Association of the built environment and neighborhood resources with obesity-related health behaviors in older veterans with hypertension.

OBJECTIVE: To evaluate the association of the built environment and neighborhood resources with exercise, diet, and body mass index (BMI). METHOD: Person-level data were collected from 533 veterans with uncontrolled hypertension. Neighborhood measures were: (a) census-tract level walkability; and (b) healthy food proximity (HFP). Robust or logistic regression (adjusting for age, race, education, comorbidity, and clustered by provider) was used to evaluate associations between neighborhood and exercise duration (hours/week), exercise adherence (% adherent), saturated fat index (0-10), Healthy Eating Index (HEI; 0-100), HEI adherence (≥ 74 score), stage of change (SOC) for exercise and diet (% in action/maintenance), BMI (kg/m²), and obesity (BMI ≥ 30 kg/m²). RESULTS: The adjusted difference in HEI score (standard error [SE]) between the highest and lowest walkability tertiles was 3.67 (1.35), p = .006; the corresponding comparison for the saturated fat index was 1.03 (.50), p = .041 and BMI was -1.12 (.45), p = .013. The adjusted odds ratio (OR; 95% confidence intervals [CI]) between the highest and lowest walkability tertiles for HEI adherence was 2.16 [1.22, 3.82], p = .009 and for action/maintenance for exercise SOC was 1.78 [1.15, 2.76], p = .011. The adjusted difference (SE) between the highest and lowest HFP tertiles for exercise duration was .65 (.31), p = .03. The adjusted OR [95% CI] between the highest and lowest HFP tertiles for exercise adherence was 1.74 [1.08, 2.79], p = .023 and for action/maintenance for exercise SOC was 1.75 [1.10, 2.79], p = .034. CONCLUSIONS: Geographical location is associated with exercise and diet. Environment-tailored health recommendations could promote healthier lifestyles and decrease obesity-related cardiovascular disease. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sustained Benefit of Alternate Behavioral Interventions to Improve Hypertension Control: A Randomized Clinical Trial.

[Figure: see text].

Validity and reliability of a short self-efficacy instrument for hypertension treatment adherence among adults with uncontrolled hypertension.

OBJECTIVE: To establish the reliability and validity of a self-report measure designed to assess self-efficacy for hypertension treatment adherence. METHODS: This investigation was embedded within a six-month randomized clinical trial (RCT), which demonstrated that a tailored, stage-matched intervention was more effective at improving hypertension control than usual care among individuals (n = 533) with repeated uncontrolled hypertension. The instrument used to assess self-efficacy for hypertension treatment adherence (SE-HTA) comprised three subscales that assessed diet self-efficacy (DSE), exercise self-efficacy (ESE), and medication self-efficacy (MSE). To determine SE-HTA validity and reliability, we assessed internal consistency using Cronbach's α coefficients, conducted exploratory factor analysis, and evaluated convergent and discriminant validity, as well as test-retest reliability using Spearman's ρ correlation coefficients. RESULTS: Cronbach's α (internal consistency) values for DSE, ESE, and MSE were 0.81, 0.82 and 0.74. Factor analysis and the scree plot demonstrated three distinct factors, which correspond to the three subscales contained in the SE-HTA instrument. SE-HTA possessed good convergent and discriminant validity, and moderate test-retest reliability. CONCLUSION: The SE-HTA instrument containing diet, exercise, and medication adherence subscales is valid and reliable in adults with uncontrolled hypertension. PRACTICE IMPLICATIONS: This SE-HTA instrument measures self-efficacy and could help facilitate behavior change in hypertension.

A Tailored Behavioral Intervention to Promote Adherence to the DASH Diet.

Objectives: In this study, we evaluated the effects of a Transtheoretical model (TTM)-based tailored behavioral intervention (TBI), a non-tailored intervention (NTI) or usual care (UC) on: (1) the Dietary Approaches to Stop Hypertension (DASH) dietary pattern in 533 individuals with uncontrolled hypertension; and (2) the change from baseline to 6 months in proportion of participants in action or maintenance stages of change (SOC). Methods: This was a randomized clinical trial. Diet was evaluated using the validated Harvard DASH score calculated from Willett Food Frequency Questionnaires (range 8-40). The randomized groups were compared using the Wilcoxon rank-sum test, with adjustment for clustering by physician and baseline DASH scores. Results: At 6 months, compared to UC, TBI had a 1.28 point increase in DASH score (p ≤ .01) while NTI was not significant. At 6-month follow-up, TBI was more effective in advancing dietary SOC when compared to UC (56% vs 43%, p < .01) and NTI was not effective (46% vs 43%, p = .64). Conclusions: A phone-delivered tailored TTM-based intervention achieved greater improvement in DASH score and dietary SOC, suggesting that TTM-based tailored interventions can increase patients' dietary adherence.

