Understanding Factors that Moderate the Relationship Between Student ADHD Behaviors and Teacher Stress.

Teaching is a stressful profession, and teacher stress has been shown to be associated with job dissatisfaction, attrition from the field, and negative outcomes for teachers and their students. A major contributor to teacher stress is disruptive student behavior. Given that students with or at-risk for attention-deficit/hyperactivity disorder (ADHD) demonstrate high rates of disruptive behaviors and are present in nearly every classroom, studying the connection between student ADHD symptoms and teacher stress may provide useful insights for better supporting teachers and their students. Aims of this study were to (1) assess the replicability of a previous finding that teachers rate their students with elevated ADHD symptoms to be more stressful to teach than students without these symptoms and (2) explore the extent to which key factors (i.e., overall work-related stress and student-teacher relationship quality) moderate the relationship between student ADHD symptoms and related teacher stress. Participants were 97 K-2nd grade teachers who completed an online survey about themselves and two male students in their classroom. Results showed that teachers report students with elevated levels of ADHD symptoms and impairment to be more stressful to work with than students who do not exhibit these symptoms (d = 1.52). Additionally, overall work-related stress and conflict in the student-teacher relationship exacerbated the relationship between student ADHD symptom severity and related teacher stress, whereas closeness in the student-teacher relationship mitigated this association. Implications of these findings and directions for future research are discussed.

What would it take to convince you to donate? A survey study of the relationship between motivators, barriers, and payment for whole blood, plasma, and platelet donation.

BACKGROUND: With growing discussion about blood donor remuneration, the present study examined the level of payment that may be required to convince individuals to engage in whole blood, plasma, and platelet donations. STUDY DESIGN AND METHODS: Anonymous online surveys were completed by a college sample [n = 490; 76.9% female; Mean Age = 20.3 (SD = 4.9) years; 32.9% whole blood donors] and a ResearchMatch sample [n = 323; 70.6% female; Mean Age = 50.7 (SD = 16.6) years; 82.7% whole blood donors]. Level of payment needed to motivate whole blood, plasma, and platelet donation was examined as a function of donation history, sample, and gender. In addition, path analyses examined associations between donation motivators, barriers, and payment level. RESULTS: Across all types of donation, history of whole blood donation was related to a greater willingness to donate without payment. At the same time, however, sizeable portions of prior donors indicated that monetary payment would convince them to donate whole blood (24%), plasma (51%), or platelets (57%). Across all types of donation, donation-related barriers (i.e., anxiety, fear) were indirectly related to higher payment levels via lower self-efficacy and more negative donation attitudes. Donation-related motivators (i.e., warm glow, regret, and altruism) were indirectly related to lower payment levels via higher self-efficacy and more positive donation attitudes. CONCLUSION: Despite reporting a strong commitment to nonremunerated blood donation, many respondents with and without a history of blood donation indicated that money would convince them to engage in whole blood, plasma, and platelet donation.

Fear is associated with attrition of first-time whole blood donors: A longitudinal examination of donor confidence and attitude as potential mediators.

BACKGROUND: Elevated fear and anxiety regarding donation-related stimuli (e.g., needles, pain, blood, fainting) has been associated with reduced blood donor recruitment and retention. The present longitudinal study tests the notion that this inverse relationship may be accounted for by lower donation confidence and more negative donation attitudes among fearful first-time donors. STUDY DESIGN AND METHODS: In a sample of 1479 first-time whole blood donors [67.9% female; mean age = 19.3 (standard deviation (SD) = 2.5) years], path analyses were conducted to examine relationships among donor ratings of fear of blood draw and donation anxiety obtained approximately 1 week after donation, donation confidence and attitudes assessed approximately 6 weeks later, and donation attempts over the 14 months following the original donation. RESULTS: Path analyses indicated that both fear of blood draws and donation anxiety were associated with fewer attempted donations, and that these effects were indirectly mediated by a combination of lower donor confidence and more negative donation attitudes. CONCLUSION: Because retention of new blood donors is essential to maintain a healthy blood supply, the results of the present study suggest that first-time donors should be assessed for fear and anxiety so that appropriate strategies can be provided to address their concerns, bolster their confidence and attitudes, and ultimately promote their long-term retention.

Results from the blood donor competence, autonomy, and relatedness enhancement (blood donor CARE) randomized trial.

