Daily Health Behaviors Research Articles

Anxiety and Depression Predict the Paths Through Which Rumination Acts on Behavior: A Daily Diary Study

Introduction: Rumination—thinking passively, negatively, and repetitively—is a common cognitive process that is associated with poor health behaviors. Rumination impacts health behaviors through two distinct behavioral pathways: acting too quickly (impulsivity) or not acting at all (amotivation), though no research to date has examined the conditions under which rumination may manifest in these two disparate behavioral paths. The presence of anxiety and depression may lead to the behavioral manifestations of rumination, which may then differentially impact health behavior patterns. In this study, we tested whether individuals reporting anxiety who ruminate will then act impulsively and individuals reporting depression who ruminate will then not act in the context of their daily health behaviors. Methods: We recruited 285 college students (mean age = 19.3; 76.8% female; 79.4% Caucasian) and had them complete a baseline survey and an 11-day online daily diary to assess associations among anxiety, depression, rumination, and health behaviors. Results: Rumination predicted health behaviors through both impulsivity and amotivation as expected. Moderation models revealed that rumination in the context of anxiety leads to impulsivity and rumination in the context of depression leads to amotivation. Limitations: The undergraduate sample limits the generalizability of this data. Discussion: These results show that those who report depression or anxiety are likely to experience more daily rumination and the deleterious behavioral manifestations of that rumination, which then affects health behavior engagement or avoidance. Future behavioral health interventions can perhaps specifically target impulsivity among individuals reporting anxiety and amotivation among individuals reporting depression in order to promote more healthy behaviors.

Development of a Lifelogs-Based Daily Wellness Score to Advance a Smart Wellness Service

Smart wellness services collect various types of lifelog data, such as the number of steps taken and sleep duration, via smart devices. However, most existing smart wellness services simply display each individual lifelog to users, limiting their ability to support overall user understanding. In this article, the authors develop a lifelogs-based daily wellness score (LDWS) to resolve such limitations by combining various lifelog data to calculate a score that represents overall daily health behaviors. LDWS was developed as part of a smart wellness service for college students in collaboration with an IT company. Lifelog data of 41 college students were collected through a four-week trial and were subsequently fitted to a random effects model. Based on the model estimates, LDWS was determined by linearly aggregating seven behavior variables. The utility of the developed LDWS was validated through a second trial of the service. The authors also discuss other potential uses of LDWS and the factors to be considered for developing a lifelogs-based wellness score for a smart wellness service.

Independent and relative effects of stress, depressive symptoms, and affect on college students' daily health behaviors.

Stress and depressive symptoms are associated with maladaptive health behavior practices such as unhealthy eating, sedentary behavior, insufficient sleep, and substance use. The relative and interactive effects of stress and depressive symptoms on health behavior practices are less well understood. The present study examined these processes in a daily diary study of 127 college students. Results from hierarchical generalized linear models indicated that depressive symptoms, and chronic and daily stress, but not acute stressful life events, were significantly associated with a composite score of daily maladaptive health behavior engagement (depressive symptomsb=.01, SE= .00, p < .01; chronic stress, b = .03, SE= .01, p < .01; daily stress, b = .01, SE= .01, p = .02); unexpectedly, the effect of stress on health behaviors was not moderated by depressive symptoms. Additionally, results demonstrated that the effect of depressive symptoms on health behaviors was mediated by fluctuations in daily negative affect. These results bear implications for intervention during a crucial period in the development of mental and physical health.