Effectiveness of a tailored behavioral intervention to improve hypertension control: primary outcomes of a randomized controlled trial.

UNLABELLED: Blood pressure (BP) control rates are suboptimal. We evaluated the effectiveness of 2 behavioral interventions to improve BP control via a 3-arm, randomized controlled trial of 533 adults with repeated uncontrolled BP, despite antihypertensive drug treatment for ≥6 months. The interventions were a tailored stage-matched intervention (SMI) or a nontailored health education intervention (HEI) of 6 monthly calls targeting diet, exercise, and medication. Control was usual care (UC). There were no baseline group differences. Baseline BP control was 42.6%, 40.6%, and 44.6% in SMI, HEI, and UC (P=0.74), respectively; systolic BP (with SEs) was 136 (0.89), 137 (1.33), and 137 (0.96) mm Hg. Six-month control was 64.6% (SMI), 54.3% (HEI), and 45.8% (UC) (P values for pairwise comparisons versus UC, 0.001 [SMI] and 0.108 [HEI]). At 6 months, systolic BP (SE) was 131.2 (1.05), 131.8 (0.99), and 134.7 (1.02) for SMI, HEI, and UC, respectively (P values for pairwise comparisons versus UC, 0.009 for SMI and 0.047 for HEI). SMI led to lower systolic BP and better BP control than UC. SMI constitutes a new, potent approach to assist patients with uncontrolled hypertension to reach BP goals. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00286754.

Who is being reached for a telephone-delivered intervention for patients with uncontrolled hypertension?

BACKGROUND: Telephone-delivered interventions to provide health counseling for complex chronic medical conditions are convenient, acceptable, and cost-effective. However, little is known about which patients are reached, their characteristics, and who benefits most from telephone-delivered counseling. MATERIALS AND METHODS: This study examined whether baseline characteristics are predictive of being easily reached for a monthly, telephone-delivered behavioral intervention to improve treatment adherence in Veterans with uncontrolled hypertension. Participants were to complete a telephone session once a month for 6 months. RESULTS: Participants completed an average of 5.71 out of a possible 6 sessions. Participants who were unmarried, African American, unemployed, or younger or did not complete high school required significantly more call attempts per completed session. CONCLUSIONS: Overall, telephone-delivered counseling is a feasible approach to reaching hypertensive patients. Patients who are married, Hispanic, retired, or older or graduated college may be easier to reach and engage in telephone-delivered counseling. Reaching patients with other sociodemographic characteristics may require more resources or alternate methods.

Clustering of cardiac risk factors associated with the metabolic syndrome and associations with psychosocial distress in a young Asian Indian population.

The metabolic syndrome is a precursor for coronary heart disease. However, its pathophysiology is not clear, its phenotypic expression may vary by region; also, the phenotypic manifestation may be exacerbated by psychosocial distress and family history. The purpose of the current study was to assess the factor structure of the metabolic syndrome in young urban Asian Indians. Asian Indian youth (N = 112) were evaluated for body mass index (BMI), waist-hip ratio, blood pressure (systolic: SBP; diastolic: DBP), blood sugar, triglycerides, cholesterol, insulin, psychosocial distress and family health history. Factor analyses were computed on components of the metabolic syndrome. Three factors were identified for the entire sample: hemodynamic-obesity (SBP, DBP, waist-hip ratio), Lipid (cholesterol, triglyceride), and insulin-obesity (blood sugar, BMI, insulin). Similar to previous research with this population, three distinct factors with no overlap were identified. Factors did not correlate with psychosocial distress or family history. Lack of correlation with family history and psychosocial distress may be a function of the young age and demographics of the sample.

Challenges and recommendations for blinding in behavioral interventions illustrated using a case study of a behavioral intervention to lower blood pressure.