BACKGROUND: This study aimed to promote competence, autonomy, and relatedness among first-time whole blood donors to enhance intrinsic motivation and increase retention. STUDY DESIGN AND METHODS: Using a full factorial design, first-time donors (N = 2002) were randomly assigned to a no-treatment control condition or to one of seven intervention conditions designed to promote donation competence, autonomy, relatedness, a combination of two (e.g., competence and autonomy), or all three constructs. Participants completed donor motivation measures before the intervention and 6 weeks later, and subsequent donation attempts were assessed for 1 year. RESULTS: There was no significant group difference in the frequency of donation attempts or in the number of days to return. Significant effects of group were observed for 10 of the 12 motivation measures, although follow-up analyses revealed significant differences from the control group were restricted to interventions that included an autonomy component. Path analyses confirmed direct associations between interventions involving autonomy and donor motivation, and indirect mediation of donation attempts via stronger donation intentions and lower donation anxiety. CONCLUSION: Among young, first-time, whole blood donors, brief interventions that include support for donor autonomy were associated with direct effects on donor motivation and indirect, but small, effects on subsequent donation behavior.

Pain resilience, pain catastrophizing, and executive functioning: performance on a short-term memory task during simultaneous ischemic pain.

Among pain researchers there is a growing interest in the relationship between psychological resilience and pain experience. Whereas much of this work has focused on individual differences in pain perception or sensitivity, an equally important dimension of resilience is the capacity to persist with goal-directed activity despite experiencing pain. Consistent with this latter focus, the current study examined how pain resilience and pain catastrophizing combine to moderate the effects of ischemic pain on short-term memory task performance. Using a within-subjects design, 121 healthy participants completed four trials of a Corsi block-tapping task with pain exposure during the second and fourth trials. Results indicated that a combination of high pain resilience and low pain catastrophizing was associated with better task performance during the second pain exposure. These findings confirm existing evidence that resilience can moderate performance during pain, and offer new evidence that resilience and catastrophizing interact to shape this effect.

Donation related fears predict vasovagal reactions and donor attrition among high school donors.

BACKGROUND: This longitudinal study of high school whole blood donors examined relationships among donation-related fears assessed prior to donation, vasovagal reactions to donation, and the proportion of donors who attempted another donation over the subsequent 60 weeks. STUDY DESIGN AND METHODS: Data regarding vasovagal reactions and attempted donation were obtained from donor records of 530 female and 342 male high school donors who answered questions about five types of fear (ie, of blood draw, needles, seeing blood, feeling pain, or fainting) prior to their index donation. RESULTS: Each type of fear was associated with an increased risk of vasovagal reactions (all P < .001) and a smaller percentage of attempted donations was seen among those who reported at least one type of fear (53%) as compared to those who did not report any fear (62.1%); P = .022; ß = -0.374, OR = 0.69; 95% CI, 0.50-0.94. Path analyses of the relationships among fear, vasovagal reaction, and attempted donation revealed significant indirect effects for each type of fear. Specifically, donors who reported fear were at increased odds of experiencing a vasovagal reaction, which, in turn, was associated with decreased odds of attempting a repeat donation. CONCLUSION: Donation-related fears are associated with reduced donor return rates, and this effect is mediated through an increased risk for vasovagal reactions. For both practical and ethical reasons, blood collectors are encouraged to identify and intervene with fearful donors to reduce the likelihood of negative donation-related symptoms and enhance donor retention.

Pain Acceptance Partially Mediates the Relationship Between Perceived Injustice and Pain Outcomes Over 3 Months.

OBJECTIVES: Perceived injustice is a maladaptive cognitive appraisal of pain or injury, characterized by attributions of blame, unfairness, severity of loss, and irreparability of loss. Research suggests that perceived injustice may negatively affect pain outcomes by inhibiting the development of pain-related acceptance. The current study aimed to extend cross-sectional research by testing whether pain acceptance mediates the effects of perceived injustice on pain-related outcomes longitudinally. MATERIALS AND METHODS: Data was analyzed from a prospective study to examine the potential mediating role of pain acceptance on recovery 3 months after an episode of low back pain. Using Mechanical Turk, we recruited participants who experienced an episode of back pain within the preceding 2 weeks, 343 of whom completed measures of perceived injustice, pain acceptance, pain ratings, and quality of life at each of 3 timepoints (recruitment, 1 mo later, and 3 mo later). Path analyses were conducted to examine pain acceptance at 1 month as a potential mediator of the relationship between perceived injustice at recruitment and pain intensity, disability, and depressive symptoms at 3 months. RESULTS: Results indicated that perceived injustice at recruitment was directly related to pain intensity, disability, and depressive symptoms 3 months later, and that pain acceptance partially mediated these relationships. DISCUSSION: Although these findings provide further support for pain acceptance as a buffer for the deleterious effects of perceived injustice, they also highlight that adjunctive mechanisms should be investigated to provide more comprehensive clinical insight.

