Health Psychology

Evidence-based guidelines are often not implemented effectively with the result that best health outcomes are not achieved. This may be due to a lack of theoretical understanding of the processes involved in changing the behaviour of healthcare professionals. This paper reports the development of a consensus on a theoretical framework that could be used in implementation research. The objectives were to identify an agreed set of key theoretical constructs for use in (1) studying the implementation of evidence based practice and (2) developing strategies for effective implementation, and to communicate these constructs to an interdisciplinary audience.

Objective: Meta-analyses of behavior change (BC) interventions typically find large heterogeneity in effectiveness and small effects. This study aimed to assess the effectiveness of active BC interventions designed to promote physical activity and healthy eating and investigate whether theoretically specified BC techniques improve outcome. Design: Interventions, evaluated in experimental or quasi-experimental studies, using behavioral and/or cognitive techniques to increase physical activity and healthy eating in adults, were systematically reviewed. Intervention content was reliably classified into 26 BC techniques and the effects of individual techniques, and of a theoretically derived combination of self-regulation techniques, were assessed using meta-regression. Main Outcome Measures: Valid outcomes of physical activity and healthy eating. Results: The 122 evaluations (N ϭ 44,747) produced an overall pooled effect size of 0.31 (95% confidence interval ϭ 0.26 to 0.36, I 2 ϭ 69%). The technique, "self-monitoring," explained the greatest amount of among-study heterogeneity (13%). Interventions that combined selfmonitoring with at least one other technique derived from control theory were significantly more effective than the other interventions (0.42 vs. 0.26). Conclusion: Classifying interventions according to component techniques and theoretically derived technique combinations and conducting meta-regression enabled identification of effective components of interventions designed to increase physical activity and healthy eating.

A number of factors are thought to influence people's dietary choices, including health, cost, convenience and taste, but there are no measures that address healthrelated and non-health-related factors in a systematic fashion. This paper describes the development of a multidimensional measure of motives related to food choice. The Food Choice Questionnaire (FCQ) was developed through factor analysis of responses from a sample of 358 adults ranging in age from 18 to 87 years. Nine factors emerged, and were labelled health, mood, convenience, sensory appeal, natural content, price, weight control, familiarity and ethical concern. The questionnaire structure was verified using confirmatory factor analysis in a second sample (n=358), and test-retest reliability over a 2-to 3-week period was satisfactory. Convergent validity was investigated by testing associations between FCQ scales and measures of dietary restraint, eating style, the value of health, health locus of control and personality factors. Differences in motives for food choice associated with sex, age and income were found. The potential uses of this measure in health psychology and other areas are discussed.

With the burgeoning use of qualitative methods in health research, criteria for judging their value become increasingly necessary. Interpretative phenomenological analysis (IPA) is a distinctive approach to conducting qualitative research being used with increasing frequency in published studies. A systematic literature review was undertaken to identify published papers in the area of health psychology employing IPA. A total of 52 articles are reviewed here in terms of the following: methods of data collection, sampling, assessing wider applicability of research and adherence to the theoretical foundations and procedures of IPA. IPA seems applicable and useful in a wide variety of research topics. The lack of attention sometimes afforded to the interpretative facet of the approach is discussed.

Almost 30 years ago, Hamachek (1978) suggested that two forms of perfectionism be distinguished, a positive form labeled „normal perfectionism” and a negative form labeled „neurotic perfectionism.” Focusing on the positive, we present an overview of the different empirical conceptions of the two forms of perfectionism and present a common framework for the two basic approaches: the dimensional approach differentiating two dimensions of perfectionism (perfectionistic strivings and perfectionistic concerns) and the group-based approach differentiating two groups of perfectionists (healthy perfectionists and unhealthy perfectionists). Moreover, we review the evidence demonstrating that (a) perfectionistic strivings are associated with positive characteristics and (b) healthy perfectionists show higher levels of positive characteristics compared to unhealthy perfectionists and nonperfectionists. While questions on core facets, positive effects, and developmental antecedents of positive forms of perfectionism remain, our findings suggest that self-oriented perfectionistic strivings are positive, if perfectionists are not overly concerned about mistakes and negative evaluations by others.

