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.

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.

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.

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.

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).

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.

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.

Dispositional Mindfulness Predicts Adaptive Affective Responses to Health Messages and Increased Exercise Motivation.

Feelings can shape how people respond to persuasive messages. In health communication, adaptive affective responses to potentially threating messages constitute one key to intervention success. The current study tested dispositional mindfulness, characterized by awareness of the present moment, as a predictor of adaptive affective responses to potentially threatening health messages and desirable subsequent health outcomes. Both general and discrete negative affective states (i.e., shame) were examined in relation to mindfulness and intervention success. Individuals (n=67) who reported less than 195 weekly minutes of exercise were recruited. At baseline, participants' dispositional mindfulness and exercise outcomes were assessed, including self-reported exercise motivation and physical activity. A week later, all participants were presented with potentially threatening and self-relevant health messages encouraging physical activity and discouraging sedentary lifestyle, and their subsequent affective response and exercise motivation were assessed. Approximately one month later, changes in exercise motivation and physical activity were assessed again. In addition, participants' level of daily physical activity was monitored by a wrist worn accelerometer throughout the entire duration of the study. Higher dispositional mindfulness predicted greater increases in exercise motivation one month after the intervention. Importantly, this effect was fully mediated by lower negative affect and shame specifically, in response to potentially threatening health messages among highly mindful individuals. Baseline mindfulness was also associated with increased self-reported vigorous activity, but not with daily physical activity as assessed by accelerometers. These findings suggest potential benefits of considering mindfulness as an active individual difference variable in theories of affective processing and health communication.

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.

Self-affirmation activates brain systems associated with self-related processing and reward and is reinforced by future orientation.

Self-affirmation theory posits that people are motivated to maintain a positive self-view and that threats to perceived self-competence are met with resistance. When threatened, self-affirmations can restore self-competence by allowing individuals to reflect on sources of self-worth, such as core values. Many questions exist, however, about the underlying mechanisms associated with self-affirmation. We examined the neural mechanisms of self-affirmation with a task developed for use in a functional magnetic resonance imaging environment. Results of a region of interest analysis demonstrated that participants who were affirmed (compared with unaffirmed participants) showed increased activity in key regions of the brain's self-processing (medial prefrontal cortex + posterior cingulate cortex) and valuation (ventral striatum + ventral medial prefrontal cortex) systems when reflecting on future-oriented core values (compared with everyday activities). Furthermore, this neural activity went on to predict changes in sedentary behavior consistent with successful affirmation in response to a separate physical activity intervention. These results highlight neural processes associated with successful self-affirmation, and further suggest that key pathways may be amplified in conjunction with prospection.

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.

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.

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.

Data Quality in web-based HIV/AIDS research: Handling Invalid and Suspicious Data.

Invalid data may compromise data quality. We examined how decisions taken to handle these data may affect the relationship between Internet use and HIV risk behaviors in a sample of young men who have sex with men (YMSM). We recorded 548 entries during the three-month period, and created 6 analytic groups (i.e., full sample, entries initially tagged as valid, suspicious entries, valid cases mislabeled as suspicious, fraudulent data, and total valid cases) using data quality decisions. We compared these groups on the sample's composition and their bivariate relationships. Forty-one cases were marked as invalid, affecting the statistical precision of our estimates but not the relationships between variables. Sixty-two additional cases were flagged as suspicious entries and found to contribute to the sample's diversity and observed relationships. Using our final analytic sample (N = 447; M = 21.48 years old, SD = 1.98), we found that very conservative criteria regarding data exclusion may prevent researchers from observing true associations. We discuss the implications of data quality decisions and its implications for the design of future HIV/AIDS web-surveys.

A picture may be worth a thousand texts: obese adolescents' perspectives on a modified photovoice activity to aid weight loss.

BACKGROUND: In an effort to enhance the vividness and personal relevance of a text messaging intervention to promote weight loss among obese adolescents, a modified Photovoice process was evaluated with adolescents in a weight management program. METHODS: Photovoice is a method using photography to generate relevant images and stories from users. Participants were recruited from the Michigan Pediatric Outpatient Weight Evaluation and Reduction (MPOWER) program, a multidisciplinary weight management program for obese adolescents and their parents. Twenty-three adolescents with a mean BMI of 40 were asked to take pictures on three to five randomly assigned weight-related topics, such as "something that reminds you to exercise," and to text them to a research assistant. Adolescents then engaged in semistructured interviews about the experience. Detailed notes of the interviews were analyzed to identify themes. RESULTS: Participants generally provided high ratings of the process, indicating that (1) deciding what pictures to take caused them to reflect on their weight loss experience, and (2) a mobile intervention incorporating personally relevant images (e.g., basketball as their favorite sport rather than sports in general) would increase treatment adherence. The submitted photographs frequently featured family members and friends, and participants indicated that family and friends played a major role in motivating and supporting them. CONCLUSIONS: This study suggests that a Photovoice component has the potential to enhance weight management programs for teens as part of a text messaging intervention and as an independent entity. Further work should evaluate the effect of this promising intervention on weight loss.

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.

OMG do not say LOL: obese adolescents' perspectives on the content of text messages to enhance weight loss efforts.

Adolescents participating in weight loss programs experience difficulty adhering to behavior change recommendations. Communications technology provides a low cost means to increase the frequency of contact with adolescents which can improve their engagement and also lead to behavior change. Within a larger project on the development of tailored text messages for adolescents enrolled in an existing multidisciplinary weight management program, this study explored participants' perspectives about message content. A library of messages was developed focused on topics central to weight management. Four focus groups were conducted with a total of 24 participants from the weight management program to gage their reactions to the messages. Detailed notes from the focus groups were analyzed to assess the acceptability of individual messages and to identify overriding themes. Results indicate that participants were very enthusiastic about receiving text messages. They preferred messages that provided recipe ideas, included successful weight loss strategies used by peers, and requested feedback regarding their progress. They preferred positive, encouraging, and direct messages. They were unanimous that messages should include encouraging symbols (e.g., exclamation points and "smiley faces") as often as possible. They emphasized that any mention of unhealthy foods or behaviors would trigger them to eat those foods or engage in those behaviors. Text messaging acronyms (e.g., LOL) were considered too informal for messages from healthcare providers. This study suggests that including text messages in obesity interventions is acceptable to obese adolescents as a means of supporting their weight loss efforts, and it highlights the need for such messages to be carefully constructed.