Health Psychology

Health Psychology special series on health disparities.
With the initiation of this new ongoing special series in Health Psychology on health disparities, we will publish articles that highlight ways in which health psychology can contribute to understanding and ameliorating these disparities. We welcome articles for this new special series and anticipate the submission of manuscripts across the full spectrum of topics related to health psychology and health disparities. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Family poverty is associated with cytomegalovirus antibody titers in U.S. Children.
Objective: Early life environmental and psychological influences are thought to play an important role in the development of the immune system. Antibody response to latent herpesviruses has been used as an indirect measure of cell-mediated immune function but has seldom been applied to younger age groups. Methods: We used data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES) to test for an association between family poverty and continuous antibody response to cytomegalovirus in U.S. children aged 6–16 (N = 2,226) using ordinary least squares regression. Results: Poverty was significantly associated with increased antibody levels among seropositive individuals. The association between income and antibody levels exhibited a threshold effect, with additional income beyond the poverty line not associated with increased antibody titers. This relationship was more robust among older compared with younger children. Conclusions: Early life social factors such as family poverty could have detrimental impacts on the developing immune system, with potentially important consequences for later life health outcomes. Exposure to socioeconomic stressors for longer periods during childhood may further enhance alterations in immune response to cytomegalovirus. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Social support and socioeconomic status interact to predict Epstein-Barr virus latency in women awaiting diagnosis or newly diagnosed with breast cancer.
Objective: Both higher socioeconomic status (SES) and supportive personal relationships confer health benefits, including better immune function. This study assessed the joint impact of SES and social support on the expression of a latent herpesvirus, Epstein-Barr virus (EBV), in a group of highly stressed women. Methods: Two-hundred and twenty four women either awaiting further evaluation following an abnormal mammogram or newly diagnosed with breast cancer completed questionnaires and provided blood samples to assess EBV viral capsid antigen (VCA) IgG antibody titers. Results: More highly educated women with more support from friends had lower EBV VCA antibody titers, reflecting a stronger cellular immune response to the latent virus; however, among less educated women, friend support was not associated with EBV antibody titers. As revealed in an ancillary analysis, more highly educated women with more friend support had lower systolic blood pressure (SBP); however, friend support was not associated with SBP among less educated women. Neither depression nor perceived stress mediated these associations. Neither cancer status nor cancer stage among those diagnosed with cancer was significantly related to these outcomes. Conclusion: Lower SES women may not reap the same immunological benefits from friend support when experiencing a stressful life event as their higher SES counterparts. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Impact of hepatitis B and C infection on health services utilization in homeless adults: A test of the Gelberg-Andersen behavioral model for vulnerable populations.
Objective: Homeless people have disproportionately high rates of viral hepatitis. The Gelberg-Andersen Behavioral Model for Vulnerable Populations (predisposing, enabling, and need variables) was expanded to predict prevalence and awareness of hepatitis B (HBV) or hepatitis C (HCV) infection, as well as health services utilization (HSU) among homeless adults using structural equation modeling. Design: A population-based sample of 534 homeless adults in Los Angeles' “Skid Row” was interviewed and tested for HBV and HCV. Main Outcome Measures: Main outcome measures included HBV/HCV seropositivity, awareness of seropositivity, and HSU in the previous 12 months. Results: Seropositivity (43%), usually unknown (72% of seropositives), was predicted by injection drug use, alcohol use, older age, and risky sexual behavior. No regular source of care, risky sexual behavior, less case management, and greater age predicted not knowing one's positive status. Health insurance, younger age, alcohol use, perceived bad health and more medical conditions predicted emergency room (ER) use; ER use was less likely among seropositives. Hospitalizations were predicted by more medical conditions and greater percentage of life homeless and were less frequent among African Americans and males. Ambulatory visits were predicted by a regular source of care, case management, more education and perceived bad health; they were less likely among seropositives. Conclusion: The Gelberg-Andersen Behavioral Model provided a useful guide for predicting HBV/HCV positivity as well as HSU in homeless adults. Most hepatitis-positives did not know their status and used health services less often than other homeless adults. More aggressive detection of hepatitis B and C among homeless adults is needed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Race and sexual behavior predict uptake of the human papillomavirus vaccine.
