Proof-of-concept testing of a brief virtual ACT workshop for emotional eating.

BACKGROUND: Emotional eating, or eating in response to negative emotions, is a commonly reported short-term emotion regulation strategy but has been shown to be ineffective in the long term. Most emotional eating interventions based on Acceptance and Commitment Therapy (ACT) have been delivered in the context of weight loss trials, highlighting a need for ACT-based emotional eating interventions in weight-neutral contexts. AIMS: This proof-of-concept study aimed to test the acceptability and efficacy potential of a brief virtual ACT workshop for emotional eating in a small sample of adults identifying as emotional eaters. METHODS: Twenty-six adult emotional eaters completed an ACT workshop delivered in two 1.5-h sessions over two weeks. The workshop targeted awareness and acceptance of emotions and eating urges, and valued actions around eating. RESULTS: The acceptability of the workshop was demonstrated by high participant satisfaction. Significant improvements on all outcome measures were found and maintained up to 3 months follow-up. CONCLUSIONS: These proof-of-concept findings suggest that a brief virtual ACT workshop may improve emotional eating and associated ACT processes. Results from this study can inform a future randomized controlled trial to test the efficacy of the workshop and the role of theoretical processes of change. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04457804. LEVEL OF EVIDENCE: Level IV, evidence obtained from multiple time series with the intervention.

An umbrella review of the literature on the effectiveness of goal setting interventions in improving health outcomes in chronic conditions.

PURPOSE: To identify the contexts in which goal setting has been used in chronic disease management interventions and to estimate the magnitude of its effect on improvement of health outcomes. METHODS: The strength of evidence and extent of potential bias in the published systematic reviews of goal setting interventions in chronic conditions were summarized using AMSTAR2 quality appraisal tool, number of participants, 95% prediction intervals, and between-study heterogeneity. Components of goal setting interventions were also extracted. RESULTS: Nine publications and 35 meta-analysis models were identified, investigating 25 health outcomes. Of the 35 meta-analyses, none found strong evidence and three provided some suggestive evidence on symptom reduction and perceived well-being. There was weak evidence for effects on eight health outcomes (HbA1c, self-efficacy, depression, anxiety, distress, medication adherence, health-related quality of life and physical activity), with the rest classified as non-significant. Half of the meta-analyses had high level of heterogeneity. CONCLUSION: Goal setting by itself affects outcomes of chronic diseases only to a small degree. This is not unexpected finding as changing outcomes in chronic diseases requires a complex and individualized approach. Implementing goal setting in a standardized way in the management of chronic conditions would seem to be a way forward.IMPLICATIONS FOR REHABILITATIONThe link between goal setting and health outcomes seems to be weak.Some levels of positive behavioural change could be of benefits to patients as seen by improved self-efficacy, patients' satisfaction and overall quality of life.Systematic and consistent application of personalized goal-oriented interventions considering patient's readiness to change could better predict improved outcomes.Incorporation of various goal setting components while actively engaging patient and/or their care givers in the process could appraise how goal setting could help with challenges in faced by people living with chronic conditions in different areas.

Compensatory health motivations and behaviors scale: Development, evaluation, psychometric properties and a preliminary validation.