Considering high alcohol and violence neighborhood context using daily diaries and GPS: A pilot study among people living with HIV

Our understanding of how community-level context impacts care of persons living with HIV (PLWH), including antiretroviral therapy (ART) adherence and retention in care, is limited. The objective of this study was to characterize the activity spaces of PLWH from an urban area in Southeastern U.S., where the epidemic is among the nation’s highest, and to examine how such activity spaces are associated with daily mood and health behaviors. In this small, pilot study, 11 participants were tracked with a global positioning system (GPS)-enabled application on their smartphones for 2 weeks. Activity spaces were created by connecting GPS points sequentially and adding buffers. Contextual exposure data (e.g., alcohol outlets) were connected to activity spaces. Participants also completed daily diary entry through texts 3 times per day regarding outcomes of substance use behaviors, mood, and medication adherence. This yielded a total of 18,007 GPS polyline records that we aggregated into 258 person-days that captured discrete occasions of exposure to contextual factors and subjects’ behaviors and moods. On average, the participants spent 19% of their time awake during the 2-week periods in their residential census tract. Exposure to social and built environment factors such as alcohol outlets was greater when participants were outside versus inside their residential census tract. Exposures on daily routes were also significantly associated with ART adherence, alcohol consumption, and mood. Findings suggest substantial differences between activity spaces and residential contexts. Activity spaces are relevant for PLWH and may impact HIV care and behavioral outcomes such as ART adherence and substance use.

Estimating the Risk of Influenza-Like Illness Transmission Through Social Contacts: Web-Based Participatory Cohort Study.

BackgroundEpidemiological studies on influenza have focused mostly on enhancing vaccination coverage or promoting personal hygiene behavior. Few studies have investigated potential effects of personal health behaviors and social contacts on the risk of getting influenza-like illness (ILI).ObjectiveTaking advantage of an online participatory cohort, this study aimed to estimate the increased risk of getting ILI after contact with infected persons and examine how personal health behaviors, weather, and air pollution affect the probability of getting ILI.MethodsA Web-based platform was designed for participants to record daily health behaviors and social contacts during the influenza season of October 1, 2015 to March 31, 2016, in Taiwan. Data on sleep, diet, physical activity, self-reported ILI, and contact with infected persons were retrieved from the diaries. Measurements of weather and air pollutants were used for calculating environmental exposure levels for the participants. We fitted a mixed-effects logistic regression model to the daily measurements of the diary keepers to estimate the effects of these variables on the risk of getting ILI.ResultsDuring the influenza season, 160 participants provided 14,317 health diaries and recorded 124,222 face-to-face contacts. The model estimated odds ratio of getting ILI was 1.87 (95% CI 1.40-2.50) when a person had contact with others having ILI in the previous 3 days. Longer duration of physical exercise and eating more fruits, beans, and dairy products were associated with lower risk of getting ILI. However, staying up late was linked to an elevated risk of getting ILI. Higher variation of ambient temperature and worse air quality were associated with increased risk of developing ILI.ConclusionsDeveloping a healthier lifestyle, avoiding contact with persons having ILI symptoms, and staying alert with respect to temperature changes and air quality can reduce the risk of getting ILI.

MHealth Technology and Nurse Health Coaching to Improve Health in Diabetes: Protocol for a Randomized Controlled Trial.

BackgroundChronic diseases, including diabetes mellitus, are the leading cause of mortality and disability in the United States. Current solutions focus primarily on diagnosis and pharmacological treatment, yet there is increasing evidence that patient-centered models of care are more successful in improving and addressing chronic disease outcomes.ObjectiveThe objective of this clinical trial is to evaluate the impact of a mobile health (mHealth) enabled nurse health coaching intervention on self-efficacy among adults with type-2 diabetes mellitus.MethodsA randomized controlled trial was conducted at an academic health system in Northern California. A total of 300 participants with type-2 diabetes were scheduled to be enrolled through three primary care clinics. Participants were randomized to either usual care or intervention. All participants received training on use of the health system patient portal. Participants in the intervention arm received six scheduled health-coaching telephone calls with a registered nurse and were provided with an activity tracker and mobile application that integrated data into the electronic health record (EHR) to track their daily activity and health behavior decisions. All participants completed a baseline survey and follow-up surveys at 3 and 9 months. Primary and secondary outcomes include diabetes self-efficacy, hemoglobin A1c (HbA1c), and quality of life measures.ResultsData collection for this trial, funded by the Patient-Centered Outcomes Research Institute, will be completed by December 2017. Results from the trial will be available mid-2018.ConclusionsThis protocol details a patient-centered intervention using nurse health coaching, mHealth technologies, and integration of patient-generated data into the EHR. The aim of the intervention is to enhance self-efficacy and health outcomes by providing participants with a mechanism to track daily activity by offering coaching support to set reasonable and attainable health goals, and by creating a complete feedback loop by bringing patient-generated data into the EHR.Trial RegistrationClinicalTrials.gov NCT02672176; https://clinicaltrials.gov/ct2/show/NCT02672176 (Archived by WebCite at http://www.webcitation.org/6xEQXe1M5)

