First evaluation of the Behavioral Addiction Indoor Tanning Screener (BAITS) in a nationwide representative sample.

BACKGROUND: Evidence suggests that indoor tanning may have addictive properties. However, many instruments for measuring indoor tanning addiction show poor validity and reliability. Recently, a new instrument, the Behavioral Addiction Indoor Tanning Screener (BAITS), has been developed. OBJECTIVES: To test the validity and reliability of the BAITS by using a multimethod approach. METHODS: We used data from the first wave of the National Cancer Aid Monitoring on Sunbed Use, which included a cognitive pretest (August 2015) and a Germany-wide representative survey (October to December 2015). In the cognitive pretest 10 users of tanning beds were interviewed and 3000 individuals aged 14-45 years were included in the representative survey. Potential symptoms of indoor tanning addiction were measured using the BAITS, a brief screening survey with seven items (answer categories: yes vs. no). Criterion validity was assessed by comparing the results of BAITS with usage parameters. Additionally, we tested internal consistency and construct validity. RESULTS: A total of 19·7% of current and 1·8% of former indoor tanning users were screened positive for symptoms of a potential indoor tanning addiction. We found significant associations between usage parameters and the BAITS (criterion validity). Internal consistency (reliability) was good (Kuder-Richardson-20, 0·854). The BAITS was shown to be a homogeneous construct (construct validity). CONCLUSIONS: Compared with other short instruments measuring symptoms of a potential indoor tanning addiction, the BAITS seems to be a valid and reliable tool. With its short length and the binary items the BAITS is easy to use in large surveys.

A Multicomponent, School-Based Intervention, the Shaping Healthy Choices Program, Improves Nutrition-Related Outcomes.

OBJECTIVE: To evaluate the effectiveness of the Shaping Healthy Choices Program (SHCP). DESIGN: A clustered, randomized, controlled intervention lasting 1 school year. SETTING: Schools in northern and central California. PARTICIPANTS: Fourth-graders (aged 9-10 years) at 2 control schools (n = 179) and 2 intervention schools (n = 230). INTERVENTION: Garden-enhanced education, family, and community partnerships; increased regionally procured produce in the lunchroom; and school-site wellness committees. MAIN OUTCOME MEASURES: Changes in body mass index (BMI) percentiles/Z-scores; nutrition knowledge, science process skills, and vegetable identification and preferences; and reported fruit and vegetable intake. ANALYSIS: Student t test, chi-square, ANOVA of change, and multilevel regression mixed model to evaluate change in outcomes with school as a random effect to account for cluster design effects. Statistical significance was set at P < .05. RESULTS: There was a greater improvement in BMI percentile (-6.08; P < 0.01), BMI Z-score (-0.28; P < .001), and waist-to-height ratio (-0.02; P < .001) in the intervention compared with the control schools. CONCLUSIONS AND IMPLICATIONS: The SHCP resulted in improvements in nutrition knowledge, vegetable identification, and a significant decrease in BMI percentiles. This supports the concept that the SHCP can be used to improve the health of upper elementary school students.

Modeling tanning salon behavioral tendencies using appearance motivation, self-monitoring and the theory of planned behavior.

The constructs of appearance motivation and self-monitoring were added to the Theory of Planned Behavior in the prediction of tanning salon use in young people. The variables of the Theory of Planned Behavior proved effective at predicting tanning salon behavioral intentions and tendencies. Intentions and perceived behavioral control predicted tanning salon behavioral tendencies, while attitudes, subjective norms and perceived behavioral control predicted tanning salon behavioral intentions. Appearance motivation did not show any direct or interaction effects in the prediction of tanning salon behavioral intentions. It did, however, prove superior to health orientation in the prediction of tanning salon attitudes. Self-monitoring interacted with subjective norms in the prediction of tanning salon intentions, with high self-monitors showing stronger subjective norm-intention relationships than low self-monitors. These results imply that appearance-related interventions could prove efficacious in reducing young people's tanning salon behavioral tendencies. Furthermore, it may be important to consider individual's self-monitoring status when targeting skin cancer prevention information to young people.