The "Compensatory Health Beliefs" scale assesses the degree to which one believes that unhealthy behaviours can be compensated through healthier ones. However, no validated scale to assess compensatory weight-related behaviors exists. The study's objective was to develop (Study 1) and validate (Study 2) a questionnaire measuring compensatory health motivations and behaviors (CHMB) and to assess their associations with body mass index (BMI) and psychological weight-related measures. An initial 34-item measure was constructed based on a target sample's (Study 1, n = 158) suggestions and refined based on expert feedback. The measure was then tested in a representative Canadian adult sample (N = 1400, 48.7% male). The sample was stratified by sex and age and then randomly split into two (N = 701 for exploratory factor analysis; N = 699 for confirmatory factor analysis (CFA) cross-validation). Fit indices, standardized Cronbach's alphas and the associations between the CHMB model with cognitive restraint, weight concerns, and BMI were assessed in multiple linear regression models controlling for age and sex. The final CHMB model (n = 17 items) consisted of four subscales: (1) motivation, (2) use on special occasions, (3) general use, (4) compensatory health beliefs. Fit indices (Goodness of Fit Index = 0.922) and Cronbach's alphas were good (α = 0.88). In multiple linear regression models, all CHMB subscales were associated with greater cognitive restraint in eating. Compensatory behavior use on special occasions was associated with greater weight concern (B = 0.12, p < .0001), while general compensatory behavior use was associated with lower weight concern (B = -0.07, p < .05). None of the subscales were associated with BMI. The validated CHMB scale allows for the assessment of compensatory health motivations and behaviors in a Canadian population. Research on whether this scale can predict weight changes and general health is needed.

Trajectories of psychological distress during the COVID-19 pandemic among community-dwelling older adults in Quebec: A longitudinal study.

OBJECTIVE: The COVID-19 pandemic and its associated public health measures may increase the risk for psychological distress among vulnerable older adults. This longitudinal study aimed to identify predictors of psychological distress trajectories among community-dwelling older adults in Quebec, Canada. METHODS: The study spanned four time points across 13 months and three waves of the COVID-19 pandemic. The sample included 645 community-dwelling older adults ages 60 years and older in Quebec. Participants completed telephone-based interviews that included the Kessler 6-item Psychological Distress Scale (K6) to assess psychological distress at each time point as well as information on socioeconomic, medical, psychological and COVID-19 related factors. Group-based trajectory modelling was used to identify distinct trajectories of psychological distress across time. RESULTS: Three group-based trajectories of psychological distress were identified: the resilient (50.5%), reactive (34.9%), and elevated distress groups (14.6%). Individuals with mobility issues, insomnia symptoms, COVID-19 related acute stress, general health anxiety, increased loneliness symptoms, and those unable to use technology to see others were more likely to be in the reactive and elevated groups than the resilient group. Those with past mental health problems had uniquely increased odds of being in the reactive group compared to the resilient group. Individuals living in poverty and those who reported taking psychotropic medication had increased odds of being in the elevated distress group compared to the resilient group. CONCLUSION: These findings characterized distinct trajectories of psychological distress in older adults and identified risk factors for elevated distress levels.

The Dyadic Interplay Between Relationship Satisfaction, Perceived Positive and Negative Social Control, and a Reduction of Sedentary Behavior Time.

BACKGROUND: Both the close relationship processes and health model and the dyadic health influence model posit that beliefs about the relationship (e.g., relationship satisfaction) and influence strategies (e.g., social control) serve as mediators of health behavior change. The evidence for such mediation is limited. PURPOSE: This study investigated two competing hypotheses that arise from these models: (1) perceived use of positive and negative social control (attempts to influence the partner's behaviors) predict sedentary behavior (SB) indirectly, via relationship satisfaction; or (2) relationship satisfaction predicts SB indirectly, via positive and negative social control. METHODS: Data from 320 dyads (target persons and their partners, aged 18-90 years), were analyzed using mediation models. SB time was measured with GT3X-BT accelerometers at Time 1 (T1; baseline) and Time 3 (T3; 8 months following baseline). Relationship satisfaction and social control were assessed at T1 and Time 2 (T2; 2 months following baseline). RESULTS: Higher T1 relationship satisfaction among target persons predicted target persons' reporting of higher T2 negative control from partners, which in turn predicted lower T3 SB time among target persons. Lower T1 relationship satisfaction among partners predicted target persons' reporting of higher T2 perceived negative control from partners, which predicted lower T3 SB time among target persons. On average, both members of the dyad reported moderate-to-high relationship satisfaction and low-to-moderate negative control. CONCLUSIONS: In contrast to very low levels of negative control, its low-to-moderate levels may be related to beneficial behavioral effects (lower SB time) among target persons reporting moderate-to-high relationship satisfaction.

