Sense of purpose among transgender adults in the United States: comparisons of levels and health correlates.

Given the increased threats to health and well-being faced by transgender individuals, research is needed to understand potential protective factors. Recent work has suggested that a sense of purpose may be one of the health-promoting resources available to marginalized groups, and levels of purpose are often similar or even higher among these groups. However, research is limited regarding whether this factor manifests differently among transgender adults. The current study (n = 1968 U.S. adults; 4.3% identified as transgender) asked participants to complete surveys for sense of purpose, self-rated health, life satisfaction and the type of purposes they deemed important. The findings suggest no difference in levels of sense of purpose between transgender and non-transgender adults. Transgender adults reported slightly lower levels of importance across multiple purposes, which merits further investigation into whether they perceive greater obstacles toward those goals. Of central importance, sense of purpose positively correlated with self-rated health (r = .50) and life satisfaction for transgender adults (r = .77), at similar or even greater magnitudes than for the non-transgender adults. These results point to the potential of exploring sense of purpose as an intervention target for promoting transgender health and well-being, and future directions should focus on the multiple pathways by which transgender identity may influence purpose development.

Older Adults Place Greater Importance Than Younger Adults on a Purposeful Retirement.

Objective: Regarding retirement, some but not all people decline in sense of purpose, and retirees may view maintaining a sense of purpose as nonessential. These findings suggest individual differences both in the importance placed on being purposeful during retirement in general and the discrepancy for purpose importance prior to and during retirement. Method: This study surveyed U.S. adults (n = 2009, Mage = 48.51) asking them about how they viewed having a purpose in two life stages: before and during retirement, as well as personality and demographic questions. Results: Findings suggest that, overall, people believe it is important to have a purpose and direction during retirement. This tendency was greater among older adults, and those higher on conscientiousness or lower on neuroticism. However, working status did not play a role in the perceived importance of purpose during the retirement period. Moreover, age differentiated who perceives during-retirement purpose as more important than prior-to-retirement purpose. Conclusion: The current findings add to our understanding of when individuals expect to be purposeful and counter the claims that older adults may place less importance on being purposeful. Instead, these findings point to the need for continuing work on how to help older adults maintain or find a purpose in life following retirement.

Effects of self-transcendence on neural responses to persuasive messages and health behavior change.

Self-transcendence refers to a shift in mindset from focusing on self-interests to the well-being of others. We offer an integrative neural model of self-transcendence in the context of persuasive messaging by examining the mechanisms of self-transcendence in promoting receptivity to health messages and behavior change. Specifically, we posited that focusing on values and activities that transcend the self can allow people to see that their self-worth is not tied to a specific behavior in question, and in turn become more receptive to subsequent, otherwise threatening health information. To test whether inducing self-transcendent mindsets before message delivery would help overcome defensiveness and increase receptivity, we used two priming tasks, affirmation and compassion, to elicit a transcendent mindset among 220 sedentary adults. As preregistered, those who completed a self-transcendence task before health message exposure, compared with controls, showed greater increases in objectively logged levels of physical activity throughout the following month. In the brain, self-transcendence tasks up-regulated activity in a region of the ventromedial prefrontal cortex, chosen for its role in positive valuation and reward processing. During subsequent health message exposure, self-transcendence priming was associated with increased activity in subregions of the ventromedial prefrontal cortex, implicated in self-related processing and positive valuation, which predicted later decreases in sedentary behavior. The present findings suggest that having a positive self-transcendent mindset can increase behavior change, in part by increasing neural receptivity to health messaging.

Self-affirmation alters the brain's response to health messages and subsequent behavior change.

Health communications can be an effective way to increase positive health behaviors and decrease negative health behaviors; however, those at highest risk are often most defensive and least open to such messages. For example, increasing physical activity among sedentary individuals affects a wide range of important mental and physical health outcomes, but has proven a challenging task. Affirming core values (i.e., self-affirmation) before message exposure is a psychological technique that can increase the effectiveness of a wide range of interventions in health and other domains; however, the neural mechanisms of affirmation's effects have not been studied. We used functional magnetic resonance imaging (fMRI) to examine neural processes associated with affirmation effects during exposure to potentially threatening health messages. We focused on an a priori defined region of interest (ROI) in ventromedial prefrontal cortex (VMPFC), a brain region selected for its association with self-related processing and positive valuation. Consistent with our hypotheses, those in the self-affirmation condition produced more activity in VMPFC during exposure to health messages and went on to increase their objectively measured activity levels more. These findings suggest that affirmation of core values may exert its effects by allowing at-risk individuals to see the self-relevance and value in otherwise-threatening messages.