Over the past several decades, significant advances have been made in our understanding of the basic stages and mechanisms of mammalian brain development. Studies elucidating the neurobiology of brain development span the levels of neural organization from the macroanatomic, to the cellular, to the molecular. Together this large body of work provides a picture of brain development as the product of a complex series of dynamic and adaptive processes operating within a highly constrained, genetically organized but constantly changing context. The view of brain development that has emerged from the developmental neurobiology literature presents both challenges and opportunities to psychologists seeking to understand the fundamental processes that underlie social and cognitive development, and the neural systems that mediate them. This chapter is intended to provide an overview of some very basic principles of brain development, drawn from contemporary developmental neurobiology, that may be of use to investigators from a wide range of disciplines.

Although some people may develop an intention to change their health behaviour, they might not take any action. This discrepancy has been labelled the “intention–behaviour gap.” Detailed action planning, perceived self-efficacy, and self-regulatory strategies (action control) may mediate between intentions and behaviour. This was examined in a longitudinal sample of 307 cardiac rehabilitation patients who were encouraged to adopt or maintain regular exercise. At the first time point, the predictors of intention and intention itself were assessed. Two months and four months later, the mediators and outcomes were measured. Results confirmed that all the three factors (planning, maintenance self-efficacy, and action control) served to mediate between earlier exercise intentions and later physical activity, each of them making a unique contribution. The results have implications for research on the “intention–behaviour gap,” and indicate that planning, maintenance self-efficacy and action control may be important volitional variables.

In order to more effectively promote fruit and vegetable intake among children and adolescents, insight into determinants of intake is necessary. We conducted a review of the literature for potential determinants of fruit and vegetable intake in children and adolescents.

A meta-analysis of data (mm 42 independent samples examining the association of a measure of religious involvement and all-cause mortality is reported. Religious involvement was significantly associated with lower mortality (odds ratio = 1.29; 95% confidence interval: 1.20-1.39), indicating that people high in religious involvement were more likely to be alive at follow-up than people lower in religious involvement. Although the strength of the religious involvement-mortality association varied as a function of several moderator variables, the association of religious involvement and mortality was robust and on the order of magnitude that has come to be expected for psychosocial factors. Conclusions did not appear to be due to publication bias.

Objective: The purpose of this study was to prospectively evaluate the onset, overlap, and course of posttraumatic stress disorder (PTSD) and major depression following traumatic events. Method: The occurrence of PTSD and major depression and the intensity of related symptoms were assessed in 211 trauma survivors recruited from a general hospital's emergency room. Psychometrics and structured clinical interview (the Structured Clinical Interview for DSM-III-R and the Clinician-Administered PTSD Scale) were administered 1 week, 1 month, and 4 months after the traumatic event. Heart rate was assessed upon arrival at the emergency room for subjects with minor physical injury. Twenty-three subjects with PTSD and 35 matched comparison subjects were followed for 1 year. Results: Major depression and PTSD occurred early on after trauma; patients with these diagnoses had similar recovery rates: 63 survivors (29.9%) met criteria for PTSD at 1 month, and 37 (17.5%) had PTSD at 4 months. Forty subjects (19.0%) met criteria for major depression at 1 month, and 30 (14.2%) had major depression at 4 months. Comorbid depression occurred in 44.5% of PTSD patients at 1 month and in 43.2% at 4 months. Comorbidity was associated with greater symptom severity and lower levels of functioning. Survivors with PTSD had higher heart rate levels at the emergency room and reported more intrusive symptoms, exaggerated startle, and peritraumatic dissociation than those with major depression. Prior depression was associated with a higher prevalence of major depression and with more reported symptoms. Conclusions: Major depression and PTSD are independent sequelae of traumatic events, have similar prognoses, and interact to increase distress and dysfunction. Both should be targeted by early treatment interventions and by neurobiological research.

