Engagement In Health Behaviors Research Articles

Attention-deficit/hyperactivity disorder symptom clusters differentially predict prenatal health behaviors in pregnant women.

To date, most investigations of mental health in pregnant women have focused on depression or substance use. This study aimed to (a) delineate the relationships between symptoms of attention-deficit/hyperactivity disorder (ADHD) and prenatal health behaviors and (b) explore whether the symptom clusters of ADHD differentially predict prenatal health behaviors (e.g., physical strain, healthy eating, prenatal vitamin use). A total of 198 pregnant women (mean age=27.94 years) completed measures of ADHD symptoms, prenatal health behaviors, and depression. Inattention, hyperactivity, and impulsivity/emotional lability all evidenced significant relationships with the prenatal health behaviors, each differentially predicting different prenatal health behaviors. As decreased engagement in adequate prenatal health behaviors puts both the mother and fetus at risk for negative birth outcomes, future research should work to develop a brief ADHD screen to be used in obstetric clinics and should investigate these relationships within a sample of women with a diagnosis of ADHD.

Understanding the prevalence and correlates of implicit theories of weight in the United States: Insights from a nationally representative sample

Objectives: The primary aim of this research is to understand how mindsets about weight controllability in the United States relate to population health. We examined the distribution of people’s implicit theories of weight, from an incremental (controllable) to an entity (not controllable) mindset, in a nationally representative sample, as well as their relation to: sociodemographic factors, beliefs about behaviour and genetics as causes of obesity and engagement in weight management-relevant behaviours.Methods: We report data from the National Cancer Institute’s Health Information National Trends Survey 4.Results: A majority of respondents endorsed an incremental mindset of body weight, but endorsement of this mindset was stronger among younger, white respondents, and those with a higher income and more educational attainment. A stronger incremental mindset was related to stronger behaviour and weaker genetic causal beliefs about obesity, as well as a tendency to report increased engagement in weight management-relevant behaviours.Conclusions: Our research provides evidence that although incremental mindsets are more common overall and associated with engagement in health behaviours that can contribute to or detract from population health, incremental mindsets are less common among individuals from more marginalised groups.

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OBJECTIVES/SPECIFIC AIMS: Engagement in risky behaviors is not uncommon among adolescents. Two factors associated with risk taking are difficulty regulating emotions and impulsivity. Moreover, youth who exhibit higher scores on impulsivity-like personality traits (ie, negative urgency, positive urgency, sensation seeking, lack of premeditation, and lack of perseverance) are at even heightened risk. An effective intervention decreasing risk-taking behavior among adolescent populations in clinical settings is Dialectical Behavioral Therapy for Adolescents (DBT-A), which teaches skills on emotion regulation, distress tolerance, and mindfulness. However, DBT-A has yet to be tested as an intervention for youth in a nonclinical setting. The current study aimed to fill this gap in the literature. METHODS/STUDY POPULATION: A 9-week DBT-A skills group was implemented in a public high school classroom (7th-8th graders; N=41) and an alternative high school for at risk youth (7th-12th graders; n=21). Of the 41 youth from the public high school classroom participated, with preintervention and postintervention data provided by 30 participants (retention of 73%). RESULTS/ANTICIPATED RESULTS: Results found a significant increase in mindfulness skills and marginally significant increase in emotion regulation skills. Although there was not an overall change in risky behavior among participants, those who were higher on lack of premeditation and positive urgency showed steeper improvements on the skills. The second study at the alternative high school is currently underway, with no current results to report. DISCUSSION/SIGNIFICANCE OF IMPACT: This study will demonstrate that DBT-A skills training is feasible in a school-based setting and shows promising preliminary evidence of decreasing risk of engagement in risky health behaviors among adolescents, particularly among high-risk youth.

Milieu matters: Evidence that ongoing lifestyle activities influence health behaviors.