The effectiveness of a pay for performance incentive program on the comprehensive management in patients with type 2 diabetes

Objective To evaluated the effectiveness and influence of a pay for performance incentive program on the comprehensive management in patients with type 2 diabetes. Methods The large-sample prospective study recruited 1 359 eligible adult patients who were residents and had health record from three community health centers of Shanghai Jiading District. The method of randomized complete block design was used to classify the subjects into 4 groups. The physicians incentive group included 337 subjects, while the patients incentive group 338 subjects, the physicians and patients incentive group 331 subjects, the control group which the physicians and the patients would not have the incentive 353 subjects respectively. We established a cooperative pathway between community health care centers and general hospital, trained community health workers, equipped with the necessary clinical drugs, and finally, the Advance System for Diabetes Management system was used to carry out the tele-medicine. The type 2 diabetes mellitus patients, which were set goal in blood glucose and blood pressure control, managed by the general practitioners, the daily health behavior of the patients were regulated. All subjects in the patients incentive groups received the incentives if they can obtain or/and maintain the ideal level of HbA1C during the 2-years study period. The control group would not receive any incentives but would be provided with diabetes education booklet and group educational courses for diabetes mellitus control as usual. Results After 12 months and 24 months, HbA1C, systolic blood pressure, diastolic blood pressure, total cholesterol, fasting blood glucose in the four groups were all lower than baseline levels (P<0.05), while the time of related exercise parameters and the rate of HbA1C achieving target in the study groups were higher than baseline (P<0.05). Besides, the time of related exercise, time of moderate exercise intensity, time of strenuous exercise intensity, and the rate of HbA1C achieving target (after 24 months: 49.0%, 53.2%, 51.8%, 54.4%, P<0.05) had statistical significance among the physicians incentive, the patients incentive, the physicians and patients incentive, and the control groups. Logistic regression analysis showed that the duration of diabetes, the baseline HbA1C, whether using the insulin, taking hypoglycemic drugs are the main factors of the study with statistical significance (all P<0.05). Conclusions Based on general practitioners-specialist cooperation tele-medicine, by regulating the daily health behavior and using the intervention of pay for performance, the new diabetes care model could improve the treatment effect of type 2 diabetes to some extent, especially the exercise time and its intensity. Besides, the duration of diabetes, the baseline of HbA1C, the using of insulin and hypoglycemic drugs turned out to be the main factors of the study. (Chin J Endocrinol Metab, 2017, 33: 1017-1023) Key words: Diabetes mellitus, type 2; Pay for performance; General practitioners-specialist cooperation; Influencing factor

