Change in Perceived Stress and Health Behaviors of Emerging Adults in the Midst of the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has resulted in unprecedented disruptions, restrictions, and concerns about physical and mental health. Emerging adulthood, including the first year of college, is associated with declines in healthy eating and physical activity, as well as possible heightened distress. The impact of COVID-19 may exacerbate these concerns. PURPOSE: The purpose of this study was to examine changes in health behaviors and perceived stress in emerging adults over the first year of college and to determine whether prepandemic health behaviors were protective for mental health and stress during the initial changes after the COVID-19 pandemic. METHODS: First-year college students (N = 234, 58.6% female) completed three surveys during their first year of school, the third being after the onset of COVID-19 and during a stay-at-home order. At Time 3, we also assessed symptoms of anxiety and depression. RESULTS: Using linear mixed modeling, sedentary time increased and physical activity decreased over time, but 20%-35% of students reported improvements in these behaviors. Dietary changes appeared mixed, with some improvements noted early during COVID-19. Perceived stress increased over time. Multiple regression indicated that of the health behaviors examined for protective effects on mental health and stress during the pandemic, only diet quality emerged as a significant predictor. CONCLUSIONS: Although notable declines in some health habits were observed over time, including following COVID-19 disruptions, some students reported improved health behaviors. Efforts should be directed at identifying and intervening with students most at risk for poor functioning.

Go!: results from a quasi-experimental obesity prevention trial with hospital employees.

BACKGROUND: Worksite obesity prevention interventions using an ecological approach may hold promise for reducing typical weight gain. The purpose of this study was to examine the effectiveness of Go!, an innovative 12-month multi-component worksite obesity prevention intervention. METHODS: A quasi-experimental non-equivalent control group design was utilized; 407 eligible hospital employees (intervention arm) and 93 eligible clinic employees (comparison arm) participated. The intervention involved pedometer distribution, labeling of all foods in the worksite cafeteria and vending machines (with calories, step equivalent, and a traffic light based on energy density signaling recommended portion), persuasive messaging throughout the hospital, and the integration of influential employees to reinforce healthy social norms. Changes in weight, BMI, waist circumference, physical activity, and dietary behavior after 6 months and 1 year were primary outcomes. Secondary outcomes included knowledge, perceptions of employer commitment to employee health, availability of information about diet, exercise, and weight loss, perceptions of coworker support and frequency of health discussions with coworkers. A process evaluation was conducted as part of the study. RESULTS: Repeated measures ANCOVA indicated that neither group showed significant increases in weight, BMI, or waist circumference over 12 months. The intervention group showed a modest increase in physical activity in the form of walking, but decreases in fruit and vegetable servings and fiber intake. They also reported significant increases in knowledge, information, perceptions of employer commitment, and health discussions with peers. Employees expressed positive attitudes towards all components of the Go! CONCLUSIONS: This low-intensity intervention was well-received by employees but had little effect on their weight over the course of 12 months. Such results are consistent with other worksite obesity prevention studies using ecological approaches. Implementing low-impact physical activity (e.g., walking, stair use) may be more readily incorporated into the worksite setting than more challenging behaviors of altering dietary habits and increasing more vigorous forms of physical activity. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov (NCT01585480) on April 24, 2012.

Complementary health approaches and dietary supplement use trends among U.S. college students: A brief report.

OBJECTIVE: Examine differences over time in use of complementary health approaches (CHA) and dietary supplements among college students. PARTICIPANTS: Two samples of undergraduate students (Sample 1, N = 370; Sample 2, N = 482) from a midsized Midwestern university. METHOD: Using stratified random sampling, at two time points (spring 2008, spring 2019), students were surveyed. Frequency of CHA and supplement use in the past year were assessed and compared across the two time periods. RESULTS: Of the CHAs compared, 53% had changed in frequency of use with only the practice of yoga significantly increasing. As for supplements, 78% changed in their frequency of use with the rate of melatonin being the only significant increase. CONCLUSIONS: Although the reported use of many CHAs and supplements appeared to change in the time period between assessments, findings suggest that students still report using several CHA practices and, to a lesser extent, supplements.

Applying self-determination theory to internalized weight stigma and mental health correlates among young and middle adult women: A structural equation model.

