Sleeping in an Inclined Position to Reduce Snoring and Improve Sleep: In-home Product Intervention Study.

BACKGROUND: Accurately and unobtrusively testing the effects of snoring and sleep interventions at home has become possible with recent advances in digital measurement technologies. OBJECTIVE: The aim of this study was to examine the effectiveness of using an adjustable bed base to sleep with the upper body in an inclined position to reduce snoring and improve sleep, measured at home using commercially available trackers. METHODS: Self-reported snorers (N=25) monitored their snoring and sleep nightly and completed questionnaires daily for 8 weeks. They slept flat for the first 4 weeks, then used an adjustable bed base to sleep with the upper body at a 12-degree incline for the next 4 weeks. RESULTS: Over 1000 nights of data were analyzed. Objective snoring data showed a 7% relative reduction in snoring duration (P=.001) in the inclined position. Objective sleep data showed 4% fewer awakenings (P=.04) and a 5% increase in the proportion of time spent in deep sleep (P=.02) in the inclined position. Consistent with these objective findings, snoring and sleep measured by self-report improved. CONCLUSIONS: New measurement technologies allow intervention studies to be conducted in the comfort of research participants' own bedrooms. This study showed that sleeping at an incline has potential as a nonobtrusive means of reducing snoring and improving sleep in a nonclinical snoring population.

The role of anticipated regret and health beliefs in HPV vaccination intentions among young adults.

Although cognitions have predicted young adults' human papillomavirus (HPV) vaccine decision-making, emotion-based theories of healthcare decision-making suggest that anticipatory emotions may be more predictive. This study examined whether anticipated regret was associated with young adults' intentions to receive the HPV vaccine above and beyond the effects of commonly studied cognitions. Unvaccinated undergraduates (N = 233) completed a survey assessing Health Belief Model (HBM) variables (i.e., perceived severity of HPV-related diseases, perceived risk of developing these diseases, and perceived benefits of HPV vaccination), anticipatory emotions (i.e., anticipated regret if one were unvaccinated and later developed genital warts or HPV-related cancer), and HPV vaccine intentions. Anticipated regret was associated with HPV vaccine intentions above and beyond the effects of HBM variables among men. Among women, neither anticipated regret nor HBM variables showed consistent associations with HPV vaccine intentions. Findings suggest that anticipatory emotions should be considered when designing interventions to increase HPV vaccination among college men.

Cardiovascular reactivity to and recovery from stressful tasks following a mindfulness analog in college students with a family history of hypertension.

OBJECTIVES: Ninety-seven (97) undergraduates with a family history of hypertension participated in a study that evaluated the effects of a brief mindfulness-induction on cardiovascular reactivity and recovery to two stressors. MATERIALS AND METHODS: Participants were randomized to either a mindfulness-induction or control condition and were then exposed to the cold pressor task (CPT) followed by the mirror-tracing task (MT). Blood pressure and heart rate were measured at baseline and postinduction, as well as during and immediately following each stressor. RESULTS: There were no group differences in reactivity to either stressor. Participants in the mindfulness-analog condition experienced significantly greater latency to systolic blood pressure recovery following the CPT and a tendency toward greater latency to diastolic blood pressure recovery, although these findings were not replicated with the MT task. CONCLUSIONS: These results are contrary to what was hypothesized and to the anecdotal evidence available regarding effects of comprehensive mindfulness interventions on reactivity. The findings are discussed with respect to purported mechanisms of mindfulness and learning theory.

Psychosocial factors contributing to inflammatory bowel disease activity and health-related quality of life.

OBJECTIVE: This study aimed to examine the contributions of coping and social constraint to disease activity and health-related quality of life (HRQOL) and to examine group differences in disease activity and HRQOL between patients with high versus low anxiety or depression symptoms in adults with inflammatory bowel disease (IBD). METHODS: This study was a retrospective analysis in which disease activity was measured with either the Harvey-Bradshaw Index or the Simple Clinical Colitis Activity Index. HRQOL was measured with the Short Inflammatory Bowel Disease Questionnaire. Coping was measured with a modified COPE questionnaire. Anxiety and depression symptoms were measured with the Hospital Anxiety and Depression Scale. Social constraint was measured with the Social Constraint Questionnaire. Correlational and regression analyses were performed to assess the relationships between social constraint, coping, anxiety symptoms, depression symptoms, and HRQOL and disease activity. RESULTS: Data from 80 adults with IBD were reviewed. Social constraint, disengagement coping, anxiety symptoms, and depression symptoms were inversely correlated with HRQOL. Disengagement coping was positively correlated with disease activity. Regression analyses showed that smokers had significantly worse HRQOL than nonsmokers and that greater use of engagement coping was associated with significantly diminished HRQOL. Regression analyses also showed that patients diagnosed between 17 and 40 years of age were significantly less likely to have active disease than patients diagnosed before 16 years of age and that greater use of disengagement coping was associated with increased odds of having active disease. CONCLUSIONS: Medical providers should be aware that coexisting social constraint and symptoms of anxiety and depression are common in patients with IBD. Screening for these factors, as well as patients' coping styles, should be strongly considered, and patients should be referred to mental health providers as appropriate.