This review explores the role of environments in creating chronic and acute health disorders. A general framework for studying the nesting of social environments and the multiple pathways by which environmental factors may adversely affect health is offered. Treating socioeconomic status (SES) and race as contextual factors, we examine characteristics of the environments of community, work, family, and peer interaction for predictors of positive and adverse health outcomes across the lifespan. We consider chronic stress/allostatic load, mental distress, coping skills and resources, and health habits and behaviors as classes of mechanisms that address how unhealthy environments get "under the skin," to create health disorders. Across multiple environments, unhealthy environments are those that threaten safety, that undermine the creation of social ties, and that are conflictual, abusive, or violent. A healthy environment, in contrast, provides safety, opportunities for social integration, and the ability to predict and/or control aspects of that environment.

We report 10-year treatment outcomes for obese children in 4 randomized treatment studies. At 10 years, 34% decreased percentage overweight by 20% or more, and 30% were not obese. Significant effects were observed when parents and children were targeted and reinforced for weight loss in comparison with nontargeted controls and for children given lifestyle or aerobic exercise in comparison with a calisthenics control. Thirty-four percent of the variance in change in percentage overweight was predicted from sex, baseline percentage overweight, self-monitoring weight, meals eaten at home, and family and friends' support for eating and exercise. Results show long-term changes in children depend on the treatment, and evidence converges on the importance of the family and other sources of support for eating and activity change.

Smokers (N = 756) were randomly assigned by stage of change to (a) standardized self-help manuals (ALA+ condition), (b) individualized manuals matched to stage (TIT condition), (c) interactive expert-system computer reports plus individualized manuals (ITT condition), or (d) a personalized condition with 4 counselor calls, stage manuals, and computer reports (PITT condition). Over 18 months, the ITT group's results more than doubled those of the ALA+ group on abstinence measures. The ALA+ and TTT conditions were equivalent over 12 months, but at 18 months the TTT condition was more effective. The ITT condition was the best or comparable with the best treatment at all follow-ups for smokers at all stages of change. Results suggest that an effective expert system has been developed, and discussion focuses on delivering this system to entire populations of smokers.

ObjectiveHealth advocates have focused on the prevalence of advertising for calorie-dense low-nutrient foods as a significant contributor to the obesity epidemic. This research tests the hypothesis that exposure to food advertising during television viewing may also contribute to obesity by triggering automatic snacking of available food.DesignIn Experiments 1a and 1b, elementary-school-aged children watched a cartoon that contained either food advertising or advertising for other products and received a snack while watching. In Experiment 2, adults watched a television program that included food advertising that promoted snacking and/or fun product benefits, food advertising that promoted nutrition benefits or no food advertising. The adults then tasted and evaluated a range of healthy to unhealthy snack foods in an apparently separate experiment.Main Outcome MeasuresAmount of snack foods consumed during and after advertising exposure.ResultsChildren consumed 45% more when exposed to food advertising. Adults consumed more of both healthy and unhealthy snack foods following exposure to snack food advertising compared to the other conditions. In both experiments, food advertising increased consumption of products not in the presented advertisements, and these effects were not related to reported hunger or other conscious influences.ConclusionThese experiments demonstrate the power of food advertising to prime automatic eating behaviors and thus influence far more than brand preference alone.

The article reports our intervention work with Alcohol and Other Drug Abusing (AOD) People Living With HIV (PLWH). Present research has involved adapting Cognitive Behavioral Stress Management (CBSM) and other strategies to improve quality of life and health outcomes for PLWH. Historically, CBSM has used relaxation and coping skills training to reduce negative mood and improve coping behaviors. The efficacy of CBSM interventions to improve functioning has been demonstrated in many disease groups and, more recently, in ethnic-minority HIV+ samples in the US CBSM HIV risk reduction interventions are similar to other cognitive-behavioral therapies in emphasizing skills training and stress reduction. Among the most precarious and challenging clinical populations are HIV infected individuals with a history of alcohol and/or drug abuse. Compared to their counterparts with no history of alcohol or drug abuse, not only are they more likely to transmit the virus to others, but they are also at risk for problems in adhering to antiretroviral regimens. A main focus of this article is to report on our intervention work with very resource-limited, ethnicminority PLWH with substance abuse problems, particularly our NIH funded projects in Miami and Haiti and the opportunities presented by the emerging science of biological vulnerability and genomic factors.