Limited research has explored the relationship between self-determination theory constructs (basic psychological needs, autonomous/controlled regulation) and internalized weight stigma (IWS). This cross-sectional, online study surveyed 480 U.S. women aged 18-40 between 2021 and 2022. We hypothesized that need frustration and controlled weight regulation would relate to higher IWS, which would be associated with dysfunctional eating, distress, and lower life satisfaction. Conversely, we predicted that need satisfaction, autonomous regulation, and body satisfaction would be associated with reduced IWS, dysfunctional eating and distress, and higher life satisfaction. Structural equation modeling demonstrated an acceptable model fit (CMIN/DF = 2.95, CFI = 0.90, RMSEA = 0.06, SRMR = 0.07), accounting for 74% of IWS variance. Findings indicate the relevance of self-determination theory in understanding IWS, supporting a dual-process model whereby adverse and adaptive outcomes follow distinct pathways. Longitudinal studies are warranted to validate psychological needs and regulatory styles as mechanisms for IWS development and to assess generalizability across diverse populations.

Changes in basic psychological needs, passion, and well-being of first-semester graduate students.

OBJECTIVE: Examine changes in graduate student health and well-being in the first semester. PARTICIPANTS: Full-time, first-semester graduate students (N = 74) from a midsized midwestern university. METHOD: Graduate students were surveyed prior to starting their master's program and 10 weeks later. Passion for academics, basic psychological needs, physical and mental health symptoms, positive and negative affects, and quality of life were assessed. RESULTS: Need satisfaction, harmonious passion, and indicators of well-being decreased across the first semester, whereas need frustration and indicators of ill-being increased over the first semester. Obsessive passion, harmonious passion, need satisfaction, and need frustration were associated with students' well-being at the end of the semester, with need frustration being the most robust predictor. CONCLUSIONS: Although most graduate students reported good general health and moderately low mental health symptoms, findings suggest that a need supportive environment may contribute to better health and well-being.

Effects of physical activity interventions for caregivers of adults: A meta-analysis.

OBJECTIVES: Caregivers of adults afflicted with a variety of chronic physical and mental health conditions are at risk for poorer well-being and reduced health related to chronic stress. Physical activity (PA) interventions may alleviate aspects of this burden, as well as provide benefits to physical health. However, notable limitations exist in the previous reviews that have attempted to synthesize the evidence for the benefits of PA interventions. METHOD: A meta-analysis was conducted investigating and quantifying the impact of PA interventions on different domains of mental and physical health for caregivers of adults, including only randomized and nonrandomized control trials. RESULTS: A comprehensive search yielded 25 studies. PA interventions led to small-to-medium effects (Hedges' g = .37, 95% confidence interval [.18, .56]) on mental health, with the most notable impact on quality of life (Hedges' g = .74, 95% CI [48, 1.01]). PA interventions led to trivial effects on physical health (Hedges' g = .15, 95% CI [.01, .31]), with small but significant effects found for mobility outcomes (Hedges' g = .28, 95% CI [.10, .47]). Yoga interventions yielded large effects (g = .85, 95% CI [.52, 1.17], p < .001) compared to other forms of PA (g = .24, 95% CI [.40, .43], p = .018), primarily within the domain of mental health. CONCLUSIONS: PA interventions appear to be effective for improving caregiver health, particularly in relation to psychological health. Further high-quality research using standardized measures for outcome comparison is needed to determine the type, formats, and length of PA interventions that best serve different caregiving populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Coping styles and self-regulation predict complementary and alternative medicine and herbal supplement use among college students.

Studies have suggested that complementary and alternative medicine (CAM) and herbal supplement use may be high on college campuses. This study investigated the relationship between CAM and herbal supplement utilization and coping, self-regulatory, cognitive styles, and healthcare satisfaction among college students (n=370). Indeed, overall CAM and herbal supplement use during the past year appeared high; however, users of these practices appeared somewhat heterogeneous. Dispositional factors were predictive of utilization with active coping style associated with both practices, whereas support-seeking and intrinsic self-regulation were only associated with CAM use and avoidant coping was only related to use of herbal supplements. Notably, dissatisfaction with healthcare services was not associated with either CAM or herbal supplement use among students. The findings from this study offer insight regarding motives for usage that may assist in more openly dialoguing with students regarding their health-enhancing and/or health-compromising behaviors. Moreover, future studies assessing utilization of CAM will benefit from examining the definitional issues of CAM practices that are addressed.

Using self-determination theory to understand eating behaviors and weight change in emerging adults.