Emotional mechanisms and format effects of motivational questions for blood donation.

Prior studies suggest that responding to online motivational questions increases blood donation intention. The present studies were designed to extend these findings by (a) exploring the impact of methodologic variations in the content and order of administration of specific questions on donation intention and (b) examining anticipated positive and negative emotional reactions as potential mediators. STUDY DESIGN AND METHODS: In the first study, 4709 respondents (51.2% female; mean ± SD age, 38.4 ± 12.1 years) were randomly assigned to one of four motivational questions or a no-question control. In the second study, 5291 respondents (52.7% female; mean ± SD age, 37.3 ± 11.9 years) were randomly assigned to one of six motivational questions or a no-question control. In both studies, the motivational questions were followed by measures of donation intention, anticipated warm glow, and anticipated regret. RESULTS: In Study 1, three of the four questions were associated with higher donation intentions, with anticipated warm glow being a potential partial mediator for two of the questions. In Study 2, five of the six questions were associated with higher donation intentions, with anticipated warm glow and anticipated regret being potential partial mediators for three of the questions. These effects were largely consistent among donors and nondonors. CONCLUSION: These studies expand our understanding of the association between particular motivational questions and donation intentions and provide preliminary support for the notion that specific questions may influence donation intention by increasing anticipated positive and negative emotional reactions to the thought of giving or not giving, respectively.

A motivational interview promotes retention of blood donors with high internal motivation.

BACKGROUND: Based on the hypothesis that self-determined motivation is associated with an increased likelihood of future behavior, the present study examined the ability of a motivational interview to promote internal motivation for giving blood and future donation attempts. STUDY DESIGN AND METHODS: A sample of 484 recent whole-blood and double red blood cell donors (62.4% female; age = 30.2 ± 11.8 years) were randomly assigned to either a telephone-delivered motivational interview or a control call approximately 6 weeks after donating. Several weeks before the call and again 1 week after the call, participants completed the Blood Donor Identity Survey, a multidimensional measure of donor motivation, to derive indices of amotivation, external motivation, and internal motivation to give blood. Repeat donation attempts were tracked using blood center records. RESULTS: Relative to controls, participants in the motivational interview group showed a shift toward more self-determined motivation, as indicated by significant decreases in amotivation (p = 0.01) and significant increases in external (p = 0.009) and internal (p = 0.002) motivation. Furthermore, those with initially high levels of autonomous motivation were more likely to make a donation attempt in the subsequent year if they completed the motivational interview (71.1%) versus the control call (55.1%). CONCLUSION: Motivational interviewing is a potentially useful strategy to enhance retention of existing blood donors, particularly among those who express a greater sense of internal motivation for giving.

Validation of the Pain Resilience Scale in a Chronic Pain Sample.

Psychosocial factors that protect against negative outcomes for individuals with chronic pain have received increased attention in recent years. Pain resilience, or the ability to maintain behavioral engagement and regulate emotions as well as cognitions despite prolonged or intense pain, is one such factor. A measure of pain-specific resilience, the Pain Resilience Scale, was previously identified as a better predictor of acute pain tolerance than general resilience. The present study sought to validate this measure in a chronic pain sample, while also furthering understanding of the role of pain resilience compared with other protective factors. Participants with chronic pain completed online questionnaires to assess factors related to positive pain outcomes, pain vulnerability, pain intensity, and quality of life. A confirmatory factor analysis confirmed the 2-factor structure of the Pain Resilience Scale previously observed among respondents without chronic pain, although one item from each subscale was dropped in the final version. For this chronic pain sample, structural equation modeling showed that pain resilience contributes unique variance to a model including pain acceptance and pain self-efficacy in predicting quality of life and pain intensity. Further, pain resilience was a better fit in this model than general resilience, strengthening the argument for assessing pain resilience over general resilience. PERSPECTIVE: A modified version of the Pain Resilience Scale retained the original factor structure when tested in a chronic pain sample. Construct validity was supported by expected relationships with pain-related protective and vulnerability measures. Further, a model including positive pain constructs showed that pain resilience accounts for unique variability when predicting quality of life and pain intensity.