Objective: To identify predictors of human papillomavirus (HPV) vaccination initiation by girls at high risk for HPV infection. Method: Participants were 2,098 girls enrolled in the ongoing Pittsburgh Girls Study, who were between the ages of 12 and 15 years in 2008, and their primary caregivers. The study was conducted in the 2 years after the deployment of the first HPV vaccine approved by the U.S. Food and Drug Administration. Primary caregivers were asked about HPV vaccine uptake. Girls were interviewed about pubertal development and sexually intimate behavior. Results: Approximately 60% of the girls had initiated the HPV vaccine in the past year. Among the hypothesized predictors of initiation, African-American race decreased the likelihood and level of sexually intimate behavior in the previous year increased the likelihood of uptake. Controlling for receipt of public assistance, African-American girls were close to 40% less likely to be vaccinated than European-American girls. Conclusion: Racial disparities in use of preventive interventions such as the HPV vaccine exist. Lack of information about public financing of the vaccine, timing of vaccination relative to sexual activity, and perceptions of preventive value may limit uptake among those at highest risk for infection and negative sequelae from infection. Further research to probe knowledge and attitudes toward HPV vaccination and the impact of the media on vaccine initiation and uptake may reveal specific targets of intervention. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Exploratory analysis of the relationships among different methods of assessing adherence and glycemic control in youth with type 1 diabetes mellitus.
Objectives: The present study examined four methods of assessing diabetes adherence (self-report, diary measure, electronic monitoring, and provider rating) within a population of youth with Type I Diabetes Mellitus (T1DM). Methods: Comparisons were conducted among the four methods of assessing diabetes adherence. Associations among the seven different measures of blood glucose monitoring (BGM) and HbA1c were examined. An exploratory stepwise regression analysis was conducted to determine the best predictors of glycemic control (i.e., Hemoglobin A1c; HbA1c) while controlling for relevant demographic variables. Results: The adherence measures appeared to be interrelated. The relationships between many of the BGM measures and HbA1c demonstrated a medium effect size. The Self Care Inventory (SCI) adjusted global score was the strongest predictor of HbA1c, even after taking the demographic variables into account. Conclusions: The SCI is a robust, easy-to-use, and cost-efficient measure of adherence that has a strong relationship to HbA1c. Demographic variables are important to examine within the context of different methods of assessing adherence. The research methodology utilized to assess both general diabetes adherence and more specific behavioral measurements of BGM should be clearly documented in future studies to ensure accurate interpretation of results. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Using mobile phones to measure adolescent diabetes adherence.
Objectives: 1) describe and determine the feasibility of using cell-phone–based ecological momentary assessment (EMA) to measure blood glucose monitoring and insulin administration in adolescent Type 1 diabetes, 2) relate EMA to traditional self-report and glycemic control, and 3) identify patterns of adherence by time of day and over time using EMA. Method: Adolescents with Type 1 diabetes (n = 96) completed baseline measures of cell phone use and adherence. Glycemic control (measured by levels of HbA1c) was obtained from medical records. A subgroup of adolescents (n = 50) completed 10 days of EMA to assess blood glucose monitoring frequency, timing of glucose monitoring, insulin administration, and insulin dosing. One third of adolescents were not allowed to use their cell phones for diabetes at school. Parental restrictions on cell phone use at home were not prevalent. Results: The EMA response rate (59%) remained stable over the 10-day calling period. Morning time was associated with worse monitoring and insulin administration, accounting for 59–74% of missed self-care tasks. EMA-reported missed glucose checks and missed insulin doses were correlated to traditional self-report data, but not to HbA1c levels. Trajectory analyses identified two subgroups: one with consistently adequate adherence, and one with more variable, and worse, adherence. The latter adherence style showed worse glycemic control. Conclusion: Mobile phones provide a feasible method to measure glucose monitoring and insulin administration in adolescents, given a limited assessment duration. The method provided novel insights regarding patterns of adherence and should be explored in clinical settings for targeting or tailoring interventions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Effects of acculturation on a culturally adapted diabetes intervention for Latinas.