The Effectiveness of Web-Based Tailored Smoking Cessation Interventions on the Quitting Process (Project Quit): Secondary Analysis of a Randomized Controlled Trial.

BACKGROUND: Project Quit was a randomized Web-based smoking cessation trial designed and conducted by researchers from the University of Michigan, where its primary outcome was the 7-day point prevalence. One drawback of such an outcome is that it only focuses on smoking behavior over a very short duration, rather than the quitting process over the entire study period. OBJECTIVE: The aim of this study was to consider the number of quit attempts during the 6-month study period as an alternative outcome, which would better reflect the quitting process. We aimed to find out whether tailored interventions (high vs low) are better in reducing the number of quit attempts for specific subgroups of smokers. METHODS: To identify interactions between intervention components of smoking cessation and individual smoker characteristics, we employed Poisson regression to analyze the number of quit attempts. This approach allowed us to construct data-driven, personalized interventions. RESULTS: A negative effect of the number of cigarettes smoked per day (P=.03) and a positive effect of education (P=.03) on the number of quit attempts were detected from the baseline covariates (n=792). Thus, for every 10 extra cigarettes smoked per day, there was a 5.84% decrease in the expected number of quit attempts. Highly educated participants had a 15.49% increase in their expected number of quit attempts compared with their low-educated counterparts. A negative interaction between intervention component story and smoker's education was also detected (P=.03), suggesting that a high-tailored story given to highly educated people results in 13.50% decrease in the number of quit attempts compared with a low-tailored story. CONCLUSIONS: A highly individually tailored story is significantly more effective for smokers with a low level of education. This is consistent with prior findings from Project Quit based on the 7-day point prevalence.

Self-Transcendent Values and Neural Responses to Threatening Health Messages.

OBJECTIVE: Prioritizing self-transcendent values such as family and friends more than nontranscendent values such as wealth and privilege is associated with lower stress response. In this study, we tested whether having self-transcendent values can reduce specific responses in the brain in the context of potentially threatening health communications. METHODS: Sedentary adults (N = 67) who would likely feel threatened by health messages that highlight the risk of sedentary behavior were recruited. Participants indicated the degree to which they prioritize self-transcendent values more than nontranscendent values. Using functional magnetic resonance imaging, participants' neural responses to health messages were assessed within neural regions implicated in threat responses, including bilateral amygdala and anterior insula (AI). RESULTS: A tendency to prioritize self-transcendent more than nontranscendent values was associated with lower reactivity during exposure to health messages within anatomically defined regions of left amygdala (t(55) = -2.66, p = .010, 95% confidence interval [CI] = -0.08 to -0.01), right amygdala (t(55) = -2.22, p = .031, 95% CI = -0.06 to 0.0), and left AI (t(55) = -2.17, p = .034, 95% CI = -0.04 to 0.0), as well as a mask functionally defined to be associated with "threat" using an automated meta-analysis (t(55) = -2.04, p = .046, 95% CI = -0.05 to 0.0). No significant effect was obtained within the right AI (t(55) = -1.38, p = .17, 95% CI = -0.04 to .01). These effects were partially enhanced by reinforcing important values through self-affirmation, remained significant after accounting for self-reported social connection, and were specific to health message processing (versus generic self-related information). CONCLUSIONS: Attenuated neural reactivity to potentially threatening health messages may be a novel way that prioritizing self-transcendent values could lead to positive health behaviors.

Purpose in life and use of preventive health care services.