Health behaviors occur within a milieu of lifestyle activities that could conflict with health actions. We examined whether cognitions about, and performance of, other lifestyle activities augment the prediction of health behaviors, and whether these lifestyle factors are especially influential among individuals with low health behavior engagement. Participants (N = 211) completed measures of past behavior and cognitions relating to five health behaviors (e.g., smoking, getting drunk) and 23 lifestyle activities (e.g., reading, socializing), as well as personality variables. All behaviors were measured again at two weeks. Data were analyzed using neural network and cluster analyses. The neural network accurately predicted health behaviors at follow-up (R2 = .71). As hypothesized, lifestyle cognitions and activities independently predicted health behaviors over and above behavior-specific cognitions and previous behavior. Additionally, lifestyle activities and poor self-regulatory capability were more influential among people exhibiting unhealthy behaviors. Considering ongoing lifestyle activities can enhance prediction and understanding of health behaviors and offer new targets for health behavior interventions.

Depression and health behaviors in women with Peripartum Cardiomyopathy

BackgroundDepression and health behavior engagement are a critical issue for recovery and secondary prevention in heart failure patients. No prior studies have examined these important clinical outcomes in young women diagnosed with Peripartum Cardiomyopathy (PPCM). We sought to characterize the prevalence of depression and health behaviors in PPCM patients and examine whether depression is associated with reduced engagement in health behaviors. MethodsA nation-wide, cohort of 177 PPCM patients (mean age of 34.8 ± 5.7 years; median time since diagnosis of 3.0 ± 4.3 years) from a web-based quality of life registry completed questionnaires about depression (Patient Health Questionnaire; a cutoff score ≥10 was used for depression screening) and health behaviors. T-tests, chi-square and linear regression were used to compare clinical characteristics and health behaviors among depressed and non-depressed women. ResultsThe prevalence of clinical depression at enrollment was 32.3% and was associated with use of antihypertensive medications, disability insurance status, higher BMI, history of arrhythmia and current or past use of psychotropic medication. Health behavior engagement for diet, physical activity, and tobacco cessation were low in the overall sample and depressed PPCM patients were significantly less likely to attend medical appointments than non-depressed women. ConclusionsNearly 1 in 3 PPCM survivors reported symptoms of clinical depression which was associated with worse attendance at medical follow-up visits. Further research is needed to develop risk stratification models and patient-centered interventions to improve clinical outcomes for PPCM survivors.

A mixed methods study of multiple health behaviors among individuals with stroke.

BackgroundIndividuals with stroke often have multiple cardiovascular risk factors that necessitate promoting engagement in multiple health behaviors. However, observational studies of individuals with stroke have typically focused on promoting a single health behavior. Thus, there is a poor understanding of linkages between healthy behaviors and the circumstances in which factors, such as stroke impairments, may influence a single or multiple health behaviors.MethodsWe conducted a mixed methods convergent parallel study of 25 individuals with stroke to examine the relationships between stroke impairments and physical activity, sleep, and nutrition. Our goal was to gain further insight into possible strategies to promote multiple health behaviors among individuals with stroke. This study focused on physical activity, sleep, and nutrition because of their importance in achieving energy balance, maintaining a healthy weight, and reducing cardiovascular risks. Qualitative and quantitative data were collected concurrently, with the former being prioritized over the latter. Qualitative data was prioritized in order to develop a conceptual model of engagement in multiple health behaviors among individuals with stroke. Qualitative and quantitative data were analyzed independently and then were integrated during the inference stage to develop meta-inferences. The 25 individuals with stroke completed closed-ended questionnaires on healthy behaviors and physical function. They also participated in face-to-face focus groups and one-to-one phone interviews.ResultsWe found statistically significant and moderate correlations between hand function and healthy eating habits (r = 0.45), sleep disturbances and limitations in activities of daily living (r = − 0.55), BMI and limitations in activities of daily living (r = − 0.49), physical activity and limitations in activities of daily living (r = 0.41), mobility impairments and BMI (r = − 0.41), sleep disturbances and physical activity (r = − 0.48), sleep disturbances and BMI (r = 0.48), and physical activity and BMI (r = − 0.45). We identified five qualitative themes: (1) Impairments: reduced autonomy, (2) Environmental forces: caregivers and information, (3) Re-evaluation: priorities and attributions, (4) Resiliency: finding motivation and solutions, and (5) Negative affectivity: stress and self-consciousness. Three meta-inferences and a conceptual model described circumstances in which factors could influence single or multiple health behaviors.DiscussionThis is the first mixed methods study of individuals with stroke to elaborate on relationships between multiple health behaviors, BMI, and physical function. A conceptual model illustrates addressing sleep disturbances, activity limitations, self-image, and emotions to promote multiple health behaviors. We discuss the relevance of the meta-inferences in designing multiple behavior change interventions for individuals with stroke.

