Pörsti, MD; Silja Majahalme, MD; Väinö Turjanmaa, MD Abstract: Psychosocial factors have been associated with cardiovascular outcomes, but few studies have examined the association between psychosocial function and natriuretic peptides. The purpose of this study is to determine the predictive value of hostility, anger, and social support in relation to atrial natriuretic peptide (ANP), a marker of vascular health, among middle-aged men. One hundred twenty-one men (mean age = 39.8 years, SD = 4.1) underwent assessments of ANP and completed the Cook-Medley Hostility Scale, the Spielberger State-Trait Anger Scale, and the Interview Schedule for Social Interaction. Higher levels of hostility (Β = 0.22 [95 % CI 0.04, 0.40], P =0.032) and trait anger (Β = 0.18 [95 % CI 0.01, 0.37], P = 0.044) were associated with greater ANP levels. In contrast, higher perceived social support was also associated with lower ANP levels, (Β = −0.19 [95 % CI −0.05, −0.41], P = 0.010). Psychosocial factors, including hostility, anger, and social support, are associated with varying ANP levels among middle-aged men, independent of cardiovascular and behavioral risk factors. Translational Behavioral Medicine: Practice, Policy, Research Treatment-enhanced paired action contributes substantially to change across multiple health behaviors: secondary analyses of five randomized trials Authors: Hui-Qing Yin; James O. Prochaska; Joseph S. Rossi; Colleen A. Redding; Andrea L. Paiva; Bryan Blissmer; Wayne F. Velicer; Sara S. Johnson; Hisanori Kobayashi Abstract: The dominant paradigm of changing multiple health behaviors (MHBs) is based on treating, assessing, and studying each behavior separately. This study focused on individuals with co-occurring baseline health-risk behavior pairs and described whether they changed over time on both or only one of the behaviors within each pair. Data from five randomized trials of computer-tailored interventions (CTIs) that simultaneously treated MHBs were analyzed. The differences between treatment and control proportions that achieved paired action and singular action at 24 months follow-up, and the proportional contribution of paired action to overall change on each behavior, were assessed across 12 behavior pairs (including energy balance, addictive, and appearance-related behaviors). CTIs consistently produced more paired action across behavior pairs. Paired action contributed substantially more to the treatment-related outcomes than singular action. Studying concurrent changes on MHBs as demonstrated allows the effect of simultaneously treating MHBs to be assessed. Multiple health behavior change: a synopsis and comment on "A review of multiple health behavior change interventions for primary prevention" Authors: Winter Johnston, BA; Joanna Buscemi, PhD; Michael J. Coons, PhD Abstract: The ninth column on Evidence-Based Behavioral Medicine is a synthesis of a recent systematic meta-review of multiple health behavior change (MHBC) interventions published by Prochaska and Prochaska in the American Journal of Lifestyle Medicine (Am J Life Med 5:208-221, 2011). Health risk behaviors are highly prevalent and increase the risk of developing and exacerbating chronic disease. The purpose of the meta-review was to examine the efficacy of MHBC interventions in a variety of populations and settings. The available literature was synthesized into three health behavior domains including energy-balance behaviors (physical activity and nutrition), addictive behaviors, and disease-related prevention. Twelve systematic reviews were identified that summarized more than 150 randomized clinical trials. Findings suggest that: (1) Physical activity and nutrition interventions are effective in producing weight loss among adults and female youth, (2) treating two addictive behaviors produces a higher long-term abstinence rate than treating a single behavior, and (3) although preventive interventions for cardiovascular disease and cancer significantly reduce health risk behaviors, reductions in disease incidence are yet to be demonstrated. Comparing strategies to assess multiple behavior change in behavioral intervention studies Authors: Bettina F. Drake, PhD; Lisa M. Quintiliani, PhD; Amy L. Sapp, ScD; Yi Li, PhD; Amy E. Harley, PhD; Karen M. Emmons, PhD; Glorian Sorensen, PhD Abstract: Alternatives to individual behavior change methods have been proposed; however, little has been done to investigate how these methods compare. To explore the four methods that quantify change in multiple risk behaviors targeting four common behaviors, we utilized data from two cluster-randomized, multiple behavior change trials conducted in two settings: small businesses and health centers. Methods used were (1) summative, (2) z-score, (3) optimal linear combination, and (4) impact score. In the small business study, methods 2 and 3 revealed similar outcomes. However, physical activity did not contribute to method 3. In the health centers study, similar results were found with each of the methods. Multivitamin intake contributed significantly more to each of the summary measures than other behaviors. Selection of methods to assess multiple behavior change in intervention trials must consider study design and the targeted population when determining the appropriate method/s to use. Preventing substance abuse and increasing energy balance in middle school students: What works? Author: Amy A. Eyler Policy Brief Without Abstract: Unhealthy behavior patterns such as smoking, alcohol use, physical inactivity, and poor diet often being in adolescence and worsen over time. A peak time for interventions to prevent these patterns is when students are in middle school; prior to increased reluctance to change that occurs in high school. While tobacco and alcohol abuse prevention programs in schools have had mixed success, evidence of effective interventions is growing. Similarly, diet and physical activity interventions are promising within the school-age population. Computer or technology-based interventions are being used as a means to implement prevention programs, particularly with this tech-savvy generation of students. The current study combines the Transtheoretical Model of Behavior Change (TTM) with a computer-based intervention for multiple risk behaviors in middle school students. News from the CDC: collaborations to build capacity at the community level in cancer prevention and control Authors: Linda Ekwenugo, MPH; Vicki B. Benard, PhD; Cynthia Vinson MPA Abstract: The Cancer Prevention and Control Research Network (CPCRN) is a national network of ten academic centers funded by the Centers for Disease Control and Prevention and the National Cancer Institute, whose mission is to accelerate the adoption of evidence-based cancer prevention and control practices in communities through increased understanding of program dissemination and implementation. CPCRN researchers collaborate to raise awareness, provide education, guidance, and technical assistance to reduce cancer incidence and mortality rates in their communities. The CPCRN capacity building at the community level involves implementing evidence-based programs, policies, and strategies recommended by the Community Preventive Services Task Force to decrease obesity, increase physical activity, promote healthier behaviors, decrease tobacco use, and improve the appropriate use of cancer screening tests. These accomplishments demonstrate how the collaboration of federal, academic, and community-based organizations can be mutually beneficial by developing partnerships, research infrastructure, and community capacity that can catalyze behavior change.