Health Psychology

Gawande, Richa; Smith, Lydia; Comeau, Alexandra; Creedon, Timothy B.; Wilson, Caitlyn L.; Griswold, Todd; Cook, Benjamin L.; Loucks, Eric B.; Schuman-Olivier, Zev

doi: 10.1037/hea0001303pmid: 37410421

Objective: To determine the effects of mindfulness training for primary care (MTPC), an integrated warm mindfulness training program, on emotion regulation and its relationship with health behavior change. Interventions that improve self-regulation, particularly emotion regulation, are needed for the self-management of comorbid chronic physical and mental illnesses. Mindfulness-based interventions (MBIs) may impact self-regulation and facilitate health behavior change. Method: A randomized controlled comparative effectiveness trial was conducted in a population of adult primary care patients to evaluate the impact of MTPC versus a low-dose mindfulness comparator (LDC) on self-reported difficulties in emotion regulation (DERS) total score and other assays of self-regulation at baseline, Weeks 8 and 24. Self-reported action plan initiation was reported between Weeks 8 and 10. Participants had diagnoses of anxiety, depression, or stress-related disorders. MTPC is an 8-week insurance-reimbursable warm MBI designed to cultivate mindfulness and self-compassion and to catalyze chronic illness self-management related health behavior change. Results: Compared to LDC, MTPC participants had statistically significant reductions in DERS total score at 8 weeks (d = −0.59, β = −12.98, 95% CI [−23.3 to −2.6]; p = .01) and 24 weeks (d = −0.61, β = −13.35, [−24.3, −2.4]; p = .02). Compared to 38% for LDC, 63% of MTPC participants successfully initiated their action plan within 3 weeks (OR = 2.87, [1.1, 7.9]; p = .04). Conclusions: This randomized controlled trial demonstrated MTPC enhanced emotion regulation and facilitated initiation of chronic illness self-management and health behavior change among primary care patients with anxiety, depression, and stress-related disorders, replicating previous reports.

Wetzel, Karen E.; Himmelstein, Mary S.

doi: 10.1037/hea0001324pmid: 37639227

Objective: Weight stigma (social devaluation because of weight) and weight bias internalization (self-stigma due to weight) have been independently implicated in maladaptive eating, which ultimately contributes to poor cardiometabolic health. Additionally, vigilance (being on the lookout for social devaluation) is connected to stress, poor sleep, and depression. Most research considers these factors separately but establishing how these variables interact with one another is essential to understanding their cumulative impact on health behaviors. Method: Using a diverse national panel of adults in the United States (N = 1,051), this study tested several statistical moderated mediations in which weight stigma was both directly associated with maladaptive eating and indirectly associated with maladaptive eating via vigilance. We simultaneously examined whether the relationship between weight stigma and vigilance was moderated by self-stigma. Results: Results indicated that experiencing weight stigma was directly related to each of the maladaptive eating behaviors (eating to cope, restrictive dieting frequency, and binge eating). Weight stigma was also indirectly related to each eating behavior through vigilance; this indirect relationship was stronger among those with high levels of weight bias internalization, compared to those with low levels of weight bias internalization. Race moderated the relationship between weight stigma and vigilance, such that participants identifying as Black had a stronger relationship between them. Conclusions: These results provide support for a theoretical model which explains how weight stigma, self-stigma, and vigilance interact with one another to produce negative health behaviors and highlight the importance of further investigation of vigilance in the context of weight stigma.

Chow, Cheryl H. T.; Yu, Christy; Yu, Wei; Yeung, Klement; Schmidt, Louis A.; Buckley, Norman

doi: 10.1037/hea0001293pmid: 37261750

Objective: Acute postsurgical pain (APSP), defined as pain within 3 months after surgery, is reported in most surgical pediatric patients, and a significant number of patients experience pain interfering with their daily life activities. We aimed to identify perioperative and psychosocial factors associated with APSP severity in pediatric patients undergoing surgery. Method: MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and CENTRAL were searched from database inception to October 2021. Studies that reported an association between risk or protective factors and acute pain in children were included. The primary outcome was the magnitude of association between identified factors and APSP, as measured by standardized effect sizes. Results: Thirty-eight studies (7,936 participants aged 1–18 years) were included. Meta-analysis of 12 studies (1,192 participants) revealed child preoperative pain, pain immediately after surgery, anticipated pain, temperament, pain catastrophizing, age, preoperative anxiety, parent pain catastrophizing, and parent preoperative anxiety were positively associated with APSP. Child pain coping efficacy was protective against APSP. We identified several modifiable child and parent psychosocial factors as predictors of APSP severity. Conclusion: Given the small degree of association between identified factors and postsurgical pain, there is value in pursuing other factors that may better explain the variability in pain. Recognizing patients at risk for moderate to severe APSP enables early implementation of interventions to minimize pain burden. Interventions to enhance coping, an adaptive characteristic, may also help to reduce APSP.