‘I feel better when…’: An analysis of the memory-experience gap for peoples’ estimates of the relationship between health behaviours and experiences

Objective: People often overestimate how strongly behaviours and experiences are related. This memory-experience gap might have important implications for health care settings, which often require people to estimate associations, such as “my mood is better when I exercise”. This study examines how subjective correlation estimates between health behaviours and experiences relate to calculated correlations from online reports and whether subjective estimates are associated with engagement in actual health behaviour. Design: Seven-month online study on physical activity, sleep, affect and stress, with 61 online assessments. Main Outcome Measures: University students (N = 168) retrospectively estimated correlations between physical activity, sleep, positive affect and stress over the seven-month study period. Results: Correlations between experiences and behaviours (online data) were small (r = −.12–.14), estimated correlations moderate (r = −.35–.24). Correspondence between calculated and estimated correlations was low. Importantly, estimated correlations of physical activity with stress, positive affect and sleep were associated with actual engagement in physical activity. Conclusion: Estimation accuracy of relations between health behaviours and experiences is low. However, association estimates could be an important predictor of actual health behaviours. This study identifies and quantifies estimation inaccuracies in health behaviours and points towards potential systematic biases in health settings, which might seriously impair intervention efficacy.

The link between parenting approaches and health behavior: A systematic review

ABSTRACTThe familial home environment, where parenting takes place, plays an important role in the health behaviors that children and adolescents engage in and has implications on health and well-being in later life. Lifestyle-related behaviors predispose children and adolescents to the global burden of non-communicable and other lifestyle-related diseases. This review therefore examined and described previous studies looking at the associations between health behaviors and parenting approaches. It suggests that engagement in health behaviors, which promotes overall health and well-being, was associated with autonomy, supportive parenting, parental encouragement, behavior control, parental nurturance, warmth and responsiveness, and parental involvement. The review highlights the gap in literature focusing on the health behavior of children and adolescents as well as on parenting. In addition, the review also provides an overview of the continents where fewer studies have examined the presented associations. The findings presented also serve as a guide for program development and implementation to address the increase in non-communicable and other lifestyle-related diseases.

Expectations of choice: an exploration of how social context informs gendered occupation

Purpose Occupational choice describes the process that leads to occupational engagement as a result of intrinsic and extrinsic influences. There has been a considerable amount of research concerning occupational choice, gender and adolescence. However, this has largely focused on the areas of career choice and engagement in risky health behaviours. This paper aims to expand on the literature by providing a broader scope of occupation more aligned with the concept associated with occupational science. Furthering this, the researcher aims to examine the influence of gender as an extrinsic influence on occupational choice. The researcher aims to explore how contextual influences inform gendered occupational choice. Design/methodology/approach An exploratory qualitative approach was used in the current study. Incorporating photographs as a means of elucidating conversation during the interview process, photo-elicitation interview techniques were used as part of the data collection. This involved using a collection of photographs to prompt participants to discuss their interpretations of various occupations. Six adolescent boys and girls aged 11-14 years participated in the study. Participants were recruited from mixed-gendered sports clubs in the West of Ireland. Thematic analysis was used to analyse the data. An occupational justice perspective was used to interpret the data. Findings Responses suggest that gender informs occupational choice through different mechanisms. These included social systems, physical and institutional opportunities as well as expectations participants held of themselves and others they considered to be within their social grouping. Social systems included groups such as friends and family. The ease of access to physical and institutional resources was another factor that informed choice. Participants projected views of expectations they perceived others held for them informed how the participants made their choices. These factors varied across gender. Despite opportunities being available to both sexes, choices were often restricted to particular occupations. Originality/value The findings suggest that factors informing the occupational choices of adolescents included a combination of intrinsic factors such as gender and perspectives, as well as external factors including peers, family and opportunities in the local community. Practical applications of this involve acknowledging and further understanding the contextually situated nature of choice to provide more equitable practice. The results of the study may provide more insight into the factors that enable and inhibit occupation. A further understanding of these influences can redirect how we view adolescent occupations in a way that promotes health.