Examination of cognitive variables relevant to sunscreen use.

The present study is an examination of the underlying psychological variables relevant to a sun-damage preventive behavior, sunscreen use. The focus of the research was to examine cognitive predictors of sunscreen use, utilizing a decision theoretic framework. Two hundred thirty subjects were recruited from psychology classes and administered questionnaires assessing sunscreen behavioral tendencies, attitudes toward sunscreen use, and internal- and external-based cognitions relevant toward sunscreen use. In contrast to previous work that had examined only one or two of these predictor variables in isolation, the present study evaluated the relative impact of these variables on sunscreen use tendencies. The findings revealed evidence of a multivariate model (using structural equation modeling; LISREL VIII) relating perceived need for, perceived efficacy of, perceived consequences of, and social normative influences on sunscreen use. The findings are discussed with respect to improving the effectiveness of short-term education efforts to increase sunscreen use.

An examination of psychological variables relevant to artificial tanning tendencies.

Cognitions relevant to tanning salon decision making were studied using Jaccard's Theory of Alternative Behavior (J. Jaccard. Journal of Experimental Social Psychology1981; 17: 286-307). Questionnaires were administered assessing tanning salon use, attitudes toward tanning salon use, attitudes toward reasonable behavioral alternatives, and cognitive variables underlying these variables. Tanning salon use reports were very high in this sample. The results support the notion that young people make decisions regarding using tanning salons based on the behavioral alternatives available to them. Specifically, subjects with stronger preferences for using clothing to enhance appearance were less likely to use tanning salons. Furthermore, the multivariate approach used clearly delineates the specific cognitive beliefs and orientations that might be targeted to change these attitudes. The relevance of these findings to skin cancer prevention is discussed.

Examination of cognitive variables relevant to sunbathing.

This study examined cognitions relevant to sunbathing decision-making in college-aged subjects. Using Jaccard's (1981) theory of alternative behavior as a guiding model, 263 subjects were recruited from psychology classes and administered questionnaires assessing their sunbathing behavioural tendencies, attitudes toward sunbathing, attitudes toward reasonable behavioral alternatives to sunbathing, and cognitive variables underlying these attitudinal variables. The fits of models predicting sunbathing attitudes and sunbathing behavioural tendencies (evaluated using covariate structural equations modeling techniques; LIS-REL VIII) were good for all models tested. In contrast to previous work, the results of this study support the notion that young people will make their decisions regarding sunbathing based on the behavioral alternatives available to them (i.e., generally the one that they prefer most). Furthermore, the multivariate approach used clearly delineates the specific cognitive beliefs and orientations that might be targeted to change these attitudes. The relevance of these findings to skin cancer prevention interventions is discussed.

Application of Azjen's theory of planned behavior to predict sunbathing, tanning salon use, and sunscreen use intentions and behaviors.

Ajzen's (1988) theory of planned behavior (TOPB) was used to examine psychological determinants of high-risk UV radiation exposure-related behaviors (sunbathing, tanning salon use, and sunscreen use). Undergraduates at a midsized southeastern university were assessed on their psychological and behavioral tendencies toward high-risk UV radiation exposure-related behaviors. The results generally supported the utility of the TOPB as an explanatory model for high-risk behavior. Attitudes were strongly associated with high-risk intentions (e.g., not utilize sunscreen, use salons), whereas subjective norms were less so. Perceived behavioral control was found to moderate the relationship among attitudes, norms, and intentions to sunbathe and tan at a salon. Implications for intervention strategies and future model building in this area are discussed.

Investigating stress effect patterns in hospital staff nurses: results of a cluster analysis.