A Protection Motivation Theory Approach to Understanding How Fear of Falling Affects Physical Activity Determinants in Older Adults.

OBJECTIVES: This study applied an extended Protection Motivation Theory to investigate the relative importance of fear of falling (FoF) among motivational and intentional determinants of physical activity (PA) behavior. METHODS: Older U.S. adults (N = 667, 65+) were surveyed using online research panels and completed measures of self-efficacy and response efficacy (coping appraisal), perceived vulnerability and perceived severity (threat appraisal), FoF, autonomous motivation, intention, physical health, and past PA level. RESULTS: Our structural equation model showed that past PA level and health predicted intention via cognitive constructs. PA and health predicted FoF and motivation via threat and coping appraisal. FoF did not directly predict intention. DISCUSSION: Results from this sample provide support for the predictive effects of threat appraisal on fear. However, findings suggest that FoF may not be of great importance for the formation of PA intention compared with an established habit of being physically active and a subsequently fostered coping appraisal and motivation.

Effectiveness of a personalized health profile on specificity of self-management goals among people living with HIV in Canada: findings from a blinded pragmatic randomized controlled trial.

PURPOSE: To estimate among people living with chronic HIV, to what extent providing feedback on their health outcomes will affect the number and specificity of patient-formulated self-management goals. METHODS: A personalized feedback profile was produced for individuals enrolled in a Canadian HIV Brain Health Now study. Goal specificity was measured by total number of specific words (matched to a domain-specific developed lexicon) per person-words using text mining techniques. RESULTS: Of 176 participants enrolled and randomly assigned to feedback and control groups, 110 responses were received. The average number of goals was similar for both groups (3.7 vs 3.9). The number of specific words used in the goals formulated by the feedback and control group were 642 and 739, respectively. Specific nouns and actionable verbs were present to some extent and "measurable" and "time-bound" words were mainly missing. Negative binomial regression showed no difference in goal specificity among groups (RR = 0.93, 95% CI 0.78-1.10). Goals set by both groups overlapped in 8 areas and had little difference in rank. CONCLUSION: Personalized feedback profile did not help with formulation of high-quality goals. Text mining has the potential to help with difficulties of goal evaluation outside of the face-to-face setting. With more data and use of learning models automated answers could be generated to provide a more dynamic platform.

Adherence to a caloric budget and body weight change vary by season, gender, and BMI: An observational study of daily users of a mobile health app.

Objective: Self-monitoring, one of the most important behaviors for successful weight loss, can be facilitated through mobile health applications (mHealth apps). Therefore, it is of interest to determine whether consistent users of these apps succeed in achieving their weight goals. This study used data from an mHealth app that enabled tracking of caloric intake, body weight, and physical activity and provided a caloric budget depending on weight goal. The primary objective was to evaluate adherence to caloric budget and body weight change among the most consistent (i.e., daily) trackers of caloric intake over a calendar year (n = 9372, 50% male). Methods: Gender-stratified linear mixed models were conducted to examine the effects of quarter of year (Q1-Q4 as season proxies) and body mass index (BMI) group (normal weight, overweight, obesity) on adherence to a caloric budget (kcal/day). Change in body weight was analyzed using a subset of users (n = 5808) who entered their weight in the app at least once per week, once per month, or once in Q1 and Q4. Physical activity entries were evaluated in exploratory analyses. Results: Only users with obesity met their caloric budget in Q1. Deviation from budget increased for all groups from Q1 to Q2 (mean change[±standard error of the mean]: +23.7[±1.8] and +39.7[±2.2] kcal/day for female and male users, p < 0.001), was stable between Q2 and Q3, and fluctuated thereafter depending on gender and BMI, with greater deviation among males with overweight. Users with obesity with weight entries at least once per month lost the most weight (-6.1[±0.3] and -4.5[±0.3] kg for females and males, p < 0.001). Physical activity was highest in the summer months. Conclusions: Among consistent calorie trackers, adherence to a caloric budget and body weight vary by season, gender, and BMI. Self-monitoring of body weight in addition to calorie tracking may lead to improved weight loss outcomes.