The uptake of cervical cancer screening among South Asians and the general population in Hong Kong: A comparative study

ObjectivesTo compare the uptake of pap smear tests by the general public and by South Asian women in Hong Kong, and identify the factors associated with the uptake rates of these two groups of women. MethodsFor this secondary analysis, 959 Chinese women aged 50 or older from the general public and 161 South Asian women of the same age range completed a self-report survey covering demographics, health status, family history of cancer, health-related beliefs, perceived susceptibility to cancer, use of complementary therapy and uptake of Pap smear testing. Data was collected via telephone or in face-to-face interviews. ResultsPap test uptake by the ethnic minority women was significantly lower than that by the general public (36% vs 48%). Ethnicity, age, educational attainment, marital status, family history of cancer, smoking status, use of complementary therapy, the idea that exercising and visiting a doctor regularly were good for the health, and health professionals’ recommendations were significantly and independently associated with test uptake. Furthermore, the effect of the perception that exercise was good for the health was significantly stronger in the ethnic minority than in the general public. ConclusionsMore effort should be put into educating ethnic minority women about the benefits and importance of cervical cancer screening. Strategies to arouse their concern with health and appropriate lifestyle-related perceptions should be developed so as to enhance their engagement in preventive health behaviour.

Predictors of Premature Match Closure in Youth Mentoring Relationships.

Although mentoring is a popular and effective means of intervention with youth, the positive effects of mentoring can be diminished by premature match closure of relationships. Program, mentor, and mentee characteristics were examined as predictors of premature match closure. Secondary data analyses were conducted on a large national database of mentoring programs consisting of match and youth risk information from 170 mentoring programs and 6468 matches from across the U.S. Premature closure was associated with mentee age at match inception and 19 individual mentee characteristics. The set of mentee characteristics were examined as part of a cumulative risk index encompassing seven conceptually combined categories including family background characteristics, school functioning problems, engagement in risky health behaviors, self-regulation difficulties, engagement in illegal or criminal activities, and internalizing and externalizing behavior problems. Both the age of mentees when matched and the cumulative risk index score significantly predicted premature closure. Results are discussed in terms of directions for future research and suggestions for enhancing mentoring program practices.

Lesbian disclosure and health care seeking in the United States: A replication study

ABSTRACTThe current study explored factors associated with lesbian disclosure to health care providers (HCPs) and engagement in preventative health behaviors by replicating and extending a Canadian path analysis study with a sample of U.S. lesbians. Both patient (education, feminism, global outness, and internalized homophobia) and HCP-related (lesbian-friendly HCPs and patient comfort) factors were either directly or indirectly associated with disclosure and engagement in preventative health behaviors, including avoidance of health-compromising behaviors (e.g., smoking) and health care seeking. Importantly, findings suggest that HCPs—particularly those who are inclusive of lesbian patients—may play a role in assuaging their patients' experiences of minority stress. Overall, the findings were similar to those originally reported in the Canadian study, with the exception of internalized homophobia playing a more visible role in the current study.

Monetary Incentive Interventions Can Enhance Psychological Factors Related to Fruit and Vegetable Consumption.