Everyday stress response targets in the science of behavior change

Stress is an established risk factor for negative health outcomes, and responses to everyday stress can interfere with health behaviors such as exercise and sleep. In accordance with the Science of Behavior Change (SOBC) program, we apply an experimental medicine approach to identifying stress response targets, developing stress response assays, intervening upon these targets, and testing intervention effectiveness. We evaluate an ecologically valid, within-person approach to measuring the deleterious effects of everyday stress on physical activity and sleep patterns, examining multiple stress response components (i.e., stress reactivity, stress recovery, and stress pile-up) as indexed by two key response indicators (negative affect and perseverative cognition). Our everyday stress response assay thus measures multiple malleable stress response targets that putatively shape daily health behaviors (physical activity and sleep). We hypothesize that larger reactivity, incomplete recovery, and more frequent stress responses (pile-up) will negatively impact health behavior enactment in daily life. We will identify stress-related reactivity, recovery, and response in the indicators using coordinated analyses across multiple naturalistic studies. These results are the basis for developing a new stress assay and replicating the initial findings in a new sample. This approach will advance our understanding of how specific aspects of everyday stress responses influence health behaviors, and can be used to develop and test an innovative ambulatory intervention for stress reduction in daily life to enhance health behaviors.

Health behavior tracking via mobile games: A case study among school-aged children

AbstractMobile devices are increasingly being used, in various ways, to collect data and are also increasingly related to individuals’ health behaviors. Because of the paucity of available data about the process of mobile data collection in tracking daily health behaviors among children, we designed this pilot study to determine the possibilities and the enhancing and inhibiting factors of a continuous data collection process using a mobile game. Twenty 10–12-year-old school children from two schools participated in the study. We asked the participants to play a game that recorded their health-related behaviors for seven consecutive days, answering 14–16 questions daily. The questions related to children’s eating habits, hygiene habits, hobbies and activities, networks, media use and devices, and sleep. In this article, we describe and discuss the process of data collection with its advances and challenges, including the planning and preparation of the survey according to its content and technicalities, t...

Is work keeping us from acting healthy? How workplace barriers and facilitators impact nutrition and exercise behaviors.

The purpose of this study was to identify common barriers and facilitators to healthy nutrition and exercise behaviors in the workplace and examine their relationships to those actual daily health behaviors. We utilized a concurrent embedded mixed methods approach to collect data from 93 participants over the span of four days. Participants reported 2.80 nutrition and 3.28 exercise barriers on average over the 4days, while reporting 2.93 nutrition and 1.98 exercise facilitators in the same timeframe. Results indicated that workload and temptations around the office prevented nutritious eating; exercise behaviors were frequently hindered by workload. The most commonly mentioned eating facilitator was proper planning, while having time to exercise facilitated physical activity. Furthermore, the number of barriers reported negatively related to their respective health behaviors (i.e., more nutrition barriers translated to poorer nutrition habits) and facilitators were positively related to them, both overall and more so on the specific day they were reported. The implications of these finding show the importance of barriers/facilitators in the workplace and aid in the creation of more targeted health promotion that could increase positive employee health behaviors by eliminating common barriers and enhancing facilitators.

Establishment and effects evaluation of extended care plan for stroke patients

Objective To investigate the application effects of extended care plan in patients with stroke based on evidence-based nursing. Methods A total of 130 patients who met inclusion criteria were selected and received matched groups. The patients of observation group were given the implementation of evidence-based extended nursing plan, while the patients of control group were provided telephone follow-up 1 month after discharge. We compared differences in the ability of daily life (Barthel index) and health behavior (HPLP Ⅱ) between two groups at the patients discharged from hospital 1 month, 3 months, 6 months and 12 months. Results Compared between two groups at patients discharged from hospital 3 months, 6 months and 12 months, the differences of Barthel index score were statistically significant (Ftime=13.389, P<0.05; Fgroup=19.352, P<0.05; Ftime*group=3.416, P<0.05); patients discharged from hospital after 3 months, 6 months and 12 months, the differences of HPLP Ⅱ score were statistically significant between two groups (Ftime=12.187, P<0.05; Fgroup=36.512, P<0.01; Ftime*group=6.692, P<0.01); 3 months, 6 months and 12 months after discharge, the incidences of recurrence were 3.33%, 10.00%, 18.33% in observation group while they were 3.57%, 17.85%, 33.93% in the control group (P<0.01). Conclusions Taking the evidence-based nursing method to develop scientific and normative extended care plan can improve the ability of stroke patients′ daily life and health behavior and reduce the recurrence, which is worth of clinical practice recommendations. Key words: Stroke; Extended care; Evidence-based Nursing

Capsule Commentary on Raghavan et al., Incident Type 2 Diabetes Risk is Influenced by Obesity and Diabetes in Social Contacts: A Social Network Analysis.