Objective: To inform the refinement of a culturally adapted diabetes intervention, we evaluated acculturation's association with variables at several sequential steps: baseline measures of diet and physical activity, intervention engagement, putative mediators (problem solving and social resources), and outcomes (fat consumption and physical activity). Method: Latina women (N = 280) recruited from health organizations were randomly assigned to a culturally adapted lifestyle intervention (¡Viva Bien!) or usual care. A brief version of the Acculturation Rating Scale for Mexican Americans—II (ARSMA–II) acculturation scales (Anglo and Latina orientations) was administered at baseline. Assessments at baseline, 6 months, and 12 months included social supportive resources for diet and exercise, problem solving, saturated fat consumption, and physical activity. Results: Latina orientation was negatively related to saturated fat intake and physical activity at baseline. Latina orientation also was positively related to session attendance during Months 6–12 of the intervention. Independent of 6-month intervention effects, Anglo orientation was significantly positively related to improvements in problem solving and dietary supportive resources. Anglo orientation related negatively to improved physical activity at 6 and 12 months. There were no Acculturation × Intervention interactions on putative mediators or outcomes. Conclusion: The cultural adaptation process was successful in creating an engaging and effective intervention for Latinas at all levels of acculturation. However, independent of intervention effects, acculturation was related to putative mediating variables (problem solving and social resources) and an outcome variable (physical activity), an indication of acculturation's general influence on lifestyle and coping factors. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Marriage and long-term survival after coronary artery bypass grafting.
Objective: To examine the effects of marital status and marital satisfaction on survival after coronary artery bypass grafting (CABG). Methods: Participants were 225 people who had CABG between 1987 and 1990. Marital status at the time of surgery and marital satisfaction 1 year after surgery were used to predict survival 15 years after surgery. Results: Married people were 2.5 times (p <.001) more likely to be alive 15 years after CABG than those who were not married. This finding was true for men and women, although the result for women was marginally significant adjusting for age. Those in high-satisfaction marriages were 3.2 times (p <.003) more likely to be alive 15 years after CABG compared with those reporting low marital satisfaction. Highly satisfied men were 2.7 times (p <.03) and highly satisfied women were 3.9 times (p <.15) more likely to be alive adjusting for age. Although the result was not significant for women, the effect size for marital satisfaction was actually larger for women than for men. Conclusions: Being married, especially being in a highly satisfying marriage, offered a significant benefit to long-term survival after CABG. Why marital status and marital satisfaction have this effect on survival is surely mulitfactorial, most likely a combination of spousal support and survivor motivation to adopt a healthy lifestyle, along with the provision of emotional support to the survivor, which all could have the effect of modulating the physiologic mechanisms responsible for slowing the advancement of CVD. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The mediating role of partner communication frequency on condom use among African American adolescent females participating in an HIV prevention intervention.
Objective: Although effective HIV prevention interventions have been developed for adolescents, few interventions have explored whether components of the intervention are responsible for the observed changes in behaviors postintervention. This study examined the mediating role of partner communication frequency on African American adolescent females' condom use postparticipation in a demonstrated efficacious HIV risk-reduction intervention. Methods: As part of a randomized controlled trial, African American adolescent females (N = 715), 15–21 years, seeking sexual health services, completed a computerized interview at baseline (prior to intervention) and again 6 and 12 months follow-up post-intervention participation. The interview assessed adolescents' sexual behavior and partner communication skills, among other variables, at each time point. Using generalized estimating equation (GEE) techniques, both logistic and linear regression models were employed to test mediation over the 12-month follow-up period. Additional tests were conducted to assess the significance of the mediated models. Results: Mediation analyses observed that partner communication frequency was a significant partial mediator of both proportion of condom-protected sex acts (p = .001) and consistent condom use (p = .001). Conclusion: Partner communication frequency, an integral component of this HIV intervention, significantly increased as a function of participating in the intervention, partially explaining the change in condom use observed 12 months postintervention. Understanding what intervention components are associated with behavior change is important for future intervention development. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Interdependent psychological quality of life in dyads adjusting to prostate cancer.