Mind your words: positive and negative items create method effects on the Five Facet Mindfulness Questionnaire.

Mindfulness, a construct that entails moment-to-moment effort to be aware of present experiences and positive attitudinal features, has become integrated into the sciences. The Five Facet Mindfulness Questionnaire (FFMQ), one popular measure of mindfulness, exhibits different responses to positively and negatively worded items in nonmeditating groups. The current study employed confirmatory factor analysis with a large undergraduate sample to examine the validity of a hierarchical mindfulness model and whether response patterns related to item wording arose from method effects. Results indicated that a correlated facets model better explained the data and that negative and positive wording constituted substantive method effects. This study suggests that the FFMQ measures components that may relate to, but do not seem to directly reflect, a latent variable of mindfulness. The authors recommend against the use of an FFMQ total score, favoring individual scale scores, and further examination of method effects in mindfulness scales.

Mindfulness as a moderator in expressive writing.

Randomized, controlled studies have documented positive physical and psychological effects of writing about traumatic stress. Some of these studies have shown that individual differences play an important role, with participants responding differently to the intervention based on their personal characteristics. In the present expressive writing experiment, the trait of mindfulness was examined as a potential moderator. Seventy-six undergraduates were randomly assigned to either expressive writing (n = 37) or a control group (n = 39). Main effects favoring expressive writing were found, and these were qualified by significant interactions with mindfulness. Specifically, individuals with higher mindfulness scores responded better to expressive writing, experiencing greater physical and psychological benefits than individuals with lower mindfulness scores.

Factors contributing to anxious driving behavior: the role of stress history and accident severity.

Although fear and travel avoidance among anxious drivers are well documented, relatively little is known about the behavior of anxious individuals who continue to drive. Previous research has identified three broad domains of anxious driving behavior: exaggerated safety/caution behaviors, anxiety-based performance deficits, and hostile/aggressive driving behaviors. In an effort to explicate factors associated with the development of anxious driving behavior, associations with objective accident severity, accident-related distress, and life stress history were explored among individuals reporting accident involvement (N=317). Interactive effects of accident distress and self-reported stress history were noted across all three domains of anxious driving behavior. Examination of these effects indicates unique associations between accident distress and anxious behavior only in those reporting more severe life stress. Consistent with contemporary models of anxiety, these data suggest stress history may serve as a general vulnerability factor for development of anxious driving behavior following accident involvement.

Mindfulness and health behaviors: is paying attention good for you?

OBJECTIVE: the investigators examined relations between mindfulness and health behaviors in college students, as well as the role of stress in mediating these effects. PARTICIPANTS: participants were 553 undergraduates (385 females; mean age = 18.8 years, SD = 2.1) recruited from a university in the northeastern United States. METHODS: participants completed questionnaires assessing mindfulness, perceived health, health behaviors, health-related activity restriction, and stress. Data were collected from September 2007 through December 2007. RESULTS: overall perceived health and health-related activity restriction, as well as some health behaviors (eg, binge eating, sleep quality, and physical activity) were related to the Five-Factor Mindfulness Questionnaire and were partially mediated by stress. CONCLUSIONS: these results suggest that mindfulness is related to decreased stress, which in turn contributes to increased positive health perceptions and health behaviors. The findings support the utility of mindfulness in promoting physical and psychological health in college students.

Indoor tanning, mental health, and substance use among college students: the significance of gender.

This study examined relations among indoor tanning frequency, symptoms of depression, anxiety, and obsessive-compulsive disorder, and substance use. A total of 421 college students (68% female) completed self-report measures on one occasion. Among men, indoor tanning was positively associated with symptoms of anxiety and obsessive-compulsive disorder, whereas indoor tanning was unrelated to these symptoms among women. Among women, indoor tanning was positively associated with the use of alcohol, tobacco, and other substances. Further research is needed to explore contextual and coping processes that may underlie these gender differences.

Addiction to indoor tanning: relation to anxiety, depression, and substance use.