OBJECTIVE: To describe the challenges to blinding in behavioral interventions, specifically those for asymptomatic medical conditions, where the intervention is through counseling, and to provide recommendations for achieving blinding in behavioral randomized controlled trials (RCTs). METHODS: This paper reviews the challenges of preserving blinding in behavioral RCTs with a focus on interventions for asymptomatic medical conditions. This is illustrated using a case study of an ongoing behavioral intervention to improve hypertension control. RESULTS: In contrast to easily keeping study investigators and participants masked to treatment assignment through the use of identical pills or sham treatments, the need to have differing levels of blinding among study personnel and participants in randomized behavioral intervention trials is presented. Recommendations for achieving this are provided. CONCLUSIONS: Despite the challenges inherent in behavioral interventions, it is possible to achieve differing levels of blinding across study personnel and participants to minimize bias and generate valid data in RCTs that test interventions for asymptomatic medical conditions such as hypertension. Modifications may be needed for RCTs in symptomatic medical conditions. PRACTICE IMPLICATIONS: Researchers designing behavioral RCTs should be aware of the challenges to blinding all staff and study participants, and plan to have procedures in place to standardize outcome data collection and intervention delivery without compromising the varying levels of blinding. The challenges and recommendations described may need modifications in behavioral intervention studies for symptomatic conditions.

A pilot study measuring the impact of yoga on the trait of mindfulness.

BACKGROUND: The current study examined whether yoga would increase levels of mindfulness in a healthy population. METHOD: Forty-six participants were randomly assigned to an 8-week yoga intervention group or a wait-list control group. Mindfulness was assessed pre and post yoga, using the Freiburg Mindfulness Inventory (FMI). RESULTS: Results indicate that the yoga group experienced a significant increase in Overall mindfulness, and in three mindfulness subscales; Attention to the present moment, Accepting and open attitudes toward experience, and Insightful understanding (p < .01). The control group experienced a significant increase in overall mindfulness (p < .02) and insightful understanding (p < .01). Findings suggest that a yoga intervention may be a viable method for increasing levels of trait mindfulness in a healthy population, potentially implicating yoga as a preventive method for the later development of negative emotional mood states (i.e. anxiety and depression). The control group also experienced moderate elevations of mindfulness at the second assessment.

Relationship between forgiveness and psychological and physiological indices in cardiac patients.

BACKGROUND: Research suggests that forgiveness is associated with better psychological and physical health and in particular cardiovascular functioning. Despite these findings, most forgiveness studies involve healthy participants. PURPOSE: The current study assessed the psychological and physiological correlates of forgiveness in individuals with coronary artery disease (CAD). METHOD: Self-reported forgiveness, perceived stress, anxiety, and depression, and physiological data, including triglycerides, total cholesterol, high- (HDL) and low-density lipoprotein (LDL) cholesterol, were obtained from 85 hospitalized CAD patients. RESULTS: Higher levels of forgiveness were associated with lower levels of anxiety (p < 0.05), depression (p < 0.01), and perceived stress (p < 0.005) as well as lower total cholesterol to HDL and LDL to HDL ratios (both at p < 0.05) after controlling for age and gender. The psychological indices did not mediate the relationship between forgiveness and cholesterol ratios. CONCLUSIONS: Results suggest that the psychological correlates of forgiveness are similar in cardiac patients and healthy individuals. Further, among cardiac patients, forgiveness may be associated with reduced risk for future cardiovascular events.

Usefulness of a run-in period to reduce drop-outs in a randomized controlled trial of a behavioral intervention.

OBJECTIVES: We evaluated the usefulness of a simple run-in period to reduce drop-outs in a behavioral intervention to improve blood pressure (BP). In a pilot study where a run-in period was not used, we had a 25% drop-out rate. METHODS: A prospective evaluation was performed in the context of a blinded 3-arm randomized trial. Participants are eligible if they have uncontrolled BP on 2 consecutive visits. Potential participants are approached during a routine visit, informed, consented and enrolled. After a 1-month run-in period during which all participants receive a phone call to: i) verify phone availability, ii) get basic information on treatment, and iii) confirm the baseline visit, participants return for a baseline visit. They are then randomized to one of the three treatment arms: usual care, non-tailored counseling, or tailored counseling. Participants make return visits at 3, 6 and 12 months. RESULTS: Of the 1275 potential participants who received detailed study information, 301 consented to participate, of whom 226 were enrolled. During the run-in period, 73 withdrew consent and 153 participants were randomized; 7 subsequently dropped out. There were no differences (p>.1) between the 73 cancelled and the 153 randomized patients. There were fewer drop-outs than in the pilot study (5% vs. 25%, p<.0001). CONCLUSIONS: The run-in period reduces the number of drop-outs after randomization and improves statistical power. In order to retain external validity, it is important to compare participants who remain in the study and those that cancel, and incorporate that in generalizing from the study.

An open-label trial of venlafaxine in body dysmorphic disorder.