Objective: Prostate cancer negatively influences quality of life (QOL) in survivors and the people with whom they are close. The purpose of this investigation was to assess the degree of dyadic interdependence in psychological QOL in dyads adjusting to prostate cancer and its treatment. Method: Participants were 70 prostate cancer survivors and their partners, most of whom were spouses. Assessments of psychological QOL (i.e., depression, anxiety, fatigue, and positive affect) were made at three points in time, each separated by 8 weeks. Results: Survivors' prostate specific function was associated with both their own and their partners' psychological QOL. There was evidence of longitudinal dyadic interdependence for psychological QOL, particularly from partners to survivors between the T2 and T3 assessments. Conclusions: Prostate cancer survivors' psychological QOL is affected substantially by their partners' psychological QOL, consistent with theories of emotional contagion. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A longitudinal investigation of marital adjustment as a risk factor for metabolic syndrome.
Objective: Metabolic syndrome (MetS) is a constellation of features—central obesity, dyslipidemia, elevated blood pressure, and dysglycemia—that are associated with increased risk for cardiovascular disease, diabetes, stroke, and mortality. This longitudinal study was conducted to evaluate whether marital adjustment, which has been shown to predict a variety of health outcomes, increases risk for incidence of MetS. Methods: A population-based English sample of couples (N = 216 couples) completed a self-report measure of marital adjustment at baseline and nurse visits that included collection of blood pressure, blood samples, and anthropometric measures at baseline and 4-year follow-up. Multilevel modeling was used to evaluate the association between both partners' report of baseline marital adjustment and incidence of MetS, controlling for other baseline risk factors (demographics, current and previous smoking status, alcohol use, activity level, depressive symptoms, number of MetS criteria). Results: Gender moderated the association between marital adjustment and incidence of MetS. Follow-up analyses indicated that husbands' report of marital adjustment at baseline was significantly associated with incident MetS for wives at follow-up, controlling for baseline risk factors. Marital adjustment was not significantly associated with incident MetS for men. Conclusions: Findings suggest that MetS may be one mechanism by which poor marital adjustment increases risk for poor health outcomes in women. Improving marital adjustment may help prevent the incidence of MetS and improve health, particularly for women. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Motives for volunteering are associated with mortality risk in older adults.
Objective: The purpose of this study is to examine the effects of motives for volunteering on respondents' mortality risk 4 years later. Methods: Logistic regression analysis was used to examine whether motives for volunteering predicted later mortality risk, above and beyond volunteering itself, in older adults from the Wisconsin Longitudinal Study. Covariates included age, gender, socioeconomic variables, physical, mental, and cognitive health, health risk behaviors, personality traits, received social support, and actual volunteering behavior. Results: Replicating prior work, respondents who volunteered were at lower risk for mortality 4 years later, especially those who volunteered more regularly and frequently. However, volunteering behavior was not always beneficially related to mortality risk: Those who volunteered for self-oriented reasons had a mortality risk similar to nonvolunteers. Those who volunteered for other-oriented reasons had a decreased mortality risk, even in adjusted models. Conclusions: This study adds to the existing literature on the powerful effects of social interactions on health and is the first study to our knowledge to examine the effect of motives on volunteers' subsequent mortality. Volunteers live longer than nonvolunteers, but this is only true if they volunteer for other-oriented reasons. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Can self-prediction overcome barriers to Hepatitis B vaccination? A randomized controlled trial.