The purpose of this meta-analysis of randomized controlled trials was to evaluate the efficacy of psychological interventions for adults with noncancerous chronic low back pain (CLBP). The authors updated and expanded upon prior meta-analyses by using broad definitions of CLBP and psychological intervention, a broad data search strategy, and state-of-the-art data analysis techniques. All relevant controlled clinical trials meeting the inclusion criteria were identified primarily through a computer-aided literature search. Two independent reviewers screened abstracts and articles for inclusion criteria and extracted relevant data. Cohen's d effect sizes were calculated by using a random effects model. Outcomes included pain intensity, emotional functioning, physical functioning (pain interference or pain-specific disability, health-related quality of life), participant ratings of global improvement, health care utilization, health care provider visits, pain medications, and employment/disability compensation status. A total of 205 effect sizes from 22 studies were pooled in 34 analyses. Positive effects of psychological interventions, contrasted with various control groups, were noted for pain intensity, pain-related interference, health-related quality of life, and depression. Cognitive-behavioral and selfregulatory treatments were specifically found to be efficacious. Multidisciplinary approaches that included a psychological component, when compared with active control conditions, were also noted to have positive short-term effects on pain interference and positive long-term effects on return to work. The results demonstrated positive effects of psychological interventions for CLBP. The rigor of the methods used, as well as the results that reflect mild to moderate heterogeneity and minimal publication bias, suggest confidence in the conclusions of this review.

The effects of social-cognitive variables on preventive nutrition and behavioral intentions were studied in 580 adults at 2 points in time. The authors hypothesized that optimistic self-beliefs operate in 2 phases and made a distinction between action self-efficacy (preintention) and coping self-efficacy (pmtintantion). Risk perceptions, outcome expectancies, and action self-efficacy were specified as predictors of the intention at Wave 1. Behavioral intention and coping serf-efficacy served as mediatcn linking the 3 predictors with low-fat and high-fiber dietary intake 6 months later at Wave 2. Covariance structure analysis yielded a good model fit for the total sample and 6 subsamples created by a median split of 3 moderators: gender, age, and body weight. Parameter estimates differed between samples; the importance of perceived self-efficacy increased with age and weight.

This review addresses the importance of studies of human psychoneuroimmunology in understanding the role of psychological factors in physical illness. First, it provides psychologically and biologically plausible explanations for how psychological factors might influence immunity and immune system-mediated disease. Second, it covers substantial evidence that factors such as stress, negative affect, clinical depression, social support, and repression/denial can influence both cellular and humoral indicators of immune status and function. Third, at least in the case of the less serious infectious diseases (colds, influenza, herpes), it considers consistent and convincing evidence of links between stress and negative affect and disease onset and progression. Although still early in its development, research also suggests a role of psychological factors in autoimmune diseases. Evidence for effects of stress, depression, and repression/denial on onset and progression of AIDS and cancer is less consistent and inconclusive, possibly owing to methodological limitations inherent in studying these complex illnesses, or because psychological influences on immunity are not of the magnitude or type necessary to alter the body's response in these cases. What is missing in this literature, however, is strong evidence that the associations between psychological factors and disease that do exist are attributable to immune changes.