A brief motivational interview promotes internal motivation to donate blood among young adults with and without a prior donation history.

BACKGROUND: Recruitment and retention of first-time and repeat donors is essential to maintain a stable blood supply. Recent evidence has shown that promoting internal motivation may be an effective strategy to enhance donation behavior. We tested the efficacy of an in-person motivational interview at increasing internal motivation and intention to donate. STUDY DESIGN AND METHODS: A sample of 219 donors and nondonors (69.4% female; mean ± SD age, 19.2 ± 1.1 years; 52.1% nondonors) were randomly assigned to either a motivational or a knowledge interview. Immediately before and after the interview participants completed a measure of donation intention and the Blood Donor Identity Survey, which is a multidimensional measure of donor motivation. RESULTS: A latent profile analysis revealed three distinct latent classes, which were identified as low internal motivation, mid internal motivation, and high internal motivation. Comparison of change in latent class from pre- to postinterview revealed that a higher proportion of participants in the motivational interview group moved to a more internally motivated class compared to the knowledge interview group (i.e., 34% vs. 4%, respectively). Further, relative to the knowledge interview group, participants in the motivational interview group reported greater increases in intention to donate. CONCLUSION: A brief motivational interview may enhance donation intention and intrinsic motivation among both experienced donors and nondonors alike.

Donating blood on a regular basis appears to reduce blood pressure, but appearances can be deceiving.

BACKGROUND: Previous studies have reported a relationship between blood donation and decreased risk for cardiovascular events, and it has been proposed that this may be due to a lowering of blood pressure among hypertensive individuals who donate on a regular basis. STUDY DESIGN AND METHODS: With the use of a retrospective longitudinal analysis, predonation blood pressure readings were examined across consecutive whole blood donations for New York Blood Center donors. With blood pressure levels recorded at the first, second, third, and fourth donations, the sample was divided into three subgroups including high (≥140 mmHg), intermediate (>100 and <40 mmHg), and low (≤100 mmHg) systolic blood pressure (SBP). In addition, a computational approach was used to estimate regression to the mean effects for donors with high SBP or high diastolic blood pressure (DBP) at their first, second, or third donation. RESULTS: Visual examination of SBP and DBP patterns across donations revealed that, on average, donors with extreme values at one donation had relatively normal values at the other donations. Further, comparison of computed expected versus observed blood pressure decreases supported the notion of a subsequent regression to the mean among donors with elevated SBP or DBP at Donation 1, 2, or 3. CONCLUSION: Among individuals who are hypertensive at initial donation, reductions in blood pressure at subsequent donations appear to result from regression to the mean as opposed to a salutary physiologic process.

Behavioral Inhibition and Behavioral Activation are Related to Habituation of Nociceptive Flexion Reflex, but Not Pain Ratings.

Habituation (ie, decreases in responding) and sensitization (ie, increases in responding) after prolonged or repeated exposures to a fixed stimulus have been identified as important in adaptation to repeated or prolonged noxious stimulation. Determinants of habituation or sensitization are poorly understood, and experimental investigation of habituation of pain ratings have generally relied on pain reports and statistical techniques that average responses across a group of participants. Using a cross-sectional design, the current study used multilevel growth curve analyses to examine changes in the nociceptive flexion reflex (NFR), a spinal nociceptive withdrawal reflex, and pain ratings in response to 12 repeated, constant intensity, noxious electrocutaneous stimuli. Unconditional growth curve models indicated that, on average, participants evidenced habituation of the NFR and sensitization of pain ratings. However, a substantial subgroup of participants exhibited the opposite pattern of change. In conditional models, behavioral inhibition, b = .10, P = .003, and behavioral activation, b = -.07, P = .07, independently interacted with the growth curve to predict changes in NFR, but not pain ratings, across the 12 stimuli. These findings provide preliminary experimental support for Jensen and colleagues' 2-factor model of pain experience and implicate a role for approach and avoidance motivations in descending modulation of NFR. PERSPECTIVE: Using repeated NFR stimulation, this study showed that most participants exhibited NFR habituation and pain sensitization; however, a substantial subgroup showed an opposite pattern of pain habituation (25.0%) and NFR sensitization (31.4%). Further, NFR habituation was moderated by individual differences in behavioral activation and behavioral inhibition.

The impact of the context and recruitment materials on nondonors' willingness to donate blood.