Incentive interventions have gained popularity to motivate health behavior change, but some psychological theorists caution that they may have deleterious effects on factors that potentiate behavior maintenance. Importantly, no empirical study has tested whether incentives indeed have iatrogenic effects on key psychological constructs associated with health behavior change and maintenance. The study aims to explore the effects of monetary incentives on theoretically informed psychological constructs and fruit and vegetable consumption. Individuals reporting insufficient fruit and vegetable consumption were randomly assigned to receive either daily monetary incentives, delayed monetary incentives, or no incentives for their fruit and vegetable consumption during a 3-week intervention period. Behavior engagement and psychological factors were measured at baseline, at the end of the intervention, and 2weeks following the cessation of the intervention. Participants in the daily incentive condition demonstrated the greatest increase in self-reported consumption during the intervention and at the follow-up. Moreover, increases in consumption during the intervention period were associated with increases in attitudes and self-efficacy, which, in turn, predicted behavior maintenance at follow-up. Intrinsic motivation to consume fruits and vegetables increased over time across the entire sample but did not differ between groups. Monetary incentives can alter health behavior engagement without decreasing intrinsic motivation or other relevant cognitive and motivational constructs. Further, although incentives may serve as a vehicle to initiate behavior change, increased experience with the behavior may then lead to enhancements in key psychological constructs that serve as mechanisms to potentiate behavior maintenance following the cessation of incentives. The trial was registered with the ClinicalTrials.gov database (NCT02594319) https://www.clinicaltrials.gov/ct2/show/NCT02594319 .

Recent declines in cancer incidence: related to the Great Recession?

In recent years, cancer case counts in the U.S. underwent a large, rapid decline-an unexpected change given population growth for older persons at highest cancer risk. As these declines coincided with the Great Recession, we examined whether they were related to economic conditions. Using California Cancer Registry data from California's 30 most populous counties, we analyzed trends in cancer incidence during pre-recession (1996-2007) and recession/recovery (2008-2012) periods for all cancers combined and the ten most common sites. We evaluated the recession's association with rates using a multifactorial index that measured recession impact, and modeled associations between case counts and county-level unemployment rates using Poisson regression. Yearly cancer incidence rate declines were greater during the recession/recovery (3.3% among males, 1.4% among females) than before (0.7 and 0.5%, respectively), particularly for prostate, lung, and colorectal cancers. Lower case counts, especially for prostate and liver cancer among males and breast cancer, melanoma, and ovarian cancer among females, were associated with higher unemployment rates, irrespective of time period, but independent of secular effects. The associations for melanoma translated up to a 3.6% decrease in cases with each 1% increase in unemployment. Incidence declines were not greater in counties with higher recession impact index. Although recent declines in incidence of certain cancers are not differentially impacted by economic conditions related to the Great Recession relative to pre-recession conditions, the large recent absolute declines in the case counts of some cancer may be attributable to the large declines in unemployment in the recessionary period. This may occur through decreased engagement in preventive health behaviors, particularly for clinically less urgent cancers. Continued monitoring of trends is important to detect any rises in incidence rates as deferred diagnoses come to clinical attention.

Frequency of E-cigarette Use, Health Status, and Risk and Protective Health Behaviors in Adolescents.

E-cigarettes (ECs) are increasingly popular among adolescents, who perceive them as "safer" than cigarettes. Although research has examined risk factors for adolescent EC use, little is known about how EC use correlates with health status and protective health behaviors. In all, 2488 adolescents (mean age = 17.31 years, SD = 0.67; 46% male) completed a survey on EC and cigarette use, physical and mental health, physical activity, diet, sleep, and alcohol and other drug (AOD) use. Logistic regression compared EC-only users to dual EC/cigarette users, cigarette-only users, and nonusers on these health factors. Among EC-only users, separate ordinary least-squares regression models assessed the effects of health status/behavior variables on frequency of past-year EC use, controlling for demographics and smokeless tobacco use. User groups were similar on physical health and engagement in protective health behaviors (physical activity, sleep duration/quality, healthy diet), but EC-only users reported fewer mental health symptoms and less AOD use than dual or cigarette-only users. Among EC-only users, AOD use (all P < 0.0001) predicted more frequent EC use; healthy diet predicted less frequent use (P < 0.01). EC-only use is associated with lower engagement in risky behaviors, but not better health status or higher engagement in protective health behaviors, compared with cigarette smoking. Dual EC/cigarette users may represent a particularly high-risk group due to their greater AOD use and cigarette consumption. Among "intermediate-risk" EC-only users, AOD use and unhealthy diet correlated with heavier use, and may be important targets for preventing escalation to more harmful tobacco use.

The mediating role of self-efficacy in the relationship between premotivational cognitions and engagement in multiple health behaviors: a theory-based cross-sectional study among township residents in South Africa.