A comprehensive and reliable assessment of work stress, burnout, affective, and physical symptomatology was conducted with 260 hospital nurses. As previous attempts to categorize nursing stress and burnout by ward type have yielded inconsistent results, an alternative method for grouping nursing stress effects was sought. Cluster analysis was chosen as it offers a statistically sound means of delineating natural groupings within data. Sets of questionnaires measuring burnout, work stressors, and physical and emotional symptomatology were sent to all staff nurses at a large university hospital. Of 709 nurses employed there, a total of 260 nurses returned completed questionnaire packets. These nurses were separated into two equal groups using random sampling procedures. Cluster analysis of this data revealed groupings which were based on nursing stressors (particularly workload and conflict with physicians), social support, and patient loads. These cluster-analytic findings were replicated on both samples, and validated using data not used in the original cluster analysis. Results suggest that the effects of stress have more to do with the characteristics of the work environment and overall workload than with the degree of specialization on the unit. Results also suggest that intraprofessional conflict (i.e. with other nurses) is less psychologically damaging than is interprofessional conflict (i.e. conflict with physicians). Findings are discussed with respect to the burnout process and possible interventions.

Predictors of sunbathing and sunscreen use in college undergraduates.

Sunbathing and sunscreen use, as well as related intentions, attitudes, beliefs, and knowledge, were assessed in 90 Southern Appalachian undergraduates. A large majority (75%) reported sunbathing, with more than half reporting sun lamp use. A slight majority (56.7%) reported some use of sunscreen. Subjects reporting an intention to tan spent more time sunbathing, both outside and under a sun lamp. Individuals reporting a sun protection intention had lighter tans and spent less time sunbathing. Sunbathing was predicted by perceptions of sunbathing as relaxing, while sun lamp use was predicted by more positive views of suntans. Sunscreen use was predicted by more positive sun protection attitudes and less negative sunscreen attitudes.

Quantitative association between altered plasma esterified omega-6 fatty acid proportions and psychological stress.

Medical students (MS) tested during the first year of medical school showed both greater stress on the Brief Symptom Inventory and lower plasma proportions of total esterified arachidonic acid (AA, C20:4n-6), and its omega-6 fatty acid (FA) precursor, linoleic acid (C18:2n-6) than control laboratory workers. This association suggests that omega-6 FA metabolism may be affected during stress. Low AA values might result from depletion of plasma stores for immunoregulatory prostenoids formation or from modification of metabolic pathways by cortisol or other cytokine compounds implicated in stress. Values for other major FA and the omega-3 neuronal metabolic substrate, docosahexaenoic acid (DHA, C22:6n-3) were similar between students and controls. The clear preservation of the omega-3 FA pathway suggests their programmed availability for neuronal function during stress. Since plasma FA proportions may affect immune cell membrane function(s), we suggest that altered values of plasma FAs may be an important component of the physiological effects of psychological stress.

Stress-related activation of Epstein-Barr virus.

Herpesviruses characteristically persist in a latent state in the body over the lifetime of an individual. Under certain conditions, any one of the herpesviruses can be reactivated. The mechanisms underlying the establishment of latent virus infection or viral reactivation are not well understood; however, it is known that the cellular immune response plays a very important role in the maintenance of latency and in virus reactivation. One of the factors thought to be associated with the reactivation of latent herpes-viruses is psychological stress. Using an examination stress model with medical student subjects, we previously demonstrated the reactivation of latent Epstein-Barr virus (EBV), as measured by increases in antibody titers. In this follow-up study using the same group of medical students, we found evidence for incomplete reactivation of latent EBV, with only selective expression of the latent virus genome.

Psychological stress-induced modulation of interleukin 2 receptor gene expression and interleukin 2 production in peripheral blood leukocytes.