Objective: Recent models suggest that generalized anxiety disorder (GAD) symptoms may be maintained by emotional processing avoidance and interpersonal problems. Method: This is the first randomized controlled trial to test directly whether cognitive-behavioral therapy (CBT) could be augmented with the addition of a module targeting interpersonal problems and emotional processing. Eighty-three primarily White participants (mean age ϭ 37) with a principle diagnosis of GAD were recruited from the community. Participants were assigned randomly to CBT plus supportive listening (n ϭ 40) or to CBT plus interpersonal and emotional processing therapy (n ϭ 43) within a study using an additive design. Doctoral-level psychologists with full-time private practices treated participants in an outpatient clinic. Using blind assessors, participants were assessed at pretreatment, posttreatment, 6-month, 1-year, and 2-year follow-up with a composite of self-report and assessor-rated GAD symptom measures (the Penn State Worry Questionnaire; T.

Disorder (BED). The intervention employed standard and eating-specific mindfulness meditation exercises as the core part of a six-week group treatment. Eighteen obese (BMI > 27) women, ages 25 to 62, who met DSM-IV criteria for BED, participated. A single-group extended baseline design was used, with full assessment at three weeks prior, at the start and end of the six week treatment, and at three weeks follow-up, with briefer assessments weekly.

Interventions to change health-related behaviours typically have modest effects and may be more effective if grounded in appropriate theory. Most theories applied to public health interventions tend to emphasise individual capabilities and motivation, with limited reference to context and social factors. Intervention effectiveness may be increased by drawing on a wider range of theories incorporating social, cultural and economic factors that influence behaviour. The primary aim of this paper is to identify theories of behaviour and behaviour change of potential relevance to public health interventions across four scientific disciplines: psychology, sociology, anthropology and economics. We report in detail the methodology of our scoping review used to identify these theories including which involved a systematic search of electronic databases, consultation with a multidisciplinary advisory group, web searching, searching of reference lists and hand searching of key behavioural scie...

We examined the relationship between perceived emotional intelligence (PEI), measured by the Trait Meta-Mood Scale (TMMS), and psychophysiological measures of adaptive coping. The TMMS assesses perceived ability to (a) attend to moods (Attention), (b) discriminate clearly among moods (Clarity), and (c) regulate moods (Repair). Study 1 showed significant positive associations between PEI and psychological and interpersonal functioning. In Study 2, skill at mood Repair was associated with less passive coping and perceptions of repeated laboratory stressors as less threatening; Clarity was related to greater increases in negative mood, but lower cortisol release during repeated stress. In Study 3, Repair was associated with active coping and lower levels of rumination; Attention was associated with lowered cortisol and blood pressure responses to acute laboratory challenges. These findings suggest that psychophysiological responses to stress may be one potential mechanism underlying the relationship between emotional functioning and health.

Several research literatures are reviewed that address the associations of emotional, informational, and instrumental social support to psychological adjustment to cancer. Descriptive studies suggest that emotional support is most desired by patients, and correlational studies suggest that emotional support has the strongest associations with better adjustment. However, the evidence for the effectiveness of peer discussion groups aimed at providing emotional support is less than convincing. Moreover, educational groups aimed at providing informational support appear to be as effective as, if not more effective than, peer discussions. Reasons for inconsistencies between the correlational and intervention literatures are discussed, and future directions are outlined.

Prenatal psychosocial predictors of infant birth weight and length of gestation were investigated in a prospective study of 120 Hispanic and 110 White pregnant women. Hypotheses specifying that personal resources (mastery, self-esteem, optimism), prenatal stress (state and pregnancy anxiety), and sociocultural factors (income, education, ethnicity) would have different effects on birth outcomes were tested using structural equation modeling. Results confirmed that women with stronger resources had higher birth weight babies ((3 = .21), whereas those reporting more stress had shorter gestations (|3 = -.20). Resources were also associated with lower stress ((3 = -.67), being married, being White, having higher income and education, and giving birth for the first time. There was no evidence that resources buffered the effects of stress. The importance of personal resources in pregnancy is highlighted along with implications for understanding the etiology of adverse birth outcomes.

Interventions are increasingly described as theory-based; however, the basis for this is often not clear. Advancing behavioural science requires a good understanding of how interventions are informed by, and test, theory. This study aims to develop a reliable method for assessing the extent to which behavioural interventions are theory-based.