S ocial relationships are established correlates of health behavior, physical and mental health, and mortality. In this issue of JGIM, Raghavan et al. report an association between having a social contact with diabetes or with obesity and incident type 2 diabetes mellitus during 37 years of follow-up of a subgroup from the Framingham Offspring Study. The study includes baseline and follow-up data from 4797 participants and 692 incident type 2 diabetes cases. A strength of this study is the ability to test the temporal association between the independent variable and the outcome variable at multiple times. While studies have shown that obesity and type 2 diabetes clusters in social networks, the current study uses longitudinal data to delineate associations between specific types of social contacts and incident type 2 diabetes. The main finding was that incident diabetes in Framingham participants was associated with diabetes (but not obesity) in participants’ siblings and obesity (but not diabetes) in participants’ spouses. Their finding that the association differed depending on whether the social contact was a spouse or a sibling generates hypotheses about how behaviors may spread over time and influence type 2 diabetes risk. For example, a spouse may facilitate or inhibit daily health behaviors that influence diabetes risk, whereas siblings share genetic risk and early life exposures. This study raises an important question, BWhere do we begin to engage social relationships in type 2 diabetes prevention?^ For clinicians, this study reaffirms the importance of asking patients about health risks of spouses, siblings and others who may be important. This information may help identify patients at particularly high risk and lead to discussions about who influences the patient’s health behaviors. It remains unknown, however, if interventions that leverage social ties can improve health. Research is needed to identify the mechanistic links between social relationships and health outcomes and to answer key questions including: who in a person’s social network is most influential for behavior change; how do contextual factors affect the influence of social relationships on health; and how is social influence transmitted? For now, social relationships remain an untapped resource for improving health.

Completeness and Reliability of Location Data Collected on the Web: Assessing the Quality of Self-Reported Locations in an Internet Sample of Men Who Have Sex With Men.

BackgroundPlace is critical to our understanding of human immunodeficiency virus (HIV) infections among men who have sex with men (MSM) in the United States. However, within the scientific literature, place is almost always represented by residential location, suggesting a fundamental assumption of equivalency between neighborhood of residence, place of risk, and place of prevention. However, the locations of behaviors among MSM show significant spatial variation, and theory has posited the importance of nonresidential contextual exposures. This focus on residential locations has been at least partially necessitated by the difficulties in collecting detailed geolocated data required to explore nonresidential locations.ObjectiveUsing a Web-based map tool to collect locations, which may be relevant to the daily lives and health behaviors of MSM, this study examines the completeness and reliability of the collected data.MethodsMSM were recruited on the Web and completed a Web-based survey. Within this survey, men used a map tool embedded within a question to indicate their homes and multiple nonresidential locations, including those representing work, sex, socialization, physician, and others. We assessed data quality by examining data completeness and reliability. We used logistic regression to identify demographic, contextual, and location-specific predictors of answering all eligible map questions and answering specific map questions. We assessed data reliability by comparing selected locations with other participant-reported data.ResultsOf 247 men completing the survey, 167 (67.6%) answered the entire set of eligible map questions. Most participants (>80%) answered specific map questions, with sex locations being the least reported (80.6%). Participants with no college education were less likely than those with a college education to answer all map questions (prevalence ratio, 0.4; 95% CI, 0.2-0.8). Participants who reported sex at their partner’s home were less likely to indicate the location of that sex (prevalence ratio, 0.8; 95% CI, 0.7-1.0). Overall, 83% of participants placed their home’s location within the boundaries of their reported residential ZIP code. Of locations having a specific text description, the median distance between the participant-selected location and the location determined using the specific text description was 0.29 miles (25th and 75th percentiles, 0.06-0.88).ConclusionsUsing this Web-based map tool, this Web-based sample of MSM was generally willing and able to provide accurate data regarding both home and nonresidential locations. This tool provides a mechanism to collect data that can be used in more nuanced studies of place and sexual risk and preventive behaviors of MSM.