Objective: Hepatitis B virus (HBV) infection remains a serious public health problem, due in part to low vaccination rates among high-risk adults, many of whom decline vaccination because of barriers such as perceived inconvenience or discomfort. This study evaluates the efficacy of a self-prediction intervention to increase HBV vaccination rates among high-risk adults. Method: Randomized controlled trial of 1,175 adults recruited from three sexually transmitted disease clinics in the United States over 28 months. Participants completed an audio-computer-assisted self-interview, which presented information about HBV infection and vaccination, and measured relevant beliefs, behaviors, and demographics. Half of participants were assigned randomly to a “self-prediction” intervention, asking them to predict their future acceptance of HBV vaccination. The main outcome measure was subsequent vaccination behavior. Other measures included perceived barriers to HBV vaccination, measured prior to the intervention. Results: There was a significant interaction between the intervention and vaccination barriers, indicating the effect of the intervention differed depending on perceived vaccination barriers. Among high-barriers patients, the intervention significantly increased vaccination acceptance. Among low-barriers patients, the intervention did not influence vaccination acceptance. Conclusions: The self-prediction intervention significantly increased vaccination acceptance among “high-barriers” patients, who typically have very low vaccination rates. This brief intervention could be a useful tool in increasing vaccine uptake among high-barriers patients. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Risk perception measures' associations with behavior intentions, affect, and cognition following colon cancer screening messages.
Objective: Risk perception is important for motivating health behavior (e.g., Janz & Becker, 1984), but different measures of the construct may change how important that relationship appears. In two studies, we examined associations between four measures of risk perception, health behavior intentions and possible behavioral determinants. Methods: Participants in these studies, who were due for colorectal cancer screening, read an online message about the importance of screening to reduce the chance of cancer. We examined bivariate and multivariate associations between risk perception measures, including absolute, comparative, and feelings-of-risk, and behavioral intentions to screen, general worry, and knowledge and attitudes related to screening. Results: Results across the two studies were consistent, with all risk perception measures being correlated with intentions and attitudes. Multivariate analyses revealed that feelings-of-risk was most predictive of all variables, with the exception of general worry, for which comparative measures were the most predictive. Conclusions: Researchers interested in risk perception should assess feelings-of-risk along with more traditional measures. Those interested in influencing health behavior specifically should attempt to increase feelings of vulnerability rather than numerical risk. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Perceived risk as a moderator of the effectiveness of framed HIV-test promotion messages among women: A randomized controlled trial.
Objective: Researchers argue that gain-framed messages should be more effective for prevention behaviors, while loss frames should be more effective for detection behaviors (Rothman & Salovey, 1997). Evidence for this taxonomy has been mixed. This study examines whether the effects of gain- and loss-framed messages on HIV-testing intentions is moderated by perceived risk of a positive result. Method: This experiment was conducted online and utilized a single factor (frame: gain/loss) between subjects design, with a separate HIV-test promotion control and a no message control to examine whether perceived risk of a positive test result moderates the effects of framed messages on intentions to seek an HIV test in the next 3 months. The sample (N = 1052; M age = 22, SD = 2.22), recruited through Survey Sampling International, included 51% Black women (49% White women). Results: HIV-test promotion messages were more effective than no message, but there were no other main effects for condition. Results also demonstrated a significant interaction between message frame and perceived risk, which is mediated through elaborative processing of the message. The interaction demonstrated an advantage for the loss-framed message among women with some perceived risk and an advantage for the gain-framed message among women with low perceived risk. Conclusion: Results imply that the prevention/detection function of the behavior may be an inadequate distinction in the consideration of the effectiveness of framed messages promoting HIV testing. Rather, this study demonstrates that risk perceptions are an important moderator of framing effects. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Valued life activities and readiness to quit smoking among mobility-impaired smokers.