OBJECTIVE: Body dysmorphic disorder (BDD), a preoccupation with imagined ugliness, is a disabling condition that seems to respond preferentially to selective serotonin reuptake inhibitors. This open-label trial examines venlafaxine's efficacy in BDD and is the first known study of this serotonin-norepinephrine reuptake inhibitor in BDD. METHODS: A total of 17 BDD patients 16-65 years of age entered and 11 completed a 12-16 week open-label trial of venlafaxine. Participants were treated with venlafaxine until a therapeutic dose (minimum of 150 mg/day) was reached and then maintained at that dose for 8 weeks. Key outcome measures were the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder and Clinical Global Impressions-Improvement scale. RESULTS: Venlafaxine was found to be effective in lessening the specific symptoms and global severity of BDD. Paired t-tests were used to compare baseline and final ratings on the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder total, obsessions, and compulsions scores; by this measure venlafaxine significantly reduced BDD symptoms overall (P=.012), as well as obsessions (P=.034) and compulsions specifically (P=.021). A single sample t-test, comparing final Clinical Global Impressions-Improvement scale ratings to "no change" (score: 4) found significant improvement following treatment. CONCLUSION: Venlafaxine may be an effective treatment for BDD, including both obsessive and compulsive symptoms. Controlled research on venlafaxine in BDD is recommended.

The impact of forgiveness on cardiovascular reactivity and recovery.

The current study investigated the relationship between trait forgiveness and cardiovascular reactivity (CVR) and recovery in 99 normotensive participants (mean age=33.8). Cardiovascular parameters were obtained at 2-minute intervals during a 10-minute baseline period and a 20-minute recovery period, and at 1-minute intervals during a 4-minute anger recall task and a 4-minute serial subtraction task without harassment. Participants filled out a self-report measure of forgiveness prior to the laboratory procedure. Although forgiveness was not related to CVR, higher levels of trait forgiveness were predictive of lower diastolic blood pressure (DBP) at baseline (p<.02) and faster DBP recovery (p<.003). Findings suggest that forgiveness may be related to overall reductions in blood pressure levels and may aid in cardiovascular recovery from stress. The results also provide preliminary evidence that forgiveness may impact cardiovascular health not through a myocardial or vascular pathway, but through another mechanism.

Urban stress and health in developing countries: development and validation of a neighborhood stress index for India.

Stress caused by chronic difficulties encountered by people residing in poor urban neighborhoods is associated with health problems and disease in developed countries, but the relationship between neighborhood stress and health in developing nations, such as India, has not been assessed. In this study, the authors administered the City Stress Inventory, a self-report measure assessing stress experienced as a function of environmental conditions unique to living in large cities that was validated in the United States, to 163 high school students in New Delhi, India. Components of urban stress in India, with some modifications, appear to be similar to components of urban stress reported by adolescents in the United States. Urban stress was predictive of high blood pressure as reported by the adolescents 'parents. In addition, urban stress also predicted health habits, such as chewing tobacco and alcohol use, and psychosocial characteristics, such as hostility. Adolescents' reports of parental stress concerning money and social pressures were also associated with city stress. The current study indicates that the City Stress Inventory is valid in an Indian sample and is predictive of health problems.

Venlafaxine in treatment-resistant obsessive-compulsive disorder.

BACKGROUND: While selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment of obsessive-compulsive disorder (OCD), approximately 40% of patients fail to respond to SSRIs. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that might be effective in the treatment of OCD, even among those who have failed previous SSRI trials. METHOD: Thirty-nine patients who met DSM-IV criteria for OCD, including 29 who were resistant to prior SRI treatment trials, were treated with venlafaxine in an open, naturalistic fashion. Improvement was assessed using the Clinical Global Impressions-Improvement scale. RESULTS: Of 39 patients treated with venlafaxine, 27 (69.2%) were rated as sustained treatment responders. Of the 29 patients who did not respond to 1 or more previous SRI trials, 22 (75.9%) were rated as having sustained response to treatment. Mean dose of venlafaxine was 232.2 mg/day (range, 37.5-375 mg/day), and it was generally well tolerated. CONCLUSION: Venlafaxine may be beneficial to individuals with OCD, including those who have not responded to prior SSRI trials. However, these findings must be interpreted with caution, as the study is limited by its open, retrospective nature and its inclusion of patients with comorbid diagnoses and patients on concomitant medications. Prospective, controlled trials with a more homogeneous patient population are needed to replicate these preliminary findings.