Purpose in life has been linked with better health (mental and physical) and health behaviors, but its link with patterns of health care use are understudied. We hypothesized that people with higher purpose would be more proactive in taking care of their health, as indicated by a higher likelihood of using preventive health care services. We also hypothesized that people with higher purpose would spend fewer nights in the hospital. Participants (n = 7,168) were drawn from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50, and tracked for 6 y. After adjusting for sociodemographic factors, each unit increase in purpose (on a six-point scale) was associated with a higher likelihood that people would obtain a cholesterol test [odds ratio (OR) = 1.18, 95% confidence interval (CI) = 1.08-1.29] or colonoscopy (OR = 1.06, 95% CI = 0.99-1.14). Furthermore, females were more likely to receive a mammogram/X-ray (OR = 1.27, 95% CI = 1.16-1.39) or pap smear (OR = 1.16, 95% CI = 1.06-1.28), and males were more likely to receive a prostate examination (OR = 1.31, 95% CI = 1.18-1.45). Each unit increase in purpose was also associated with 17% fewer nights spent in the hospital (rate ratio = 0.83, 95% CI = 0.77-0.89). An increasing number of randomized controlled trials show that purpose in life can be raised. Therefore, with additional research, findings from this study may inform the development of new strategies that increase the use of preventive health care services, offset the burden of rising health care costs, and enhance the quality of life among people moving into the ranks of our aging society.

Purpose in life and incidence of sleep disturbances.

Purpose in life has been linked with better mental health, physical health, and health behaviors, but the association between purpose and sleep is understudied. Sleep disturbances increase with age and as the number of older adults rapidly increases, it is ever more important to identify modifiable factors that are associated with reduced incidence of sleep disturbances. We used multiple logistic regression models and data from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50, to examine whether higher purpose was linked with a reduced incidence of sleep disturbances. Among 4144 respondents reporting minimal or no sleep disturbances at baseline, higher purpose was associated with a lower incidence of sleep disturbances over the 4-year follow-up. After adjusting for sociodemographic factors, each unit increase in purpose (on a six-point scale) was associated with a 16 % reduced odds of developing sleep disturbances (OR 0.84, 95 % CI 0.77-0.92). The association between purpose and sleep disturbances remained after adjusting for sociodemographic, behavioral, psychological, and health covariates. Should future research replicate our findings, this area of research may lead to innovative efforts that improve the quality of sleep in older adults.

Reduced Epigenetic Age in Older Adults With High Sense of Purpose in Life.

Psychosocial risk factors have been linked with accelerated epigenetic aging, but little is known about whether psychosocial resilience factors (eg, Sense of Purpose in Life) might reduce epigenetic age acceleration. In this study, we tested if older adults who experience high levels of Purpose might show reduced epigenetic age acceleration. We evaluated the relationship between Purpose and epigenetic age acceleration as measured by 13 DNA methylation (DNAm) "epigenetic clocks" assessed in 1 572 older adults from the Health and Retirement Study (mean age 70 years). We quantified the total association between Purpose and DNAm age acceleration as well as the extent to which that total association might be attributable to demographic factors, chronic disease, other psychosocial variables (eg, positive affect), and health-related behaviors (heavy drinking, smoking, physical activity, and body mass index [BMI]). Purpose in Life was associated with reduced epigenetic age acceleration across 4 "second-generation" DNAm clocks optimized for predicting health and longevity (false discovery rate [FDR] q < 0.0001: PhenoAge, GrimAge, Zhang epigenetic mortality index; FDR q < 0.05: DunedinPoAm). These associations were independent of demographic and psychosocial factors, but substantially attenuated after adjusting for health-related behaviors (drinking, smoking, physical activity, and BMI). Purpose showed no significant association with 9 "first-generation" DNAm epigenetic clocks trained on chronological age. Older adults with greater Purpose in Life show "younger" DNAm epigenetic age acceleration. These results may be due in part to associated differences in health-related behaviors. Results suggest new opportunities to reduce biological age acceleration by enhancing Purpose and its behavioral sequelae in late adulthood.

Reduced epigenetic age in older adults who volunteer.