Objective: People with physical disabilities smoke at a higher rate than their nondisabled peers, with rates as high as 28–40% among nonelderly adults. One possible explanation for these findings is that restriction of valued life activities (social, professional, pleasurable or otherwise meaningful) due to mobility impairment interferes with smoking cessation. Methods: Forty-seven smokers (48.9% female; Mage = 48.91) with chronic mobility impairments (i.e., regularly use equipment to ambulate) were interviewed over the telephone. We assessed demographics, self-efficacy to quit smoking, stage of change, current engagement in valued activities, current restriction of valued activities due to physical limitations, and efforts to replace restricted valued activities in a cross sectional design. Results: Bivariate results indicate that 74% of those in the preparation stage had satisfactory replacements for their most valued restricted activity, whereas only 27% in the contemplation stage and 17% in the precontemplation stage had such satisfactory replacements. Multinomial ordinal regression analyses revealed that (a) having satisfactory replacements for activities restricted due to physical disability was significantly associated with higher stage of change and (b) more current valued activities and, to a lesser extent, fewer restricted activities were significantly associated with higher levels of self-efficacy to quit smoking. Conclusions: These results support the need for the development of treatments for smoking cessation that aim to increase engagement in valued activities, such as behavioral activation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The CHOICE study: A “taste-test” of utilitarian vs. leisure walking among older adults.
Objective: Utilitarian walking (e.g., walking for transport) and leisure walking (e.g., walking for health/recreation) are encouraged to promote health, yet few studies have explored specific preferences for these two forms of physical activity or factors that impact such preferences. A quasi-experimental crossover design was used to evaluate how training underactive midlife and older adults in each type of walking impacted total steps taken and how it was linked to their subsequent choice of walking types. Methods: Participants (N = 16) were midlife and older adults (M age = 64 ± 8 years) who were mostly women (81%) and white (75%). To control for order effects, participants were randomized to instruction in either utilitarian or leisure walking for 2 weeks and then the other type for 2 weeks. Participants then entered a 2-week “free choice” phase in which they chose any mixture of the walking types. Outcome variables included walking via OMRON pedometer and the ratio of utilitarian versus leisure walking during the free-choice phase. Participants completed surveys about their neighborhood (NEWS) and daily travel to multiple locations. Results: Instruction in leisure-only, utilitarian-only, and a freely chosen mixture of the two each resulted in significant increases in steps taken relative to baseline (ps <0.05). Having to go to multiple locations daily and traveling greater distances to locations were associated with engagement in more utilitarian walking. In contrast, good walking paths, neighborhood aesthetics, easy access to exercise facilities, and perceiving easier access to neighborhood services were associated with more leisure walking. Conclusions: Results from this pilot study suggest that midlife and older adults may most easily meet guidelines through either leisure only or a mixture of leisure and utilitarian walking, and tailored suggestions based on the person's neighborhood may be useful. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Daily stress and cortisol patterns in parents of adult children with a serious mental illness.
Objective: The goal of the current study was to examine whether parenting an adult child with a serious mental illness (SMI) has a physiological impact on parents. Method: Multiple samples of saliva were collected on 4 days from 61 parents (mean age = 60.07 years, SD = 10.01) of individuals with a SMI (bipolar disorder, schizophrenia, and major depression; mean age = 32.46 years, SD = 10.57) and a comparison group of 321 parents (mean age = 58.09 years, SD = 12.88) of individuals without a SMI (mean age = 32.36; SD = 13.87). Saliva samples were assayed for the hormone cortisol and group differences in diurnal cortisol patterns and their association with daily stress severity were explored. Results: On days after elevated stress, a hypoactivation pattern of diurnal cortisol suggestive of chronic stress was evident for parents of individuals with a SMI. After more stressful days, cortisol levels increased less from waking to 30 min after waking and declined less from 30 min after waking to bedtime for parents of individuals with a SMI. Conclusions: The results of the current study add to a growing body of evidence that the long-term effects of parenting an adult with a disability has a biological impact on aging parents and support the need for family interventions across adulthood and into old age for parents of individuals with SMI. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Health Psychology - Vol 31, Iss 1