INTRODUCTION: College may be a time when emerging adults establish eating patterns that influence future weight trajectories. Self-determination theory (SDT) suggests that satisfaction of basic psychological needs (autonomy, competence, relatedness) supports autonomous regulation of behavior, which is associated with healthier behaviors. When needs are frustrated, individuals feel as though their behaviors are controlled by others, which is associated with unhealthy behaviors. This study used SDT to examine a model for associated body satisfaction, eating/weight control behaviors, and weight change. METHODS: Using a cross-sectional design, undergraduates (N = 875; 57% women; AgeM = 20 ± 1.4 yrs.; BMIM = 24.3 ± 4.4) completed measures of need satisfaction and frustration, behavioral regulation of healthy weight, body satisfaction, eating/weight control behaviors, and weight change in their first semester of college. RESULTS: Structural equation modeling showed that need satisfaction was positively associated with greater autonomous regulation, which was positively associated with greater body satisfaction and fruit/vegetable intake. Conversely, greater need frustration was associated with greater controlled regulation, which was associated with lower body satisfaction. Participants who had greater body satisfaction engaged in fewer unhealthy weight control behaviors. Engaging in more unhealthy behaviors was associated with greater weight gain during the first semester of college, whereas fruit and vegetable intake was not associated with weight change. The associations were stronger for women than men, particularly for the relationships between body satisfaction and unhealthy weight control behaviors and increased weight gain. CONCLUSIONS: The model was generally supported, suggesting that psychological need satisfaction and autonomous motivation in college students may facilitate greater body satisfaction and healthier eating behaviors. Future longitudinal research is needed to clarify the factors that influence health behaviors and weight gain in college students.

Obesity and litigation predict workers' compensation costs associated with interbody cage lumbar fusion.

BACKGROUND CONTEXT: Results of lumbar fusion surgery have been mixed and procedures are costly. Interbody cage lumbar fusion (ICLF) has been advanced to improve arthrodesis and clinical outcomes; however, little attention has been given to ICLF costs or potential predictors of these expenses. PURPOSE: To depict medical and compensation costs associated with ICLF in a Utah cohort of patients receiving workers' compensation as well as to investigate predictors of costs. STUDY DESIGN/SETTING: A retrospective-cohort research design was used involving completion of presurgical and postsurgical medical record reviews and accrual of medical and compensation costs. Presurgical variables included in a regression model were presurgical spinal pathophysiology rating, obesity, and litigation status. PATIENT SAMPLE: Forty-three consecutive patients who were compensated by the Workers' Compensation Fund of Utah and underwent ICLF. OUTCOME MEASURES: Total accrued compensation and medical costs. METHODS: A retrospective review of presurgical variables and total accrued compensation and medical costs was conducted. RESULTS: Multiple regression analysis indicated that nonpathophysiological factors predicted compensation costs (lawyer involvement [beta=0.40]; obesity [beta=0.34]). Specifically, compensation for those with versus without lawyers was $41,657 versus $24,837, and for those who were obese versus nonobese was $46,152 versus $28,168. Arthrodesis was correlated with medical costs (r=-0.47, p=.002), with incurred costs for patients achieving solid fusion versus pseudarthrosis equaling $38,881 versus $71,655, respectively. CONCLUSIONS: Considerable costs were associated with ICLF, particularly for those who were obese, involved in litigation, or failed to achieve solid fusion. With regard to compensation costs, the findings support the importance of assessing nonpathophysiological factors in spinal fusion patients.

Telephone-based coping skills training for patients awaiting lung transplantation.

Impaired quality of life is associated with increased mortality in patients with advanced lung disease. Using a randomized controlled trial with allocation concealment and blinded outcome assessment at 2 tertiary care teaching hospitals, the authors randomly assigned 328 patients with end-stage lung disease awaiting lung transplantation to 12 weeks of telephone-based coping skills training (CST) or to usual medical care (UMC). Patients completed a battery of quality of life instruments and were followed for up to 3.4 years to assess all-cause mortality. Compared with UMC, CST produced lower scores on perceived stress, anxiety, depressive symptoms, and negative affect and improved scores on mental health functioning, optimism, vitality, and perceived social support. There were 29 deaths (9%) over a mean follow-up period of 1.1 year. Survival analyses revealed that there was no difference in survival between the 2 groups. The authors conclude that a telephone-based CST intervention can be effectively delivered to patients awaiting lung transplantation. Despite the severity of pulmonary disease in this patient population, significant improvements in quality of life, but not somatic measures or survival to transplant, were achieved.

Emotional distress and quality of life in caregivers of patients awaiting lung transplant.