BACKGROUND: Volunteering is associated with improved health and well-being outcomes, including a reduced risk of mortality. However, the biological mechanisms underlying the association between volunteering and healthy aging and longevity have not been well-established. We evaluated if volunteering was associated with reduced epigenetic age acceleration in older adults. METHODS: We evaluated associations between volunteering and age acceleration, measured by 13 DNA methylation (DNAm) "epigenetic clocks" in 4011 older adults (Mage=69 years; SDage=10 years) who participated in the Health and Retirement Study. We assessed 9 first-generation clocks (Horvath, Hannum, Horvath Skin, Lin, Garagnani, Vidalbralo, Weidner, Yang, and Bocklandt, which predict chronological age) and 4 second-generation clocks (Zhang, PhenoAge, GrimAge, and DunedinPoAm, which predict future disease or longevity). We quantified the total associations between volunteering and DNAm age acceleration as well as the extent to which these associations might be attributable to potential confounding by individual demographics (e.g., race), social demographics (e.g., income), health factors (e.g., diabetes), and health behaviors (e.g., smoking). RESULTS: Volunteering was associated with reduced epigenetic age acceleration across 6 epigenetic clocks optimized for predicting health and longevity (False Discovery Rate [FDR] q < 0.0001 for epigenetic clocks: PhenoAge, GrimAge, DunedinPoAm, Zhang mortality, Yang mitotic; FDR q < 0.01: Hannum). These associations were mostly independent of demographic and health factors, but substantially attenuated after adjusting for health behaviors. CONCLUSION: Volunteering was associated with reduced epigenetic age acceleration in 6 of 13 (mostly second-generation) epigenetic clocks. Results provide preliminary evidence that volunteering might provide health benefits through slower biological aging and implicate health behaviors as one potential mechanism of such effects.

Amygdala response to smoking-cessation messages mediates the effects of serotonin transporter gene variation on quitting.

The amygdala is critically involved in detecting emotionally salient stimuli and in enhancing memory for emotional information. Growing evidence also suggests that the amygdala plays a crucial role in addiction, perhaps by strengthening associations between emotionally-charged drug cues and drug-seeking behavior. In the current study, by integrating functional MRI (fMRI), genetics, and outcome data from a large group of smokers who completed a smoking-cessation intervention and attempted to quit, we show that the amygdala also plays a role in quitting. Specifically, we demonstrate that the amygdala response to smoking-cessation messages in smokers trying to quit is a predictor of their post-intervention quitting outcome. We further show that the amygdala response is modulated by genetic variation in the serotonin transporter and mediates the impact of this genetic variation on quitting. These results point to a gene-brain-behavior pathway relevant to smoking cessation, and add to our understanding of the role of the amygdala in nicotine addiction.

Integrating an internet-mediated walking program into family medicine clinical practice: a pilot feasibility study.

BACKGROUND: Regular participation in physical activity can prevent many chronic health conditions. Computerized self-management programs are effective clinical tools to support patient participation in physical activity. This pilot study sought to develop and evaluate an online interface for primary care providers to refer patients to an Internet-mediated walking program called Stepping Up to Health (SUH) and to monitor participant progress in the program. METHODS: In Phase I of the study, we recruited six pairs of physicians and medical assistants from two family practice clinics to assist with the design of a clinical interface. During Phase II, providers used the developed interface to refer patients to a six-week pilot intervention. Provider perspectives were assessed regarding the feasibility of integrating the program into routine care. Assessment tools included quantitative and qualitative data gathered from semi-structured interviews, surveys, and online usage logs. RESULTS: In Phase I, 13 providers used SUH and participated in two interviews. Providers emphasized the need for alerts flagging patients who were not doing well and the ability to review participant progress. Additionally, providers asked for summary views of data across all enrolled clinic patients as well as advertising materials for intervention recruitment. In response to this input, an interface was developed containing three pages: 1) a recruitment page, 2) a summary page, and 3) a detailed patient page. In Phase II, providers used the interface to refer 139 patients to SUH and 37 (27%) enrolled in the intervention. Providers rarely used the interface to monitor enrolled patients. Barriers to regular use of the intervention included lack of integration with the medical record system, competing priorities, patient disinterest, and physician unease with exercise referrals. Intention-to-treat analyses showed that patients increased walking by an average of 1493 steps/day from pre- to post-intervention (t = (36) = 4.13, p < 0.01). CONCLUSIONS: Providers successfully referred patients using the SUH provider interface, but were less willing to monitor patient compliance in the program. Patients who completed the program significantly increased their step counts. Future research is needed to test the effectiveness of integrating SUH with clinical information systems over a longer evaluation period.

Sense of purpose in life predicts greater willingness for COVID-19 vaccination.