Prospective Measurement of Daily Health Behaviors: Modeling Temporal Patterns in Missing Data, Sexual Behavior, and Substance Use in an Online Daily Diary Study of Gay and Bisexual Men.

Daily diary and other intensive longitudinal methods are increasingly being used to investigate fluctuations in psychological and behavioral processes. To inform the development of this methodology, we sought to explore predictors of and patterns in diary compliance and behavioral reports. We used multilevel modeling to analyze data from an online daily diary study of 371 gay and bisexual men focused on sexual behavior and substance use. We found that greater education and olderage as well as lower frequency of substance use were associated with higher compliance. Using polynomial and trigonometric functions, we found evidence for circaseptan patterns in compliance, sexual behavior, and substance use, as well as linear declines in compliance and behavior over time. The results suggest potential sources of non-random patterns of missing data and suggest that trigonometric terms provide a similar but more parsimonious investigation of circaseptan rhythms than do third-order polynomial terms.

The Role of Locus of Control in Daily Life

Conceived of as a stable trait, locus of control has been linked with psychological and physical health outcomes. We investigated whether locus of control operates as a state variable, whether variation in daily locus of control is associated with anxiety and stressful events, and whether it predicts daily health behaviors and symptoms. Using a daily diary study of pregnant couples, we found daily variation in locus of control was predicted by daily hassles and anxiety such that high same-day and previous-day anxiety and hassles were associated with reports of lower levels of control. Furthermore, daily locus of control was positively associated with positive health behaviors and predicted negative health symptoms. These results provide evidence for a social learning perspective on the development and maintenance of individuals' sense of control and suggest that locus of control should be considered both a state- and trait-level construct in future research.

Harnessing Different Motivational Frames via Mobile Phones to Promote Daily Physical Activity and Reduce Sedentary Behavior in Aging Adults

Mobile devices are a promising channel for delivering just-in-time guidance and support for improving key daily health behaviors. Despite an explosion of mobile phone applications aimed at physical activity and other health behaviors, few have been based on theoretically derived constructs and empirical evidence. Eighty adults ages 45 years and older who were insufficiently physically active, engaged in prolonged daily sitting, and were new to smartphone technology, participated in iterative design development and feasibility testing of three daily activity smartphone applications based on motivational frames drawn from behavioral science theory and evidence. An “analytically” framed custom application focused on personalized goal setting, self-monitoring, and active problem solving around barriers to behavior change. A “socially” framed custom application focused on social comparisons, norms, and support. An “affectively” framed custom application focused on operant conditioning principles of reinforcement scheduling and emotional transference to an avatar, whose movements and behaviors reflected the physical activity and sedentary levels of the user. To explore the applications' initial efficacy in changing regular physical activity and leisure-time sitting, behavioral changes were assessed across eight weeks in 68 participants using the CHAMPS physical activity questionnaire and the Australian sedentary behavior questionnaire. User acceptability of and satisfaction with the applications was explored via a post-intervention user survey. The results indicated that the three applications were sufficiently robust to significantly improve regular moderate-to-vigorous intensity physical activity and decrease leisure-time sitting during the 8-week behavioral adoption period. Acceptability of the applications was confirmed in the post-intervention surveys for this sample of midlife and older adults new to smartphone technology. Preliminary data exploring sustained use of the applications across a longer time period yielded promising results. The results support further systematic investigation of the efficacy of the applications for changing these key health-promoting behaviors.

Influences of spousal support and control on diabetes management through physical activity.