Phenomenological support for escape theory: a qualitative study using explicitation interviews with emotional eaters.

The current study explored the phenomenology of emotional eating, that is, the descriptive knowledge of what one perceives, senses, and knows in one's immediate awareness and experience during emotional eating. Eight individuals with emotional eating were interviewed twice using explicitation interviewing. Data were analyzed using thematic analysis, which resulted in nine themes describing the diachronic (or temporal) unfolding of emotional eating and several sub-themes that described various synchronic (or experiential) dimensions of this unfolding. The core findings of this study support the escape theory of emotional eating and recommend future directions to investigate the self-related shifts proposed by this theory. Namely, the findings show that individuals tend to use food to regulate their emotions by reducing the unpleasant experience of negative emotions and the associated unpleasant narrative processing or ruminations about stressors that caused the negative emotions. This then leads to an urge to eat associated with a desire for the sensory experience of eating. Eating then enables individuals to reduce thoughts about their stressors and bring themselves into the present moment through embodiment. Future quantitative research could investigate this mechanism of shifting from narrative to embodied processing to regulate emotions in emotional eating to develop treatment programs, such as mindfulness-based programs, that could encourage such a shift and emotion regulation without the use of food.

Emotional eating, or overeating when feeling negative emotions, is problematic because it is linked with being overweight or having obesity, diabetes, and heart disease. So far, several theories have been proposed to explain the psychological experiences of a person that leads them to emotionally eat. In this study, we explored the subjective experience, or phenomenology, of emotional eating. We interviewed eight individuals with emotional eating using a method called explicitation interviewing, which was developed to allow an interviewer to help an individual describe their subjective experience or phenomenology of a particular event or experience. Upon analyzing the data, we found support for the escape theory of emotional eating, which states that individuals eat to regulate their emotions by escaping the unpleasant feelings and thoughts that they experience while feeling negative emotions. We found that emotional eaters escape unpleasant thoughts and feelings about their past, future, or identity by shifting their attention away from these thoughts and emotions and towards the bodily sensations that they feel in the present moment while eating. Our findings encourage future studies that further investigate these shifts in attention to develop treatment methods that can help individuals regulate their emotions without using food.

Efficacy of ACT-based treatments for dysregulated eating behaviours: A systematic review and meta-analysis.

BACKGROUND: An increasing number of studies have investigated the efficacy of Acceptance and Commitment Therapy (ACT) for the reduction of dysregulated eating behaviours such as binge eating and emotional eating. However, little is known about their short- and long-term efficacy and underlying mechanisms of change. OBJECTIVES: To conduct a systematic effect size analysis to estimate the efficacy of ACT-based treatments on measures of dysregulated eating and of psychological flexibility, a theorized ACT mechanism of change. METHODS: Literature searches were conducted in PsycInfo, Medline, Web of Science, and ProQuest Dissertations. Within-group and between-group standardized mean differences were computed using Comprehensive Meta-Analysis Version 3. Additional subgroup and meta-regression analyses by study characteristics were conducted. RESULTS: A total of 20 publications (22 samples, n = 1269) were included. Pre-post and pre-follow-up effects suggest that ACT-based treatments are moderately effective in reducing dysregulated eating behaviours and increasing psychological flexibility. These effects were comparable for binge-eating and emotional eating outcomes and for face-to-face interventions, Web-based interventions, and interventions that used a self-help book. Longer treatments were associated with larger outcome effect sizes, and changes in psychological flexibility were not associated with changes in dysregulated eating outcomes. Small significant effects were found in favour of ACT when compared to inactive control groups. The only three studies that included active control groups and did not show significant differences in outcomes between ACT and other treatments. CONCLUSION: Future studies should aim to compare ACT-based treatments to active treatments and to provide empirical evidence for the theoretical mediating role of psychological flexibility in reported changes in eating behaviour.