BACKGROUND: Anxiety is a frequently cited barrier to blood donor recruitment. Although the mere presence of donation paraphernalia can heighten anxiety for some individuals, such stimuli are a necessary and unavoidable part of donation. Drawing on France and colleagues' research on tailored donor education and coping materials, the current study assessed whether modifying recruitment materials could improve donor recruitment in a context where anxiety is heightened. STUDY DESIGN AND METHODS: A field study comprising a 2 (presence or absence of a mobile blood collection unit [MCU]) × 2 (recruitment brochure: standard, coping) between-subjects design was conducted with 922 nondonors who believed themselves eligible to donate blood. In either the presence or absence of the MCU, participants received a standard or modified recruitment brochure modeled on France and colleagues' education and coping materials. Donation anxiety, attitude, subjective norm, self-efficacy, and intention were assessed, and donation behavior was tracked for 30 days. RESULTS: Participants who were assessed in the presence of the MCU reported heightened anxiety, and female participants reported decreased self-efficacy. The coping brochure improved self-efficacy, heightened the intention to donate in the presence of the MCU, and promoted blood donation behavior relative to the standard brochure. Path analyses supported a model in which, in the presence of the MCU, the coping brochure boosted self-efficacy and led to increased donation intention and behavior. CONCLUSIONS: In a context in which donation-related anxiety is heightened, provision of materials that address prospective donor concerns and suggest coping strategies can bolster self-efficacy and promote recruitment.

Development and Initial Validation of the Pain Resilience Scale.

UNLABELLED: Over the past decade, the role of positive psychology in pain experience has gained increasing attention. One such positive factor, identified as resilience, has been defined as the ability to maintain positive emotional and physical functioning despite physical or psychological adversity. Although cross-situational measures of resilience have been shown to be related to pain, it was hypothesized that a pain-specific resilience measure would serve as a stronger predictor of acute pain experience. To test this hypothesis, we conducted a series of studies to develop and validate the Pain Resilience Scale. Study 1 described exploratory and confirmatory factor analyses that support a scale with 2 distinct factors, Cognitive/Affective Positivity and Behavioral Perseverance. Study 2 showed test-retest reliability and construct validity of this new scale, including moderate positive relationships with measures of positive psychological functioning and small to moderate negative relationships with vulnerability measures such as pain catastrophizing. Finally, consistent with our initial hypothesis, study 3 showed that the Pain Resilience Scale is more strongly related to ischemic pain responses than existing measures of general resilience. Together, these studies support the predictive utility of this new pain-specific measure of resilience in the context of acute experimental pain. PERSPECTIVE: The Pain Resilience Scale represents a novel measure of Cognitive/Affective Positivity and Behavioral Perseverance during exposure to noxious stimuli. Construct validity is supported by expected relationships with existing pain-coping measures, and predictive validity is shown by individual differences in response to acute experimental pain.

Blood donation fears inventory: development and validation of a measure of fear specific to the blood donation setting.

BACKGROUND AND OBJECTIVES: Although individual differences in fear of stimuli related to blood donation is a key determinant of donor recruitment and retention, a donation-specific fear measure has yet to be developed. MATERIALS AND METHODS: A donation-related fear measure was developed and tested on an initial sample of donors and non-donors, and then re-evaluated on a second sample to confirm the observed factor structure. RESULTS: Analyses supported a four-factor structure, with subscales related to fear of: (1) syncopal symptoms, (2) blood and needles, (3) social evaluation, and (4) health screen results. CONCLUSION: The Blood Donation Fears Inventory is a novel measure to assess fears held by current and potential blood donors.

The blood donor identity survey: a multidimensional measure of blood donor motivations.

BACKGROUND: Evidence indicates that donor identity is an important predictor of donation behavior; however, prior studies have relied on diverse, unidimensional measures with limited psychometric support. The goals of this study were to examine the application of self-determination theory to blood donor motivations and to develop and validate a related multidimensional measure of donor identity. STUDY DESIGN AND METHODS: Items were developed and administered electronically to a sample of New York Blood Center (NYBC) donors (n=582) and then to a sample of Ohio University students (n=1005). Following initial confirmatory factor analysis (CFA) on the NYBC sample to identify key items related to self-determination theory's six motivational factors, a revised survey was administered to the university sample to reexamine model fit and to assess survey reliability and validity. RESULTS: Consistent with self-determination theory, for both samples CFAs indicated that the best fit to the data was provided by a six-motivational-factor model, including amotivation, external regulation, introjected regulation, identified regulation, integrated regulation, and intrinsic regulation. CONCLUSION: The Blood Donor Identity Survey provides a psychometrically sound, multidimensional measure of donor motivations (ranging from unmotivated to donate to increasing levels of autonomous motivation to donate) that is suitable for nondonors as well as donors with varying levels of experience. Future research is needed to examine longitudinal changes in donor identity and its relationship to actual donation behavior.

