Journal of Behavioral Medicine

Limited research has focused expressly on dual tobacco-alcohol use among the Latinx population. Latinx individuals who smoke represent a tobacco health disparities group and evince elevated rates of pain problems and symptoms. Prior research has consistently linked pain problems and severity to smoking and alcohol prevalence, maintenance, and behavior. Accordingly, the current study sought to build from the limited work that exists among Latinx persons who smoke and evaluate the role of alcohol use severity in terms of pain severity and interference. The current sample consisted of 228 adult Latinx daily cigarette smokers (Mage = 34.95 years; SD = 8.58; 39.0% female) who endorsed current pain. Results indicated that elevated alcohol use problems were associated with greater levels of pain severity (R2 = 0.06) and interference (R2 = 0.06). The present findings suggest that there may be utility in clinical screening for alcohol use problems among Latinx persons who smoke to offset pain problems among this high-risk group.

Long-term stress experienced by trauma patients was assessed for a sample of 137 patients treated at a large urban trauma center after suffering traumatic injuries resulting from motor vehicle/motorcycle accidents, falls, pedestrian accidents, and stabbing and gunshot wounds. Levels of psychological distress reported 3 to 39 months after the accident were considerable, but a measure of injury severity commonly used in critical care settings was not a good predictor of psychosocial outcome. The subjective impact of the accident and injury-related financial and employment problems were more important in predicting outcome than medical variables or time since injury. Family environment ratings were significantly worse for subjects with elevated levels of psychiatric symptoms. The results suggest that psychosocial interventions may benefit many of these individuals. Aspects to be considered in planning the intervention include projected functional disability, likely employment and financial problems, subjective perceptions of the accident and its implications, and family and social support.

Effective approaches to promote adolescent physical activity are needed. Moreover, a one-size-fits-all approach has been minimally successful to date. This randomized controlled trial evaluates a theory-based personalized exercise prescription to enhance motivation for being active and physical activity participation among adolescent reluctant exercisers. Adolescents were characterized by affective style as reluctant (predisposed to negative affect during exercise) or latent (predisposed to positive affect during exercise) exercisers based on their affective response to an acute exercise task, and then randomly assigned to an exercise prescription of either a personalized or a moderate intensity. Assignment was double-blind. Assessments were pre- and post- the 8-week intervention. Participants were an ethnically diverse group of adolescents (19 % non-Latino White) in a public middle-school. The exercise intensity manipulation and assessments took place at the school site during regular Physical Education. Participants were assigned to either a moderate-intensity exercise prescription [target heart rate (HR) range 60–80 % of HR max] or a personalized exercise prescription corresponding to an intensity that “feels good” to the individual for 8 weeks during daily Physical Education. Outcome measures included exercise-related intrinsic motivation (via questionnaire), and daily moderate-to-vigorous physical activity (MVPA; via accelerometer). The exercise intensity manipulation did not yield actual differences in exercise intensity during PE, and had no effect on either Intrinsic Motivation or MVPA. There was no significant interaction between affective style and group assignment in predicting Intrinsic Motivation or MVPA. This study did not find support for a link between affective experiences during exercise and physical activity participation. Providing adolescents with a personalized exercise intensity prescription and asking them to follow the prescription during PE was not an effective strategy to manipulate their affective experience of exercise. A more rigorous test of affective manipulation may require supervised exercise sessions during which exercise intensity can be directly observed and controlled.

Self-efficacy, or assessments about one's ability to carry out particular tasks, has been shown to play a central role in the adoption and maintenance of exercise. The relationship between exercise self-efficacy and socioeconomic status (SES), however, has not been formally developed or tested, and the implications of SES for exercise interventions are not known. We hypothesize pathways through which income, education, and occupation affect self-efficacy and capitalize on the availability of responses from 1944 older HMO enrollees to investigate the direct and indirect associations of SES indicators with exercise self-efficacy. Direct associations of age and education are found. Indirect associations of age, income, education, and occupation operate primarily through previous exercise experience, satisfaction with amount of walking, depression, and outcome expectations. The potentially modifiable nature of exercise outcome expectations (i.e., belief in the benefits of exercise) in combination with its strong association with exercise self-efficacy argue in support of greater consideration of its role in attempts to improve exercise self-efficacy.