Predicting Decisional Determinants of Physical Activity Among Older Adults: An Integrated Behavior Approach.

ObjectivesThe present study applied the Integrated Behavior Change Model to investigate how behavioral decisions are predicted, namely, intention, planning, and habits, with respect to physical activity. Methods: Participants were older adults (ages 65+) residing in the U.S. (N = 667) who completed online measures of behavioral determinants (autonomous motivation, perceived behavioral control, subjective norms, attitudes, intention, habit, and consistency), in addition to past behavior. Results: A structural equation model revealed that intention was predicted by past behavior and social-cognitive determinants. Social cognitive determinants mediated between past behavior and habit, as well as between autonomous motivation and habit. Intention mediated between past behavior and planning. Discussion: This study highlights the importance of multiple processes (social cognitive, habit/automatic, and post-intentional/planning) that formulate physical activity intentions. Mediation pathways revealed the importance of autonomous motivation for establishing intentions and habit. Facilitating these processes among older adults could be effective for promoting physical activity.

Development and Validation of the Four Facet Mindful Eating Scale (FFaMES).

OBJECTIVES: Previous mindful eating scales stress the attentional domains of eating-specific mindfulness, such as present-moment attention to homeostatic cues of hunger and satiety while discounting other important domains such as non-judgment and decentering. The purpose of the series of studies was to develop and evaluate a multifaceted mindful eating scale that assesses several domains of eating-specific mindfulness. METHODS: A multistep process was used to construct the Four Facet Mindful Eating Scale (FFaMES). Study 1 outlined the initial scale construction and the development of a novel item pool (N = 480). Study 2 examined the internal structure of the observed variables using exploratory analysis (N = 445) and confirmatory analysis in a separate sample (N = 445). Reliability and validity were assessed in Study 3 (N = 166). RESULTS: The final scale consists of 29 items with 4 factors: Non-Reactance, Non-Judgment, External Awareness, and Internal Awareness. The FFaMES demonstrated good internal consistency, retest reliability as well as preliminary convergent and divergent validity. CONCLUSIONS: Our findings provide reliability evidence and initial support for the construct validity of the FFaMES and the continued study of multiple facets of eating-specific mindfulness. Future research should continue to investigate the differential effects of various aspects of eating-specific mindfulness in the prevention and treatment of obesity and its comorbidities.

Group-based trajectories and predictors of adherence to physical distancing during the COVID-19 pandemic.

Objective: This study sought to identify psychosocial predictors of trajectories of adherence to physical distancing alongside changes in public health measures during the COVID-19 pandemic. Design: A three-time point longitudinal survey during the first two waves of the COVID-19 pandemic. Methods: Participants (N = 1003) completed self-report measures of adherence to physical distancing over an 8-month period at the start (T1) and end (T2) of the first wave of the pandemic, and the start of the second wave of the pandemic (T3). Participants also completed measures of their health beliefs related to the self and others, social norms, emotional distress, and sociodemographic characteristics. Results: Using group-based trajectory modeling, four trajectories of adherence to physical distancing emerged: a high-adherence trajectory, a slow-declining trajectory, a fluctuating trajectory, and a fast-declining trajectory. The most important psychosocial predictors of poorer adherence trajectories included perceptions of lower self-efficacy and higher barriers to adherence, as well as lower prosocial attitudes towards physical distancing. Conclusion: Public health messages targeting these factors may be most relevant to promote sustained adherence to physical distancing over time in the context of a pandemic.

The impact of publicly funded immunization programs on human papillomavirus vaccination in boys and girls: An observational study.