OBJECTIVE: To assess the prevalence of addiction to indoor tanning among college students and its association with substance use and symptoms of anxiety and depression. DESIGN: Two written measures, the CAGE (Cut down, Annoyed, Guilty, Eye-opener) Questionnaire, used to screen for alcoholism, and the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) (DSM-IV-TR) criteria for substance-related disorders, were modified to evaluate study participants for addiction to indoor tanning. Standardized self-report measures of anxiety, depression, and substance use also were administered. SETTING: A large university (approximately 18 000 students) in the northeastern United States. PARTICIPANTS: A total of 421 college students were recruited from September through December 2006. MAIN OUTCOME MEASURES: Self-reported addiction to indoor tanning, substance use, and symptoms of anxiety and depression. RESULTS: Among 229 study participants who had used indoor tanning facilities, 90 (39.3%) met DSM-IV-TR criteria and 70 (30.6%) met CAGE criteria for addiction to indoor tanning. Students who met DSM-IV-TR and CAGE criteria for addiction to indoor tanning reported greater symptoms of anxiety and greater use of alcohol, marijuana, and other substances than those who did not meet these criteria. Depressive symptoms did not significantly vary by indoor tanning addiction status. CONCLUSION: Findings suggest that interventions to reduce skin cancer risk should address the addictive qualities of indoor tanning for a minority of individuals and the relationship of this behavior to other addictions and affective disturbance.

Does narrative writing instruction enhance the benefits of expressive writing?

We examined whether instructing participants to write in a narrative fashion about stressful life events would produce superior physical and psychological health benefits relative to standard expressive writing instructions that do not specify the essay's structure. Undergraduates (N=101) were randomly assigned to engage in two, 20-minute narrative writing, standard expressive writing, or control writing tasks. Follow-up data were obtained one month later. The essays of the narrative writing group evidenced higher levels of narrative structure than did those of the expressive writing group. Greater narrative structure was associated with mental health gains, and self-rated emotionality of the essays was associated with lesser perceived stress at follow-up. In addition, the narrative and expressive writing groups reported lower levels of perceived stress and depressive symptoms relative to controls but did not differ from each other with regard to these outcomes. Health care utilization at follow-up did not vary by group assignment. Findings suggest that both emotional expression and narrative structure may be key factors underlying expressive writing's mental health benefits. Results also suggest that, among college students, instruction in narrative formation does not increase the positive effects of expressive writing relative to standard expressive writing instructions.

Comparing brief stress management courses in a community sample: mindfulness skills and progressive muscle relaxation.

This study sought to compare a five-week mindfulness meditation (MM) course to a five-week course that taught progressive muscle relaxation (PMR). Forty-three adults from the community were randomly assigned to either MM (n = 19) or PMR (n = 24) courses after responding to flyers and other advertisements for a free stress management course. Mindfulness meditation participants practiced meditation significantly more often than PMR participants practiced relaxation during the intervention period (F[1, 43] = 7.42; P < .05). Interestingly, the two conditions did not differ significantly in their posttreatment levels of relaxation or mindfulness. Although there were no differences between groups on any of the primary outcome measures, across both treatment conditions there were statistically significant reductions from pretreatment to posttreatment in general psychological distress. Thus, although MM did not emerge as clearly superior to PMR, results of this study suggest that a brief mindfulness skills course may be effective for stress management.

Unmet needs of patients with systemic lupus erythematosus.

The authors' goal was to assess unmet needs of patients with systemic lupus erythematosus (SLE). Participants (N = 112), who were recruited through the mailing list and support group meetings of a Lupus Alliance of America Affiliate, completed a survey based on prior research. All participants perceived at least 1 unmet need. The most frequently reported unmet needs were in the physical symptoms domain. Older patients were more likely than younger patients to have higher levels of unmet needs related to physical and psychological functioning. African American patients were more likely than white patients to have higher levels of unmet needs related to health services and information. Our findings document the high prevalence and variety of unmet needs among these patients, as well as variations among demographic groups. To address unmet needs of SLE patients, targeted referrals to patient educators, mental health professionals, and support organizations are important adjuncts to medical treatment.

Cancer Patients Versus Cancer Survivors: Social and Emotional Consequences of Word Choice.

Two studies examined the social and emotional implications of different linguistic classifications of individuals with cancer. Undergraduates were randomly assigned to rate their reactions to either cancer patients or cancer survivors. Across studies, participants held more favorable perceptions of the character of cancer survivors relative to cancer patients and displayed more positive attitudes toward the former group. In addition, participants in Study 1 reported greater willingness to interact with cancer survivors compared with cancer patients. Positive perceptions of prognosis did not appear to account for favorable attitudes toward cancer survivors; most participants in Study 2 did not assume that cancer survivors were beyond the treatment phase of their illness or cured of their disease. Findings point to a potentially powerful effect of word choice on reactions to individuals with cancer.

Agentic and communal personality traits: relations to disordered eating behavior, body shape concern, and depressive symptoms.

This study was designed to examine links between agentic and communal personality traits and disordered eating behavior and related problems (i.e., body shape concern and depressive symptoms) in a sample of 298 undergraduates. As predicted, unmitigated agency was positively associated with uncontrolled eating, and unmitigated communion was positively related to emotional eating and fasting for at least 24 h in order to control weight. When controlling for depressive symptomatology, unmitigated communion was no longer associated with emotional eating. Whereas unmitigated agentic and communal characteristics were positively associated with problematic eating patterns, agency was negatively associated with fasting and body shape concern. Findings suggest that further examination of the potential influence of gender-linked personality traits on disordered eating behavior is warranted.