We explored the expression of the interleukin 2 receptor (IL-2R) and the synthesis of IL-2R messenger RNA by peripheral blood leukocytes obtained from medical students experiencing examination stress in three independent studies. The peripheral blood leukocytes obtained at low-stress baseline periods had significantly higher percentages of IL-2R-positive cells when compared with cells obtained from the same individuals during examinations. In addition, IL2-R messenger RNA in peripheral blood leukocytes decreased significantly during examination periods in a subset of 13 subjects. In one study, we found an increase in the accumulation of interleukin 2 in cultures of cells showing down regulation of IL-2R expression and IL-2R messenger RNA levels. While there are ample data demonstrating stress-associated decrements in the immune response in humans and animals, these data provide the first evidence that this interaction may be observed at the level of gene expression. The data suggest one mechanism whereby the central nervous system modulates the immune response during psychological stress.

A controlled evaluation of the addition of cognitive therapy to a home-based biofeedback and relaxation treatment of vascular headache.

Seventy-six patients with vascular (migraine or mixed migraine and tension) headache (HA) participated in a controlled evaluation of a minimal-therapist-contact, largely home-based, treatment program which combined relaxation (R) training with thermal biofeedback (TBF). One group received TBF + R administered in 3 office visit over 8 weeks, supplemented by audio tapes and manuals. A second group received the TBF + R plus instruction in cognitive stress coping techniques, all of which was administered in 5 office visits over 8 weeks. A third group monitored headache activity for 8 weeks. Evaluations, based on 4 weeks of HA diary at pre-treatment and after treatment, revealed significantly greater reductions in HA activity and medication consumption for both treated groups than the HA monitoring controls who did not change. Significantly more of the treated patients had clinically significant reductions in HA activity than the controls. The two treated groups did not differ on any measure.

A controlled evaluation of thermal biofeedback and thermal biofeedback combined with cognitive therapy in the treatment of vascular headache.

One-hundred-sixteen patients suffering from vascular headache (migraine or combined migraine and tension) were, after 4 weeks of pretreatment baseline headache monitoring, randomly assigned to one of four conditions: (a) thermal biofeedback with adjunctive relaxation training (TBF); (b) TBF plus cognitive therapy; (c) pseudomediation as an ostensible attention-placebo control; or (d) headache monitoring. The first three groups received 16 individual sessions over 8 weeks, while the fourth group continued to monitor headaches. All groups then monitored headaches for a 4-week posttreatment baseline. Analyses revealed that all treated groups improved significantly more than the headache monitoring group with no significant differences among the three treated groups. On a measure of clinically significant improvement, the two TBF groups had slightly higher (51%) degree of improvement than the meditation group (37.5%). It is argued that the attention-placebo control became an active relaxation condition.

Placebo-controlled evaluation of abbreviated progressive muscle relaxation and of relaxation combined with cognitive therapy in the treatment of tension headache.

Sixty-six tension headache patients were randomly assigned to one of four conditions for 8 weeks: (a) progressive muscle relaxation (PMR) alone; (b) PMR plus cognitive therapy (PMR + Cog); (c) pseudomeditation, a credible attention-placebo control; or (d) continued headache monitoring. A comparison of overall headache activity (headache index), derived from a daily headache diary, for 4 weeks before treatment to 4 weeks after treatment, revealed that active treatment (PMR and PMR + Cog) was superior to either control condition. Moreover, level of headache medication consumption decreased significantly for the active treatment groups. Although headache-index comparisons of the two active treatments showed no advantage for adding cognitive therapy to PMR, a measure of clinically significant change showed a trend for PMR + Cog to be superior to PMR alone.

What is an adequate length of baseline in research and clinical practice with chronic headache?

We examined the representatives of baseline headache diary recording periods of 1, 2, 3, and 4 weeks for three kinds of headache disorder--tension, migraine, and combined migraine and tension. For research purposes at pretreatment, 2 weeks of diary recording are preferable for tension headache, while at least 3 weeks are preferred for migraine and combined headache. At follow-up, 1 week of diary recording appears adequate for all three headache types. Recommendations are also made for clinical practice.