Background: Reaching and maintaining high global human papillomavirus (HPV) vaccine uptake has been challenging. The impact of publicly funded HPV immunization programs and the interplay of sociodemographic, psychosocial and policy factors in maximizing vaccination is poorly understood. This observational study examined the impact of introducing publicly funded school-based HPV vaccination programs for boys directly on uptake in boys and indirectly on uptake in girls, while concurrently examining other important sociodemographic and psychosocial factors. Methods: Data were collected from a national, longitudinal sample of Canadian parents of children aged 9-16 years during August-September 2016 (T1) and June-July 2017 (T2). Participants completed an online questionnaire measuring sociodemographic characteristics, vaccine knowledge and attitudes, health care provider recommendation, and HPV vaccine uptake. Analyses were conducted separately for parents of boys and girls using logistic regression analyses at T1 and T2. Jurisdictions with HPV vaccine funding for boys at both time-points were compared to those with funding at neither time-points and those that introduced funding between time-points. Findings: The sample included parents of boys (n = 716) and girls (n = 843). In multivariable analyses, jurisdictions with funding for boys at both time-points had higher odds of vaccination (adjusted odds ratio, T1 = 10.18, T2 = 11.42; 95% confidence interval, T1 = 3.08-33.58, T2 = 5.61-23.23) than jurisdictions without funding at both time-points; however, funded jurisdictions did not have higher odds of vaccination compared to jurisdictions that newly introduced funding for boys. Vaccination was associated with consistent determinants in boys and girls including child's age, health care provider recommendation, perceived vaccine harms, and perceived vaccine affordability. Interpretation: This gender-sensitive analysis highlights the interplay of sociodemographic, psychosocial, and policy factors that can improve HPV vaccination. Publicly funded school-based programs are an impactful strategy to increase vaccine uptake. Funding: This work was supported by the Canadian Cancer Society Research Institute (#704,036). GKS was supported by the Vanier Canada Graduate Scholarship and Queen Elizabeth II Diamond Jubilee Scholarship programs. The funders of this work had no role in the data collection, analysis, or interpretation, or any aspect pertinent to the study.

Mindfulness and equanimity moderate approach/avoidance motor responses.

A person's tendency to approach pleasant stimuli and to avoid unpleasant stimuli reflects a basic psychological phenomenon. The present research aimed to investigate the extent to which mindfulness practices and trait equanimity can attenuate this motivational process. In two studies, participants were asked to perform an Approach/Avoidance Task (AAT). In Study 1 (N = 84), prior to completing the AAT, participants were randomly assigned to one of two guided mindfulness-based meditation conditions (breathing or body-scan) or to an active control condition. In Study 2 (N = 71), which controlled for mindfulness practice, motor responses to the AAT were compared by level of equanimity of the participants (low vs. high). The results revealed that breathing meditation practice and trait equanimity significantly moderated participants' motor responses to the AAT, and that the body-scan meditation did not moderate these responses. Bayesian analyses showed that participants in the breathing meditation group (Study 1) and those with higher equanimity (Study 2) showed a reduction of bias in their motor responses to the AAT. These results suggest that meditation practice and trait equanimity may promote a decrease in automatic motivational approach and avoidance tendencies evoked by positive and negative stimuli.

Socio-demographic, social, cognitive, and emotional correlates of adherence to physical distancing during the COVID-19 pandemic: a cross-sectional study.