BackgroundNoncommunicable diseases (NCDs) are one of the major global health challenges in developed countries and are rapidly increasing globally. Perception of self-efficacy is important for complex activities and long-term changes in health behavior. This study aimed to determine whether self-efficacy mediates the effect of individual beliefs (perceived severity, susceptibility, benefits and barriers) among informal settlement residents’ health behavior in relation to the prevention and management of NCDs.MethodsA cross-sectional survey was conducted using a closed-ended questionnaire among informal settlement residents in Diepsloot, Johannesburg. The proposed model was tested using structural equation modeling (AMOS software).ResultsA total of 2,277 participants were interviewed during this survey, consisting of 1,236 (54.3%) females, with the majority of them aged between 20 and 29 years. All constructs in the questionnaire had a good reliability with a Cronbach’s alpha of >0.7. Perceived benefits and perceived barriers were the strongest predictors of self-efficacy, with the highest beta values of 0.14 and 0.15, respectively. Once associated with perceived self-efficacy, the direct effect of perceived susceptibility and perceived benefits on health behavior was statistically nonsignificant (P=0.0894 and P=0.2839, respectively). Perceived benefits and perceived susceptibility were totally mediated by self-efficacy. The indirect effects of perceived severity and perceived barriers (through self-efficacy) on health behavior were significant. Thus, perceived severity and perceived barriers were partially mediated by self-efficacy.ConclusionPerceived susceptibility and perceived benefits did not affect health behavior unless associated with self-efficacy. In contrast, individual perception of the seriousness of NCDs and perceived barriers might still have a direct influence on health behavior even if the person does not feel able to prevent NCDs. However, this influence would be more significant when perceived severity and perceived barriers of NCDs are associated with self-efficacy.

Evaluating Integrative Cancer Clinics With the Claim Assessment Profile: An Example With the InspireHealth Clinic.

Background: The evaluation of freestanding integrative cancer clinical programs is challenging and is rarely done. We have developed an approach called the Claim Assessment Profile (CAP) to identify whether evaluation of a practice is justified, feasible, and likely to provide useful information. Objectives: A CAP was performed in order to (1) clarify the healing claims at InspireHealth, an integrative oncology treatment program, by defining the most important impacts on its clients; (2) gather information about current research capacity at the clinic; and (3) create a program theory and path model for use in prospective research. Study Design/Methods: This case study design incorporates methods from a variety of rapid assessment approaches. Procedures included site visits to observe the program, structured qualitative interviews with 26 providers and staff, surveys to capture descriptive data about the program, and observational data on program implementation. Results: The InspireHealth program is a well-established, multi-site, thriving integrative oncology clinical practice that focuses on patient support, motivation, and health behavior engagement. It delivers patient-centered care via a standardized treatment protocol. There arehigh levels of research interest from staff and resources by which to conduct research. Conclusions: This analysis provides the primary descriptive and claims clarification of an integrative oncology treatment program, an evaluation readiness report, a detailed logic model explicating program theory, and a clinical outcomes path model for conducting prospective research. Prospective evaluation of this program would be feasible and valuable, adding to our knowledge base of integrative cancer therapies.

Protocol for a randomized controlled trial testing the impact of feedback on familial risk of chronic diseases on family-level intentions to participate in preventive lifestyle behaviors.