Self-regulation systems are designed to adapt to threats via coping procedures that make efficient use of resources based upon valid representations of the environment. We discuss two components of the common-sense model of health threats: illness representations (e.g., content and organization) and coping procedures (e.g., classes of procedure and their attributes -outcome expectancies, time-lines, dose-efficacy beliefs, etc.). Characteristics of each of these domains, and the connection between the two, are critical to understanding human adaptation to problems of physical health. Rather than posing a barrier to factors outside the person that control behavior, an emphasis on subjective construal involves a view of the person as an active problem-solver embedded in a bi-directional system of sensitivity and responsiveness vis Ii vis the social, physical, and institutional environments in which health threats occur and through which intervention efforts may be directed.

Perceived support is consistently linked to good mental health, which is typically explained as resulting from objectively supportive actions that buffer stress. Yet this explanation has difficulty accounting for the often-observed main effects between support and mental health. Relational regulation theory (RRT) hypothesizes that main effects occur when people regulate their affect, thought, and action through ordinary yet affectively consequential conversations and shared activities, rather than through conversations about how to cope with stress. This regulation is primarily relational in that the types of people and social interactions that regulate recipients are mostly a matter of personal taste. RRT operationally defines relationships quantitatively, permitting the clean distinction between relationships and recipient personality. RRT makes a number of new predictions about social support, including new approaches to intervention.

The present study compared the modelling and control theories of parental in¯uence on children's eating attitudes and behaviour with a focus on snack foods. Matched questionnaires describing reported snack intake, eating motivations and body dissatisfaction were completed by 112 parent/child pairs. Parents completed additional items relating to control in terms of attempts to control their child's food intake and using food as a tool for controlling behaviour. The results showed signi®cant correlations between parent and child for reported snack intake, eating motivations and body dissatisfaction, indicating an important role for modelling. Parents were then divided according to their control scores. Children whose parents indicated greater attempts to control their child's diets reported higher intakes of both healthy and unhealthy snack foods. In addition, those children whose parents indicated a greater use of food as a means to control their child's behaviour reported higher levels of body dissatisfaction. The results provide some support for both the modelling and control theories of parental in¯uence. However, whereas modelling appears to have a consistent impact, parental control has a differential impact depending upon whether this control is focused on the child's diet or on other aspects of their behaviour. To conclude, a positive parental role model may be a better method for improving a child's diet than attempts at dietary control.

Often, health behavior seems to be governed not only by reasoned attitudes and goaldirected behavior but also by impulsive influences. The notion of a conflict between reflective and impulsive processing which is incorporated in prominent dual-system accounts (e.g., ) may yield important benefits for the understanding and prediction of health-related behavior. In this article, we suggest a basic framework for the prediction of health-related behavior which combines (a) reflective influences (as measured via self-report), (b) impulsive influences (as measured via implicit measures), and (c) situational or dispositional moderators that shift the weight between reflective and impulsive influences. The practical utility of such a framework is demonstrated by drawing on recent evidence from several areas of health psychology such as eating, drinking, drug abuse, and sexual behavior. Implications for the understanding of health behavior and applied health interventions are discussed.

Background Health at midlife is associated with early-life socioeconomic status (SES), intelligence and education; the latter often used as a marker of SES in adulthood. SES is typically modelled as a latent construct with reflective indicators (where the construct causes the variables) but may be better operationalised as a formative trait (where the variables cause the construct). In this report, the authors explain the difference between these two approaches and evaluate reflective and formative modelling for the prediction of health outcomes.

Methods The Aberdeen Children of the 1950s Study comprises 12150 children from the Aberdeen area of Scotland, of whom 7183 completed a follow-up questionnaire in middle age. Data were available on indicators of parental SES at birth of the participant, childhood intelligence at age 11 and education and self-rated health at midlife.