OBJECTIVES: In order for physical distancing directives to be effective at lowering and flattening the epidemic peak during a pandemic, individuals must adhere to confinement guidelines. Recent reviews highlight the paucity of research on empirical correlates of adherence to physical distancing and quarantine directives. METHODS: In this cross-sectional study, 1003 individuals were recruited using quota sampling to form a sample approximately representative of the population of Quebec (Canada) in terms of age, gender, and urbanicity. Participants completed an online survey on adherence to physical distancing during the COVID-19 pandemic. This survey evaluated socio-demographic, health, cognitive, emotional, and social factors related to physical distancing. RESULTS: Individuals aged 70 and older (OR = 1.67, 95% CI = 1.04-2.67), women (OR = 1.35, 95% CI = 1.02-1.79), and those who were not essential workers (OR = 3.28, 95% CI = 2.24-4.81) reported more physical distancing. Injunctive personal norms (OR = 1.67, 95% CI = 1.23-2.31), perceived benefits of physical distancing to others (OR = 1.47, 95% CI = 1.12-1.93), and descriptive social norms (OR = 1.26, 95% CI = 1.04-1.52) were independent predictors of adherence status. Individuals adhered more to physical distancing if they believed that it was their civic duty to do so and that physical distancing helped protect others, and if they perceived that most other people were following these directives. In contrast, perceived personal risk and emotional factors were not independently related to physical distancing. CONCLUSION: These results highlight the importance of health beliefs and perceived social norms in shaping responses to physical distancing directives. These findings offer insights into ways to frame public health communications to promote physical distancing during a pandemic.

RéSUMé: OBJECTIFS: Afin d'assurer l'efficacité des directives de distanciation physique à aplatir la courbe épidémique lors d'une pandémie, les membres de la communauté doivent respecter les règles de confinement. Des revues de la littérature mettent en évidence le manque de données empiriques sur les corrélats de l'adhérence aux directives de distanciation physique et de quarantaine. MéTHODES: Dans cette étude transversale, 1 003 individus ont été recrutés en utilisant une méthode d'échantillonnage par quota afin de constituer un échantillon approximativement représentatif de la population du Québec, Canada, en termes d'âge, de genre, et de ruralité. Les participants ont complété une enquête en ligne sur l'adhérence à la distanciation physique durant la pandémie de la COVID-19. Cette enquête a évalué l'association entre l'adhérence à la distanciation physique et les facteurs sociodémographiques, médicaux, cognitifs, émotionnels, et sociaux. RéSULTATS: Les individus âgés de 70 ans et plus (RC = 1,67, IC95% = 1,04­2,67), les femmes (RC = 1,35, IC95% = 1,02­1,79) et ceux qui n'étaient pas des travailleurs essentiels (RC = 3,28, IC95% = 2,24­4,81) ont rapporté plus de distanciation physique. Les normes injonctives personnelles (RC = 1,67, IC95% = 1,23­2,31), la perception de bénéfices de la distanciation physique pour les autres (RC = 1,47, IC95% = 1,12­1,93), et les normes sociales descriptives (RC = 1,26, IC95% = 1,04­1,52) étaient des facteurs prédictifs indépendants de l'adhérence. L'adhérence à la distanciation physique était plus probable chez les individus qui croyaient qu'il était de leur devoir civique de respecter les directives et que la distanciation physique aidait à protéger les autres, et qui percevaient que la plupart des autres personnes respectaient aussi ces directives. La perception du risque personnel et les facteurs émotionnels n'étaient pas associés de façon indépendante à la distanciation physique. CONCLUSION: Ces résultats soulignent l'importance des croyances sur la santé et des normes sociales perçues dans la réponse aux directives de distanciation physique. Ces résultats suggèrent différentes façons d'optimiser la présentation des communications de santé publique afin de promouvoir la distanciation physique lors d'une pandémie.

Differences and similarities of physical activity determinants between older adults who have and have not experienced a fall: Testing an extended health belief model.