RATIONALE: Despite the clear public health significance of herd immunity to COVID-19, a host of individual differences influence willingness to get vaccinated. One factor likely to motivate individuals is the extent they have a sense of purpose in life, based on the health correlates of purpose and purposeful individuals' desire to return to their pre-pandemic environments. OBJECTIVE: The current study examined sense of purpose as a predictor of COVID-19 vaccination willingness in the United States immediately following the initial approval of a COVID-19 vaccine in the United States in 2020. METHODS: A nationwide sample of U. S. adults (N = 2009) completed a poll including information on their sense of purpose in life, demographic factors, and depressive symptoms, immediately following the initial approval of a COVID-19 vaccine in the United States in 2020. In addition, they reported on how willing they would be to get the vaccine, assuming that the costs would be covered, as well as their motivations to get the vaccine. RESULTS: Multiple regression analyses found that sense of purpose predicted greater willingness to get vaccinated, even when accounting for demographic factors, political affiliation, and psychological wellbeing. Adults higher on sense of purpose reported greater importance of getting the vaccine for personal health, the health of others, and to return to regular activities. Exploratory analyses also suggest that purpose may provide a stronger impetus to vaccinate among those in age groups associated with lower risk for severe COVID-19 complications. CONCLUSIONS: Although cross-sectional in nature, the current findings suggest sense of purpose in life may be an important factor in encouraging vaccination. Implications are discussed regarding how purposeful messaging may yield greater vaccination rates among individuals who otherwise may be less motivated due to health concerns.

A randomized clinical trial evaluating online interventions to improve fruit and vegetable consumption.

OBJECTIVES: We assessed change in fruit and vegetable intake in a population-based sample, comparing an online untailored program (arm 1) with a tailored behavioral intervention (arm 2) and with a tailored behavioral intervention plus motivational interviewing-based counseling via e-mail (arm 3). METHODS: We conducted a randomized controlled intervention trial, enrolling members aged 21 to 65 years from 5 health plans in Seattle, Washington; Denver, Colorado; Minneapolis, Minnesota; Detroit, Michigan; and Atlanta, Georgia. Participants reported fruit and vegetable intake at baseline and at 3, 6, and 12 months. We assessed mean change in fruit and vegetable servings per day at 12 months after baseline, using a validated self-report fruit and vegetable food frequency questionnaire. RESULTS: Of 2540 trial participants, 80% were followed up at 12 months. Overall baseline mean fruit and vegetable intake was 4.4 servings per day. Average servings increased by more than 2 servings across all study arms (P<.001), with the greatest increase (+2.8 servings) among participants of arm 3 (P=.05, compared with control). Overall program satisfaction was high. CONCLUSIONS: This online nutritional intervention was well received, convenient, easy to disseminate, and associated with sustained dietary change. Such programs have promise as population-based dietary interventions.

An online community improves adherence in an internet-mediated walking program. Part 1: results of a randomized controlled trial.

BACKGROUND: Approximately half of American adults do not meet recommended physical activity guidelines. Face-to-face lifestyle interventions improve health outcomes but are unlikely to yield population-level improvements because they can be difficult to disseminate, expensive to maintain, and inconvenient for the recipient. In contrast, Internet-based behavior change interventions can be disseminated widely at a lower cost. However, the impact of some Internet-mediated programs is limited by high attrition rates. Online communities that allow participants to communicate with each other by posting and reading messages may decrease participant attrition. OBJECTIVE: Our objective was to measure the impact of adding online community features to an Internet-mediated walking program on participant attrition and average daily step counts. METHODS: This randomized controlled trial included sedentary, ambulatory adults who used email regularly and had at least 1 of the following: overweight (body mass index [BMI] ≥ 25), type 2 diabetes, or coronary artery disease. All participants (n = 324) wore enhanced pedometers throughout the 16-week intervention and uploaded step-count data to the study server. Participants could log in to the study website to view graphs of their walking progress, individually-tailored motivational messages, and weekly calculated goals. Participants were randomized to 1 of 2 versions of a Web-based walking program. Those randomized to the "online community" arm could post and read messages with other participants while those randomized to the "no online community" arm could not read or post messages. The main outcome measures were participant attrition and average daily step counts over 16 weeks. Multiple regression analyses assessed the effect of the online community access controlling for age, sex, disease status, BMI, and baseline step counts. RESULTS: Both arms significantly increased their average daily steps between baseline and the end of the intervention period, but there were no significant differences in increase in step counts between arms using either intention-to-treat or completers analysis. In the intention-to-treat analysis, the average step count increase across both arms was 1888 ± 2400 steps. The percentage of completers was 13% higher in the online community arm than the no online community arm (online community arm, 79%, no online community arm, 66%, P = .02). In addition, online community arm participants remained engaged in the program longer than no online community arm participants (hazard ratio = 0.47, 95% CI = 0.25 - 0.90, P = .02). Participants with lower baseline social support posted more messages to the online community (P < .001) and viewed more posts (P < .001) than participants with higher baseline social support. CONCLUSION: Adding online community features to an Internet-mediated walking program did not increase average daily step counts but did reduce participant attrition. Participants with low baseline social support used the online community features more than those with high baseline social support. Thus, online communities may be a promising approach to reducing attrition from online health behavior change interventions, particularly in populations with low social support. TRIAL REGISTRATION: NCT00729040; http://clinicaltrials.gov/ct2/show/NCT00729040 (Archived by WebCite at http://www.webcitation.org/5v1VH3n0A).