Results Childhood SES predicted childhood intelligence and educational attainment in adulthood, both of which partially mediated the effects of SES on self-rated health. Both approaches produced well-fitting models (CFI>0.99, TLI>0.99 and RMSEA<0.03), detected indirect effects from parental SES to health (all ps<0.001) and accounted for similar proportions of variance in health.

Conclusions In these data, there was little difference between reflective and formative models of SES in their ability to elucidate pathways from childhood SES to adult health. Formative approaches to modelling SES seem appropriate theoretically, yet reflective models were equally informative. The outcome chosen here was self-rated health, but the models are extensible to other health outcomes. Results may differ in other data sets, suggesting that it is first appropriate to compare both strategies.

The 2019 novel coronavirus (COVID-2019) has led to a serious outbreak of often severe respiratory disease, which originated in China and has quickly become a global pandemic, with far-reaching consequences that are unprecedented in the modern era. As public health officials seek to contain the virus and mitigate the deleterious effects on worldwide population health, a related threat has emerged: global media exposure to the crisis. We review research suggesting that repeated media exposure to community crisis can lead to increased anxiety, heightened stress responses that can lead to downstream effects on health, and misplaced health-protective and help-seeking behaviors that can overburden health care facilities and tax available resources. We draw from work on previous public health crises (i.e., Ebola and H1N1 outbreaks) and other collective trauma (e.g., terrorist attacks) where media coverage of events had unintended consequences for those at relatively low risk for direct exposure, leading to potentially severe public health repercussions. We conclude with recommendations for individuals, researchers, and public health officials with respect to receiving and providing effective communications during a public health crisis.

In a meta-analysis of 37 studies, the effects of psychoeducational (health education and stress management) programs for coronary heart disease patients were examined. The results suggest that these programs yielded a 34% reduction in cardiac mortality; a 29% reduction in recurrence of myocardial infarction (MI); and significant (p < .025) positive effects on blood pressure, cholesterol, body weight, smoking behavior, physical exercise, and eating habits. No effects of psychoeducational programs were found in regard to coronary bypass surgery, anxiety, or depression. The results also suggest that cardiac rehabilitation programs that were successful on proximal targets (systolic blood pressure, smoking behavior, physical exercise, emotional distress) were more effective on distal targets (cardiac mortality and MI recurrences) than programs without success on proximal targets.

This study examined the importance of major depression, depressive symptoms, history of major depression, anxiety, anger-in, anger-out, and perceived social support, measured in the hospital after a myocardial infarction (MI), in predicting cardiac events over the subsequent 12 months in a sample of 222 patients. Cardiac events included both recurrences of acute coronary syndromes (unstable angina admissions and survived and nonsurvived MI recurrences) and probable arrhythmic events (survived cardiac arrests and arrhythmic deaths). Major depression, depressive symptoms, anxiety, and history of major depression all significantly predicted cardiac events. Multivariate analyses showed that depressive symptoms, anxiety, and history of major depression each had an impact independent of each other, as well as of measures of cardiac disease severity.

This article evaluates an intervention based on P. M. concept of implementation intentions. Women registered at a medical practice in rural England (N = 114) completed measures of the theory of planned behavior variables before a manipulation that induced one half of the sample to form implementation intentions specifying when, where, and how they would make the appointment Subsequent attendance was determined from medical records. Findings show that the theory of planned behavior variables and previous delay behavior provided good prediction of attendance. However, despite equivalent motivation to attend, participants who formed implementation intentions were much more likely to attend for screening compared with controls (92% vs. 69%). Evidence also suggests that implementation intentions attenuated the relationship between previous delay behavior and subsequent attendance.