Hevel, Derek J.; Henshaw, Michelle; Endrighi, Romano; Adams, William G.; Heeren, Timothy; Jankowski, Alexis; Borrelli, Belinda

doi: 10.1037/hea0001308pmid: 37307330

Objective: Oral health self-efficacy is a modifiable determinant of early childhood caries, which is one of the most prevalent childhood diseases. Yet, two common measures of self-efficacy (i.e., context-specific and behavior-specific) lack validation and clarity in the prediction of children’s oral health behaviors. This study examined the psychometric properties of two caregiver oral health self-efficacy measures and investigated the predictive ability and age-varying effects of caregiver oral health self-efficacy on child oral health behaviors. Method: In this secondary data analysis of caregiver–child dyads (n = 754, Mchild age = 2.4, 56.2% Black or African American, 68.3% below poverty level), caregivers reported their oral health self-efficacy and their child’s tooth brushing frequency, diet, and sugar-sweetened beverage (SSB) consumption at baseline and 4, 12, and 24 months. Psychometrics were examined with confirmatory factor analyses (CFAs) and the predictive ability and age-varying effects of caregiver self-efficacy on child oral health behaviors were examined with time-varying effect models (TVEMs). Results: The context- and behavior-specific oral health self-efficacy CFA models indicated mixed model fit. In the predictive TVEM models, greater behavior-specific, but not context-, oral health self-efficacy predicted greater child tooth brushing across all ages. Greater context-specific oral health self-efficacy predicted healthier child diet throughout childhood, but greater behavior-specific self-efficacy only predicted healthier child diet in older children. Greater behavior-specific self-efficacy predicted lower SSB consumption throughout childhood while greater context-specific self-efficacy only predicted lower SSB consumption in younger children. Conclusions: Both caregiver oral health self-efficacy measures were psychometrically comparable and differentially predicted oral health behaviors across varying childhood ages.

Wang, Shoushi; Zhang, Chunyang; Xu, Wei

doi: 10.1037/hea0001315pmid: 37616101

Objectives: Due to the population aging, there is an urgent need to focus on how to help the oldest old (people age 80 years or older) to reach successful aging and improve their life quality. In this study, a longitudinal design spanning 1 year was used to explore the relationship between trait mindfulness and the physical and mental health of the oldest old and the mediating role of attitude toward one’s own aging (ATOA). Method: A total of 437 older adults from Jiangsu, China, participated in this study and completed questionnaires about trait mindfulness and ATOA at baseline, and their death, disability, negative affect (NA), and health-related quality of life (HRQoL) were collected after 1 year. Results: The results indicated that trait mindfulness in the oldest old was negatively associated with their mortality, disability rate, and NA and positively associated with individual HRQoL. The results of structural equation modeling analyses indicated that ATOA mediated the association of trait mindfulness with mortality, disability rate, anxiety, and three HRQoL subdimensions: role limitations because of emotional problems, vitality, and mental health. Conclusions: This study confirmed the positive longitudinal relationships between trait mindfulness and ATOA on physical health (especially mortality and disability rates), mental health, and emotional aspects of HRQoL in the oldest old population. The findings highlight the potential significance of promoting trait mindfulness and ATOA as interventions to enhance successful aging among the oldest old, which is of particular relevance in the context of the global trend of population aging.

Fosco, Gregory M.; Lee, Hyanghee; Feinberg, Mark E.; Fang, Shichen; Sloan, Carlie J.

doi: 10.1037/hea0001313pmid: 37561523

Objective: Health-protective behavior (HPB) adherence (wearing protective face masks, social distancing, and increased handwashing) plays a critical role in reducing infectious disease transmission; yet factors underlying HPB adherence are not well understood. Most research focuses on individual factors—beliefs about susceptibility, severity, and HPB efficacy; however, understanding parent and child HPB adherence may require a family conceptualization. This study evaluated whether family relations (cohesion, conflict, and chaos), as well as parent–child conflict regarding pandemic-specific circumstances (e.g., social distancing prohibitions about spending time with friends) account for parent and child HPB adherence, over and above parents’ individual concerns about COVID-19 risks. Method: This study utilized data reported by parents in 204 families with children (Mage = 4.2; 45% girls) collected on 16 occasions between May 2020 through April 2021. The impact of within-person (WP) and between-person (BP) effects of each family-level factor on parent and child HPB adherence was evaluated in a series of two-level multilevel models. Results: Over the course of the study, parent HPB adherence was generally stable and child HPB adherence declined early on but then leveled off. Results showed the protective effect of family cohesion for both parent and child HPB adherence at the WP and BP level. In addition, periods of higher COVID-19-related conflict corresponded to increases in parent and child HPB adherence. Conclusions: Intervention efforts should be directed at promoting family cohesion in order to promote sustained parent and child HPB adherence.