Developing multicomponent interventions using fractional factorial designs.

Multicomponent interventions composed of behavioral, delivery, or implementation factors in addition to medications are becoming increasingly common in health sciences. A natural experimental approach to developing and refining such multicomponent interventions is to start with a large number of potential components and screen out the least active ones. Factorial designs can be used efficiently in this endeavor. We address common criticisms and misconceptions regarding the use of factorial designs in these screening studies. We also provide an operationalization of screening studies. As an example, we consider the use of a screening study in the development of a multicomponent smoking cessation intervention. Simulation results are provided to support the discussions.

Recruitment to a randomized web-based nutritional intervention trial: characteristics of participants compared to non-participants.

BACKGROUND: Web-based behavioral programs efficiently disseminate health information to a broad population, and online tailoring may increase their effectiveness. While the number of Internet-based behavioral interventions has grown in the last several years, additional information is needed to understand the characteristics of subjects who enroll in these interventions, relative to those subjects who are invited to enroll. OBJECTIVE: The aim of the study was to compare the characteristics of participants who enrolled in an online dietary intervention trial (MENU) with those who were invited but chose not to participate, in order to better understand how these groups differ. METHODS: The MENU trial was conducted among five health plans participating in the HMO Cancer Research Network in collaboration with the University of Michigan Center for Health Communication Research. Approximately 6000 health plan members per site, between the ages of 21 and 65, and stratified by gender with oversampling of minority populations, were randomly selected for recruitment and were mailed an invitation letter containing website information and a US$2 bill with the promise of US$20 for completing follow-up surveys. Administrative and area-based data using geocoding along with baseline survey data were used to compare invitees (HMO members sent the introductory letter), responders (those who entered a study ID on the website), and enrollees (those who completed the enrollment process). Generalized estimating equation multivariate and logistic regression models were used to assess predictors of response and enrollment. RESULTS: Of 28,460 members invited to participate, 4270 (15.0%) accessed the website. Of the eligible responders, 2540 (8.9%) completed the consent form and baseline survey and were enrolled and randomized. The odds of responding were 10% lower for every decade of increased age (P < .001), while the likelihood of enrolling was 10% higher for every decade increase in age (P < .001). Women were more likely to respond and to enroll (P < .001). Those living in a census tract associated with higher education levels were more likely to respond and enroll, as well as those residing in tracts with higher income (P < .001). With a 22% (n = 566) enrollment rate for African Americans and 8% (n = 192) for Hispanics, the enrolled sample was more racially and ethnically diverse than the background sampling frame. CONCLUSIONS: Relative to members invited to participate in the Internet-based intervention, those who enrolled were more likely to be older and live in census tracts associated with higher socioeconomic status. While oversampling of minority health plan members generated an enrolled sample that was more racially and ethnically diverse than the overall health plan population, additional research is needed to better understand methods that will expand the penetration of Internet interventions into more socioeconomically diverse populations. TRIAL REGISTRATION: Clinicaltrials.gov NCT00169312; http://clinicaltrials.gov/ct2/show/NCT00169312 (Archived by WebCite at http://www.webcitation.org/5jB50xSfU).

Purpose in life and conflict-related neural responses during health decision-making.