Objective: Stress in pregnancy predicts earlier birth and lower birth weight. The authors investigated whether pregnancy-specific stress contributes uniquely to birth outcomes compared with general stress, and whether prenatal health behaviors explain this association. Design: Three structured prenatal interviews (N ϭ 279) assessing state anxiety, perceived stress, life events, pregnancy-specific stress, and health behaviors. Main Outcome Measures: Gestational age at delivery, birth weight, preterm delivery (Ͻ37 weeks), and low birth weight (Ͻ2,500 g). Results: A latent pregnancy-specific stress factor predicted birth outcomes better than latent factors representing state anxiety, perceived stress, or life event stress, and than a latent factor constructed from all stress measures. Controlling for obstetric risk, pregnancy-specific stress was associated with smoking, caffeine consumption, and unhealthy eating, and inversely associated with healthy eating, vitamin use, exercise, and gestational age at delivery. Cigarette smoking predicted lower birth weight. Clinically-defined birth outcomes were predicted by cigarette smoking and pregnancy-specific stress. Conclusion: Pregnancy-specific stress contributed directly to preterm delivery and indirectly to low birth weight through its association with smoking. Pregnancyspecific stress may be a more powerful contributor to birth outcomes than general stress.

In this paper, we introduce the IM taxonomy of behavior change methods and its potential to be developed into a coding taxonomy. That is, although IM and its taxonomy of behavior change methods are not in fact new, because IM was originally developed as a tool for intervention development, this potential was not immediately apparent. Second, in explaining the IM taxonomy and defining the relevant constructs, we call attention to the existence of parameters for effectiveness of methods, and explicate the related distinction between theory-based methods and practical applications and the probability that poor translation of methods may lead to erroneous conclusions as to method-effectiveness. Third, we recommend a minimal set of intervention characteristics that may be reported when intervention descriptions and evaluations are published. Specifying these characteristics can greatly enhance the quality of our meta-analyses and other literature syntheses. In conclusion, the dynamics of...

Objective: To translate the Perceived Stress Scale and to assess its psychometric properties in a sample of general Greek population. Methods: 941 individuals completed anonymously questionnaires comprising of PSS, the Depression Anxiety and Stress scale (DASS-21 version), and a list of stress-related symptoms. Psychometric properties of PSS were investigated by confirmatory factor analysis (construct validity), Cronbach's alpha (reliability), and by investigating relations with the DASS-21 scores and the number of symptoms, across individuals' characteristics. The two-factor structure of PSS-10 and PSS-14 was confirmed in our analysis. We found satisfactory Cronbach's alpha values (0.82 for the full scale) for PSS-14 and PSS-10 and marginal satisfactory values for PSS-4 (0.69). PSS score exhibited high correlation OPEN ACCESS

Objective. The identification of the determinants of physical activity (PA) among older adults is an important avenue of research. To date, although the health action process approach (HAPA) has proven to be a valid framework for the prediction of PA among heterogeneous sample of both middle-aged and older adults in rehabilitation and work settings, no studies have specifically considered its predictive value among older adults in their retirement years. Therefore, drawing upon the HAPA, the present study aimed to identify the social cognitive determinants of PA involvement among retired older adults.

This research used the Information-Motivation-Behavioral Skills (1MB) model of AIDS risk behavior change to reduce AIDS risk behavior in a college student population. College students received an 1MB model-based intervention that addressed AIDS risk reduction information, motivation, and behavioral skills deficits that had been empirically identified in this population, or were assigned to a no-treatment control condition. At a 1-month follow-up, results confirmed that the intervention resulted in increases in AIDS risk reduction information, motivation, and behavioral skills, as well as significant increases in condom accessibility, safer sex negotiations, and condom use during sexual intercourse. At a long-term follow-up, the intervention again resulted in significant increases in AIDS preventive behaviors.

As the use of qualitative inquiry increases within the field of social work, researchers must consider the issue of establishing rigor in qualitative research. This article presents research procedures used in a study of autoethnographies that were written regarding the experience of being Jewish. In this project, the researchers utilized reflexivity, audit trail, triangulation by observer, peer debriefing, member check and prolonged engagement in order to manage the threats to trustworthiness as discussed by Padgett (1998). Implications of the project suggest that research procedures utilized by qualitative researchers to establish rigor are an important way to increase our confidence that the voice of the participants is heard, therefore fitting the mission of the social work profession.