Predictors of tanning salon use: behavioral alternatives for enhancing appearance, relaxing and socializing.

This study investigated cognitive predictors of tanning salon use, based on Jaccard's Theory of Alternative Behavior. A total of 164 undergraduates completed questionnaires that assessed tanning salon use, attitudes toward tanning salon use and attitudes toward behavioral alternatives for enhancing appearance, relaxing and socializing. Results indicated that attitudes toward alternatives for enhancing appearance were not significantly related to tanning salon use. However, favorable attitudes toward engaging in a hobby to relax and going to the gym to socialize were inversely related to frequency of tanning salon use. Findings suggest that interventions for reducing skin cancer risk should focus not only on decreasing favorable attitudes toward tanning, but also on increasing favorable attitudes toward healthier alternatives to tanning salon use.

Post-traumatic growth and psychosocial adjustment of daughters of breast cancer survivors.

PURPOSE/OBJECTIVES: To examine post-traumatic growth, or positive life changes, and its correlates among adult daughters of breast cancer survivors and to compare their psychosocial adjustment to women with healthy parents. DESIGN: Descriptive, cross-sectional survey. SETTING: Outpatient oncology units in two urban hospitals and two breast cancer organizations. SAMPLE: 30 adult daughters of breast cancer survivors (mean age = 38.1 years) and 16 women with healthy parents. METHODS: Participants were recruited by hospital or research staff or responded to an announcement in a newsletter. Respondents completed the Post-Traumatic Growth Inventory and standardized assessments of psychosocial adjustment. MAIN RESEARCH VARIABLES: Post-traumatic growth and demographic, stressor, and psychosocial variables. FINDINGS: Women who cared for their mothers following breast cancer diagnosis and perceived their mothers' illness to be stressful reported greater post-traumatic growth. Life satisfaction, social support, emotional processing strategies, and problem-focused coping strategies also were positively associated with growth. Women with maternal histories of breast cancer and those with healthy parents did not differ in psychosocial well-being, including affect, life satisfaction, and social support. CONCLUSIONS: Findings suggest that some daughters of breast cancer survivors experience positive life changes following their mothers' illness. IMPLICATIONS FOR NURSING: For nurses seeking to adopt a holistic approach to practice, the personal growth of women following life-threatening familial illness warrants attention.

Expressive disclosure and benefit finding among breast cancer patients: mechanisms for positive health effects.

A randomized trial (n = 60; A. L. Stanton, S. Danoff-Burg, L. A. Sworowski, et al., 2002) revealed that 4 sessions of written expressive disclosure or benefit finding produced lower physical symptom reports and medical appointments for cancer-related morbidities at 3-month follow-up among breast cancer patients relative to a fact-control condition. The goal of this article is to investigate mechanisms underlying these effects. Within-session heart rate habituation mediated effects of expressive disclosure on physical symptoms, and greater use of negative emotion words in essays predicted a decline in physical symptoms. Postwriting mood and use of positive emotion and cognitive mechanism words in essays were not significant mediators, although greater cognitive mechanism word use was related to greater heart rate habituation and negative emotion word use.

Social predictors of sunscreen and self-tanning product use.

This study investigated social predictors of sunscreen and self-tanning product use among 164 undergraduates. Immediate family members' sunscreen use predicted participants' facial sunscreen use while sunbathing but not their sunscreen use on other areas of the body. In addition, familial support of a tanned appearance was inversely associated with self-tanning product use, whereas romantic partners' support of a tanned appearance was positively associated with this behavior. The results of this study suggest that it may be important to include socially significant others in interventions for reducing the risk of skin cancer in college students.

A pilot study of the effects of behavioral weight loss treatment on fibromyalgia symptoms.

OBJECTIVE: Previous studies have found a relation between weight loss and pain severity in various chronic pain populations. However, there has been little research examining the relation between body mass index (BMI) and fibromyalgia syndrome (FMS). The purpose of this pilot study was to investigate the relationship between BMI and FMS symptoms and to determine if FMS symptoms would decrease following weight loss. METHODS: Overweight and obese women participated in a 20-week behavioral weight loss treatment. RESULTS: Participants, on average, lost 9.2 lbs (4.4% of their initial weight), and there were significant pre-postimprovements on several outcome measures. Although weight was not significantly related to pain at baseline, weight loss significantly predicted a reduction in FMS, pain interference, body satisfaction, and quality of life (QOL). CONCLUSION: Findings suggest that behavioral weight loss treatment could be included in the treatment for overweight/obese women with FMS.