PURPOSE: Experiencing a fall can be a detrimental experience for older adults and may affect an individual's beliefs about participating in future physical activity (PA) behavior. The purpose of this study was to identify if determinants of PA differ between older adults who have a history of a fall (HF) and those with no history of a fall (NHF) within the Health Belief Model (HBM), expanded through the constructs of intention and habit. MATERIALS AND METHODS: Participants (N = 667) were community-dwelling older adults who completed online measures of original HBM determinants (beliefs, barriers, self-efficacy, cues, and perceived threat variables) related to participating in PA in addition to past PA behavior and intention. RESULTS: Novel findings include perceived barriers significantly predicted intention to participate in PA among those with a HF but not among those with NHF, and past PA behavior predicted decreased perceived threat of falling among both groups. The model also supported cues to predict physical activity habit. CONCLUSIONS: Perceived barriers (time constraints and bodily pain) deterred PA intentions among those with a HF, suggesting the importance of intervention planning to reduce/resolve these barriers for this group. Past PA was negatively associated with perceived threat of falling, which signposts the importance of providing a safe environment for older adults to engage in PA. The study also provides formative notes for interpreting and further investigating perceived threat and its antecedents (susceptibility and seriousness) in addition to cues, which generally have been omitted in previous studies that employ the HBM.

Promoting medication adherence from the perspective of adolescent and young adult kidney transplant recipients, parents, and health care professionals: A TAKE-IT TOO study.

Medication non-adherence is an important factor limiting allograft survival after kidney transplantation in AYA. Some interventions, including the TAKE-IT, showed some success in promoting adherence but the potential for scalability and use in routine clinical practice is limited. We applied user-centered design to gather the perspectives of recipients, parents, and health professionals concerning their needs, challenges, and potential intervention strategies to design an optimal, multi-component medication adherence intervention. The qualitative study was conducted at four Canadian and three American kidney transplant programs. Separate focus groups for recipients, parents, and health professionals were convened to explore these stakeholders' perspectives. Directed content analysis was employed to identify themes that were shared vs distinct across stakeholders. All stakeholder groups reported challenges related to taking medications on time in the midst of their busy schedules and the demands of transitioning toward independence during adolescence. The stakeholders also made suggestions for the multi-component behavioral intervention, including an expanded electronic pillbox and companion website, education materials, and customized digitized features to support shared responsibility and communication among recipients, parents, and health professionals. Several suggestions regarding the functionality and features of the potential intervention reported in this early stage will be explored in more depth as the iterative process unfolds. Our approach to actively involve all stakeholders in the process increases the likelihood of designing an adherence intervention that is truly user-informed and fit for the clinical setting.

Weight cycling is associated with adverse cardiometabolic markers in a cross-sectional representative US sample.

BACKGROUND: Whether weight cycling (repeated weight loss and regain) is associated with cardiometabolic health is unclear. Study objective was to examine whether weight cycling since young adulthood (ie, 25 years of age) was associated with cardiometabolic markers. METHODS: Data from a nationally representative cross-sectional US sample (National Health and Nutrition Examination Survey, 1999-2014) were used. Weight history was based on self-reported weight at age 25, 10 years prior and 1 year prior to the survey (n=4190, 51% male). Using current self-reported weight as the anchor, participants were classified as (1) stable weight, (2) weight losers, (3) weight gainers and (4) weight cyclers. Cardiometabolic markers included fasting lipids, insulin sensitivity and blood pressure. Multiple linear regressions were used to analyse weight history (reference: stable weight) and adjusted for covariates. Analyses incorporated the sampling design and survey weights and were stratified by sex or weight status. RESULTS: Compared with females with stable weight, female weight cyclers had worse lipids and homeostasis model assessment for insulin resistance (HOMA-IR) (all ps<0.05). Compared with males with stable weight, male weight cyclers had worse high-density lipoprotein cholesterol (HDL) and HOMA-IR (ps<0.05). Weight cyclers with normal weight had worse HDL and low-density lipoprotein cholesterol (ps<0.05), and weight cyclers with overweight or obesity had worse HOMA-IR (p=0.05). Blood pressure was not associated. CONCLUSION: Weight cycling is adversely associated with cardiometabolic markers but associations differ by sex and weight status. While weight cycling is consistently associated with worse cardiometabolic markers among females, results are mixed among males. Weight cycling is associated with worse lipid measures for normal weight persons, and marginally worse insulin sensitivity for those with overweight/obesity.