OBJECTIVE: The aims of this study are to characterize the levels of emotional distress and quality of life among caregivers of lung transplant candidates and to examine the relation of coping styles and perceived caregiver burden to caregivers' self-reported emotional distress. METHODS: A consecutive series of primary caregivers of potential lung transplant candidates completed a battery of psychosocial measures, including the Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory, Medical Coping Modes Questionnaire (MCMQ), Scale for Caregiver Burden (SCB), and Medical Outcomes Survey, Short Form-36 (SF-36). RESULTS: Only 12 of the 82 caregivers (14.6%) who volunteered for the study reported clinically significant levels of depression (BDI-II > or =14), and only 2 caregivers (2.4%) reported clinically significant levels of anxiety (STAI > or =60). Passive coping strategies were associated with higher levels of emotional distress; specifically, resignation was associated with increased depression (r=.27, P<.04), while avoidance was associated with increased anxiety (r=.29, P<.04). In addition, caregivers who reported greater perceived caregiver burden experienced higher levels of depression (r=.45, P<.001) and anxiety (r=.43, P<.01). Moreover, the social functioning of caregivers of lung transplant patients was more than one standard deviation from a normative sample of the population (Cohen's d=1.16), indicating that caregivers of transplant patients experienced greater impairment in this area. DISCUSSION: Although most caregivers of transplant patients do not report significant impairment in functioning, assessing caregivers' coping strategies and caregiving burden may identify those caregivers who experience increased emotional distress.

Presurgical biopsychosocial factors predict multidimensional patient: outcomes of interbody cage lumbar fusion.

BACKGROUND CONTEXT: Interbody cage lumbar fusion (ICLF) has been advanced to improve arthrodesis; however, little attention has been given to quality of life and functional outcomes. Studies suggest that psychosocial factors may be important modifiers of low back surgical outcomes. PURPOSE: To depict outcomes of ICLF surgery across multiple dimensions and to investigate presurgical biopsychosocial predictors of these outcomes. STUDY DESIGN/SETTING: A retrospective-cohort research design was used that involved completion of presurgical medical record reviews and postsurgical telephone outcome surveys at least 18 months after surgery. Presurgical variables included in a regression model were age at the time of surgery, spinal pathophysiology rating, smoking tobacco, depression, and pursuing litigation. PATIENT SAMPLE: Seventy-three patients received ICLF, and of those 56 patients completed the outcome survey an average of 2.6 years after surgery. OUTCOME MEASURES: Outcome measures consisted of arthrodesis status, patient satisfaction, back-specific functioning, disability status, and quality of life. RESULTS: Although arthrodesis occurred in 84% of the patients, nearly half were dissatisfied with their current back condition. Functional status was worse than expected, and 38% were totally disabled at follow-up. Regression analyses revealed tobacco use, depression, and litigation were the most consistent presurgical predictors of poorer patient outcomes. CONCLUSIONS: Overall, despite a high rate of arthrodesis, ICLF was not associated with substantial improvements in patient functioning. Presurgical biopsychosocial variables predicted patient outcomes, which may help improve patient selection and possible targeted interventions.

Outcomes and presurgery correlates of lumbar discectomy in Utah Workers' Compensation patients.

BACKGROUND CONTEXT: Lumbar discectomy is the most common type of back surgery performed in the United States. Outcomes after this procedure can be variable and it appears that Workers' Compensation patients might be at increased risk for poor outcomes. PURPOSE: To examine long-term multidimensional outcomes of lumbar discectomy within a cohort of Workers' Compensation patients from Utah and identify presurgical biopsychosocial factors related to poor outcomes. STUDY DESIGN/SETTING: A retrospective cohort study consisting of a review of presurgical medical records and assessment of patient outcomes via a telephone survey. Outcomes were assessed at least 2 years postsurgery. PATIENT SAMPLE: A consecutive sample of 271 workers from Utah who underwent lumbar discectomy from 1994 to 1999. A total of 134 patients were surveyed at the time of follow-up. OUTCOME MEASURES: Patient satisfaction, Roland-Morris Disability Questionnaire, SF-36v2, and Stauffer-Coventry Index. METHODS: A retrospective review of presurgical biopsychosocial variables and outcome assessment via telephone survey was conducted. RESULTS: Work disability rate for the cohort was 12.7% (17/134). Analysis of patient satisfaction, back pain-related dysfunction, and the Short-Form Health Survey-36 subscales indicated approximately 25% of patients experienced poor outcomes. Older age, number of comorbid health conditions, assigned case manager, litigation, and time delay from injury to surgery were consistently statistically significant predictors (p<.05) of poor outcomes. CONCLUSIONS: Results of this study suggest that compensated back surgery patients are at greater risk for poor lumbar discectomy outcomes than noncompensation patients. Presurgery correlates of poor outcomes may be useful in identifying high-risk compensation patients.