Development of common metrics for donation attitude, subjective norm, perceived behavioral control, and intention for the blood donation context.

BACKGROUND: The Theory of Planned Behavior has been widely used in blood donation research, but the lack of uniform, psychometrically sound measures makes it difficult to draw firm conclusions or compare results across studies. Accordingly, the goal of this study was to develop such measures of donation attitude, subjective norm, perceived behavioral control, and intention. STUDY DESIGN AND METHODS: Exploratory and confirmatory factor analyses (CFAs) were conducted on survey responses collected from college students (n = 1080). The resulting scales were then administered to an independent sample of experienced donors (n = 433) for additional CFAs and to test whether the Theory of Planned Behavior model provided a good fit to the data. RESULTS: CFAs conducted on both samples support the use of six-item scales, with two factors each, to measure donation attitude, subjective norm, and perceived behavioral control and a single-factor three-item scale to measure donation intention. Further, structural equation modeling of these measures revealed that the Theory of Planned Behavior provided a strong fit to the data (comparative fit index, 0.976; root mean square error of approximation, 0.041; standardized root mean square residual, 0.055) and accounted for 73.7% of the variance in donation intention. CONCLUSION: The present findings confirm the applicability of the Theory of Planned Behavior to the blood donation context and more importantly provide psychometric support for the future use of four brief measures of donation attitude, subjective norm, perceived behavioral control, and intention.

Fear of blood draws, vasovagal reactions, and retention among high school donors.

BACKGROUND: We previously demonstrated that fear of having blood drawn is one of the strongest known predictors of vasovagal reactions among high school blood donors. This report examines the combined effects of donor fear and experience of vasovagal reactions on repeat donation attempts among high school blood donors. STUDY DESIGN AND METHODS: Immediately after completing the blood donor health screening, 1715 high school students were asked about their fear of having blood drawn. The donor record was then used to collect information regarding their experience of vasovagal reactions at the time of donation as well as their subsequent donation attempts within the following year. RESULTS: Fear of having blood drawn and the experience of a vasovagal reaction each contributed to donor attrition, with only 33.2% of fearful donors who experienced a vasovagal reaction returning in the following year compared to 56.7% of nonfearful nonreactors. Path analyses demonstrated that fear has an indirect effect (through vasovagal reactions) on repeat donations among first-time donors and both direct and indirect effects on repeat donation attempts among experienced donors. CONCLUSION: Among high school blood donors, fear of having blood drawn has both a direct negative effect on donor retention and an indirect negative effect by increasing the risk of vasovagal reactions. Accordingly, targeted efforts to reduce donor fear may be particularly efficient in promoting long-term donor loyalty among our youngest donors.

Donor anxiety, needle pain, and syncopal reactions combine to determine retention: a path analysis of two-year donor return data.

BACKGROUND: Efforts to expand the donor pool by recruiting younger donors have resulted in higher numbers of initial donations, but retention of young donors continues to be challenging. STUDY DESIGN AND METHODS: Path analysis was used to examine the simultaneous relationships among syncopal reactions, donation anxiety, needle pain, donor satisfaction, and donation intention in predicting repeat donation. Participants included 421 first- and second-time donors recruited for a study comparing the effects of predonation water loading with and without the use of applied muscle tension during donation (52% female, 60.8% first-time donor, mean age 20.3 years). For this longitudinal follow-up study, donor database records were accessed 2 years after the index donation to assess repeat donation. RESULTS: Results of a series of path analyses demonstrated the influential role of donor anxiety in shaping donor retention (final model χ(2) = 35.75, root mean square error of approximation 0.03, comparative fit index 0.98, weighted root mean square residual 0.74). First, anxiety exerted a direct negative influence on donation intention, the proximal and sole direct predictor of repeat donation. Second, anxiety increased the likelihood of donor-reported needle pain, adversely affecting donation satisfaction and, subsequently, donation intention. Finally, anxiety was associated with donor ratings of syncopal reactions through its impact on needle pain, which also contributed to decreased donation intention. CONCLUSION: These results provide novel evidence that donation anxiety plays a central role in shaping future donation behavior. Individual differences in anxiety must be considered when developing and testing strategies to enhance blood donor retention.