BackgroundCommon disease risk clusters in families due to shared genetics, exposure to environmental risk factors, and because many health behaviours are established and maintained in family environments. This randomised controlled trial will test whether the provision of a family health history (FHH) risk assessment tool increases intentions and engagement in health behaviors. Message distribution and collective behavior change within family networks will be mapped using social network analysis. The relative intervention impact will be compared between families from different ethnic backgrounds.MethodsOne hundred and fifty mothers (50 Anglo-Australian, 50 Italian-Australian, 50 Vietnamese-Australian) will be recruited, with four or more other family members across three generations, including a child (aged 10–18 years). Each family is randomly assigned to intervention or control. At baseline and 6-month follow-up, all participants complete surveys to assess dietary and physical activity intentions and behaviors, attitudes towards food, and perceived disease risk. Intervention families receive a visual pedigree detailing their FHH of diabetes, heart disease, breast and bowel cancer, a health education workbook to ascertain members’ disease risk (i.e. average or above average risk), and screening and primary prevention recommendations. After completion of follow-up assessments, controls will receive their pedigree and workbook. The primary hypothesis is that attitudes and lifestyle behaviors will improve more within families exposed to FHH feedback, although the extent of this improvement may vary between families from different ethnic backgrounds. Additionally, the extent of improvement in the treatment group will be moderated by the level of family disease risk, with above-average risk leading to greater improvement. A secondary aim will explore different family members’ roles in message distribution and collective responses to risk using social network approaches and to compare network functioning between families with different ethnic backgrounds.DiscussionResults will guide future health promotion programs aimed at improving lifestyle factors. This research will assess whether FHH can motivate families to adopt family-level strategies to support health promoting behaviors. Secondary analyses aim to identify change agents within the family who are particularly effective in shifting normative behaviors.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12613001033730. Retrospectively registered: 17 September, 2013.

A Qualitative Study of Multiple Health Behaviors in Adults with Multiple Sclerosis.

Background: Evidence regarding inflammatory pathways, elevated cardiovascular risk, and negative effects of secondary conditions on disability progression provide a strong rationale for promoting multiple health behaviors in adults with multiple sclerosis (MS). However, many unanswered questions remain about the best ways to design multiple behavior change interventions for adults with MS. We sought to identify facilitators and barriers to engaging in multiple health behaviors (physical activity, nutrition, and sleep) and to gain further insights into how to develop multiple health behavior change interventions based on preferences of adults with MS. Methods: Focus groups and one-on-one interviews were conducted with 17 participants with MS. Results: Five qualitative themes were identified as either facilitating or hindering engagement in multiple health behaviors: 1) roles, priorities, and preferences; 2) sense of duty; 3) the fatigue and mobility problem; 4) taking control; and 5) resiliency. Participants identified advantages and disadvantages of delivery formats (eg, face-to-face group vs. telephone), frequency of contacts, and intervention strategies based on their individual circumstances and obligations. Participants felt that discussing the benefits of engaging in multiple health behaviors, developing action plans, accommodating preferences, and addressing health problems would be helpful strategies to include in a multiple behavior change intervention. Conclusions: These findings indicate that there may be common facilitators and barriers that can be targeted to promote multiple behavior changes. Future research should explore the best ways to tailor multiple behavior change interventions to preferences, symptoms, psychological traits, and social cognitions.

Spread of health behaviors in young couples: How relationship power shapes relational influence

IntroductionRomantic relationships provide a context in which partners can influence each other's health behaviors (e.g., weight-related behaviors, substance use). Partner influence may be especially pronounced among newly parenting adolescent and young adult couples because of the desire to maintain relationships (and therefore openness to influence), and because parenting-related challenges can pose risk for uptake of unhealthy behaviors. Two understudied factors that might affect partner influence on health behaviors include relative power within the relationship and prior levels of engagement in health behaviors. MethodsThe current study explored longitudinal partner influence effects in a sample of newly parenting adolescent and young adult females and their male partners (Ncouples = 157) recruited from four obstetrics/gynecology clinics in Connecticut between July 2007 and February 2011. Five health behaviors in two domains were explored: weight-related behaviors (unhealthy eating, exercise) and substance use (cigarette, alcohol, and marijuana use). Relationship power and previous levels of health behaviors were examined as moderators. Variations across gender were also examined. ResultsResults of dyadic analysis showed partner influences for alcohol use. Partner influence depended on relationship power for eating, alcohol, and marijuana use, and on previous behavior for cigarette use. Results also varied by gender – only female-to-male influence was found for unhealthy eating and cigarette use. Higher relationship power was protective against smoking escalation for females. Discussion.These results differ from previous research findings mainly on male-to-female influences. Such asymmetries may reflect traditional female dominance in food preparation, as well as shifts in power balances postpartum. Targeting relational power dynamics may buffer the spread and escalation of unhealthy behaviors in young parents, with implications for the health of both members of a couple as well as their children.