Spouses may be involved in their partner's diabetes management by providing social support to affirm healthy behaviors and social control to modify health behaviors. Yet, investigations of the influence of spousal involvement on daily patient health behaviors are limited. In daily diaries, we investigated how spousal support and control independently and jointly influence patient physical activity and efficacy to engage in physical exercise on a daily basis. Older adults (age 55 and older) with Type 2 diabetes and their spouses (N = 70 couples) completed electronic diaries for seven consecutive days that assessed spouse-reported involvement and patient-reported minutes of physical exercise and efficacy to engage in future physical exercise. A subset of patients (N = 53) also wore an activity monitoring device on the wrist that provided a measure of energy expenditure. Multilevel analyses indicated that on a daily basis, spousal support was positively associated with physical activity, whereas spousal control was either unrelated or linked to less physical activity. On days in which spouses provided high levels of both support and control, however, patients felt more efficacious that day about exercising tomorrow and exhibited an increase in energy expenditure on the next day. Findings suggest that spousal exercise support on its own or in conjunction with spousal exercise control may facilitate daily diabetes management through physical activity.

Changing everyday health behaviors through descriptive norm manipulations

We conducted an observational study to examine the effects of descriptive norm information on daily health behaviors. For 3 weeks, in three university campus locations, we counted the number of people who used an elevator versus stairs to go up one or two floors. Signs posted near two of the elevators during the second week stated either that most people used the stairs or that taking the stairs was a good way to get some exercise. In the location with the norm information sign, the number of individuals who used the elevator versus the stairs dropped by 46% between the first and second week. This lower rate of elevator use was also found the week after the sign had been removed. No significant change in elevator use was seen either at the location with the sign encouraging exercise or at the location with no sign. The findings are consistent with the focus theory of normative conduct and suggest avenues for improving everyday health behaviors.

Daily work–family conflict and alcohol use: Testing the cross-level moderation effects of peer drinking norms and social support.

In the current study, we conducted daily telephone interviews with a sample of Chinese workers (N = 57) for 5 weeks to examine relationships between daily work-family conflict and alcohol use. Drawn from the tension reduction theory and the stressor-vulnerability model, daily work-family conflict variables were hypothesized to predict employees' daily alcohol use. Further, social variables (i.e., peer drinking norms, family support, and coworker support) were hypothesized to moderate the relationship between work-family conflict and alcohol use. Results showed that daily work-to-family conflict but not family-to-work conflict had a significant within-subject main effect on daily alcohol use. In addition, there was significant between-subject variation in the relationship between work-to-family conflict and alcohol use, which was predicted by peer drinking norms, coworker support, and family support. The current findings shed light on the daily health behavior consequences of work-family conflict and provide important theoretical and practical implications.

Living With Genetic Test Results for Hereditary Breast and Ovarian Cancer

To examine adaptation by nonsymptomatic individuals who knew the results of a genetic test for hereditary breast and ovarian cancer (HBOC) for at least 4 years. Longitudinal grounded theory study. Follow-up interviews after a 3- to 4-year interval were conducted by telephone or e-mail with seven asymptomatic participants originally recruited for an earlier study of genetic testing experiences. A total of 14 interviews, 2 for each participant were conducted. Conceptual analysis on these 14 interviews focused on impact on daily life and health behavior decisions made in the intervening years. Participants described the impact of the result and adaptations made in relationships, sexuality, outlook, and plans for the future. Participants accepted recommended surveillance and preventative measures to maximize a healthy lifestyle and reported both the benefits of knowing their mutation status as well as challenges they had encountered since testing. Adaptation to living with genetic test results indicating a disease-related mutation is an ongoing process of balancing the knowledge of risk with living a normal life. Over time, awareness of genetic risk does not appear to diminish. Positive and negative long-term consequences of genetic testing for hereditary breast or ovarian cancer may influence many aspects of the personal lives and health care decisions of those tested.