OBJECTIVE: Having a strong sense of purpose in life is associated with positive health behaviors. However, the processes through which purpose leads to health are unclear. The current study compared neural activity among individuals with higher versus lower purpose while they made health-related decisions in response to messages promoting health behavior change. METHOD: A total of 220 adults with a sedentary lifestyle who were likely to feel conflicted in response to health messages underwent functional MRI while viewing messages encouraging physical activity and indicated the self-relevance of the messages. We focused on activity within dorsal anterior cingulate cortex (dACC), anterior insula (AI), dorsolateral prefrontal cortex (DLPFC), and ventrolateral prefrontal cortex (VLPFC) as identified by meta-analytically defined maps of regions previously implicated in conflict-related processing, while participants considered the self-relevance of the messages. RESULTS: Individuals with higher (vs. lower) purpose showed less activity in dACC, AI, DLPFC, and VLPFC while making health-decisions. Lower brain response in these regions mediated the effect of higher purpose on greater endorsement of the messages. CONCLUSIONS: Individuals with strong purpose may be less likely to experience conflict-related regulatory burden during health decision-making, which may in turn allow them to accept conflicting yet beneficial health messages. Reduced brain reactivity in dACC, AI, DLPFC, and VLPFC may reflect reduced conflict-related processing during health decision-making relevant to longer term lifestyle goals. This adds to mounting evidence linking purpose and a range of positive health-related outcomes, as well as evidence suggesting that dACC, AI, DLPFC, and VLPFC track conflict-related processes relevant to longer term goals and values. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Effect of incentives and mailing features on online health program enrollment.

BACKGROUND: With the growing use of Internet-based interventions, strategies are needed to encourage broader participation. This study examined the effects of combinations of monetary incentives and mailing characteristics on enrollment, retention, and cost effectiveness for an online health program. METHODS: In 2004, a recruitment letter was mailed to randomly selected Midwestern integrated health system members aged 21-65 and stratified by gender and race/ethnicity; recipients were randomly pre-assigned to one of 24 combinations of incentives and various mailing characteristics. Enrollment and 3-month retention rates were measured by completion of online surveys. Analysis, completed in 2005, compared enrollment and retention factors using t tests and chi-square tests. Multivariate logistic regression modeling assessed the probability of enrollment and retention. RESULTS: Of 12,289 subjects, 531 (4.3%) enrolled online, ranging from 1% to 11% by incentive combination. Highest enrollment occurred with unconditional incentives, and responses varied by gender. Retention rates ranged from 0% to 100%, with highest retention linked to higher-value incentives. The combination of a $2 bill prepaid incentive and the promise of $20 for retention (10% enrollment and 71% retention) was optimal, considering per-subject recruitment costs ($32 enrollment, $70 retention) and equivalent enrollment by gender and race/ethnicity. CONCLUSIONS: Cash incentives improved enrollment in an online health program. Men and women responded differently to mailing characteristics and incentives. Including a small prepaid monetary incentive ($2 or $5) and revealing the higher promised-retention incentive was cost effective and boosted enrollment.

Web-based smoking-cessation programs: results of a randomized trial.

BACKGROUND: Initial trials of web-based smoking-cessation programs have generally been promising. The active components of these programs, however, are not well understood. This study aimed to (1) identify active psychosocial and communication components of a web-based smoking-cessation intervention and (2) examine the impact of increasing the tailoring depth on smoking cessation. DESIGN: Randomized fractional factorial design. SETTING: Two HMOs: Group Health in Washington State and Henry Ford Health System in Michigan. PARTICIPANTS: 1866 smokers. INTERVENTION: A web-based smoking-cessation program plus nicotine patch. Five components of the intervention were randomized using a fractional factorial design: high- versus low-depth tailored success story, outcome expectation, and efficacy expectation messages; high- versus low-personalized source; and multiple versus single exposure to the intervention components. MEASUREMENTS: Primary outcome was 7 day point-prevalence abstinence at the 6-month follow-up. FINDINGS: Abstinence was most influenced by high-depth tailored success stories and a high-personalized message source. The cumulative assignment of the three tailoring depth factors also resulted in increasing the rates of 6-month cessation, demonstrating an effect of tailoring depth. CONCLUSIONS: The study identified relevant components of smoking-cessation interventions that should be generalizable to other cessation interventions. The study also demonstrated the importance of higher-depth tailoring in smoking-cessation programs. Finally, the use of a novel fractional factorial design allowed efficient examination of the study aims. The rapidly changing interfaces, software, and capabilities of eHealth are likely to require such dynamic experimental approaches to intervention discovery.