The rate at which medical patients physician-referred to an 8-week stress reduction program completed the prescribed intervention was measured and predictors of compliance sought. Seven hundred eighty-four consecutive patients who enrolled in the program over a 2-year period were studied. Of these, 598 (76%) completed the program and 186 (24%) did not. Multiple regression analysis showed that (1) among chronic pain patients, only sex discriminated between completers and noncompleters, with females more than twice as likely to complete the program as males (odds ratio=2.4; 95% CI=1.2, 4.4); (2) among patients with stress-related disorders, only the OC scores of the SCL-90-R discriminated between completers and noncompleters (odds ratio=2.0; 95% CI=1.2, 3.4). Completion rates for specific diagnoses are reported and discussed. The high rate of completion observed for this intensive program in health behavior change is discussed in terms of the design features and therapeutic modalities of the intervention.

Reducing pre-hospital delay is crucial in reducing mortality from acute coronary syndrome (ACS). Patient’s causal beliefs and coping styles may affect symptom appraisal and help-seeking behavior. We examined whether patient’s beliefs about the causes of their ACS and denial of impact were associated with pre-hospital delay. Pre-hospital delay data were collected from 177 patients with ACS. Retrospective causal beliefs and cardiac denial of impact were assessed using questionnaires. Factor analysis of causal beliefs produced 3 factors; beliefs in stress and emotional state, behavioral and clinical risk factors, and in heredity as causal influences. Patients with strong beliefs that stress and emotional state caused their ACS were more likely to have long pre-hospital delays (>130 min). There were no significant associations between pre-hospital delay and the other two causal belief factors. Patients with greater denial scores were also more likely to have long delays than those with low scores. These effects were independent of age, gender, education, previous myocardial infarction, history of depression and negative affectivity. Cognitive and emotional factors including patient’s beliefs about causes and avoidant coping help to explain variations in pre-hospital delay.

Suppression of anger may be linked to heightened pain report and pain behavior during a subsequent painful event among chronic low back patients, but it is not clear whether these effects are partly accounted for by increased physiological reactivity during suppression. Chronic low back pain patients (N = 58) were assigned to Suppression or No Suppression conditions for a “cooperative” computer maze task during which a confederate harassed them. During baseline and maze task, patients’ lower paraspinal and trapezius muscle tension, blood pressure and heart rate were recorded. After the maze task, patients underwent a structured pain behavior task (behaviors were videotaped and coded). Results showed that: (a) Suppression condition patients revealed greater lower paraspinal muscle tension and systolic blood pressure (SBP) increases during maze task than No Suppression patients (previously published results showed that Suppression condition patients exhibited more pain behaviors than No Suppression patients); (b) residualized lower paraspinal and SBP change scores were related significantly to pain behaviors; (c) both lower paraspinal and SBP reactivity significantly mediated the relationship between Condition and frequency of pain behaviors. Results suggest that suppression-induced lower paraspinal muscle tension and SBP increases may link the actual suppression of anger during provocation to signs of clinically relevant pain among chronic low back pain patients.

A correlational study was conducted to identify attitudinal variables specified by the Health Belief Model that were related to frequency and total performance (frequency and proficiency) of breast self-examination (BSE). The probability sample consisted of 362 women, ages 35 and over, who were initially contacted via random digit dialing. Data were collected during in-home interviews by trained graduate assistants and by telephone interview 1 year later. Results supported the ability of past performance, perceived barriers, and knowledge to predict current total performance (combined frequency and proficiency). In addition, frequency for breast self-examination was predicted by past frequency, barriers, health motivation, control, being taught by a doctor, confidence, having BSE procedure checked, benefits, and susceptibility. Results lend support to use of attitudinal and experiential variables in predicting women's actual behaviors in relation to breast self-examination.

Meta-analysis revealed that in studies evaluating behavioral treatments for tension headaches, the treatment outcome has varied with the client samples (e.g., age, gender, referral source) that have been used but not with the treatment procedures (e.g., type of behavioral intervention, length of treatment, whether or not efforts were made to facilitate transfer of training) or the research designs (e.g., internal validity, explicitness of diagnostic criteria) that have been used. Mean client age proved the best predictor of treatment outcome, accounting for 30% of the outcome variance following behavior therapy. Significantly poorer outcomes have also been reported in recent studies than were reported in early studies. These findings suggest that (1) outcomes obtained with behavioral interventions have been less dependent upon the treatment variables that have been the primary focus of research attention than upon characteristics of client samples and (2) behavioral interventions may be less effective in reducing headache activity than has previously been assumed.